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Hassan RMA, Almalki YE, Basha MAA, Alduraibi SK, Hassan AH, Aboualkheir M, Almushayti ZA, Alduraibi AK, Amer MM, Basha AMA, Refaat MM. Predicting the Consistency of Pituitary Macroadenomas: The Utility of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Measurements for Surgical Planning. Diagnostics (Basel) 2024; 14:493. [PMID: 38472965 DOI: 10.3390/diagnostics14050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Understanding the consistency of pituitary macroadenomas is crucial for neurosurgeons planning surgery. This retrospective study aimed to evaluate the utility of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) as non-invasive imaging modalities for predicting the consistency of pituitary macroadenomas. This could contribute to appropriate surgical planning and therefore reduce the likelihood of incomplete resections. The study included 45 patients with pathologically confirmed pituitary macroadenomas. Conventional MRI sequences, DWIs, ADC maps, and pre- and post-contrast MRIs were performed. Two neuroradiologists assessed all of the images. Neurosurgeons assessed the consistency of the tumor macroscopically, and histopathologists examined it microscopically. The MRI findings were compared with postoperative data. According to the operative data, macroadenomas were divided into the two following categories based on their consistency: aspirable (n = 27) and non-aspirable tumors (n = 18). A statistically significant difference in DWI findings was found when comparing macroadenomas of different consistencies (p < 0.001). Most aspirable macroadenomas (66.7%) were hyperintense according to DWI and hypointense on ADC maps, whereas most non-aspirable macroadenomas (83.3%) were hypointense for DWI and hyperintense on ADC maps. At a cut-off value of 0.63 × 10-3 mm2/s, the ADC showed a sensitivity of 85.7% and a specificity of 75% for the detection of non-aspirable macroadenomas (AUC, 0.946). The study concluded that DWI should be routinely performed in conjunction with ADC measurements in the preoperative evaluation of pituitary macroadenomas. This approach may aid in surgical planning, ensure that appropriate techniques are utilized, and reduce the risk of incomplete resection.
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Affiliation(s)
- Rania Mostafa A Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | | | - Alshehri Hanan Hassan
- Internal Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Mona M Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | | | - Mona Mohammed Refaat
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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Bertolini G, Romano A, Fusella C, Froio E, Serra S, La Corte E, Mazzatenta D, Ghadirpour R. Role of magnetic resonance imaging in differentiating intrasellar cavernous hemangioma and pituitary adenoma: A case report-Decipit frons prima multos. Neuroradiol J 2023; 36:610-613. [PMID: 36598406 PMCID: PMC10569201 DOI: 10.1177/19714009221150854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cavernous hemangioma represents a rare vascular malformation usually located in the cavernous sinus that could be exceptionally found purely in the intrasellar region. The clinical presentation of intrasellar cavernous hemangioma (ICH), frequently variable and unspecific, poses the patient at risk for misdiagnosis and the clinical consequences of suboptimal treatment. We present a case of ICH and describe the advanced magnetic resonance imaging (MRI) features that should direct toward the clinical suspicion of ICH. CASE PRESENTATION An illustrative case of a 61-year-old man complaining of recurrent headaches and diagnosed with a sellar and parasellar lesion was reported and used as a cue to discuss MRI imaging sequences that may aid in the distinction of ICH from pituitary adenoma and other skull base lesions. Heterogeneous enhancement followed by intense homogeneous enhancement at the dynamic contrast-enhanced sequences ("fill-in" phenomenon), absence of blooming signs at the gradient recalled echo (GRE) T2*-weighted and/or susceptibility-weighted imaging (SWI) MRI sequences, and elevated apparent diffusion coefficient (ADC) values usually characterize ICH instead of pituitary adenoma. CONCLUSION Advanced MRI imaging plays an invaluable role in the pre-operative characterization of skull base lesions. Although rare, skull base surgeons should be aware of the ICH in the differential diagnosis process in case of the intrasellar lesion, and a tailored MRI examination should be performed to direct the patient toward the safest and optimal treatment.
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Affiliation(s)
- Giacomo Bertolini
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Italy and IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Antonio Romano
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Italy and IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Claudio Fusella
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Italy and IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Elisabetta Froio
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Serra
- Pathological Anatomy Service, Oncology Department and Advanced Technologies, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Emanuele La Corte
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, Pituitary Unit,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Italy
| | - Reza Ghadirpour
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Italy and IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Collision of Two Tumors: A Case Report of a Lung Adenocarcinoma With Metastasis to a Pituitary Adenoma. J ASEAN Fed Endocr Soc 2022; 37:89-94. [PMID: 36578883 PMCID: PMC9758545 DOI: 10.15605/jafes.037.02.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
A collision tumor involving metastasis to a pituitary adenoma is rare. We describe a case of a 68-year-old Bidayuh woman with underlying treatment-responsive lung adenocarcinoma, who presented with mass effect, panhypopituitarism and polyuria. Her initial imaging study reported pituitary macroadenoma, and she was treated with hormone replacement therapy. She then underwent transsphenoidal tumor debulking surgery with subsequent histopathological findings of a collision tumor of an adenocarcinoma with metastasis to a non-functioning pituitary adenoma.
