Contrast-free MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders: A Practical Approach.

Objectives Most of the pituitary MRI examinations in children with growth or puberty disorders (GPD) might not require gadolinium-based contrast agent (GBCA) administration. Methods Retrospective re-analysis of contrast-enhanced 567 pituitary MRIs of children with GPD. Two sets of sequences were created from each MRI examination: Set1 - common sequences without contrast administration and Set2 - common pre- and post-contrast sequences. The differences in the visibility of pituitary lesions between sets were statistically analyzed. Results The overall frequency of Rathke's cleft cysts was 11.6%, ectopic posterior pituitary 3.5% and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases, while lesions diagnosed only after contrast injection accounted for 0.18% of all patients. Statistical analysis showed the advantage of antero-posterior (AP) pituitary dimension over 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, 1.35-3.71, p-value=0.002 and in ROC analysis: AUC:72.9% with cut-off value 7.5 mm, with sensitivity/specificity rates: 69.2%/73.5%. Conclusions In most cases, the use of GBCA in pituitary MRI in children with GPD is unnecessary. The additional advantages of GBCA omission include: shortening the time of MRI examination and of general anesthesia.