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Yuzkan S, Erkan B, Dogukan FM, Ozkiziltan U, Balsak S, Arslan FZ, Tutuncuoglu B, Arikan CC, Karatay H, Akpinar E, Ertan Y, Hatipoglu E, Eraslan C, Kitis O, Calli C, Kocak B. Distinguishing Pituitary Metastasis and Pituitary Neuroendocrine Tumors through Conventional MR Imaging and Clinical Features. AJNR Am J Neuroradiol 2024; 45:1063-1069. [PMID: 38871368 PMCID: PMC11383409 DOI: 10.3174/ajnr.a8302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/14/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND PURPOSE Given their overlapping features, pituitary metastases frequently imitate pituitary neuroendocrine tumors in neuroimaging studies. This study aimed to distinguish pituitary metastases from pituitary neuroendocrine tumors on the basis of conventional MR imaging and clinical features as a practical approach. MATERIALS AND METHODS In this 2-center retrospective study, backward from January 2024, preoperative pituitary MR imaging examinations of 22 pituitary metastases and 74 pituitary neuroendocrine tumors were analyzed. Exclusion criteria were as follows: absence of a definitive histopathologic diagnosis, history of pituitary surgery or radiation therapy before MR imaging, and pituitary neuroendocrine tumors treated with medical therapy. Two radiologists systematically evaluated 13 conventional MR imaging features that have been reported more commonly as indicative of pituitary metastases and pituitary neuroendocrine tumors in the literature. Age, sex, history of cancer, and maximum tumor size constituted the clinical/epidemiologic features. The primary cancer origin for this study was also noted. Univariable and multivariable logistic regression was used for the selection of variables, determining independent predictors, and modeling. Interobserver agreement was evaluated for all imaging parameters using the Cohen κ statistic or intraclass correlation coefficient. RESULTS A total of 22 patients with pituitary metastases (8 women; mean age, 49.5 [SD, 13] years) and 74 patients with pituitary neuroendocrine tumors (36 women; mean age, 50.1 [SD, 11] years) were enrolled. There was no statistically significant distributional difference in age, sex, or maximum tumor size between the 2 groups. Lung cancer (9/22; 41%) was the most commonly reported primary tumor, followed by breast (3/22; 13.6%) and unknown cancer (3/22; 13.6%). Logistic regression revealed 3 independent predictors: rapid growth on control MR imaging, masslike or nodular expansion of the pituitary stalk, and a history of cancer. The model based on these 3 features achieved an area under the curve, accuracy, sensitivity, specificity, and Brier score of 0.987 (95% CI, 0.964-1), 97.9% (95% CI, 92.7%-99.8%), 95.5% (95% CI, 77.2%-99.9%), 98.6% (95% CI, 92.7%-100%), and 0.025, respectively. CONCLUSIONS Two conventional features based on pituitary MR imaging with the clinical variable of history of cancer had satisfying predictive performance, making them potential discriminators between pituitary metastases and pituitary neuroendocrine tumors. In cases in which differentiation between pituitary metastases and pituitary neuroendocrine tumors poses a challenge, the results of this study may help with the diagnosis.
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Affiliation(s)
- Sabahattin Yuzkan
- From the Department of Radiology (S.Y.), Koc University Hospital, Istanbul, Turkey
| | - Buruc Erkan
- Department of Neurosurgery (B.E., E.A.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
- Pituitary Diseases Practice and Research Center (B.E.), University of Health Sciences, Istanbul, Turkey
| | - Fatih Mert Dogukan
- Department of Pathology (F.M.D., H.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Uluc Ozkiziltan
- Department of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
| | - Serdar Balsak
- Department of Radiology (S.B.), Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Fatma Zeynep Arslan
- Department of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Berk Tutuncuoglu
- Department of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ceyda Ceren Arikan
- Department of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Huseyin Karatay
- Department of Pathology (F.M.D., H.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ebubekir Akpinar
- Department of Neurosurgery (B.E., E.A.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Yesim Ertan
- Department of Pathology (Y.E.), Ege University School of Medicine, Izmir, Turkey
| | - Esra Hatipoglu
- Division of Endocrinology (E.H.), Department of Internal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cenk Eraslan
- Department of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
| | - Omer Kitis
- Department of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
| | - Cem Calli
- Department of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
| | - Burak Kocak
- Department of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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