Preoperative volume of the optic chiasm is an easily obtained predictor for visual recovery of pituitary adenoma patients following endoscopic endonasal transsphenoidal surgery: a cohort study.

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Abstract

Predicting postoperative visual outcome of pituitary adenoma patients is important but remains challenging. This study aimed to identify a novel prognostic predictor which can be automatically obtained from routine MRI using deep learning approach.A total of 220 pituitary adenoma patients were prospectively enrolled and stratified into the recovery and non-recovery group according to visual outcome at six months after endoscopic endonasal transsphenoidal surgery. The optic chiasm was manually segmented on preoperative coronal T2WI, and its morphometric parameters were measured including suprasellar extension distance, chiasmal thickness and chiasmal volume. Univariate and multivariate analyses were conducted on clinical and morphometric parameters to identify predictors for visual recovery. Additionally, a deep learning model for automated segmentation and volumetric measurement of optic chiasm was developed with nnU-Net architecture and evaluated in a multi-center dataset covering 1026 pituitary adenoma patients from 4 institutions.Larger preoperative chiasmal volume was significantly associated with better visual outcome (P=0.001). Multivariate logistic regression suggested it could be taken as the independent predictor for visual recovery (odds ratio=2.838, P<0.001). The auto-segmentation model represented good performances and generalizability in internal (Dice=0.813) and three independent external test sets (Dice=0.786, 0.818 and 0.808, respectively). Moreover, the model achieved accurate volumetric evaluation of the optic chiasm with intraclass correlation coefficient of more than 0.83 in both internal and external test sets.The preoperative volume of the optic chiasm could be utilized as the prognostic predictor for visual recovery of pituitary adenoma patients after surgery. Moreover, the proposed deep learning-based model allowed for automated segmentation and volumetric measurement of the optic chiasm on routine MRI.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.