MR imaging of pituitary adenomas after gamma knife stereotactic radiosurgery

OBJECTIVE: The purpose of this study was to evaluate the response of pituitary adenomas to radiosurgery as manifested by changes in size and appearance on serial MR imaging. MATERIALS AND METHODS: Over a mean follow-up period of 36 months, changes in 44 pituitary adenomas were assessed on 147 enhanced MR imaging studies. Prior surgery had been performed in 36 tumors (82%). RESULTS: At the time of radiosurgery, mean tumor volume was 5.9 +/- 0.8 cm(3) (mean diameter, 2.2 cm). The mean reduction in volume at last follow-up was 41% (+/- 5%, p < 0.001), and a decrease in tumor volume of 25-100% was observed in 34 tumors (77%). Mean reduction in tumor volume at 6 months after radiosurgery was 9% (p = 0.095); at 1 year, 24% (p < 0.001); at 2 years, 34% (p < 0.001); at 3 years, 41% (p < 0.001); and at 4 years, 50% (p = 0.008). Six months after radiosurgery a slight and transient increase in size was observed in 21% of tumors. During follow-up, neither decreased contrast enhancement nor cyst development was associated with changes in tumor volume. CONCLUSION: Tumor control was observed for most pituitary adenomas after radiosurgery and occurred gradually over a period of several years. A small increase in tumor size might be observed in the first 6 months after radiosurgery. In most cases, reductions in tumor size were not accompanied by a change in contrast enhancement or cyst formation.