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<p>High-resolution pituitary MRI localises most pituitary neuroendocrine tumours (PitNETs), yet clinically important subgroups remain challenging: (i) very small functioning tumours, particularly corticotroph microadenomas, and (ii) post-operative remnants where scar, gland and tumour cannot be reliably separated. Functional imaging, specifically PET has matured into a problem-solving modality when conventional imaging is equivocal, provided it is used selectively and interpreted within a physiology-led framework. This review proposes an MRI-first, tiered imaging strategy and a pragmatic approach to tracer selection from the available armamentarium ([<sup>11</sup>C]methionine, [<sup>68</sup>&#xa0;Ga]SSTR ligands, [<sup>68</sup>&#xa0;Ga]PentixaFor, [<sup>18</sup>F]FET and [<sup>18</sup>F]FDG). We emphasise how to optimise PET acquisition and reporting, and how to integrate imaging with endocrine phenotype, treatment history and surgical/radiosurgical planning to maximise clinical impact while safeguarding pituitary function.</p>

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Functional pituitary adenoma imaging

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Linus Hesse,
  • Linus Haberbosch

摘要

High-resolution pituitary MRI localises most pituitary neuroendocrine tumours (PitNETs), yet clinically important subgroups remain challenging: (i) very small functioning tumours, particularly corticotroph microadenomas, and (ii) post-operative remnants where scar, gland and tumour cannot be reliably separated. Functional imaging, specifically PET has matured into a problem-solving modality when conventional imaging is equivocal, provided it is used selectively and interpreted within a physiology-led framework. This review proposes an MRI-first, tiered imaging strategy and a pragmatic approach to tracer selection from the available armamentarium ([11C]methionine, [68 Ga]SSTR ligands, [68 Ga]PentixaFor, [18F]FET and [18F]FDG). We emphasise how to optimise PET acquisition and reporting, and how to integrate imaging with endocrine phenotype, treatment history and surgical/radiosurgical planning to maximise clinical impact while safeguarding pituitary function.