Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 698-701
DOI: 10.4103/ajns.AJNS_56_16
Original Article

Initial experience with diffusion-weighted imaging to predict the tumor consistency and surgical success in solid growth hormone producing pituitary macroadenomas

Maysam Alimohamadi
Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran
,
Reza Sanjari
1   Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran
,
Mohamad Shirani
1   Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran
,
Fariba Alikhani
Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran
,
Abbas Amirjamshidi
1   Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Background: Tumor consistency is an important factor impeding transsphenoidal resection of some pituitary macroadenomas. Preoperative prediction of the tumor consistency may help neurosurgeons in preparing the patients for other therapeutic options after a subtotally resected growth hormone (GH)-producing macroadenoma. We present the preliminary results of our study about the application of the preoperative diffusion-weighted (DW) magnetic resonance imaging (MRI) to predict the consistency and resection rate of GH-producing pituitary macroadenomas. Materials and Methods: Sixteen primary patients with solid GH-producing pituitary macroadenomas were enrolled. Hormonal assays as well as standard and DW-MRI were obtained before surgery. All the patients were operated via an endoscopic transsphenoidal approach. The intraoperative tumor consistencies (suctionable versus nonsuctionable) were documented. The samples were stained for measurement of the collagen content (low, moderate, and high). Postoperative hormonal study and MRI were performed after 8 weeks to evaluate the resection ratio and the hormonal remission. Results: On DW images, the tumor diffusion was enhanced (free) in four, moderate in ten, and restricted in two patients. The tumor was suctionable in 14 cases; gross total resection and hormonal remission were achieved in 12/14 of these. All the 14 suctionable tumors had moderate to enhanced diffusion on DW imaging (DWI). The two patients with a nonsuctionable fibrous tumor had a restricted diffusion in DWI. These were the only ones to have high collagen content in the histopathologic study. Conclusion: DWI could help identify the fibrous nonsuctionable GH-producing adenomas from the others.

Key-words:

Acromegaly - diffusion weighted - hypophysis - pituitary adenoma - transsphenoid

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jazayeri SB, Rahimi-Movaghar V, Shokraneh F, Saadat S, Ramezani R. Epidemiology of primary CNS tumors in Iran: A systematic review. Asian Pac J Cancer Prev 2013;14:3979-85.
  • 2 Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: A community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010;72:377-82.
  • 3 Swearingen B, Barker FG 2nd, Katznelson L, Biller BM, Grinspoon S, Klibanski A, et al. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 1998;83:3419-26.
  • 4 Naganuma H, Satoh E, Nukui H. Technical considerations of transsphenoidal removal of fibrous pituitary adenomas and evaluation of collagen content and subtype in the adenomas. Neurol Med Chir (Tokyo) 2002;42:202-12.
  • 5 Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, et al. Pituitary macroadenomas: Preoperative evaluation of consistency with diffusion-weighted MR imaging – Initial experience. Radiology 2006;239:223-31.
  • 6 Snow RB, Lavyne MH, Lee BC, Morgello S, Patterson RH Jr. Craniotomy versus transsphenoidal excision of large pituitary tumors: The usefulness of magnetic resonance imaging in guiding the operative approach. Neurosurgery 1986;19:59-64.
  • 7 Iuchi T, Saeki N, Tanaka M, Sunami K, Yamaura A. MRI prediction of fibrous pituitary adenomas. Acta Neurochir (Wien) 1998;140:779-86.
  • 8 Bahuleyan B, Raghuram L, Rajshekhar V, Chacko AG. To assess the ability of MRI to predict consistency of pituitary macroadenomas. Br J Neurosurg 2006;20:324-6.
  • 9 Boxerman JL, Rogg JM, Donahue JE, Machan JT, Goldman MA, Doberstein CE. Preoperative MRI evaluation of pituitary macroadenoma: Imaging features predictive of successful transsphenoidal surgery. AJR Am J Roentgenol 2010;195:720-8.
  • 10 Chakrabortty S, Oi S, Yamaguchi M, Tamaki N, Matsumoto S. Growth hormone-producing pituitary adenomas: MR characteristics and pre- and postoperative evaluation. Neurol Med Chir (Tokyo) 1993;33:81-5.
  • 11 Calvar JA, Meli FJ, Romero C, Calcagno ML, Yánez P, Martinez AR, et al. Characterization of brain tumors by MRS, DWI and Ki-67 labeling index. J Neurooncol 2005;72:273-80.
  • 12 Yrjänä SK, Tuominen H, Karttunen A, Lähdesluoma N, Heikkinen E, Koivukangas J. Low-field MR imaging of meningiomas including dynamic contrast enhancement study: evaluation of surgical and histopathologic characteristics. AJNR Am J Neuroradiol 2006;27:2128-34.
  • 13 Suzuki C, Maeda M, Hori K, Kozuka Y, Sakuma H, Taki W, et al. Apparent diffusion coefficient of pituitary macroadenoma evaluated with line-scan diffusion-weighted imaging. J Neuroradiol 2007;34:228-35.
  • 14 Mahmoud OM, Tominaga A, Amatya VJ, Ohtaki M, Sugiyama K, Sakoguchi T, et al. Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas. Eur J Radiol 2011;80:412-7.
  • 15 Mohamed F, Abouhashem S. Diagnostic value of apparent diffusion coefficient (ADC) in assessment of pituitary macroadenoma consistency. Egypt J Radiol Nucl Med 2013;44:617-24.