Sanei Taheri Morteza, Kimia Farnaz, Mehrnahad Mersad, Saligheh Rad Hamidreza, Haghighatkhah Hamidreza, Moradi Afshin, Kazerooni Anahita Fathi, Alviri Mohammadreza, Absalan Abdorrahim
1 Department of Radiology, Shahid Beheshti University of Medical Sciences, Iran.
2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran.
Neuroradiol J. 2019 Apr;32(2):74-85. doi: 10.1177/1971400918809825. Epub 2018 Dec 3.
The purpose of this study was to determine the accuracy of selected first or second-order histogram features in differentiation of functional types of pituitary macro-adenomas.
Diffusion-weighted imaging magnetic resonance imaging was performed on 32 patients (age mean±standard deviation = 43.09 ± 11.02 years; min = 22 and max = 65 years) with pituitary macro-adenoma (10 with functional and 22 with non-functional tumors). Histograms of apparent diffusion coefficient were generated from regions of interest and selected first or second-order histogram features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and graded as containing <1%, 1-3%, and >3% of collagen.
Among selected first or second-order histogram features, uniformity ( p = 0.02), 75th percentile ( p = 0.03), and tumor smoothness ( p = 0.02) were significantly different between functional and non-functional tumors. Tumor smoothness > 5.7 × 10 (area under the curve = 0.75; 0.56-0.89) had 70% (95% confidence interval = 34.8-93.3%) sensitivity and 33.33% (95% confidence interval = 14.6-57.0%) specificity for diagnosis of functional tumors. Uniformity ≤179.271 had a sensitivity of 60% (95% confidence interval = 26.2-87.8%) and specificity of 90.48% (95% confidence interval = 69.6-98.8%) with area under the curve = 0.76; 0.57-0.89. The 75th percentile >0.7 had a sensitivity of 80% (95% confidence interval = 44.4-97.5%) and specificity of 66.67% (95% confidence interval = 43.0-85.4%) for categorizing tumors to functional and non-functional types (area under the curve = 0.74; 0.55-0.88). Using these cut-offs, smoothness and uniformity are suggested as negative predictive indices (non-functional tumors) whereas 75th percentile is more applicable for diagnosis of functional tumors.
First or second-order histogram features could be helpful in differentiating functional vs non-functional pituitary macro-adenoma tumors.
本研究旨在确定所选的一阶或二阶直方图特征在鉴别垂体大腺瘤功能类型方面的准确性。
对32例垂体大腺瘤患者（年龄均值±标准差 = 43.09 ± 11.02岁；最小22岁，最大65岁）进行了扩散加权成像磁共振成像检查，其中10例为功能性肿瘤，22例为无功能性肿瘤。从感兴趣区域生成表观扩散系数直方图，并提取所选的一阶或二阶直方图特征。对手术切除肿瘤的胶原含量采用Masson三色染色进行组织化学检查，并分级为胶原含量<1%、1 - 3%和>3%。
在所选的一阶或二阶直方图特征中，功能性和无功能性肿瘤之间的均匀性（p = 0.02）、第75百分位数（p = 0.03）和肿瘤平滑度（p = 0.02）存在显著差异。肿瘤平滑度>5.7×10（曲线下面积 = 0.75；0.56 - 0.89）对功能性肿瘤诊断的敏感性为70%（95%置信区间 = 34.8 - 93.3%），特异性为33.33%（95%置信区间 = 14.6 - 57.0%）。均匀性≤179.271时，敏感性为60%（95%置信区间 = 26.2 - 87.8%），特异性为90.48%（95%置信区间 = 69.6 - 98.8%），曲线下面积 = 0.76；0.57 - 0.89。第75百分位数>0.7时，对肿瘤分为功能性和无功能性类型的敏感性为80%（95%置信区间 = 44.4 - 97.5%），特异性为66.67%（95%置信区间 = 43.0 - 85.4%）（曲线下面积 = 0.74；0.55 - 0.88）。使用这些临界值，平滑度和均匀性被建议作为阴性预测指标（无功能性肿瘤），而第75百分位数更适用于功能性肿瘤的诊断。
一阶或二阶直方图特征有助于鉴别功能性与无功能性垂体大腺瘤。
