This step-by-step guide is for MRI students, radiographers and technologists who wish to improve their planning skills and master the pituitary MRI protocol.
What you will learn:
Key factors in pituitary MRIs, including trade-offs.
Patient and scanner setup tips.
Best pulse sequences and planning techniques.
Ways to avoid common artifacts.
What great pituitary images should look like.
Key Takeaways
Because pituitary MRIs require high detail, it's recommended to prioritize resolution.
The pituitary gland is tiny and complex, so we need high-resolution images to detect subtle abnormalities. Therefore, we typically 1) prioritize resolution, 2) maintain good SNR for clarity, and 3) optimize scan time as needed.
Use a small field of view (FOV).
Because the pituitary gland is so tiny, using a small FOV helps us improve resolution, detect subtle lesions, and minimize interference from surrounding tissues.
Add a dynamic contrast series when a microadenoma is suspected.
Standard post-contrast T1 covers most indications. Where the question is a microadenoma, for example in hyperprolactinemia or Cushing's disease, add serial coronal T1 sets from the moment of injection. The adenoma shows up as a focus that enhances later than the normal gland.
Avoid these 6 common pituitary artifacts.
Artifacts
Solution – How to Avoid It
Motion artifacts
Instruct the patient to remain still, and keep sequences short so any motion spoils less of the acquisition.
Chemical shift artifacts
Increase the bandwidth, and use fat suppression on the sequences where it is available.
Wrap-around artifacts
Enable anti-aliasing or foldover suppression, so anatomy outside the field of view does not overlay the sella.
Cross-talk artifacts
Keep a small gap between 2D slices, usually around 20% of slice thickness and no more than 30%. Interleaved acquisition also limits cross-talk, so some departments run contiguous slices instead.
Flow artifacts
Choose the phase direction so the ghost track runs clear of the sella, and apply flow compensation or a saturation band over the inflowing vessels.
Susceptibility artifacts
Keep TE short where the contrast allows, raise the bandwidth, and use TSE rather than gradient echo near the sphenoid sinus.
Intro to Pituitary MRIs
The pituitary gland is a small but powerful gland at the base of the brain. It regulates hormones that control growth, metabolism, and reproduction. Despite its size, it plays a key role in maintaining the body’s balance.
Given its importance, the pituitary is often imaged with MRI to look for tumors, the structural cause of a hormonal imbalance, and other abnormalities of the sella, making it a core area of study in brain imaging.
In MRI, we always face a trade-off between 3 key metrics:
Scan Time: How fast a pulse sequence can be completed.
Resolution: How much detail the image can display.
SNR: How clear the image is, meaning how much signal we have compared with noise.
Improving one of these metrics often reduces the performance of the others. To decide what trade-offs to make, we must consider the needs of each clinical situation.
For pituitary MRIs, we face these challenges:
The gland is roughly 10 mm across, and the lesions we hunt for are often 3 mm or smaller. At coarse resolution a microadenoma is averaged into the surrounding gland and loses the contrast that makes it detectable.
High resolution means small voxels, and small voxels cost signal. We need enough SNR left to still see the gland clearly against surrounding fat and vessels.
The high-resolution sequences this study needs are slow, and the scan must still fit a clinical slot. A pituitary study is requested less often than routine brain, spine, or knee scans, so it can usually afford a longer slot than those examinations.
Therefore, we typically:
Prioritize resolution, since a microadenoma averaged into a large voxel usually loses the contrast that would reveal it.
Maintain enough SNR to keep that resolution diagnostic, buying it back with extra averages where needed.
Optimize scan time last, since this study can usually afford a longer slot than routine scans.
Note! Prioritizing resolution in pituitary MRIs is only a general guideline, NOT a strict rule. If the patient cannot hold still, scan time moves up the order, because a blurred high-resolution acquisition is less useful than a sharp one at slightly lower resolution. The right balance always depends on factors such as field strength, patient cooperation, available hardware, and the clinical question.
Pituitary Health Conditions and the MRI Sequences That Reveal Them
The pituitary gland MRI study can help us diagnose a wide range of health conditions. The table below lists some of the most common conditions and which pulse sequences reveal them:
Common Pituitary Conditions
Clearly Seen on Sequence
Why this Sequence?
