Tumor Consistency of PituitaryMacroadenomas : Predictive Analysis on the Basis of Imaging Features with Contrast-Enhanced 3 D FIESTA at 3 T
BACKGROUND AND PURPOSE: Preoperative evaluation of pituitary macroadenoma tumor consistency is important for neurosurgery. Thus, we aimed to retrospectively assess the role of contrast-enhanced FIESTA in predicting the tumor consistency of pituitary macroadenomas. MATERIALS AND METHODS: Twenty-nine patients with pituitary macroadenomas underwent conventional MR imaging sequences and contrast-enhanced FIESTA before surgery. Two neuroradiologists assessed the contrast-enhanced FIESTA, contrast-enhanced T1WI, and T2WI. On the basis of surgical findings, the macroadenomas were classified by the neurosurgeons as either soft or hard. Finally, Fisher exact probability tests and unpaired t tests were used to compare predictions on the basis of the MR imaging findings with the tumor consistency, collagen content, and postoperative tumor size. RESULTS: The 29 pituitary macroadenomas were classified as either solid or mosaic types. Solid type was characterized by a homogeneous pattern of tumor signal intensity without intratumoral hyperintense dots, whereas the mosaic type was characterized by many intratumoral hyperintense dots on each MR image. Statistical analyses revealed a significant correlation between tumor consistency and contrast-enhanced FIESTA findings. Sensitivity and specificity were higher for contrast-enhanced FIESTA (1.00 and 0.88 – 0.92, respectively) than for contrast-enhanced T1WI (0.80 and 0.25– 0.33, respectively) and T2WI (0.60 and 0.38 – 0.54, respectively). Compared with mosaictype adenomas, solid-type adenomas tended to have a hard tumor consistency as well as a significantly higher collagen content and lower postoperative tumor size. CONCLUSIONS: Contrast-enhanced FIESTA may provide preoperative information regarding the consistency of macroadenomas that appears to be related to the tumor collagen content. ABBREVIATIONS: CE contrast-enhanced; PCC percentage of collagen content; SI signal intensity The transsphenoidal approach of removing pituitary adenomas has been widely adopted as a safe and effective method. Recently, the endoscopic transsphenoidal technique has been applied as a minimally invasive surgery to remove pituitary adenomas. Most pituitary adenomas are soft and thus can be adequately removed by aspiration and curettage via the transsphenoidal route. However, 5–15% of pituitary adenomas are firm and fibrous. This can occur quite often, and, unfortunately, there are no preoperative predictors of its occurrence. Thus, preoperative evaluation of tumor consistency is essential for