Role of diffusion weighted magnetic resonance imaging DW-MRI in proper surgical planning for pituitary macroadenoma resection

Document Type : Original Article

Authors

1 radiodiagnosis,medicine,zagazig university,zagazig,Egypt

2 department of radio-diagnosis, faculty of medicine,Zagazig university, Zagazig, Egypt

3 Radio-diagnosis department /Faculty of medicine/Zagazig university

4 radiology department, faculty of medicine, zagazig university, Zagazig, Egypt

Abstract

BACKGROUND: Assessment pituitary macroadenoma consistency before surgical resection is crucial for neurosurgeons for appropriate choice of the surgical procedure. So, we sought to evaluate the DW-MRI role as a noninvasive method in predicting pituitary macroadenoma consistency
PATIENTS AND METHODS: Conventional MRI sequences, DWI-MRI with ADC map were done on twenty four patients. We determined the tumor consistency both macroscopically by neurosurgeons and microscopically by histopathologists.
RESULTS: According to ADC values, we had three categories of macroadenoma consistency; the mean ADC value of the soft category was (0.49) x 10ˉ³ mm² /s, the intermediate category was (0.80) x 10ˉ³ mm² /s and the hard category was (0.98) x 10ˉ³ mm²/s. The soft tumors were well suctioned by endoscopic transsphenoidal procedure. While, transsphenoidal approach failed in completely removing the intermediate and hard tumors and they needed further extensive transcranial approach with sensitivity 100% and specificity 83.8%.
CONCLUSIONS: As a part of the routine pre-operative assessment of macroadenoma consistency, we should include DWI and the corresponding ADC value to choose the suitable resection approach with recommendation of ADC cut off value of 0.61 x 10ˉ³ mm²/s, for proper differentiation of soft macroadenomas from the intermediate/hard adenomas.

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Zagazig University Medical Journal
Volume 29, Issue 2
March 2023
Pages 404-410

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