Prevalence and Imaging-Based Classification of Pituitary Adenomas with Hard Consistency: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE Transsphenoidal resection of pituitary adenomas may be difficult in patients with hard tumors. To determine the genuine incidence and performance of radiological features in diagnosing pituitary adenomas with hard consistency, we conducted a comprehensive review and meta-analysis of the literature. METHODS A literature search was conducted and publications comparing intraoperative pituitary tumor consistency and preoperative magnetic resonance imaging (MRI) were included. The authors assessed the prevalence of hard pituitary tumors using a random-effects meta-analysis and univariate analysis. RESULTS Of 916 studies, 888 were excluded. Finally, 28 trials with 1116 patients with pituitary tumors were considered. Hard-consistency tumors were adjudicated intraoperatively in 219 patients (weighted incidence, 16.82%; 95% CI, 12.35-22.48%, I2 = 65.1%). With a weighted proportion of 15%, 17 studies (60%) demonstrated a link between radiological results and intraoperative tumor consistency in at least one MRI sequence (95% CI, 10,31% - 22,70%). In 31% and 53% of the trials, apparent diffusion correlation (ADC) and T2-weighted sequences were linked to tumor consistency. Nonetheless, inconsistent signal intensities across trials make it impossible for conventional MRI sequences to correctly estimate pituitary tumor consistency. CONCLUSION In the current study population, the weighted incidence of pituitary tumors classified as having a hard consistency was 16%.