Multiple microcysts and clivus invasion diagnose T-box pituitary transcription factor 19 lineage adenomas in non-functioning pituitary adenomas

BackgroundPreoperative identification of T-box pituitary transcription factor 19 (TPIT) lineage silent adenomas in non-functioning pituitary adenomas (NFPAs) is important.PurposeTo compare the clinical, laboratory, and radiological features of the three cell lineages of adenomas in NFPAs and evaluate the diagnostic efficacy of multiple microcysts and clivus invasion on magnetic resonance imaging (MRI) for TPIT lineage adenomas in NFPAs.Material and MethodsA total of 405 patients with NFPA were retrospectively enrolled, including steroidogenic factor 1 (SF-1) lineage adenomas (n = 204), TPIT lineage adenomas (n = 111), and pituitary transcription factor 1 (PIT-1) lineage adenomas (n = 90). The clinical, laboratory, and radiological features of the three lineages adenomas were compared. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of multiple microcysts, clivus invasion, and their combination were calculated to diagnose TPIT lineage adenomas in NFPAs.ResultsAmong the three lineages of NFPAs, patients with SF-1 lineage were older than those with TPIT and PIT-1 lineages (<i>P</i> < 0.001). TPIT lineage adenomas were most common in women (<i>P</i> < 0.001) and had the highest tumor volume (<i>P</i> < 0.001), and incidence of clivus invasion (<i>P</i> < 0.001). The multiple microcysts and clivus invasion in the diagnosis of TPIT lineage adenomas in NFPAs had high specificity (88.44% vs. 98.64%) and accuracy (77.28%).ConclusionThe MRI findings of multiple microcysts and clivus invasion can help diagnose TPIT lineage adenomas in NFPAs with high specificity.