1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan.
2Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan.
J Neurosurg. 2019 Feb 1;132(2):351-359. doi: 10.3171/2018.10.JNS181783. Print 2020 Feb 1.
A subset of benign, nonfunctioning pituitary macroadenomas (NFMAs) has been shown to undergo early progression/recurrence (P/R) during the first years after surgical resection. The aim of this study was to determine preoperative MR imaging features for the prediction of P/R in benign solid NFMAs, with emphasis on apparent diffusion coefficient (ADC) values.
We retrospectively investigated the preoperative MR imaging features for the prediction of P/R in benign solid NFMAs. Only the patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year (at least every 6-12 months) were included. From November 2010 to December 2016, a total of 30 patients diagnosed with benign solid NFMAs were included (median follow-up time 45 months), and 19 (63.3%) patients had P/R (median time to P/R 24 months).
Benign solid NFMAs with cavernous sinus invasion, failed chiasmatic decompression, large tumor height and tumor volume, high diffusion-weighted imaging (DWI) signal, and lower ADC values/ratios were significantly associated with P/R (p < 0.05). The cutoff points of ADC value and ADC ratio for prediction of P/R are 0.77 × 10-3 mm2/sec and 1.01, respectively, with area under the curve (AUC) values (0.9 and 0.91) (p < 0.01). In multivariate Cox proportional hazards analysis, low ADC value (< 0.77 × 10-3 mm2/sec) is a high-risk factor of P/R (p < 0.05) with a hazard ratio of 14.07.
Benign solid NFMAs with low ADC values/ratios are at a significantly increased risk of P/R, and aggressive treatments accompanied by close follow-up with imaging studies should be considered.
已经证实，一部分良性、无功能垂体大腺瘤（NFMA）在手术后的最初几年会出现早期进展/复发（P/R）。本研究旨在确定术前磁共振成像（MRI）特征，以预测良性实性 NFMA 的 P/R，重点是表观扩散系数（ADC）值。
我们回顾性调查了术前 MRI 特征对良性实性 NFMA 预测 P/R 的作用。仅纳入接受过术前 MRI 检查和术后 MRI 随访超过 1 年（至少每 6-12 个月一次）的患者。2010 年 11 月至 2016 年 12 月，共纳入 30 例诊断为良性实性 NFMA 的患者（中位随访时间为 45 个月），其中 19 例（63.3%）发生 P/R（P/R 中位时间为 24 个月）。
海绵窦侵袭、视交叉减压失败、肿瘤高度和体积大、弥散加权成像（DWI）信号高、ADC 值/比值低的良性实性 NFMA 与 P/R 显著相关（p < 0.05）。预测 P/R 的 ADC 值和 ADC 比值的截断点分别为 0.77×10-3mm2/sec 和 1.01，曲线下面积（AUC）值分别为 0.9 和 0.91（p < 0.01）。在多变量 Cox 比例风险分析中，低 ADC 值（<0.77×10-3mm2/sec）是 P/R 的高风险因素（p < 0.05），风险比为 14.07。
低 ADC 值/比值的良性实性 NFMA 发生 P/R 的风险显著增加，应考虑采用积极的治疗方法，并密切随访影像学检查。
