Are you looking to improve your pituitary MRI skills?
The pituitary MRI protocol is essential for evaluating hormonal disorders, detecting tumors, and assessing structural abnormalities in the pituitary gland.
This step-by-step guide is for MRI students and technologists who wish to improve their professional skills and master the pituitary MRI protocol.
What you will learn:
Key factors in pituitary MRIs, including trade-offs.
Patient and scanner setup tips.
Best pulse sequences and planning techniques.
Ways to avoid common artifacts.
Qualities of great pituitary images.
Key Takeaways
Because pituitary MRIs require high detail, it's recommended to prioritize resolution.
The pituitary gland is tiny and complex, so we need high-resolution images to detect subtle abnormalities. Therefore, we typically 1) prioritize resolution, 2) maintain good SNR for clarity, and 3) optimize scan time as needed.
Use a small field-of-view (FOV).
Because the pituitary gland is so tiny, using a small FOV helps us improve resolution, detect subtle lesions, and minimize interference from surrounding tissues.
Use dynamic contrast-enhanced sequences for detailed assessment.
Dynamic contrast-enhanced MRI captures the pituitary gland's enhancement patterns over time. This helps us detect microadenomas and other subtle lesions.
Avoid these 6 common pituitary artifacts.
Artifacts
Solution – How to Avoid It
Motion artifacts
Use saturation bands and instruct the patient to remain still. Consider shorter sequences to minimize motion.
Chemical shift artifacts
Increase receiver bandwidth and ensure optimal fat suppression techniques.
Wrap-around artifacts
Enable anti-aliasing or fold-over suppression to avoid overlay of anatomy outside the field of view.
Cross-talk artifacts
Use non-contiguous slices or increase slice gap to avoid slice overlap.
Flow artifacts
Adjust phase direction parallel to cerebrospinal fluid (CSF) flow and apply flow compensation techniques.
Susceptibility artifacts
Reduce echo time (TE) and apply finer resolution or higher bandwidth to limit signal distortion.
Intro to Pituitary MRIs
The pituitary gland is a small but powerful gland at the base of your brain. It regulates hormones that control growth, metabolism, and reproduction. Despite its size, it plays a key role in maintaining the body’s balance.
Given its importance, the pituitary is often evaluated in MRI to detect tumors, hormonal imbalances, and structural abnormalities, making it a critical area of study in brain imaging.
In MRI, we always face a trade-off between 3 key metrics:
Scan Time: How fast a pulse sequence can be completed.
Resolution: How much detail the image can display.
SNR: How clear the image is, i.e. how much signal relative to noise.
Improving one of these metric reduces the performance of the others. To decide what trade-offs to make, we must consider the needs of each clinical situation.
For pituitary MRIs: This is a tiny and complex organ. And while it’s highly requested, it’s less common than routine scans like brain, spine, and knee.
Therefore, we typically 1) prioritize resolution, 2) maintain good SNR for clarity, and 3) optimize scan time as needed for pituitary MRIs.
High-resolution images are critical to see this tiny structure clearly and detect subtle abnormalities. However, we must still ensure a good SNR and adequate scan time too.
Pituitary Health Conditions – and the MRI Sequences That Detect Them
The pituitary gland MRI study can help us diagnose a wide range of health conditions. The table below lists some of the most common conditions — and what pulse sequences that detect them:
Highlights water-rich structures, making it ideal for detecting cystic lesions and characterizing fluid-filled spaces.
T2 provides clear contrast between cystic components and surrounding soft tissues, helping differentiate lesions.
Offers excellent tissue contrast for fat and structural detail, ideal for identifying solid tumors, hemorrhagic changes, or fat-containing lesions.
Provides a clear distinction between normal pituitary tissue and abnormalities.
Enhances visualization of vascular structures and lesion margins.
This helps detect tumor enhancement patterns, meningioma infiltration, and vascular abnormalities.
