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Index / Incidental findings

Incidental pituitary lesion

ACR 2018CTMRIPET
Flowchart · click to enlarge
Incidental pituitary lesion on CT or MRI

Asymptomatic adults imaged for an unrelated reason. Report composition, size, and mass effect or invasion.

LesionManagement
Simple cyst, no mass effectNo further evaluation (likely Rathke cleft cyst)
Solid/mixed < 5 mmNo further imaging; correlate for hypersecretion; consider pseudolesion
Solid/mixed 5–10 mmNo further imaging; correlate; consider endocrine tests
Solid/mixed > 10 mm, no mass effectEndocrine function tests; pituitary MRI in 6–12 months
Any lesion with mass effect or invasionEndocrine and/or neurosurgical referral
  • Indeterminate composition: manage as solid.
  • FDG PET uptake: same pathway; obtain a pituitary MRI if composition or size cannot be assessed. Consider life expectancy.

Sources

  1. Hoang JK, Hoffman AR, González RG, et al. Management of incidental pituitary findings on CT, MRI, and 18F-fluorodeoxyglucose PET: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2018;15:966–972.PubMed ↗
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Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.