Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

Sun, Hai; Yedinak, Chris G.; Ozpinar, Alp; Anderson, Jim; Doğan, Aclan; Delashaw, Johnny B.; Fleseriu, Maria

doi:10.1055/s-0034-1543970

Cited by 9 publications

(7 citation statements)

References 35 publications

(53 reference statements)

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“…18 Additionally, Sun et al showed that MRI findings for lateralization significantly correlated with surgery lateralization results. 21 In our study, the accuracy in the lateralization site of MRI in patients with adenoma identified on the pre-operative study was calculated as 76.4% (13/17) similar to the literature (Table 3). Central venous sampling is a diagnostic test in patients with suspected CD who have nondiagnostic laboratory results or negative MRI findings.…”

Section: Discussionsupporting

confidence: 74%

Central venous sampling and magnetic resonance imaging in the diagnosis of ACTH-dependent Cushing’s syndrome

et al. 2022

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Objectives Central venous sampling (CVS) with corticotropin-releasing hormone (CRH) stimulation is a crucial technique in evaluating adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (CS). We evaluated central venous sampling (CVS) and magnetic resonance imaging (MRI) findings in predicting the localization and lateralization of pituitary microadenomas. Methods We analyzed 29 patients with CS who underwent CVS with CRH stimulation and examined with MRI retrospectively. Catheterization to central sinuses was successfully performed in 26 patients. Three patients with variant anatomy or inability to cannulate were diagnosed with CD after examination of pathology. Results After CVS, among 26 patients, 23 patients were determined to have CD (88.4%) and 2 (7.7%) patients were diagnosed with ectopic ACTH syndrome. One patient was diagnosed with CD postoperatively. While the sensitivity of the CVS was 95.6%, sensitivity of the preoperative pituitary MRI was lower (69.5%). Also, the negative predictive value ratio was higher in CVS than in MRI (66% versus 22%). Diagnostic accuracy in the lateralization of the tumor was high as in CVS as in MRI (76.4% versus 73.9%). Conclusion Central venous sampling with higher sensitivity in the localization of pituitary microadenoma, also has approximately similar diagnostic accuracy in lateralizing the tumor with MRI.

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Section: Discussionsupporting

confidence: 74%

Central venous sampling and magnetic resonance imaging in the diagnosis of ACTH-dependent Cushing’s syndrome

et al. 2022

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“…DCE MRI, referring to the continuous acquisition of MR images within seconds after the injection of gadolinium, showed that the best contrast for microadenomas compared with normal pituitary tissue. However, dynamic imaging may also generate blurring technical artefacts that could be interpreted as microadenomas 23,24 . Volumetric gradient recalled echo (3D‐GRE) MRI was introduced more recently than DCE MRI.…”

Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced 3D‐T2‐weighted SPACE sequence for MRI detection and localization of adrenocorticotropin (ACTH)‐secreting pituitary microadenomas

Cai

Rui

et al. 2021

Clinical Endocrinology

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Objective Cushing disease is a potentially fatal endocrine disorder caused by adrenocorticotropin (ACTH)‐secreting microadenomas in the pituitary gland. Accurate detection and localization of the adenomas is the key to clinical treatment. This study analysed the value of contrast‐enhanced Sampling Perfection with Application‐optimized Contrasts using different flip angle Evolutions (SPACE) sequence in magnetic resonance imaging (MRI) assessment of ACTH‐secreting pituitary microadenomas. Design and Patients We carried out a retrospective study in which 45 patients with ACTH‐secreting pituitary microadenomas were enrolled. Dynamic contrast‐enhanced (DCE) coronal T1‐SE sequence was performed. A contrast‐enhanced coronal SPACE sequence was added immediately after DCE MRI finished. Two independent observers assessed the tumour existence and location, then the results were compared with surgical findings. Results Twenty‐four lesions (53.3%) were detected by the DCE T1‐SE sequence alone, while 35 lesions (80.0%) were detected with the addition of contrast‐enhanced SPACE sequence. The sensitivity (58.5% vs. 85.3%; p < .05) and best diagnostic accuracy (62.0% vs. 84.4%; p < .05) were significantly better for addition with SPACE sequence than DCE‐SE images alone in detection of ACTH‐secreting pituitary microadenomas. For lesions <5 mm, the detected numbers were 4 (16.6%) versus 10 (27.8%) by DCE T1‐SE sequence and combined DCE T1‐SE with SPACE sequence. Conclusions A combination of contrast‐enhanced SPACE with DCE T1‐SE sequence could improve the detection of ACTH‐secreting pituitary microadenomas. Contrast‐enhanced SPACE sequence could be a supplementary sequence for imaging of ACTH‐secreting pituitary adenomas when T1‐SE sequence provides negative or equivocal findings.

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“…However, the results of cavernous sinus sampling had no association with intraoperatively found lateralization of the tumor (r = 0.14, p = 0.4). Hence, the dynamic MRI could help to discover the site of tumor more accurately than CSS [ 14 ]. This is in accordance to our study results that indicated that dMRI could predict the tumor location more accurately than IPSS results.…”

Section: Discussionmentioning

confidence: 99%

Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Ghorbani

Akbari

Griessenauer

et al. 2020

Heliyon

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Background Inferior petrosal sinus sampling (IPSS) is known as the gold standard to distinguish whether excessive adrenocorticotropin hormone (ACTH) production origins from the pituitary gland or an ectopic source. However, due to a number of factors, the value of IPSS for adenoma lateralization may be limited. Aim of this study was to evaluate the influence of parasellar venous drainage (VD) patterns on IPSS findings in predicting lateralization of pituitary microadenomas. Methods We retrospectively reviewed records of confirmed cases of Cushing's disease which were evaluated by IPSS prior to endoscopic tansnasal trans-sphenoidal surgery (ETSS) to assess the ability of IPSS to predict adenoma laterality. Results Seventeen patients with pathologically confirmed Cushing's disease were retrospectively reviewed. The median age of the included patients was 37 years. Laterality of parasellar VD perfectly associated with lateralization as measured by IPSS. Symmetrical VD was associated with symmetrical ACTH gradient on IPSS. However, lateralization measured by IPSS did not show any significant correlation with lateralization detected during ETSS. Conclusion Our study suggests that IPSS lateralization results strongly depend on parasellar VD pattern but show no significant correlation with the adenoma lateralization found during ETSS. Thus, IPSS does not appear to be an appropriate modality to predict adenoma lateralization.

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Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

Cited by 9 publications

References 35 publications

Central venous sampling and magnetic resonance imaging in the diagnosis of ACTH-dependent Cushing’s syndrome

Central venous sampling and magnetic resonance imaging in the diagnosis of ACTH-dependent Cushing’s syndrome

Contrast‐enhanced 3D‐T2‐weighted SPACE sequence for MRI detection and localization of adrenocorticotropin (ACTH)‐secreting pituitary microadenomas

Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

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