Thin-Slice Pituitary MRI with Deep Learning–Based Reconstruction for Preoperative Prediction of Cavernous Sinus Invasion by Pituitary Adenoma: A Prospective Study

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FIG 1.
Patient inclusion process and image analysis.
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FIG 2.
A 55-year-old man who underwent a combined MR imaging protocol for preoperative evaluation of pituitary adenoma. On a 3-mmMRI, coronal, contrast-enhanced T1-weighted image (A), the tumor is present beyond the lateral intercarotid line (modified Knosp classification 3A) and is about 180° in contact with the intracavernous ICA. One-mmMRI, coronal, contrast-enhanced T1-weighted image (B) was reconstructed using DLR (C), and the tumor is shown to encase the intracavernous ICA (arrows, modified Knosp classification 4).
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FIG 3.
A 60-year-old woman who underwent a combined MR imaging protocol for preoperative evaluation of pituitary adenoma. On a 3-mmMRI, coronal, contrast-enhanced T1-weighted image (A), the tumor is present beyond the medial intercarotid line but not beyond the median intercarotid line (modified Knosp classification 1) and is <180° in contact with the intracavernous ICA. One-mmMRI, coronal, contrast-enhanced T1-weighted image (B) was reconstructed with DLR (C), and the tumor is shown to extend beyond the median intercarotid line (modified Knosp classification 2) and is <270° in contact with the intracavernous ICA (arrows).

Table 1:

Clinical characteristics of the patients^{^a}

Characteristics
Total	67
Age (yr)	53 (SD, 12)
No. of female patients	28 (42)
Functioning adenoma	14 (21)
Prolactin	5 (7.5)
Growth hormone	7 (10)
Adrenocorticotropic hormone	1 (1.5)
Thyroid stimulating hormone	1 (1.5)
CS invasion by reference standard	29 (43)
Residual tumor following operation determined by follow-up MR imaging	11 (16)
Postoperative stereotactic radiation therapy	7 (10)

Note:—CS indicates cavernous sinus.
↵a Data are expressed as the mean (SD) or numbers with percentages in parenthesis.

Table 2:

Depth of invasion and degree of contact with the intracavernous ICA by pituitary adenoma on 3-mmMRI, 1-mmMRI and 1-mmMRI with DLR^{^a}

	3-mmMRI	P Value	1-mmMRI	P Value	1-mmMRI+DLR
Depth of invasion (mm)	3.12 (2.44–3.81)	<.001	3.82 (3.10–4.55)	.004	4.07 (3.35–4.80)
Degree of contact with intracavernous ICA
Total encasement	9 (13.4%)	<.001	13 (19.4%)	.02	25 (37.3%)
>270°	11 (16.4%)	<.001	15 (22.4%)	.04	26 (38.8%)
>180°	17 (25.4%)	.001	21 (31.3%)	.11	30 (44.8%)

↵a P value was calculated by using paired t test for depth of invasion and McNemar test for degree of contact with the intracavernous ICA. Data are mean or number of patients, and data in parentheses are 95% confidence intervals unless otherwise specified.