E-ISSN: 1019-5157
ISSN: 2651-5024
Case Report
Rare MRI Finding in Pituitary Apoplexy: Brush-Like Sign on T1-Weighted Imaging—a Report of Three Cases
Huijian Zhang✉ ,
Heng Zhang ,
Shousen Wang
Shousen Wang
Neurosurgery, The 900th Hospital
Accepted: 07/08/2026
Article in Press
Corresponding Author:
Huijian Zhang (huijiansky@163.com)
Abstract
Objective: To report three pituitary apoplexy (PA) cases with a distinctive “brush-like sign” on T1-weighted imaging and preliminarily explore its potential clinical implications with consideration of the study’s limitations.
Methods: Three patients with severe headache, hyponatremia, and hypopituitarism were diagnosed with PA via 3.0 T MRI and underwent transsphenoidal resection. The study was approved by the Institutional Review Board, and informed consent was obtained from all patients. Histopathological examination was performed on resected specimens.
Results: The brush-like sign (alternating linear hyperintense/hypointense signals on T1WI) was detected on symptom onset day (Case 1), 11 days post-onset (Case 2), and 5 days post-onset (Case 3). Intraoperatively, tumors were firm with hemorrhage and poor perfusion; pathology confirmed pituitary adenoma (2 GH-secreting, 1 nonfunctional) with infarction. Postoperatively, symptoms and electrolytes improved, but partial hypopituitarism persisted. Key clinical, imaging, and pathological findings of the three cases are summarized in a structured table.
Conclusion: The T1WI brush-like sign is a distinctive imaging feature that may be associated with concurrent hemorrhage and infarction in PA, and it may provide a potential reference clue for early clinical diagnosis. The diagnostic value and clinical significance of this sign need to be validated by large-sample prospective studies.
Methods: Three patients with severe headache, hyponatremia, and hypopituitarism were diagnosed with PA via 3.0 T MRI and underwent transsphenoidal resection. The study was approved by the Institutional Review Board, and informed consent was obtained from all patients. Histopathological examination was performed on resected specimens.
Results: The brush-like sign (alternating linear hyperintense/hypointense signals on T1WI) was detected on symptom onset day (Case 1), 11 days post-onset (Case 2), and 5 days post-onset (Case 3). Intraoperatively, tumors were firm with hemorrhage and poor perfusion; pathology confirmed pituitary adenoma (2 GH-secreting, 1 nonfunctional) with infarction. Postoperatively, symptoms and electrolytes improved, but partial hypopituitarism persisted. Key clinical, imaging, and pathological findings of the three cases are summarized in a structured table.
Conclusion: The T1WI brush-like sign is a distinctive imaging feature that may be associated with concurrent hemorrhage and infarction in PA, and it may provide a potential reference clue for early clinical diagnosis. The diagnostic value and clinical significance of this sign need to be validated by large-sample prospective studies.
Keywords
Pituitary apoplexy
Hemorrhage
Infarction
Magnetic resonance imaging
Brush-like sign