Cystic, Fluid-Filled and Mass-Effect Findings:
• Rathke's cleft cyst
• Arachnoid cyst
• Cystic degeneration within an adenoma
• Compression of the optic chiasm
T2 TSE
Highlights water-rich structures, making it ideal for detecting cystic lesions and characterizing fluid-filled spaces.
T2 provides clear contrast between cystic components and surrounding soft tissues, helping differentiate lesions.
Solid and Hemorrhagic Lesions:
• Solid pituitary tumors
• Hemorrhage in adenomas
• Fat-rich lesions (lipomas)
T1 TSE
Offers excellent tissue contrast for fat and structural detail, ideal for identifying solid tumors, hemorrhagic changes, or fat-containing lesions.
Provides a clear distinction between normal pituitary tissue and abnormalities.
Enhancement is what separates an adenoma from normal gland. On dynamic imaging, the normal gland enhances first, and the adenoma appears as a darker focus. Post-contrast T1 also defines lesion margins and cavernous sinus involvement.
How to Perform a Pituitary MRI
This step-by-step guide below will show you how to set up and perform a pituitary MRI protocol in practice.
There is no single correct way to run a pituitary protocol. The setup below is a general approach that works for most cases, but departments differ on which sequences are included, whether whole-brain imaging is part of the study, and whether the sellar images are acquired in 2D or 3D. Always follow your own department's protocol where it differs from this one.
We will perform the protocol in 3 parts:
Set up the Patient and MRI Scanner
Plan and Acquire the Protocol Sequences
Review the Images
Part 1: Set up the Patient and MRI Scanner
1. Position the Patient and the Coils
Lay the patient head-first and supine (on their back).
Make sure the laser is centered on the glabella (the spot between the eyebrows), which brings the sella close to the scanner’s isocenter.
Use a multichannel head coil, which is the standard choice for pituitary imaging. It gives good signal coverage of the sella and the parasellar structures, including the optic chiasm, infundibulum and cavernous sinuses.
Once the patient is in place, review your scanner’s hardware settings.
In this guide, we will use the following settings:
Scanner Setting
Value
Why This Value
Magnetic field strength
1.5 T
The most common clinical field strength, giving enough SNR for this protocol with less susceptibility and B1 artifact than 3 T, which matters directly above the air-filled sphenoid sinus.
Maximum gradient strength
45 mT/m
Provides strong, versatile gradient performance that supports fast imaging and precise spatial encoding.
This hardware setup is widely used in clinical practice. It balances acquisition time, image quality, and patient comfort.
3. Capture the Initial Localizer Images
Before we can perform any MRI protocol, we must always capture initial localizer images of the patient. These images act as a guide for planning the detailed scans we will perform next.
We should always capture localizers in three planes:
Axial
Sagittal
Coronal
Once acquired, load the initial localizer images into the three viewports.
Then, scroll through each of the image stacks to locate a central slice that shows the sella region. The gland itself is not resolved on the localizers, but the slice is enough to plan the small field of view sequences on.
✅ Correct Setup of Localizer Images for Pituitary MRI:
Part 2: Plan and Acquire the Protocol Sequences
When all preparations are ready, we can start planning and acquiring the protocol sequences.
Let’s go through the pulse sequences that a standard pituitary MRI protocol includes, why we perform them, and how to set them up.
The 6 Sequences of a Standard Pituitary MRI
Axial T2 FLAIR
Sagittal T1 TSE
Coronal T1 TSE
Coronal T2 TSE (Optional)
Post-contrast Sagittal T1 TSE
Post-contrast Coronal T1 TSE
Turbo Spin Echo is used in this protocol for two reasons. Its refocusing pulses make it far more resistant to susceptibility distortion than gradient echo, which matters because the sella sits directly above the air-filled sphenoid sinus. It is also efficient enough to acquire thin, high-resolution slices in a workable scan time.
The axial T2 FLAIR at the start is a whole-brain survey. It checks for findings outside the sella before attention narrows to the gland.
Post-contrast T1 shows which tissue takes up gadolinium. That is what separates a normal gland from an adenoma, defines lesion margins and reveals cavernous sinus invasion.
