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Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?

Joanna Bladowska, Anna Biel, Anna Zimny, Katarzyna Lubkowska, Grazyna Bednarek-Tupikowska, Tomasz Sozanski, Urszula Zaleska-Dorobisz, Marek Sasiadek

Med Sci Monit 2011; 17(10): MT83-90

DOI: 10.12659/MSM.881966

Available online: 2011-10-01

Published: 2011-10-01

Background:    The proper diagnosis and management of patients after surgery for pituitary tumors are of great importance in clinical practice. The purpose of this study was to investigate the magnetic resonance features of the postoperative sella with fast spin echo T2-weighted imaging and to evaluate the benefits of this sequence compared to the classically performed contrast-enhanced T1-weighted imaging at 1.5T unit.
    Material/Methods:    The study group consisted of 101 patients who underwent resection of pituitary tumors. There were 58 women (57.4%), aged 22 to 75 (mean age, 52.67 years) and 43 men (42.6%), aged 21 to 79 (mean age, 49 years). In all patients preoperative and multiple postoperative MR studies were performed. Post-contrast T1 and pre-contrast T2 images were interpreted by 2 independent readers (neuroradiologists).
    Results:    Contrast-enhanced T1-weighted imaging was significantly superior to T2-weighted imaging in assessment of infundibulum (p<0.05). There was no statistically significant difference for each of readers between T1- and T2-weighted images regarding to the following features: visualization of residual pituitary gland (p=0.062 and p=0.368), contours of pituitary (p=0.959 and p=0.265), optic chiasm (p=0.294 and p=0.843), and visualization of presence of residual tumor (p=0.204 and p=0.169). T2-weighted images were significantly superior to contrast-enhanced T1-weighted imaging with regard to visualization of contours of residual tumors (p<0.05).
    Conclusions:    T2-weighted images may help to discriminate tumorous from non-tumorous involvement of the postoperative sella and the sphenoid sinus. T2-weighted images are also very useful for a long time after the resection in the postopera¬≠tive evaluation of the implanted muscle with fascia.

Keywords: Pituitary Gland, Posterior - pathology, Magnetic Resonance Imaging - methods, Adult, Pituitary Neoplasms - surgery, Postoperative Period, Sella Turcica - pathology