Immediate post-surgery MRI following pituitary adenoma resection: a systematic review and meta-analysis of diagnostic utility

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.