ASSESSMENT OF UTILITY OF T1 &T2 SIGNAL INTENSITY VOLUMETRIC VALUES IN ENHANCING TROUILLAS' GRADING SYSTEM FOR PITUITARY ADENOMAS USING MRI

Abstract

Background: Pituitary adenomas are heterogeneous tumors that vary in size, invasiveness, and hormonal activity, necessitating accurate classification for prognosis and treatment planning. Trouillas’ grading system categorizes adenomas based on invasion and proliferation, but its reliance on subjective imaging interpretations may limit precision. MRI-based volumetric analysis of T1 and T2 signal intensity provides an objective method to enhance tumor characterization. Assessing the correlation between volumetric MRI parameters and tumor grading may improve risk stratification and guide clinical decision-making.

Objective: To evaluate the utility of MRI-based volumetric T1 and T2 signal intensity analysis in enhancing the precision of the Trouillas grading system for pituitary adenomas, improving classification, prognosis, and treatment planning.

Methods: A cross-sectional study was conducted at Aznostics, The Diagnostic Centre, Lahore, from July to October 2024. A total of 110 participants with radiologically confirmed pituitary adenomas were recruited using a convenient sampling technique. MRI scans were analyzed for volumetric T1 and T2 signal intensity values. Patient demographic and clinical data were collected through structured questionnaires. Adenoma size, enhancement, stalk displacement, optic chiasm compression, and Trouillas grading were recorded. Statistical analysis was performed using SPSS, applying chi-square tests and Pearson’s correlation to assess associations between imaging parameters and tumor grading.

Results: Among 110 participants, 58.2% were female and 41.8% male. Hormonal imbalance was the most common symptom (54.5%), followed by blurred vision (53.6%), fatigue (50.9%), and headaches (39.1%). MRI findings showed adenoma enhancement in 57.3% of cases, with nearly equal distribution of microadenomas (50.9%) and macroadenomas (49.1%). Stalk displacement was observed in 52.7%, optic chiasm compression in 48.2%, and cystic areas in 40.9%. Trouillas grading classified 30.0% as G1, 32.7% as G2, 16.4% as G3, and 20.9% as G4. A statistically significant association was found between cystic areas and tumor grading (p=0.014). However, volumetric T1 and T2 signal intensity showed weak, non-significant correlations with Trouillas grades (p>0.05).

Conclusion: The study highlights the role of MRI-based volumetric analysis in refining pituitary adenoma classification. While volumetric T1 and T2 values did not strongly correlate with tumor grades, associations between cystic areas, stalk displacement, and optic chiasm compression suggest their potential as prognostic markers. These findings reinforce the need for multimodal assessment in grading pituitary adenomas, supporting early detection and tailored treatment strategies.