The values in the tables below are worked examples for the 1.5 T setup used in this guide. Exact numbers vary by scanner, coil and department, so treat them as a starting point rather than as fixed limits.
In the sections below, we go through how to plan and set up each sequence.
1. Axial T2 FLAIR
✅ Correct Planning:
Planning Instructions:
Use a full field of view (FOV) to cover the entire brain.
Align slices as follows:
Sagittal Localizer: Middle slice should be parallel to the AC-PC line (Anterior Commissure - Posterior Commissure).
Coronal Localizer: Rotate the FOV slightly to ensure it’s perpendicular to the mid-sagittal line.
Expand slices to cover the brain from the vertex to the foramen magnum.
Reduce slice thickness and keep the slice gap at about 20% of slice thickness, while keeping scan time reasonable.
If the scanner warns that the requested number of slices does not fit the TR, accept the suggested number of concatenations or set concatenation to automatic, which adjusts it for you whenever you change the TR or the slice count.
Parameters for Axial T2 FLAIR:
Because this sequence surveys the whole brain rather than the gland, it can use thicker slices and give scan time more weight than the small field of view sequences do.
Parameter
Recommended Values
Why These Values
Echo Time (TE)
130–150 ms
Long TE is required for T2 contrast.
Repetition Time (TR)
6,000–8,000 ms
Long enough for CSF magnetization to recover before the next inversion pulse, so the null holds.
Inversion Time (TI)
2,200–2,500 ms
Nulls cerebrospinal fluid at 1.5 T. The null point shifts with TR, so re-check TI if you change TR.
Field of View (FOV)
200 x 230 mm
Large enough to cover the entire brain.
Matrix
384 x 288
Gives 0.52 x 0.80 mm pixels across a whole-brain FOV, with the 5 mm slices holding SNR up.
Foldover Direction (Phase)
Anterior-to-Posterior (AP)
Phase runs anterior to posterior, the head's longer in-plane axis, so the 230 mm phase FOV covers it without wrap.
Number of Slices
25–30
Enough slices to cover the entire brain, from the vertex to the foramen magnum.
Slice Thickness
5 mm
At or below the 5 mm ceiling recommended for brain imaging, while keeping enough signal per slice to avoid extra averages.
Slice Gap
1 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
250–290 Hz/px
High enough to keep chemical shift under one pixel and shorten echo spacing, at an SNR cost.
NEX / Averages
1–2
To get enough SNR, while keeping scan time short.
Turbo Factor / ETL
15–25
Higher turbo factor reduces scan time, and long effective TE provides T2 weighting.
Foldover Suppression
No
The 230 mm phase FOV already covers the head anterior to posterior, so there is nothing to wrap in.
Fat Suppression
None
Not needed, since scalp fat does not obscure a whole-brain survey.
2. Sagittal T1 TSE
✅ Correct Planning:
Planning Instructions:
Use a small field of view (FOV) to focus on the pituitary gland and surrounding structures.
Copy the image position from the sagittal localizer as a starting point.
Align slices as follows:
Axial Localizer: Scroll to the slice where the gland is clearly visible, center the slice package over it, and angle it parallel to the mid-sagittal line.
Coronal Localizer: Center the package on the gland and angle it parallel to the mid-sagittal line here as well.
Expand coverage laterally to include the optic nerves and the vessels on either side.
Reduce slice thickness and keep the slice gap at about 20% of slice thickness, and no more than 30%.
Parameters for Sagittal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Short TE is required for T1 contrast.
Repetition Time (TR)
400–600 ms
Short TR is required for T1 contrast.
Field of View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
Gives 0.63 mm in-plane pixels at this FOV, small enough to resolve the gland and stalk, at an SNR cost.
Foldover Direction (Phase)
Foot-to-Head (FH)
Ghosting from the globes propagates foot to head rather than posteriorly into the sella.
Number of Slices
8–10
Enough slices to cover the gland laterally out to the optic nerves and carotids.
Slice Thickness
3 mm
Thin enough to limit partial volume over a gland roughly 10 mm across, at an SNR cost.
Slice Gap
0.6 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
450–550 Hz/px
Limits chemical shift misregistration at the air and bone interfaces around the sella, at an SNR cost the extra averages offset.