How to Perform a Pituitary MRI
This step-by-step guide below will show you how to set up and perform a pituitary MRI protocol in practice.
We will perform the protocol in 3 parts:
Set up the Patient and MRI Scanner
Plan and Acquire the Protocol Sequences
Review the Images
Part 1: Set up the Patient and MRI Scanner
1. Position the Patient and the Coils
Lay the patient head-first and supine (on their back).
Make sure the laser is centered on the glabella (the spot between the eyebrows) to align the pituitary gland perfectly with the scanner’s isocenter.
Use a high-quality coil optimized for the sella turcica and surrounding structures. This setup gives us strong signal coverage for imaging the optic chiasm, infundibulum, and cavernous sinuses.
Once the patient is in place, review your scanner’s hardware settings.
We recommend using the following settings:
Scanner Setting
Recommended Value
Why This Value
Magnetic field strength
1.5 T
Enables high Signal-to-Noise Ratio, which gives superior image quality.
Maximum gradient strength
45 mT/m
Enables faster acquisitions while preserving high image quality.
This hardware setup is widely used in clinical practice. It balances acquisition time, image quality, and patient comfort.
3. Capture the Initial Localizer Images
Before we can perform any MRI protocol, we must always capture initial localizer images of the patient. These images act as a guide for planning the detailed scans we will perform next.
We should always capture localizers in three planes:
Axial
Sagittal
Coronal
Once acquired, upload the initial localizer images into the three viewports.
Then, scroll through each of the image stacks to locate a central slice that clearly shows the anatomy of the pituitary gland.
✅ Correct Setup of Localizer Images for Pituitary MRI:
Part 2: Plan and Acquire the Protocol Sequences
When all preparations are ready, we can start planning and acquiring the protocol sequences.
Let’s go through the pulse sequences that a standard pituitary MRI protocol includes, why we perform them, and how to set them up.
The 6 Sequences of a Standard Pituitary MRI
Axial T2 FLAIR
Sagittal T1 TSE
Coronal T1 TSE
Coronal T2 TSE (Optional)
Post-contrast Sagittal T1 TSE
Post-contrast Coronal T1 TSE
We use Turbo Spin Echo and FLAIR sequences to highlight small structures, which makes them ideal for the pituitary gland, optic chiasm, and cavernous sinuses. These sequences and contrasts help detect adenomas, inflammation, or compression effects.
Post-contrast T1 sequences enhances visualization of lesions and the gland's vascular features, which ensures detailed and diagnostic imaging.
The ideal time delay for dynamic post-contrast sequences is typically 30-60 seconds after injection to capture microadenomas.
In the sections below, we go through how to plan and set up each sequence.
1. Axial T2 FLAIR
✅ Correct Planning:
Planning Instructions:
Use a full field-of-view (FOV) to cover the entire brain.
Align slices as follows:
Sagittal Localizer: Middle slice should be parallel to the AC–PC line (Anterior Commissure – Posterior Commissure).
Coronal Localizer: Rotate the FOV slightly to ensure it’s perpendicular to the mid-sagittal line.
Expand slices to cover the brain from the vertex to the foramen magnum.
Minimize slice gap and slice thickness for finer slices while maintaining reasonable scan time.
Parameters for Axial T2 FLAIR:
Because we are imaging the entire brain in this scan — rather than the pituitary specifically — we don’t need as high resolution, and can instead prioritize scan time slightly more.
Parameter
Recommended Values
Why These Values
Echo Time (TE)
130–150 ms
Longer TE is required for T2 contrast.
Repetition Time (TR)
5,000–6,000 ms
Longer TR is required for T2 contrast.
Inversion Time (TI)
1,800–2,500 ms
High enough TI to match the null point of cerebrospinal fluid (CSF) and suppress its signal in 1.5 T. The goal of a FLAIR is to nullify CSF signal.
Field-of-View (FOV)
200 x 230 mm
Large enough to cover the entire brain.
