|
1
|
Korbecki A, Wagel J, Zacharzewska-Gondek A, Gewald M, Korbecka J, Sobański M, Kacała A, Zdanowicz-Ratajczyk A, Kaczorowski M, Hałoń A, Trybek G, Kapetanakis S, Bladowska J. Role of diffusion-weighted imaging in the diagnosis of pituitary region tumors. Neuroradiology 2025; 67:437-447. [PMID: 39340651 PMCID: PMC11893710 DOI: 10.1007/s00234-024-03467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE This study aimed to assess the role of Diffusion-Weighted Imaging (DWI) in routine pituitary Magnetic Resonance Imaging (MRI) protocols for distinguishing sellar and parasellar tumors, addressing the lack of clear guidelines in contemporary literature. METHODS A retrospective analysis of 242 pituitary MRI scans with DWI sequences was conducted in a single-center study using a 1.5 T scanner and standard DWI sequence parameters. Measurements of both absolute and relative mean apparent diffusion coefficient (ADC) values, along with minimal ADC values within tumors, were performed. The adopted region of interest (ROI) based method used for these measurements was validated. RESULTS Invasive pituitary adenomas exhibited significantly lower min ADC and min rADC than meningiomas, with optimal cut-off points of 0.64 (sensitivity 73%, specificity 82%) and 0.78 (sensitivity 73%, specificity 89%), respectively. Post-hemorrhagic pituitary adenomas demonstrated lower ADC values than adamantinomatous craniopharyngiomas, with an AUC of 0.893 for min rADC = 1.07, and Rathke's Cleft Cysts with mucous content, AUC 0.8 for min rADC = 1.01. Specific differentiation with high sensitivity and specificity based on diffusion parameters was observed for these tumor groups. Cystic pituitary non-functional adenomas obtained significantly lower ADC values compared to the adamantinomatous type of craniopharyngiomas and serous Rathke's Cleft Cysts (AUC up to 0.942). CONCLUSIONS The study concludes that integrating DWI into routine pituitary MRI protocols enhances diagnostic accuracy in distinguishing sellar and parasellar tumors. The short scan time of one minute makes DWI a valuable and precise tool, supporting its recommendation as a standard component of pituitary MRI examinations.
Collapse
Affiliation(s)
- Adrian Korbecki
- Department of General Radiology, Interventional Radiology and Neuroradiology, University Clinical Hospital, Borowska 213, 50-556, Wroclaw, Poland.
| | - Justyna Wagel
- Department of General Radiology, Interventional Radiology and Neuroradiology, University Clinical Hospital, Borowska 213, 50-556, Wroclaw, Poland
| | - Anna Zacharzewska-Gondek
- Department of General Radiology, Interventional Radiology and Neuroradiology, University Clinical Hospital, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Justyna Korbecka
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Sobański
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Arkadiusz Kacała
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Zdanowicz-Ratajczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Kaczorowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Maxillofacial Surgery Clinic, Wroclaw 4th Military Clinical Hospital, Wroclaw, Poland
| | - Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Joanna Bladowska
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Department of Radiology, Wroclaw 4th Military Clinical Hospital, Wroclaw, Poland
| |
Collapse
|
|
2
|
Baban MIA, Omer SN, AlZuhairy AKA, Mahmoud AA. The role of preoperative MRI in endoscopic transnasal transsphenoidal hypophysectomy of pituitary adenoma. Eur Arch Otorhinolaryngol 2024; 281:1961-1969. [PMID: 38319368 DOI: 10.1007/s00405-024-08472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The trans-sphenoidal approach, commonly used for removing pituitary adenomas, has become a widely accepted and successful method. In recent years, the endoscopic trans-sphenoidal technique has emerged as a minimally invasive surgical approach for pituitary adenoma removal. The majority of pituitary adenomas exhibit a soft consistency and can be successfully extracted with aspiration and curettage using the trans-sphenoidal approach. However, a subset of around 5-15% of these adenomas possess a solid and fibrous texture. The occurrence of firm and fibrous adenomas is relatively common; unfortunately, there are no reliable predictors to identify them preoperatively. OBJECTIVES The ability to forecast the reliability of magnetic resonance imaging (MRI) holds promise for improving prior preparation and impacts the extent of resection. DESIGN A cross-sectional analysis of the investigation of magnetic resonance imaging (MRI) in relation to cancer histology was performed on 68 patients who had endoscopic trans-nasal excision for nonfunctional adenomas. MATERIALS AND METHODS The determination of an intensity ratio was performed by employing quantitative estimates of MRI signal intensity obtained from both the adenoma and pons. During the surgical procedure, a series of sequential-graded procedures were used for the removal of tumours with varying consistencies. Softer tumours were addressed using the Suction technique (R1), while tumours of intermediate consistency were treated using curettes (R2). In order to evaluate the fibrotic content of firmer tumours, the utilization of Cavitron Ultrasound Surgical Aspirator (CUSA), and/or other micro-instruments (R3) was employed, with the histologic collagen fraction being quantified. In order to investigate and analyse the data, a statistical analysis was conducted. A predictive relationship between resection category and both intensity ratio, and collagen percentage was noted. The primary objective of this study was to determine the appropriate cutoff criteria for clinical utilization, as well as to investigate the association between intensity ratios and collagen percentage. RESULTS Tumors with ratios ≤ 1.6 on the T2-weighted image and collagen content > 5.3% required more meticulous and sharp dissection for resection. CONCLUSIONS The utilization of MRI analysis may offer some assistance, but not conclusive, in the prediction of tumour consistency.
Collapse
Affiliation(s)
- Muaid I Aziz Baban
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaymaniyah Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq.
- Unit of Skull Base Surgery, Shar Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq.
| | - Shkar N Omer
- Unit of Skull Base Surgery, Shar Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq
| | - Abeer K Abbas AlZuhairy
- Unit of Radiology, Department of Surgery, Branch of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaymaniyah Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq
| | - Abbas A Mahmoud
- Unit of Skull Base Surgery, Shar Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq
- Unit of Neurosurgery, Shar Teaching Hospital, Sulaymaniyah, 46001, Kurdistan Region, Iraq
| |
Collapse
|
|
3
|
Barbosa MA, Pereira EGR, da Mata Pereira PJ, Guasti AA, Andreiuolo F, Chimelli L, Kasuki L, Ventura N, Gadelha MR. Diffusion-weighted imaging does not seem to be a predictor of consistency in pituitary adenomas. Pituitary 2024; 27:187-196. [PMID: 38273189 DOI: 10.1007/s11102-023-01377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE To prospectively evaluate the usefulness of T1-weighted imaging (T1WI) and diffusion-weighted imaging (DWI) sequences in predicting the consistency of macroadenomas. In addition, to determine their values as prognostic factors of surgical outcomes. METHODS Patients with pituitary macroadenoma and surgical indication were included. All patients underwent pre-surgical magnetic resonance imaging (MRI) that included the sequences T1WI before and after contrast administration and DWI with the apparent diffusion coefficient (ADC) map. Post-surgical MRI was performed at least 3 months after surgery. The consistency of the macroadenomas was evaluated at surgery, and they were grouped into soft and intermediate/hard adenomas. Mean ADC values, signal on T1WI and the ratio of tumor ADC values to pons (ADCR) were compared with tumor consistency and grade of surgical resection. RESULTS A total of 80 patients were included. A softened consistency was found at surgery in 53 patients and hardened in 27 patients. The median ADC in the soft consistency group was 0.532 × 10-3 mm2/sec (0.306 - 1.096 × 10-3 mm2/sec), and in the intermediate/hard consistency group was 0.509 × 10-3 mm2/sec (0.308 - 0.818 × 10-3 mm2/sec). There was no significant difference between the median values of ADC, ADCR and signal on T1W between the soft and hard tumor groups, or between patients with and without tumor residue. CONCLUSION Our results did not show usefulness of the DWI and T1WI for assessing the consistency of pituitary macroadenomas, nor as a predictor of the degree of surgical resection.
Collapse
Affiliation(s)
- Monique Alvares Barbosa
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil.
- MRI Unit, Clínica de Diagnóstico por Imagem, DASA, Rio de Janeiro, Brazil.
- Serviço de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, Rua do Rezende, 156, Centro, Rio de Janeiro, 20231-092, Brazil.
| | | | - Paulo José da Mata Pereira
- Neurosurgery Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - André Accioly Guasti
- Neurosurgery Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Felipe Andreiuolo
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Nina Ventura
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroradiology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroradiology Unit, Samaritano Hospital, Grupo Fleury, Rio de Janeiro, Brazil
| | - Monica R Gadelha
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| |
Collapse
|
|
4
|
Ito S, Okuchi S, Fushimi Y, Otani S, Wicaksono KP, Sakata A, Miyake KK, Numamoto H, Nakajima S, Tagawa H, Tanji M, Sano N, Kondo H, Imai R, Saga T, Fujimoto K, Arakawa Y, Nakamoto Y. Thin-slice reverse encoding distortion correction DWI facilitates visualization of non-functioning pituitary neuroendocrine tumor (PitNET)/pituitary adenoma and surrounding normal structures. Eur Radiol Exp 2024; 8:28. [PMID: 38448783 PMCID: PMC10917724 DOI: 10.1186/s41747-024-00430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To evaluate the clinical usefulness of thin-slice echo-planar imaging (EPI)-based diffusion-weighted imaging (DWI) with an on-console distortion correction technique, termed reverse encoding distortion correction DWI (RDC-DWI), in patients with non-functioning pituitary neuroendocrine tumor (PitNET)/pituitary adenoma. METHODS Patients with non-functioning PitNET/pituitary adenoma who underwent 3-T RDC-DWI between December 2021 and September 2022 were retrospectively enrolled. Image quality was compared among RDC-DWI, DWI with correction for distortion induced by B0 inhomogeneity alone (B0-corrected-DWI), and original EPI-based DWI with anterior-posterior phase-encoding direction (AP-DWI). Susceptibility artifact, anatomical visualization of cranial nerves, overall tumor visualization, and visualization of cavernous sinus invasion were assessed qualitatively. Quantitative assessment of geometric distortion was performed by evaluation of anterior and posterior displacement between each DWI and the corresponding three-dimensional T2-weighted imaging. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient values were measured. RESULTS Sixty-four patients (age 70.8 ± 9.9 years [mean ± standard deviation]; 33 females) with non-functioning PitNET/pituitary adenoma were evaluated. In terms of susceptibility artifacts in the frontal and temporal lobes, visualization of left trigeminal nerve, overall tumor visualization, and anterior displacement, RDC-DWI performed the best and B0-corrected-DWI performed better than AP-DWI. The right oculomotor and right trigeminal nerves were better visualized by RDC-DWI than by B0-corrected-DWI and AP-DWI. Visualization of cavernous sinus invasion and posterior displacement were better by RDC-DWI and B0-corrected-DWI than by AP-DWI. SNR and CNR were the highest for RDC-DWI. CONCLUSIONS RDC-DWI achieved excellent image quality regarding susceptibility artifact, geometric distortion, and tumor visualization in patients with non-functioning PitNET/pituitary adenoma. RELEVANCE STATEMENT RDC-DWI facilitates excellent visualization of the pituitary region and surrounding normal structures, and its on-console distortion correction technique is convenient. RDC-DWI can clearly depict cavernous sinus invasion of PitNET/pituitary adenoma even without contrast medium. KEY POINTS • RDC-DWI is an EPI-based DWI technique with a novel on-console distortion correction technique. • RDC-DWI corrects distortion due to B0 field inhomogeneity and eddy current. • We evaluated the usefulness of thin-slice RDC-DWI in non-functioning PitNET/pituitary adenoma. • RDC-DWI exhibited excellent visualization in the pituitary region and surrounding structures. • In addition, the on-console distortion correction of RDC-DWI is clinically convenient.
Collapse
Affiliation(s)
- Shuichi Ito
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Sachi Okuchi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan.
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Sayo Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Krishna Pandu Wicaksono
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Kanae Kawai Miyake
- Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Hitomi Numamoto
- Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Hiroshi Tagawa
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Masahiro Tanji
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Noritaka Sano
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Hiroki Kondo
- MRI Systems Division, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara, 324-8550, Japan
| | - Rimika Imai
- MRI Systems Division, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara, 324-8550, Japan
| | - Tsuneo Saga
- Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Koji Fujimoto
- Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 606-8507, Japan
| |
Collapse
|
|
5
|
Hassan RMA, Almalki YE, Basha MAA, Alduraibi SK, Hassan AH, Aboualkheir M, Almushayti ZA, Alduraibi AK, Amer MM, Basha AMA, Refaat MM. Predicting the Consistency of Pituitary Macroadenomas: The Utility of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Measurements for Surgical Planning. Diagnostics (Basel) 2024; 14:493. [PMID: 38472965 DOI: 10.3390/diagnostics14050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Understanding the consistency of pituitary macroadenomas is crucial for neurosurgeons planning surgery. This retrospective study aimed to evaluate the utility of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) as non-invasive imaging modalities for predicting the consistency of pituitary macroadenomas. This could contribute to appropriate surgical planning and therefore reduce the likelihood of incomplete resections. The study included 45 patients with pathologically confirmed pituitary macroadenomas. Conventional MRI sequences, DWIs, ADC maps, and pre- and post-contrast MRIs were performed. Two neuroradiologists assessed all of the images. Neurosurgeons assessed the consistency of the tumor macroscopically, and histopathologists examined it microscopically. The MRI findings were compared with postoperative data. According to the operative data, macroadenomas were divided into the two following categories based on their consistency: aspirable (n = 27) and non-aspirable tumors (n = 18). A statistically significant difference in DWI findings was found when comparing macroadenomas of different consistencies (p < 0.001). Most aspirable macroadenomas (66.7%) were hyperintense according to DWI and hypointense on ADC maps, whereas most non-aspirable macroadenomas (83.3%) were hypointense for DWI and hyperintense on ADC maps. At a cut-off value of 0.63 × 10-3 mm2/s, the ADC showed a sensitivity of 85.7% and a specificity of 75% for the detection of non-aspirable macroadenomas (AUC, 0.946). The study concluded that DWI should be routinely performed in conjunction with ADC measurements in the preoperative evaluation of pituitary macroadenomas. This approach may aid in surgical planning, ensure that appropriate techniques are utilized, and reduce the risk of incomplete resection.
