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CT Sella / Pituitary (With and Without Contrast)

CT+ ContrastNeuroverify

Indications

Suspected pituitary macroadenoma/microadenoma when MRI contraindicated or unavailable
Sellar/parasellar mass characterization, bony sella assessment
Pituitary apoplexy, suspected hemorrhage
Pre-operative (transsphenoidal) bony anatomy and sphenoid sinus pneumatization
Evaluation of sellar calcification (e.g. craniopharyngioma)

Patient prep

For contrast: screen eGFR, IV access, document allergy/premedicate
No routine NPO; remove metallic head objects
Supine head-first; immobilize head, minimize motion

Contrast

Agentiodinated (e.g. iohexol 350 or iopamidol 370)

RouteIV

Dose≈70-100 mL at 2-3 mL/s

TimingThin-section dynamic/early post-contrast through sella ~25-40 s plus delayed; pre-contrast series for comparison

Technique

Supine, head first; thin-section helical volume focused on the sella turcica (coverage from sphenoid sinus floor through suprasellar cistern)
120 kV; mAs per scanner with AEC; small FOV over sella
Reconstruct thin (0.5-0.75 mm) source; direct/reformatted thin coronal and sagittal aligned to pituitary stalk
Bone kernel for sellar floor/sphenoid for transsphenoidal planning
No breath-hold

Series / Sequences

#	Series / Sequence	Plane	Thickness	Notes
1	Pre-contrast axial/coronal	coronal	0.5-1 mm	Baseline; detect calcification/hemorrhage
2	Post-contrast coronal (thin)	coronal	0.5-1 mm	Primary plane for adenoma; microadenoma = relatively hypoenhancing focus on early imaging
3	Post-contrast sagittal reformat	sagittal	0.5-1 mm	Stalk, suprasellar extension
4	Bone reformat	coronal	0.5-1 mm	Sellar floor, sphenoid septations for surgery

Key points

MRI is the gold standard for pituitary; CT is reserved for MRI-incompatible patients, bony/calcific assessment, or surgical planning
Thin coronal reformats are the workhorse plane; microadenomas are subtle (look for stalk deviation, focal hypoenhancement, gland convexity)
CT excels at sellar floor erosion, sphenoid sinus septations, and calcification (craniopharyngioma, meningioma)
Keep lens/orbit dose ALARA

References

• ACR–ASNR–SPR Practice Parameter for the Performance of CT of the Brain
• ACR Appropriateness Criteria: Neuroendocrine Imaging
• Radiopaedia: Pituitary (CT) link
• RadioGraphics: Imaging of the Sella and Parasellar Region

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.