Pituitary macroadenoma

chronicChronic headache, diminution of vision and bi-temporal hemianopia on ophthalmological examination.

Pituitary macroadenomasare the most common suprasellar mass in adults, and responsible for the majority of trans-sphenoidal hypophysectomy.

On imaging, they usually present as a solid tumour and demonstrates moderate contrast enhancement. They are isointense to the grey matter both on T1 and T2-weighted images. However, signal characteristics can significantly vary depending on tumour components such as haemorrhage, cystic transformation or necrosis.

brainBrain and sella

Evidence of a sizable sellar and supra-sellar mass lesion ,It. It is iso to hypointense on T1WI and iso- to hyperintense on T2WI and FLAIR. It shows heterogenous enhancement with small cystic non enhanced-enhanced components.

Extensions and mass effect:

• laterally, it is partially encasing both internal carotid arteries at the cavernous sinus bilaterally, yet still patent judged by signal void denoting their patency 
• inferiorly, expanding the sellar cavity and its floor compressing both sphenoid sinuses with no intra-sinus extensions
• superiorly, it is markedly compressing the optic chiasm and both optic tracts, additionally noted it is indented by the diaphragma sellae giving it a snowman configuration (or "figure 8" or "dumbbell" configuration) as at coronal image.

Multiple bilateral periventricular white matter patches and foci of altered signal intensities eliciting bright T2 and FLAIR signal suggesting small artery disease (Fazekas type II)

Cavum septum pellucidum is incidentally noted.