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Postoperative sella: evaluation with fast spin echo T2-weighted high-resolution imaging

Y Nakasu1, R Itoh, S Nakasu

  • 1Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan.

Neurosurgery
|September 11, 1998
PubMed
Summary

Fast spin echo (FSE) T2-weighted imaging offers high-resolution assessment of the postoperative sella. This magnetic resonance imaging technique reliably visualizes normal structures and mass lesions after transsphenoidal surgery.

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Area of Science:

  • Radiology
  • Neurosurgery
  • Endocrinology

Background:

  • Post-transsphenoidal surgery assessment of the sella is crucial for evaluating residual or recurrent pituitary adenomas.
  • Traditional magnetic resonance imaging (MRI) sequences may have limitations in delineating postoperative anatomical structures and lesions.

Purpose of the Study:

  • To investigate the magnetic resonance (MR) features of the postoperative sella using fast spin echo (FSE) T2-weighted high-resolution imaging.
  • To evaluate the benefits of FSE T2-weighted imaging in a follow-up MR imaging protocol after transsphenoidal surgery.

Main Methods:

  • Prospective acquisition of coronal spin echo (SE) T1-weighted and FSE T2-weighted MR images in 24 patients post-transsphenoidal surgery for pituitary adenomas.
  • Observation of signals and contours of normal structures, fluid collections, implanted materials, and mass lesions (granulation tissue, adenoma).

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Main Results:

  • FSE T2-weighted images delineated the pituitary gland with clear boundaries in 90.2% of cases, compared to 20.4% for SE T1-weighted images.
  • Mass lesions were identified with good resolution on FSE T2-weighted images in 12 patients, whereas SE T1-weighted images showed indistinct boundaries in 7 of these patients.
  • Interobserver agreement for mass lesion detection was significantly higher with FSE T2-weighted images (kappa=0.8) than with SE T1-weighted images (kappa=0.25).

Conclusions:

  • FSE T2-weighted imaging is a reliable MR method for high-resolution assessment of the sella post-transsphenoidal surgery.
  • Combining unenhanced SE T1-weighted and FSE T2-weighted images may reduce the need for contrast material in postoperative pituitary surgery follow-up.