What enhancement characteristic is useful in distinguishing between macroadenoma and meningioma?
Macroadenomas tend to have a less vivid and less homogeneous enhancement, almost akin to static on an untuned cathode ray TV (although I suspect I am dating myself).
As is usually the case, what should you attempt to identify to locate the normal pituitary gland and what sequences are particularly helpful?
The posterior pituitary bright spot, in this case is displaced superiorly and to the left. It is most easily seen on thin T1 sequences (see subsequent annotated images).
A large right paraselllar mass is noted measuring up to 18 mm thick, filling the cavernous sinus and moderately narrowing in the transverse portion of the cavernous carotid artery. Anteriorly, the tumour extends for 1 centimetre into the apex of the right orbit, medially into the upper right sphenoid sinus. The tumour grows over the suprasellar region, displacing the posterior pituitary bright spot up and to the left. It contacts the optic chiasm and posteriorly mildly thickens the prepontine dura and anterior right tentorium. Inferiorly, the tumour extends into Meckels cave almost completely filling it.