After Surgery

MRI obtained in the immediate post-operative period is often not reliable for the search of a tumoral remnant which can be masked by packing material and/or serohematic suffusion. Over 6 months post-op, the surgical bed is clean. Only fat grafts can persist for decades. A frequent mistake is the confusion between the normal pituitary tissue and a pituitary adenoma remnant. The T2W signal of the normal residual pituitary tissue is very similar to that of the temporal cortex. The pituitary stalk is oriented toward the normal pituitary, which is located laterally, against the cavernous sinus. Beyond the sixth post-operative month and the following years, the most cost-effective follow-up must be taken into consideration and two sequences including a coronal T2W sequence are usually enough for non-secreting PitNETs control. Reproducibility is essential. On the opposite, a full MRI with CE 3D T1WIs must be realized for secreting PitNETs follow-up.