World neurosurgery · 2026
A Grading System Based on Multiparametric Magnetic Resonance Imaging-Predicted Tumor Perfusion, Invasiveness, and Texture (GOLDS-PIT) for Surgical Difficulty Assessment in Pituitary Macroadenomas: A Prospective Single-Center Cohort Study.
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Yao Shun, Rui Wenting, Yang Jinming, Chen Xuehui, Wu Guoqing, Cheng Haixia, Ma Jingyi, Shi Huidong, Ma Zengyi, Ye Zhao, Zhang Qilin, Shou Xuefei, Shen Ming, Zhou Xiang, Cao Xiaoyun, Liu Yuyu, Liao Yankai, Zhang Yichao, Chen Zhengyuan, Ji Chenxing, Wang Yongfei, Yao Zhenwei, Qiao Nidan, Zhao Yao
Аннотация
OBJECTIVE: To develop and validate a novel grading system (Grading system Of 4-Level assessing Difficulty of Surgery based on Perfusion, Invasiveness, and Texture [GOLDS-PIT]) for assessing surgical difficulty based on multiparametric magnetic resonance imaging (MRI)-predicted perfusion, invasiveness, and texture in patients with pituitary macroadenomas (PMAs).
METHODS: Preoperative multiparametric MRI scans were prospectively collected from 240 patients (cohort A) with PMAs to construct a radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture. The GOLDS-PIT based on multiparametric MRI-predicted tumor perfusion, invasiveness, and texture was then developed with cohort A and validated with another 162 cases of internal cohort B.
RESULTS: The areas under the curve of the radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture in the validation cohort were 0.906 and 0.908, respectively. A 16-score GOLDS-PIT stratified surgical difficulty into low, medium, high, and extremely high categories. In the validation cohort, combined approaches were selected in more patients in extremely high and high difficulty groups, which was significantly higher than low and moderate difficulty groups (33% vs. 1%; P < 0.001). These groups had a lower gross total resection rate (84% vs. 46%; P < 0.001), higher severe complication rate (50% vs. 19%; P < 0.001), and higher surgical resource consumption: intraoperative blood loss (600 mL [363-1425] vs. 300 mL [200-400]; P < 0.001), operative duration (5.9 hours [4.0-7.0] vs. 3.0 hours [2.5-4.0]; P < 0.001), and hospitalization cost (¥96,433 vs. ¥67,264; P < 0.001).
CONCLUSIONS: We developed and validated a novel surgical difficulty grading system for PMAs, which can assist surgeons in surgical planning and anticipating surgical outcomes, providing a practical reference for determining appropriate resection strategies.
METHODS: Preoperative multiparametric MRI scans were prospectively collected from 240 patients (cohort A) with PMAs to construct a radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture. The GOLDS-PIT based on multiparametric MRI-predicted tumor perfusion, invasiveness, and texture was then developed with cohort A and validated with another 162 cases of internal cohort B.
RESULTS: The areas under the curve of the radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture in the validation cohort were 0.906 and 0.908, respectively. A 16-score GOLDS-PIT stratified surgical difficulty into low, medium, high, and extremely high categories. In the validation cohort, combined approaches were selected in more patients in extremely high and high difficulty groups, which was significantly higher than low and moderate difficulty groups (33% vs. 1%; P < 0.001). These groups had a lower gross total resection rate (84% vs. 46%; P < 0.001), higher severe complication rate (50% vs. 19%; P < 0.001), and higher surgical resource consumption: intraoperative blood loss (600 mL [363-1425] vs. 300 mL [200-400]; P < 0.001), operative duration (5.9 hours [4.0-7.0] vs. 3.0 hours [2.5-4.0]; P < 0.001), and hospitalization cost (¥96,433 vs. ¥67,264; P < 0.001).
CONCLUSIONS: We developed and validated a novel surgical difficulty grading system for PMAs, which can assist surgeons in surgical planning and anticipating surgical outcomes, providing a practical reference for determining appropriate resection strategies.