Collapse
Affiliation(s)
- Rania Mostafa A Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | | | - Alshehri Hanan Hassan
- Internal Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Mona M Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | | | - Mona Mohammed Refaat
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| |
Collapse
|
|
6
|
Zheng L, Jiang P, Lin D, Chen X, Zhong T, Zhang R, Chen J, Song Y, Xue Y, Lin L. Histogram analysis of mono-exponential, bi-exponential and stretched-exponential diffusion-weighted MR imaging in predicting consistency of meningiomas. Cancer Imaging 2023; 23:117. [PMID: 38053183 DOI: 10.1186/s40644-023-00633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The consistency of meningiomas is critical to determine surgical planning and has a significant impact on surgical outcomes. Our aim was to compare mono-exponential, bi-exponential and stretched exponential MR diffusion-weighted imaging in predicting the consistency of meningiomas before surgery. METHODS Forty-seven consecutive patients with pathologically confirmed meningiomas were prospectively enrolled in this study. Two senior neurosurgeons independently evaluated tumour consistency and classified them into soft and hard groups. A volume of interest was placed on the preoperative MR diffusion images to outline the whole tumour area. Histogram parameters (mean, median, 10th percentile, 90th percentile, kurtosis, skewness) were extracted from 6 different diffusion maps including ADC (DWI), D*, D, f (IVIM), alpha and DDC (SEM). Comparisons between two groups were made using Student's t-Test or Mann-Whitney U test. Parameters with significant differences between the two groups were included for Receiver operating characteristic analysis. The DeLong test was used to compare AUCs. RESULTS DDC, D* and ADC 10th percentile were significantly lower in hard tumours than in soft tumours (P ≤ 0.05). The alpha 90th percentile was significantly higher in hard tumours than in soft tumours (P < 0.02). For all histogram parameters, the alpha 90th percentile yielded the highest AUC of 0.88, with an accuracy of 85.10%. The D* 10th percentile had a relatively higher AUC value, followed by the DDC and ADC 10th percentile. The alpha 90th percentile had a significantly greater AUC value than the ADC 10th percentile (P ≤ 0.05). The D* 10th percentile had a significantly greater AUC value than the ADC 10th percentile and DDC 10th percentile (P ≤ 0.03). CONCLUSION Histogram parameters of Alpha and D* may serve as better imaging biomarkers to aid in predicting the consistency of meningioma.
Collapse
Affiliation(s)
- Lingmin Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Peirong Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Danjie Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Xiaodan Chen
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Tianjin Zhong
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Rufei Zhang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Yang Song
- MR Scientific Marketing, Healthineers Ltd, Siemens, Shanghai, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, 350004, China.
| |
Collapse
|
|
7
|
Calandrelli R, Pilato F, D'Apolito G, Schiavetto S, Gessi M, D'Alessandris QG, Lauretti L, Gaudino S. MRI and Trouillas' grading system of pituitary tumors: the usefulness of T2 signal intensity volumetric values. Neuroradiology 2023; 65:1567-1578. [PMID: 37233819 DOI: 10.1007/s00234-023-03162-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To classify pituitary macroadenomas according to the Trouillas' grading system; to compare this grading system with T2 values of volumetric signal intensity to determine T2 values able to predict the final grade. METHODS A total of 106 patients with macroadenomas were grouped according to the grading system score combining proliferation and invasiveness criteria of Trouillas' classification. Normalized volumetric signal intensity values were extracted from coronal T2-weighted images (nT2mean, nT2Max, nT2min) and were compared with the final grading score system. RESULTS Thirty-three patients were in grade 1a (non-invasive, non-proliferative tumors), 17 patients in grade 1b (non-invasive, proliferative tumors), 36 patients in grade 2a (invasive, non-proliferative tumors), and 20 patients in grade 2b (invasive, proliferative tumors). No patient was in grade 3 (metastatic tumors). nT2Max and nT2min were the best quantitative values to discriminate invasive from non-invasive grades; in invasive grades, nT2Max intensity values were higher, and nT2min intensity values were lower than in non-invasive grades. Receiver operating characteristic analysis of nT2 values showed that nT2min values had a better diagnostic performance than nT2Max values because they allowed differentiating with a moderate accuracy invasive tumors (2a or 2b grades) from both non-invasive proliferative tumors (1b) and non-invasive-non proliferative tumors (1a) (2a vs 1b: AUCnT2min = 0.78, 2b vs 1b: AUCnT2min = 0.72, 2a vs 1a: AUCnT2min = 0.72, 2b vs 1a AUCnT2min = 0.69). CONCLUSION Volumetric nT2Max and nT2min values of MRI might be practical and non-invasive markers for assessing tumor invasiveness although nT2 min signal intensity values have more effects in discriminating tumor's invasive behavior.
Collapse
Affiliation(s)
- Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Fabio Pilato
- Research Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine and Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italia
| | - Gabriella D'Apolito
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Stefano Schiavetto
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Simona Gaudino
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Institute of Radiology, L.go A. Gemelli, Rome, Italy
| |
Collapse
|
|
8
|
Mendi BAR, Batur H, Çay N, Çakır BT. Radiomic analysis of preoperative magnetic resonance imaging for the prediction of pituitary adenoma consistency. Acta Radiol 2023; 64:2470-2478. [PMID: 37170546 DOI: 10.1177/02841851231174462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND The consistency of pituitary adenomas affects the course of surgical treatment. PURPOSE To evaluate the diagnostic capabilities of radiomics based on T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MRI) in conjunction with two machine-learning (ML) techniques (support vector machine [SVM] and random forest classifier [RFC]) for assessing the consistency of pituitary adenomas. MATERIAL AND METHODS The institutional database was retrospectively scanned for patients who underwent surgical excision of pituitary adenomas. Surgical notes were accepted as a reference for the adenoma consistency. Radiomics analysis was performed on preoperative coronal 3.0T T1W and T2W images. First- and second-order parameters were calculated. Inter-observer reproducibility was assessed with Spearman's Correlation (ρ) and intra-observer reproducibility was evaluated with the intraclass correlation coefficient (ICC). Least absolute shrinkage and selection operator (LASSO) was used for dimensionality reduction. SVM and RFC were used as ML methods. RESULTS A total of 52 patients who produced 206 regions of interest (ROIs) were included. Twenty adenomas that produced 88 ROIs had firm consistency. There was both inter-observer and intra-observer reproducibility. Ten parameters that were based on T2W images with high discriminative power and without correlation were chosen by LASSO. The diagnostic performance of SVM and RFC was as follows: sensitivity = 95.580% and 92.950%, specificity = 83.670% and 88.420%, area under the curve = 0.956 and 0.904, respectively. CONCLUSION Radiomics analysis based on T2W MRI combined with various ML techniques, such as SVM and RFC, can provide preoperative information regarding pituitary adenoma consistency with high diagnostic accuracy.
Collapse
Affiliation(s)
| | - Halitcan Batur
- Department of Radiology, Nigde Omer Halisdemir University Training and Research Hospital, Nigde, Turkey
| | - Nurdan Çay
- Department of Radiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Banu Topçu Çakır
- Department of Radiology, Faculty of Medicine, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
|
9
|
Cheng MZ, Saraswathula A, Qureshi HA, Mukherjee D, Rowan NR. Otolaryngology Considerations of Pituitary Surgery: What an Endocrinologist Should Know. J Endocr Soc 2023; 7:bvad058. [PMID: 37313347 PMCID: PMC10259068 DOI: 10.1210/jendso/bvad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Indexed: 06/15/2023] Open
Abstract
Endoscopic endonasal skull base surgery is the preferred surgical approach for the management of pituitary adenomas. Perioperative management of pituitary lesions requires multidisciplinary care and typically includes a dual surgeon team consisting of a neurosurgeon and an otolaryngologist. The involvement of the otolaryngologist allows for a safe surgical approach with excellent intraoperative visualization of the tumor to enable an effective resection of the tumor by the neurosurgeon. Detection and treatment of sinonasal pathology is essential prior to surgery. Patients may experience sinonasal complaints following endoscopic transsphenoidal surgery, although this is typically temporary. Sinonasal care in the postoperative period can expedite recovery to baseline. Here we discuss the perioperative factors of endoscopic pituitary surgery that endocrinologists should be aware of, ranging from preoperative patient selection and optimization to postoperative care, with a particular emphasis on anatomic and surgical factors.
Collapse
Affiliation(s)
- Michael Z Cheng
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Anirudh Saraswathula
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Hannan A Qureshi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Nicholas R Rowan
- Correspondence: Nicholas R Rowan, MD, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N Caroline St, 6th floor, Baltimore, MD 21287, USA.
| |
Collapse
|
|
10
|
Anwar SSM, Hilal K, Khan A, Ahmad A. Magnetic resonance imaging grading of pituitary macroadenoma – SIPAP classification revisited. Eur J Radiol Open 2023; 10:100486. [PMID: 36969507 PMCID: PMC10033953 DOI: 10.1016/j.ejro.2023.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is regarded as the modality of choice in diagnosis of pituitary macroadenomas. Since surgery is the first line therapy for all pituitary adenomas, simple and reproducible MRI classification based on major directions of tumour growth is an essential tool. SIPAP MRI classification for pituitary adenoma describes tumor extension in parasellar, suprasellar, infrasellar, anterior and posterior directions. We, therefore, evaluated reproducibility of SIPAP classification in reporting of pituitary adenomas. Methods Forty-nine patients with biopsy-proven pituitary macroadenoma were graded according to SIPAP classification. Data was analyzed using Stata version 15. Interobserver variability was calculated using Cohen’s Kappa. Comparison between grading before and after treatment was performed by Chi-square test. P values < 0.05 were considered statistically significant. Results Individual tumour extensions according to SIPAP for pre- and post-operative grading showed significant difference (p-value <0.001), except for anterior extension. For suprasellar extension, 67.3 % patients had pre-operative grade-3 and 63.3 % had post-operative grade-0. For infrasellar extension, 51.0 % had pre-operative grade-2 and 71.4 % had post-operative grade-0. Anterior, posterior and parasellar extensions showed increased frequency in grade-0 in post-operative stage compared to pre-operative. Substantial inter-observer agreement was achieved for Superior, Inferior, Anterior and Posterior extent with all Kappa statistics values above 0.7 (p-value <0.001). Conclusion We propose incorporating simple and objective SIPAP classification in routine MR reporting for ideal pituitary tumour delineation, relationship to juxtasellar structures and tumour size, hence facilitating greater success rate in surgical and subsequent clinical management.
Collapse
|
|
11
|
Castle-Kirszbaum M, Wang YY, King J, Kam J, Goldschlager T. The HACKD Score-Predicting Extent of Resection of Pituitary Macroadenomas Through an Endoscopic Endonasal Transsphenoidal Approach. Oper Neurosurg (Hagerstown) 2023; 24:154-161. [PMID: 36354325 DOI: 10.1227/ons.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Predicting extent of resection before pituitary surgery is imperative for operative planning and patient counseling. In the era of endoscopic endonasal transsphenoidal surgery (EEA), a specific, reliable tool for predicting resection of macroadenomas would have widespread applications. OBJECTIVE To identify factors that predict resection of pituitary macroadenomas through the EEA. METHODS A prospectively maintained, multicenter database of 277 consecutive macroadenomas resected through the EEA was analyzed. Multivariate logistic regression identified predictors of gross total resection (GTR). A simple scoring system, the Hardy, Age, Clival, Knosp, Depth (HACKD) Score, was developed and tested. RESULTS GTR was achieved in 82.3% (228/277) of cases. Older than 50 years (odds ratio [OR] 2.96, P = .01), clival extension (OR 5.87, P < .01), Hardy grade C or D suprasellar extension (OR 3.91, P = .01), Knosp grade 3 or 4 cavernous sinus invasion (OR 7.62, P < .01), and tumor depth >20 mm (OR 5.14, P < .01) were all associated with subtotal resection. The HACKD score, awarding 1 point each for Hardy grade C or D, and older than 50 years, and 2 points each for clival extension, Knosp grades 3 or 4, and tumor depth >20 mm, demonstrated excellent discriminative ability (AUROC 0.887, 95% CI: 0.839-0.934). The rate of GTR progressively decreased with a higher HACKD score. Rates of GTR were 95.8% (182/190) for low (HACKD ≤2), 59.5% (44/74) for moderate (HACKD 3-5), and 15.4% (2/13) for high (HACKD 6+) HACKD scores. CONCLUSION The HACKD score is a simple and accurate tool based on the largest study analyzing predictors of GTR in pituitary macroadenomas operated through the EEA.
