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

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.

Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

“…The current analysis showed that adenoma consistency was associated with the occurrence of postoperative CSF leakage. Most PAs have a soft texture that can easily be resected with curettage and suction [49]. Hard (fibrous) tumors account for approximately 5%-13% of PA and are difficult to separate from critical structures, often requiring removal using sharp dissection or laser techniques [9,49].…”

“…Most PAs have a soft texture that can easily be resected with curettage and suction [49]. Hard (fibrous) tumors account for approximately 5%-13% of PA and are difficult to separate from critical structures, often requiring removal using sharp dissection or laser techniques [9,49]. Therefore, the consistency of an adenoma affects its resection success [50].…”

Application of “mosiac sign” on T2-WI in predicting the consistency of pituitary neuroendocrine tumors

“…As far as we know, currently, studies on preoperative prediction of tumor consistency have focused on imaging findings on T2-WI ( 11 , 22 ). Although there are controversies, it seems that T2-WI strongly indicates tumor consistency ( 23 ). Some studies have shown that a low signal on T2-weighted images corresponds to fibrotic tumors.…”

Risk Factors For Postoperative Cerebrospinal Fluid Leakage After Transsphenoidal Surgery For Pituitary Adenoma: A Meta-Analysis And Systematic Review

“…The current analysis showed that adenoma consistency was associated with the occurrence of postoperative CSF leakage. Most PAs have a soft texture that can easily be resected with curettage and suction [49]. Hard ( brous) tumors account for approximately 5-13% of PA and are di cult to separate from critical structures, often requiring removal using sharp dissection or laser techniques [10,49].…”

“…Most PAs have a soft texture that can easily be resected with curettage and suction [49]. Hard ( brous) tumors account for approximately 5-13% of PA and are di cult to separate from critical structures, often requiring removal using sharp dissection or laser techniques [10,49]. Therefore, the consistency of an adenoma affects its resection success [50].…”