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J Neurol Surg B Skull Base 2015; 76(05): 344-350
DOI: 10.1055/s-0035-1549307
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Imaging of Resected Nonfunctioning Pituitary Adenomas: The Cost of Surveillance

Heather M. Kistka
1   Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Rebecca A. Kasl
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Arash Nayeri
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Andrea L. Utz
3   Division of Endocrinology, Department of Medicine and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Kyle D. Weaver
1   Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Lola B. Chambless
1   Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations
Further Information

Publication History

02 September 2014

02 March 2015

Publication Date:
08 May 2015 (online)

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Abstract

Objectives To determine the cost of annual magnetic resonance imaging (MRI) surveillance after resection of nonfunctioning pituitary adenomas (NFPAs) and its effectiveness in reducing visual compromise due to tumor recurrence.

Design Retrospective case series.

Setting Vanderbilt University Medical Center (2003–2011).

Participants A total of 120 patients underwent primary transsphenoidal resection and surveillance of NFPAs between 2003 and 2011.

Main Outcome Measures Time from initial surgery to most recent imaging or progression. Surveillance MRI costs according to Centers for Medicare and Medicaid database and visual field deficits.

Results Patients received 382 surveillance scans at a total cost of $218,477.30. The median follow-up was 47 months (interquartile range [IQR]: 26–76), and the median interval between scans was 357 days (IQR: 225–434). Overall, 50 scans (13%) revealed tumor growth. The cost per scan revealing growth was $4,369.55. The cost to identify 19 patients (16%) with clinically significant growth was $11,498.80 per patient. A total of 5 of 19 patients (26%) experienced new visual deficits prior to intervention. Patients with visual decline tended to have longer scan intervals than those with preserved vision (mean: 239 versus 794 days; p = 0.0584). No patient with annual surveillance imaging experienced visual decline.

Conclusions Annual MRI scans are a sensitive and cost-conscious method to identify NFPA recurrence prior to visual decline.

Keywords

pituitary adenoma - follow-up - management - cost - MRI
 

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