Value of Internal Carotid Artery Stenosis in the Differential Diagnosis between Invasive Pituitary Adenoma and Invasive Meningioma.

ABSTRACT

Objective To assess the value of internal carotid artery stenosis in differentiating invasive pituitary adenoma (IPA) from invasive meningiomas (IM). Methods The clinical and imaging data of 28 IPA patients and 15 IM patients who were treated in our center from January 2012 to December 2016 were retrospectively analyzed. The magnetic resonance imaging (MRI) features were analyzed. The narrowest diameter (Dstenosis) and area (Astenosis) of internal carotid artery around the tumor were measured by computed tomography angiography (CTA),followed by the calculation of the stenosis score (%stenosis). The diagnostic validity of the measured indicators were calculated by receiver operating characteristic (ROC) curve. Results The median Ki-67 was 3% (2%-5%) in IPA group,which was significantly higher than that in IM group (1%,1%-2%) (Z=-3.983,P=0.000). The tumor texture showed significant differences between these two groups (P=0.001). While there was no significant difference in the average diameter [(39.63±13.15)mm in IPA group vs. (37.09±16.13)mm in IM group (t=0.518,P=0.607)],the shape (P=0.010),T1WI (P=0.001),signal (P=0.000),post-gadolinium enhancement (P=0.000),separation from normal pituitary (P=0.001),dural tail sign (P=0.000),and skull (P=0.001) showed significant differences. ROC analysis showed that the AUC of Dstenosis was 0.725 (P=0.006),the cut-off was 3.45 mm,the sensitivity was 62.50%,and the specificity was 76.47%;the AUC of Astenosis was 0.737 (P=0.003),the cut-off level was 11.00 mm2,the sensitivity was 75.00%,and the specificity was 64.71%;finally,the AUC of %stenosis was 0.711 (P=0.013),the cut-off level was 0.306,the sensitivity was 43.75%,and the specificity was 97.06%. Conclusions In addition to the common imaging features,the internal carotid artery stenosis is a valuable tool for differentiating IPA from IM. Three indicators including Dstenosis,Astenosis,and %stenosis have moderate diagnostic validity.