Collapse
Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Jeremy Kam
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| |
Collapse
|
|
12
|
Černý M, Sedlák V, Lesáková V, Francůz P, Netuka D. Methods of preoperative prediction of pituitary adenoma consistency: a systematic review. Neurosurg Rev 2022; 46:11. [PMID: 36482215 DOI: 10.1007/s10143-022-01909-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aims to review the current literature on methods of preoperative prediction of pituitary adenoma consistency. Pituitary adenoma consistency may be a limiting factor for successful surgical removal of tumors. Efforts have been made to investigate the possibility of an accurate assessment of the preoperative consistency to allow for safer and more effective surgery planning. We searched major scientific databases and systematically analyzed the results. A total of 54 relevant articles were identified and selected for inclusion. These studies evaluated methods based on either MRI intensity, enhancement, radiomics, MR elastometry, or CT evaluation. The results of these studies varied widely. Most studies used the average intensity of either T2WI or ADC maps. Firm tumors appeared hyperintense on T2WI, although only 55% of the studies reported statistically significant results. There are mixed reports on ADC values in firm tumors with findings of increased values (28%), decreased values (22%), or no correlation (50%). Multiple contrast enhancement-based methods showed good results in distinguishing between soft and firm tumors. There were mixed reports on the utility of MR elastography. Attempts to develop radiomics and machine learning-based models have achieved high accuracy and AUC values; however, they are prone to overfitting and need further validation. Multiple methods of preoperative consistency assessment have been studied. None demonstrated sufficient accuracy and reliability in clinical use. Further efforts are needed to enable reliable surgical planning.
Collapse
Affiliation(s)
- Martin Černý
- Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic.
- 1st Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
| | - Vojtěch Sedlák
- Department of Radiodiagnostics, Central Military Hospital Prague, Prague, Czech Republic
| | - Veronika Lesáková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Prague, Czech Republic
| | - Peter Francůz
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic
| |
Collapse
|
|
13
|
Fajardo-Montañana C, Villar R, Gómez-Ansón B, Brea B, Mosqueira AJ, Molla E, Enseñat J, Riesgo P, Cardona-Arboniés J, Hernando O. Recommendations for the diagnosis and radiological follow-up of pituitary neuroendocrine tumours. ENDOCRINOL DIAB NUTR 2022; 69:744-761. [PMID: 36428207 DOI: 10.1016/j.endien.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 06/16/2023]
Abstract
Pituitary neuroendocrine tumours (PitNETs) constitute a heterogeneous group of tumours with a gradually increasing incidence, partly accounted for by more sensitive imaging techniques and more extensive experience in neuroradiology in this regard. Although most PitNETs are indolent, some exhibit aggressive behaviour, and recurrence may be seen after surgical removal. The changes introduced in the WHO classification in 2017 and terminological debates in relation to neuroendocrine tumours warrant an update of the guidelines for the diagnosis, preoperative and postoperative management, and follow-up of response to treatment of PitNETs. This multidisciplinary document, an initiative of the Neuroendocrinology area of the Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition] (SEEN), focuses on neuroimaging studies for the diagnosis, prognosis and follow-up of PitNETs. The basic requirements and elements that should be covered by magnetic resonance imaging are described, and a minimum radiology report to aid clinicians in treatment decision-making is proposed. This work supplements the consensus between the Neuroendocrinology area of the SEEN and the Sociedad Española de Anatomía Patológica [Spanish Society of Pathology] (SEAP) for the pathological study of PitNETs.
Collapse
Affiliation(s)
| | - Rocío Villar
- Departamento de Endocrinología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Beatriz Gómez-Ansón
- Neurorradiología, Departamento de Radiodiagnóstico, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Beatriz Brea
- Departamento de Radiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Jesús Mosqueira
- Departamento de Radiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Enrique Molla
- Departamento de Radiología, Hospital Universitario de la Ribera, Alcira, Valencia, Spain
| | - Joaquín Enseñat
- Departamento de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Riesgo
- Departamento de Neurocirugía, Hospital Universitario de la Ribera, Alcira, Valencia, Spain
| | - Jorge Cardona-Arboniés
- Departamento de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ovidio Hernando
- Departamento de Oncología Radioterápica, Centro Integral Oncológico Clara Campal, Madrid, Spain
| |
Collapse
|
|
14
|
Mukada N, Tosaka M, Yamaguchi R, Tanaka Y, Takahashi A, Shimauchi-Otaki H, Osawa S, Tsushima Y, Yoshimoto Y. Preoperative Magnetic Resonance Imaging Localization of the Normal Pituitary Gland in Nonfunctioning Pituitary Adenoma Patients Using the Radiological Sign of "Internal Carotid Artery Notch". World Neurosurg 2022; 166:e177-e188. [PMID: 35792224 DOI: 10.1016/j.wneu.2022.06.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Asymmetric features of nonfunctioning pituitary adenoma (NFPA) are poorly understood. We investigated the asymmetry in NFPA on magnetic resonance imaging. METHODS We reviewed preoperative magnetic resonance imaging findings of patients initially treated for NFPA. The internal carotid artery (ICA) often seemed to cause an indentation in the external shape of the tumor (i.e., the ICA notch). RESULTS Two cases with a normal pituitary gland located at the midline were excluded. The remaining 66 cases were examined. The side where the normal gland was located was defined as the normal pituitary side and the opposite side as the cavernous sinus side. The Knosp grade was significantly higher on the cavernous sinus side (P < 0.001), and the vertical distance of the ICA was significantly greater on the cavernous sinus side (P < 0.001). The ICA notch was found in 87.9% of all cases on the normal pituitary side, but in only 45.5% on the cavernous sinus side (P < 0.001). In cases with a single-side ICA notch (34 of 68), the ICA notch was found in 91.2% of cases and on the cavernous sinus side in 8.8% (P < 0.001). CONCLUSIONS Magnetic resonance imaging of NFPA frequently shows asymmetry. The tumor does not extend laterally on the normal pituitary side but extends laterally more freely on the cavernous sinus side. The ICA notch is often found on the normal pituitary side where the position of ICA does not move. This may be useful as a preoperative sign to indicate the normal pituitary side.
Collapse
Affiliation(s)
- Naoto Mukada
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Rei Yamaguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yukitaka Tanaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ayako Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Shimauchi-Otaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sho Osawa
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| |
Collapse
|
|
15
|
Nie D, Zhao P, Li C, Liu C, Zhu H, Gui S, Zhang Y, Cao L. Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors. Front Surg 2022; 9:922626. [PMID: 35959133 PMCID: PMC9360528 DOI: 10.3389/fsurg.2022.922626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Tumor consistency is important for pituitary neuroendocrine tumors (PitNETs) resection to improve surgical outcomes. In this study, we evaluated the T2-WI of PitNETs and defined a specific T2-WI signaling manifestation, the “Mosaic sign,” to predict tumor consistency and resection of PitNETs. Design A retrospective review of MRI and tumor histology of 137 consecutive patients who underwent endoscopic endonasal resection for PitNETs was performed. Methods The “Mosaic sign” was defined by the ratio of the tumor itself T2-WI signals, and characterized by multiple intratumor hyperintense dots. The degree of tumor resection was an assessment by postoperative MRI examination. The presence of the “Mosaic sign” was compared with patients' basic information, tumor consistency, tumor pathological staining, and surgical result. To determine whether the presence or absence of “Mosaic sign” could predict tumor consistency and guide surgical resection of tumors. Results Statistical analysis showed that the consistency of the tumor and the degree of resection were correlated with the “Mosaic sign”. In the 137 cases of T2-WI, 43 had “Mosaic sign”, 39 cases had soft tumor consistency, and 4 were classified as fibrous, of which 42 were completely resected and 1 was subtotal resected. Of the 94 patients without “Mosaic sign”, the consistency of tumor of 54 cases were classified as soft, the remaining 40 cases were fibrous, 80 cases were completely resected, and 14 cases were subtotal resected. Postoperative cerebrospinal fluid leakage occurred in 1 patient. The number of corticotroph adenomas in the group of “Mosaic sign” was higher, with the statistical difference between the two groups (P = 0.0343). Conclusions The presence of the “Mosaic sign” in T2-WI may provide preoperative information for pituitary adenomas consistency and effectively guide surgical approaches.
Collapse
Affiliation(s)
- Ding Nie
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chunhui Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Correspondence: Yazhuo Zhang Lei Cao
| | - Lei Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Correspondence: Yazhuo Zhang Lei Cao
| |
Collapse
|
|
16
|
Chen YJ, Hsieh HP, Hung KC, Shih YJ, Lim SW, Kuo YT, Chen JH, Ko CC. Deep Learning for Prediction of Progression and Recurrence in Nonfunctioning Pituitary Macroadenomas: Combination of Clinical and MRI Features. Front Oncol 2022; 12:813806. [PMID: 35515108 PMCID: PMC9065347 DOI: 10.3389/fonc.2022.813806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives A subset of non-functioning pituitary macroadenomas (NFMAs) may exhibit early progression/recurrence (P/R) after tumor resection. The purpose of this study was to apply deep learning (DL) algorithms for prediction of P/R in NFMAs. Methods From June 2009 to December 2019, 78 patients diagnosed with pathologically confirmed NFMAs, and who had undergone complete preoperative MRI and postoperative MRI follow-up for more than one year, were included. DL classifiers including multi-layer perceptron (MLP) and convolutional neural network (CNN) were used to build predictive models. Categorical and continuous clinical data were fed into the MLP model, and images of preoperative MRI (T2WI and contrast enhanced T1WI) were analyzed by the CNN model. MLP, CNN and multimodal CNN-MLP architectures were performed to predict P/R in NFMAs. Results Forty-two (42/78, 53.8%) patients exhibited P/R after surgery. The median follow-up time was 42 months, and the median time to P/R was 25 months. As compared with CNN using MRI (accuracy 83%, precision 87%, and AUC 0.84) or MLP using clinical data (accuracy 73%, precision 73%, and AUC 0.73) alone, the multimodal CNN-MLP model using both clinical and MRI features showed the best performance for prediction of P/R in NFMAs, with accuracy 83%, precision 90%, and AUC 0.85. Conclusions DL architecture incorporating clinical and MRI features performs well to predict P/R in NFMAs. Pending more studies to support the findings, the results of this study may provide valuable information for NFMAs treatment planning.
Collapse
Affiliation(s)
- Yan-Jen Chen
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan.,Graduate Institute of Electronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsun-Ping Hsieh
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yun-Ju Shih
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States.,Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| |
Collapse
|
|
17
|
Cohen-Cohen S, Helal A, Yin Z, Ball MK, Ehman RL, Van Gompel JJ, Huston J. Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg 2022; 136:1356-1363. [PMID: 34715659 PMCID: PMC9050965 DOI: 10.3171/2021.6.jns204425] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pituitary adenoma is one of the most common primary intracranial neoplasms. Most of these tumors are soft, but up to 17% may have a firmer consistency. Therefore, knowing the tumor consistency in the preoperative setting could be helpful. Multiple imaging methods have been proposed to predict tumor consistency, but the results are controversial. This study aimed to evaluate the efficacy of MR elastography (MRE) in predicting tumor consistency and its potential use in a series of patients with pituitary adenomas. METHODS Thirty-eight patients with pituitary adenomas (≥ 2.5 cm) were prospectively evaluated with MRI and MRE before surgery. Absolute MRE stiffness values and relative MRE stiffness ratios, as well as the relative ratio of T1 signal, T2 signal, and diffusion-weighted imaging apparent diffusion coefficient (ADC) values were determined prospectively by calculating the ratio of those values in the tumor to adjacent left temporal white matter. Tumors were classified into three groups according to surgical consistency (soft, intermediate, and firm). Statistical analysis was used to identify the predictive value of the different radiological parameters in determining pituitary adenoma consistency. RESULTS The authors included 32 (84.21%) nonfunctional and 6 (15.79%) functional adenomas. The mean maximum tumor diameter was 3.7 cm, and the mean preoperative tumor volume was 16.4 cm3. Cavernous sinus invasion was present in 20 patients (52.63%). A gross-total resection was possible in 9 (23.68%) patients. The entire cohort's mean absolute tumor stiffness value was 1.8 kPa (range 1.1-3.7 kPa), whereas the mean tumor stiffness ratio was 0.66 (range 0.37-1.6). Intraoperative tumor consistency was significantly correlated with absolute and relative tumor stiffness (p = 0.0087 and 0.007, respectively). Tumor consistency alone was not a significant factor for predicting gross-total resection. Patients with intermediate and firm tumors had more complications compared to patients with soft tumors (50.00% vs 12.50%, p = 0.02) and also had longer operative times (p = 0.0002). CONCLUSIONS Whereas other MRI sequences have proven to be unreliable in determining tumor consistency, MRE has been shown to be a reliable tool for predicting adenoma consistency. Preoperative knowledge of tumor consistency could be potentially useful for surgical planning, counseling about potential surgical risks, and estimating the length of operative time.
Collapse
Affiliation(s)
| | - Ahmed Helal
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Ziying Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jamie J. Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
|
18
|
Gadelha MR, Barbosa MA, Lamback EB, Wildemberg LE, Kasuki L, Ventura N. Pituitary MRI Standard and Advanced Sequences: Role in the Diagnosis and Characterization of Pituitary Adenomas. J Clin Endocrinol Metab 2022; 107:1431-1440. [PMID: 34908114 DOI: 10.1210/clinem/dgab901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Indexed: 11/19/2022]
Abstract
Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas, and aneurysms. High-quality imaging is fundamental for diagnosis, characterization, and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing. A systematic MRI approach to the pituitary region generally provides information that includes the size and shape of the PA, the presence of cysts or hemorrhage within the tumor, its relationship with the optic pathways and surrounding structures, potential cavernous sinus invasion, sphenoid sinus pneumatization type, and differential diagnosis with other sellar lesions. The standard protocol is sufficient for the evaluation of most cases; however, some advanced techniques (susceptibility imaging, diffusion-weighted imaging, 3D T2w high-resolution sequences, magnetic resonance elastography, perfusion-weighted imaging) may render additional information, which may be important for some cases. In this "approach to the patient" manuscript, we will discuss the use of standard and advanced MRI sequences in the diagnosis and characterization of PAs, including MRI features associated with treatment response that may aid in presurgical evaluation and planning, and red flags that may point to an alternative diagnosis.
