{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T16:58:39Z","timestamp":1780333119719,"version":"3.54.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The physical consistency of pituitary adenomas (PAs) is highly variable, ranging from soft\/cystic to firm\/calcified. The association between PA consistency and surgical\/endocrinological outcomes has been well established, with firm tumors demonstrating poorer outcomes and higher complication rates. However, to date, no reliable means to determine PA consistency preoperatively exist, although T2- and diffusion-weighted imaging show early promise. As such, this study aimed to quantitatively analyze the value of normalized T2-weighted imaging (T2WI) and diffusion-weighted imaging ratios in the preoperative prediction of PA consistency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      The authors reviewed a prospectively maintained database of all patients undergoing PA resection at a single institution between 2011 and 2024. Inclusion criteria included the following: 1) a PA with a minimum diameter \u2265 20 mm in at least one dimension; 2) a consistency grade assigned at the time of surgery using a previously validated grading scale; and 3) preoperative MRI performed prior to surgery. Normalized tumor to cerebellar T2-weighted imaging intensity (TCTI) ratios were calculated using 10-mm\n                      <jats:sup>2<\/jats:sup>\n                      regions of interest. Data were analyzed using Kruskal-Wallis tests, multivariable ordinal logistic regression models, and receiver operating characteristic (ROC) curve analyses with 4-fold cross-validation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 189 patients (mean age 55.4 years, 49.2% female) were included, of whom 77 (40.7%) had PAs with a consistency grade of 1+2, 76 with a consistency grade of 3 (40.2%), and 36 (19%) with a consistency grade of 4+5. When using mean T2WI intensity measurements, TCTI ratios were lower for grade 4+5 tumors (1.48 \u00b1 0.24, p &lt; 0.001) than for grade 3 tumors (1.77 \u00b1 0.44) and grade 1+2 tumors (2.16 \u00b1 1.10, p = 0.001). When using maximum T2WI measurements, TCTI ratios were also lower for grade 4+5 tumors (1.50 \u00b1 0.24, p &lt; 0.001) compared with grade 3 tumors (1.79 \u00b1 0.45), and grade 1+2 tumors (2.15 \u00b1 0.81, p &lt; 0.001). No association between apparent diffusion coefficient values and tumor consistency was observed. In the ROC analysis, comparing soft (grade 1+2) with firm (grade 4+5) tumors, an area under the curve of 0.877 was observed when using maximum signal intensity measurements within the ROI. A TCTI ratio cutoff of 1.682 was associated with a sensitivity of 80.6% and specificity of 85.7% in predicting firm tumors (grade 4+5) versus all other grades in the test dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The T2WI TCTI ratio is predictive of PA consistency where higher ratios are associated with softer tumors. Preoperative prediction of PA consistency using the TCTI ratio might improve patient selection and outcome predication, and guide the excision technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns25387","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:22Z","timestamp":1769083222000},"page":"937-946","source":"Crossref","is-referenced-by-count":1,"title":["Utility of standardized T2-weighted MRI intensity ratio for prediction of pituitary macroadenoma consistency"],"prefix":"10.3171","volume":"144","author":[{"given":"Ishan","family":"Shah","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gomez","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cote","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Briggs","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce D.","family":"Beutler","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Fixman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Pham","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Chung","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Levy","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Sisti","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Assadsangabi","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Endocrinology, Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Biomedicines","first-page":"494","article-title":"Pituitary adenomas: from diagnosis to therapeutics","volume":"9","author":"Banskota S","year":"2021","unstructured":"Banskota S, Adamson DC. Pituitary adenomas: from diagnosis to therapeutics. Biomedicines. 