Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

• Published in: American journal of neuroradiology : AJNR Vol. 32; no. 4; pp. 785 - 789
• Main Authors: CHEN, X, DAI, J, AI, L, RU, X, WANG, J, LI, S, YOUNG, G. S
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01.04.2011
• Subjects: Adenoma - diagnostic imaging; Adenoma - epidemiology; Adenoma - surgery; Adult; Biological and medical sciences; Cranial Fossa, Posterior - diagnostic imaging; Female; Head and Neck; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - epidemiology; Nervous system; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - epidemiology; Pituitary Neoplasms - surgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Preoperative Care; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors; Sex Distribution; Tomography, X-Ray Computed - methods; Tomography, X-Ray Computed - statistics & numerical data; Treatment Outcome; Recurrence; Nervous system diseases; Endocrine gland; Detector; Radiodiagnosis; Sex; Complication; Pituitary gland; Computerized axial tomography; Subtype; Invasion
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A2364

Clival invasion, a rare but potentially significant complication of pituitary adenoma, is difficult to detect on MR imaging. Because CT is widely used in adjunct guidance of pituitary surgery and it has recently been suggested that preoperative CT may add useful diagnostic information in addition to pituitary MR imaging, we performed the first large cross-sectional imaging study to define the image attributes, clinical correlates, and prognostic implications of clival invasion on CT for pituitary adenoma surgical guidance. Preoperative CT images from 390 patients with histopathologically diagnosed pituitary macroadenoma were reviewed retrospectively and classified by the presence and degree of clival invasion. Tumor volume, tumor subtype, patient sex, operative complication, and recurrence rates were compared between groups. After we corrected for multiple correlations, the most significant independent risk factor for clival invasion was female sex (OR=3.62, P=.014, multinomial logistic regression), followed by large tumor volume (OR=1.08, P<.001), and null-cell subtype (OR=5.47, P<.001). Larger tumor volume correlated with null-cell subtype (Mann-Whitney U test, P=.006), incidence of clival invasion (P<.001), and extent of clival invasion (P=.038). Clival invasion was associated with a significantly higher ratio of operative complications (15.63%, χ(2)=7.067, P=.008) and recurrence (57.14%, χ(2)=10.739, P=.001). CT detection of clival invasion by pituitary macroadenoma is significantly more common in women, in patients with large tumors, and in patients with null-cell tumors, and it is associated with a higher rate of operative complications and recurrences. Attention to the presence of clival invasion on preoperative CT and prospective investigation of its prognostic significance are indicated. Attention to this finding on pituitary guidance CT is warranted.