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An Infundibular Unidentified Object (IUO): a new pituitary stalk marker?

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Abstract

Purpose

Measurement of the pituitary stalk (PS) diameter does not always solve the issue of minimal PS thickening. A previously undescribed image is found at the infundibular level on high resolution thin section T2W MRI in a large number of normal individuals. We speculate that this image—whose exact origin is still unknown—may serve as a marker of the normal infundibulum.

Methods

In the last 6 months, 350 consecutive adult patients suspected of sellar pathology or controlled after medical or surgical treatment prospectively underwent a pituitary MRI including a sagittal T2W high resolution sequence. One hundred twelwe patients presenting a pituitary mass with suprasellar extension or those whose PS was not entirely visible were excluded.

Results

A short focal annular T2 hypointense thickening of the wall of the infundibular recess of the third ventricle, more pronounced anteriorly was found in 151/238 patients. Additionally, a more or less tiny ventral extension was demonstrated on sagittal T2W sequence in 105/151 patients. These images were not identified on T1W or on T1W gadolinium enhanced sequences. The ring-like infundibular thickening and/or its ventral extension were not identified in 87/238 patients; in 43/87 of these patients the PS was found severely stretched mainly in case of primary or secondary empty sella. If patients with empty sella were excluded, our finding was observed in 194/238 cases, i.e. in 82%.

Conclusions

A detailed appearance of the PS on T2W MRI is described for the first time. A previously unreported T2W hypointense annular focal image prolonged by a tiny spicular or nodular ventral bud is found at the lower part of the infundibulum in a majority of normal patients, but not if the PS is stretched such as in empty sella. This image has to be recognized as a normal anatomical landmark. The possible origin of this image is discussed but not totally elucidated. An ongoing research will demonstrate or not if this image may serve as a marker to improve the early diagnosis of PS lesions.

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Acknowledgements

The authors would like to thank Laurent Tatu for his researches, Sylvia Asa and Jacqueline Trouillas for their advices and Etienne Laurent for his didactic drawings.

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Authors and Affiliations

  1. Centre Hospitalier Universitaire de Liege, Liège, Belgium

    J.-F. Bonneville, L. Tshibanda & A. Beckers

Authors
  1. J.-F. Bonneville
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  2. L. Tshibanda
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  3. A. Beckers
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Corresponding author

Correspondence to J.-F. Bonneville.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All imaging was performed during routine neuroradiological work-up of patients based on clinical indications; no prospective imaging of normal volunteers was performed in this study. As such, according to guidelines of the revised Declaration of Helsinki, this study reported the retrospective analysis of data (images) obtained from ‘routine sources’ where consent of individual patients and ethical approval for research analysis was, therefore, not considered necessary.

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This article does not contain any studies with human subjects or animals performed by the authors.

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Bonneville, JF., Tshibanda, L. & Beckers, A. An Infundibular Unidentified Object (IUO): a new pituitary stalk marker?. Pituitary 24, 964–969 (2021). https://doi.org/10.1007/s11102-021-01169-w

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  • DOI: https://doi.org/10.1007/s11102-021-01169-w

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