Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?

Bladowska, Joanna; Biel, Anna; Zimny, Anna; Lubkowska, Katarzyna; Bednarek-Tupikowska, Grażyna; Sozański, Tomasz; Zaleska-Dorobisz, Urszula; Sąsiadek, Marek

doi:10.12659/msm.881966

Cited by 14 publications

(9 citation statements)

References 13 publications

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“…T2-weighted sequences have been shown to be superior for the evaluation of the sellar region. 4 In fact, Knosp and colleagues stated in their article that high-resolution T2-weighted MRI better demonstrated CSI than T1-weighted imaging in some cases, but this was not formally evaluated. 24 With newer high-resolution MRI sequences being developed, the imaging capabilities for pituitary and sellar pathologies have improved.…”

Section: Discussionmentioning

confidence: 99%

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Lang

Silva

Dai

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Preoperatively determining the extent of parasellar invasion of pituitary macroadenomas is useful for surgical planning and patient counseling. Here, the authors compared constructive interference in steady state (CISS), a T2-weighted gradient-echo MRI sequence, to volume-interpolated breath-hold examination (VIBE), a T1-weighted gradient-echo MRI sequence, for evaluation of cavernous sinus invasion (CSI) by pituitary macroadenomas. METHODS VIBE and CISS images of 98 patients with pituitary macroadenoma were retrospectively analyzed and graded using the modified Knosp classification. The Knosp grades were correlated to surgical findings of CSI, which were determined intraoperatively using 0° and 30° endoscopes. The predictive accuracies for CSI according to the Knosp grades derived from the CISS and VIBE images were compared using receiver operating characteristic (ROC) curves. Postoperative MRI was used to evaluate the gross-total resection (GTR) rates. RESULTS The CSI rate by pituitary macroadenomas was 27.6% (27 of 98 cases). Of 196 assessments (left and right sides of 98 macroadenomas), 45 (23.0%) had different Knosp grades when scored using VIBE versus CISS images. For the VIBE images, 0% of Knosp grade 0, 4.5% of grade 1, 23.8% of grade 2, 42.1% of grade 3A, 100% of grade 3B, and 83.3% of grade 4 macroadenomas were found to have CSI intraoperatively. For the CISS images, 0% of Knosp grade 0, 2.1% of grade 1, 31.3% of grade 2, 56.3% of grade 3A, 100% of grade 3B, and 100% of grade 4 macroadenomas were found to have CSI intraoperatively. Two pituitary macroadenomas were classified as grade 4 on VIBE sequences but grades 3A and 2 on CISS sequences; CSI was not observed intraoperatively in both cases. The GTR rate was 64.3% and 60.0% for high-grade (3A, 3B, and 4) macroadenomas classified using VIBE and CISS sequences, respectively. The areas under the ROC curves were 0.94 and 0.97 for VIBE- and CISS-derived Knosp grades (p = 0.007), respectively. CONCLUSIONS Knosp grades determined using CISS sequence images are better correlated with intraoperative CSI than those determined using VIBE sequence images. CISS sequences may be valuable for the preoperative assessment of pituitary macroadenomas.

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Section: Discussionmentioning

confidence: 99%

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Lang

Silva

Dai

et al. 2019

Journal of Neurosurgery

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“…Accordingly, we used a combination of preoperative MR (SE, SPGR, fSPGR), neuronavigation and iMRI. For pituitary adenoma depiction we followed current recommendations [25][26][27]. To a standard SE sequence we added SPGR, fSPGR sequences and analysis of their combinations.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging and histology correlation in Cushing's disease

Masopust

Netuka

Beneš

et al. 2017

Neurologia i Neurochirurgia Polska

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“…Delayed surveillance is performed in patients with known subtotal pituitary adenoma resection [86], nonfunctioning pituitary adenomas [87], and postresection of sellar/ suprasellar nonadenoma masses guided by tumor pathology and patient symptoms. In the immediate postoperative setting, local complications may be difficult to discern from normal postoperative changes [88,89].…”

Section: Variant 5: Adult Surveillance Postpituitary or Sellar Mass mentioning

confidence: 99%

“…MRI using high-resolution pituitary protocols is the most useful tool for diagnostic assessment following pituitary surgery. MRI with and without IV contrast adds additional information when new tumor is suspected in the setting of gross total tumor resection [86], surveillance of smaller known masses [64], and hormone-secreting microadenomas when there is an unexpected hormonal response to medical therapy. In patients with known tumors and normal hormone levels on dopamine agonist therapy, MRI follow-up may be unnecessary [96].…”

Section: Variant 5: Adult Surveillance Postpituitary or Sellar Mass mentioning

confidence: 99%

ACR Appropriateness Criteria® Neuroendocrine Imaging

Burns

Policeni

Bykowski

et al. 2019

Journal of the American College of Radiology

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Neuroendocrine dysfunction includes suspected hyper-and hypofunction of the pituitary gland. Causative lesions may include primary masses of the pituitary such as pituitary microadenomas and macroadenomas, as well as extrinsic masses, typically centered in the suprasellar cistern. Clinical syndromes related to hormonal dysfunction can be caused by excessive hormonal secretion or by inhibited secretion due to mass effect upon elements of the hypothalamic-pituitary axis. Additionally, complications such as hemorrhage may be seen in the setting of an underlying mass and can result in hormonal dysfunction. MRI with high-resolution protocols is the best firstline test to evaluate the sella turcica and parasellar region. CT provides complementary information regarding bony anatomy, and may be appropriate as a first-line test in certain instances, but it provides less detail and lesion characterization when compared to MRI.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

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Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?

Cited by 14 publications

References 13 publications

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Magnetic resonance imaging and histology correlation in Cushing's disease

ACR Appropriateness Criteria® Neuroendocrine Imaging

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