Objective: To compare the performances of the coronal contrast-enhanced T1-weighted (ceT1-w) and T2-weighted (T2-w) sequences, for the diagnosis of progression during the MRI follow-up of NFPAs.
Materials and methods: 106 patients who had at least two MRIs for the follow-up of NFPA were retrospectively included. The largest diameter of the adenomas was measured on coronal ceT1-w and separately on T2-w sequences for all the MRIs of the follow-up, and by 2 independent neuroradiologists on a sample of 100 examinations to assess interobserver variability. Progression was defined by an increase ≥ 2 mm of this diameter between 2 MRIs. Progress thresholds of 3 and 4 mm were also tested. The concordance was analyzed between the results of ceT1-w and T2-w sequences.
Results: On 580 follow-up MRIs, there was 93.1% concordance between ceT1-w and T2-w coronal sequences. In case of a possible progression, there was 64.4% concordance for a threshold of 2 mm, 87.7% for 3 mm and 97.1% for 4 mm. The discordance was mainly observed on the first postoperative MRI and in case of multiple recurrences. Kappa was better for the diagnosis of progression on T2-w than on ceT1-w sequences (0.67 vs 0.54). Of note, an agreement of 100% was noted between the 2 sequences on the 82 follow-up MRIs of patients with complete surgical resection.
Conclusion: The coronal ceT1-w and T2-w sequences were concordant in 93.1% during the MRI follow-up of NFPAs, meaning that the systematic injection of Gadolinium should be questioned. If first-line examination without gadolinium injection could be proposed, our results indicate that ceT1-w sequences should be kept for the first postoperative MRI and for the follow-up of aggressive and recurrent NFPAs.
21 May 2022 - 24 May 2022