Mastorakos Panagiotis, Mehta Gautam U, Chatrath Ajay, Moosa Shayan, Lopes Maria-Beatriz, Payne Spencer C, Jane John A
Department of Neurological Surgery, University of Virginia Health Science Center, University of Virginia, Charlottesville, Virginia, United States.
Department of Neurological Surgery, NIH/NINDS, Bethesda, Maryland, United States.
J Neurol Surg B Skull Base. 2019 Jun;80(3):252-257. doi: 10.1055/s-0038-1668516. Epub 2018 Aug 24.
The consistency of pituitary macroadenomas affects the complexity of surgical resection. On T2-weighted (T2W) imaging, the intensity ratio of the tumor to the cerebellar peduncle (tumor to cerebellar peduncle T2-weighted imaging intensity [TCTI] ratio) correlates with meningioma consistency. We aimed to determine the correlation of this radiographic finding with pituitary macroadenoma consistency and to determine whether it can be used for preoperative planning. We performed a retrospective evaluation of 196 patients with macroadenomas who underwent endoscopic transsphenoidal resection from January 2012 to June 2017. Macroadenoma consistency was determined by one senior neurosurgeon at the time of surgery. Axial and coronal T2W magnetic resonance imaging images were evaluated retrospectively, and adenoma size, Knosp grade, suprasellar extension and TCTI were calculated. The mean TCTI ratio was 1.70 (95% confidence interval [CI]: 1.65-1.75). Intraoperatively, 140 (71.4%) adenomas were classified as soft and 48 (24.5%) as fibrous. Gross total resection was achieved in 66.7% of fibrous adenomas and in 86.4% of soft adenomas ( = 0.007). The mean ratio was 1.68 (95% CI: 1.62-1.74) for soft tumors and 1.76 (95%CI: 1.67-1.84) for fibrous tumors. There was no difference in the mean TCTI ratio between groups. Lactotroph and somatotroph adenomas had a lower mean TCTI ratio compared with other functioning and nonfunctioning adenomas with a mean TCTI of 1.52 compared with 1.77. In this retrospective cohort study, we found that the TCTI ratio does not correlate with tumor consistency. We also noted that the TCTI ratio is increased in prolactin and growth hormone-secreting adenomas.
垂体大腺瘤的质地影响手术切除的复杂性。在T2加权（T2W）成像上，肿瘤与小脑脚的强度比（肿瘤与小脑脚T2加权成像强度[TCTI]比）与脑膜瘤质地相关。我们旨在确定这一影像学表现与垂体大腺瘤质地的相关性，并确定其是否可用于术前规划。
我们对2012年1月至2017年6月期间接受内镜经蝶窦切除术的196例大腺瘤患者进行了回顾性评估。大腺瘤质地由一位资深神经外科医生在手术时确定。对轴向和冠状位T2W磁共振成像图像进行回顾性评估，并计算腺瘤大小、克诺斯普分级、鞍上延伸和TCTI。
平均TCTI比为1.70（95%置信区间[CI]：1.65 - 1.75）。术中，140例（71.4%）腺瘤被分类为软质，48例（24.5%）为纤维质。纤维性腺瘤的全切除率为66.7%，软性腺瘤的全切除率为86.4%（P = 0.007）。软质肿瘤的平均比值为1.68（95%CI：1.62 - 1.74），纤维质肿瘤的平均比值为1.76（95%CI：1.67 - 1.84）。各组之间的平均TCTI比无差异。与其他功能性和无功能性腺瘤相比，催乳素瘤和生长激素瘤的平均TCTI比更低，分别为1.52和1.77。
在这项回顾性队列研究中，我们发现TCTI比与肿瘤质地无关。我们还注意到，催乳素和生长激素分泌腺瘤的TCTI比升高。