2021;9(5):494."},{"issue":"16","key":"b2","series-title":"JAMA","first-page":"1386","article-title":"Diagnosis and management of pituitary adenomas: a review","volume":"329","author":"Tritos NA","year":"2023","unstructured":"Tritos NA, Miller KK. Diagnosis and management of pituitary adenomas: a review. JAMA. 2023;329(16):1386\u20131398."},{"issue":"3","key":"b3","series-title":"Endocrine","first-page":"559","article-title":"Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery","volume":"78","author":"Acitores Cancela A","year":"2022","unstructured":"Acitores Cancela A, Rodr\u00edguez Berrocal V, Pian Arias H, D\u00edez JJ, Iglesias P. Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery. Endocrine. 2022;78(3):559\u2013569."},{"issue":"1","key":"b4","series-title":"BMC Endocr Disord","first-page":"92","article-title":"Pituitary adenoma consistency affects postoperative hormone function: a retrospective study","volume":"23","author":"De Alcubierre D","year":"2023","unstructured":"De Alcubierre D, Puliani G, Cozzolino A,  Pituitary adenoma consistency affects postoperative hormone function: a retrospective study. BMC Endocr Disord. 2023;23(1):92."},{"issue":"5","key":"b5","series-title":"J Neurosurg","first-page":"1331","article-title":"Association between meningioma consistency and surgical outcomes","volume":"142","author":"Shah I","year":"2025","unstructured":"Shah I, Chung RS, Liu K,  Association between meningioma consistency and surgical outcomes. J Neurosurg. 2025;142(5):1331\u20131337."},{"issue":"6","key":"b6","series-title":"J Neurosurg","first-page":"1674","article-title":"Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience","volume":"142","author":"Guerra GA","year":"2025","unstructured":"Guerra GA, Kashif Z, Cote DJ,  Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience. J Neurosurg. 2025;142(6):1674\u20131681."},{"key":"b7","series-title":"Pol J Radiol","first-page":"40","article-title":"Intracranial lesions with low signal intensity on T2-weighted MR images - review of pathologies","volume":"80","author":"Zimny A","year":"2015","unstructured":"Zimny A, Neska-Matuszewska M, Bladowska J, S\u0105siadek MJ. Intracranial lesions with low signal intensity on T2-weighted MR images - review of pathologies. Pol J Radiol. 2015;80:40\u201350."},{"issue":"1","key":"b8","series-title":"Neuroradiology","first-page":"15","article-title":"Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke","volume":"64","author":"Gaddamanugu S","year":"2022","unstructured":"Gaddamanugu S, Shafaat O, Sotoudeh H,  Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology. 2022;64(1):15\u201330."},{"issue":"3","key":"b9","series-title":"J Neuroradiol","first-page":"186","article-title":"Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results","volume":"43","author":"Yiping L","year":"2016","unstructured":"Yiping L, Ji X, Daoying G, Bo Y. Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J Neuroradiol. 2016;43(3):186\u2013194."},{"issue":"1","key":"b10","series-title":"Neurosurg Rev","first-page":"11","article-title":"Methods of preoperative prediction of pituitary adenoma consistency: a systematic review","volume":"46","author":"\u010cern\u00fd M","year":"2022","unstructured":"\u010cern\u00fd M, Sedl\u00e1k V, Les\u00e1kov\u00e1 V, Franc\u016fz P, Netuka D. Methods of preoperative prediction of pituitary adenoma consistency: a systematic review. Neurosurg Rev. 2022;46(1):11."},{"issue":"15","key":"b11","series-title":"Cancers (Basel)","first-page":"3914","article-title":"Consistency of pituitary adenoma: prediction by pharmacokinetic dynamic contrast-enhanced MRI and comparison with histologic collagen content","volume":"13","author":"Kamimura K","year":"2021","unstructured":"Kamimura K, Nakajo M, Bohara M,  Consistency of pituitary adenoma: prediction by pharmacokinetic dynamic contrast-enhanced MRI and comparison with histologic collagen content. Cancers (Basel). 2021;13(15):3914."},{"issue":"6","key":"b12","series-title":"J Neurosurg","first-page":"1800","article-title":"Development and clinical validation of a grading system for pituitary adenoma consistency","volume":"134","author":"Rutkowski MJ","year":"2021","unstructured":"Rutkowski MJ, Chang KE, Cardinal T,  Development and clinical validation of a grading system for pituitary adenoma consistency. J Neurosurg. 