Comparison of contrast-enhanced SPACE and CISS in evaluating cavernous sinus invasion by pituitary macroadenomas on 3-T magnetic resonance.

PURPOSE:SPACE (sampling perfection with application-optimized contrasts by using different flip angle evolutions) and CISS (constructive interference in steady state) are 3-dimensional sequences that can increase the signal intensity of cavernous sinus. The purpose of this study was to determine whether contrast-enhanced (CE) SPACE and CE CISS can well demonstrate cavernous sinus invasion (CSI) by pituitary macroadenoma and which one performed better. METHODS:In 56 cavernous sinuses from 28 patients with pituitary macroadenoma, CSI grades and image quality were assessed by using CE SPACE and CISS. The assessment results were compared with Knops' classification on T1-weighted images. The interreader agreement of assessment results were analyzed with k statistics. Qualitative analyses were compared using the Wilcoxon signed-ranks test. RESULTS:Two radiologists were in substantial agreement of CSI evaluation on both CE SPACE (k = 0.87) and CE CISS (k = 0.83). The evaluation results on CE SPACE (k = 0.76) were more coincident with Knops' classification than CE CISS (k = 0.71). Identification of CSI worked well with either CE SPACE or CE CISS, but CE SPACE performed better (mean, 3.48 ± 0.61 vs 3.28 ± 0.80; P < 0.05). Contrast-enhanced SPACE had significantly higher image scores than CE CISS in description of the relationship between pituitary adenoma and internal carotid artery (mean, 3.26 ± 0.93 vs 2.96 ± 1.01; P < 0.05). Contrast-enhanced CISS demonstrated more susceptibility artifacts (10.7% vs 0%; P < 0.05) and vessel flow artifacts (53.6% vs 0%; P < 0.05). There was no significant difference regarding contrast enhancement of pituitary adenoma and cavernous sinus (mean, 3.07 ± 1.12 vs 3.04 ± 0.96; P > 0.05). CONCLUSIONS:Contrast-enhanced SPACE is superior than CE CISS for identification of CSI by pituitary macroadenoma.