Yu Yi, Feng Bao, Ren Yin, Yu Peiming, Zhu Yufu
The Affiliated Hospital of Xuzhou Medical University, Department of Neurosurgery, Xuzhou, Jiangsu, China.
Endocrine. 2025 Aug 20. doi: 10.1007/s12020-025-04392-8.
The consistency of pituitary adenomas (PAs) significantly influences the success of complete tumor resection, which is crucial for prognosis in patients. The aim of this study is to use preoperative diffusion-weighted imaging (DWI) to evaluate tumor consistency, thereby assisting surgeons in achieving optimal resection outcomes during neuroendoscopic procedures.
We collected clinical data (including age, sex, symptoms, and consistency), pathological data (including collagen content), and imaging data (including tumor size and ADC ratio) from 264 patients with pituitary macroadenomas. Patients were categorized based on intraoperative consistency assessments and postoperative resection rates to analyze the efficacy of DWI in predicting consistency and identifying determinants of the completeness of resection. Correlation analysis and multiple linear regression were used to explore the relationships among the ADC ratio, tumor consistency, and collagen content. Logistic regression was applied to analyze the factors influencing tumor resection.
This study included 264 patients. There were 202 patients with a soft consistency and 62 patients with a hard consistency. A total of 212 patients achieved complete resection. The median ADC ratio for the soft consistency group was 1.27 [1.04, 1.59], and that for the hard consistency group was 0.89 [0.83, 0.94] (P < 0.05). The median collagen content in the soft group was 4.55 [2.13, 6.69], and that in the hard group was 13.91 [10.30, 19.20] (P < 0.05). The ADC ratio was significantly related to the collagen content (ρ = -0.965; 95% CI: -0.973 ~ -0.955; P < 0.05). The ADC ratio was a significant predictor for achieving gross-total tumor resection (OR: 5.714; 95% CI: 1.032-31.628; P < 0.05).
For most patients with pituitary macroadenomas, neuroendoscopic transsphenoidal surgery is the first-line treatment. Preoperative apparent diffusion coefficient (ADC) ratios obtained from diffusion-weighted imaging (DWI) can help to evaluate tumor consistency and collagen content, thus guiding neurosurgeons in predicting resection ability under neuroendoscopy and thereby improving preoperative assessments for these patients.
垂体腺瘤（PAs）的质地一致性对肿瘤全切手术的成功与否有显著影响，这对患者预后至关重要。本研究旨在利用术前扩散加权成像（DWI）评估肿瘤质地，从而协助外科医生在神经内镜手术中实现最佳切除效果。
我们收集了264例垂体大腺瘤患者的临床数据（包括年龄、性别、症状和质地）、病理数据（包括胶原含量）和影像数据（包括肿瘤大小和表观扩散系数[ADC]比值）。根据术中质地评估和术后切除率对患者进行分类，以分析DWI在预测质地和确定切除完整性决定因素方面的有效性。采用相关性分析和多元线性回归探讨ADC比值、肿瘤质地和胶原含量之间的关系。应用逻辑回归分析影响肿瘤切除的因素。
本研究共纳入264例患者。质地柔软的患者有202例，质地坚硬的患者有62例。共有212例患者实现了全切。质地柔软组的ADC比值中位数为1.27[1.04，1.59]，质地坚硬组为0.89[0.83，0.94]（P<0.05）。柔软组的胶原含量中位数为4.55[2.13，6.69]，坚硬组为13.91[10.30，19.20]（P<0.05）。ADC比值与胶原含量显著相关（ρ=-0.965；95%CI：-0.973~-0.955；P<0.05）。ADC比值是实现肿瘤全切的重要预测指标（OR：5.714；95%CI：1.032-31.628；P<0.05）。
对于大多数垂体大腺瘤患者，神经内镜经蝶手术是一线治疗方法。术前通过扩散加权成像（DWI）获得的表观扩散系数（ADC）比值有助于评估肿瘤质地和胶原含量，从而指导神经外科医生预测神经内镜下的切除能力，进而改善对这些患者的术前评估。
