Increased diagnostic confidence in the diagnosis of pituitary micro-lesions with the addition of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions sequences.

Background Conventional magnetic resonance imaging (MRI) is adversely affected by thick slices, small intersection gaps, and the partial volume effect, leading to the missed diagnosis or misdiagnosis of pituitary micro-lesions. Purpose To evaluate the diagnostic yield of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-T2 SPACE) sequences compared with a standard MRI protocol for the diagnosis of pituitary micro-lesions. Material and Methods The MRI findings of 664 patients with clinically suspected pituitary lesions were retrospectively analyzed. All patients underwent coronal 3D-T2 SPACE sequences followed by T1-weighted (T1W) imaging. Conventional scanning sequences included coronal and sagittal T1W imaging and post-contrast enhanced coronal and sagittal T1 imaging. All images were independently evaluated by two experienced neuroradiologists. The inter-observer agreement was analyzed using kappa statistics. Results Compared with conventional sequences, there was an increase in diagnostic confidence of 60.3% for the diagnosis of pituitary micro-lesions with the addition of 3D-T2 SPACE sequences. The lesion conspicuity scores of combined conventional and 3D-T2 SPACE sequences were significantly higher than those of conventional imaging (z = -6.403, P < 0.01) and 3D-T2 SPACE sequences (z = -4.243, P < 0.01). In addition, the inter-observer agreement of 3D-T2 SPACE sequences was good (κ = 0.826). Conclusion Combined with routine sequences, post-contrast enhanced 3D-T2 SPACE sequences effectively improve diagnostic confidence in the diagnosis of pituitary micro-lesions. Post-contrast enhanced 3D-T2 SPACE is suitable for detecting pico-adenomas, micro-lesions adjacent to the cavernous sinuses or sellar floor, lesions between the anterior and posterior lobes, and lesions with early phase enhancement.