Korbecki Adrian, Wagel Justyna, Zacharzewska-Gondek Anna, Gewald Maja, Korbecka Justyna, Sobański Michał, Kacała Arkadiusz, Zdanowicz-Ratajczyk Agata, Kaczorowski Maciej, Hałoń Agnieszka, Trybek Grzegorz, Kapetanakis Stylianos, Bladowska Joanna
Department of General Radiology, Interventional Radiology and Neuroradiology, University Clinical Hospital, Borowska 213, 50-556, Wroclaw, Poland.
Wroclaw Medical University, Wroclaw, Poland.
Neuroradiology. 2025 Feb;67(2):437-447. doi: 10.1007/s00234-024-03467-z. Epub 2024 Sep 28.
This study aimed to assess the role of Diffusion-Weighted Imaging (DWI) in routine pituitary Magnetic Resonance Imaging (MRI) protocols for distinguishing sellar and parasellar tumors, addressing the lack of clear guidelines in contemporary literature.
A retrospective analysis of 242 pituitary MRI scans with DWI sequences was conducted in a single-center study using a 1.5 T scanner and standard DWI sequence parameters. Measurements of both absolute and relative mean apparent diffusion coefficient (ADC) values, along with minimal ADC values within tumors, were performed. The adopted region of interest (ROI) based method used for these measurements was validated.
Invasive pituitary adenomas exhibited significantly lower min ADC and min rADC than meningiomas, with optimal cut-off points of 0.64 (sensitivity 73%, specificity 82%) and 0.78 (sensitivity 73%, specificity 89%), respectively. Post-hemorrhagic pituitary adenomas demonstrated lower ADC values than adamantinomatous craniopharyngiomas, with an AUC of 0.893 for min rADC = 1.07, and Rathke's Cleft Cysts with mucous content, AUC 0.8 for min rADC = 1.01. Specific differentiation with high sensitivity and specificity based on diffusion parameters was observed for these tumor groups. Cystic pituitary non-functional adenomas obtained significantly lower ADC values compared to the adamantinomatous type of craniopharyngiomas and serous Rathke's Cleft Cysts (AUC up to 0.942).
The study concludes that integrating DWI into routine pituitary MRI protocols enhances diagnostic accuracy in distinguishing sellar and parasellar tumors. The short scan time of one minute makes DWI a valuable and precise tool, supporting its recommendation as a standard component of pituitary MRI examinations.
本研究旨在评估扩散加权成像（DWI）在垂体磁共振成像（MRI）常规检查方案中对鞍区及鞍旁肿瘤的鉴别作用，以解决当代文献中缺乏明确指南的问题。
在一项单中心研究中，使用1.5T扫描仪和标准DWI序列参数，对242例带有DWI序列的垂体MRI扫描进行回顾性分析。测量了绝对和相对平均表观扩散系数（ADC）值，以及肿瘤内的最小ADC值。对用于这些测量的基于感兴趣区域（ROI）的方法进行了验证。
侵袭性垂体腺瘤的最小ADC和最小相对ADC显著低于脑膜瘤，最佳截断点分别为0.64（敏感性73%，特异性82%）和0.78（敏感性73%，特异性89%）。出血后垂体腺瘤的ADC值低于造釉细胞瘤型颅咽管瘤，最小相对ADC = 1.07时曲线下面积（AUC）为0.893，而含黏液的拉克氏囊肿，最小相对ADC = 1.01时AUC为0.8。在这些肿瘤组中观察到基于扩散参数的具有高敏感性和特异性的特异性鉴别。囊性垂体无功能腺瘤的ADC值明显低于造釉细胞瘤型颅咽管瘤和浆液性拉克氏囊肿（AUC高达0.942）。
该研究得出结论，将DWI纳入垂体MRI常规检查方案可提高鞍区及鞍旁肿瘤鉴别的诊断准确性。一分钟的短扫描时间使DWI成为一种有价值且精确的工具，支持将其推荐为垂体MRI检查的标准组成部分。
