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Research ArticleBRAIN TUMOR IMAGING

Distinguishing Pituitary Metastasis and Pituitary Neuroendocrine Tumors through Conventional MR Imaging and Clinical Features

Sabahattin Yuzkan, Buruc Erkan, Fatih Mert Dogukan, Uluc Ozkiziltan, Serdar Balsak, Fatma Zeynep Arslan, Berk Tutuncuoglu, Ceyda Ceren Arikan, Huseyin Karatay, Ebubekir Akpinar, Yesim Ertan, Esra Hatipoglu, Cenk Eraslan, Omer Kitis, Cem Calli and Burak Kocak
American Journal of Neuroradiology June 2024, DOI: https://doi.org/10.3174/ajnr.A8302
Sabahattin Yuzkan
aFrom the Department of Radiology (S.Y.), Koc University Hospital, Istanbul, Turkey
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Buruc Erkan
bDepartment of Neurosurgery (B.E., E.A.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
cPituitary Diseases Practice and Research Center (B.E.), University of Health Sciences, Istanbul, Turkey
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Fatih Mert Dogukan
dDepartment of Pathology (F.M.D., H.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Uluc Ozkiziltan
eDepartment of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
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  • ORCID record for Uluc Ozkiziltan
Serdar Balsak
fDepartment of Radiology (S.B.), Bezmialem Vakif University Hospital, Istanbul, Turkey
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  • ORCID record for Serdar Balsak
Fatma Zeynep Arslan
gDepartment of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Berk Tutuncuoglu
gDepartment of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Ceyda Ceren Arikan
gDepartment of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Huseyin Karatay
dDepartment of Pathology (F.M.D., H.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Ebubekir Akpinar
bDepartment of Neurosurgery (B.E., E.A.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Yesim Ertan
hDepartment of Pathology (Y.E.), Ege University School of Medicine, Izmir, Turkey
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Esra Hatipoglu
iDivision of Endocrinology (E.H.), Department of Internal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Cenk Eraslan
eDepartment of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
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Omer Kitis
eDepartment of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
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Cem Calli
eDepartment of Radiology (U.O., C.E., O.K., C.C.), Ege University School of Medicine, Izmir, Turkey
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Burak Kocak
gDepartment of Radiology (F.Z.A., B.T., C.C.A., B.K.), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Abstract

BACKGROUND AND PURPOSE: Given their overlapping features, pituitary metastases frequently imitate pituitary neuroendocrine tumors in neuroimaging studies. This study aimed to distinguish pituitary metastases from pituitary neuroendocrine tumors on the basis of conventional MR imaging and clinical features as a practical approach.

MATERIALS AND METHODS: In this 2-center retrospective study, backward from January 2024, preoperative pituitary MR imaging examinations of 22 pituitary metastases and 74 pituitary neuroendocrine tumors were analyzed. Exclusion criteria were as follows: absence of a definitive histopathologic diagnosis, history of pituitary surgery or radiation therapy before MR imaging, and pituitary neuroendocrine tumors treated with medical therapy. Two radiologists systematically evaluated 13 conventional MR imaging features that have been reported more commonly as indicative of pituitary metastases and pituitary neuroendocrine tumors in the literature. Age, sex, history of cancer, and maximum tumor size constituted the clinical/epidemiologic features. The primary cancer origin for this study was also noted. Univariable and multivariable logistic regression was used for the selection of variables, determining independent predictors, and modeling. Interobserver agreement was evaluated for all imaging parameters using the Cohen κ statistic or intraclass correlation coefficient.

RESULTS: A total of 22 patients with pituitary metastases (8 women; mean age, 49.5 [SD, 13] years) and 74 patients with pituitary neuroendocrine tumors (36 women; mean age, 50.1 [SD, 11] years) were enrolled. There was no statistically significant distributional difference in age, sex, or maximum tumor size between the 2 groups. Lung cancer (9/22; 41%) was the most commonly reported primary tumor, followed by breast (3/22; 13.6%) and unknown cancer (3/22; 13.6%). Logistic regression revealed 3 independent predictors: rapid growth on control MR imaging, masslike or nodular expansion of the pituitary stalk, and a history of cancer. The model based on these 3 features achieved an area under the curve, accuracy, sensitivity, specificity, and Brier score of 0.987 (95% CI, 0.964–1), 97.9% (95% CI, 92.7%–99.8%), 95.5% (95% CI, 77.2%–99.9%), 98.6% (95% CI, 92.7%–100%), and 0.025, respectively.

CONCLUSIONS: Two conventional features based on pituitary MR imaging with the clinical variable of history of cancer had satisfying predictive performance, making them potential discriminators between pituitary metastases and pituitary neuroendocrine tumors. In cases in which differentiation between pituitary metastases and pituitary neuroendocrine tumors poses a challenge, the results of this study may help with the diagnosis.

ABBREVIATIONS:

AUC
area under the curve
PitNET
pituitary neuroendocrine tumor
PM
pituitary metastasis
ROC
receiver operating characteristic

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  • © 2024 by American Journal of Neuroradiology
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Sabahattin Yuzkan, Buruc Erkan, Fatih Mert Dogukan, Uluc Ozkiziltan, Serdar Balsak, Fatma Zeynep Arslan, Berk Tutuncuoglu, Ceyda Ceren Arikan, Huseyin Karatay, Ebubekir Akpinar, Yesim Ertan, Esra Hatipoglu, Cenk Eraslan, Omer Kitis, Cem Calli, Burak Kocak
Distinguishing Pituitary Metastasis and Pituitary Neuroendocrine Tumors through Conventional MR Imaging and Clinical Features
American Journal of Neuroradiology Jun 2024, DOI: 10.3174/ajnr.A8302

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Distinguishing Pituitary Metastasis and Pituitary Neuroendocrine Tumors through Conventional MR Imaging and Clinical Features
Sabahattin Yuzkan, Buruc Erkan, Fatih Mert Dogukan, Uluc Ozkiziltan, Serdar Balsak, Fatma Zeynep Arslan, Berk Tutuncuoglu, Ceyda Ceren Arikan, Huseyin Karatay, Ebubekir Akpinar, Yesim Ertan, Esra Hatipoglu, Cenk Eraslan, Omer Kitis, Cem Calli, Burak Kocak
American Journal of Neuroradiology Jun 2024, DOI: 10.3174/ajnr.A8302
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