Pituitary neuroendocrine tumors: imaging features, clinical relevance, and a proposal for standardized MRI reporting

Abstract

Pituitary neuroendocrine tumors (PitNETs) are a heterogeneous group of lesions redefined in the 2022 WHO classification, emphasizing their neuroendocrine nature and biological variability. Despite advances in imaging, radiological reporting of PitNETs remains inconsistent and lacks standardized descriptors. This review aims to summarize the main updates of the 2022 WHO classification and to propose a structured MRI-based reporting framework. A comprehensive literature review was conducted focusing on the 2022 WHO classification and radiological features of PitNETs. Imaging parameters were analyzed to identify reproducible descriptors relevant to tumor morphology, internal composition, enhancement characteristics, and invasion patterns. These parameters were organized into a categorical model analogous to the VASARI framework. The proposed model includes 19 standardized MRI descriptors designed to capture key imaging features of PitNETs. Each parameter can be scored categorically to promote consistent interpretation, facilitate multicenter data comparison, and support radiologic–pathologic correlation. The system provides a reproducible structure for reporting that integrates seamlessly with the diagnostic and prognostic context of the 2022 WHO classification. The proposed standardized reporting framework introduces 19 reproducible MRI descriptors that collectively address tumor localization, internal composition, enhancement characteristics, and invasion patterns. Beyond their descriptive value, each parameter carries potential clinical implications for tumor subtype identification, surgical approach planning, prediction of resectability, and assessment of prognosis. By providing a structured reporting system aligned with the 2022 WHO classification, this framework has the potential to enhance interobserver consistency, strengthen radiologic–pathologic correlation, and ultimately support more informed and individualized treatment decisions in patients with PitNETs. Prospective multicenter validation will be essential to establish its full clinical utility.