目的:术前确定垂体大腺瘤鞍旁浸润的程度对于手术计划和患者咨询是有用的。这里,作者比较了稳态下的建设性干扰(CISS),T2加权梯度回波MRI序列,容积内插屏气检查(VIBE),T1加权梯度回波MRI序列,用于评估垂体大腺瘤的海绵窦侵袭(CSI)。回顾性分析98例垂体大腺瘤患者的METHODSVIBE和CISS图像,并使用改良的Knosp分类进行分级。Knosp评分与CSI的手术结果相关,术中使用0°和30°内窥镜确定。使用接收器工作特征(ROC)曲线比较了根据CISS和VIBE图像得出的Knosp等级的CSI预测准确性。术后MRI用于评估总切除率(GTR)。结果垂体大腺瘤的CSI发生率为27.6%(98例中有27例)。在196个评估中(98个大型腺瘤的左侧和右侧),使用VIBEversusCISS图像进行评分时,45分(23.0%)具有不同的Knosp等级。对于VIBE图像,0级Knosp的0%,1级的4.5%,2级的23.8%,3A级的42.1%,100%的3B级,术中发现4级大腺瘤的83.3%有CSI。对于CISS映像,0级Knosp的0%,1级的2.1%,2级的31.3%,3A级的56.3%,100%的3B级,100%的4级大腺瘤术中发现有CSI。两个垂体大腺瘤在VIBE序列上被分类为4级,而在CISS序列上被分类为3A级和2级;两种情况下术中均未观察到CSI。高等级的GTR率为64.3%和60.0%(3A,3B,和4)使用VIBE和CISS序列分类的大腺瘤,分别。对于VIBE和CISS衍生的Knosp等级,ROC曲线下的面积分别为0.94和0.97(p=0.007),分别。结论使用CISS序列图像确定的SKnosp等级与术中CSI的相关性比使用VIBE序列图像确定的等级更好。CISS序列对于垂体大腺瘤的术前评估可能很有价值。
Preoperatively determining the extent of parasellar invasion of pituitary macroadenomas is useful for surgical planning and patient counseling. Here, the authors compared constructive interference in steady state (CISS), a T2-weighted gradient-echo MRI sequence, to volume-interpolated breath-hold examination (VIBE), a T1-weighted gradient-echo MRI sequence, for evaluation of cavernous sinus invasion (CSI) by pituitary macroadenomas.
VIBE and CISS images of 98 patients with pituitary macroadenoma were retrospectively analyzed and graded using the modified Knosp classification. The Knosp grades were correlated to surgical findings of CSI, which were determined intraoperatively using 0° and 30° endoscopes. The predictive accuracies for CSI according to the Knosp grades derived from the CISS and VIBE images were compared using receiver operating characteristic (ROC) curves. Postoperative MRI was used to evaluate the gross-total resection (GTR) rates.
The CSI rate by pituitary macroadenomas was 27.6% (27 of 98 cases). Of 196 assessments (left and right sides of 98 macroadenomas), 45 (23.0%) had different Knosp grades when scored using VIBE versus CISS images. For the VIBE images, 0% of Knosp grade 0, 4.5% of grade 1, 23.8% of grade 2, 42.1% of grade 3A, 100% of grade 3B, and 83.3% of grade 4 macroadenomas were found to have CSI intraoperatively. For the CISS images, 0% of Knosp grade 0, 2.1% of grade 1, 31.3% of grade 2, 56.3% of grade 3A, 100% of grade 3B, and 100% of grade 4 macroadenomas were found to have CSI intraoperatively. Two pituitary macroadenomas were classified as grade 4 on VIBE sequences but grades 3A and 2 on CISS sequences; CSI was not observed intraoperatively in both cases. The GTR rate was 64.3% and 60.0% for high-grade (3A, 3B, and 4) macroadenomas classified using VIBE and CISS sequences, respectively. The areas under the ROC curves were 0.94 and 0.97 for VIBE- and CISS-derived Knosp grades (p = 0.007), respectively.
Knosp grades determined using CISS sequence images are better correlated with intraoperative CSI than those determined using VIBE sequence images. CISS sequences may be valuable for the preoperative assessment of pituitary macroadenomas.