Matrix
384 x 288
Medium matrix size to get sufficient resolution and detail, while maintaining high SNR and short scan time.
Foldover Direction (Phase)
Anterior-to-Posterior (AP)
To minimize aliasing artifacts from lateral skull and external structures, and avoid signal overlap or interference from regions outside FOV.
Number of Slices
25–30
Enough slices to cover the entire brain, from the vertex to the foramen magnum.
Slice Thickness
5 mm
Medium thickness to get good resolution, without sacrificing scan time or SNR.
Slice Gap
1 mm
20% of slice thickness to avoid cross-talk artifacts.
Bandwidth
100,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
Turbo Factor / ETL
20
High turbo to shorten scan time. Adjust to balance contrast and sharpness based on echo time and weighting.
NEX / Averages
1-2
To get enough SNR, while keeping scan time short.
Fold-over Suppression
Optional
If needed to avoid aliasing or wrap-around artifacts.
2. Sagittal T1 TSE
✅ Correct Planning:
Planning Instructions:
Use a small field-of-view (FOV) to focus on the pituitary gland and surrounding structures.
Align slices as follows:
Axial Localizer: Position the middle slice through the center of the pituitary gland.
Coronal Localizer: Center slices directly on the pituitary gland and ensure alignment parallel to the sella turcica.
Reduce slice thickness and slice gap for high-resolution imaging.
Parameters for Sagittal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Shorter TE is required for T1 contrast.
Repetition Time (TR)
500–600 ms
Shorter TR is required for T1 contrast.
Field-of-View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
High matrix for this FOV to get a small voxel size. This increases resolution and detail.
Foldover Direction (Phase)
Foot-to-Head (FH) / Superior-to-Inferior
To align with the pituitary’s orientation. This minimizes aliasing and avoids artifact overlap.
Number of Slices
8-10
Enough slices to cover the entire pituitary, until we reach the optical nerves.
Slice Thickness
3 mm
Thinner slices required to preserve detailed information with our smaller voxel size.
Slice Gap
0.6 mm
20% of slice thickness to minimize cross-talk between adjacent slices, while maintaining good anatomical continuity.
Bandwidth
125,000–128,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
NEX / Averages
3-5
To get high enough SNR, without making scan time too long.
Turbo Factor / ETL
3
Low turbo to maintain high resolution and SNR, and balanced T1/T2 contrast.
Fold-over Suppression
Yes
To avoid aliasing or wrap-around artifacts. (Higher risk for this at small FOVs).
3. Coronal T1 TSE
✅ Correct Planning:
Planning Instructions:
Use a small field-of-view (FOV) to focus on the pituitary gland and surrounding structures.
Align slices as follows:
Axial Localizer: Center slices over the pituitary gland and extend laterally to include the optic nerves.
Sagittal Localizer: Ensure slices are perpendicular to the mid-sagittal line.
Coronal Localizer: Position slices exactly on the pituitary gland.
Minimize slice gap and slice thickness for precise imaging of small structures.
Parameters for Coronal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Shorter TE is required for T1 contrast.
Repetition Time (TR)
500–600 ms
Shorter TR is required for T1 contrast.
Field-of-View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
High matrix for this FOV to get a small voxel size. This increases resolution and detail.
Foldover Direction (Phase)
Right-to-Left (RL)
To minimize aliasing artifacts from superior and inferior structures and avoid motion artifacts from swallowing or breathing.
Number of Slices
8-10
Enough slices to cover the entire pituitary, until we reach the optical nerves.
Slice Thickness
3 mm
Thinner slices required to preserve detailed information with our smaller voxel size.
Slice Gap
0.6 mm
20% of slice thickness to minimize cross-talk between adjacent slices, while maintaining good anatomical continuity.
Bandwidth
125,000–128,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
NEX / Averages
3-5
To get high enough SNR, without making scan time too long.
