Testing magnetic resonance imaging parameters to predict pituitary macroadenoma consistency

Q: What was the main objective of the study?

To evaluate whether conventional T2-weighted imaging can predict pituitary macroadenoma consistency by comparing isolated tumor signal intensity with the adenoma-to-middle cerebellar peduncle (ACP) ratio.

Q: How were MRI measurements and consistency classification performed?

Three blinded radiologists independently measured adenoma signal intensity and middle cerebellar peduncle signal intensity on MRI, and the ACP ratio was calculated. Tumor consistency (soft or fibrous) was determined intraoperatively by a single neurosurgeon.

Q: Which imaging approach performed better in distinguishing soft versus fibrous tumors?

The ACP ratio demonstrated stronger discriminatory power than isolated adenoma signal intensity on T2-weighted imaging, with a reported ROC area under the curve of 0.939.

Sep 29, 2026

Uploaded by Patrick

Pituitary macroadenomas are often soft and readily resectable, but a subset is fibrous and can complicate neurosurgical removal. This study assessed whether conventional T2-weighted imaging could predict tumor consistency preoperatively by comparing isolated tumor signal intensity with an adenoma-to-middle cerebellar peduncle (ACP) ratio. MRI from 45 patients was reviewed by three blinded radiologists, while consistency was classified intraoperatively. The ACP ratio showed superior discrimination, supporting its use as a noninvasive imaging biomarker.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Methods (Reproducibility and Ethics)

Surgical assessment of tumor consistency

Article published online: 2025-12-02 Original Article 1 Testing magnetic resonance imaging parameters to predict pituitary macroadenoma consistency Thaylla Maybe Bedinot da Conceição 1,3 Jaisa Quedi Araújo da Silva 1,2 Matheus de Lima Rufﬁni2 Adolfo Moraes de Souza2 Fabiano Reis3 Ápio Cláudio Martins Antunes 1,2 Marino Muxfeldt Bianchin 1,2 Juliana Ávila Duarte 1,2 1 Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil. 2 Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre RS, Brazil. 3 Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas SP, Brazil. Arq. Neuro-Psiquiatr. 2025;83(11):s00451813239 . Address for correspondence Juliana Ávila Duarte (email: [juduarte@hcpa.edu.br](juduarte@hcpa.edu.br)) Abstract Keywords ► Pituitary Neoplasms ► Magnetic Resonance Imaging ► Neuroimaging ► Surgical Oncology Background Pituitary macroadenomas (PMAs) are frequently encountered tumors, predominantly characterized as soft and easily resectable during neurosurgery. In contrast, ﬁbrous PMAs present difﬁculties during surgical removal. Therefore, the ability to predict the consistency of PMAs preoperatively could enhance surgical planning. Objective To evaluate the ability of conventional T2-weighted imaging (T2WI) to predict PMA consistency by comparing isolated tumor signal intensity with the adenoma-to-middle cerebellar peduncle (ACP) ratio. Methods Magnetic resonance imaging (MRI) scans from 45 patients with PMAs were independently reviewed by 3 blinded radiologists. For each case, the signal intensity (SI) of the adenoma and of the middle cerebellar peduncle was measured, and the ACP ratio (SIadenoma/SIpeduncle) was calculated. Tumor consistency (soft or ﬁbrous) was determined intraoperatively by a single neurosurgeon. Results Intraoperative assessment classiﬁed 29 PMAs (64.4%) as soft and 16 (35.6%) as ﬁbrous. Isolated adenoma SI on T2WI differed signiﬁcantly between soft and ﬁbrous tumors (p ¼ 0.013), while the ACP ratio demonstrated stronger discriminatory power (p <0.0001) . The receiver operating characteristic (ROC) curve yielded an area under the curve of 0.939 for the ACP ratio. Threshold values > 1.59 were highly predictive of soft tumors (sensitivity 72.4%; speciﬁcity 100.0%), whereas values < 1.27 were associated with ﬁbrous tumors (sensitivity 100.0%; speciﬁcity 37.5%) . Conclusion Although isolated adenoma SI on T2WI showed statistical signiﬁcance, it was not sufﬁcient for consistent preoperative prediction of tumor consistency. The ACP ratio provided superior accuracy and clinical utility, supporting its role as a noninvasive imaging biomarker to enhance preoperative assessment and surgical planning inpatients with pituitary macroadenomas. received June 13, 2025 received in its ﬁnal form September 18, 2025 accepted September 21, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1813239 . ISSN 0004-282X. Editor-in-Chief: Hélio A. G. Teive. Associate Editor: Leandro Tavares Lucato. © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil 2 MRI parameters to predict adenoma consistency Conceição et al. INTRODUCTION Most pituitary macroadenomas (PMAs) are soft, facilitating effective transsphenoidal resection. However, 􀀂 10% of these tumors are ﬁbrous, which may affect the surgical approach. Various magnetic resonance imaging (MRI) techniques have been explored to ascertain PMA consistency, includingthe evaluation o

FAQs

What was the main objective of the study?

To evaluate whether conventional T2-weighted imaging can predict pituitary macroadenoma consistency by comparing isolated tumor signal intensity with the adenoma-to-middle cerebellar peduncle (ACP) ratio.

How were MRI measurements and consistency classification performed?

Three blinded radiologists independently measured adenoma signal intensity and middle cerebellar peduncle signal intensity on MRI, and the ACP ratio was calculated. Tumor consistency (soft or fibrous) was determined intraoperatively by a single neurosurgeon.

Which imaging approach performed better in distinguishing soft versus fibrous tumors?

The ACP ratio demonstrated stronger discriminatory power than isolated adenoma signal intensity on T2-weighted imaging, with a reported ROC area under the curve of 0.939.

Sep 29, 2026

Uploaded by Patrick