Article
High-field MRI at 3 Tesla for diagnosis and surgery of perisellar pathologies
Hochfeld MRT (3 Tesla) für Diagnose und Chirurgie perisellärer Prozesse
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Authors
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S. Wolfsberger
- Klinik für Neurochirurgie, Medizinische Universität Wien
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K. Pinker
- Radiodiagnostik, Medizinische Universität Wien
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F. Marhold
- Klinik für Neurochirurgie, Medizinische Universität Wien
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T. Czech
- Klinik für Neurochirurgie, Medizinische Universität Wien
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S. Trattnig
- Radiodiagnostik, Medizinische Universität Wien
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E. Knosp
- Klinik für Neurochirurgie, Medizinische Universität Wien
| Published: | May 4, 2005 |
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Outline
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Objective
To determine the value of high-field magnetic resonance imaging (MRI) for diagnosis and surgery of perisellar pathologies.
Methods
High-field MRI using a 3 Tesla (T) Bruker Medspec® 30/80 scanner was obtained from 30 patients (1) to verify a pituitary microadenoma that was suspected endocrinologically and/or with 1.0 – 1.5T standard MRI (sMRI), (2) to preoperatively delineate perisellar anatomical structures with special regard to the medial border of the cavernous sinus and a possible invasion of a sellar tumour therein and (3) to assess the application of high-resolution images for intraoperative neuronavigation. 3T MRI was compared to the already available sMRI and to intraoperative findings.
Results
Of 5 patients with a suspected pituitary microadenoma, 3T MRI depicted an endosellar hypointensity in 3. Anatomical structures were studied in 60 cavernous sinuses: The medial cavernous sinus border was rated intact in 53% of sMRI, in 72 % of 3T MRI and in 81% intraoperatively. With a positive correlation to surgical findings in 84% of 3T MRI compared to 59% of sMRI, a sensitivity of 83% vs. 67% and a specificity of 84% vs. 58% (P=0.016, McNemar test) 3T MRI was superior in predicting tumour invasion through the medial cavernous sinus border. There was a better delineation of the lateral cavernous sinus compartment using 3T MRI: It was clearly visible in 95% of 3T MRI vs. 81% of sMRI. Identification of the intracavernous cranial nerves III, IV, V1, V2 and VI was improved using 3T MRI: It delineated mean 4 cranial nerves (range 2 – 5 hypointense spots) vs. 3 (range 0 – 4) by sMRI. Intraoperative navigation with fusion of 3T MR and computed tomography (CT) images were performed in 7 patients: 3T MRI was particularly useful for visualization of parasellar tumour extension during microsurgical and/or endoscopic resection.
Conclusions
According to our preliminary results, 3T MRI was found superior to sMRI for diagnosis and surgery of sellar lesions: 3T MRI may be able to visualize microadenomas that can only be suspected on sMRI, to delineate parasellar anatomy to a detail that the medial cavernous sinus border may be visible, and to provide optimal imaging during intraoperative navigation.
