Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas
Most pituitary macroadenomas (PMA) are soft and suckable allowing transsphenoidal resection. A small percentage of PMA are firm, which significantly alters the time, technical difficulty, and effectiveness of transsphenoidal surgery. No current imaging technology can reliably assess PMA viscoelastic consistency in preparation for surgery. Magnetic resonance elastography (MRE) is an MRI-based technique that measures the propagation of mechanically induced shear waves through tissue to calculate stiffness. We prospectively evaluated MRE in 10 patients undergoing transsphenoidal resection of PMA to determine feasibility and potential usefulness.
10 patients with PMA > 2.0 cm in maximum diameter were prospectively imaged with MRE prior to transsphenoidal surgery. Mean patient age was 59.5 ± 16.2 (22–78) years. Five were female and five male. MRE was performed with a modified single-shot spin-echo echo-planar-imaging pulse sequence on a 3T MRI. MRE values were independently calculated. The surgeon, blinded to the MRE results, graded tumor consistency at surgery as soft, intermediate, or firm. Chi-squared test compared surgical grading and MRE stiffness values.
MRE was accomplished in all patients with excellent resolution. By surgical categorization, six tumors were soft and four intermediate. The mean MRE value for soft tumors was 1.38 ± 0.36 (1.08–1.87) kPa, while for intermediate tumors it was 1.94 ± 0.26 (1.72–2.32) kPa (p = 0.020).
Determination of PMA stiffness is feasible with MRE. There was a statistically significant difference in MRE values between soft and intermediate PMAs. Further study in a larger series is ongoing to determine whether MRE will prove useful in preoperative planning for PMA.
KeywordsMagnetic resonance elastography MRE Pituitary macroadenoma Consistency Stiffness
This research received funding from the National Institutes of Health, R01 Grant EB001981.
Compliance with ethical standards
Conflict of interest
Richard Ehman and John Huston and the Mayo Clinic have intellectual property rights and a potential financial interest in some of the technology used in this study.
- 3.Mahmoud OM, Tominaga A, Amatya VJ, Ohtaki M, Sugiyama K, Sakoguchi T, Kinoshita Y, Takeshima Y, Abe N, Akiyama Y, El-Ghoriany AI, Abd Alla AK, El-Sharkawy MA, Arita K, Kurisu K, Yamasaki F (2011) Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas. Eur J Radiol 80(2):412–417. doi: 10.1016/j.ejrad.2010.05.023 CrossRefPubMedGoogle Scholar
- 4.Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, Fiorelli M, Bianco F, Natalizi S, Ferrante L, Bozzao L (2006) Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging—initial experience. Radiology 239(1):223–231. doi: 10.1148/radiol.2383042204 CrossRefPubMedGoogle Scholar
- 6.Yamamoto J, Kakeda S, Shimajiri S, Takahashi M, Watanabe K, Kai Y, Moriya J, Korogi Y, Nishizawa S (2014) Tumor consistency of pituitary macroadenomas: predictive analysis on the basis of imaging features with contrast-enhanced 3D FIESTA at 3T. AJNR Am J Neuroradiol 35(2):297–303. doi: 10.3174/ajnr.A3667 CrossRefPubMedGoogle Scholar
- 13.Murphy MC, Huston J 3rd, Jack CR Jr, Glaser KJ, Senjem ML, Chen J, Manduca A, Felmlee JP, Ehman RL (2013) Measuring the characteristic topography of brain stiffness with magnetic resonance elastography. PLoS One 8(12):e81668. doi: 10.1371/journal.pone.0081668 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Alimohamadi M, Sanjari R, Mortazavi A, Shirani M, Moradi Tabriz H, Hadizadeh Kharazi H, Amirjamshidi A (2014) Predictive value of diffusion-weighted MRI for tumor consistency and resection rate of nonfunctional pituitary macroadenomas. Acta Neurochir (Wien) 156(12):2245–2252. doi: 10.1007/s00701-014-2259-6 (discussion 2252) CrossRefGoogle Scholar