Keywords:
Pathology, Neoplasia, Education and training, Surgery, Diagnostic procedure, MR, Neuroradiology brain, Head and neck, CNS
Authors:
T. M. B. Da Conceiテァテ」o1, J. Quedi Araテコjo da Silva2, ソス. C. Martins Antunes 2, M. Muxfeldt Bianchin 2, J. テ」ila Duarte2; 1Porto Alegre, RS/BR, 2Porto Alegre/BR
DOI:
10.26044/ecr2019/C-1871
Aims and objectives
Most macroadenomas are soft allowing transsphenoidal resection.
However,
approximately 10% of Macroadenoma pituitary (PAM) are fibrous and may impact surgical approach and treatment outcome [1].
Numerous magnetic resonance imaging (MRI) based methods have been investigated in order to determine the consistency of pituitary macroadenomas (Ps).
Among these methods are the measurement of standard T1 and T2 signal and features of contrast enhancement,
diffusion and elastography (which are based on static imaging characteristics and cannot directly measure stiffness) [1-9].
These studies try to identify MRI findings capable of showing the relationship between tumor consistency and water contents in different tumors,
but showed conflicting results [1,3,10-12,14-18].
While some studies have been successful in predicting PAMs窶 consistency [1,3,10-12] and others failed in this venue [13,14,15,17,18].
In this study we tested the parameters proposed by Smith et al [1] to evaluate preoperative consistency of PAMs.
These authors applied an index that used cerebellar peduncle as an internal reference for T2 signal intensity,
based on the fact that cerebellar peduncle may be a large anatomical landmark that allows easy reproducibility.
The ratios of signal intensity of adenoma to cerebellar peduncle on MRI T2-weighted imaging could allow us to predict consistency while reliably standardizing MRI signals to a consistent anatomical landmark.
We hope that our study could contribute to preoperative evaluation of these patients,
possibly by improving decision making in PAMs surgery,
improving medical care in these conditions.
General objective
- To propose a preoperative magnetic resonance (MR) evaluation of the consistency of the pituitary macroadenomas through a predictive method based on the signal intensity in the TSE T2 sequence.
Specific objectives
- To detail the accuracy of MRI for preoperative evaluation of pituitary macroadenomas in determining tumor consistency.
- To retrospectively analyze the diagnostic accuracy of the signal isolated in the T2-weighted sequence in the evaluation of the tumor consistency.
- To retrospectively verify the diagnostic accuracy of the average adenoma-to-peduncle cerebellar ratio (ACP) in the evaluation of tumor consistency.
- To compare which of the two parameters is most adequate to predict the preoperative consistency of pituitary tumors: the signal isolated in the tumor T2-weighted sequence or the average adenoma-to- peduncle cerebellar ratio (ACP).