NEX / Averages
3–5
Rebuilds the SNR lost to 0.63 mm pixels and 3 mm slices, at proportionally longer scan time.
Turbo Factor / ETL
2–4
Kept short so the effective TE stays short, preserving T1-weighting.
Foldover Suppression
Yes
Oversamples in the phase direction so anatomy outside the 160 mm FOV does not wrap into the sella.
Fat Suppression
None
Not used before contrast, so bright marrow and parasellar fat outline the gland and the sella floor.
3. Coronal T1 TSE
✅ Correct Planning:
Planning Instructions:
Use a small field of view (FOV) to focus on the pituitary gland and surrounding structures.
Copy the orientation and geometry from the sagittal T1 if your scanner allows it, then adjust the angle.
Align slices as follows:
Sagittal Localizer: Angle the package perpendicular to the floor of the sella turcica. This usually needs a small counterclockwise adjustment.
Axial Localizer: Check that the field of view is perpendicular to the mid-sagittal line.
Coronal Localizer: Place the center of the package directly on the pituitary gland.
Extend coverage from the optic nerves anteriorly to the dorsum sellae posteriorly.
Reduce slice thickness and keep the slice gap at about 20% of slice thickness, for precise imaging of small structures.
Parameters for Coronal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Short TE is required for T1 contrast.
Repetition Time (TR)
400–600 ms
Short TR is required for T1 contrast.
Field of View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
Gives 0.63 mm in-plane pixels at this FOV, small enough to resolve the gland and stalk, at an SNR cost.
Foldover Direction (Phase)
Right-to-Left (RL)
Phase runs right to left, the shorter in-plane axis, so less oversampling is needed to keep head height from wrapping in.
Number of Slices
8–10
Enough slices to cover the gland from the optic nerves to the dorsum sellae.
Slice Thickness
3 mm
Thin enough to limit partial volume over a gland roughly 10 mm across, at an SNR cost.
Slice Gap
0.6 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
450–550 Hz/px
Limits chemical shift misregistration at the air and bone interfaces around the sella, at an SNR cost the extra averages offset.
NEX / Averages
3–5
Rebuilds the SNR lost to 0.63 mm pixels and 3 mm slices, at proportionally longer scan time.
Turbo Factor / ETL
2–4
Kept short so the effective TE stays short, preserving T1-weighting.
Foldover Suppression
Yes
Oversamples in the phase direction so anatomy outside the 160 mm FOV does not wrap into the sella.
Fat Suppression
None
Not used before contrast, so bright marrow and parasellar fat outline the gland and the sella floor.
4. Coronal T2 TSE (Optional)
This sequence is optional in some departments. Follow your local protocol, or the reporting radiologist's instruction, rather than deciding at the console from how the images look.
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the previous coronal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between T2 and T1 images.
Parameters for Coronal T2 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
90–110 ms
Long TE is required for T2 contrast.
Repetition Time (TR)
3,000–4,000 ms
Long TR is required for T2 contrast.
Field of View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
Gives 0.63 mm in-plane pixels at this FOV, small enough to resolve the gland and stalk, at an SNR cost.
Foldover Direction (Phase)
Right-to-Left (RL)
Phase runs right to left, the shorter in-plane axis, so less oversampling is needed to keep head height from wrapping in.
Number of Slices
8–10
Enough slices to cover the gland from the optic nerves to the dorsum sellae.
Slice Thickness
3 mm
Thin enough to limit partial volume over a gland roughly 10 mm across, at an SNR cost.
Slice Gap
0.6 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
450–550 Hz/px
Limits chemical shift misregistration at the air and bone interfaces around the sella, at an SNR cost the extra averages offset.
NEX / Averages
3–5
Rebuilds the SNR lost to 0.63 mm pixels and 3 mm slices, at proportionally longer scan time.
Turbo Factor / ETL
15–25
Higher turbo factor reduces scan time, and long effective TE provides T2 weighting.
Foldover Suppression
Yes
Oversamples in the phase direction so anatomy outside the 160 mm FOV does not wrap into the sella.
Fat Suppression
None
Not used before contrast, so bright marrow and parasellar fat outline the gland and the sella floor.
