Objective: MRI is the modality of choice to evaluate morphology of hypothalamic pituitary axis (HPA) and associated endocrinopathies. In the paediatric population it presents a diagnostic challenge because of small size and varied disease processes. We undertook a retrospective study to determine the pitfalls in reporting of pituitary imaging.
Methods: Evaluation of pituitary MRI scans in 18 patients. We sought a second opinion from a paediatric neuro-radiologist and compared it with the local opinion of a general radiologist. We also evaluated the time delay, difference in diagnosis and the effect on the management.
Results: Eighteen patients were recruited for the study, ten male, eight females with a mean age 7 years 10 months. The mean time between the scan and its first report was 12 days (range: 054); whilst the mean time between the scan and the second opinion was 53 days (2183). 11 patients presented with varying endocrine pathology namely GH deficiency, precocious puberty, congenital hypothyroidism, premature thelarche and hypogonadotrophic hypogonadism. Seven patients with non-endocrine pathology were excluded from analysis. Specialist opinion on MRI was different from the initial report in nine out of 11 patients. Four diagnosed as pituitary microadenoma were either normal or incidental pars intermedia cyst. One diagnosed as hypothalamic hamartoma was an artefactual abnormality. One diagnosed as possible Langerhan cell histiocytosis with thickened infundibulum was considered a congenital malformation. Two scans reported as normal or possible bulky pituitary underwent rescanning for further information. One scan was amended with additional findings of thickening of skull bones, suggesting a different pathology.
Conclusions: False positive results in paediatric pituitary scans can lead to parental anxiety and wrong management plans. Paediatric pituitary MRI should be reported by specialist paediatric neuroradiologists in conjunction with the clinical multi-disciplinary team.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology