Nie Ding, Zhao Peng, Li Chuzhong, Liu Chunhui, Zhu Haibo, Gui Songbai, Zhang Yazhuo, Cao Lei
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Surg. 2022 Jul 26;9:922626. doi: 10.3389/fsurg.2022.922626. eCollection 2022.
Tumor consistency is important for pituitary neuroendocrine tumors (PitNETs) resection to improve surgical outcomes. In this study, we evaluated the T2-WI of PitNETs and defined a specific T2-WI signaling manifestation, the "Mosaic sign," to predict tumor consistency and resection of PitNETs.
A retrospective review of MRI and tumor histology of 137 consecutive patients who underwent endoscopic endonasal resection for PitNETs was performed.
The "Mosaic sign" was defined by the ratio of the tumor itself T2-WI signals, and characterized by multiple intratumor hyperintense dots. The degree of tumor resection was an assessment by postoperative MRI examination. The presence of the "Mosaic sign" was compared with patients' basic information, tumor consistency, tumor pathological staining, and surgical result. To determine whether the presence or absence of "Mosaic sign" could predict tumor consistency and guide surgical resection of tumors.
Statistical analysis showed that the consistency of the tumor and the degree of resection were correlated with the "Mosaic sign". In the 137 cases of T2-WI, 43 had "Mosaic sign", 39 cases had soft tumor consistency, and 4 were classified as fibrous, of which 42 were completely resected and 1 was subtotal resected. Of the 94 patients without "Mosaic sign", the consistency of tumor of 54 cases were classified as soft, the remaining 40 cases were fibrous, 80 cases were completely resected, and 14 cases were subtotal resected. Postoperative cerebrospinal fluid leakage occurred in 1 patient. The number of corticotroph adenomas in the group of "Mosaic sign" was higher, with the statistical difference between the two groups ( = 0.0343).
The presence of the "Mosaic sign" in T2-WI may provide preoperative information for pituitary adenomas consistency and effectively guide surgical approaches.
肿瘤质地对于垂体神经内分泌肿瘤（PitNETs）切除术以改善手术效果很重要。在本研究中，我们评估了PitNETs的T2加权成像（T2-WI），并定义了一种特定的T2-WI信号表现，即“马赛克征”，以预测PitNETs的肿瘤质地和切除术情况。
对137例连续接受经鼻内镜下PitNETs切除术患者的MRI和肿瘤组织学进行回顾性研究。
“马赛克征”由肿瘤本身T2-WI信号的比例定义，其特征为肿瘤内多个高信号点。肿瘤切除程度通过术后MRI检查评估。将“马赛克征”的存在情况与患者的基本信息、肿瘤质地、肿瘤病理染色及手术结果进行比较。以确定“马赛克征”的有无能否预测肿瘤质地并指导肿瘤的手术切除。
统计分析表明，肿瘤质地和切除程度与“马赛克征”相关。在137例T2-WI病例中，43例有“马赛克征”，其中39例肿瘤质地为软，4例为纤维性，42例完全切除，1例次全切除。94例无“马赛克征”的患者中，54例肿瘤质地为软，其余40例为纤维性，80例完全切除，14例次全切除。1例患者术后发生脑脊液漏。“马赛克征”组促肾上腺皮质激素腺瘤数量较多，两组间有统计学差异（P = 0.0343）。
T2-WI中“马赛克征”的存在可为垂体腺瘤质地提供术前信息，并有效指导手术入路。
