Abstract
Even a tiny functioning pituitary adenoma could cause symptoms; hence, accurate diagnosis and treatment are crucial for management. However, it is difficult to diagnose a small pituitary adenoma using conventional MR sequence. Deep learning-based reconstruction (DLR) using magnetic resonance imaging (MRI) enables high-resolution thin-section imaging with noise reduction. In the present single-institution retrospective study of 201 patients, conducted between August 2019 and October 2020, we compared the performance of 1 mm DLR MRI with that of 3 mm routine MRI, using a combined imaging protocol to detect and delineate pituitary adenoma. Four readers assessed the adenomas in a pairwise fashion, and diagnostic performance and image preferences were compared between inexperienced and experienced readers. The signal-to-noise ratio (SNR) was quantitatively assessed. New detection of adenoma, achieved using 1 mm DLR MRI, was not visualised using 3 mm routine MRI (overall: 6.5% [13/201]). There was no significant difference depending on the experience of the readers in new detections. Readers preferred 1 mm DLR MRI over 3 mm routine MRI (overall superiority 56%) to delineate normal pituitary stalk and gland, with inexperienced readers more preferred 1 mm DLR MRI than experienced readers. The SNR of 1 mm DLR MRI was 1.25-fold higher than that of the 3 mm routine MRI. In conclusion, the 1 mm DLR MRI achieved higher sensitivity in the detection of pituitary adenoma and provided better delineation of normal pituitary gland than 3 mm routine MRI.
Highlights
Pituitary adenoma with hormone excess, irrespective of size, sometimes requires accurate detection and surgical treatment1,2
Patients were excluded if: [1] they did not undergo the sellar magnetic resonance imaging (MRI) (n = 104); [2] they had other sellar diseases, including meningioma or craniopharyngioma (n = 82); [3] they had no gross tumour at the sellar fossa (n = 15); [4] they were missing any part of the combined protocol of 3 mm routine MRI and 1 mm deep learning-based reconstruction (DLR) MRI (n = 61); and [5] they showed image artifacts due to aneurysm clips and dental hardware (n = 8)
The readers recorded new detection on 1 mm DLR MRI that was not visualised on 3 mm routine MRI, as well as new detection on 3 mm routine MRI that was not visualised on 1 mm DLR MRI
Summary
Pituitary adenoma with hormone excess, irrespective of size, sometimes requires accurate detection and surgical treatment. DLR could be used to better detect pituitary adenoma and delineate normal pituitary stalk and gland from tumour tissue. The purpose of the present study was to compare the diagnostic performance and image preference in the paired 1 mm DLR MRI and 3 mm routine MRI for clinical translation and application of DLR MRI. We expected it would be helpful for inexperienced radiologists and clinicians who are not familiar with DLR images and do not have preference biases. We compared both diagnostic performances and image preference between inexperienced and experienced radiologists
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