Collapse
Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Monique Alvares Barbosa
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Radiology Unit, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil
- MRI Unit, Clínica de Diagnóstico por imagem, DASA, Rio de Janeiro, Brazil
| | - Elisa Baranski Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Luiz Eduardo Wildemberg
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Nina Ventura
- Radiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuroradiology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- Neuroradiology Unit, Samaritano Hospital, Grupo Fleury, Rio de Janeiro, Brazil
| |
Collapse
|
|
19
|
White A, Junior de Andrade E, Kshettry VR, Sindwani R, Recinos PF. Preoperative Workup for Patients with Pituitary Lesions. Otolaryngol Clin North Am 2022; 55:233-246. [DOI: 10.1016/j.otc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
|
20
|
Fajardo-Montañana C, Villar R, Gómez-Ansón B, Brea B, Mosqueira AJ, Molla E, Enseñat J, Riesgo P, Cardona-Arboniés J, Hernando O. Recomendaciones sobre el diagnóstico y seguimiento radiológico de los tumores neuroendocrinos hipofisarios. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
|
21
|
Ko CC, Chang CH, Chen TY, Lim SW, Wu TC, Chen JH, Kuo YT. Solid tumor size for prediction of recurrence in large and giant non-functioning pituitary adenomas. Neurosurg Rev 2021; 45:1401-1411. [PMID: 34606021 PMCID: PMC8976796 DOI: 10.1007/s10143-021-01662-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 10/31/2022]
Abstract
A subset of large non-functioning pituitary adenomas (lNFPA) and giant non-functioning pituitary adenomas (gNFPA) undergoes early progression/recurrence (P/R) after surgery. This study revealed the clinical and image predictors of P/R in lNFPA and gNFPA, with emphasis on solid tumor size. This retrospective study investigated the preoperative MR imaging features for the prediction of P/R in lNFPA (> 3 cm) and gNFPA (> 4 cm). Only the patients with a complete preoperative brain MRI and undergone postoperative MRI follow-ups for more than 1 year were included. From November 2010 to December 2020, a total of 34 patients diagnosed with lNFPA and gNFPA were included (median follow-up time 47.6 months) in this study. A total of twenty-three (23/34, 67.6%) patients had P/R, and the median time to P/R is 25.2 months. Solid tumor diameter (STD), solid tumor volume (STV), and extent of resection are associated with P/R (p < 0.05). Multivariate analysis showed large STV is a risk factor for P/R (p < 0.05) with a hazard ratio of 30.79. The cutoff points of STD and STV for prediction of P/R are 26 mm and 7.6 cm3, with AUCs of 0.78 and 0.79 respectively. Kaplan-Meier analysis of tumor P/R trends showed that patients with larger STD and STV exhibited shorter progression-free survival (p < 0.05). For lNFPA and gNFPA, preoperative STD and STV are significant predictors of P/R. The results offer objective and valuable information for treatment planning in this subgroup.
Collapse
Affiliation(s)
- Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Chin-Hong Chang
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA, USA.,Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
|
22
|
Wan T, Wu C, Meng M, Liu T, Li C, Ma J, Qin Z. Radiomic Features on Multiparametric MRI for Preoperative Evaluation of Pituitary Macroadenomas Consistency: Preliminary Findings. J Magn Reson Imaging 2021; 55:1491-1503. [PMID: 34549842 DOI: 10.1002/jmri.27930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preoperative assessment of the consistency of pituitary macroadenomas (PMA) might be needed for surgical planning. PURPOSE To investigate the diagnostic performance of radiomics models based on multiparametric magnetic resonance imaging (mpMRI) for preoperatively evaluating the tumor consistency of PMA. STUDY TYPE Retrospective. POPULATION One hundred and fifty-six PMA patients (soft consistency, N = 104 vs. hard consistency, N = 52), divided into training (N = 108) and test (N = 48) cohorts. The tumor consistency was determined on surgical findings. FIELD STRENGTH/SEQUENCE T1-weighted imaging (T1WI), contrast-enhanced T1WI (T1CE), and T2-weighted imaging (T2WI) using spin-echo sequences with a 3.0-T scanner. ASSESSMENT An automated three-dimensional (3D) segmentation was performed to generate the volume of interest (VOI) on T2WI, then T1WI/T1CE were coregistered to T2WI. A total of 388 radiomic features were extracted on each VOI of mpMRI. The top-discriminative features were identified using the minimum-redundancy maximum-relevance method and 0.632+ bootstrapping. The radiomics models based on each sequence and their combinations were established via the random forest (RF) and support vector machine (SVM), and independently evaluated for their ability in distinguishing PMA consistency. STATISTICAL TESTS Mann-Whitney U-test and Chi-square test were used for comparison analysis. The area under the receiver operating characteristic curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), and relative standard deviation (RSD) were calculated to evaluate each model's performance. ACC with P-value<0.05 was considered statistically significant. RESULTS Eleven mpMRI-based features exhibited statistically significant differences between soft and hard PMA in the training cohort. The radiomics model built on combined T1WI/T1CE/T2WI demonstrated the best performance among all the radiomics models with an AUC of 0.90 (95% confidence interval [CI]: 0.87-0.92), ACC of 0.87 (CI: 0.84-0.89), SEN of 0.83 (CI: 0.81-0.85), and SPE of 0.87 (CI: 0.85-0.99) in the test cohort. DATA CONCLUSION Radiomic features based on mpMRI have good performance in the presurgical evaluation of PMA consistency. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Tao Wan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Chunxue Wu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Meng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Chuzhong Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zengchang Qin
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| |
Collapse
|
|
23
|
Acitores Cancela A, Rodríguez Berrocal V, Pian H, Martínez San Millán JS, Díez JJ, Iglesias P. Clinical relevance of tumor consistency in pituitary adenoma. Hormones (Athens) 2021; 20:463-473. [PMID: 34148222 DOI: 10.1007/s42000-021-00302-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/13/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To review the clinical relevance of pituitary adenoma (PA) consistency and its relationship to clinical presentation, radiologic and histopathological characteristics, and surgical outcomes. BACKGROUND PA consistency is a critical factor influencing operative planning, surgical outcomes, and patient counseling. There is no validated classification of PA consistency in the literature, and there are no current preoperative variables capable of predicting it. REVIEW We conducted a thorough literature review of the Medline, Embase, Web of Science, and Cochrane Library databases. The inclusion criteria were all articles that described PA consistency and correlated it with preoperative aspects, radiological, pathological, and operative findings, or clinical outcomes. DISCUSSION Although most authors differentiate easily aspirated (soft) tumors from those that are not (fibrous, might require prior fragmentation), there is no universally accepted PA consistency classification. Fibrous PA tends to be hypointense on T2WI and has lower apparent diffusion coefficient (ADC) values. Fibrous tumors seemed to present higher invasion into neighboring structures, including the cavernous sinus. Several articles suggest that dopamine agonists could increase PA consistency and that prior surgery and radiotherapy also make PA more fibrous. The anatomopathological studies identify collagen as being mainly responsible for fibrous consistency of adenomas. CONCLUSIONS Preoperative knowledge of PA consistency affords the neurosurgeon substantial benefit, which clearly appears to be relevant to surgical planning, risks, and surgery outcomes. It could also encourage the centralization of these high complexity tumors in reference centers. Further studies may be enhanced by applying standard consistency classification of the PA and analyzing a more extensive and prospective series of fibrous PA.
Collapse
Affiliation(s)
- Alberto Acitores Cancela
- Department of Neurosurgery, Hospital Universitario Ramón Y Cajal, Ctra. de Colmenar Viejo km. 9, 100, 28034, Madrid, Spain.
| | - Víctor Rodríguez Berrocal
- Department of Neurosurgery, Hospital Universitario Ramón Y Cajal, Ctra. de Colmenar Viejo km. 9, 100, 28034, Madrid, Spain
| | - Héctor Pian
- Departments of Neurosurgery and Pathology, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | | | - Juan José Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| |
Collapse
|
|
24
|
Kamimura K, Nakajo M, Bohara M, Nagano D, Fukukura Y, Fujio S, Takajo T, Tabata K, Iwanaga T, Imai H, Nickel MD, Yoshiura T. Consistency of Pituitary Adenoma: Prediction by Pharmacokinetic Dynamic Contrast-Enhanced MRI and Comparison with Histologic Collagen Content. Cancers (Basel) 2021; 13:cancers13153914. [PMID: 34359814 PMCID: PMC8345382 DOI: 10.3390/cancers13153914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Transsphenoidal resection of hard pituitary adenomas have a particularly high risk of residual tumor and complications. Therefore, prediction of tumor consistency is valuable for planning pituitary adenoma surgery. We prospectively examined whether quantitative pharmacokinetic analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is useful for predicting consistency of pituitary adenoma in 49 participants. We found that the measure of volume of extravascular extracellular space per unit volume of tissue derived from DCE-MRI could predict the consistency of pituitary adenomas. Furthermore, the volume of extravascular extracellular space per unit volume of tissue was significantly positively correlated with histopathologic collagen content of the adenoma. Our results suggest that volume of extravascular extracellular space per unit volume of tissue derived from quantitative pharmacokinetic analysis of DCE-MRI has a predictive value for consistency of pituitary adenomas. Abstract Prediction of tumor consistency is valuable for planning transsphenoidal surgery for pituitary adenoma. A prospective study was conducted involving 49 participants with pituitary adenoma to determine whether quantitative pharmacokinetic analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is useful for predicting consistency of adenomas. Pharmacokinetic parameters in the adenomas including volume of extravascular extracellular space (EES) per unit volume of tissue (ve), blood plasma volume per unit volume of tissue (vp), volume transfer constant between blood plasma and EES (Ktrans), and rate constant between EES and blood plasma (kep) were obtained. The pharmacokinetic parameters and the histologic percentage of collagen content (PCC) were compared between soft and hard adenomas using Mann–Whitney U test. Pearson’s correlation coefficient was used to correlate pharmacokinetic parameters with PCC. Hard adenomas showed significantly higher PCC (44.08 ± 15.14% vs. 6.62 ± 3.47%, p < 0.01), ve (0.332 ± 0.124% vs. 0.221 ± 0.104%, p < 0.01), and Ktrans (0.775 ± 0.401/min vs. 0.601 ± 0.612/min, p = 0.02) than soft adenomas. Moreover, a significant positive correlation was found between ve and PCC (r = 0.601, p < 0.01). The ve derived using DCE-MRI may have predictive value for consistency of pituitary adenoma.
Collapse
Affiliation(s)
- Kiyohisa Kamimura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
- Correspondence: ; Tel.: +81-99-275-5417
| | - Masanori Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
| | - Manisha Bohara
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
| | - Daigo Nagano
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
| | - Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
| | - Shingo Fujio
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (S.F.); (T.T.)
| | - Tomoko Takajo
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (S.F.); (T.T.)
| | - Kazuhiro Tabata
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan;
| | - Takashi Iwanaga
- Department of Radiological Technology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan;
| | - Hiroshi Imai
- MR Research & Collaboration, Siemens Healthcare K.K., 1-11-1 Osaki, Shinagawa, Tokyo 141-8644, Japan;
| | | | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; (M.N.); (M.B.); (D.N.); (Y.F.); (T.Y.)
| |
Collapse
|
|
25
|
Rutland JW, Loewenstern J, Ranti D, Tsankova NM, Bellaire CP, Bederson JB, Delman BN, Shrivastava RK, Balchandani P. Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J Neurosurg 2021; 134:771-779. [PMID: 32109870 DOI: 10.3171/2019.12.jns192940] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic surgery is an effective treatment strategy for pituitary adenomas; however, intrinsic tumor properties such as tumor consistency can challenge or preclude gross-total resection. Preoperative characterization of tumor consistency may help to guide the surgical approach and to predict the extent of resection that is possible. Advanced radiological modalities such as 7T diffusion-weighted imaging (DWI) may be useful in probing biological tissue properties of pituitary adenomas. The objective of the present study was to examine 7T DWI as a novel method of measuring the consistency of pituitary adenomas. METHODS Thirteen patients with pituitary macroadenomas underwent 7T MRI, including a DWI image acquisition. Tumor apparent diffusion coefficient (ADC) was normalized to the adjacent temporal gray matter ADC. All patients underwent resection, and a single neurosurgeon blinded to ADC values rated tumor firmness from 1 (least firm) to 5 (most firm) using objective criteria. The tumor specimens were evaluated histopathologically for cellularity, collagen content, and vascularity by a neuropathologist who was also blinded to ADC values. The tumor ADC was correlated with intraoperative consistency rating, histopathology, and extent of resection. Receiver operating characteristic (ROC) curve analyses were performed to identify thresholds to predict tumor consistency. RESULTS Corrected ADC values were significantly correlated with both tumor firmness (r = -0.60, p = 0.029) and the extent of trichrome staining (r = -0.72, p = 0.009) such that greater ADC values were associated with both decreased tumor firmness and decreased collagen staining. Correlations between ADC values and tumor vascularity were not significant (r = -0.09, p = 0.78). Corrected ADC values in totally resected tumors (1.54) were greater than those in subtotally resected tumors (0.85) (p = 0.02), and ADC values were greater with moderate tumor cellularity (1.51) than with high tumor cellularity (0.8) (p = 0.035). There was a trend-level association for partial resections to exhibit greater tumor firmness rating (3 vs 1.7; p = 0.051). Finally, the degree of trichrome staining positively correlated with tumor firmness (r = 0.60, p = 0.04). The optimal threshold for predicting intraoperative consistency rating was an ADC ratio of 0.87 (sensitivity 80%, specificity 100%, area under the curve [AUC] 0.90; p = 0.043). The optimal cutoff for distinguishing the extent of resection was 1.19 (sensitivity 85.7%, specificity 83.3% AUC 0.833; p = 0.046). CONCLUSIONS The authors' results suggest that a high-resolution ADC of pituitary adenomas is a sensitive measure of tumor consistency. 7T DWI may hold clinical value in the preoperative workup and surgical management of patients with pituitary macroadenomas.
