Predictive value of diffusion-weighted MRI for tumor consistency and resection rate of nonfunctional pituitary macroadenomas

Alimohamadi, Maysam; Sanjari, Reza; Mortazavi, Abolghassem; Shirani, Mohamad; Tabriz, Hedieh Moradi; Kharazi, Homayoun Hadizadeh; Amirjamshidi, Abbas

doi:10.1007/s00701-014-2259-6

Cited by 44 publications

(38 citation statements)

References 19 publications

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“…Pierallini et al found that fibrous tissue and high cellularity with a low nucleus‐to‐cytoplasm ratio can produce a decrease in the SI, whereas an increase in free water may cause a large increase in the SI on T 2 WI. These results indicate that multiple factors, including fibrous content, cellularity, nuclear‐to‐cytoplasmic ratio, and amount of free water in the extracellular space, may influence the SI of the tumor on T 2 WI, which may therefore limit the diagnostic utility of T 2 WI in the assessment of consistency of macroadenomas.…”

Section: Discussionmentioning

confidence: 99%

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Texture Analysis of High b‐Value Diffusion‐Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas

Zhang

Pan

et al. 2019

Magnetic Resonance Imaging

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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/mm 2 ) and a high b-value (b = 2000 s/mm 2 ) 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 T 2 -weighted imaging (T 2 WI), Readout Segmentation of Long Variable Echo-trains (RESOLVE) DWI at b = 1000 s/mm 2 and b = 2000 s/mm 2 were acquired with 3.0T MRI. Assessment: The corresponding apparent diffusion coefficient (ADC) maps (ADC 1000 and ADC 2000 ) were registered to T 2 WI. Regions of interest (ROIs) were manually drawn along the solid part of the tumor from the coregistered T 2 WI-ADC images. The texture parameters from T 2 WI, ADC 1000 , and ADC 2000 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 ADC 1000 and ADC 2000 were observed between soft and hard types (P < 0.05 for all), whereas the TA of T 2 WI resulted in no significant difference (P > 0.05 for all). TA of ADC 2000 provided a superior diagnostic performance compared with that of ADC 1000 (P = 0.038). A combination of mean value and entropy of ADC 2000 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. ADC 2000 may facilitate better type discrimination. Level of Evidence: 3 Technical Efficacy Stage: 2 J. MAGN. RESON. IMAGING 2020;51:1507-1513.View this article online at wileyonlinelibrary.com.

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Section: Discussionmentioning

confidence: 99%

“…PITUITARY TUMORS originating from adenohypophysial cells are the most common lesions of the sella turcica, which are believed to comprise 10–15% of all primary brain tumors . The endoscopic transsphenoidal technique has been applied as a preferred minimally invasive surgical approach to remove pituitary macroadenomas .…”

mentioning

confidence: 99%

Texture Analysis of High b‐Value Diffusion‐Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas

Zhang

Pan

et al. 2019

Magnetic Resonance Imaging

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“…These systems create maps from preoperative magnetic resonance imaging (MRI) and computed tomography (CT) imaging and allow the real-time tracking of surgical instruments’ position during surgery, thereby allowing the surgeon to see what lies beyond the view of the endoscope. Together, the endoscope and navigation platform allow the surgeon better visualization of tumor boundaries 24,31 , tumor composition 1,36 , and the tumor’s relationship to nearby cranial nerves and branches of the ICA 21 . Injury to these neural and vascular structures leads to significant patient morbidity, and possibly mortality 16 .…”

Section: Introductionmentioning

confidence: 99%

First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

et al. 2017

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Background Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of skull base. In this study, we apply a 7T imaging protocol to patients with skull base tumors and compare the images to clinical standard of care. Methods Images were acquired at 7T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5T, 3T, and 7T scans for detection of intracavernous cranial nerves and ICA branches. Detection rates were compared. Images were utilized for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Results Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7T. 7T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Conclusion Our study represents the first application of 7T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7T MRI compared to 3T and 1.5 T, and found that integration of 7T into surgical planning and guidance was feasible. These results suggest a potential for 7T MRI to reduce surgical complications. Future studies comparing standardized 7T, 3T, and 1.5 T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7T MRI for endonasal endoscopic surgical efficacy.

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“…They found no correlation between the appearance of macroadenomas and T2W MRI appearance. Several of the above studies have concluded the same [6,14,15]. …”

Section: Discussionmentioning

confidence: 68%

“…Alimohamadi et al [14] found that an ADC value of 0.600-0.740 × 10-3 mm2/s was associated with more residual tumor after transsphenoidal resection. However, ADC values were not predictive of surgical consistency.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas

et al. 2016

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INTRODUCTION Most pituitary macroadenomas (PMA) are soft and suckable allowing transsphenoidal resection. A small percentage of PMA are firm, which significantly alters the time, technical difficulty, and effectiveness of transsphenoidal surgery. No current imaging technology can reliably assess PMA viscoelastic consistency in preparation for surgery. Magnetic Resonance Elastography (MRE) is a MRI-based technique that measures the propagation of mechanically induced shear waves through tissue to calculate stiffness. We prospectively evaluated MRE in 10 patients undergoing transsphenoidal resection of PMA to determine feasibility and potential usefulness. METHODS 10 patients with PMA > 2.0 cm in maximum diameter were prospectively imaged with MRE prior to transsphenoidal surgery. Mean patient age was 59.5 ± 16.2 (22-78) years. Five were female and five male. MRE was performed with a modified single-shot spin-echo echo-planar-imaging pulse sequence on a 3T MRI. MRE values were independently calculated. The surgeon, blinded to the MRE results, graded tumor consistency at surgery as soft, intermediate, or firm. Chi-squared test compared surgical grading and MRE stiffness values. RESULTS MRE was accomplished in all patients with excellent resolution. By surgical categorization, six tumors were soft and four intermediate. The mean MRE value for soft tumors was 1.38 ± 0.36 (1.08−1.87) kPa, while for intermediate tumors it was 1.94 ± 0.26 (1.72−2.32) kPa (p= 0.020). CONCLUSION Determination of PMA stiffness is feasible with MRE. There was a statistically significant difference in MRE values between soft and intermediate PMAs. Further study in a larger series is ongoing to determine whether MRE will prove useful in preoperative planning for PMA.

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Predictive value of diffusion-weighted MRI for tumor consistency and resection rate of nonfunctional pituitary macroadenomas

Abstract: DW MRI was useful to predict the tumor consistency, collagen content and the chance of removal of pituitary macroadenomas through endoscopic transsphenoidal surgery, and is recommended in the preoperative patient evaluation.

Cited by 44 publications

References 19 publications

Texture Analysis of High b‐Value Diffusion‐Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas

Texture Analysis of High b‐Value Diffusion‐Weighted Imaging for Evaluating Consistency of Pituitary Macroadenomas

First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas

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