European Journal of Cardiovascular Medicine

The sellar and juxtasellar regions are complex areas in the skull base with various neoplastic and nonneoplastic lesions. They account for 15-20% of intracranial tumors, with neoplastic lesions ranging from benign to malignant. Pituitary tumors account for up to 15% of all masses. (1,2,3)

The pituitary gland, located in the central skull base, is surrounded by neurovascular structures. Its anatomically complex region can cause various pathologies. MRI is the preferred imaging modality due to its superior tissue resolution. Radiologists provide specific diagnoses and guide surgical management, alerting surgeons to potential complications during transsphenoidal endoscopic resection. 4

The study aimed to assess the radiological diagnostic accuracy of MRI imaging in sellar and juxtasellar lesions.

AIMS AND OBJECTIVES

• To investigate the function of gadolinium in the characterization of sellar and parasellar lesions; to characterize the aspects of magnetic resonance imaging that aid in lesion identification.
• Assessing the diagnostic precision of magnetic resonance imaging (MRI) in identifying and characterizing sellar and parasellar lesions using histopathological correlation as the gold standard.

STUDY DESIGN – Hospital based retrospective observational study.

STUDY POPULATION –It includes patients with sellar and parasellar lesions who are willing to get operated during the study period in king george hospital,visakhapatnam

STUDY SETTING – Dept of Radiodiagnosis , Andhra Medical College, Visakhapatnam.

STUDY PERIOD – From February 2023 to January 2024

SAMPLE SIZE –Convenient sampling of 60 clinically suspected patients of sellar and parasellar masses referred to Radiology department was taken.

INCLUSION CRITERIA

1. Patients who are willing for the study
2. Individuals who may have a pituitary mass lesion.
3. Both male and female patients.
4. Age range: 0–70 years

EXCLUSION CRITERIA

1. Patients who had surgery and experienced recurrence.
2. People receiving radiation and chemotherapy.

Patients with suspected sellar or parasellar mass undergo MRI after a thorough clinical history, physical examination, and blood investigations. Radiological features like texture, signal intensity, size, mass effect, soft tissue extension, and contrast enhancement are considered. Histopathology is correlated with these features, and sensitivity, specificity, and diagnostic accuracy are calculated.

Statistical analysis :

The data will be entered into MS Excel and analyzed using the SPSS version 21 statistical package for social sciences, with descriptive statistical analysis performed. Results will be presented in tabular and graphic formats.

Table 1:Distribution of patients based on the age group.

Table 2 : Percentage distribution of final/histopathological diagnosis:

According to our research, P. macroadenoma accounts for 63% of all lesions in sellar pathology. Meningiomas (12%), glial tumors (5%), clival lesions (5%), and P. microadenoma (2%), in that order, are the most common lesions.

Table 3: Age specific distribution of P.macroadenoma

The majority of P. macroadenoma patients are aged 30-39 years, followed by those aged 50-59 years, 40-49 years, 20-29 years, 60-69 years, and 2.6% of the 70-year age group.

Table 4: Age specific distribution of cranipharyngioma

The age distribution of cranipharyngioma is bimodal, with 25% occurring between 20-29 years, 40% between 40-49 years, 25% between 50-59 years, and 12.5% between 10-19 years.

Table 5:Texture distribution of cases

The texture distribution of P. microadenoma cases is 58.3% homogenous, 41.6% heterogeneous, with 100% homogenous cases. The distribution of glial, meningioma, macroadenoma, craniopharyngioma, and cilial lesions is also homogenous.

Table 6 :T1 signal distribution of total cases

The T1 signal distribution in the cases reveals 43% isointensity, 13.3% hypointensity, 8.3% hyperintensity, and 35% mixed intensity.

Table 7 :T2 signal distribution of total cases

The T2 signal distribution in the cases shows that 11.6% have isointensity, 1.6% have hypointensity, 56.6% have hyperintensity, and 30% have mixed intensity.

Table 8 :T2 FLAIR signal distribution of the case

T 2 FLAIR signal distribution reveals that 26.6% of the overall patients have FLAIR hypointensity and 73.3% have FLAIR hyperintensity.

