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MRI texture analysis in acromegaly and its role in predicting response to somatostatin receptor ligands

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Abstract

Purpose

Given the paucity of reliable predictors of tumor recurrence, progression, or response to somatostatin receptor ligand (SRL) therapy in acromegaly, we attempted to determine whether preoperative MR image texture was predictive of these clinical outcomes. We also determined whether image texture could differentiate somatotroph adenomas from non-functioning pituitary adenomas (NFPAs).

Methods

We performed a retrospective study of patients with acromegaly due to a macroadenoma who underwent transsphenoidal surgery at our institution between 2007 and 2015. Clinical data were extracted from electronic medical records. MRI texture analysis was performed on preoperative non-enhanced T1-weighted images using ImageJ (NIH). Logistic and Cox models were used to determine if image texture parameters predicted outcomes.

Results

Eighty-nine patients had texture parameters measured, which were compared to that of NFPAs, while 64 of these patients had follow-up and were included in the remainder of analyses. Minimum pixel intensity, skewness, and kurtosis were significantly different in somatotroph adenomas versus NFPAs (area under the receiver operating characteristic curve, 0.7771, for kurtosis). Furthermore, those with a maximum pixel intensity above the median had an increased odds of IGF-I normalization on SRL therapy (OR 5.96, 95% CI 1.33–26.66), which persisted after adjusting for several potential predictors of response. Image texture did not predict tumor recurrence or progression.

Conclusion

Our data suggest that MRI texture analysis can distinguish NFPAs from somatotroph macroadenomas with good diagnostic accuracy and can predict normalization of IGF-I with SRL therapy.

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This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Author notes

  1. Brandon P. Galm and Colleen Buckless are first authors.

Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Suite 140, Boston, MA, 02114, USA

    Brandon P. Galm, Anne Klibanski & Nicholas A. Tritos

  2. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Colleen Buckless, Martin Torriani & Miriam A. Bredella

  3. Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Brooke Swearingen

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  1. Brandon P. Galm
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Contributions

NAT and MAB originally conceived of the study. BPG extracted clinical data, performed the statistical analyses, and wrote the first draft of the manuscript. CB performed the image texture analyses. All authors were involved in study design and interpretation of results. All authors revised the manuscript critically for important intellectual content, agreed on the final content of the manuscript, and agreed to be accountable for all aspects of the work.

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Correspondence to Brandon P. Galm.

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Conflict of interest

AK serves on the scientific advisory board for Crinetics, which works on developing acromegaly-targeted pharmaceuticals, but does not have any conflicts of interest related to the present work. There are no conflicts of interest related to this study reported by any of the other authors.

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Galm, B.P., Buckless, C., Swearingen, B. et al. MRI texture analysis in acromegaly and its role in predicting response to somatostatin receptor ligands. Pituitary 23, 212–222 (2020). https://doi.org/10.1007/s11102-019-01023-0

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