2021;134(6):1800\u20131807."},{"issue":"5","key":"b13","series-title":"J Neurol Surg B Skull Base","first-page":"340","article-title":"Prediction of consistency of pituitary adenomas by magnetic resonance imaging","volume":"76","author":"Smith KA","year":"2015","unstructured":"Smith KA, Leever JD, Chamoun RB. Prediction of consistency of pituitary adenomas by magnetic resonance imaging. J Neurol Surg B Skull Base. 2015;76(5):340\u2013343."},{"issue":"5","key":"b14","series-title":"J Neurosurg","first-page":"1356","article-title":"Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography","volume":"136","author":"Cohen-Cohen S","year":"2022","unstructured":"Cohen-Cohen S, Helal A, Yin Z,  Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg. 2022;136(5):1356\u20131363."},{"issue":"3","key":"b15","series-title":"J Neurol Surg B Skull Base","first-page":"252","article-title":"Tumor to cerebellar peduncle T2-weighted imaging intensity ratio fails to predict pituitary adenoma consistency","volume":"80","author":"Mastorakos P","year":"2019","unstructured":"Mastorakos P, Mehta GU, Chatrath A,  Tumor to cerebellar peduncle T2-weighted imaging intensity ratio fails to predict pituitary adenoma consistency. J Neurol Surg B Skull Base. 2019;80(3):252\u2013257."},{"issue":"1","key":"b16","series-title":"Acta Neurochir (Wien)","first-page":"84","article-title":"Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score","volume":"166","author":"Acitores Cancela A","year":"2024","unstructured":"Acitores Cancela A, Rodr\u00edguez Berrocal V, Pian Arias H, D\u00edez G\u00f3mez JJ, Iglesias Lozano P. Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score. Acta Neurochir (Wien). 2024;166(1):84."},{"issue":"6","key":"b17","series-title":"Neurochirurgie","first-page":"453","article-title":"Is it really possible to predict the consistency of a pituitary adenoma preoperatively?","volume":"63","author":"Thotakura AK","year":"2017","unstructured":"Thotakura AK, Patibandla MR, Panigrahi MK, Mahadevan A. Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie. 2017;63(6):453\u2013457."},{"issue":"8","key":"b18","series-title":"Int J Clin Exp Med","first-page":"12898","article-title":"Relationship between pituitary adenoma texture and collagen content revealed by comparative study of MRI and pathology analysis","volume":"8","author":"Wei L","year":"2015","unstructured":"Wei L, Lin SA, Fan K, Xiao D, Hong J, Wang S. Relationship between pituitary adenoma texture and collagen content revealed by comparative study of MRI and pathology analysis. Int J Clin Exp Med. 2015;8(8):12898\u201312905."},{"issue":"5","key":"b19","series-title":"Neurosurg Rev","first-page":"2933","article-title":"Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma","volume":"44","author":"Ding W","year":"2021","unstructured":"Ding W, Huang Z, Zhou G, Li L, Zhang M, Li Z. Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma. Neurosurg Rev. 2021;44(5):2933\u20132941."},{"issue":"3","key":"b20","series-title":"J Neurosurg","first-page":"771","article-title":"Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency","volume":"134","author":"Rutland JW","year":"2021","unstructured":"Rutland JW, Loewenstern J, Ranti D,  Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J Neurosurg. 2021;134(3):771\u2013779."},{"issue":"2","key":"b21","series-title":"Radiology","first-page":"492","article-title":"Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging","volume":"237","author":"Thoeny HC","year":"2005","unstructured":"Thoeny HC, De Keyzer F, Vandecaveye V,  Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology. 2005;237(2):492\u2013499."},{"key":"b22","series-title":"Med Sci Monit","first-page":"e919565","article-title":"Relationship between pituitary adenoma consistency and extent of resection based on tumor\/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on postoperative MRI","volume":"26","author":"Chen XY","year":"2020","unstructured":"Chen XY, Ding CY, You HH,  Relationship between pituitary adenoma consistency and extent of resection based on tumor\/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on postoperative MRI. Med Sci Monit. 2020;26:e919565."