Demonstration of the optic pathway in sellar/juxtasellar tumours with visual disturbance on MR imaging

To prospectively compare the demonstration of the intracranial optic pathway in patients with sellar/juxtasellar tumours and with clinical evidence of visual disturbance using either spoiled gradient recalled acquisition in steady state (SPGR) or conventional spin echo (CSE) T1-weighted imaging.

We studied 108 patients with sellar/juxtasellar tumours presenting visual disturbance. Visualization of the optic pathway (nerves, chiasm, tracts) was compared between CSE T1-weighted coronal image and SPGR coronal image. In 18 patients, SPGR imaging was performed before and after administration of Gd-DTPA and visualization of the optic pathway was compared.

On CSE T1-weighted coronal images of 108 patients with visual disturbance, the rates for visualization of the optic nerves, chiasms and tracts were 50%, 77.8% and 89.8% respectively. In contrast, on SPGR coronal image the rates were 80.6%, 96.3% and 92.6% respectively. The rates of visualization of the optic pathway were greater in non-enhanced that in those with enhancement. The rates of visualization in patients with recurrent tumours were less than those in patients with primary tumours. The rate of visualization of optic nerves in patients with meningioma was less than in patients with pituitary adenoma, craniopharyngioma or Rathke cleft cyst.

The rate of visualization of optic pathway structures on SPGR imaging (without enhancement) is greater than that on CSE T1-weighted imaging. It is important to understand the accurate position of the optic pathways with using new MR modality especially in surgical planning for lesions around the sella turcica.