Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng Distinct, Beijing, 100730, China.
Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng Distinct, Beijing, 100730, China.
Eur Radiol. 2023 Sep;33(9):5984-5992. doi: 10.1007/s00330-023-09585-1. Epub 2023 May 22.
To assess the diagnostic performance of high-resolution contrast-enhanced MRI (hrMRI) with three-dimensional (3D) fast spin echo (FSE) sequence by comparison with conventional contrast-enhanced MRI (cMRI) and dynamic contrast-enhanced MRI (dMRI) with 2D FSE sequence for identifying pituitary microadenomas.
This single-institutional retrospective study included 69 consecutive patients with Cushing's syndrome who underwent preoperative pituitary MRI, including cMRI, dMRI, and hrMRI, between January 2016 to December 2020. Reference standards were established by using all available imaging, clinical, surgical, and pathological resources. The diagnostic performance of cMRI, dMRI, and hrMRI for identifying pituitary microadenomas was independently evaluated by two experienced neuroradiologists. The area under the receiver operating characteristics curves (AUCs) were compared between protocols for each reader by using the DeLong test to assess the diagnostic performance for identifying pituitary microadenomas. The inter-observer agreement was assessed by using the κ analysis.
The diagnostic performance of hrMRI (AUC, 0.95-0.97) was higher than cMRI (AUC, 0.74-0.75; p ≤ .002) and dMRI (AUC, 0.59-0.68; p ≤ .001) for identifying pituitary microadenomas. The sensitivity and specificity of hrMRI were 90-93% and 100%, respectively. There were 78% (18/23) to 82% (14/17) of the patients, who were misdiagnosed on cMRI and dMRI and correctly diagnosed on hrMRI. The inter-observer agreement for identifying pituitary microadenomas was moderate on cMRI (κ = 0.50), moderate on dMRI (κ = 0.57), and almost perfect on hrMRI (κ = 0.91), respectively.
The hrMRI showed higher diagnostic performance than cMRI and dMRI for identifying pituitary microadenomas in patients with Cushing's syndrome.
• The diagnostic performance of hrMRI was higher than cMRI and dMRI for identifying pituitary microadenomas in Cushing's syndrome. • About 80% of patients, who were misdiagnosed on cMRI and dMRI, were correctly diagnosed on hrMRI. • The inter-observer agreement for identifying pituitary microadenomas was almost perfect on hrMRI.
通过与常规对比增强磁共振成像（cMRI）和二维快速自旋回波（2D FSE）序列动态对比增强磁共振成像（dMRI）比较，评估三维（3D）快速自旋回波（FSE）序列高分辨率对比增强磁共振成像（hrMRI）对识别垂体微腺瘤的诊断性能。
这项单机构回顾性研究纳入了 2016 年 1 月至 2020 年 12 月期间 69 例经术前垂体 MRI（包括 cMRI、dMRI 和 hrMRI）检查诊断为库欣综合征的连续患者。参考标准通过使用所有可用的影像学、临床、手术和病理资源建立。两名有经验的神经放射科医生独立评估 cMRI、dMRI 和 hrMRI 识别垂体微腺瘤的诊断性能。使用 DeLong 检验比较每个读者不同方案的受试者工作特征曲线下面积（AUC），以评估识别垂体微腺瘤的诊断性能。使用κ分析评估观察者间一致性。
hrMRI（AUC：0.95-0.97）的诊断性能高于 cMRI（AUC：0.74-0.75；p≤0.002）和 dMRI（AUC：0.59-0.68；p≤0.001），用于识别垂体微腺瘤。hrMRI 的敏感性和特异性分别为 90-93%和 100%。在 cMRI 和 dMRI 误诊的 23 例患者中有 78%（18/23）至 82%（14/17）在 hrMRI 上得到正确诊断。cMRI 识别垂体微腺瘤的观察者间一致性为中度（κ=0.50），dMRI 为中度（κ=0.57），hrMRI 为极好（κ=0.91）。
在库欣综合征患者中，hrMRI 对识别垂体微腺瘤的诊断性能优于 cMRI 和 dMRI。
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