},{"issue":"5","key":"b1","series-title":"Biomedicines","first-page":"494","article-title":"Pituitary adenomas: from diagnosis to therapeutics","volume":"9","author":"Banskota S","year":"2021","unstructured":"Banskota S, Adamson DC. Pituitary adenomas: from diagnosis to therapeutics. Biomedicines. 2021;9(5):494."},{"issue":"16","key":"b2","series-title":"JAMA","first-page":"1386","article-title":"Diagnosis and management of pituitary adenomas: a review","volume":"329","author":"Tritos NA","year":"2023","unstructured":"Tritos NA, Miller KK. Diagnosis and management of pituitary adenomas: a review. JAMA. 2023;329(16):1386\u20131398."},{"issue":"3","key":"b3","series-title":"Endocrine","first-page":"559","article-title":"Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery","volume":"78","author":"Acitores Cancela A","year":"2022","unstructured":"Acitores Cancela A, Rodr\u00edguez Berrocal V, Pian Arias H, D\u00edez JJ, Iglesias P. Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery. Endocrine. 2022;78(3):559\u2013569."},{"issue":"1","key":"b4","series-title":"BMC Endocr Disord","first-page":"92","article-title":"Pituitary adenoma consistency affects postoperative hormone function: a retrospective study","volume":"23","author":"De Alcubierre D","year":"2023","unstructured":"De Alcubierre D, Puliani G, Cozzolino A,  Pituitary adenoma consistency affects postoperative hormone function: a retrospective study. BMC Endocr Disord. 2023;23(1):92."},{"issue":"5","key":"b5","series-title":"J Neurosurg","first-page":"1331","article-title":"Association between meningioma consistency and surgical outcomes","volume":"142","author":"Shah I","year":"2025","unstructured":"Shah I, Chung RS, Liu K,  Association between meningioma consistency and surgical outcomes. J Neurosurg. 2025;142(5):1331\u20131337."},{"issue":"6","key":"b6","series-title":"J Neurosurg","first-page":"1674","article-title":"Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience","volume":"142","author":"Guerra GA","year":"2025","unstructured":"Guerra GA, Kashif Z, Cote DJ,  Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience. J Neurosurg. 2025;142(6):1674\u20131681."},{"key":"b7","series-title":"Pol J Radiol","first-page":"40","article-title":"Intracranial lesions with low signal intensity on T2-weighted MR images - review of pathologies","volume":"80","author":"Zimny A","year":"2015","unstructured":"Zimny A, Neska-Matuszewska M, Bladowska J, S\u0105siadek MJ. Intracranial lesions with low signal intensity on T2-weighted MR images - review of pathologies. Pol J Radiol. 2015;80:40\u201350."},{"issue":"1","key":"b8","series-title":"Neuroradiology","first-page":"15","article-title":"Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke","volume":"64","author":"Gaddamanugu S","year":"2022","unstructured":"Gaddamanugu S, Shafaat O, Sotoudeh H,  Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology. 2022;64(1):15\u201330."},{"issue":"3","key":"b9","series-title":"J Neuroradiol","first-page":"186","article-title":"Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results","volume":"43","author":"Yiping L","year":"2016","unstructured":"Yiping L, Ji X, Daoying G, Bo Y. Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J Neuroradiol. 2016;43(3):186\u2013194."},{"issue":"1","key":"b10","series-title":"Neurosurg Rev","first-page":"11","article-title":"Methods of preoperative prediction of pituitary adenoma consistency: a systematic review","volume":"46","author":"\u010cern\u00fd M","year":"2022","unstructured":"\u010cern\u00fd M, Sedl\u00e1k V, Les\u00e1kov\u00e1 V, Franc\u016fz P, Netuka D. Methods of preoperative prediction of pituitary adenoma consistency: a systematic review. Neurosurg Rev. 2022;46(1):11."},{"issue":"15","key":"b11","series-title":"Cancers (Basel)","first-page":"3914","article-title":"Consistency of pituitary adenoma: prediction by pharmacokinetic dynamic contrast-enhanced MRI and comparison with histologic collagen content","volume":"13","author":"Kamimura K","year":"2021","unstructured":"Kamimura K, Nakajo M, Bohara M,  Consistency of pituitary adenoma: prediction by pharmacokinetic dynamic contrast-enhanced MRI and comparison with histologic collagen content. Cancers (Basel). 2021;13(15):3914."},{"issue":"6","key":"b12","series-title":"J Neurosurg","first-page":"1800","article-title":"Development and clinical validation of a grading system for pituitary adenoma consistency","volume":"134","author":"Rutkowski MJ","year":"2021","unstructured":"Rutkowski MJ, Chang KE, Cardinal T,  Development and clinical validation of a grading system for pituitary adenoma consistency. J Neurosurg. 