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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Identification of tumour residuals in pituitary adenoma surgery with intraoperative MRI – Do we need gadolinium?

Benötigt man Gadolinium bei der Indentifikation von Resttumor bei Hypophysenadenom OPs in einem intraoperativen MRT?

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  • presenting/speaker Constantin Roder - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland
  • Benjamin Bender - Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
  • Georg Gohla - Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
  • Ulrike Ernemann - Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland
  • Jürgen Honegger - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV143

doi: 10.3205/20dgnc143, urn:nbn:de:0183-20dgnc1435

Published: June 26, 2020

© 2020 Roder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To evaluate the diagnostic accuracy of high-resolution T2w intraoperative magnetic resonance imaging (iMRI) with 1.5T for detecting pituitary adenoma remnants compared to contrast enhanced T1-weighted images.

Methods: 42 patients underwent iMRI-guided resection of large pituitary macroadenomas and fulfilled the inclusion criteria for this retrospective analysis. Intraoperative and postoperative imaging evaluation of tumor residuals and localization were assessed by two experienced neuroradiologists in a blinded fashion. The diagnostic accuracy of T2w and contrast enhanced T1w images were evaluated.

Results: The diagnostic accuracy for detecting tumor residuals of high-resolution T2w images showed highly significant association to contrast enhanced T1w images (p<0.0001). Furthermore, identification rate of tumor remnants in different compartments, e.g. cavernous sinus, was comparable. In total, coronal T2w images provided a diagnostic sensitivity of 97.7 % and specificity of 100 % compared to the gold standard of contrast enhanced T1w images. The postoperatively expected extent of resection proved to be true in 97.6% according to MRI 3 months after resection.

Conclusion: High-resolution T2w intraoperative MR images provide excellent diagnostic accuracy for detecting tumor remnants in macroadenoma surgery with highly significant association compared to T1w images with gadolinium. The routine-use and need of gadolinium in these patients should be questioned critically in each case in the future.