Table 9: Contrast pattern distribution of the cases

The distribution of the entire cases' contrast patterns reveals that 61.6% of instances have homogeneous enhancement, 10% have heterogenous enhancement, 11.6% have rim enhancement, 6.6% have nodular enhancement, and 1.6% have dynamic enhancement.

Table 10 :Distribution of Associated effects:

Table 11 : Validity of MRI in relation to HPE

The study at Andhra Medical College investigated the accuracy of MRI in diagnosing diseases in the sellar and juxtasellar regions. The majority of cases were aged 30-39, with the majority being female. Pituitary adenoma was the most frequently reported lesion, accounting for over 90% of cases. MRI showed 100% sensitivity, specificity, and accuracy in diagnosing P.microadenoma, pilocytic astrocytoma, and diffuse astrocytoma.[5,6]

A study of 60 cases identified 5% of them as plasmacytoma, clival chordoma, and nasopharyngeal carcinoma. The majority of cases were female (86%), with a mean age of 39.3 years. The lesions were extra axial and homogenous, with most being parasellar. The majority of the lesions were FLAIR hyperintense and solid consistency, with 23.6% showing mixed consistency. GRE blooming was noted in 34.2% of cases, suggesting hemorraghic change. Contrast examination showed homogenous enhancement, with some cases showing nodular enhancement, leading to false positive diagnoses.[7,8]

A study of 60 cases found 13.3% of cases as Craniopharyngioma, with a sex predilection of 37.5% in males and 62.5% in females. The majority of cases were homogenous (87.5%), with the lesions predominantly found in sellar and parasellar locations.[9]

Microadenomas are seen on coronal images using dynamic contrast sequences. Plasmacytoma shows a bubbly expansile lesion with T1 isointensity, T2 hyperintensity, and variable contrast enhancement. Meningioma shows homogenous enhancement and luminal narrowing of the ICA, while Pituitary macroadenoma can differentiate between meningioma and ICA constriction. MRI is the most reliable sign of cavernous sinus invasion, making surgical removal impossible and requiring radiation therapy. Invasive Pituitary macroadenoma looks similar to chordoma, but craniopharyngioma can also present with a dural tail sign. MRI is the preferred investigation for evaluating hypothalamic-pituitary-related sellar and juxtasellar region endocrine diseases.

1. Sellar Masses: An Epidemiological StudyKhaled Al-Dahmani, Syed Mohammad, Fatima Imran, Chris Theriault,Steve Doucette, Deborah Zwicker, Churn-Ern Yip, David B. Clarke, Syed Ali Imran
2. Freda PU, Wardlaw SL, Post KD 1996 Unusual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J ClinEndocrinol Metab 81:3455–3459
3. Valassi E, Biller BM, Klibanski A, Swearingen B 2010 Clinical featuresof non-pituitary sellar lesions in a large surgical series. ClinEndocrinol (Oxf) 73:798–807
4. Imaging of the sellar and parasellar regions Andrei Jipa a,*, Vikas Jain b a Radiology Residency Program, Case Western Reserve School of Medicine and MetroHealth Medical Center, Cleveland, OH, USA b Case Western Reserve School of Medicine and MetroHealth Medical Center, Cleveland, OH, USA
5. Batra V, Gupta PK, Gehlot R, Awasthi P. Radiopathological correlation of sellar and suprasellar masses: Our experience. Int J Res Med Sci 2016;4:3924
6. Johnson DE, Woodruff WW, Allen IS, Cera PJ, Funkbouser GR, Coleman LL. MR imaging of sellar and juxtasellar regions. Radiographics. 1991:11:727-58.
7. Bartynski WS, Lin L. Dynamic and conventional spin-echo MR of pituitary microlesions. AJNR Am J Neuroradiol 1997;18:965–72.
8. Batra V, Gupta PK, Gehlot R, Awasthi P. Radiopathological correlation of sellar and suprasellar masses: Our experience. Int J Res Med Sci 2016;4:3924