Testing magnetic resonance imaging parameters to predict pituitary macroadenoma consistency

Area of Science:

• Neurosurgery
• Radiology
• Oncology

Background:

• Pituitary macroadenomas (PMAs) are common tumors, with fibrous consistency posing surgical challenges.
• Accurate preoperative assessment of PMA consistency can optimize surgical planning and outcomes.

Purpose of the Study:

• To evaluate the efficacy of T2-weighted imaging (T2WI) in predicting PMA consistency.
• To compare the diagnostic performance of isolated adenoma signal intensity (SI) versus the adenoma-to-middle cerebellar peduncle (ACP) ratio for predicting PMA consistency.

Main Methods:

• Retrospective analysis of MRI scans from 45 patients with PMAs.
• Independent review by 3 blinded radiologists to measure adenoma SI and calculate the ACP ratio.
• Intraoperative neurosurgical assessment determined tumor consistency (soft or fibrous).

Main Results:

• The ACP ratio demonstrated significantly stronger discriminatory power (p < 0.0001) than isolated adenoma SI (p = 0.013) in predicting PMA consistency.
• Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.939 for the ACP ratio.
• ACP ratio thresholds >1.59 predicted soft tumors (97.3% sensitivity, 100% specificity), while <1.27 predicted fibrous tumors (100% sensitivity, 62.5% specificity).

Conclusions:

• Isolated adenoma SI on T2WI is insufficient for reliable preoperative prediction of PMA consistency.
• The ACP ratio is a highly accurate and clinically useful noninvasive imaging biomarker for preoperative assessment of PMA consistency.
• Utilizing the ACP ratio can enhance surgical planning for pituitary macroadenomas.