Collapse
Affiliation(s)
- John W Rutland
- 1Translational and Molecular Imaging Institute; and
- Departments of2Neurosurgery
| | | | | | | | | | | | - Bradley N Delman
- 1Translational and Molecular Imaging Institute; and
- 3Diagnostic, Molecular and Interventional Radiology, and
| | | | | |
Collapse
|
|
26
|
Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma. Neurosurg Rev 2021; 44:2933-2941. [PMID: 33506362 DOI: 10.1007/s10143-020-01469-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the role of diffusion-weighted imaging (DWI) in predicting tumor consistency, extent of surgical resection, and recurrence in pituitary adenoma (PA). We reviewed a prospectively collected database of surgically treated PA between March 2016 and October 2017. Predictors for extent of resection and recurrence/progression were assessed with logistic and Cox regression analysis. Of the 183 patients, the tumor consistency was found soft in 107 (58.5%) patients, intermediate in 41 (22.4%) patients, and hard in 35 (19.1%) patients. The mean of ADC ratio was 0.92 ± 0.22 for hard tumor, 1.03 ± 0.22 for intermediate tumor, and 1.41 ± 0.62 for soft tumor (P < 0.001). The mean collagen content was 25.86% ± 15.00% for hard tumor, 16.05% ± 9.90% for intermediate tumor, and 5.00% ± 6.00% for soft tumor (P < 0.001). Spearman analysis showed a significant correlation between ADC ratio and collagen content (ρ = - 0.367; P < 0.001). Gross-total resection (GTR) was obtained in 68.3% of patients, and multivariable logistic regression analysis showed that ADC ratio (OR, 12.135; 95% CI, 4.001-36.804; P < 0.001), giant PA (OR, 0.233; 95% CI, 0.105-0.520; P < 0.001), and invasion (OR, 0.459; 95% CI, 0.220-0.960; P = 0.039) were significantly predictive of GTR. Twenty-seven (14.8%) patients suffered recurrence/progression in the mean follow-up of 35.14 months. Invasion (HR, 2.728; 95% CI, 1.262-5.899; P = 0.011) was identified as independent predictors of recurrence/progression. ADC ratio of DWI could be used for preoperative assessment of tumor consistency, tumor collagen content, and extent of surgical resection, which might be useful in preoperative planning for patients with PA.
Collapse
|
|
27
|
Zhang Y, Ko CC, Chen JH, Chang KT, Chen TY, Lim SW, Tsui YK, Su MY. Radiomics Approach for Prediction of Recurrence in Non-Functioning Pituitary Macroadenomas. Front Oncol 2020; 10:590083. [PMID: 33392084 PMCID: PMC7775655 DOI: 10.3389/fonc.2020.590083] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives A subset of non-functioning pituitary macroadenomas (NFPAs) may exhibit early progression/recurrence (P/R) after surgical resection. The purpose of this study was to apply radiomics in predicting P/R in NFPAs. Methods Only patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year were included in this study. From September 2010 to December 2017, 50 eligible patients diagnosed with pathologically confirmed NFPAs were identified. Preoperative coronal T2WI and contrast-enhanced (CE) T1WI imaging were analyzed by computer algorithms. For each imaging sequence, 32 first-order features and 75 texture features were extracted. Support vector machine (SVM) classifier was utilized to evaluate the importance of extracted parameters, and the most significant three parameters were used to build the prediction model. The SVM score was calculated based on the three selected features. Results Twenty-eight patients exhibited P/R (28/50, 56%) after surgery. The median follow-up time was 38 months, and the median time to P/R was 20 months. Visual disturbance, hypopituitarism, extrasellar extension, compression of the third ventricle, large tumor height and volume, failed optic chiasmatic decompression, and high SVM score were more frequently encountered in the P/R group (p < 0.05). In multivariate Cox hazards analysis, symptoms of sex hormones, hypopituitarism, and SVM score were high risk factors for P/R (p < 0.05) with hazard ratios of 10.71, 2.68, and 6.88. The three selected radiomics features were T1 surface-to-volume radio, T1 GLCM-informational measure of correlation, and T2 NGTDM-coarseness. The radiomics predictive model shows 25 true positive, 16 true negative, 6 false positive, and 3 false negative cases, with an accuracy of 82% and AUC of 0.78 in differentiating P/R from non-P/R NFPAs. For SVM score, optimal cut-off value of 0.537 and AUC of 0.87 were obtained for differentiation of P/R. Higher SVM scores were associated with shorter progression-free survival (p < 0.001). Conclusions Our preliminary results showed that objective and quantitative MR radiomic features can be extracted from NFPAs. Pending more studies and evidence to support the findings, radiomics analysis of preoperative MRI may have the potential to offer valuable information in treatment planning for NFPAs.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States.,Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kai-Ting Chang
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yu-Kun Tsui
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
|
28
|
Guerriero E, Ugga L, Cuocolo R. Artificial intelligence and pituitary adenomas: A review. Artif Intell Med Imaging 2020; 1:70-77. [DOI: 10.35711/aimi.v1.i2.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/15/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this review was to provide an overview of the main concepts in machine learning (ML) and to analyze the ML applications in the imaging of pituitary adenomas. After describing the clinical, pathological and imaging features of pituitary tumors, we defined the difference between ML and classical rule-based algorithms, we illustrated the fundamental ML techniques: supervised, unsupervised and reinforcement learning and explained the characteristic of deep learning, a ML approach employing networks inspired by brain’s structure. Pre-treatment assessment and neurosurgical outcome prediction were the potential ML applications using magnetic resonance imaging. Regarding pre-treatment assessment, ML methods were used to have information about tumor consistency, predict cavernous sinus invasion and high proliferative index, discriminate null cell adenomas, which respond to neo-adjuvant radiotherapy from other subtypes, predict somatostatin analogues response and visual pathway injury. Regarding neurosurgical outcome prediction, the following applications were discussed: Gross total resection prediction, evaluation of Cushing disease recurrence after transsphenoidal surgery and prediction of cerebrospinal fluid fistula’s formation after surgery. Although clinical applicability requires more replicability, generalizability and validation, results are promising, and ML software can be a potential power to facilitate better clinical decision making in pituitary tumor patients.
Collapse
Affiliation(s)
- Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
| |
Collapse
|
|
29
|
Prediction of pituitary adenoma surgical consistency: radiomic data mining and machine learning on T2-weighted MRI. Neuroradiology 2020; 62:1649-1656. [PMID: 32705290 PMCID: PMC7666676 DOI: 10.1007/s00234-020-02502-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022]
Abstract
Purpose Pituitary macroadenoma consistency can influence the ease of lesion removal during surgery, especially when using a transsphenoidal approach. Unfortunately, it is not assessable on standard qualitative MRI. Radiomic texture analysis could help in extracting mineable quantitative tissue characteristics. We aimed to assess the accuracy of texture analysis combined with machine learning in the preoperative evaluation of pituitary macroadenoma consistency in patients undergoing endoscopic endonasal surgery. Methods Data of 89 patients (68 soft and 21 fibrous macroadenomas) who underwent MRI and transsphenoidal surgery at our institution were retrospectively reviewed. After manual segmentation, radiomic texture features were extracted from original and filtered MR images. Feature stability analysis and a multistep feature selection were performed. After oversampling to balance the classes, 80% of the data was used for hyperparameter tuning via stratified 5-fold cross-validation, while a 20% hold-out set was employed for its final testing, using an Extra Trees ensemble meta-algorithm. The reference standard was based on surgical findings. Results A total of 1118 texture features were extracted, of which 741 were stable. After removal of low variance (n = 4) and highly intercorrelated (n = 625) parameters, recursive feature elimination identified a subset of 14 features. After hyperparameter tuning, the Extra Trees classifier obtained an accuracy of 93%, sensitivity of 100%, and specificity of 87%. The area under the receiver operating characteristic and precision-recall curves was 0.99. Conclusion Preoperative T2-weighted MRI texture analysis and machine learning could predict pituitary macroadenoma consistency. Electronic supplementary material The online version of this article (10.1007/s00234-020-02502-z) contains supplementary material, which is available to authorized users.
Collapse
|
|
30
|
Conficoni A, Feraco P, Mazzatenta D, Zoli M, Asioli S, Zenesini C, Fabbri VP, Cellerini M, Bacci A. Biomarkers of pituitary macroadenomas aggressive behaviour: a conventional MRI and DWI 3T study. Br J Radiol 2020; 93:20200321. [PMID: 32628097 DOI: 10.1259/bjr.20200321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Pituitary macroadenomas (PAs) are usually defined as benign intracranial tumors. However, they may present local aggressive course. High Ki67 labelling index (LI) values have been related to an aggressive tumor behavior. A recent clinicopathological classification of PA based on local invasiveness and proliferation indexes, divided them in groups with different prognosis. We evaluated the utility of conventional MRI (cMRI) and diffusion-weighted imaging (DWI), in predicting the Ki67- LI according the clinicopathological classification. METHODS 17 patients (12 M and 5 F) who underwent surgical removal of a PA were studied. cMRI features, quantification of T1W and T2W signal intensity, degree of contrast uptake (enhancement ratio, ER) and apparent diffusion coefficient (ADC) values were evaluated by using a 3 T scan. Statistics included Mann-Whitney test, Spearman's test, and receiver operating characteristic analysis. A value of p ≤ 0.05 was considered significant for all the tests. RESULTS Negative correlations were observed between Ki-67 LI, ADCm (ρ = - 0.67, p value = 0.005) and ER values (ρ = -0.62; p = 0.008). ER values were significantly lower in the proliferative PA group (p = 0.028; p = 0.017). ADCm showed sensitivity and specificity of 90 and 85% respectively into predict Ki67-LI value. A value of ADCm ≤0, 711 x 10-6 mm2 emerged as a cut-off of a value of Ki67-LI ≥ 3%. CONCLUSION Adding quantitative measures of ADC values to cMRI could be used routinely as a non-invasive marker of specific predictive biomarker of the proliferative activity of PA. ADVANCES IN KNOWLEDGE Routinely use of DWI on diagnostic work-up of pituitary adenomas may help in establish the likely biological aggressive lesions.
Collapse
Affiliation(s)
- Alberto Conficoni
- Department of Radiology, Neuroradiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 44124 Ferrara, Italy.,Department of Neuroradiology, Ospedale Bellaria, IRCCS Institute of Neurological Sciences of Bologna, Via Altura, 3; 40100 Bolgona, Italy
| | - Paola Feraco
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via S. Giacomo 14, 40138 Bologna, Italy.,Department of Neuroradiology, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari, Largo medaglie d'oro 9, 38122 , Trento, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM) of Neurological Sciences of Bologna, Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, Bologna, Italy
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM) of Neurological Sciences of Bologna, Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, Bologna, Italy
| | - Sofia Asioli
- Section of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Bologna, Italy, Via Altura9; 40100 Bolgona, Italy
| | - Corrado Zenesini
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Viscardo Paolo Fabbri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via S. Giacomo 14, 40138 Bologna, Italy.,Section of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Bologna, Italy, Via Altura9; 40100 Bolgona, Italy
| | - Martino Cellerini
- Department of Neuroradiology, Ospedale Bellaria, IRCCS Institute of Neurological Sciences of Bologna, Via Altura, 3; 40100 Bolgona, Italy
| | - Antonella Bacci
- Department of Neuroradiology, Ospedale Bellaria, IRCCS Institute of Neurological Sciences of Bologna, Via Altura, 3; 40100 Bolgona, Italy
| |
Collapse
|
|
31
|
Ko CC, Chen TY, Lim SW, Kuo YT, Wu TC, Chen JH. Prediction of recurrence in solid nonfunctioning pituitary macroadenomas: additional benefits of diffusion-weighted MR imaging. J Neurosurg 2020; 132:351-359. [PMID: 30717054 DOI: 10.3171/2018.10.jns181783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A subset of benign, nonfunctioning pituitary macroadenomas (NFMAs) has been shown to undergo early progression/recurrence (P/R) during the first years after surgical resection. The aim of this study was to determine preoperative MR imaging features for the prediction of P/R in benign solid NFMAs, with emphasis on apparent diffusion coefficient (ADC) values. METHODS We retrospectively investigated the preoperative MR imaging features for the prediction of P/R in benign solid NFMAs. Only the patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year (at least every 6-12 months) were included. From November 2010 to December 2016, a total of 30 patients diagnosed with benign solid NFMAs were included (median follow-up time 45 months), and 19 (63.3%) patients had P/R (median time to P/R 24 months). RESULTS Benign solid NFMAs with cavernous sinus invasion, failed chiasmatic decompression, large tumor height and tumor volume, high diffusion-weighted imaging (DWI) signal, and lower ADC values/ratios were significantly associated with P/R (p < 0.05). The cutoff points of ADC value and ADC ratio for prediction of P/R are 0.77 × 10-3 mm2/sec and 1.01, respectively, with area under the curve (AUC) values (0.9 and 0.91) (p < 0.01). In multivariate Cox proportional hazards analysis, low ADC value (< 0.77 × 10-3 mm2/sec) is a high-risk factor of P/R (p < 0.05) with a hazard ratio of 14.07. CONCLUSIONS Benign solid NFMAs with low ADC values/ratios are at a significantly increased risk of P/R, and aggressive treatments accompanied by close follow-up with imaging studies should be considered.