Turbo Factor / ETL
3
Low turbo to maintain high resolution and SNR, and balanced T1/T2 contrast.
Fold-over Suppression
Yes
To avoid aliasing or wrap-around artifacts. (Higher risk for this at small FOVs).
4. Coronal T2 TSE (Optional)
If the outcome of the scan is already clear rom the previous sequences, you can skip running this sequence.
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the previous coronal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between T2 and T1 images.
Parameters for Coronal T2 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Shorter TE is required for T1 contrast.
Repetition Time (TR)
500–600 ms
Shorter TR is required for T1 contrast.
Field-of-View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
High matrix for this FOV to get a small voxel size. This increases resolution and detail.
Foldover Direction (Phase)
Right-to-Left (RL)
To minimize aliasing artifacts from superior and inferior structures and avoid motion artifacts from swallowing or breathing.
Number of Slices
8–10
Enough slices to cover the entire pituitary, until we reach the optical nerves.
Slice Thickness
3 mm
Thinner slices required to preserve detailed information with our smaller voxel size.
Slice Gap
0.6 mm
20% of slice thickness to minimize cross-talk between adjacent slices, while maintaining good anatomical continuity.
Bandwidth
125,000–128,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
NEX / Averages
3–5
To get high enough SNR, without making scan time too long.
Turbo Factor / ETL
3
Low turbo to maintain high resolution and SNR, and balanced T1/T2 contrast.
Fold-over Suppression
Yes
To avoid aliasing or wrap-around artifacts. (Higher risk for this at small FOVs).
5. Dynamic Post-Contrast Sagittal T1 TSE
The ideal time delay for dynamic post-contrast sequences is typically 30-60 seconds after injection to capture microadenomas.
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the pre-contrat sagittal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between pre- and post-contrast images.
Parameters for Post-Contrast Sagittal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
80–100 ms
Longer TE is required for T2 contrast.
Repetition Time (TR)
4,000–5,000 ms
Longer TR is required for T2 contrast.
Field-of-View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
High matrix for this FOV to get a small voxel size. This increases resolution and detail.
Foldover Direction (Phase)
Right-to-Left (RL)
To minimize aliasing artifacts from superior and inferior structures and avoid motion artifacts from swallowing or breathing.
Number of Slices
8–10
Enough slices to cover the entire pituitary, until we reach the optical nerves.
Slice Thickness
3 mm
Thinner slices required to preserve detailed information with our smaller voxel size.
Slice Gap
0.6 mm
20% of slice thickness to minimize cross-talk between adjacent slices, while maintaining good anatomical continuity.
Bandwidth
125,000–128,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
NEX / Averages
3–5
To get high enough SNR, without making scan time too long.
Turbo Factor / ETL
3
Low turbo to maintain high resolution and SNR, and balanced T1/T2 contrast.
Fold-over Suppression
Yes
To avoid aliasing or wrap-around artifacts. (Higher risk for this at small FOVs).
6. Dynamic Post-Contrast Coronal T1 TSE
✅ Correct Planning:
Planning Instructions:
Copy the slice geometry and planning from the pre-contrast coronal T1 sequence.
Maintain identical slice angulation, coverage, and positioning to ensure precise comparison between pre- and post-contrast images.
Parameters for Post-Contrast Coronal T1 TSE:
Parameter
Recommended Values
Why These Values
Echo Time (TE)
8–12 ms
Shorter TE is required for T1 contrast.
Repetition Time (TR)
500–600 ms
Shorter TR is required for T1 contrast.
Field-of-View (FOV)
160 x 160 mm
Small FOV to focus on the pituitary region.
Matrix
256 x 256
High matrix for this FOV to get a small voxel size. This increases resolution and detail.
Foldover Direction (Phase)
Foot-to-Head (FH) / Superior-to-Inferior
To align with the pituitary’s orientation. This minimizes aliasing and avoids artifact overlap.
