Synoptic reporting of pituitary magnetic resonance imaging

Pituitary adenomas are common, often asymptomatic tumours that are diagnosed incidentally by magnetic resonance imaging (MRI) of the brain. There is considerable variation in the reporting of pituitary MRI, in part because there is no consensus as to what information should be included in such reports. Synoptic reporting consists of using structured checklists to standardize communication. It has been adopted in the surgical pathology literature and more recently in the breast imaging field. The purpose of this study was to assess what parameters of a pituitary MRI report were useful to surgeons and in doing so, to propose a synoptic reporting template.

We used the Delphi technique to obtain group consensus between three neuroradiologists, three otolaryngologists and three anterior skull base neurosurgeons across three tertiary Melbourne hospitals. Answers from the three speciality groups were then converted into numerical scores for analysis.

There was statistically significant consensus between specialties over which characteristics were deemed most important. These were T1 pre- and post-contrast sequences in the coronal and sagittal planes, the degree of displacement of the optic chiasm, invasion of the medial wall of the cavernous sinus, the size and pneumatization pattern of the sphenoid sinus and the differential diagnosis of aneurysm. There were also significant differences between groups.

There are similarities and differences between what radiologists, otolaryngologists and neurosurgeons deem as important features when reporting pituitary MRI. A synoptic reporting system template is proposed to improve consistency in pituitary imaging reports.