5. Post-Contrast Sagittal T1 TSE
These are the standard post-contrast acquisitions. Where a microadenoma is suspected, a dynamic series is added on top: serial coronal T1 sets from the moment of injection, one every 10–30 seconds for 3–5 minutes.
The adenoma stands out most in the first 30–60 seconds, while the normal gland has enhanced and the adenoma has not.
A dynamic series needs a different workflow from the one described later for the standard post-contrast acquisitions. The patient stays in the bore with the line already sited, and the serial acquisition starts as the injection is given, because the first 30 to 60 seconds cannot be recovered afterwards.
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the pre-contrast sagittal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between pre- and post-contrast images.
Parameters for Post-Contrast Sagittal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Short TE is required for T1 contrast.
Repetition Time (TR)
400–600 ms
Short TR is required for T1 contrast.
Field of View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
Gives 0.63 mm in-plane pixels at this FOV, small enough to resolve the gland and stalk, at an SNR cost.
Foldover Direction (Phase)
Foot-to-Head (FH)
Ghosting from the globes propagates foot to head rather than posteriorly into the sella.
Number of Slices
8–10
Enough slices to cover the gland laterally out to the optic nerves and carotids.
Slice Thickness
3 mm
Thin enough to limit partial volume over a gland roughly 10 mm across, at an SNR cost.
Slice Gap
0.6 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
450–550 Hz/px
Matched to the pre-contrast sequence, so any difference is enhancement, not distortion.
NEX / Averages
3–5
Rebuilds the SNR lost to 0.63 mm pixels and 3 mm slices, at proportionally longer scan time.
Turbo Factor / ETL
2–4
Matched to the pre-contrast sequence.
Foldover Suppression
Yes
Oversamples in the phase direction so anatomy outside the 160 mm FOV does not wrap into the sella.
Fat Suppression
Spectral
Fat is bright on T1 and can be mistaken for enhancement, so it is suppressed after contrast.
6. Post-Contrast Coronal T1 TSE
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the pre-contrast coronal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between pre- and post-contrast images.
Parameters for Post-Contrast Coronal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Short TE is required for T1 contrast.
Repetition Time (TR)
400–600 ms
Short TR is required for T1 contrast.
Field of View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
Gives 0.63 mm in-plane pixels at this FOV, small enough to resolve the gland and stalk, at an SNR cost.
Foldover Direction (Phase)
Right-to-Left (RL)
Phase runs right to left, the shorter in-plane axis, so less oversampling is needed to keep head height from wrapping in.
Number of Slices
8–10
Enough slices to cover the gland from the optic nerves to the dorsum sellae.
Slice Thickness
3 mm
Thin enough to limit partial volume over a gland roughly 10 mm across, at an SNR cost.
Slice Gap
0.6 mm
20% of slice thickness, which limits cross-talk without hiding anatomy.
Bandwidth per pixel
450–550 Hz/px
Matched to the pre-contrast sequence, so any difference is enhancement, not distortion.
NEX / Averages
3–5
Rebuilds the SNR lost to 0.63 mm pixels and 3 mm slices, at proportionally longer scan time.
Turbo Factor / ETL
2–4
Matched to the pre-contrast sequence.
Foldover Suppression
Yes
Oversamples in the phase direction so anatomy outside the 160 mm FOV does not wrap into the sella.
Fat Suppression
Spectral
Fat is bright on T1 and can be mistaken for enhancement, so it is suppressed after contrast.
How to Avoid Artifacts When Planning the Sequences
The table below lists 6 common pituitary gland artifacts and the techniques that reduce them:
Artifacts
Solution – How to Avoid It
Motion artifacts
Instruct the patient to remain still, and keep sequences short so any motion spoils less of the acquisition.
Chemical shift artifacts
Increase the bandwidth, and use fat suppression on the sequences where it is available.
Wrap-around artifacts
Enable anti-aliasing or foldover suppression, so anatomy outside the field of view does not overlay the sella.
Cross-talk artifacts
Keep a small gap between 2D slices, usually around 20% of slice thickness and no more than 30%. Interleaved acquisition also limits cross-talk, so some departments run contiguous slices instead.
Flow artifacts
Choose the phase direction so the ghost track runs clear of the sella, and apply flow compensation or a saturation band over the inflowing vessels.
