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Purpose <p>The consistency of pituitary adenomas (PAs) significantly influences the success of complete tumor resection, which is crucial for prognosis in patients. The aim of this study is to use preoperative diffusion-weighted imaging (DWI) to evaluate tumor consistency, thereby assisting surgeons in achieving optimal resection outcomes during neuroendoscopic procedures.</p> Methods <p>We collected clinical data (including age, sex, symptoms, and consistency), pathological data (including collagen content), and imaging data (including tumor size and ADC ratio) from 264 patients with pituitary macroadenomas. Patients were categorized based on intraoperative consistency assessments and postoperative resection rates to analyze the efficacy of DWI in predicting consistency and identifying determinants of the completeness of resection. Correlation analysis and multiple linear regression were used to explore the relationships among the ADC ratio, tumor consistency, and collagen content. Logistic regression was applied to analyze the factors influencing tumor resection.</p> Results <p>This study included 264 patients. There were 202 patients with a soft consistency and 62 patients with a hard consistency. A total of 212 patients achieved complete resection. The median ADC ratio for the soft consistency group was 1.27 [1.04, 1.59], and that for the hard consistency group was 0.89 [0.83, 0.94] (P &lt; 0.05). The median collagen content in the soft group was 4.55 [2.13, 6.69], and that in the hard group was 13.91 [10.30, 19.20] (P &lt; 0.05). The ADC ratio was significantly related to the collagen content (ρ = −0.965; 95% CI: −0.973 ~ −0.955; P &lt; 0.05). The ADC ratio was a significant predictor for achieving gross-total tumor resection (OR: 5.714; 95% CI: 1.032–31.628; P &lt; 0.05).</p> Conclusion <p>For most patients with pituitary macroadenomas, neuroendoscopic transsphenoidal surgery is the first-line treatment. Preoperative apparent diffusion coefficient (ADC) ratios obtained from diffusion-weighted imaging (DWI) can help to evaluate tumor consistency and collagen content, thus guiding neurosurgeons in predicting resection ability under neuroendoscopy and thereby improving preoperative assessments for these patients.</p>

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The utilization of preoperative DWI for pituitary macroadenoma surgical planning: Implications for neuroendoscopic surgery

  • 期刊论文

  • 发表日期：

    2025年8月20日

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  • Yi Yu,
  • Bao Feng,
  • Yin Ren,
  • Peiming Yu,
  • Yufu Zhu

摘要

Purpose

The consistency of pituitary adenomas (PAs) significantly influences the success of complete tumor resection, which is crucial for prognosis in patients. The aim of this study is to use preoperative diffusion-weighted imaging (DWI) to evaluate tumor consistency, thereby assisting surgeons in achieving optimal resection outcomes during neuroendoscopic procedures.

Methods

We collected clinical data (including age, sex, symptoms, and consistency), pathological data (including collagen content), and imaging data (including tumor size and ADC ratio) from 264 patients with pituitary macroadenomas. Patients were categorized based on intraoperative consistency assessments and postoperative resection rates to analyze the efficacy of DWI in predicting consistency and identifying determinants of the completeness of resection. Correlation analysis and multiple linear regression were used to explore the relationships among the ADC ratio, tumor consistency, and collagen content. Logistic regression was applied to analyze the factors influencing tumor resection.

Results

This study included 264 patients. There were 202 patients with a soft consistency and 62 patients with a hard consistency. A total of 212 patients achieved complete resection. The median ADC ratio for the soft consistency group was 1.27 [1.04, 1.59], and that for the hard consistency group was 0.89 [0.83, 0.94] (P < 0.05). The median collagen content in the soft group was 4.55 [2.13, 6.69], and that in the hard group was 13.91 [10.30, 19.20] (P < 0.05). The ADC ratio was significantly related to the collagen content (ρ = −0.965; 95% CI: −0.973 ~ −0.955; P < 0.05). The ADC ratio was a significant predictor for achieving gross-total tumor resection (OR: 5.714; 95% CI: 1.032–31.628; P < 0.05).

Conclusion

For most patients with pituitary macroadenomas, neuroendoscopic transsphenoidal surgery is the first-line treatment. Preoperative apparent diffusion coefficient (ADC) ratios obtained from diffusion-weighted imaging (DWI) can help to evaluate tumor consistency and collagen content, thus guiding neurosurgeons in predicting resection ability under neuroendoscopy and thereby improving preoperative assessments for these patients.