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Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas

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Abstract

Introduction

Most pituitary macroadenomas (PMA) are soft and suckable allowing transsphenoidal resection. A small percentage of PMA are firm, which significantly alters the time, technical difficulty, and effectiveness of transsphenoidal surgery. No current imaging technology can reliably assess PMA viscoelastic consistency in preparation for surgery. Magnetic resonance elastography (MRE) is an MRI-based technique that measures the propagation of mechanically induced shear waves through tissue to calculate stiffness. We prospectively evaluated MRE in 10 patients undergoing transsphenoidal resection of PMA to determine feasibility and potential usefulness.

Methods

10 patients with PMA > 2.0 cm in maximum diameter were prospectively imaged with MRE prior to transsphenoidal surgery. Mean patient age was 59.5 ± 16.2 (22–78) years. Five were female and five male. MRE was performed with a modified single-shot spin-echo echo-planar-imaging pulse sequence on a 3T MRI. MRE values were independently calculated. The surgeon, blinded to the MRE results, graded tumor consistency at surgery as soft, intermediate, or firm. Chi-squared test compared surgical grading and MRE stiffness values.

Results

MRE was accomplished in all patients with excellent resolution. By surgical categorization, six tumors were soft and four intermediate. The mean MRE value for soft tumors was 1.38 ± 0.36 (1.08–1.87) kPa, while for intermediate tumors it was 1.94 ± 0.26 (1.72–2.32) kPa (p = 0.020).

Conclusion

Determination of PMA stiffness is feasible with MRE. There was a statistically significant difference in MRE values between soft and intermediate PMAs. Further study in a larger series is ongoing to determine whether MRE will prove useful in preoperative planning for PMA.

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Acknowledgments

This research received funding from the National Institutes of Health, R01 Grant EB001981.

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Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Joshua D. Hughes & J. Van Gompel

  2. Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA

    Nikoo Fattahi, Arvin Arani, Richard Ehman & John Huston III

  3. Mayo Clinic, 200 1st Street SW, Rochester, MN, 55901, USA

    John Huston III

Authors
  1. Joshua D. Hughes
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  2. Nikoo Fattahi
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  3. J. Van Gompel
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  4. Arvin Arani
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  5. Richard Ehman
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Correspondence to John Huston III.

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Conflict of interest

Richard Ehman and John Huston and the Mayo Clinic have intellectual property rights and a potential financial interest in some of the technology used in this study.

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Hughes, J.D., Fattahi, N., Van Gompel, J. et al. Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas. Pituitary 19, 286–292 (2016). https://doi.org/10.1007/s11102-016-0706-5

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  • DOI: https://doi.org/10.1007/s11102-016-0706-5

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