Role of diffusion weighted magnetic resonance imaging DW-MRI in choice of the surgical approach for pituitary macroadenoma resection

Abstract

Background and purposeConsistency of pituitary macroadenoma is a crucial information for neurosurgeons. We aimed to assess the role of DW-MRI as non invasive imaging modality in predicting the tumour consistency of pituitary macroadenoma. Materials and methodsTwenty patients with pituitary macroadenoma underwent conventional MR imaging sequences, pre contrast, post contrast MRI and diffusion weighted MRI with ADC map. The tumour consistency was determined both macroscopic by neurosurgeons and microscopic by histopathologists. ResultsOur study included 12 soft, 4 intermediate and 4 hard tumours. The tumour consistency and the collagen contents were correlated with diffusion and ADC values. The mean ADC value of patients with soft tumours was 0.54 × 10−3 mm2/s while for intermediate tumour was 0.82 × 10−3 mm2/s and for hard tumours was 1.11 × 10−3 mm2/s. Soft and intermediate consistency tumours were successfully managed by endoscopic transsphenoidal approach; suction and curettage. While, hard tumours could not be managed by the transsphenoidal approach and needed further transcranial procedure with sensitivity 95% and specificity 95%. ConclusionDWI-MRI is a useful tool to predict the pituitary macroadenoma consistency and the suitable surgical approach for resection.