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Predictive value of diffusion-weighted MRI for tumor consistency and resection rate of nonfunctional pituitary
Maysam Alimohamadi1, Reza Sanjari, Abolghassem Mortazavi
1Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran, alimohamadi59@gmail.com.
Backgrounds:
Firm tumor consistency is one of the most important factors that impede sufficient removal of pituitary macroademoas via a transsphenoidal approach. The utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) in predicting the tumor consistency and successfulness of transsphenoidal resection was evaluated in this study.
Methods:
Thirty consecutive primary cases of nonfunctional pituitary macroadenomas were prospectively enrolled. Conventional and DW MRI were done for all the patients and the apparent diffusion coefficient (ADC) values and the signal intensity of the solid tumor were determined. Intraoperative report of tumor consistency, the degree of fibrosis and percentage of collagen content were documented. The 8 weeks postoperative MRI was used for calculation of the tumor resection rate.
Results:
The tumor consistency was soft in 10 patients (33.3 %), intermediate in 14 patients (46.7 %) and hard in 6 patients (20 %). The mean collagen content percentage was 10, 23.5 and 66 % (p = 0.009) and the average resection rate was 75, 43 39 % in the three groups respectively (p = 0.001). The mean ADC value was not significantly correlated with the tumor consistency and resection rate. Tumors with isointense to hyperintense signal on DW MRI were more commonly removable by suction and had higher resection rates than those with hypointense signals (p = 0.019). For ADC values within the range of 600-740 × 10(-3) mm(2)/s, a residual volume larger than 20 % of the tumor was more likely.
Conclusions:
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.
Insights
Diffusion-weighted MRI (DW-MRI) helps predict pituitary macroadenoma consistency and surgical outcomes. This imaging technique aids in planning transsphenoidal surgery for better tumor removal rates.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Pituitary macroadenomas pose surgical challenges due to firm tumor consistency, hindering transsphenoidal resection.
- Diffusion-weighted magnetic resonance imaging (DW-MRI) is explored for its potential to predict tumor characteristics and surgical success.
Purpose of the Study:
- To evaluate the utility of DW-MRI in predicting pituitary macroadenoma consistency.
- To assess the correlation between DW-MRI findings and transsphenoidal resection success.
Main Methods:
- Thirty patients with nonfunctional pituitary macroadenomas underwent conventional and DW-MRI.
- Tumor consistency, collagen content, and apparent diffusion coefficient (ADC) values were analyzed.
- Postoperative MRI assessed tumor resection rates.
Main Results:
- Tumor consistency varied, with hard tumors showing higher collagen content and lower resection rates.
- DW-MRI signal intensity correlated with resectability; isointense/hyperintense tumors had higher resection rates.
- Apparent diffusion coefficient (ADC) values did not significantly correlate with consistency or resection rate, but specific ranges indicated higher residual tumor volume.
Conclusions:
- DW-MRI is a valuable tool for predicting pituitary macroadenoma consistency and collagen content.
- DW-MRI aids in estimating the likelihood of successful tumor removal via transsphenoidal surgery.
- Preoperative DW-MRI is recommended for patient evaluation in endoscopic transsphenoidal procedures.
