# Combined Use of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Sellar Tumors: A Single-Centre Experience

## TL;DR

This study shows that combining diffusion and perfusion MRI improves the diagnosis of certain sellar tumors, especially meningiomas versus pituitary adenomas.

## Contribution

The study demonstrates the added diagnostic value of combining diffusion and perfusion MRI in specific sellar tumor differentiations.

## Key findings

- Combined DWI and PWI improved accuracy in distinguishing meningiomas from non-functional pituitary adenomas.
- ADCmin and rPHmax together achieved 88% sensitivity and 76% specificity in this differentiation.
- In some cases, single parameters like rCBVmax already provided high diagnostic accuracy.

## Abstract

Background/Objectives: To evaluate whether incorporating both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in pituitary MRI examinations improves differential diagnosis by providing additional diagnostic value. Methods: A retrospective analysis was performed on 88 patients with histologically confirmed sellar or parasellar tumors who underwent 1.5T MRI with DWI and dynamic susceptibility contrast PWI (DSC-PWI) between October 2007 and April 2023. DWI parameters included minimum apparent diffusion coefficient (ADCmin) and relative ADCmin (rADCmin). PWI parameters included mean and maximum relative cerebral blood volume (rCBV, rCBVmax) and relative peak height (rPH, rPHmax), normalized to white matter. Tumor regions of interest were manually segmented, excluding calcified or hemorrhagic areas. Group comparisons and ROC analyses assessed diagnostic performance of individual and combined parameters. Results: Significant differences in diffusion and perfusion metrics were observed among the five tumor types. The combined analysis of DWI and PWI improved diagnostic accuracy in selected comparisons. The greatest benefit occurred in distinguishing meningiomas from solid non-functional pituitary adenomas (pituitary neuroendocrine tumors-PitNET), where the combination of ADCmin and rPHmax yielded an AUC of 0.818, sensitivity of 88%, and specificity of 76%, exceeding the performance of either parameter alone. In other comparisons, including meningiomas versus invasive PitNETs and adamantinomatous craniopharyngiomas, combined analysis did not substantially improve accuracy when single parameters, particularly rCBVmax (AUC = 0.995), already demonstrated excellent performance. Conclusions: Integration of DWI and PWI into pituitary MRI protocols enhances diagnostic performance in selected tumor groups. The additive value is context-dependent, supporting the tailored application of these sequences in the evaluation of sellar and parasellar tumors.