Keita Watanabe, Presenter: Nothing to Disclose

Shingo Kakeda MD, Abstract Co-Author: Nothing to Disclose

Rieko Watanabe, Abstract Co-Author: Nothing to Disclose

Yukunori Korogi MD, Abstract Co-Author: Nothing to Disclose

Junkoh Yamamoto, Abstract Co-Author: Nothing to Disclose

Shigeru Nishizawa, Abstract Co-Author: Nothing to Disclose

In large suprasellar tumors, although a preoperative understanding of the anatomical relationship between the anterior optic pathways and tumors is an important factor in determining surgical approaches, conventional MR imaging often fails to depict the optic nerves and tracts because of their marked thinning due to long-term compression. Fast imaging employing steady-state acquisition (FIESTA) sequence has high spatial resolution and shows increased contrast as concentration of contrast agent increases. Our purpose was to evaluate the contrast-enhanced (CE) FIESTA for the detectability of the anterior optic pathways in patients with large suprasellar tumors by correlation with intraoperative findings.

This study consisted of 28 patients with suprasellar tumor undergoing the surgical treatment. Pathology revealed pituitary adenoma in 18 patients, craniopharyngioma in 3 and meningioma in 7. All patients underwent the preoperative MRI including CE FIESTA. First, two radiologists assessed the visibility of five segments of anterior optic pathway (right and left optic nerves, optic chiasm, right and left optic tracts) on conventional MRI, including the coronal T2WI with 3 mm slice thickness, using the following 5 point quality rating: 1 definitely invisible, 2 probably invisible, 3 uncertain, 4 probably visible, and 5 definitely visible. Second, on CE FIESTA, the radiologists rated the visibility of anterior optic pathways in the same way as conventional MRI, and then manually traced them. Finally, the MR findings were correlated with the surgical findings.

For the depiction of anterior optic pathway, the average reader ratings were significantly higher for CE FIESTA (mean score = 4.91) than for conventional MRI (mean score = 3.88). Of all 140 segments (28 patients x 5 segments) of the anterior optic pathway, 38 segments (27%) were invisible with conventional MRI, while 139 segments (99%) could be identified with CE FIESTA. All preoperative CE FIESTA were compatible with operative findings.

CE FIESTA is useful in determining the location of the anterior optic pathways in patients with large suprasellar tumor.

CE FIESTA makes it possible to visualize the optic pathway in large suprasellar tumors; this information is useful in predicting surgical anatomy and selecting a proper surgical approach.

Watanabe, K, Kakeda, S, Watanabe, R, Korogi, Y, Yamamoto, J, Nishizawa, S, Missing Optic Nerve in Suprasellar Tumors: Detection with Contrast-enhanced FIESTA Image.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006866.html