Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print February 1, 2006, 10.1148/radiol.2383042204
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pierallini, A.
Right arrow Articles by Bozzao, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pierallini, A.
Right arrow Articles by Bozzao, L.

Pituitary Macroadenomas: Preoperative Evaluation of Consistency with Diffusion-weighted MR Imaging—Initial Experience1

Alberto Pierallini, MD, Francesca Caramia, MD, Carlo Falcone, MD, Emanuele Tinelli, MD, Amalia Paonessa, MD, Alessia Bernardo Ciddio, MD, Marco Fiorelli, MD, Federico Bianco, MD, Stefania Natalizi, MD, Luigi Ferrante, MD and Luigi Bozzao, MD

1 From the Neuroradiology Section (A. Pierallini, F.C., C.F., E.T., A.B.C., M.F., L.B.) and Neuroradiology Unit, Department of ENS and Neurology (F.B.), Section of Neuropathology (S.N.), Department of Neurological Sciences, University of Rome, "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy; Department of Neuroradiology, I.R.C.C.S. San Raffaele Pisana, Rome, Italy (A. Pierallini, F.C., A. Paonessa); and Section of Neurosurgery, Department of Neurological Sciences, Sant' Andrea Hospital, Rome, Italy (L.F.). Received December 29, 2004; revision requested March 1, 2005; revision received April 29; accepted June 3; final version accepted August 5. Address correspondence to A. Pierallini (e-mail: alberto.pierallini{at}uniroma1.it).


Figure 1
View larger version (157K):

[in a new window]
  		Figure 1a: Macroadenoma with soft consistency in 46-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous isointense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hyperintense mass (arrows) with respect to normal white matter. (c) Coronal ADC map shows mass (arrows) with decreased diffusion coefficient of (0.593 ± 0.126) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with scant fibrous stroma (in red). (Sirius red stain; original magnification, x20.)

 

Figure 1
View larger version (131K):

[in a new window]
  		Figure 1b: Macroadenoma with soft consistency in 46-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous isointense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hyperintense mass (arrows) with respect to normal white matter. (c) Coronal ADC map shows mass (arrows) with decreased diffusion coefficient of (0.593 ± 0.126) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with scant fibrous stroma (in red). (Sirius red stain; original magnification, x20.)

 

Figure 1
View larger version (131K):

[in a new window]
  		Figure 1c: Macroadenoma with soft consistency in 46-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous isointense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hyperintense mass (arrows) with respect to normal white matter. (c) Coronal ADC map shows mass (arrows) with decreased diffusion coefficient of (0.593 ± 0.126) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with scant fibrous stroma (in red). (Sirius red stain; original magnification, x20.)

 

Figure 1
View larger version (216K):

[in a new window]
  		Figure 1d: Macroadenoma with soft consistency in 46-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous isointense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hyperintense mass (arrows) with respect to normal white matter. (c) Coronal ADC map shows mass (arrows) with decreased diffusion coefficient of (0.593 ± 0.126) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with scant fibrous stroma (in red). (Sirius red stain; original magnification, x20.)

 

Figure 2
View larger version (144K):

[in a new window]
  		Figure 2a: Macroadenoma with intermediate consistency in 57-year-old man. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous slightly hyperintense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows slightly hyperintense lesion (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with diffusion coefficient similar to that of normal parenchyma, (0.842 ± 0.103) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with relatively conspicuous stromal fibrosis (in red). (Sirius red stain; original magnification, x20.)

 

Figure 2
View larger version (125K):

[in a new window]
  		Figure 2b: Macroadenoma with intermediate consistency in 57-year-old man. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous slightly hyperintense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows slightly hyperintense lesion (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with diffusion coefficient similar to that of normal parenchyma, (0.842 ± 0.103) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with relatively conspicuous stromal fibrosis (in red). (Sirius red stain; original magnification, x20.)

 

Figure 2
View larger version (109K):

[in a new window]
  		Figure 2c: Macroadenoma with intermediate consistency in 57-year-old man. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous slightly hyperintense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows slightly hyperintense lesion (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with diffusion coefficient similar to that of normal parenchyma, (0.842 ± 0.103) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with relatively conspicuous stromal fibrosis (in red). (Sirius red stain; original magnification, x20.)

 

Figure 2
View larger version (198K):

[in a new window]
  		Figure 2d: Macroadenoma with intermediate consistency in 57-year-old man. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous slightly hyperintense pituitary mass (arrows). (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows slightly hyperintense lesion (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with diffusion coefficient similar to that of normal parenchyma, (0.842 ± 0.103) x 10–3 mm2/sec. (d) Specimen of mass at histologic examination shows small cells (in blue) with relatively conspicuous stromal fibrosis (in red). (Sirius red stain; original magnification, x20.)

