X-ray of the Turkish saddle: what they do, what they show

Today in medicine, many methods of diagnosing diseases and injuries are used. One of the long-standing proven methods for many years has been radiography, which provides valuable information to doctors of various specialties. Often, an x-ray of the Turkish saddle is also prescribed - a deep bone formation in the human sphenoid bone, in which the pituitary gland is located - the endocrine gland. The study is prescribed for various pathological disorders of a neuroendocrine, neurological or neuroophthalmic nature.[1]

Indications for the procedure

The Turkish saddle is a bone element, so its condition can be traced with the help of an X-ray examination. The results of such diagnostics are often needed in neuropathological, ophthalmic and gynecological practice.[2]

The pituitary bone bed in the form of a Turkish saddle is examined in such situations:

• for the diagnosis of neuroendocrine disorders, for the detection of tumor processes affecting the hypothalamic-pituitary mechanism;
• with an increased level of the hormone prolactin in the blood;
• with increased intracranial pressure;
• with abnormal development of the skull;
• with growth deficiency or its pathological acceleration;
• with craniocerebral injuries;
• with disorders of the monthly cycle in women and girls;
• with visual disorders of unclear etiology;
• with infertility (after hormonal studies);
• with regular headaches.

Why do an x-ray of the Turkish saddle?

X-ray diagnostics helps to identify tumor processes in the pituitary gland (for example, prolactinoma ), osteoporosis, changes in the vascular network due to increased intracranial pressure. The picture shows the configuration, outlines and dimensions of the studied bone element. If its size is increased, the entrance to it is expanded, there is a bypass, then we can assume the development of a tumor in the pituitary gland and correctly prescribe the subsequent diagnosis.

An x-ray of the Turkish saddle is prescribed by a doctor to confirm or refute various pathologies. Most often, patients are referred for examination if a pituitary tumor is suspected.

X-ray of the Turkish saddle in gynecology

X-ray analysis of the state of the Turkish saddle is a relatively common diagnostic procedure, including in gynecology. In order for a gynecologist to prescribe this type of study, there are a number of indications:

• severe menstrual dysfunction of unknown origin;
• inability to conceive, infertility;
• increased amount of prolactin in the blood (prolactinemia).

Pituitary disorders in female patients often reveal themselves as systematic poor health, deterioration of skin turgor, and early appearance of wrinkles. Hairline suffers: brittleness and hair loss are observed. Digestive disorders are often disturbed, appetite decreases, constipation is noted. To understand the causes of such manifestations, the doctor may need additional diagnostics, including a gynecological examination with smear cytology, laboratory hormonal studies, pelvic ultrasound, and sometimes magnetic resonance imaging. An integrated approach to diagnosis allows you to determine the cause of the disorder and prescribe an effective therapeutic regimen.

Preparation

There is no need for any special preparation of the patient for the X-ray of the Turkish saddle.

Immediately before the diagnostic procedure, the patient must remove all metallized accessories and jewelry from the head and neck area - that is, earrings, glasses, chains, hairpins, etc. If there are prostheses - for example, a cochlear implant - then the doctor should be warned about this in advance. Removable dentures and hearing aids should be removed. It is advisable to unfasten the top buttons of clothing.

There are no restrictions in the use of food and drinks, taking medications.

Technique of the turkish saddle x-ray

An x-ray of the Turkish saddle can be survey or sighting. With a plain radiograph, the doctor examines the condition of the cranium in general. Aiming radiography involves a more thorough study of individual parts of the skull - in particular, the Turkish saddle.

During the exposure, the patient can sit, stand, or lie on his back or stomach, depending on the desired image projection. The radiologist usually takes 1-2 pictures. Most common position:

• the patient lies on his back, arms are along the body, the chin is lowered;
• the head is rotated at an angle of 45 degrees to the side being examined (you can put a soft roller for convenience);
• the head is fixed with an elastic bandage;
• adjacent organs are covered with protective lead plates.

During radiographic fixation, the patient should not breathe or swallow.

Another installation method:

• the patient lies on his stomach or sits, his head is pressed sideways to the surface of the table;
• the upper limbs are located along the body, the forearms rest on the surface of the table;
• the shoulder and chin adjacent to the table should be slightly raised with a wedge-shaped roller so that the median sagittal cranial plane is parallel to the plane of the x-ray film;
• the head is fixed.

At the end of the diagnostic procedure, the patient is sent home or to the doctor, depending on the situation.

X-ray pathology of the Turkish saddle

On the radiograph of the Turkish saddle, pituitary tumors can be detected. Signs of such a pathological process are:

• local or total areas of osteoporosis, characterized by bone thinning;
• atrophic changes in the walls of the bone;
• unevenness of the inner outline of the saddle;
• thinning of the wedge-shaped processes;
• the emergence of a "double loop".

