Pre-operative MRI predictors of hormonal remission status post pituitary adenoma resection

Braileanu, Maria; Hu, Ranliang; Hoch, M.; Mullins, Mark E.; Ioachimescu, Adriana G.; Oyesiku, Nelson M.; Pappy, Adlai; Saindane, Amit M.

doi:10.1016/j.clinimag.2019.01.020

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…The following demographic and clinical variables were included in our pituitary database: age, sex, diabetes mellitus, obesity, cardiovascular disease, hypertension, headache, visual impairment, and symptoms or signs of hypopituitarism, due to hormonal excess production. Visual involvement was defined as the presence of any degree of visual acuity compromise, from mild to severe visual acuity involvement and from partial to complete field conditions ( 9 ).…”

Section: Methodsmentioning

confidence: 99%

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

et al. 2022

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PurposeTo evaluate which radiological classification, Knosp, revised-Knosp, or Hardy–Wilson classification, is better for the prediction of surgical outcomes in the endoscopic endonasal transsphenoidal (EET) surgery of pituitary adenomas (PAs).MethodsThis is a retrospective study of patients with PAs who underwent EET PA resection for the first time between January 2009 and December 2020. Radiological cavernous sinus invasiveness was defined as a Knosp or revised-Knosp grade >2 or a grade E in the Hardy–Wilson classification.ResultsA total of 228 patients with PAs were included. Cavernous sinus invasion was evident in 35.1% and suprasellar extension was evident in 74.6%. Overall, surgical cure was achieved in 64.3% of patients. Surgical cure was lower in invasive PAs than in non-invasive PAs (28.8% vs. 83.1%, p < 0.0001), and the risk of major complications was higher (13.8% vs. 3.4%, p = 0.003). The rate of surgical cure decreased as the grade of Knosp increased (p < 0.001), whereas the risk of complications increased (p < 0.001). Patients with Knosp 3B PAs tended to achieve surgical cure less commonly than Knosp 3A PAs (30.0% vs. 56.0%, p = 0.164). Similar results were observed based on the invasion and extension of Hardy–Wilson classification (stage A–C 83.1% vs. E 28.8% p < 0.0001, grade 0–II 81.1% vs. III–IV 59.7% p = 0.008). The Knosp classification offered the greatest diagnostic accuracy for the prediction of surgical cure (AUC 0.820), whereas the invasion Hardy–Wilson classification lacked utility for this purpose (AUC 0.654).ConclusionThe Knosp classifications offer a good orientation for the estimation of surgical cure and the risk of complications in patients with PAs submitted to EET surgery. However, the invasion Hardy–Wilson scale lacks utility for this purpose.

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Section: Methodsmentioning

confidence: 99%

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

et al. 2022

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“…Knowing about these complications is the first step in preventing them (1). Timely diagnosis and effective treatment to control hormone hypersecretion and relieve mass effects along with replacement of deficient hormones are crucial to reduce these associated health risks (7), because PA invasion of local structures on MRI is associated with postoperative outcomes following surgical resection (15). We recommend the transsphenoidal surgery for GH secreting PA as a safe and effective approach.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional MRI sequences, such as contrastenhanced (CE), T1 weighted image (WI), and T2WI, are commonly used to assess adenoma characteristics such as invasion and size (15). All patients in this study were evaluated with a 1.5 T magnetic resonance imaging (MRI) unit before surgery, using T1-and T2weighted spin echo before and after the addition of gadolinium-based contrast.…”

Section: Neuroimaging Evaluationmentioning

confidence: 99%

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

Özdemi̇r

Batçık

2021

Middle Black Sea Journal of Health Science

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2014 to May 2021. All patients underwent a microscopic transnasal approach. It was aimed gross total excision of adenoma. For functioning adenomas, hormonal assessment was done on follow-up (8 weeks) and remission was said to be achieved if normal hormonal levels were achieved along with gross total tumor removal. Surgical complications were evaluated, and postoperative follow-up with laboratory and imaging studies were performed. Results: 78 patients were operated by trans nasal route in our hospital between January 2014-June 2021. Of these 78 pituitary tumors, 22 were growth hormone secreting adenoma. The study population consisted of 22 people, 11 men and 11 women, and the average age of the population was calculated as 60.45 years ± 18.4. Statistical analysis showed that the difference between the pre-operative and post-operative somamedine and growth hormone level was statistically significant Conclusions: Microscopic Trans-Sphenoidal Surgery for Acromegalic patients is a minimally invasive, safe, and efficacious choice

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“…Especially in cases of large tumors markedly displacing the optic chiasm, the normal gland tissue and neurovascular structures within the cavernous sinus, a proper correlation of intraoperative and neuronavigation images is crucial. Sequences that are able to establish high spatial resolution and therefore the possibility to better distinguish contrast difference have been investigated [22,23]. VIBE sequences have been found to reach a high spatial resolution and therefore improve the visualization of soft tissue.…”

Section: Mr Sequences For Visualization Of Sellar and Parasellar Strumentioning

confidence: 99%

“…With advancements in MRI technology, sequences have been developed that can readily identify the tumor extension into the CS as well as the CS structures in a preoperative planning setting [21,22]. Two sequences have turned out to be the most useful:…”

Section: Introductionmentioning

confidence: 99%

Optimizing MR imaging for intraoperative image guidance in sellar pathologies

et al. 2020

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Purpose With the advancement of extended endonasal approaches, the ability to surgically reach parasellar tumor extensions increase. The aim of the study was to propose an optimized imaging protocol for surgical guidance in the cavernous sinus (CS) for proper visualization structures at risk. Methods Prospective case control analysis of 20 consecutive pituitary adenoma patients scheduled for endoscopic transnasal surgery. Assessment of the capability of three different MRI sequences (MPRAGE, VIBE, CISS) by 4 investigators to correctly visualize sellar and parasellar structures. Invasiveness and position of the normal pituitary gland were compared with the intraoperative findings. Results The consensus between the 4 examiners to achieve the same results for all modalities was 40% for MPRAGE, 70% for VIBE and 60% for CISS sequences (p = 0.155). A consensus of Knosp Grade per patient was 80% for MPRAGE, 100% for VIBE and 90% for CISS (overall kappa 0.60). A higher Knosp Grade was found in MPRAGE sequences compared to the other sequences. Intraoperative status of invasiveness was correctly identified in 12/20 (60%) with MPRAGE, 19/20 (95%) with VIBE and 11/20 (55%) with CISS sequences. The position of the normal pituitary gland was most frequent evaluable in 15/20 (75%) and correctly identified in 12/15 (80%) cases. Conclusion Our data showed that VIBE sequences obtain the highest degree of consensus with intraoperative findings of invasiveness and position of the normal pituitary gland. VIBE sequences, due to their high spatial resolution and at the same time fast image acquisition could provide improved imaging for neuronavigation.

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Pre-operative MRI predictors of hormonal remission status post pituitary adenoma resection

Cited by 10 publications

References 16 publications

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

Optimizing MR imaging for intraoperative image guidance in sellar pathologies

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