 

Figure 3
View larger version (151K):

[in a new window]
  		Figure 3a: Macroadenoma with hard consistency in 32-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous hyper- and isointense mass (arrows) with respect to white matter. (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hypointense mass (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with marked increase of diffusion coefficient as compared with that of brain parenchyma, (1.349 ± 0.099) x 10–3 mm2/sec. (d) Specimen at histologic examination shows mass characterized by areas with moderate cellularity (in blue) and little fibrosis (in red) as shown at bottom and areas with abundant fibrous stroma and low cellularity as seen at top. (Sirius red stain; original magnification, x20.)

 

Figure 3
View larger version (131K):

[in a new window]
  		Figure 3b: Macroadenoma with hard consistency in 32-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous hyper- and isointense mass (arrows) with respect to white matter. (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hypointense mass (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with marked increase of diffusion coefficient as compared with that of brain parenchyma, (1.349 ± 0.099) x 10–3 mm2/sec. (d) Specimen at histologic examination shows mass characterized by areas with moderate cellularity (in blue) and little fibrosis (in red) as shown at bottom and areas with abundant fibrous stroma and low cellularity as seen at top. (Sirius red stain; original magnification, x20.)

 

Figure 3
View larger version (142K):

[in a new window]
  		Figure 3c: Macroadenoma with hard consistency in 32-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous hyper- and isointense mass (arrows) with respect to white matter. (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hypointense mass (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with marked increase of diffusion coefficient as compared with that of brain parenchyma, (1.349 ± 0.099) x 10–3 mm2/sec. (d) Specimen at histologic examination shows mass characterized by areas with moderate cellularity (in blue) and little fibrosis (in red) as shown at bottom and areas with abundant fibrous stroma and low cellularity as seen at top. (Sirius red stain; original magnification, x20.)

 

Figure 3
View larger version (195K):

[in a new window]
  		Figure 3d: Macroadenoma with hard consistency in 32-year-old woman. (a) Coronal spin-echo T2-weighted MR image (3000/110) shows large inhomogeneous hyper- and isointense mass (arrows) with respect to white matter. (b) Coronal DW single-shot spin-echo echo-planar MR image (5000/101) with diffusion gradient in three principal orthogonal axes and b values of 0 and 1000 sec/mm2 shows hypointense mass (arrows) with respect to normal white matter. (c) ADC map shows mass (arrows) with marked increase of diffusion coefficient as compared with that of brain parenchyma, (1.349 ± 0.099) x 10–3 mm2/sec. (d) Specimen at histologic examination shows mass characterized by areas with moderate cellularity (in blue) and little fibrosis (in red) as shown at bottom and areas with abundant fibrous stroma and low cellularity as seen at top. (Sirius red stain; original magnification, x20.)

 

Figure 4
View larger version (23K):

[in a new window]
  		Figure 4a: Box plots show (a) median, interquartile range, and extreme cases of absolute ADC values; (b) SI ratio on DW images; and (c) SI ratio on T2-weighted images in three groups of macroadenomas according to consistency. Significant associations between tumor consistency and ADC values, SI ratio on DW images, and SI ratio on T2-weighted images were observed (P < .05, analysis of variance). A horizontal reference line is drawn at ADC value of 1 mm2/sec, which could be used as a cutoff value to differentiate tumors amenable to aspiration, because of small overlap between ADC values of tumors in the hard versus the soft or intermediate group. ADC values are expressed in squared millimeters per second.

 

Figure 4
View larger version (24K):

[in a new window]
  		Figure 4b: Box plots show (a) median, interquartile range, and extreme cases of absolute ADC values; (b) SI ratio on DW images; and (c) SI ratio on T2-weighted images in three groups of macroadenomas according to consistency. Significant associations between tumor consistency and ADC values, SI ratio on DW images, and SI ratio on T2-weighted images were observed (P < .05, analysis of variance). A horizontal reference line is drawn at ADC value of 1 mm2/sec, which could be used as a cutoff value to differentiate tumors amenable to aspiration, because of small overlap between ADC values of tumors in the hard versus the soft or intermediate group. ADC values are expressed in squared millimeters per second.

 

Figure 4
View larger version (25K):

[in a new window]
  		Figure 4c: Box plots show (a) median, interquartile range, and extreme cases of absolute ADC values; (b) SI ratio on DW images; and (c) SI ratio on T2-weighted images in three groups of macroadenomas according to consistency. Significant associations between tumor consistency and ADC values, SI ratio on DW images, and SI ratio on T2-weighted images were observed (P < .05, analysis of variance). A horizontal reference line is drawn at ADC value of 1 mm2/sec, which could be used as a cutoff value to differentiate tumors amenable to aspiration, because of small overlap between ADC values of tumors in the hard versus the soft or intermediate group. ADC values are expressed in squared millimeters per second.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE
Copyright © 2006 by the Radiological Society of North America.