Lesions of the Hypothalamus: MR Imaging Diagnostic Features

MRI atlas of the human hypothalamus

Gaining new insights into the anatomy of the human hypothalamus is crucial for the development of new treatment strategies involving functional stereotactic neurosurgery. Here, using anatomical comparisons between histology and magnetic resonance images of the human hypothalamus in the coronal plane, we show that discrete gray and white hypothalamic structures are consistently identifiable by MRI. Macroscopic and microscopic images were used to precisely annotate the MRI sequences realized in the coronal plane in twenty healthy volunteers. MRI was performed on a 1.5 T scanner, using a protocol including T1-weighted 3D fast field echo, T1-weighted inversion-recovery, turbo spin echo and T2-weighted 2D fast field echo imaging. For each gray matter structure as well as for white matter bundles, the different MRI sequences were analyzed in comparison to each other. The anterior commissure and the fornix were often identifiable, while the mammillothalamic tract was more difficult to spot. Qualitative analyses showed that MRI could also highlight finer structures such as the paraventricular nucleus, the ventromedial nucleus of the hypothalamus and the infundibular (arcuate) nucleus, brain nuclei that play key roles in the regulation of food intake and energy homeostasis. The posterior hypothalamic area, a target for deep brain stimulation in the treatment of cluster headaches, was readily identified, as was the lateral hypothalamic area, which similar to the aforementioned hypothalamic nuclei, could be a putative target for deep brain stimulation in the treatment of obesity. Finally, each of the identified structures was mapped to Montreal Neurological Institute (MNI) space.

Detailed visualization of the functional regions of the rat pituitary gland by high-resolution T2-weighted MRI

This high-resolution MRI study focuses on the visualization of the detailed morphology of the rat's pituitary gland by means of post-mortem as well as in vivo MRI at 9.4 T. Determination of the local T1- and T2-relaxation decay times allows to explain the regional image intensities which reflects the degree of tissue organization at the molecular level. Detailed characterization of the molecular level of the pituitary gland, as provided by the relaxation decay times, can offer a rigid platform with respect to functional or pathological explorations. It is demonstrated that T1-weighted imaging, as is routinely used in the clinic, can differentiate between the posterior and anterior lobe but not between the posterior and intermediate lobe. T2-weighted images, however, clearly show the three distinct lobes of the rat pituitary gland without the use of contrast agents, i.e. the posterior, the intermediate and the anterior lobe. Histological analysis of the rat's pituitary gland confirms the morphological structures seen on the MR images. Although the intermediate lobe is less defined in humans and can neither be differentiated by T1-weighted MRI, its clinical visualization might be possible in T2-weighted images.

Pituitary abscess: an unexpected diagnosis

The pituitary gland can demonstrate a variety of pathologies with different clinical presentations. Amongst them, pituitary abscess is a rare infectious disease for which contrast-enhanced MRI aids the diagnostic pathway. We present a 16-year-old girl with imaging and surgical findings consistent with primary pituitary abscess.

[Neuroendocrine dysfunction and brain damage. A consensus statement]

This consensus statement aims to enhance awareness of the incidence and risks of hypopituitarism in patients with traumatic brain injury (TBI) and/or brain hemorrhages among physicians treating patients with brain damage. The importance of this problem is related not only to the frequency of TBI but also to its prevalence in younger populations. The consequences of TBI are characterized by a series of symptoms that depend on the type of sequels related to neuroendocrine dysfunction. The signs and symptoms of hypopituitarism are often confused with those of other sequels of TBI. Consequently, patients with posttraumatic hypopituitarism may receive suboptimal rehabilitation unless the underlying hormone deficiency is identified and treated. This consensus is based on the recommendation supported by expert opinion that patients with a TBI and/or brain hemorrhage should undergo endocrine evaluation in order to assess pituitary function and, if deficiency is detected, should receive hormone replacement therapy.