Role of PROPELLER diffusion weighted imaging and apparent diffusion coefficient in the diagnosis of sellar and parasellar lesions

doi:10.1016/j.ejrad.2009.03.031

European Journal of Radiology

Volume 74, Issue 3, June 2010, Pages 420-427

https://doi.org/10.1016/j.ejrad.2009.03.031 Get rights and content

Abstract

Objective

To evaluate the role of the apparent diffusion coefficient (ADC) using periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) diffusion weighted imaging (DWI) in the differentiation between sellar and parasellar mass lesions.

Materials and methods

The study protocol was approved by our institutional review board. We retrospectively studied 60 patients with sellar and parasellar lesions who had undergone PROPELLER DWI on a 3-T MR imager. Conventional MRI findings were expressed as the ratio of signal intensity (SI) in the lesions to the normal white matter and the degree of contrast enhancement. ADC values were calculated as the minimum (ADC-MIN), mean (ADC-MEAN), and maximum (ADC-MAX). All patients underwent surgery and all specimens were examined histologically. Logistic discriminant analysis was performed by using the SI ratios on T1- and T2-weighted images (T1-WI, T2-WI), the degree of enhancement, and absolute ADC values as independent variables.

Results

ADC-MIN of hemorrhagic pituitary adenomas was lower than of the other lesions with similar appearance on conventional MRI (non-hemorrhagic pituitary adenomas, craniopharyngiomas, Rathke's cleft cysts; accuracy 100%); the useful cut-off value was 0.700 × 10⁻³ mm²/s. ADC-MAX of meningiomas was lower than of non-hemorrhagic pituitary adenomas (accuracy 90.3%; p < 0.01). ADC-MIN of craniopharyngiomas was lower than of Rathke's cleft cysts (accuracy 100%; p < 0.05).

Conclusion

As PROPELLER DWI is less sensitive to susceptibility artifacts than single-shot echoplanar DWI, it is more useful in the examination of sellar and parasellar lesions. Calculation of the ADC values helps to differentiate between various sellar and parasellar lesions.

Introduction

Radiological imaging of the pituitary gland and parasellar region is challenging because the pituitary gland is a very small organ near many important structures. Magnetic resonance imaging (MRI) is the modality of choice; it provides multiplanar high-contrast images of the pituitary gland and adjacent structures [1]. Typical MRI protocols used for the evaluation of sellar masses include pre- and post-gadolinium-enhanced T1-weighted and T2-weighted coronal and sagittal sequences with a section thickness of 3 mm or less. However, it can be very difficult to distinguish between the sellar and parasellar tumors even with high-field MRI.

DWI provides information on water mobility or diffusion within tissues by demonstrating Brownian motion in those tissues [2] and its role in the characterization and grading of brain tumors has been studied [3], [4]. As echo-planar DWI, a widely accepted method, is often associated with strong susceptibility artifacts near the skull base, image distortion is a problem [2], [5]. Periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) DWI was first described by Pipe et al. [6]. This sequence consists of a multishot-fast spin echo (FSE) sequence that takes advantage of both FSE methods with far fewer B₀-related artifacts (from, for example metal, sinuses, and eddy currents) and PROPELLER MRI, which oversamples the region in the center of the k-space to correct for inconsistencies before combing the data [6].

This is the first report of the use of a high-field (3-T) MR imager and PROPELLER DWI to evaluate sellar and parasellar tumors. In this study we evaluated the benefit of adding PROPELLER DWI and ADC to conventional MRI for the diagnosis of these tumors. We also examined the value of calculating ADC-MIN, ADC-MEAN, and ADC-MAX for the differentiation among various sellar lesions.

Section snippets

Materials and methods

We retrospectively studied sellar and parasellar lesions that were newly diagnosed and operated between October 2006 and February 2008 at Hiroshima University Hospital. During this period, 83 patients of sellar and parasellar lesions were operated in our institution but we excluded all tumors less than 10 mm in size (n = 16) from this study to avoid partial volume effect on the measurement of regions of interest (ROI). Also, we excluded all clear Rathke's cleft cyst (RCC) from our study (n = 7)

Results

All tumors in the sellar and parasellar region were clearly visualized on PROPELLER DWI; there was no image degradation. Conventional MRI findings on the sellar and parasellar lesions are listed in Table 1; ADC-MIN, ADC-MEAN, and ADC-MAX values are shown in Table 2.

