0:00

Here's a quick protocol example for you,

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that is paired with the initial protocol introduction.

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I want to show you a dynamic

0:09

coronal T1-weighted sequence.

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And you can follow along or you can sing

0:14

along, watch where the slice is located.

0:17

So the first slice is back here in the posterior

0:19

pituitary region with the posterior

0:22

pituitary bright spot.

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And we start out pre-contrast.

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And then immediately,

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we go to the post-contrast image at about

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10 to 15 seconds at the same locus.

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And then we watch it fill in.

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Now we're in the posterior gland,

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so we're not going to see much vascularity there.

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We keep going forward and get to the next slice.

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And here we are at the next slice.

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We're starting to see the base of the pituitary

0:45

stalk and the region of the median eminence.

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We're catching a little bit of the pars intermedia,

0:50

maybe a little bit of the anterior gland.

0:52

And then we follow that along as contrast enters.

0:56

And then we go to the next slice right here.

0:58

And now we're starting to get into

1:00

the anterior pituitary gland or pars distalis.

1:04

And we're seeing the gland fill in with a little bit

1:06

of the pituitary tuft in the midline and

1:08

the cavernous sinuses on either side.

1:11

We follow that every 10 to 15 seconds.

1:13

Watch that fill in.

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Yes, there are some little dots and ditzels here,

1:17

none of which are displacing the stalk,

1:20

none of which are producing upward convexity.

1:22

It's very common to see these little

1:24

ill-defined dark spots with high resolution.

1:27

These are 2 mm cuts with contiguous slices.

1:31

No skip. Let's keep moving forward.

1:33

Now, we're at the next slice,

1:34

right in the middle of the pituitary gland.

1:37

This is a pubertal individual,

1:39

so there is a little bit of upward convexity.

1:41

That's allowed.

1:41

Here's the gland filling in the pars distalis.

1:44

Here's the tuft in the middle.

1:46

Let's watch the contrast enter.

1:48

It does. Let's keep going.

1:50

And now we're getting to the very anterior tip

1:52

of the gland with a little bit of the tuft.

1:54

And we watch that fill in.

1:55

And then suddenly, we are out of the gland.

1:58

Now, we can throw in a little extra here.

1:59

We've got a sagittal T2,

2:01

in case we want to see what's happening anteroposteriorly.

2:05

We've got a coronal T2,

2:06

in case we want to see what's happening with the optic

2:09

chiasm or what's happening with the cavernous

2:11

sinuses and the carotid arteries,

2:13

looking for aneurysm, etc.

2:15

And then you can add and subtract, as you see fit,

2:17

as the individual case dictates.

2:20

Quick look.

2:21

Dynamic imaging,

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coronal projection,

2:24

10 to 15 seconds per run.

2:26

You can also get it delayed if you wish.

2:28

It's probably a good thing to do.

2:30

Contrast-enhanced MRI,

2:32

the pituitary gland, and the coronal projection,

2:35

especially when you're on a search for microadenoma.