Susceptibility artifacts
Keep TE short where the contrast allows, raise the bandwidth, and use TSE rather than gradient echo near the sphenoid sinus.
How to Prepare and Administer the Contrast Injection
Before you perform post-contrast sequences, prepare and administer the contrast injection carefully to ensure imaging quality and patient safety.
Follow these steps:
Confirm the Patient Can Receive Gadolinium:
Follow your department's screening policy for the contrast agent it stocks. For the Group II agents in common use, the ASNR's 2025 position is that these are no longer withheld from patients with chronic kidney disease when the study is medically indicated, and that a department using Group II agents exclusively can discontinue routine renal function checks. Some product labels still call for risk-based screening, so the local policy is what decides.
Confirm there is no history of reaction to a gadolinium-based agent, and check pregnancy status. Gadolinium is not given routinely in pregnancy, because the fetal risk is unknown, and is used only where the clinician judges the diagnostic benefit to outweigh it. Anything unresolved goes back to the clinician before the post-contrast sequences run.
Plan Your Post-Contrast Sequences Before Administering the Contrast:
Before injecting the contrast agent, ensure that your sagittal and coronal T1 sequences are already planned and named as post-contrast acquisitions. This step ensures that sequences are ready to run immediately after the injection.
Enable Fat Saturation:
Make sure to activate spectral fat saturation in the sequence settings when planning them. Fat saturation reduces the bright signal from fat in post-contrast T1 images, which can otherwise obscure inflammation or vascular enhancement.
Spectral fat saturation is frequency-selective. It applies a pulse tuned to the resonant frequency of fat rather than relying on the T1 difference between fat and water. Purely selective saturation, sometimes called CHESS, has no inversion time. Spectrally selective inversion methods such as SPIR and SPAIR do have an adjustable delay, and that is what the simulator's "Fat sat. Inversion Time" control represents. 180 ms reproduces typical clinical fat suppression, but adjust it to match your clinic.
Pause the Workflow to Prepare the Contrast Injection:
Use the scanner’s pause function to temporarily stop the imaging workflow. This provides sufficient time to prepare and administer the contrast injection without rushing. Contrast can be administered either:
Manually: Using a syringe, or
Automatically: Using an MR-conditional power injector, depending on your department's setup.
Prepare the Contrast Agent:
Gadolinium is dosed by molar amount, not volume. The standard dose is 0.1 mmol/kg, and the volume that corresponds to it depends on the concentration your department stocks.
For an 80 kg patient at 0.1 mmol/kg:
A 0.5 mol/L agent gives 16 mL
A 1.0 mol/L agent gives 8 mL
Follow your department's dosing chart and the product labeling. The video uses 10 mL, which is less than the 16 mL a 0.5 mol/L agent would require for this patient, so treat it as a demonstration volume rather than a dose.
Set the contrast agent concentration and injection volume in the scanner’s settings.
Administer the Contrast and Resume Imaging:
After injecting the contrast:
Place the patient back into the scanner bore, close the door, and return to the console. This applies to the standard post-contrast acquisitions. If a dynamic series is planned, the patient stays in the bore throughout and the contrast is given through the sited line while the serial acquisition runs.
Time the acquisition to the clinical question. A standard post-contrast T1 is usually acquired within 2–5 minutes. Delayed imaging at 10–20 minutes can be added, because some microadenomas become more conspicuous once the normal gland has begun to wash out, and it is an addition rather than a substitute for early dynamic imaging. The video sets a 12-minute delay, which falls in that delayed window.
Monitor the Patient During Imaging:
While acquiring post-contrast sequences, regularly check the patient for signs of discomfort, allergic reactions, or irregular breathing patterns.
Part 3: Review the Images
Finally, we will review the images to ensure all the anatomical information we need is clear.
These key structures must be clearly visible in a pituitary MRI:
Pituitary gland
Infundibulum (pituitary stalk)
Sella turcica, including the floor and the dorsum sellae
Optic chiasm
Cavernous sinuses and internal carotid arteries
Hypothalamus
Sphenoid sinus
Clivus
Below, we will go through all the different image contrasts and explain their specific role in imaging the pituitary gland.
