Transcranial Sonography in the Diagnosis of Pituitary Tumor—A Direct Comparison With MRI

Abstract

BackgroundTranscranial sonography (TCS) is a convenient tool for detecting certain brain diseases, such as brain tumors. Few studies have reported on the use of TCS in the area of Sella turcica. The accuracy and repeatability of Sella turcica with or without pituitary tumor is not clear.PurposeThis study aimed to investigate the feasibility and accuracy of TCS to measure the size of Sella turcica according to the measurement in MRI and determine its diagnostic performance in individuals with pituitary tumor.Materials and MethodsIn this cross-sectional comparative study, healthy volunteers and patients with pituitary tumor were enrolled for examination of TCS and MRI between October 2020 and July 2021. The transverse diameter (D1, cm) of Sella turcica and the volume of the pituitary tumor were measured by TCS and MRI, respectively, and compared by using Student’s t-test or Mann–Whitney test, using the receiver operating characteristic (ROC) curve to analyze the diagnostic value of D1 in TCS for pituitary tumor.ResultsA total of 75 healthy volunteers and 51 patients with pituitary tumor were evaluated. In healthy volunteers, the mean D1 was 1.30 ± 0.35 (range, 0.82–3.22) by TCS and 1.32 ± 0.29 (range, 0.94–3.02) by MRI (P = 0.054). In patients with pituitary tumor, the mean D1 was 2.0 ± 0.65 (range, 0.90–3.48) by TCS and 2.42 ± 1.0 (range, 0.80–4.70) by MRI (P = 0.000). The median measurement volume was 4.41 and 6.59 cm3 in TCS and MR, respectively (P = 0.000). The mean D1 was 1.31 ± 0.35 in healthy volunteers and 2.0 ± 0.65 cm in patients with pituitary tumor (P = 0.000). In the ROC curve analysis, the area under the curve was 0.836, and the optimal cutoff value (1.56) exhibited a sensitivity and specificity of 67.31 and 88.0%, respectively.ConclusionThe consistency between the two imaging technologies performed well in D1 measurement, while the volume of the pituitary tumor was smaller as assessed by TCS than by MRI. D1 in TCS had good diagnostic performance in pituitary tumor.

Transcranial ultrasound evaluation of pituitary macroadenoma

“…Transcranial sonography allows for the observation of the morphological appearance of the sella turcica, which typically lies in the axial position anterior to the brain stem. 3 Intracranial vessels, clearly visible through transcranial sonography with color Doppler imaging, can serve as additional reference points for enhancing the identification of intracranial structures. The pituitary gland is situated within the circle of Willis, between the cavernous internal carotid arteries (Figure 4).…”

“…Additionally, challenges may arise when attempting the procedure with inadequate bone acoustic windows. 3…”

“…However, it is important to note that ultrasound of the brain, like ultrasound in general, is operator‐dependent and requires the expertise of a skilled operator as the first line of imaging. Additionally, challenges may arise when attempting the procedure with inadequate bone acoustic windows 3 …”

“…2 It also offers an alternative approach for visualizing pituitary macroadenoma, providing a rapid, portable, repeatable, and cost-effective examination. 3…”

“…Additionally, transcranial brain tumor sonography, using B‐mode imaging and Color‐Doppler, has been widely adopted and is especially valuable for intraoperative imaging 2 . It also offers an alternative approach for visualizing pituitary macroadenoma, providing a rapid, portable, repeatable, and cost‐effective examination 3 …”