Discussion

There are few reports on the use of DWI for the diagnosis of sellar lesions [8], [9]. Ours is the first study to employed PROPELLER DWI and 3.0 T-MRI to study sellar and parasellar lesions. On PROPELLER DWI the effect of susceptibility artifacts, common on single-shot echoplanar DWI especially in the sellar region, is decreased. We also took advantage of the higher signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and spatial resolution on 3.0 T-MRI compared to 1.5 T-MRI. In this study,

Conflict of interest

None of the authors has to disclose any conflicts.

Acknowledgements

We thank Ursula Petralia for editorial review. This study was partially supported by the grant-in-aid for Young Scientists (Start-up), grants-in-aid from Japan Society for the Promotion of Science, the Ministry of Education, Culture, Sports, Science and Technology, Japan (grant No. 19890135).

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Rogg et al.,13 and Lomban et al.,14 found hyperintense SI at DWI and low ADC in a case of pituitary apoplexy assisting in early diagnosis. Mahmoud et al.,15 retrospectively studied 60 cases of sellar and suprasellar lesions by DWI and compared them with histopathology after surgery, concluding that ADC can assist in differentiating between different sellar and suprasellar pathologies. Furthermore, the ADC values of macroadenomas were found to be higher in more dense tumours.1
To establish the value of early contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating residual pituitary adenoma from postoperative surgical changes.
Thirty patients with non-functioning pituitary macroadenomas, who were undergoing trans-sphenoidal adenomectomy, were prospectively studied. Patients were imaged with both MRI and DWI in the early postoperative period, as well as 6-months post-surgery. Patterns of postoperative contrast enhancement were described (non-enhancement, peripheral enhancement, and nodular enhancement). Apparent diffusion coefficient (ADC) maps were utilised to select the region of interest (ROI) for ADC calculations.
Seventeen patients had postoperative surgical granulation tissue and 13 had residual adenoma based on the 6 months follow-up imaging. Mean ADC values of postoperative granulation tissue and residual adenoma were 1.476±0.476×10⁻³ mm²/s and 0.855±0.190×10⁻³ mm²/s, respectively, in the early postoperative period, and 1.357±0.416×10⁻³ mm²/s and 0.829±0.201×10⁻³ mm²/s, respectively, at the 6-month follow-up. ADC values of granulation tissue were significantly different from that of residual adenoma at both time points (p<0.001). Sensitivity, specificity, positive and negative predictive values of early MRI were 84.6%, 94.1%, 91.7%, and 88.9% respectively, and of early DWI were 91%, 97%, 94.3%, and 93%, respectively.
Early postoperative DWI after trans-sphenoidal resection of pituitary macroadenomas may be more helpful than early MRI in differentiating residual adenoma from post-surgical changes.
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Role of PROPELLER diffusion weighted imaging and apparent diffusion coefficient in the diagnosis of sellar and parasellar lesions

Abstract

Objective

Materials and methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conflict of interest

Acknowledgements

Clin Neurol Neurosurg

Eur J Radiol

Surg Neurol

Apparent diffusion coefficient of human brain tumors at MR imaging

Radiology

Diffusion weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response

Rev Radiol

Artifacts and pitfalls in diffusion MRI

J Magn Reson Imaging

Multishot diffusion-weighted FSE using PROPELLER MRI

Magn Reson Med

On the existence of maximum likelihood estimates in logistic regression models

Biometrika

Diffusion-weighted echo-planar MR imaging in differential diagnosis of brain tumors and tumor-like conditions

Eur Radiol

Rathke's cleft cysts: Differentiation from other cystic lesions in the pituitary fossa by use of single-shot fast spin-echo diffusion weighted MR imaging

Acta Neurochir (Wien)