Zurich pituitary score calculator for pituitary adenomas (CT/MRI)

Notes

Measurements

• Both measurements should be performed in the coronal plane
• The original publication has an excellent illustration showing the appropriate position of the caliper measurements for tumors of all grades

Zurich pituitary score grades

• The Zurich pituitary score has the following categories:
  • grade I: ZPS ratio ≤ 0.75
  • grade II: 0.75 < ratio ≤ 1.25
  • grade III: 1.25 < ratio
  • grade IV: encasement of the intracavernous ICA (uni- or bilaterally)

Practical points

• The score has been designed for MRI, but if necessary CT can be used too

• It has been shown that the Zurich pituitary score is a good predictor of postoperative residual tumor volume, and gross total resection rate with grade I-IV tumors having 92, 77, 67 and 15% total resection rate respectively
  • ^{Serra C, Staartjes VE, Maldaner N, Muscas G, Akeret K, Holzmann D, Soyka MB, Schmid C, Regli L. Predicting extent of resection in transsphenoidal surgery for pituitary adenoma. Acta Neurochir (Wien). 2018 Nov;160(11):2255-2262. doi: 10.1007/s00701-018-3690-x. Epub 2018 Sep 29. PMID: 30267209.}
  • ^{Staartjes VE, Serra C, Zoli M, Mazzatenta D, Pozzi F, Locatelli D, D’Avella E, Solari D, Cavallo LM, Regli L. Multicenter external validation of the Zurich Pituitary Score. Acta Neurochir (Wien). 2020 Jun;162(6):1287-1295. doi: 10.1007/s00701-020-04286-w. Epub 2020 Mar 14. PMID: 32172439.}
• Since it relies on caliper measurements the Zurich pituitary score has good interrater agreement, which had been an issue with earlier graidng systems such as the Knosp scale

Further reading

• Radiopaedia article

Last updated: 2021-12-06