Abstract / Summary
Abstract Background The timing of MRI following transsphenoidal pituitary adenoma resection (pituitary surgery) to detect residual tumour is contentious. This review was to determine the diagnostic utility of post-operative day 1 (POD1) MRI to predict residual disease and guide potential immediate surgical re-exploration. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant systematic review was conducted. A review of the literature was performed using PubMed and EMBASE/Ovid. Studies were included if they assessed post-operative MRI (within 10-days after surgery) to identify residual tumour. Pooled statistics were obtained with a bivariate random-effects model. Results Seven studies with a combined total of 449 patients with pituitary adenoma were included. To detect residual disease, immediate post-surgery MRI had a sensitivity of 93.4% [CI: 85.9 – 97.1%] and specificity of 95.0% [CI: 87.1 – 98.2%]. Youden’s J statistic was 0.884 [CI: 0.813 – 0.956]. Positive likelihood ratio was 18.73, while the negative likelihood ratio was 0.07 and diagnostic odds ratio was 269 [CI: 0 – 46249785%]. Conclusion Immediate post-surgery MRI has excellent diagnostic characteristics to detect residual tumour post-pituitary surgery, however there is a paucity of literature surrounding the utility of early MRI to inform further surgical re-exploration and the influence on long-term disease remission.