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Tumor T2 signal intensity and stalk angulation correlates with endocrine status in pituitary adenoma patients: a quantitative 7 tesla MRI study

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Pituitary adenomas are common CNS tumors that can cause endocrine dysfunction due to hormone oversecretion and by mass effect on the normal gland. The study of pituitary adenomas and adjacent sellar anatomy with high-resolution 7 T MRI may further characterize endocrine dysfunction. The purpose of this study was to determine the efficacy of 7 T MRI in identifying radiological markers for endocrine function.

Methods

MR images obtained in 23 patients with pituitary adenomas were reviewed by consensus between three neuroradiologists. Landmarks and criteria were devised to measure radiological features of stalk, tumor, and normal gland. Fischer’s exact tests and nominal logistic regression were performed.

Results

Mean cross-sectional area of the stalk just below the infundibular recess was 6.3 ± 3.7 mm2. Mean curvature and deviation angles were 34.2° ± 23.2° and 29.7° ± 17.3°, respectively. Knosp scores obtained differed between 7 T and lower field strength scans (P < 0.0001 [right] and P = 0.0006 [left]). Ability to characterize tumor was rated higher at 7 T compared with lower field MRI, P = 0.05. Confidence in visualizing normal gland was also higher using 7 T MRI, P = 0.036. The six hormone-secreting tumors had higher corrected T2 mean SI than non-secreting tumors (2.54 vs. − 0.38, P = 0.0196). Seven patients had preoperative hypopituitarism and had significantly greater stalk curvature angles than patients without hypopituitarism (71.7° vs. 36.55°, P = 0.027).

Conclusion

Radiological characterization of pituitary adenomas and adjacent native pituitary tissue may benefit with the use of 7 T MRI. Corrected T2 SI of tumor may be a sensitive predictor of hormonal secretion and may be useful in the diagnostic work-up for pituitary adenoma.

Summary statement

7 T MRI may be valuable in identifying markers of endocrine function in patients with pituitary adenomas. Our results indicate that hormone-secreting tumors have higher T2-weighted SI and tumors associated with preoperative hypopituitarism have greater stalk curvature angles.

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Abbreviations

ROI :

Region of interest

SI:

Signal intensity

SNR:

Signal-to-noise ratio

T :

Tesla

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Funding

The following funding was received for this study: NIH R01 CA202911 and the Icahn School of Medicine Capital Campaign, Translational and Molecular Imaging Institute, and Department of Radiology, Icahn School of Medicine at Mount Sinai. No other sources of funding were received for this study.

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Authors and Affiliations

  1. Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    John W. Rutland, Bradley N. Delman & Priti Balchandani

  2. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, Floor 1, New York, NY, 10129, USA

    John W. Rutland, Corey M. Gill & Raj K. Shrivastava

  3. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Puneet Pawha, Puneet Belani & Bradley N. Delman

  4. Department of Medicine, Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Teresa Brown & Khadeen Cheesman

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  1. John W. Rutland
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Corresponding author

Correspondence to John W. Rutland.

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Conflicts of interest

PB (the Principal Investigator in this study) is a named inventor on patents relating to magnetic resonance imaging (MRI) and RF pulse design. The patents have been licensed to GE Healthcare, Siemens AG, and Philips International and PB receives royalty payments relating to these patents. PB is a named inventor on patents relating to Slice-selective adiabatic magnetization T2-preparation (SAMPA) for efficient T2-weighted imaging at ultrahigh field strengths, methods for producing a semi-adiabatic spectral-spatial spectroscopic imaging sequence and devices thereof, and semi-adiabatic spectral-spatial spectroscopic imaging. These patents have been filed through MSIP; they remain unlicensed, there is no discussion to license them in the near future, and there are consequently no royalties revolving around them. The remaining authors declare no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Key points

-7 T MRI yielded Knosp scores that were significantly different than those derived using lower field strength imaging.

-Secreting tumors had higher average T2-weighted SI than non-secreting tumors.

-Tumors associated with preoperative hypopituitarism had greater stalk curvature angles.

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Rutland, J.W., Pawha, P., Belani, P. et al. Tumor T2 signal intensity and stalk angulation correlates with endocrine status in pituitary adenoma patients: a quantitative 7 tesla MRI study. Neuroradiology 62, 473–482 (2020). https://doi.org/10.1007/s00234-019-02352-4

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