The Diagnostic Accuracy of Dynamic Contrast Magnetic Resonance Imaging (MRI) in Symptomatic Patients with Pituitary Macroadenomas Taking Histopathology as Gold Standard
Keywords:Dynamic contrast Magnetic Resonance Imaging (MRI), pituitary, macroadenoma, diagnostic accuracy.
AbstractBackground: The pituitary gland also known as the “master gland,” is involved in maintaining the homeostasis of various body functions. The pituitary gland is comprised of adenohypophysis and neurohypophysis, and stays in an indent in the sphenoid bone called sella turcica. Objective: To determine the diagnostic accuracy of dynamic contrast Magnetic Resonance Imaging (MRI) in symptomatic patients with pituitary macroadenoma keeping histopathology as gold standard. Methods: Cross-sectional study carried out in Department of Radiology, Tertiary Care Hospital, Lahore from May 2019 to Oct 2020. Prospective. One hundred and one patients (101) were enrolled. Dynamic contrast magnetic resonance imaging (MRI) of patients was performed on 1.5 Tesla GE MRI machine using head coil. Transsphenoidal endoscopic surgery of seventy-five patients was done due to their progressing symptoms and out of these four patients lost to follow up. All the available post operative specimens were reviewed by experienced histopathologist and were labelled as positive and negative for pituitary macroadenoma. Results: Mean age of patients (n=71) was 37.4 years. Out of 71 patients, MRI showed pituitary macroadenoma in 64 patients (90.1%) of which two were false positives. 3 patients (4.2%) showed pituitary microadenoma, 1 ( 1.4%) represented meningioma,1 ( 1.4%) showed craniopharyngioma and 2 ( 2.8%) showed pituitary hyperplasia. Sensitivity was found to be 96.9% , specificity was 71.4% , positive predictive value (PPV) was 96.9% , negative predictive value (NPV) was 71.4% and accuracy of dynamic contrast MRI in detecting pituitary macroadenoma was 94.3%. Conclusion: Dynamic contrast MRI is an authentic and non-invasive diagnostic imaging modality due to its better soft tissue contrast, multiplanar images and no risk of ionizing irradiation that allows the detection of pituitary macroadenoma with high sensitivity, specificity and accuracy. It also provides practical information about the interrelation of the gland with adjoining anatomical structures and helps to schedule medical or surgical treatment.
- 2022-11-24 (3)
- 2022-10-21 (1)
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