Collapse
Affiliation(s)
- Ching-Chung Ko
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Tai-Yuan Chen
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan
- 2Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan
| | - Sher-Wei Lim
- 3Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan
- 4Department of Nursing, Min-Hwei College of Health Care Management, Tainan
| | - Yu-Ting Kuo
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan
- 5Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Te-Chang Wu
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan
- 6Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei
| | - Jeon-Hor Chen
- 7Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; and
- 8Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, California
| |
Collapse
|
|
32
|
Chen XY, Ding CY, You HH, Chen JY, Jiang CZ, Yan XR, Lin ZY, Kang DZ. Relationship Between Pituitary Adenoma Consistency and Extent of Resection Based on Tumor/Cerebellar Peduncle T2-Weighted Imaging Intensity (TCTI) Ratio of the Point on Preoperative Magnetic Resonance Imaging (MRI) Corresponding to the Residual Point on Postoperative MRI. Med Sci Monit 2020; 26:e919565. [PMID: 31904008 PMCID: PMC6977630 DOI: 10.12659/msm.919565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Controversies exist in imaging modalities for predicting adenoma consistency. In this study, we proposed a method of predicting consistency by magnetic resonance T2-sequence imaging based on adenoma to cerebellar peduncle signal (TCTI) ratio. Material/Methods Between January 2013 and May 2017, 191 consecutive patients with pituitary adenoma diagnosed at our institution were retrospectively studied. The consistency grade for each lesion was assigned. And the TCTI ratio based on preoperative and postoperative T2-weighted imaging was calculated. Results The median TCTI ratio was 1.55, 1.28, and 1.25 for soft, fibrous, and hard adenomas, respectively. The differences were significant for all groups (p<0.001). A cutoff value of 1.38 for soft adenomas was found to be 80.2% sensitive and 88.7% specific. The median ratio of the outermost layer of residual tumor was 1.25 (SD±0.408, 95% CI 1.27–1.42). It was less than that ratio of the upper, lower quarter, and middle region of adenoma, respectively, and the inter-group differences were all statistically significant with p≤0.001. The extent of resection for the soft group was significantly greater than that of the hard group (85.3% vs. 70.6%, p=0.011). Analysis of Variance (ANOVA) revealed that the consistency grade was the influencing factor of degree of resection. p=0.003. Conclusions The TCTI ratio showed a good correlation with pituitary adenoma consistency. We also determined the optimal ratio of the residual adenoma.
Collapse
Affiliation(s)
- Xiao-Yong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Chen-Yu Ding
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Hong-Hai You
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Jin-Yuan Chen
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Chang-Zhen Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Xiao-Rong Yan
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Zhang-Ya Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| |
Collapse
|
|
33
|
Su CQ, Zhang X, Pan T, Chen XT, Chen W, Duan SF, Ji J, Hu WX, Lu SS, Hong XN. Texture Analysis of High b-Value Diffusion-Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas. J Magn Reson Imaging 2019; 51:1507-1513. [PMID: 31769565 DOI: 10.1002/jmri.26941] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Preoperative evaluation of the consistency of pituitary macroadenomas is important for neurosurgeons to prepare the surgical plan. PURPOSE To evaluate the diagnostic performance of texture analysis (TA) of diffusion-weighted imaging (DWI) at a standard b-value (b = 1000 s/mm2 ) and a high b-value (b = 2000 s/mm2 ) for their ability to assess the tumor consistency of pituitary macroadenomas. STUDY TYPE Retrospective. POPULATION/SUBJECTS Fifty patients with histologically confirmed pituitary macroadenomas were classified as soft (n = 37) or hard (n = 13) types. FIELD STRENGTH/SEQUENCE Coronal T2 -weighted imaging (T2 WI), Readout Segmentation of Long Variable Echo-trains (RESOLVE) DWI at b = 1000 s/mm2 and b = 2000 s/mm2 were acquired with 3.0T MRI. ASSESSMENT The corresponding apparent diffusion coefficient (ADC) maps (ADC1000 and ADC2000 ) were registered to T2 WI. Regions of interest (ROIs) were manually drawn along the solid part of the tumor from the coregistered T2 WI-ADC images. The texture parameters from T2 WI, ADC1000 , and ADC2000 were acquired. STATISTICAL TESTS The texture parameters were compared between the two types by using unpaired Student's t-test. Receiver operating characteristic (ROC) curves and logistic regression analyses were used to assess their diagnostic performance. RESULTS Significant differences in TA parameters of ADC1000 and ADC2000 were observed between soft and hard types (P < 0.05 for all), whereas the TA of T2 WI resulted in no significant difference (P > 0.05 for all). TA of ADC2000 provided a superior diagnostic performance compared with that of ADC1000 (P = 0.038). A combination of mean value and entropy of ADC2000 yielded an AUC, a sensitivity, and a specificity of 0.911, 78.4% and 92.3%, respectively. DATA CONCLUSION TA of ADC values were useful for assessing the tumor consistency of pituitary macroadenomas. ADC2000 may facilitate better type discrimination. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1507-1513.
Collapse
Affiliation(s)
- Chun-Qiu Su
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Zhang
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Pan
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Tian Chen
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Jing Ji
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Xing Hu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shan-Shan Lu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xun-Ning Hong
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
|
34
|
Khant ZA, Azuma M, Kadota Y, Hattori Y, Takeshima H, Yokogami K, Watanabe T, Enzaki M, Nakaura T, Hirai T. Evaluation of pituitary structures and lesions with turbo spin-echo diffusion-weighted imaging. J Neurol Sci 2019; 405:116390. [PMID: 31476623 DOI: 10.1016/j.jns.2019.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Turbo spin-echo diffusion-weighted imaging (TSE-DWI) has not been used for evaluating pituitary lesions. We compared the usefulness of TSE-DWI and echo-planar (EP)-DWI for assessing normal pituitary structures and lesions. MATERIALS AND METHODS Our study included 41 consecutive patients (27 pituitary adenomas, 8 Rathke's cleft cysts, 4 craniopharyngiomas, 1 germinoma, 1 pituitary metastasis) who underwent conventional pre- and post-contrast magnetic resonance imaging (MRI) and TSE- and EP-DWI at 3T. Two observers independently performed qualitative assessment of normal pituitary structures and lesions on sagittal DWI and apparent diffusion coefficient (ADC) maps. One observer recorded ADC values of normal brain structures and pituitary lesions. Kappa (κ) statistics, Wilcoxon signed-rank test, intraclass correlation coefficient, Bland-Altman analysis, Pearson correlation coefficient and independent t-test were used for statistical analysis. RESULTS Interobserver agreement for qualitative evaluations was good to excellent (κ = 0.65-1.0). On both DWI and ADC maps, visualization of the pituitary gland, of the spatial relationship between the lesion and its normal surroundings, and the whole image quality were significantly better on TSE- than EP sequences (p < .01). In normal brain structures, the ADC value on TSE- and EP-sequences was significantly correlated (r = 0.6979, p < .05). The TSE-ADC value was significantly lower for pituitary adenomas than craniopharyngiomas (p < .05). CONCLUSIONS For the evaluation of normal pituitary structures and lesions, TSE-DWI is more useful than EP-DWI. The TSE-ADC value may help to differentiate between pituitary adenoma and craniopharyngioma.
Collapse
Affiliation(s)
- Zaw Aung Khant
- Department of Radiology, University of Miyazaki, Miyazaki, Japan
| | - Minako Azuma
- Department of Radiology, University of Miyazaki, Miyazaki, Japan.
| | - Yoshihito Kadota
- Department of Radiology, University of Miyazaki, Miyazaki, Japan
| | - Youhei Hattori
- Department of Radiology, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, University of Miyazaki, Miyazaki, Japan
| | | | - Takashi Watanabe
- Department of Neurosurgery, University of Miyazaki, Miyazaki, Japan
| | - Masahiro Enzaki
- Radiology Section, Miyazaki University Hospital, Miyazaki, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Radiology, University of Miyazaki, Miyazaki, Japan
| |
Collapse
|
|
35
|
Barile A, Brunese L, Giovagnoni A. Gland diseases: new perspectives in diagnostic radiology. Gland Surg 2019; 8:S126-S129. [PMID: 31559178 DOI: 10.21037/gs.2019.03.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Luca Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica Delle Marche, Ancona, Italy.
| |
Collapse
|
|
36
|
Varrassi M, Cobianchi Bellisari F, Bruno F, Palumbo P, Natella R, Maggialetti N, De Filippo M, Di Cesare E, Barile A, Masciocchi C, Caranci F, Splendiani A. High-resolution magnetic resonance imaging at 3T of pituitary gland: advantages and pitfalls. Gland Surg 2019; 8:S208-S215. [PMID: 31559187 DOI: 10.21037/gs.2019.06.08] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is the primary imaging tool for the evaluation of pituitary gland pathology. In the last decades, MRI with high-field scanners has become widely used in clinical practice, leading to significant improvements in image quality mainly thanks to a superior spatial resolution and signal intensity. Moreover, several advanced functional MRI sequences have been implemented for pituitary imaging, providing valuable information in diagnostic and presurgical planning of pituitary adenomas. Higher field strength presents however some technical pitfalls to be aware of. The purpose of this article is to review the state of the art of high-resolution MRI of the pituitary gland at 3 Tesla (3T), with a particular focus on the main benefits and the possible limitations of higher field imaging.
Collapse
Affiliation(s)
- Marco Varrassi
- Radiology Department, S. Salvatore Hospital, L'Aquila, Italy
| | | | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Natella
- Radiology Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Maggialetti
- Department of Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | | | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
|
37
|
Yun JJ, Johans SJ, Shepherd DJ, Martin B, Joyce C, Borys E, Reddy AS, Patel CR, Germanwala AV. The Utility of Using Preoperative MRI as a Predictor for Intraoperative Pituitary Adenoma Consistency and Surgical Resection Technique. J Neurol Surg B Skull Base 2019; 81:651-658. [PMID: 33381369 DOI: 10.1055/s-0039-1694049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objective Most pituitary adenomas are of soft consistency and can be resected during surgery with routine suction instruments. However, fibrous adenomas may require more aggressive techniques. The ability to predict consistency on magnetic resonance imaging (MRI) would improve preoperative preparation and may have implications on the extent of resection. Design A retrospective review of MRI and tumor histology of 50 consecutive patients who underwent endoscopic endonasal resection for nonfunctional adenomas was performed. Methods An intensity ratio was calculated based on quantitative MRI signal intensity of the adenoma and pons. Intraoperatively, a sequentially graded technique required for resection ranged from suction (R1) for softer tumors, curettes (R2) for tumors with intermediate consistency, and aspirators and/or other microinstruments (R3) for firmer tumors. Fibrotic content was determined from histologic collagen percentage, and rates of gross total resection (GTR) were calculated from postoperative imaging. Statistical analyses were performed to determine if resection classification could be predicted by intensity ratio or collagen percentage, calculate ratio of cut-off points for clinical use, and assess for correlation between intensity ratios and collagen percentage. Results Tumors with ratios < 1.6 on the T2-weighted coronal image and collagen content > 5.3% were likely to have required a more aggressive resection technique. Statistically significant lower rates of GTR and higher rates of perioperative complications were seen with such tumors. Conclusion Preoperative MRI analyses can be helpful but not definitive in predicting adenoma consistency. Fibrous adenomas, associated with higher collagen content, are more difficult to resect and have higher rates of subtotal resection.
Collapse
Affiliation(s)
- Jonathan J Yun
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Stephen J Johans
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Daniel J Shepherd
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Brendan Martin
- Clinical Research Office, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, United States
| | - Cara Joyce
- Clinical Research Office, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, United States
| | - Ewa Borys
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States.,Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States
| | - A Suresh Reddy
- Edward Hines, Jr. VA Hospital, Hines, Illinois, United States
| | - Chirag R Patel
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States.,Edward Hines, Jr. VA Hospital, Hines, Illinois, United States.,Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Anand V Germanwala
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States.,Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States.,Edward Hines, Jr. VA Hospital, Hines, Illinois, United States.,Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| |
Collapse
|
|
38
|
Kim HY, Kim ST, Kim HJ, Jeon P, Byun HS, Kim YK, Cha J, Park GM, Nam DH, Kong DS. Differentiation of postoperative changes and residual tumors in dynamic contrast-enhanced sella MRI after transsphenoidal resection of pituitary adenoma. Medicine (Baltimore) 2019; 98:e16089. [PMID: 31277105 PMCID: PMC6635295 DOI: 10.1097/md.0000000000016089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To establish magnetic resonance imaging (MRI) features that differentiate residual tumors from postoperative surgical changes following the transsphenoidal approach of a pituitary adenoma.We analyzed residual enhancements at the tumor bed in 52 patients who underwent dynamic contrast-enhanced sella MRI within 48 hours after surgery and at 6 to 28 months. Patients were divided into 2 groups defined by either peripheral or nodular enhancement patterns. For each group, we measured the maximum thickness of the residual enhancing portion and compared differences in the residual tumor and postoperative changes.Among the tumors examined in the 52 patients, 19 residual tumors showed nodular (n = 16) and peripheral (n = 3) enhancement patterns, and 33 postoperative changes showed nodular (n = 3) and peripheral (n = 30) enhancement patterns. The mean residual tumor thickness was 7.1 mm (range, 2.9-16.8 mm) and 1.9 mm (range, 1.0-7.4 mm) in the postoperative change. Receiver operating characteristic curve analysis revealed that a 3.9-mm thickness was associated with 89% sensitivity, 97% specificity, and 94% accuracy for diagnosis of residual tumor.On immediate postoperative MRI, residual enhancement with greater than 3.9-mm thickness and nodular pattern suggest residual pituitary adenoma tumor.
