{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:25:30Z","timestamp":1760235930623,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["Grant SUB.C270.21.020"],"award-info":[{"award-number":["Grant SUB.C270.21.020"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study was to assess the diagnostic value of non-contrast pituitary MRI in children with growth or puberty disorders (GPDs) and to determine the criteria indicating the necessity to perform post-contrast examination. A retrospective study included re-analysis of 567 contrast-enhanced pituitary MRIs of children treated in a tertiary reference center. Two sets of sequences were created from each MRI examination: Set 1, including common sequences without contrast administration, and Set 2, which included common pre- and post-contrast sequences (conventional MRI examination). The differences in the visibility of pituitary lesions between pairs of sets were statistically analyzed. The overall frequency of Rathke\u2019s cleft cysts was 11.6%, ectopic posterior pituitary 3.5%, and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases. Lesions not visible before and diagnosed only after contrast injection accounted for only 0.18% of all patients. Statistical analysis showed the advantage of the antero-posterior (AP) pituitary dimension over the other criteria in determining the appropriateness of using contrast in pituitary MRIs. The AP dimension was the most significant factor in logistic regression analysis: OR = 2.23, 95% CI, 1.35\u20133.71, p-value = 0.002, and in ROC analysis: AUC: 72.9% with a cut-off value of 7.5 mm, with sensitivity\/specificity rates of 69.2%\/73.5%. In most cases, the use of gadolinium-based contrast agent (GBCA) in pituitary MRI in children with GPD is unnecessary. The advantages of GBCA omission include shortening the time of MRI examination and of general anesthesia; saving time for other examinations, thus increasing the availability of MRI for waiting children; and acceleration in their further clinical management.<\/jats:p>","DOI":"10.3390\/jcm10194598","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T16:23:58Z","timestamp":1633623838000},"page":"4598","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders\u2014Is Gadolinium Contrast Administration Actually Needed?"],"prefix":"10.3390","volume":"10","author":[{"given":"Marta","family":"Michali-Stolarska","sequence":"first","affiliation":[{"name":"Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5278-989X","authenticated-orcid":false,"given":"Andrzej","family":"Tukiendorf","sequence":"additional","affiliation":[{"name":"Department of Public Health, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1801-6142","authenticated-orcid":false,"given":"Anna","family":"Zacharzewska-Gondek","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jagoda","family":"Jack\u00f3w-Nowicka","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Chrzanowska","sequence":"additional","affiliation":[{"name":"Department of Developmental Endocrinology and Diabetology, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3900-4901","authenticated-orcid":false,"given":"Grzegorz","family":"Trybek","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0597-8457","authenticated-orcid":false,"given":"Joanna","family":"Bladowska","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1159\/000489456","article-title":"Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature\/Growth Hormone Deficiency","volume":"90","author":"Derrick","year":"2018","journal-title":"Horm. Res. Paediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5152\/dir.2019.19352","article-title":"The neuroimaging features of rathke\u2019s cleft cysts in children with endocrine-related diseases","volume":"26","year":"2020","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.ejrad.2004.08.006","article-title":"The value of high-field MRI (3 T) in the assessment of sellar lesions","volume":"54","author":"Pinker","year":"2005","journal-title":"Eur. J. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.mri.2019.03.015","article-title":"Golden-angle radial sparse parallel (GRASP) MRI in clinical routine detection of pituitary microadenomas: First experience and feasibility","volume":"60","author":"Hainc","year":"2019","journal-title":"Magn. Reson. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/cen.12069","article-title":"Volume interpolated 3D-spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for MRI detection of corticotropin secreting pituitary microadenomas","volume":"78","author":"Kasaliwal","year":"2013","journal-title":"Clin. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1016\/j.ejrad.2014.06.018","article-title":"3D dynamic pituitary MR imaging with CAIPIRINHA: Initial experience and comparison with 2D dynamic MR imaging","volume":"83","author":"Fushimi","year":"2014","journal-title":"Eur. J. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1177\/0284185118774954","article-title":"Increased diagnostic confidence in the diagnosis of pituitary micro-lesions with the addition of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions sequences","volume":"60","author":"Tang","year":"2019","journal-title":"Acta Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.3174\/ajnr.A4324","article-title":"High-Resolution DCE-MRI of the Pituitary Gland Using Radial k -Space Acquisition with Compressed Sensing Reconstruction","volume":"36","author":"Bangiyev","year":"2015","journal-title":"Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.3174\/ajnr.A5244","article-title":"Role of High-Resolution Dynamic Contrast-Enhanced MRI with Golden-Angle Radial Sparse Parallel Reconstruction to Identify the Normal Pituitary Gland in Patients with Macroadenomas","volume":"38","author":"Sen","year":"2017","journal-title":"Am. J. Neuroradiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1002\/jmri.26962","article-title":"Evaluation of image quality of pituitary dynamic contrast-enhanced MRI using time-resolved angiography with interleaved stochastic trajectories (TWIST) and iterative reconstruction TWIST (IT-TWIST)","volume":"51","author":"Yokota","year":"2020","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_11","first-page":"982","article-title":"Pituitary gland tumors","volume":"59","year":"2019","journal-title":"Radiologe"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s12098-019-02891-x","article-title":"Use and Safety of Gadolinium Based Contrast Agents in Pediatric MR Imaging","volume":"86","author":"Holowka","year":"2019","journal-title":"Indian J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1148\/radiol.2018181151","article-title":"Gadolinium retention: A research roadmap from the 2018 NIH\/ACR\/RSNA workshop on gadolinium chelates","volume":"289","author":"McDonald","year":"2018","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1148\/radiol.2015142690","article-title":"Gadolinium-based contrast agent accumulates in the brain even in subjects without severe renal dysfunction: Evaluation of autopsy brain specimens with inductively coupled plasma mass spectroscopy","volume":"276","author":"Kanda","year":"2015","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.pediatrneurol.2018.07.010","article-title":"Safety of Gadolinium Administration in Children","volume":"86","author":"Elbeshlawi","year":"2018","journal-title":"Pediatr. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1001\/jamapediatrics.2017.0264","article-title":"Intracranial gadolinium deposition following gadodiamide-enhanced magnetic resonance imaging in pediatric patients: A case-control study","volume":"171","author":"McDonald","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s11102-010-0222-y","article-title":"A modified protocol using half-dose gadolinium in dynamic 3-Tesla magnetic resonance imaging for detection of ACTH-secreting pituitary tumors","volume":"13","year":"2010","journal-title":"Pituitary"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.clineuro.2006.11.001","article-title":"Imaging of sellar and parasellar lesions","volume":"109","author":"Rennert","year":"2007","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.clp.2019.08.001","article-title":"Human Studies of Anesthesia-Related Neurotoxicity in Children: A Narrative Review of Recent Additions to the Clinical Literature","volume":"46","year":"2019","journal-title":"Clin. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Warner, D.O., Zaccariello, M.J., Katusic, S.K., Schroeder, D.R., Hanson, A.C., Schulte, P.J., Buenvenida, S.L., Gleich, S.J., Wilder, R.T., and Sprung, J. (2018). Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia, The Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology, 89\u2013105.","DOI":"10.1097\/ALN.0000000000002232"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1177\/0883073817691696","article-title":"Anesthetic-Related Neurotoxicity and Neuroimaging in Children: A Call for Conversation","volume":"32","author":"Bjur","year":"2017","journal-title":"J. Child. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1001\/jama.2016.6967","article-title":"Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood","volume":"315","author":"Sun","year":"2016","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s00247-017-3871-4","article-title":"Pediatric anesthesia and neurotoxicity: What the radiologist needs to know","volume":"48","author":"Barton","year":"2018","journal-title":"Pediatr. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1097\/ALN.0b013e3181d049cd","article-title":"Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain","volume":"112","author":"Brambrink","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s00247-018-4070-7","article-title":"Pituitary height at magnetic resonance imaging in pediatric isolated growth hormone deficiency","volume":"48","author":"Dumrongpisutikul","year":"2018","journal-title":"Pediatr. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.2214\/ajr.162.5.8166005","article-title":"MR imaging diagnosis of central precocious puberty: Importance of changes in the shape and size of the pituitary gland","volume":"162","author":"Sharafuddin","year":"1994","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1515\/jpem-2015-0404","article-title":"Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls","volume":"29","author":"Kessler","year":"2016","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_28","unstructured":"(2021, September 10). R Team Core R: A Language and Environment for Statistical Computing Version 4.0.2 2020. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.C., and M\u00fcller, M. (2011). pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform., 12.","DOI":"10.1186\/1471-2105-12-77"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3171\/jns.1998.89.4.0547","article-title":"The descriptive epidemiology of craniopharyngioma","volume":"89","author":"Bunin","year":"1998","journal-title":"J. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1159\/000091574","article-title":"Diagnosis and management of pediatric sellar lesions","volume":"34","author":"Jagannathan","year":"2006","journal-title":"Front. Horm. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00002142-200112000-00004","article-title":"Magnetic resonance imaging of pediatric brain tumors: State of the art","volume":"12","author":"Poussaint","year":"2001","journal-title":"Top. Magn. Reson. Imaging"},{"key":"ref_33","first-page":"299","article-title":"Neuroimaging of pediatric craniopharyngiomas: A pictorial essay","volume":"19","author":"Rossi","year":"2006","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s11102-019-00940-4","article-title":"Pituitary incidentalomas in paediatric age are different from those described in adulthood","volume":"22","author":"Souteiro","year":"2019","journal-title":"Pituitary"},{"key":"ref_35","first-page":"2144","article-title":"Pituitary cysts in childhood evaluated by MR imaging","volume":"26","author":"Takanashi","year":"2005","journal-title":"Am. J. Neuroradiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/BF03350700","article-title":"Human pituitary adenomas. Recent advances in morphological studies","volume":"13","author":"Giannattasio","year":"1990","journal-title":"J. Endocrinol. Investig. Off. J. Ital. Soc. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1148\/radiology.193.1.8090885","article-title":"Incidental pituitary lesions in 1,000 unselected autopsy specimens","volume":"193","author":"Teramoto","year":"1994","journal-title":"Radiology"},{"key":"ref_38","first-page":"525","article-title":"Rathke cleft cysts: Correlation of enhanced MR and surgical findings","volume":"15","author":"Sumida","year":"1994","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000357673","article-title":"Paediatric pituitary adenomas: A decade of change","volume":"81","author":"Guaraldi","year":"2014","journal-title":"Horm. Res. Paediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/BF02012988","article-title":"MR imaging of the pituitary gland in central precocious puberty","volume":"22","author":"Kao","year":"1992","journal-title":"Pediatr. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/RLI.0000000000000431","article-title":"Effect of Age on High T1 Signal Intensity of the Dentate Nucleus and Globus Pallidus in a Large Population Exposed to Gadodiamide","volume":"53","author":"Quattrocchi","year":"2018","journal-title":"Invest. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1148\/radiol.14140364","article-title":"High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: Association with linear versus macrocyclic gadolinium chelate administration","volume":"275","author":"Kanda","year":"2015","journal-title":"Radiology"},{"key":"ref_43","first-page":"1","article-title":"Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children","volume":"47","author":"Bernardi","year":"2017","journal-title":"Pediatr. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/S1474-4422(17)30158-8","article-title":"Gadolinium deposition in the brain: Summary of evidence and recommendations","volume":"16","author":"Gulani","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/s00234-020-02434-8","article-title":"Exposure to gadolinium and neurotoxicity: Current status of preclinical and clinical studies","volume":"62","author":"Mallio","year":"2020","journal-title":"Neuroradiology"},{"key":"ref_46","unstructured":"European Medicines Agency (2021, September 10). EMA\u2019s Final Opinion Confirms Restrictions on Use of Linear Gadolinium Agents in Body Scans. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/press-release\/emas-final-opinion-confirms-restrictions-use-linear-gadolinium-agents-body-scans_en.pdf."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00401-018-1857-4","article-title":"Gadolinium-based contrast agents induce gadolinium deposits in cerebral vessel walls, while the neuropil is not affected: An autopsy study","volume":"136","author":"Fingerhut","year":"2018","journal-title":"Acta Neuropathol."},{"key":"ref_48","unstructured":"FDA (2021, September 10). FDA Drug Safety Communication: FDA Warns that Gadolinium-Based Contrast Agents (GBCAs) Are Retained in the Body; Requires New Class Warnings, Available online: https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-warns-gadolinium-based-contrast-agents-gbcas-are-retained-body."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s00247-017-3999-2","article-title":"Do we need gadolinium-based contrast medium for brain magnetic resonance imaging in children?","volume":"48","author":"Krause","year":"2018","journal-title":"Pediatr. Radiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s11102-018-0928-9","article-title":"A plea for the T2W MR sequence for pituitary imaging","volume":"22","author":"Bonneville","year":"2019","journal-title":"Pituitary"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s11102-018-00931-x","article-title":"Long term MRI surveillance of pituitary macroadenomas: Gadolinium is not obligatory","volume":"22","author":"Bonneville","year":"2019","journal-title":"Pituitary"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/19\/4598\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:09:58Z","timestamp":1760166598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/19\/4598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,6]]},"references-count":51,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jcm10194598"],"URL":"https:\/\/doi.org\/10.3390\/jcm10194598","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,10,6]]}}}