Ching-Chung Ko1, Tai-Yuan Chen1,2, Sher-Wei Lim3,4, Yu-Ting Kuo1,5, Te-Chang Wu1,6, Jeon-Hor Chen7,8. 1. 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan. 2. 2Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan. 3. 3Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan. 4. 4Department of Nursing, Min-Hwei College of Health Care Management, Tainan. 5. 5Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung. 6. 6Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei. 7. 7Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; and. 8. 8Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, California.
Abstract
OBJECTIVE: A subset of benign, nonfunctioning pituitary macroadenomas (NFMAs) has been shown to undergo early progression/recurrence (P/R) during the first years after surgical resection. The aim of this study was to determine preoperative MR imaging features for the prediction of P/R in benign solid NFMAs, with emphasis on apparent diffusion coefficient (ADC) values. METHODS: We retrospectively investigated the preoperative MR imaging features for the prediction of P/R in benign solid NFMAs. Only the patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year (at least every 6-12 months) were included. From November 2010 to December 2016, a total of 30 patients diagnosed with benign solid NFMAs were included (median follow-up time 45 months), and 19 (63.3%) patients had P/R (median time to P/R 24 months). RESULTS: Benign solid NFMAs with cavernous sinus invasion, failed chiasmatic decompression, large tumor height and tumor volume, high diffusion-weighted imaging (DWI) signal, and lower ADC values/ratios were significantly associated with P/R (p < 0.05). The cutoff points of ADC value and ADC ratio for prediction of P/R are 0.77 × 10-3 mm2/sec and 1.01, respectively, with area under the curve (AUC) values (0.9 and 0.91) (p < 0.01). In multivariate Cox proportional hazards analysis, low ADC value (< 0.77 × 10-3 mm2/sec) is a high-risk factor of P/R (p < 0.05) with a hazard ratio of 14.07. CONCLUSIONS: Benign solid NFMAs with low ADC values/ratios are at a significantly increased risk of P/R, and aggressive treatments accompanied by close follow-up with imaging studies should be considered.
OBJECTIVE: A subset of benign, nonfunctioning pituitary macroadenomas (NFMAs) has been shown to undergo early progression/recurrence (P/R) during the first years after surgical resection. The aim of this study was to determine preoperative MR imaging features for the prediction of P/R in benign solid NFMAs, with emphasis on apparent diffusion coefficient (ADC) values. METHODS: We retrospectively investigated the preoperative MR imaging features for the prediction of P/R in benign solid NFMAs. Only the patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year (at least every 6-12 months) were included. From November 2010 to December 2016, a total of 30 patients diagnosed with benign solid NFMAs were included (median follow-up time 45 months), and 19 (63.3%) patients had P/R (median time to P/R 24 months). RESULTS: Benign solid NFMAs with cavernous sinus invasion, failed chiasmatic decompression, large tumor height and tumor volume, high diffusion-weighted imaging (DWI) signal, and lower ADC values/ratios were significantly associated with P/R (p < 0.05). The cutoff points of ADC value and ADC ratio for prediction of P/R are 0.77 × 10-3 mm2/sec and 1.01, respectively, with area under the curve (AUC) values (0.9 and 0.91) (p < 0.01). In multivariate Cox proportional hazards analysis, low ADC value (< 0.77 × 10-3 mm2/sec) is a high-risk factor of P/R (p < 0.05) with a hazard ratio of 14.07. CONCLUSIONS: Benign solid NFMAs with low ADC values/ratios are at a significantly increased risk of P/R, and aggressive treatments accompanied by close follow-up with imaging studies should be considered.
Entities:
Keywords:
ADC; ADC = apparent diffusion coefficient; AUC = area under the curve; CE = contrast enhanced; DWI; DWI = diffusion-weighted imaging; GTR = gross-total resection; MRI; NACP = normal-appearing central pons; NFMA = nonfunctioning pituitary macroadenoma; P/R = progression/recurrence; PFS = progression-free survival; ROC = receiver operating characteristic; ROI = region of interest; RT = radiotherapy; STR = subtotal resection; T1WI = T1-weighted imaging; TSA = transsphenoidal approach; pituitary macroadenoma; pituitary surgery; recurrence