Yamamoto J, Kakeda S, Shimajiri S, Takahashi M, Watanabe K, Kai Y, Moriya J, Korogi Y, Nishizawa S
From the Departments of Neurosurgery (J.Y., M.T., K.W., S.N.).
AJNR Am J Neuroradiol. 2014 Feb;35(2):297-303. doi: 10.3174/ajnr.A3667. Epub 2013 Aug 8.
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.
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.
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 mosaic-type adenomas, solid-type adenomas tended to have a hard tumor consistency as well as a significantly higher collagen content and lower postoperative tumor size.
Contrast-enhanced FIESTA may provide preoperative information regarding the consistency of macroadenomas that appears to be related to the tumor collagen content.
垂体大腺瘤肿瘤质地的术前评估对神经外科手术很重要。因此，我们旨在回顾性评估对比增强FIESTA序列在预测垂体大腺瘤肿瘤质地方面的作用。
29例垂体大腺瘤患者在手术前行常规磁共振成像序列及对比增强FIESTA检查。两名神经放射科医生对对比增强FIESTA、对比增强T1WI和T2WI进行评估。根据手术结果，神经外科医生将大腺瘤分为软质或硬质。最后，采用Fisher精确概率检验和非配对t检验，将基于磁共振成像结果的预测与肿瘤质地、胶原含量及术后肿瘤大小进行比较。
29例垂体大腺瘤分为实性或镶嵌型。实性型的特征是肿瘤信号强度均匀，无瘤内高信号点，而镶嵌型的特征是每个磁共振图像上有许多瘤内高信号点。统计分析显示肿瘤质地与对比增强FIESTA结果之间存在显著相关性。对比增强FIESTA的敏感性和特异性（分别为1.00和0.88 - 0.92）高于对比增强T1WI（分别为0.80和0.25 - 0.33）和T2WI（分别为0.60和0.38 - 0.54）。与镶嵌型腺瘤相比，实性型腺瘤往往具有较硬的肿瘤质地，以及显著更高的胶原含量和更小的术后肿瘤大小。
对比增强FIESTA可能提供有关大腺瘤质地的术前信息，这似乎与肿瘤胶原含量有关。