Collapse
Affiliation(s)
- Ha Youn Kim
- Department of Radiology, Eulji University Hospital, Daejeon
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hong Sik Byun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yi Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jihoon Cha
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Gyeong Min Park
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
|
39
|
Masuda H, Nemoto M, Harada N, Fuchinoue Y, Okonogi S, Node Y, Ando S, Kondo K, Sugo N. Comparison of quantitative measurements of central nervous system tumour consistency and the associated preoperative imaging findings. Br J Neurosurg 2019; 33:522-527. [DOI: 10.1080/02688697.2019.1617405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hiroyuki Masuda
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Masaaki Nemoto
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yutaka Fuchinoue
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Shinichi Okonogi
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yasuhiro Node
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Shunpei Ando
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| |
Collapse
|
|
40
|
Zeynalova A, Kocak B, Durmaz ES, Comunoglu N, Ozcan K, Ozcan G, Turk O, Tanriover N, Kocer N, Kizilkilic O, Islak C. Preoperative evaluation of tumour consistency in pituitary macroadenomas: a machine learning-based histogram analysis on conventional T2-weighted MRI. Neuroradiology 2019; 61:767-774. [PMID: 31011772 DOI: 10.1007/s00234-019-02211-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the potential value of machine learning (ML)-based histogram analysis (or first-order texture analysis) on T2-weighted magnetic resonance imaging (MRI) for predicting consistency of pituitary macroadenomas (PMA) and to compare it with that of signal intensity ratio (SIR) evaluation. METHODS Fifty-five patients with 13 hard and 42 soft PMAs were included in this retrospective study. Histogram features were extracted from coronal T2-weighted original, filtered and transformed MRI images by manual segmentation. To achieve balanced classes (38 hard vs 42 soft), multiple samples were obtained from different slices of the PMAs with hard consistency. Dimension reduction was done with reproducibility analysis, collinearity analysis and feature selection. ML classifier was artificial neural network (ANN). Reference standard for the classifications was based on surgical and histopathological findings. Predictive performance of histogram analysis was compared with that of SIR evaluation. The main metric for comparisons was the area under the receiver operating characteristic curve (AUC). RESULTS Only 137 of 162 features had excellent reproducibility. Collinearity analysis yielded 20 features. Feature selection algorithm provided six texture features. For histogram analysis, the ANN correctly classified 72.5% of the PMAs regarding consistency with an AUC value of 0.710. For SIR evaluation, accuracy and AUC values were 74.5% and 0.551, respectively. Considering AUC values, ML-based histogram analysis performed better than SIR evaluation (z = 2.312, p = 0.021). CONCLUSION ML-based T2-weighted MRI histogram analysis might be a useful technique in predicting the consistency of PMAs, with a better predictive performance than that of SIR evaluation.
Collapse
Affiliation(s)
- Amalya Zeynalova
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Emine Sebnem Durmaz
- Department of Radiology, Buyukcekmece Mimar Sinan State Hospital, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kerem Ozcan
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gamze Ozcan
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Okan Turk
- Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
|
41
|
Alimohamadi M, Sanjari R, Shirani M, Alikhani F, Amirjamshidi A. Initial Experience with Diffusion-weighted Imaging to Predict the Tumor Consistency and Surgical Success in Solid Growth Hormone Producing Pituitary Macroadenomas. Asian J Neurosurg 2019; 14:698-701. [PMID: 31497087 PMCID: PMC6702998 DOI: 10.4103/ajns.ajns_56_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Tumor consistency is an important factor impeding transsphenoidal resection of some pituitary macroadenomas. Preoperative prediction of the tumor consistency may help neurosurgeons in preparing the patients for other therapeutic options after a subtotally resected growth hormone (GH)-producing macroadenoma. We present the preliminary results of our study about the application of the preoperative diffusion-weighted (DW) magnetic resonance imaging (MRI) to predict the consistency and resection rate of GH-producing pituitary macroadenomas. Materials and Methods: Sixteen primary patients with solid GH-producing pituitary macroadenomas were enrolled. Hormonal assays as well as standard and DW-MRI were obtained before surgery. All the patients were operated via an endoscopic transsphenoidal approach. The intraoperative tumor consistencies (suctionable versus nonsuctionable) were documented. The samples were stained for measurement of the collagen content (low, moderate, and high). Postoperative hormonal study and MRI were performed after 8 weeks to evaluate the resection ratio and the hormonal remission. Results: On DW images, the tumor diffusion was enhanced (free) in four, moderate in ten, and restricted in two patients. The tumor was suctionable in 14 cases; gross total resection and hormonal remission were achieved in 12/14 of these. All the 14 suctionable tumors had moderate to enhanced diffusion on DW imaging (DWI). The two patients with a nonsuctionable fibrous tumor had a restricted diffusion in DWI. These were the only ones to have high collagen content in the histopathologic study. Conclusion: DWI could help identify the fibrous nonsuctionable GH-producing adenomas from the others.
Collapse
Affiliation(s)
- Maysam Alimohamadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Sanjari
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Shirani
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Alikhani
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
42
|
Fan Y, Hua M, Mou A, Wu M, Liu X, Bao X, Wang R, Feng M. Preoperative Noninvasive Radiomics Approach Predicts Tumor Consistency in Patients With Acromegaly: Development and Multicenter Prospective Validation. Front Endocrinol (Lausanne) 2019; 10:403. [PMID: 31316464 PMCID: PMC6611436 DOI: 10.3389/fendo.2019.00403] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Prediction of tumor consistency before surgery is of vital importance to determine individualized therapeutic schemes for patients with acromegaly. The present study was performed to noninvasively predict tumor consistency based on magnetic resonance imaging and radiomics analysis. Methods: In total, 158 patients with acromegaly were randomized into the primary cohort (n = 100) and validation cohort (n = 58). The consistency of the tumor was classified as soft or firm according to the neurosurgeon's evaluation. The critical radiomics features were determined using the elastic net feature selection algorithm, and the radiomics signature was constructed. The most valuable clinical characteristics were then selected based on the multivariable logistic regression analysis. Next, a radiomics model was developed using the radiomics signature and clinical characteristics, and 30 patients with acromegaly were recruited for multicenter validation of the radiomics model. The model's performance was evaluated based on the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), accuracy, and other associated classification measures. Its calibration, discriminating capacity, and clinical usefulness were also evaluated. Results: The radiomics signature established according to four radiomics features screened in the primary cohort exhibited excellent discriminatory capacity in the validation cohort. The radiomics model, which incorporated both the radiomics signature and Knosp grade, displayed favorable discriminatory capacity and calibration, and the AUC was 0.83 (95% confidence interval, 0.81-0.85) and 0.81 (95% confidence interval, 0.78-0.83) in the primary and validation cohorts, respectively. Furthermore, compared with the clinical characteristics, the as-constructed radiomics model is more effective in prediction of the tumor consistency in patients with acromegaly. Moreover, the multicenter validation and decision curve analysis suggested that the radiomics model was clinically useful. Conclusions: This radiomics model can assist neurosurgeons in predicting tumor consistency in patients with acromegaly before surgery and facilitates the determination of individualized therapeutic schemes.
Collapse
Affiliation(s)
- Yanghua Fan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Hua
- School of Electrical Engineering and Automation, East China Jiaotong University, Nanchang, China
| | - Anna Mou
- Department of Radiology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Miaojing Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaohai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Renzhi Wang
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Ming Feng ;
| |
Collapse
|
|
43
|
Sanei Taheri M, Kimia F, Mehrnahad M, Saligheh Rad H, Haghighatkhah H, Moradi A, Kazerooni AF, Alviri M, Absalan A. Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency. Neuroradiol J 2018; 32:74-85. [PMID: 30501465 DOI: 10.1177/1971400918809825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the accuracy of selected first or second-order histogram features in differentiation of functional types of pituitary macro-adenomas. MATERIALS AND METHODS Diffusion-weighted imaging magnetic resonance imaging was performed on 32 patients (age mean±standard deviation = 43.09 ± 11.02 years; min = 22 and max = 65 years) with pituitary macro-adenoma (10 with functional and 22 with non-functional tumors). Histograms of apparent diffusion coefficient were generated from regions of interest and selected first or second-order histogram features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and graded as containing <1%, 1-3%, and >3% of collagen. RESULTS Among selected first or second-order histogram features, uniformity ( p = 0.02), 75th percentile ( p = 0.03), and tumor smoothness ( p = 0.02) were significantly different between functional and non-functional tumors. Tumor smoothness > 5.7 × 10-9 (area under the curve = 0.75; 0.56-0.89) had 70% (95% confidence interval = 34.8-93.3%) sensitivity and 33.33% (95% confidence interval = 14.6-57.0%) specificity for diagnosis of functional tumors. Uniformity ≤179.271 had a sensitivity of 60% (95% confidence interval = 26.2-87.8%) and specificity of 90.48% (95% confidence interval = 69.6-98.8%) with area under the curve = 0.76; 0.57-0.89. The 75th percentile >0.7 had a sensitivity of 80% (95% confidence interval = 44.4-97.5%) and specificity of 66.67% (95% confidence interval = 43.0-85.4%) for categorizing tumors to functional and non-functional types (area under the curve = 0.74; 0.55-0.88). Using these cut-offs, smoothness and uniformity are suggested as negative predictive indices (non-functional tumors) whereas 75th percentile is more applicable for diagnosis of functional tumors. CONCLUSION First or second-order histogram features could be helpful in differentiating functional vs non-functional pituitary macro-adenoma tumors.
Collapse
Affiliation(s)
| | - Farnaz Kimia
- 1 Department of Radiology, Shahid Beheshti University of Medical Sciences, Iran
| | - Mersad Mehrnahad
- 1 Department of Radiology, Shahid Beheshti University of Medical Sciences, Iran
| | - Hamidreza Saligheh Rad
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | | | - Afshin Moradi
- 3 Department of Pathology, Shahid Beheshti University of Medical Sciences, Iran
| | - Anahita Fathi Kazerooni
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | - Mohammadreza Alviri
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | - Abdorrahim Absalan
- 4 Department of Medical Laboratory Sciences, Khomein University of Medical Sciences, Markazi Province, Iran
| |
Collapse
|
|
44
|
Mastorakos P, Mehta GU, Chatrath A, Moosa S, Lopes MB, Payne SC, Jane JA. Tumor to Cerebellar Peduncle T2-Weighted Imaging Intensity Ratio Fails to Predict Pituitary Adenoma Consistency. J Neurol Surg B Skull Base 2018; 80:252-257. [PMID: 31143567 DOI: 10.1055/s-0038-1668516] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022] Open
Abstract
Object The consistency of pituitary macroadenomas affects the complexity of surgical resection. On T2-weighted (T2W) imaging, the intensity ratio of the tumor to the cerebellar peduncle (tumor to cerebellar peduncle T2-weighted imaging intensity [TCTI] ratio) correlates with meningioma consistency. We aimed to determine the correlation of this radiographic finding with pituitary macroadenoma consistency and to determine whether it can be used for preoperative planning. Methods We performed a retrospective evaluation of 196 patients with macroadenomas who underwent endoscopic transsphenoidal resection from January 2012 to June 2017. Macroadenoma consistency was determined by one senior neurosurgeon at the time of surgery. Axial and coronal T2W magnetic resonance imaging images were evaluated retrospectively, and adenoma size, Knosp grade, suprasellar extension and TCTI were calculated. Results The mean TCTI ratio was 1.70 (95% confidence interval [CI]: 1.65-1.75). Intraoperatively, 140 (71.4%) adenomas were classified as soft and 48 (24.5%) as fibrous. Gross total resection was achieved in 66.7% of fibrous adenomas and in 86.4% of soft adenomas ( p = 0.007). The mean ratio was 1.68 (95% CI: 1.62-1.74) for soft tumors and 1.76 (95%CI: 1.67-1.84) for fibrous tumors. There was no difference in the mean TCTI ratio between groups. Lactotroph and somatotroph adenomas had a lower mean TCTI ratio compared with other functioning and nonfunctioning adenomas with a mean TCTI of 1.52 compared with 1.77. Conclusions In this retrospective cohort study, we found that the TCTI ratio does not correlate with tumor consistency. We also noted that the TCTI ratio is increased in prolactin and growth hormone-secreting adenomas.
