Preoperative assessment of pituitary adenoma consistency using MRI and multiparametric models: a pilot study highlighting the TCTI ratio and perivascular fibrosis
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Updated: May 28, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Joel Abraham Velazquez-Castillo1,2, Victor Ramzes Chavez-Herrera2, Martin Paredes-Cruz3
1Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
Objectives:
Intraoperative consistency (IoC) of pituitary adenomas (PAs) impacts surgical outcomes. We evaluated individual parameters and MRI multiparametric models (MPMs) using apparent diffusion coefficient (ADC), tumor to cerebellar peduncle T2-weighted intensity (TCTI) ratio, and contrast-enhanced FIESTA (CE-FIESTA) to assess IoC of PAs. Additionally, collagen content (CC) and perivascular fibrosis (PF) in tumor specimens were evaluated and compared to IoC.
Methods:
We prospectively included 27 patients who underwent preoperative MRI with ADC, TCTI ratio, and CE-FIESTA. IoC was assessed during surgical resection. Each MRI sequence and combinatorial MPMs were evaluated to identify their association with IoC. Subsequently, the degree of CC and the presence of PF in tumor samples were compared to IoC.
Results:
Individually, TCTI ratio demonstrated a statistically significant association with IoC (p = 0.049), whereas ADC and CE-FIESTA did not. Among the combinatorial strategies, the comprehensive Full-MPM (TCTI ratio + ADC + CE-FIESTA) demonstrated statistically significant association (p = 0.044). MPM1 showed a trend towards significance, while MPM2 and MPM3 did not. Histologically, high CC (p = 0.045) and the presence of PF (p = 0.03) were significantly associated with firm consistency.
Conclusions:
While multiparametric models show exploratory potential for assessing tumor consistency, their current statistical uncertainty limits definitive application. Consequently, this pilot study suggests that TCTI may represent the most practical tool for anticipating tumor firmness or confirming soft consistency. Furthermore, both high collagen content and perivascular fibrosis provide crucial histopathological anchors for the low TCTI ratios. Ultimately, these findings provide neurosurgeons with accessible imaging parameters to support preoperative planning.
Insights
The TCTI ratio MRI parameter shows promise for assessing pituitary adenoma consistency, aiding neurosurgeons in preoperative planning. Histological analysis reveals collagen content and perivascular fibrosis correlate with tumor firmness.
Area of Science:
- Neurosurgery
- Radiology
- Pathology
Background:
- Intraoperative consistency (IoC) of pituitary adenomas (PAs) is crucial for surgical outcomes.
- Assessing IoC preoperatively can optimize surgical planning and patient management.
Purpose of the Study:
- To evaluate the utility of individual MRI parameters and multiparametric models (MPMs) in assessing PA IoC.
- To correlate MRI findings with histological features like collagen content (CC) and perivascular fibrosis (PF).
Main Methods:
- Prospective inclusion of 27 patients undergoing preoperative MRI (ADC, TCTI ratio, CE-FIESTA).
- IoC assessed intraoperatively; MRI sequences and MPMs correlated with IoC.
- Tumor samples analyzed for CC and PF, compared with IoC.
Main Results:
- TCTI ratio significantly associated with IoC (p=0.049).
- Comprehensive Full-MPM (TCTI ratio + ADC + CE-FIESTA) also showed significant association (p=0.044).
- High CC (p=0.045) and PF (p=0.03) significantly correlated with firm consistency.
Conclusions:
- MPMs show potential but require further validation due to statistical uncertainty.
- TCTI ratio may be a practical tool for predicting PA consistency.
- CC and PF serve as histopathological correlates for MRI findings, aiding preoperative planning.
