Identification of tumor residuals in pituitary adenoma surgery with intraoperative MRI: do we need gadolinium?
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To evaluate the diagnostic accuracy of high-resolution T2w intraoperative magnetic resonance imaging (iMRI) for detecting pituitary adenoma remnants compared to contrast-enhanced T1-weighted images.
42 patients underwent iMRI-guided resection of large pituitary macroadenomas and fulfilled the inclusion criteria for this retrospective analysis. Intraoperative and postoperative imaging evaluation of tumor residuals and localization were assessed by two experienced neuroradiologists in a blinded fashion. The diagnostic accuracy of T2w and contrast-enhanced T1w images were evaluated.
The diagnostic accuracy for detecting tumor residuals of high-resolution T2w images showed highly significant association to contrast-enhanced T1w images (p < 0.0001). Furthermore, identification rate of tumor remnants in different compartments, e.g., cavernous sinus, was comparable. In total, coronal T2w images provided a diagnostic sensitivity of 97.7% and specificity of 100% compared to the gold standard of contrast-enhanced T1w images. The postoperatively expected extent of resection proved to be true in 97.6% according to MRI 3 months after resection.
High-resolution T2w intraoperative MR images provide excellent diagnostic accuracy for detecting tumor remnants in macroadenoma surgery with highly significant association compared to T1w images with gadolinium. The routine-use and need of gadolinium in these patients should be questioned critically in each case in the future.
KeywordsPituitary adenoma Intraoperative MRI High-resolution MRI Gadolinium
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the local institutional review board (Project 208/2019/BO2).
In accordance with local privacy protection laws (§13(1) LDSG-Anpassungsgesetz) and EU regulation 2016/679 Art. 5, 6, 9, and 89, informed consent was waived for this retrospective evaluation of clinical data.
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