Primary visual cortical thickness in correlation with visual field defects in patients with pituitary macroadenomas: a structural 7-Tesla retinotopic analysis

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  • 1 Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai;
  • 2 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai;
  • 3 Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai;
  • 4 Department of Psychology, New York University;
  • 5 Department of Population Health Science and Policy, Mount Sinai Hospital; and
  • 6 Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
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OBJECTIVE

Vision loss remains a debilitating complication of pituitary adenomas, although there is considerable variability in visual impairment before and after decompression surgery. Growing evidence suggests secondary damage to remote visual structures may contribute to vision loss in patients with chiasmatic compression. The present study leverages ultrahigh field 7-T MRI to study the retinotopic organization of the primary visual cortex (V1), and correlates visual defects with cortical thinning in V1 to characterize consequences of pituitary adenomas on the posterior visual system.

METHODS

Eight patients (4 males and 4 females, mean age 44.3 years) with pituitary adenomas who exhibited chiasmatic compression and visual field defects, as well as 8 matched healthy controls (4 males and 4 females, mean age 43.3 years), were scanned at 7-T MRI for this prospective study. Whole-brain cortical thickness was calculated using an automated algorithm. A previously published surface-based algorithm was applied to associate the eccentricity and polar angle with each position in V1. Cortical thickness was calculated at each point in the retinotopic organization, and a cortical thickness ratio was generated against matched controls for each point in the visual fields. Patients with adenoma additionally underwent neuroophthalmological examination including 24–2 Humphrey automated visual field perimetry. Pattern deviation (PD) of each point in the visual field, i.e., the deviation in point detection compared with neurologically healthy controls, was correlated with cortical thickness at corresponding polar and eccentricity angles in V1.

RESULTS

Whole-brain cortical thickness was successfully derived for all patients and controls. The mean tumor volume was 19.4 cm3. The median global thickness of V1 did not differ between patients (mean ± SD 2.21 ± 0.12 cm), compared with controls (2.06 ± 0.13 cm, p > 0.05). Surface morphometry–based retinotopic maps revealed that all 8 patients with adenoma showed a significant positive correlation between PD and V1 thickness ratios (r values ranged from 0.31 to 0.53, p < 0.05). Mixed-procedure analysis revealed that PD = −8.0719 + 5.5873*[Median V1 Thickness Ratio].

CONCLUSIONS

All 8 patients showed significant positive correlations between V1 thickness and visual defect. These findings provide retinotopic maps of localized V1 cortical neurodegeneration spatially corresponding to impairments in the visual field. These results further characterize changes in the posterior visual pathway associated with chiasmatic compression, and may prove useful in the neuroophthalmological workup for patients with pituitary macroadenoma.

ABBREVIATIONS CBF = cerebral blood flow; DTI = diffusion tensor imaging; fMRI = functional MRI; PD = pattern deviation; RNFL = retinal nerve fiber layer; V1 = primary visual cortex.

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Contributor Notes

Correspondence John W. Rutland: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY. jack.rutland@icahn.mssm.edu.

INCLUDE WHEN CITING Published online October 18, 2019; DOI: 10.3171/2019.7.JNS191712.

Disclosures Dr. Balchandani (principal investigator in this study) is a named inventor on patents relating to MRI and radiofrequency (RF) pulse design. The patents have been licensed to GE Healthcare, Siemens AG, and Philips International; Dr. Balchandani receives royalty payments relating to these patents. Dr. Balchandani is also a named inventor on patents relating to slice-selective adiabatic magnetization T2 preparation (SAMPA) for efficient T2-weighted imaging at ultrahigh field strengths, methods for producing a semi-adiabatic spectral-spatial spectroscopic imaging sequence and devices thereof, and semi-adiabatic spectral-spatial spectroscopic imaging. Dr. Bederson (a significant contributor in this study and chair of the Department of Neurosurgery) owns equity in Surgical Theater, LLC (manufacturer of the Surgical Navigation Advanced Platform [SNAP] system that may have been used for intraoperative image guidance in the study).

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