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Tumor T2 signal intensity and stalk angulation correlates with endocrine status in pituitary adenoma patients: a quantitative 7 tesla MRI study

  • John W. RutlandEmail author
  • Puneet Pawha
  • Puneet Belani
  • Bradley N. Delman
  • Corey M. Gill
  • Teresa Brown
  • Khadeen Cheesman
  • Raj K. Shrivastava
  • Priti Balchandani
Diagnostic Neuroradiology

Abstract

Purpose

Pituitary adenomas are common CNS tumors that can cause endocrine dysfunction due to hormone oversecretion and by mass effect on the normal gland. The study of pituitary adenomas and adjacent sellar anatomy with high-resolution 7 T MRI may further characterize endocrine dysfunction. The purpose of this study was to determine the efficacy of 7 T MRI in identifying radiological markers for endocrine function.

Methods

MR images obtained in 23 patients with pituitary adenomas were reviewed by consensus between three neuroradiologists. Landmarks and criteria were devised to measure radiological features of stalk, tumor, and normal gland. Fischer’s exact tests and nominal logistic regression were performed.

Results

Mean cross-sectional area of the stalk just below the infundibular recess was 6.3 ± 3.7 mm2. Mean curvature and deviation angles were 34.2° ± 23.2° and 29.7° ± 17.3°, respectively. Knosp scores obtained differed between 7 T and lower field strength scans (P < 0.0001 [right] and P = 0.0006 [left]). Ability to characterize tumor was rated higher at 7 T compared with lower field MRI, P = 0.05. Confidence in visualizing normal gland was also higher using 7 T MRI, P = 0.036. The six hormone-secreting tumors had higher corrected T2 mean SI than non-secreting tumors (2.54 vs. − 0.38, P = 0.0196). Seven patients had preoperative hypopituitarism and had significantly greater stalk curvature angles than patients without hypopituitarism (71.7° vs. 36.55°, P = 0.027).

Conclusion

Radiological characterization of pituitary adenomas and adjacent native pituitary tissue may benefit with the use of 7 T MRI. Corrected T2 SI of tumor may be a sensitive predictor of hormonal secretion and may be useful in the diagnostic work-up for pituitary adenoma.

Summary statement

7 T MRI may be valuable in identifying markers of endocrine function in patients with pituitary adenomas. Our results indicate that hormone-secreting tumors have higher T2-weighted SI and tumors associated with preoperative hypopituitarism have greater stalk curvature angles.

Keywords

Pituitary infundibulum Pituitary adenoma Endocrine abnormality Ultrahigh field MRI 

Abbreviations

ROI

Region of interest

SI

Signal intensity

SNR

Signal-to-noise ratio

T

Tesla

Notes

Funding information

The following funding was received for this study: NIH R01 CA202911 and the Icahn School of Medicine Capital Campaign, Translational and Molecular Imaging Institute, and Department of Radiology, Icahn School of Medicine at Mount Sinai. No other sources of funding were received for this study.

Compliance with ethical standards

Conflicts of interest

PB (the Principal Investigator in this study) is a named inventor on patents relating to magnetic resonance imaging (MRI) and RF pulse design. The patents have been licensed to GE Healthcare, Siemens AG, and Philips International and PB receives royalty payments relating to these patents. PB is a named inventor on patents relating to Slice-selective adiabatic magnetization T2-preparation (SAMPA) for efficient T2-weighted imaging at ultrahigh field strengths, methods for producing a semi-adiabatic spectral-spatial spectroscopic imaging sequence and devices thereof, and semi-adiabatic spectral-spatial spectroscopic imaging. These patents have been filed through MSIP; they remain unlicensed, there is no discussion to license them in the near future, and there are consequently no royalties revolving around them. The remaining authors declare no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • John W. Rutland
    • 1
    • 2
    Email author
  • Puneet Pawha
    • 3
  • Puneet Belani
    • 3
  • Bradley N. Delman
    • 1
    • 3
  • Corey M. Gill
    • 2
  • Teresa Brown
    • 4
  • Khadeen Cheesman
    • 4
  • Raj K. Shrivastava
    • 2
  • Priti Balchandani
    • 1
  1. 1.Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of NeurosurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  4. 4.Department of Medicine, Division of Endocrinology, Diabetes and Bone DiseasesIcahn School of Medicine at Mount SinaiNew YorkUSA

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