Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency.
Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency.
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DOI：
10.3171/2019.12.jns192940
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发表时间：
2020-02
影响因子：
4.1
通讯作者：
John W. Rutland;Joshua Loewenstern;D. Ranti;N. Tsankova;Christopher P. Bellaire;J. Bederson;B. Delman;R. Shrivastava;P. Balchandani
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文献类型：
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作者：
John W. Rutland;Joshua Loewenstern;D. Ranti;N. Tsankova;Christopher P. Bellaire;J. Bederson;B. Delman;R. Shrivastava;P. Balchandani
目的内窥镜手术治疗垂体腺瘤是一种有效的治疗策略，但肿瘤的固有性质，如肿瘤的一致性，可能会挑战或排除大体全切除。术前肿瘤的一致性特征可能有助于指导手术入路和预测可能的切除范围。先进的放射学方法，如7T弥散加权成像(DWI)可能有助于探讨垂体腺瘤的生物组织特性。本研究的目的是探讨7T弥散加权成像作为一种测量垂体腺瘤密度的新方法。方法对13例垂体大腺瘤患者行7T MRI检查，包括DWI图像采集。肿瘤表观扩散系数(ADC)与邻近颞叶灰质ADC归一化。所有患者都接受了切除，一名神经外科医生盲目地使用客观标准将肿瘤的坚固性从1(最不坚固)到5(最坚固)进行分级。肿瘤标本的细胞密度、胶原含量和血管密度由神经病理学家进行组织病理学评估，他也对ADC值视而不见。肿瘤的ADC值与术中一致性分级、组织病理学和切除范围相关。受试者工作特征(ROC)曲线分析用于确定预测肿瘤一致性的阈值。结果校正后的ADC值与肿瘤硬度(r=-0.6，p=0.029)和三色染色程度(r=-0.72，p=0.009)显著相关，ADC值越大，肿瘤硬度越低，胶原染色越弱。ADC值与肿瘤血管密度无显著相关性(r=-0.09，p=0.78)。全切除肿瘤的校正ADC值(1.5 4)大于次全切除肿瘤的校正ADC值(0.85)(p=0.0 2)，中度肿瘤细胞密度的ADC值(1.5 1)大于高细胞肿瘤的ADC值(0.8)(p=0.035)。部分切除的患者显示出更高的肿瘤坚固性等级(3vs1.7；p=0.051)。三色染色程度与肿瘤硬度呈正相关(r=0.60，p=0.04)。预测术中一致性评分的最佳阈值是ADC值0.87(灵敏度80%，特异度100%，曲线下面积0.90；p=0.043)。判断切除范围的最佳界值为1.19(敏感度85.7%，特异度83.3%，AUC 0.833；p=0.046)。结论作者的研究结果表明，垂体腺瘤的高分辨率ADC是衡量肿瘤一致性的敏感指标。7T弥散加权成像对垂体大腺瘤患者的术前体格检查和手术治疗有一定的临床价值。
OBJECTIVE Endoscopic surgery is an effective treatment strategy for pituitary adenomas; however, intrinsic tumor properties such as tumor consistency can challenge or preclude gross-total resection. Preoperative characterization of tumor consistency may help to guide the surgical approach and to predict the extent of resection that is possible. Advanced radiological modalities such as 7T diffusion-weighted imaging (DWI) may be useful in probing biological tissue properties of pituitary adenomas. The objective of the present study was to examine 7T DWI as a novel method of measuring the consistency of pituitary adenomas. METHODS Thirteen patients with pituitary macroadenomas underwent 7T MRI, including a DWI image acquisition. Tumor apparent diffusion coefficient (ADC) was normalized to the adjacent temporal gray matter ADC. All patients underwent resection, and a single neurosurgeon blinded to ADC values rated tumor firmness from 1 (least firm) to 5 (most firm) using objective criteria. The tumor specimens were evaluated histopathologically for cellularity, collagen content, and vascularity by a neuropathologist who was also blinded to ADC values. The tumor ADC was correlated with intraoperative consistency rating, histopathology, and extent of resection. Receiver operating characteristic (ROC) curve analyses were performed to identify thresholds to predict tumor consistency. RESULTS Corrected ADC values were significantly correlated with both tumor firmness (r = -0.60, p = 0.029) and the extent of trichrome staining (r = -0.72, p = 0.009) such that greater ADC values were associated with both decreased tumor firmness and decreased collagen staining. Correlations between ADC values and tumor vascularity were not significant (r = -0.09, p = 0.78). Corrected ADC values in totally resected tumors (1.54) were greater than those in subtotally resected tumors (0.85) (p = 0.02), and ADC values were greater with moderate tumor cellularity (1.51) than with high tumor cellularity (0.8) (p = 0.035). There was a trend-level association for partial resections to exhibit greater tumor firmness rating (3 vs 1.7; p = 0.051). Finally, the degree of trichrome staining positively correlated with tumor firmness (r = 0.60, p = 0.04). The optimal threshold for predicting intraoperative consistency rating was an ADC ratio of 0.87 (sensitivity 80%, specificity 100%, area under the curve [AUC] 0.90; p = 0.043). The optimal cutoff for distinguishing the extent of resection was 1.19 (sensitivity 85.7%, specificity 83.3% AUC 0.833; p = 0.046). CONCLUSIONS The authors' results suggest that a high-resolution ADC of pituitary adenomas is a sensitive measure of tumor consistency. 7T DWI may hold clinical value in the preoperative workup and surgical management of patients with pituitary macroadenomas.