MRI characteristics provide valuable insights into prolactinoma response to bromocriptine therapy. Tumor size, cystic components, and invasion patterns play critical roles in predicting treatment success. Sphenoid sinus and optic chiasm invasions were strong predictors of favorable outcomes, while cavernous sinus invasion was associated with poor responses. Cystic changes post-treatment were impacted to prolactin level, though hemorrhagic changes was statistic significant in post treatment changes, but were not predictive of hormonal response. These findings can aid clinicians in optimizing treatment strategies for prolactinoma patients.

These findings highlight the importance of considering both tumor morphology and specific invasion patterns in treatment planning. MRI characteristics, particularly cystic and hemorrhagic changes, along with invasion patterns, offer valuable predictive information that can guide clinicians in assessing prolactinoma prognosis and tailoring patient-specific treatment strategies. Further research is warranted to explore the underlying mechanisms driving these MRI changes and their hormonal impacts.

This study's strengths include comprehensive MRI analysis and the use of advanced statistical methods, though limitations such as a single-center design and a relatively small sample size should be considered. Future studies with larger cohorts and long-term follow-up are recommended to validate and expand upon these findings.