Evidence map›Paper›PMID 42050162›Full record

ArticlePituitary2026

A Retrospective cohort study of Knosp grade reporting of cavernous sinus invasion in pituitary macroadenomas.

Kate Spuler, Roland White, Wu Tzen Lim, Jacob Deeb, James McNeil, George Bouras, Alistair Jukes, Stephen Santoreneos, Alkis Psaltis, Sandy Patel and 1 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Pituitary, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Kate SpulerAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia. kate.spuler@adelaide.edu.au.
Roland WhiteDepartment of Radiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
Wu Tzen LimAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia.
Jacob DeebAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia.
James McNeilAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia.
George BourasAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia.
Alistair JukesDepartment of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
Stephen SantoreneosDepartment of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
Alkis PsaltisDepartment of Otorhinolaryngology, Royal Adelaide Hospital, Adelaide, SA, Australia.
Sandy PatelDepartment of Radiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
Sunita M C De SousaAdelaide Medical School, (Faculty of Health and Medical Sciences), University of Adelaide, Adelaide, SA, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe Knosp grading system classifies the extent of cavernous sinus invasion (CSI) in pituitary adenomas (PAs). Knosp grade is predictive of surgical remission rates and is used in decision-making for the management of these adenomas. This study evaluates the rate and accuracy of Knosp grade reporting of PAs by radiologists.

methodsThis is a retrospective observational study of 100 consecutive patients with pituitary macroadenomas who underwent pituitary MR imaging between March 2023 and March 2025. The rate of CSI reporting in radiologist reports of the scans was determined, and the reported grade was compared with the Knosp grade calculated by the study panel.

resultsRadiologist reports contained a specific comment regarding CSI, or its absence, in 73/100 (73%) of patients. Analysing left and right cavernous sinuses as separate observations, implicit phrasing reporting a specific Knosp grade occurred in 12/200 (6%), and explicit reporting occurred in 10/200 (5%). Analysis of implicit and explicit reporting revealed a statistically significant difference between the reported Knosp grades and study grades (p = 0.02). No significant correlation was found between CSI reporting rates and patients undergoing surgery (p = 0.179), radiotherapy (p = 0.427), or medical therapy (p = 0.127) before or at the time of the MRI.

conclusionDespite the integral importance of CSI in pituitary adenoma management decisions as enshrined in international guidelines, the rate and accuracy of Knosp grade reporting are suboptimal. Knosp reporting in MRI reports should be standardised to improve the rate and quality of CSI reporting.

Indexed as

AdenomaCavernous SinusCavernous Sinus SyndromesPituitary NeoplasmsAdultAgedFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedNeoplasm GradingNeoplasm InvasivenessRetrospective StudiesCavernous sinus invasionKnosp classificationPituitary adenomaPituitary neuroendocrine tumourTrans-sphenoidal surgery

Identifiers

PMID42050162
PMCPMC13124751

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.