• Alper Dincer, Vaishnavi Sharma, Neel Madan, and Carl Heilman.
• Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
• J Neuroimaging. 2023 Jan 1; 33 (1): 737873-78.

Background And PurposePituitary macroadenomas and meningiomas are common neoplasms arising within the cavernous sinus. Imaging characteristics on MRI can often distinguish these tumors from one another; however, some cases may be more difficult to differentiate. This study compares patterns of cavernous segment internal carotid artery (CS-ICA) stenosis between the two tumor types to establish a novel radiographic method of differentiation.MethodsA retrospective analysis of patients with pathology-confirmed meningioma and pituitary adenomas at Tufts Medical Center was performed. The diameter of the CS-ICA at the narrowest point within the cavernous sinus was measured and compared to the ipsilateral petrous segment ICA and contralateral CS-ICA. The mean and range of percent stenosis and frequency of cases of CS-ICA stenosis >15% were determined. Statistical analysis to compare the groups was conducted using the Chi-squared test, Fisher's exact test, and t-test.ResultsThere were a total of 78 out of 231 patients who were included in the study. The mean % ICA stenosis for all meningiomas was 9.3%, with increasing stenosis with increasing World Health Organization grade. Of all meningioma cases, 13 (33%) had greater than 15% ICA stenosis. Mean ICA stenosis for pituitary adenomas was -1.48%. There were no cases of pituitary adenomas causing ICA stenosis >15%.ConclusionsDifferentiating pituitary adenomas and intracavernous meningioma tumors can have important implications on surgical approach and outcome. Our study found that stenosis of the CS-ICA greater than 15% is highly specific to meningiomas and can serve as a radiologic sign to distinguish between these two tumors.© 2022 American Society of Neuroimaging.

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