title: Preoperative depiction of cavernous sinus invasion by pituitary macroadenoma using three-dimensional anisotropy contrast periodically rotated overlapping parallel lines with enhanced reconstruction imaging on a 3-tesla system.
abstract: OBJECTIVE
  Three-dimensional anisotropy contrast (3DAC) magnetic resonance (MR) imaging provides clear depiction of neuronal fibers. The aim of this study was to identify intracavernous cranial nerves in patients with pituitary macro-adenoma and in healthy volunteers by using 3DAC MR imaging on a 3-tesla system and to preoperatively predict cavernous sinus invasion by pituitary macroadenoma.
  
  
  METHODS
  Thirty-three patients (cavernous sinuses in 66 sides) with pituitary macroadenomas and 25 healthy volunteers (50 sides) participated in this study. Coronal 3DAC MR images constructed from diffusion weighted images, acquired with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) sequences, and T2-weighted reverse images were obtained at the same anatomical locations using a 3-tesla MR imaging system. Attempts were made to identify the cranial nerves.
  
  
  RESULTS
  The oculomotor and ophthalmic/maxillary nerves were preoperatively identified in all sides (66 sides in patients and 50 sides in healthy volunteers) on 3DAC MR images. In the 33 patients, cavernous sinus invasion was revealed in 10 (12 [18.2%] of 66 sides) by intraoperative endoscopic observation. Coronal 3DAC MR images revealed that the oculomotor nerves were half surrounded with adenoma in all 12 of these sides, and the ophthalmic/maxillary nerves were half encapsulated with tumor (sensitivity/specificity: 100%/100% and 83%/100%, respectively).
  
  
  CONCLUSIONS
  Preoperative evaluation of pituitary macroadenomas using 3DAC PROPELLER MR imaging on a 3-tesla system is likely to be a powerful noninvasive method of detecting cavernous sinus invasion, which can potentially dominate the therapeutic strategy for these lesions.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, University of Niigata, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yoneoka
authors.forename: Naoto
authors.initials: N
authors.lastname: Watanabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuzawa
authors.forename: Itaru
authors.initials: I
authors.lastname: Tsumanuma
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ueki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nakada
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D002426:Cavernous Sinus / Q000294:innervation* / Q000473:pathology; D003391:Cranial Nerves / Q000473:pathology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results