Zhang Jing, Zhao Zhiyong, Dong Li, Han Tao, Zhang Guojin, Cao Yuntai, Zhou Junlin
Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.
Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.
Endocr Connect. 2020 Dec;9(12):1233-1239. doi: 10.1530/EC-20-0434.
It is difficult to distinguish between non-functioning pituitary macroadenomas (NFPMAs) and sellar meningiomas because of their overlapping imaging manifestations on routine MRI, especially in cases of meningiomas growing into the saddle. Here, we aimed to differentiate between these two tumors using apparent diffusion coefficient (ADC) values and MRI characteristics.
A total of 60 NFPMA and 52 sellar meningioma cases confirmed by the pathological analysis were retrospectively reviewed. All patients were examined via routine MRI and diffusion-weighted imaging (DWI) before undergoing surgery. The clinical characteristics, MRI characteristics, and max ADC (ADCmax), average ADC (ADCmean), and minimum ADC (ADCmin) values were compared between the two tumors via Chi-square test and two sample t-tests. Receiver operating characteristic (ROC) curve and binary logistic regression analyses were conducted to determine the discrimination ability.
The ADCmax, ADCmean, and ADCmin values were significantly higher in NFPMAs compared to sellar meningiomas (P < 0.001 for all). Among ADC values, ADCmax demonstrated good performance with an AUC of 0.896 (95% CI, 0.823-0.969) and accuracy of 88.7%. A cut-off value of 0.97 × 10-3 mm2/s was used for ADCmax for differentiation between tumors. A combination of ADCmax values and clinicoradiological features showed the best discrimination ability for differential diagnosis between the two tumors, with an AUC of 0.981 (95% CI, 0.958-1.000) and accuracy of 96.9%.
A combination of ADCmax and clinicoradiological features demonstrates good discrimination ability and high accuracy for differentiation between NFPMAs and sellar meningiomas, and is a potential quantitative tool to aid in the selection of surgical techniques.
由于无功能垂体大腺瘤（NFPMAs）和鞍区脑膜瘤在常规MRI上的影像学表现重叠，尤其是脑膜瘤向鞍内生长的情况，因此很难将两者区分开来。在此，我们旨在利用表观扩散系数（ADC）值和MRI特征来鉴别这两种肿瘤。
回顾性分析60例经病理分析确诊的NFPMAs患者和52例鞍区脑膜瘤患者。所有患者在手术前行常规MRI和扩散加权成像（DWI）检查。通过卡方检验和两样本t检验比较两种肿瘤的临床特征、MRI特征以及最大ADC（ADCmax）、平均ADC（ADCmean）和最小ADC（ADCmin）值。进行受试者操作特征（ROC）曲线和二元逻辑回归分析以确定鉴别能力。
与鞍区脑膜瘤相比，NFPMAs的ADCmax、ADCmean和ADCmin值显著更高（所有P均<0.001）。在ADC值中，ADCmax表现良好，曲线下面积（AUC）为0.896（95%可信区间，0.823 - 0.969），准确率为88.7%。以0.97×10⁻³mm²/s作为ADCmax的临界值用于肿瘤鉴别。ADCmax值与临床放射学特征相结合在鉴别这两种肿瘤时显示出最佳鉴别能力，AUC为0.981（95%可信区间，0.958 - 1.000），准确率为96.9%。
ADCmax与临床放射学特征相结合在鉴别NFPMAs和鞍区脑膜瘤方面显示出良好的鉴别能力和高准确率，是一种有助于选择手术技术的潜在定量工具。