Number of Slices
8–10
Enough slices to cover the entire pituitary, until we reach the optical nerves.
Slice Thickness
3 mm
Thinner slices required to preserve detailed information with our smaller voxel size.
Slice Gap
0.6 mm
20% of slice thickness to minimize cross-talk between adjacent slices, while maintaining good anatomical continuity.
Bandwidth
125,000–128,000 Hz
High bandwidth to avoid chemical shift artifacts. Increase if needed.
NEX / Averages
3–5
To get high enough SNR, without making scan time too long.
Turbo Factor / ETL
3
Low turbo to maintain high resolution and SNR, and balanced T1/T2 contrast.
Fold-over Suppression
Yes
To avoid aliasing or wrap-around artifacts. (Higher risk for this at small FOVs).
How to Avoid Artifacts When Planning the Sequences
The table below lists the 6 common pituitary gland artifacts, and what techniques you can use to avoid them:
Artifacts
Solution – How to Avoid It
Motion artifacts
Use saturation bands and instruct the patient to remain still. Consider shorter sequences to minimize motion.
Chemical shift artifacts
Increase receiver bandwidth and ensure optimal fat suppression techniques.
Wrap-around artifacts
Enable anti-aliasing or fold-over suppression to avoid overlay of anatomy outside the field of view.
Cross-talk artifacts
Use non-contiguous slices or increase slice gap to avoid slice overlap.
Flow artifacts
Adjust phase direction parallel to cerebrospinal fluid (CSF) flow and apply flow compensation techniques.
Susceptibility artifacts
Reduce echo time (TE) and apply finer resolution or higher bandwidth to limit signal distortion.
How to Prepare and Administer the Contrast Injection
Before you perform dynamic post-contrast T1 sequences, it’s crucial to prepare and administer the contrast injection properly to ensure optimal imaging quality and patient safety.
Follow these steps:
Plan Your Post-Contrast Sequences Before Administering the Contrast:
Before injecting the contrast agent, ensure that your sagittal and coronal T1 sequences are already planned and named as post-contrast acquisitions. This step ensures that sequences are ready to run immediately after the injection.
Enable Fat Saturation:
Make sure to activate spectral fat saturation in the sequence settings when planning them. Fat saturation reduces the bright signal from fat in post-contrast T1 images, which can otherwise obscure inflammation or vascular enhancement.
Adjust the inversion time (if needed) to match fat signal characteristics specific to your clinic’s MRI system. A typical inversion time for fat is 180 ms, but this can vary.
Pause the Workflow to Prepare the Contrast Injection:
Use the scanner’s pause function to temporarily stop the imaging workflow. This provides sufficient time to prepare and administer the contrast injection without rushing. Contrast can be administered either:
Manually: Using a syringe, or
Automatically: Using an infusion pump, based on your clinic’s setup and protocols.
Prepare the Contrast Agent:
Check the patient’s weight to calculate the appropriate dosage. For example, an 80 kg patient typically requires 10–16 mL of contrast agent.
Set the contrast agent concentration and injection volume in the scanner’s settings.
Administer the Contrast and Resume Imaging:
After injecting the contrast:
Place the patient back into the scanner bore, close the door, and return to the console.
Monitor the timing for sequence acquisition. For dynamic imaging, sequences may need to begin at specific intervals (e.g., 12 minutes post-injection) to capture contrast wash-in and wash-out effectively.
Monitor the Patient During Imaging:
While acquiring post-contrast sequences, regularly check the patient for signs of discomfort, allergic reactions, or irregular breathing patterns.
Part 3: Review the Images
Finally, we will review the images to ensure all the anatomical information we need is clear.
These key structures must be clearly visible in a pituitary MRI:
Pituitary gland and stalk
Infundibulum
Cavernous sinuses and internal carotid arteries
Optic chiasm
Hypothalamus
Sphenoid sinus
Clivus
Below, we will go through all the different image contrasts and explain their specific role in imaging the pituitary gland.
