Diagnostic accuracy of preoperative CT scanning of pituitary prolactinomas

Between 1980 and 1985, 102 patients (84 women and 18 men) who had coronal CT scans of the sella turcica for suspected prolactin adenoma underwent transsphenoidal exploration. The CT examinations were performed with a fourth-generation EMI scanner (CT 7070), and reports of the preoperative CT examinations were compared with the findings at transsphenoidal exploration. The same neurosurgeon performed all the operations. In 97 patients distinct adenomas were found at surgery, among which were 36 macroadenomas (diameter larger than 10 mm) and 62 microadenomas (one patient had two coexisting microadenomas). All macroadenomas were identified correctly on the preoperative CT scans. Preoperative CT scans correctly localized 58 microadenomas in 57 of 62 patients, for a sensitivity rate of 91.9%; this included correct localization in four patients with recurrent microprolactinomas and in the one patient with two coexisting adenomas. Three patients in whom the adenomas were found in a location other than that reported on the preoperative CT scan were considered to have false-negative scans for the purpose of statistical calculations; two other false negatives occurred in patients whose scans had been interpreted as entirely normal and who were subsequently found to have adenomas at operation. Four patients had negative surgical explorations and the preoperative CT scan was correct in one, for a specificity of 25%. The overall accuracy rate was 92.1% for the entire group of patients and 87.7% for the subgroup of microadenomas. In our experience, coronal CT scanning has high diagnostic accuracy in patients with pituitary prolactinomas.