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Lamorie-Foote K, Rangwala SD, Kammen A, Gnass E, Kramer DR, Rutkowski M, Strickland BA, Carmichael JD, Zada G. Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2167. [PMID: 36046510 PMCID: PMC9394700 DOI: 10.3171/case2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Metastases to the central nervous system are often multiple in number and typically favor the gray-white matter junction. Collision tumors, defined as the coexistence of two morphologically different tumors, such as metastases to a known pituitary adenoma (PA), are exceedingly rare. Only a few reported cases of metastases to a PA exist in the literature.
OBSERVATIONS
The authors present the case of a 64-year-old man with a known history of stage IV metastatic melanoma who was found to have hypermetabolic activity in the sellar region on surveillance positron emission tomography. On laboratory evaluation, he had clear evidence of pituitary axis dysfunction without diabetes insipidus. Subsequent magnetic resonance imaging showed a 2.4-cm sellar mass with features of a pituitary macroadenoma and internal hemorrhage, although no clinical symptoms of apoplexy were noted. He underwent a transsphenoidal endoscopic endonasal approach for resection of the sellar lesion. Final pathology showed a collision tumor with melanoma cells intermixed with PA cells.
LESSONS
Histological analysis verified the rare presence of a collision tumor of a melanoma metastasis to a nonfunctional pituitary macroadenoma. Metastasis to a preexisting PA, although rare, should be considered in the differential diagnosis in patients with sellar lesions and a known cancer history.
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Affiliation(s)
| | | | | | - Esteban Gnass
- Pathology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Daniel R. Kramer
- Department of Neurosurgery, University of Colorado, Aurora, Colorado; and
| | - Martin Rutkowski
- Department of Neurosurgery, Augusta University Medical Center, Augusta, Georgia
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Guerriero E, Ugga L, Cuocolo R. Artificial intelligence and pituitary adenomas: A review. Artif Intell Med Imaging 2020; 1:70-77. [DOI: 10.35711/aimi.v1.i2.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/15/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this review was to provide an overview of the main concepts in machine learning (ML) and to analyze the ML applications in the imaging of pituitary adenomas. After describing the clinical, pathological and imaging features of pituitary tumors, we defined the difference between ML and classical rule-based algorithms, we illustrated the fundamental ML techniques: supervised, unsupervised and reinforcement learning and explained the characteristic of deep learning, a ML approach employing networks inspired by brain’s structure. Pre-treatment assessment and neurosurgical outcome prediction were the potential ML applications using magnetic resonance imaging. Regarding pre-treatment assessment, ML methods were used to have information about tumor consistency, predict cavernous sinus invasion and high proliferative index, discriminate null cell adenomas, which respond to neo-adjuvant radiotherapy from other subtypes, predict somatostatin analogues response and visual pathway injury. Regarding neurosurgical outcome prediction, the following applications were discussed: Gross total resection prediction, evaluation of Cushing disease recurrence after transsphenoidal surgery and prediction of cerebrospinal fluid fistula’s formation after surgery. Although clinical applicability requires more replicability, generalizability and validation, results are promising, and ML software can be a potential power to facilitate better clinical decision making in pituitary tumor patients.
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Affiliation(s)
- Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples 80131, Italy
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Pituitary Blastoma in a 19-Year-Old Woman: A Case Report and Review of Literature. World Neurosurg 2020; 139:310-313. [PMID: 32339726 DOI: 10.1016/j.wneu.2020.04.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pituitary blastoma is a malignant neoplasm of the pituitary gland that was recognized by the World Health Organization in 2017. It is commonly diagnosed in children before 24 months of age. Here, we report the first case of a young adult patient who was diagnosed with pituitary blastoma with increased levels of growth hormone instead of adrenocorticotropic hormone and provide a review of the literature. CASE DESCRIPTION A 19-year-old woman presented to our hospital with visual disturbance. She had a medical history of Wilms' tumor and multinodular goiter. The brain imaging showed a 3.2 × 2.5 × 1.8-cm solid sellar and suprasellar cystic mass that upwardly displaced the optic chiasm. She had an elevated level of growth hormone but a normal level of adrenocorticotropic hormone, cortisol, and prolactin. The mass was subtotally removed through the left pterional craniotomy. The pathologic examination suggested a pituitary blastoma. Thereafter, the patient was treated with chemotherapy and radiotherapy. At 4-year follow-up postsurgery, her overall well-being is good. CONCLUSIONS Although in this case the patient was a young adult, pituitary blastoma should be taken into consideration when children have an enhanced sellar and suprasellar mass with peripherally located cysts.
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