This article is part of Uncovering the Link Between Bariatric Surgery, Inflammation & Type 2 Diabetes.
When microadenomas are correctly identified and localized preoperatively in the pituitary gland, a minimally invasive surgery can be curative. But pituitary microadenomas present as small as one-third the size of a pea, making them difficult to detect with traditional MRI imaging sequences. Radiologists at NYU Langone instead rely on two novel sequences with higher soft-tissue resolution that allows them to localize even the smallest pituitary lesions: golden-angle radial sparse parallel, or GRASP, and constructive interference in steady state, or CISS.
Compared to conventional sequences, GRASP provides greater through-plane resolution, improved sensitivity to motion and flow, and inherent fat suppression. Whereas CISS, a fast-gradient echo sequence, is characterized by high signal-to-noise ratio and high spatial resolution (0.6 mm). Once the microadenomas are successfully localized and surgical removal is recommended, surgeons rely on these same high-resolution imaging techniques in the operating room to ensure that the tumor has been completely resected.
In addition, neuroradiologists Elcin Zan, MD, and Giresh Fatterpekar, MD, and nuclear medicine physicians combine these MRI sequences with Ga68-DOTATATE PET scans to find rare ectopic tumors in patients with acromegaly or Cushing’s syndrome. Physicians image the body from the top of the skull to the toes, taking advantage of the molecular and physiologic features from Ga68-DOTATATE PET and structural features from high-resolution MRI to identify the source with increasing diagnostic precision, making changes in real time as necessary.