Maria Braileanu1, Ranliang Hu2, Michael J Hoch3, Mark E Mullins4, Adriana G Ioachimescu5, Nelson M Oyesiku6, Adlai Pappy7, Amit M Saindane8. 1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: mbraile@emory.edu. 2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: ranliang.hu@emory.edu. 3. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: michael.hoch@emory.edu. 4. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: memulli@emory.edu. 5. Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America; Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: aioachi@emory.edu. 6. Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: noyesik@emory.edu. 7. Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: adlai.pappy.ii@emory.edu. 8. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America. Electronic address: asainda@emory.edu.
Abstract
INTRODUCTION: Contrast-enhanced (CE) Constructive Interference in Steady State (CISS) and Volumetric Interpolated Breath-hold Examination (VIBE) are MRI sequences used to improve the detection of pituitary adenomas and adjacent cranial nerves. The purpose of this study was to assess image quality and identify imaging predictors of postoperative hormonal remission of functioning pituitary adenomas using CE-T1 weighted image (WI), T2WI, CE-CISS, and CE-VIBE MRI sequences. MATERIALS AND METHODS: Patients with pre-operative CE-T1WI, T2WI, CE-CISS, and CE-VIBE pituitary MRI sequences were included in this institutional retrospective review. Three raters independently reviewed randomized sequences in a blinded fashion for adenoma characteristics and parasellar invasion. Subgroup analysis of hormonal remission was performed. RESULTS: A total of 34 functioning pituitary adenoma patients were included (average age 39.3 ± 12.2; female n = 27), 30 of which had post-operative hormonal remission (n = 34; 88.2%). Compared to CE-T1WI, CE-CISS has significantly higher number of sequences rated "good" image quality (p = 0.02). Hormone remission was associated with decreased degrees of pre-operative internal carotid artery (ICA) contact and Knosp score (p ≤ 0.02) on all sequences except for Knosp score on T2WI. On receiver operating characteristic analysis, the area under curve for differentiating endocrine remission ranged from 0.88 to 0.92 for Knosp score and 0.85-0.93 for ICA contact, depending on sequence. CONCLUSION: Extent of pituitary adenoma cavernous sinus invasion as measured by degrees of ICA contact and Knosp score is associated with postoperative endocrine outcomes. Given improved image quality, inclusion of CE-CISS may be helpful for pre-surgical planning.
INTRODUCTION: Contrast-enhanced (CE) Constructive Interference in Steady State (CISS) and Volumetric Interpolated Breath-hold Examination (VIBE) are MRI sequences used to improve the detection of pituitary adenomas and adjacent cranial nerves. The purpose of this study was to assess image quality and identify imaging predictors of postoperative hormonal remission of functioning pituitary adenomas using CE-T1 weighted image (WI), T2WI, CE-CISS, and CE-VIBE MRI sequences. MATERIALS AND METHODS:Patients with pre-operative CE-T1WI, T2WI, CE-CISS, and CE-VIBE pituitary MRI sequences were included in this institutional retrospective review. Three raters independently reviewed randomized sequences in a blinded fashion for adenoma characteristics and parasellar invasion. Subgroup analysis of hormonal remission was performed. RESULTS: A total of 34 functioning pituitary adenomapatients were included (average age 39.3 ± 12.2; female n = 27), 30 of which had post-operative hormonal remission (n = 34; 88.2%). Compared to CE-T1WI, CE-CISS has significantly higher number of sequences rated "good" image quality (p = 0.02). Hormone remission was associated with decreased degrees of pre-operative internal carotid artery (ICA) contact and Knosp score (p ≤ 0.02) on all sequences except for Knosp score on T2WI. On receiver operating characteristic analysis, the area under curve for differentiating endocrine remission ranged from 0.88 to 0.92 for Knosp score and 0.85-0.93 for ICA contact, depending on sequence. CONCLUSION: Extent of pituitary adenoma cavernous sinus invasion as measured by degrees of ICA contact and Knosp score is associated with postoperative endocrine outcomes. Given improved image quality, inclusion of CE-CISS may be helpful for pre-surgical planning.
Authors: Brandon P Galm; Colleen Buckless; Brooke Swearingen; Martin Torriani; Anne Klibanski; Miriam A Bredella; Nicholas A Tritos Journal: Pituitary Date: 2020-06 Impact factor: 4.107
Authors: Alexander Micko; Arthur Hosmann; Wolfgang Marik; Sophie Bartsch; Michael Weber; Engelbert Knosp; Stefan Wolfsberger Journal: Pituitary Date: 2020-06 Impact factor: 4.107