Collapse
Affiliation(s)
- Panagiotis Mastorakos
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States.,Department of Neurological Surgery, NIH/NINDS, Bethesda, Maryland, United States
| | - Gautam U Mehta
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States.,Department of Neurological Surgery, NIH/NINDS, Bethesda, Maryland, United States.,Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Ajay Chatrath
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States
| | - Maria-Beatriz Lopes
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States.,Department of Neuroathology, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States
| | - Spencer C Payne
- Department of Otolaryngology, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States
| |
Collapse
|
|
45
|
Onofrj V, Vallejo C, Puac P, Zamora C, Castillo M. Relationship between postoperative volume of macroadenomas and clinical outcome after endoscopic trans-sphenoidal resection. Neuroradiol J 2018; 31:565-571. [PMID: 30091660 DOI: 10.1177/1971400918791699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Although symptoms are expected to improve after the resection of pituitary macroadenomas, tumor resection volume does not always correlate with the patient's symptoms. Our objectives were to assess the pre and postoperative volumes of pituitary macroadenomas before, immediately after surgery and at follow-up, and to explore possible associations and correlations among these changes and symptoms. MATERIALS AND METHODS We retrospectively reviewed the clinical records and the preoperative and postoperative magnetic resonance imaging studies at 24 hours and at 3, 6 and 9 months follow-up of 146 patients who underwent surgery for pituitary macroadenomas. We measured tumor volumes before and after surgery and compared changes with symptom improvement. RESULTS The mean preoperative tumor volume was 24.66 cm3 (standard deviation 65.18 cm3, 95% confidence interval (CI) 14-35.32). The most common symptoms were visual/cranial nerve abnormalities (65%) and headaches (56%). Immediately after surgery, symptoms persisted without significant changes in all patients. A progressive tumor volume decrease was noted during follow-up, and symptoms improved in 78% of patients. Despite no imaging evidence of chiasm or cavernous sinus compression, 32 patients showed no symptom improvement. Patients with symptoms for more than 1 year (mean duration of symptoms 26 months, SD 24.3, 95% CI 22.03-29.97 months) had a higher risk of the persistence of symptoms compared to patients with a mean duration of symptoms of less than 1 year (odds ratio 2.5, 95% CI 2.4-3, P < 0.005). CONCLUSIONS The duration of symptoms prior of surgery is a more important factor than tumor resection volume alone when considering the long-term outcome of symptoms. Furthermore, lack of symptom improvement in the immediate postoperative period does not necessarily represent an inadequate resection.
Collapse
Affiliation(s)
- Valeria Onofrj
- 1 Department of Radiology, University of North Carolina Hospitals, USA
| | - Carina Vallejo
- 2 Department of Radiology, Clinica Santiago de Leon, Venezuela
| | - Paulo Puac
- 3 Department of Radiology, Sanatorio El Pilar, Guatemala
| | - Carlos Zamora
- 1 Department of Radiology, University of North Carolina Hospitals, USA
| | - Mauricio Castillo
- 1 Department of Radiology, University of North Carolina Hospitals, USA
| |
Collapse
|
|
46
|
Wang M, Liu H, Wei X, Liu C, Liang T, Zhang X, Jin C, Li X, Sun Q, Jiang H, Yang J. Application of Reduced-FOV Diffusion-Weighted Imaging in Evaluation of Normal Pituitary Glands and Pituitary Macroadenomas. AJNR Am J Neuroradiol 2018; 39:1499-1504. [PMID: 30026383 DOI: 10.3174/ajnr.a5735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE FOV optimized and constrained undistorted single-shot imaging provides relatively high-resolution images with few artifacts. This study evaluated the image quality and value of FOV optimized and constrained undistorted single-shot DWI in the evaluation of normal pituitary glands and pituitary macroadenomas. MATERIALS AND METHODS Subjects with normal pituitary glands and patients with pituitary macroadenomas underwent FOV optimized and constrained undistorted single-shot and EPI DWI. Two neuroradiologists graded the image quality based on visualization of the pituitary stalk, pituitary gland, and pituitary macroadenoma. Intra- and interobserver agreements were assessed by κ statistics. Image quality and ADCs were compared between the 2 methods by the paired Wilcoxon signed rank test and t test. Differences in ADC between normal pituitary glands and macroadenomas were analyzed by the independent-samples t test. RESULTS Twenty-eight subjects with normal pituitary glands and 16 patients with macroadenomas were enrolled. Intra- and interobserver agreements for image-quality assessment were moderate to substantial. Relative to EPI DWI, FOV optimized and constrained undistorted single-shot DWI exhibited obviously better image quality both in normal pituitary glands and macroadenomas. There was no significant difference in ADCs of macroadenomas between the 2 methods. Macroadenomas with soft consistency (0.75 ± 0.14 × 10-3 mm2/s) had significantly lower mean ADC than normal pituitary glands (1.18 ± 0.19 × 10-3 mm2/s; P < .001). CONCLUSIONS FOV optimized and constrained undistorted single-shot DWI helps acquire high-resolution images of normal pituitary glands and pituitary macroadenomas with relatively few susceptibility artifacts in a clinically feasible scan time. This sequence might be helpful for evaluating the consistency of pituitary macroadenomas.
Collapse
Affiliation(s)
- M Wang
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - H Liu
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital.,Department of Biomedical Engineering (H.L., T.L., Q.L.S., H.X.J., J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - X Wei
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - C Liu
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - T Liang
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital.,Department of Biomedical Engineering (H.L., T.L., Q.L.S., H.X.J., J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - X Zhang
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - C Jin
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - X Li
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital
| | - Q Sun
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital.,Department of Biomedical Engineering (H.L., T.L., Q.L.S., H.X.J., J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - H Jiang
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital.,Department of Biomedical Engineering (H.L., T.L., Q.L.S., H.X.J., J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - J Yang
- From the Department of Diagnostic Radiology (M.M.W., H.L., X.C.W., C.C.L., T.L., X.H.Z., C.J., X.J.L., Q.L.S., H.X.J., J.Y.), the First Affiliated Hospital .,Department of Biomedical Engineering (H.L., T.L., Q.L.S., H.X.J., J.Y.), the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
|
47
|
Rutkowski MJ, Alward RM, Chen R, Wagner J, Jahangiri A, Southwell DG, Kunwar S, Blevins L, Lee H, Aghi MK. Atypical pituitary adenoma: a clinicopathologic case series. J Neurosurg 2018; 128:1058-1065. [PMID: 28598278 DOI: 10.3171/2016.12.jns162126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2004, the WHO classified atypical pituitary adenoma as a distinct adenoma subtype. However, the clinical significance of this distinction remains undetermined. The authors sought to define patient characteristics, tumor features, and treatment outcomes associated with atypical pituitary adenoma. METHODS The authors reviewed records of patients who underwent resection of pituitary adenoma at the University of California, San Francisco, between 2007 and 2014. Per institutional protocol, adenomas exhibiting mitotic activity underwent evaluation for all 3 markers of atypicality (mitotic index, extensive p53 staining, and MIB-1 index ≥ 3%). Statistical analyses were performed using χ2, Fisher's exact test, t-test, log-rank, and logistic regression. RESULTS Between 2007 and 2014, 701 patients underwent resection for pituitary adenoma. Among these patients, 122 adenomas exhibited mitotic activity and therefore were evaluated for all 3 markers of atypicality, with 36 tumors (5%) proving to be atypical. There were 21 female patients (58%) and 15 male patients (42%) in the atypical cohort, and 313 female patients (47%) and 352 male patients (53%) in the nonatypical cohort (p = 0.231). The mean age of patients in the atypical cohort was 37 years (range 10-65 years), which was significantly lower than the mean age of 49 years (range 10-93 years) for patients in the nonatypical cohort (p < 0.001). The most common presenting symptoms for patients with atypical adenomas were headaches (42%) and visual changes (33%). Atypical adenomas were more likely to be functional (78%) than nonatypical adenomas (42%; p < 0.001). Functional atypical adenomas were significantly larger than functional nonatypical adenomas (mean diameter 2.2 vs 1.4 cm; p = 0.009), as were nonfunctional atypical adenomas compared with nonfunctional nonatypical adenomas (mean diameter 3.3 vs 2.3 cm; p = 0.01). Among the entire adenoma cohort, larger presenting tumor size was associated with cavernous sinus invasion (p < 0.001), and subtotal resection was associated with cavernous sinus invasion (p < 0.001) and larger size (p < 0.001) on binomial multivariate regression. The median time until recurrence was 56 months for atypical adenomas, 129 months for functional nonatypical adenomas, and 204 months for nonfunctional nonatypical adenomas (p < 0.001). Functional atypical adenomas recurred more frequently and significantly earlier than functional nonatypical adenomas (p < 0.001). When accounting for extent of resection, cavernous sinus invasion, size, age, sex, and functional subtype, atypicality remained a significant predictor of earlier recurrence among functional adenomas (p = 0.002). CONCLUSIONS When compared with nonatypical pituitary adenomas, atypical adenomas are more likely to present in younger patients at a larger size, are more often hormonally hypersecretory, and are associated with earlier recurrence. These features lend credence to atypical pituitary adenomas being a distinct clinical entity in addition to a discrete pathological diagnosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Han Lee
- 2Neuropathology, California Center for Pituitary Disorders, University of California, San Francisco, California
| | | |
Collapse
|
|
48
|
Singh A, Grewal SS, Kumar N. Endoscopic Endo-Nasal Trans-Sphenoidal Excision of Pituitary Tumors: An Institutional Experience. Indian J Otolaryngol Head Neck Surg 2018; 70:98-101. [PMID: 29456951 PMCID: PMC5807291 DOI: 10.1007/s12070-017-1194-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/01/2017] [Indexed: 12/28/2022] Open
Abstract
To analyze the clinical presentation, management and outcomes of patients with pituitary adenoma treated by Endoscopic Endo-nasal Trans-sphenoidal (EETS) excision. Study was conducted on the basis of medical records of 14 patients who had undergone EETS excision of pituitary adenomas. The data obtained was assessed for demographic and clinical characteristics, radiographic features and post-operative outcomes. Study included 10 males and 4 females. Mean age of patients was 46.43 years (range 16-70 Years). Most common presentation was diminished vision reported in 79% patients. Features of acromegaly encountered in 21% cases. Location of majority of tumors was sellar with supra-sellar extension (71%) followed by sellar (14%), sellar with para-sellar extension (7%) and sellar with supra-sellar and para-sellar extensions (7%). Total tumor resection was achieved in 64% cases and sub-total resection in 36% cases. One of the lesions on biopsy revealed granulomatous pathology. No post-operative complication was seen in 71% patients. Transient Diabetes Insipidus was observed in 21% cases that resolved within 3-4 days. One patient expired due to meningitis and septicemia. One patient had CSF leak that was effectively managed by placing lumbar drain. There was significant improvement in visual symptoms and hormonal levels. Average hospital stay was 13.54 days and mean follow up period was 13 months. EETS approach is safe, minimally invasive and effective surgical technique for resection of pituitary adenomas with low post-operative morbidity, reduced hospital stay and better remission of symptoms.
Collapse
Affiliation(s)
- Amardeep Singh
- Department of Otorhinolaryngology, Christian Medical College and Hospital, Ludhiana, Punjab 141008 India
| | - Sarvpreet Singh Grewal
- Department of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab India
| | - Navneet Kumar
- Department of Otorhinolaryngology, Christian Medical College and Hospital, Ludhiana, Punjab 141008 India
| |
Collapse
|
|
49
|
Hassan HA, Bessar MA, Herzallah IR, Laury AM, Arnaout MM, Basha MAA. Diagnostic value of early postoperative MRI and diffusion-weighted imaging following trans-sphenoidal resection of non-functioning pituitary macroadenomas. Clin Radiol 2018; 73:535-541. [PMID: 29329735 DOI: 10.1016/j.crad.2017.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
AIM To establish the value of early contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating residual pituitary adenoma from postoperative surgical changes. MATERIALS AND METHODS Thirty patients with non-functioning pituitary macroadenomas, who were undergoing trans-sphenoidal adenomectomy, were prospectively studied. Patients were imaged with both MRI and DWI in the early postoperative period, as well as 6-months post-surgery. Patterns of postoperative contrast enhancement were described (non-enhancement, peripheral enhancement, and nodular enhancement). Apparent diffusion coefficient (ADC) maps were utilised to select the region of interest (ROI) for ADC calculations. RESULTS Seventeen patients had postoperative surgical granulation tissue and 13 had residual adenoma based on the 6 months follow-up imaging. Mean ADC values of postoperative granulation tissue and residual adenoma were 1.476±0.476×10-3 mm2/s and 0.855±0.190×10-3 mm2/s, respectively, in the early postoperative period, and 1.357±0.416×10-3 mm2/s and 0.829±0.201×10-3 mm2/s, respectively, at the 6-month follow-up. ADC values of granulation tissue were significantly different from that of residual adenoma at both time points (p<0.001). Sensitivity, specificity, positive and negative predictive values of early MRI were 84.6%, 94.1%, 91.7%, and 88.9% respectively, and of early DWI were 91%, 97%, 94.3%, and 93%, respectively. CONCLUSION Early postoperative DWI after trans-sphenoidal resection of pituitary macroadenomas may be more helpful than early MRI in differentiating residual adenoma from post-surgical changes.
Collapse
Affiliation(s)
- H A Hassan
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt.
| | - M A Bessar
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
| | - I R Herzallah
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Egypt
| | - A M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Houston, TX, USA
| | - M M Arnaout
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
| | - M A A Basha
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
| |
Collapse
|
|
50
|
Alashwah MA, Moharram MA, Allakany AS. Role of diffusion weighted magnetic resonance imaging DW-MRI in choice of the surgical approach for pituitary macroadenoma resection. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|