Biomarkers of pituitary macroadenomas aggressive behaviour: a conventional MRI and DWI 3T study

Br J Radiol. 2020 Sep 1;93(1113):20200321. doi: 10.1259/bjr.20200321. Epub 2020 Jul 6.


Objective: Pituitary macroadenomas (PAs) are usually defined as benign intracranial tumors. However, they may present local aggressive course. High Ki67 labelling index (LI) values have been related to an aggressive tumor behavior. A recent clinicopathological classification of PA based on local invasiveness and proliferation indexes, divided them in groups with different prognosis. We evaluated the utility of conventional MRI (cMRI) and diffusion-weighted imaging (DWI), in predicting the Ki67- LI according the clinicopathological classification.

Methods: 17 patients (12 M and 5 F) who underwent surgical removal of a PA were studied. cMRI features, quantification of T1W and T2W signal intensity, degree of contrast uptake (enhancement ratio, ER) and apparent diffusion coefficient (ADC) values were evaluated by using a 3 T scan. Statistics included Mann-Whitney test, Spearman's test, and receiver operating characteristic analysis. A value of p ≤ 0.05 was considered significant for all the tests.

Results: Negative correlations were observed between Ki-67 LI, ADCm (ρ = - 0.67, p value = 0.005) and ER values (ρ = -0.62; p = 0.008). ER values were significantly lower in the proliferative PA group (p = 0.028; p = 0.017). ADCm showed sensitivity and specificity of 90 and 85% respectively into predict Ki67-LI value. A value of ADCm ≤0, 711 x 10-6 mm2 emerged as a cut-off of a value of Ki67-LI ≥ 3%.

Conclusion: Adding quantitative measures of ADC values to cMRI could be used routinely as a non-invasive marker of specific predictive biomarker of the proliferative activity of PA.

Advances in knowledge: Routinely use of DWI on diagnostic work-up of pituitary adenomas may help in establish the likely biological aggressive lesions.

MeSH terms

  • Adenoma / chemistry
  • Adenoma / diagnostic imaging*
  • Adenoma / pathology
  • Adenoma / surgery
  • Cell Nucleus / chemistry
  • Cell Proliferation
  • Diffusion Magnetic Resonance Imaging / methods
  • Diffusion Tensor Imaging / methods
  • Female
  • Humans
  • Ki-67 Antigen / analysis*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Neoplasm Grading / methods
  • Neoplasm Invasiveness
  • Pituitary Neoplasms / chemistry
  • Pituitary Neoplasms / diagnostic imaging*
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / surgery
  • ROC Curve
  • Sensitivity and Specificity
  • Statistics, Nonparametric


  • Ki-67 Antigen