Abstract
PurposeTo evaluate the use of preoperative virtual Magnetic Resonance Elastography (vMRE) for patients undergoing transsphenoidal resection of pituitary adenomas (PA).MethodsTen patients (60.2 ± 19.6 years; 8 males) were prospectively examined with the vMRE-method prior to transsphenoidal surgery. vMRE-images, reflecting tissue stiffness were reconstructed. From these images, histograms as well as the mean stiffness values over the tumor body were extracted. Finally, vMRE-data was compared with the PA consistency at surgery blinded to vMRE.ResultsIn all patients, successful vMRE-examination was performed enabling evaluation of even small PAs. For tumors with homogenous tissue, the mean stiffness value increased with surgical consistency grading. For heterogenous tumors, however, the mean stiffness value did not consistently reflect the grading at surgery. On the other hand, the vMRE-images and histograms were found to be able to characterize the tumor heterogeneity and display focal regions of high stiffness that were found to affect the surgery outcome in these PAs. The vMRE-images and histograms showed great promise in characterizing the consistency at surgery for these PAs.ConclusionEvaluation of PA consistency in preparation for surgery seems to be feasible using the vMRE-method. Our findings also address the need for high resolution diagnostic methods that can non-invasively display focal regions of increased stiffness, as such regions may increase the difficulty of transsphenoidal PA-resection.
Highlights
Pituitary adenomas (PA) account for 10–15% of all intracranial tumors [1, 2]
The data was derived from the Gothenburg Pituitary Tumor (GoPT) study, which is a prospective study that is enrolling patients scheduled for pituitary surgery at Sahlgrenska University Hospital, the sole provider of neurosurgical services for 1.8 million people in the western region of Sweden [15]
The patients displayed a large range of tumor size from 10 to 44 mm and a large variation in PA consistency from very soft to very hard
Summary
The majority of the PAs have a soft texture and can be resected with curettage and suction [3]. About 10% of the tumors have a fibrous content that makes the tumor difficult to completely resect without injury to surrounding vital structures [4]. To characterize the consistency of PAs, various magnetic resonance imaging (MRI) methods based on standardized T1- and T2-weighted imaging, as well as contrast media enhanced MRI imaging and standardized diffusion weighted imaging have been investigated [6,7,8,9,10]. Up to this date, these methods have not shown sufficient feasibility
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