2021;134(6):1800\u20131807."},{"issue":"5","key":"b13","series-title":"J Neurol Surg B Skull Base","first-page":"340","article-title":"Prediction of consistency of pituitary adenomas by magnetic resonance imaging","volume":"76","author":"Smith KA","year":"2015","unstructured":"Smith KA, Leever JD, Chamoun RB. Prediction of consistency of pituitary adenomas by magnetic resonance imaging. J Neurol Surg B Skull Base. 2015;76(5):340\u2013343."},{"issue":"5","key":"b14","series-title":"J Neurosurg","first-page":"1356","article-title":"Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography","volume":"136","author":"Cohen-Cohen S","year":"2022","unstructured":"Cohen-Cohen S, Helal A, Yin Z,  Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg. 2022;136(5):1356\u20131363."},{"issue":"3","key":"b15","series-title":"J Neurol Surg B Skull Base","first-page":"252","article-title":"Tumor to cerebellar peduncle T2-weighted imaging intensity ratio fails to predict pituitary adenoma consistency","volume":"80","author":"Mastorakos P","year":"2019","unstructured":"Mastorakos P, Mehta GU, Chatrath A,  Tumor to cerebellar peduncle T2-weighted imaging intensity ratio fails to predict pituitary adenoma consistency. J Neurol Surg B Skull Base. 2019;80(3):252\u2013257."},{"issue":"1","key":"b16","series-title":"Acta Neurochir (Wien)","first-page":"84","article-title":"Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score","volume":"166","author":"Acitores Cancela A","year":"2024","unstructured":"Acitores Cancela A, Rodr\u00edguez Berrocal V, Pian Arias H, D\u00edez G\u00f3mez JJ, Iglesias Lozano P. Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score. Acta Neurochir (Wien). 2024;166(1):84."},{"issue":"6","key":"b17","series-title":"Neurochirurgie","first-page":"453","article-title":"Is it really possible to predict the consistency of a pituitary adenoma preoperatively?","volume":"63","author":"Thotakura AK","year":"2017","unstructured":"Thotakura AK, Patibandla MR, Panigrahi MK, Mahadevan A. Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie. 2017;63(6):453\u2013457."},{"issue":"8","key":"b18","series-title":"Int J Clin Exp Med","first-page":"12898","article-title":"Relationship between pituitary adenoma texture and collagen content revealed by comparative study of MRI and pathology analysis","volume":"8","author":"Wei L","year":"2015","unstructured":"Wei L, Lin SA, Fan K, Xiao D, Hong J, Wang S. Relationship between pituitary adenoma texture and collagen content revealed by comparative study of MRI and pathology analysis. Int J Clin Exp Med. 2015;8(8):12898\u201312905."},{"issue":"5","key":"b19","series-title":"Neurosurg Rev","first-page":"2933","article-title":"Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma","volume":"44","author":"Ding W","year":"2021","unstructured":"Ding W, Huang Z, Zhou G, Li L, Zhang M, Li Z. Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma. Neurosurg Rev. 2021;44(5):2933\u20132941."},{"issue":"3","key":"b20","series-title":"J Neurosurg","first-page":"771","article-title":"Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency","volume":"134","author":"Rutland JW","year":"2021","unstructured":"Rutland JW, Loewenstern J, Ranti D,  Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J Neurosurg. 2021;134(3):771\u2013779."},{"issue":"2","key":"b21","series-title":"Radiology","first-page":"492","article-title":"Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging","volume":"237","author":"Thoeny HC","year":"2005","unstructured":"Thoeny HC, De Keyzer F, Vandecaveye V,  Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology. 2005;237(2):492\u2013499."},{"key":"b22","series-title":"Med Sci Monit","first-page":"e919565","article-title":"Relationship between pituitary adenoma consistency and extent of resection based on tumor\/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on postoperative MRI","volume":"26","author":"Chen XY","year":"2020","unstructured":"Chen XY, Ding CY, You HH,  Relationship between pituitary adenoma consistency and extent of resection based on tumor\/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on postoperative MRI. 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