These signs indicate the presence of a small pituitary tumor. At the same time, the doctor can pay attention to such pathological manifestations as thickening of the occipital and frontal bones, calcification of the hard shell of the brain and the formation of calcifications in the brain tissue.

A large Turkish saddle on an x-ray may indicate pathological conditions such as pituitary adenoma, cyst, aneurysm, primary hypothyroidism, increased intracranial pressure, etc. If it is necessary to confirm or clarify the diagnosis, the doctor may additionally prescribe computed or magnetic resonance imaging. Modern tomography equipment helps to detect even very small neoplasms.

In some patients, x-rays reveal the so-called "empty Turkish saddle." In the image, the pathology is located under the diaphragm of the bone formation and is manifested by the following signs:

• bottom symmetry in the frontal plane;
• vertical increase in education, isolation of the configuration;
• bottom bypass on the sagittal image.

Symptoms of such changes may be absent, therefore, when an “empty Turkish saddle” is found, they often resort only to dynamic observation of patients. Pituitary dysfunction is more common in women.

Contraindications to the procedure

Any person in everyday life receives a certain dose of radiation from natural radiating sources. This dose is approximately equal to 1 μSv, since it depends on many factors - in particular, on the area of residence, on working conditions, etc.

In situations where it is necessary to make a reliable diagnosis in order to prescribe effective subsequent treatment, the potential harm from radiation may not be taken into account, since the benefit of diagnosis becomes much more important. Although some contraindications still exist and are considered relative: if the benefit outweighs the potential harm, then a diagnostic study is still carried out. Such contraindications can be:

• decompensated diseases of the cardiovascular system;
• pregnancy (especially the first trimester);
• extreme degree of exhaustion of the patient;
• early childhood.

The decision on the possibility and necessity of an x-ray of the Turkish saddle is made by the attending physician.

Normal performance

The resulting x-ray image of the Turkish saddle - the lateral craniogram - is carefully studied by the doctor, who evaluates the contours of the bone formation, its size and configuration, and the state of the element as a whole.

The following diagnostic indicators are considered normal:

• the norm of the sagittal indicator is 9-15 mm;
• the norm of the vertical indicator is 7-12 mm;
• the value of the ratio of the height and length of the saddle, the so-called saddle index - in children more than 1, in older patients less than 1.

Complications after the procedure

X-ray is a very common diagnostic technique for both adults and children. Although children are prescribed a study only if there are vital indications. If the risk of developing complications from the pathological process exceeds the possible harm from the irradiating dose of X-ray, doctors perform diagnostics, giving preference to modern X-ray technology.

In general, the destructive effect of X-ray radiation largely depends on the duration and degree of radiation exposure, on the number of times the images are taken. If the exposure is prolonged, then an increased risk of developing certain complications is not excluded:

• blood diseases;
• cataracts, visual impairment;
• oncological processes, benign tumors;
• metabolic disorders;
• premature aging;
• violations in the work of the reproductive apparatus.

Doctors insist: a single diagnosis within the recommended framework cannot lead to consequences of this kind. In addition, an important role is played by the power of the X-ray machine, its type, regime equipment. It has been proven that modern digital devices do not lead to any negative effects even if they are used repeatedly.

Consequences after the procedure

X-ray of the Turkish saddle, like other types of X-ray examination, is associated with a fairly high radiation exposure. However, modern diagnostic devices, the operation of which is based on digital technologies, have a much smaller amount of ionizing radiation, unlike outdated equipment. Therefore, we can safely say that x-rays have become a fairly safe procedure today. Although it is also not worth abusing the study.

Doctors insist that this type of diagnosis does not carry any particular danger. The moment of the x-ray and the exit of the rays from the emitter lasts only a fraction of a second. In this case, non-aggressive, filtered radiation comes out.

To reduce the likelihood of developing adverse effects, an X-ray of the Turkish saddle is not recommended for pregnant patients, young children without good evidence.

Care after the procedure

No special patient care is required after a sella turcica x-ray. If a person wants to protect himself from the additional influence of radiation exposure, then it is better to take care of this in advance. It is desirable that the following foods predominate in the diet:

• nuts (walnuts, almonds);
• oatmeal, beans, lentils;
• apples, pears;
• pumpkin, zucchini;
• seaweed, seafood.

After receiving a particular dose of radiation, you should eat more fiber, which helps to remove radioactive decay products from the body.

In addition, you need:

• drink clean water, up to 2-3 liters per day for an adult;
• eat more vegetables, herbs, berries and fruits;
• add dairy products to the diet, especially cottage cheese and sour cream.

In addition to water, you can drink a decoction of dried fruits, green tea, fresh juices (only natural, own extraction). You can drink some dry wine (about 50 ml).

It is necessary to walk a lot in the fresh air, lead an active lifestyle, and then the X-ray of the Turkish saddle will not leave any adverse effects in the body.