T2 FLAIR – Focused Fluid Imaging without CSF Interference
T2 FLAIR imaging makes fluid appear bright while suppressing cerebrospinal fluid (CSF) signals. This contrast is ideal for detecting fluid-related abnormalities without interference from surrounding CSF.
In the pituitary region, T2 FLAIR is especially useful for identifying edema, cysts, or inflammatory changes in the gland or adjacent structures. It also helps visualize mass effects on the optic chiasm and asymmetry in the cavernous sinuses.
✅ Axial T2 FLAIR of Pituitary – Correct Image:
An Axial T2 FLAIR provides cross-sectional details of the gland, internal carotid arteries, and cavernous sinuses. This view is best for assessing asymmetry and detecting fluid-related pathology localized in the transverse plane.
T1 TSE – Highlight Fat-Containing Tissues and Structural Abnormalities
T1-weighted imaging makes fat appear bright and fluid dark. This contrast is ideal for fat-rich tissues and abnormalities. Because fat is solid and well-defined, anatomical structures become clearer in T1 – as we can easier see where different solid tissues, like muscle and fat, meet.
In the pituitary region, T1 TSE is crucial for delineating the gland, stalk, and vasculature. It helps identify gland asymmetry, stalk thickening, and parasellar abnormalities.
✅ Sagittal T1 TSE of Pituitary – Correct Image:
Sagittal T1 TSE provides a midline view of the pituitary gland, stalk, and sphenoid sinus. This view is ideal for assessing the gland’s vertical relationships with the optic chiasm and hypothalamus.
✅ Coronal T1 TSE of Pituitary – Correct Image:
Coronal T1 TSE captures the lateral extent of the pituitary gland and its relationship to the cavernous sinuses. This view is best for identifying gland asymmetry or parasellar invasion.
T2 TSE – Highlights Fluid-Related Tissues and Conditions
T2-weighted imaging makes fluid appear bright and fat dark. This contrast is ideal to detect tissues and abnormalities associated with high water content.
In the pituitary region, T2 TSE excels at detecting cystic changes, fluid accumulation, or inflammation. It also highlights structural relationships between the gland, sphenoid sinus, and clivus.
✅ Coronal T2 TSE of Pituitary – Correct Image:
Coronal T2 TSE offers a frontal view of the pituitary gland, optic chiasm, and cavernous sinuses. This view is ideal for evaluating gland symmetry, fluid-related pathologies, and stalk abnormalities.
Dynamic Post-Contrast T1 – Clearest View of Structural and Vascular Abnormalities
Dynamic post-contrast T1 imaging is the gold standard for detecting enhancing lesions and abnormal blood flow. It highlights areas with contrast uptake, such as tumors, inflammation, or vascular changes, with particular detail.
In the pituitary region, post-contrast T1 highlights enhancement patterns in the gland and stalk, helping differentiate normal tissue from tumors or cysts. It also assesses vascular structures and potential cavernous sinus invasion.
✅ Post-Contrast Sagittal T1 TSE of Pituitary – Correct Image:
Sagittal post-contrast T1 TSE enhances the visualization of the gland, stalk, and hypothalamus. This view is ideal for detecting subtle lesions or enhancement abnormalities along the vertical axis.
✅ Post-Contrast Coronal T1 TSE of Pituitary – Correct Image:
Coronal post-contrast T1 TSE provides detailed imaging of the gland’s lateral structures, including the cavernous sinuses and internal carotid arteries. This view is best for detecting asymmetric enhancement and parasellar masses.
Final Checks:
Ensure the imaging plane fully covers the sella turcica and parasellar region.
Verify that contrast and resolution are sufficient to detect microadenomas and assess the gland’s symmetry.
In the T2 FLAIR sequences, confirm that CSF signals are properly suppressed.
In the dynamic post-contrast sequences, confirm that the desired areas are properly enhanced.
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