EP1086 - ECE_1685 - The possible role of black blood magnetic resonance imaging sequences in pituitary tumor diagnosis

Le résumé fourni par la source

Abstract Background In the diagnosis of pituitary tumors, especially in Cushing's disease (CD), conventional MRI could be inconclusive, forcing clinicians to perform invasive tests like Inferior Petrosal-Sinus Sampling (IPSS) and exploring surgery. The black-blood (BB) MRI sequences are widely used in the diagnostic workup of several conditions including brain tumors, because the suppression of fast-flowing blood signal improves the identification of surrounding tissues, helping to differentiate tumoral lesions from vascular structures that could look similar on standard imaging. However, the role of BB in the diagnosis of pituitary adenomas has not been fully assessed. Aim of the Study to evaluate the potential utility of BB-MRI sequences in the diagnostic workup of pituitary adenomas. Patients from January 2023, 3T MRI with BB sequences was performed in 20 patients whose MRI findings remained inconclusive despite evaluation by an expert pituitary neuroradiologist within a dedicated multidisciplinary pituitary disease meeting. Among them, 4 patients with CD had undetectable lesion, 11 cases had doubtful findings and 5 patients were reported to have two lesions. The final clinical diagnoses were CD (n = 14), acromegaly (n = 2), prolactinoma (n = 2), NFPA (n = 1) and suspected pituitary metastasis (n = 1). Results BB-MRI sequences provide further diagnostic information in 16/20 cases and in 7 cases the final report was completely revised. Among patients with suspected double lesions, the diagnosis was confirmed in 2 cases, while in 2 patients only one lesion was reported, and they underwent trans-sphenoidal surgery (TSS) with histological confirmation of corticotroph PitNET; instead, in the remaining patient no lesion was described and IPSS was scheduled. In the group with doubtful lesions, the diagnosis was confirmed in 7 patients, 3 of whom underwent TSS. In 2 patients (a prolactinoma and a suspected NFPA), respectively the lesions were re-classified as Rathke's cleft cyst and partial volume artifact, while in the other 2 cases MRI remained inconclusive. In the group with negative MRI, a microadenoma was identified, with histological confirmation of corticotroph PitNET after TSS. However, MRI persisted negative in one patient and in 2 cases were still considered doubtful (one patient continued medical treatment, while one person underwent TSS with negative histology). Conclusions BB-MRI sequencing is a simple and non-invasive tool which could be helpful in the diagnostic workup of unclear pituitary lesions. However, given the small sample size and potential bias in patient selection, further studies are needed to better define its clinical impact.

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