T2 FLAIR – Focused Fluid Imaging without CSF Interference
T2 FLAIR keeps the T2-weighting that makes water-rich tissue bright, but adds an inversion pulse that nulls free-flowing cerebrospinal fluid (CSF). Edema, protein-rich cyst contents and inflammatory change stay bright, while the CSF that would obscure them turns dark.
In the pituitary region, T2 FLAIR is the survey sequence. It screens the rest of the brain for edema, infarction, hydrocephalus and inflammatory change before attention narrows to the sella, and it shows any mass effect large enough to reach beyond the suprasellar cistern.
✅ Axial T2 FLAIR of Pituitary – Correct Image:
The axial T2 FLAIR covers the whole brain at 5 mm, so it places the sella in context rather than resolving it. Gland asymmetry and cavernous sinus involvement are assessed on the small field of view coronal images.
T1 TSE – Highlights Fat-Containing Tissues and Structural Abnormalities
T1-weighted imaging makes fat appear bright and fluid dark. This contrast is ideal for fat-rich tissues and structural abnormalities. T1 shows anatomical structures clearly here, because the bright marrow of the clivus and the fat in the cavernous sinus outline the darker gland and stalk against them.
In the pituitary region, T1 TSE is the sequence that delineates the gland, stalk and vasculature. It helps identify gland asymmetry, stalk thickening, and parasellar abnormalities.
✅ Sagittal T1 TSE of Pituitary – Correct Image:
Sagittal T1 TSE provides a midline view of the pituitary gland, stalk, and sphenoid sinus. This view is ideal for assessing the gland’s vertical relationships with the optic chiasm and hypothalamus.
✅ Coronal T1 TSE of Pituitary – Correct Image:
Coronal T1 TSE captures the lateral extent of the pituitary gland and its relationship to the cavernous sinuses. This view is best for identifying gland asymmetry or parasellar invasion.
T2 TSE – Highlights Fluid-Related Tissues and Conditions
T2-weighted imaging makes fluids appear bright. This contrast is ideal to detect tissues and abnormalities with high water content.
In the pituitary region, T2 TSE excels at detecting cystic changes, fluid accumulation, or inflammation. It also highlights structural relationships between the gland, sphenoid sinus, and clivus.
✅ Coronal T2 TSE of Pituitary – Correct Image:
Coronal T2 TSE offers a frontal view of the pituitary gland, optic chiasm, and cavernous sinuses. This view is ideal for characterizing cystic and fluid-filled components, and for judging the relationship between the gland, the sphenoid sinus and the clivus.
Post-Contrast T1 – Shows Which Tissue Takes Up Contrast
Post-contrast T1 shows which tissue takes up gadolinium. That is what separates a normal gland from an adenoma, defines the margins of a lesion, and reveals extension into the cavernous sinus.
In the pituitary region, post-contrast T1 highlights enhancement patterns in the gland and stalk, helping differentiate normal tissue from tumors or cysts. It also shows the internal carotid arteries and the cavernous sinuses, so parasellar extension can be judged.
✅ Post-Contrast Sagittal T1 TSE of Pituitary – Correct Image:
Sagittal post-contrast T1 TSE enhances the visualization of the gland, stalk, and hypothalamus. This view is ideal for detecting subtle lesions or enhancement abnormalities along the vertical axis.
✅ Post-Contrast Coronal T1 TSE of Pituitary – Correct Image:
Coronal post-contrast T1 TSE provides detailed imaging of the gland’s lateral structures, including the cavernous sinuses and internal carotid arteries. This view is best for detecting asymmetric enhancement and parasellar masses.
Final Checks:
Before finishing a pituitary MRI, always check these 5 points to ensure diagnostic quality:
Gland and Stalk Visibility: The gland and stalk must be fully included and sharply depicted on both the sagittal and coronal T1 series.
Contrast Enhancement: Post-contrast T1 must show clear enhancement of the normal gland, so that any focus enhancing less, or later, stands out against it.
Stalk and Optic Chiasm Coverage: Slices must include the entire stalk and extend up to the optic chiasm.
CSF Suppression: In the axial T2 FLAIR, CSF should be dark, so edema and other findings across the brain stand out.
Image Quality and Artifacts: All images must have strong SNR, sharp borders, and no motion, aliasing, or ghosting artifacts.
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