Endocrine Abstracts

Preoperative evaluation of pituitary macroadenoma tumor consistency is important for neurosurgery. Thus, we aimed to retrospectively assess the role of contrast-enhanced fast imaging employing steady - state acquisition (FIESTA) in predicting the tumor consistency of pituitary macroadenomas.

Objectives: In endoscopic endonasal transsphenoidal surgery of pituitary adenoma, after the removal of the lower component of the tumor, the upper component does not sag and the tumor may remain at the time of operation. We investigated whether residual tumor can be predicted from presurgical neuroimaging findings in pituitary macroadenoma retrospectively.

Subjects: Among the cases of pituitary adenomas mainly composed of solid components with a size exceeding 20 mm in which endonasal transsphenoidal surgery was performed from January 2008 to October 2019, we investigated the cases in which the residural tumor was observed in the postoperative magnetic resonance imaging (MRI) findings retrospectively.

Results: The subjects were 13 cases, 4 males and 9 females, and the median age was 72 years (39–88 years). It was difficult to predict the residural tumor after surgery from T1-weighted images, T2-weighted images, contrast-enhanced T1-weighted images, and apparent diffusion coefficiennt (ADC) map in MRI. In addition, contrast-enhanced FIESTA was performed in 12 cases. Five cases of the low signal intensity region in preoperative contrast-enhanced FIESTA almost coincided with the residual tumor. Four cases of the low signal intensity region in preoperative contrast-enhanced FIESTA partially coincided with the residual tumor. There was no correlation between both images in three cases.

Conclusion: The low signal intensity region with contrast-enhanced FIESTA is considered to be a finding suggesting the possibility of residual tumor in endoscopic nasal surgery in pituitary adenoma.