Volume interpolated 3<scp>D</scp>‐spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for <scp>MRI</scp> detection of corticotropin secreting pituitary microadenomas

Kasaliwal, Rajeev; Sankhe, Shilpa; Lila, Anurag; Budyal, Sweta; Jagtap, Varsha S.; Sarathi, Vijaya; Kakade, Harshal; Bandgar, Tushar; Menon, P. S. N.; Shah, Nalini

doi:10.1111/cen.12069

Cited by 53 publications

(42 citation statements)

References 18 publications

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“…However, most patients with ACTH-dependent Cushing’s syndrome have an occult (i.e., hidden) tumor. Pituitary adenomas can be very small and be missed by even the most advanced magnetic resonance scanning techniques described below (123,194,278). Furthermore, ectopic ACTH-secreting neuroendocrine tumors (e.g., bronchial carcinoids) can be small ( < 1 cm) and difficult to identify in imaging studies.…”

Section: Clinical Features Of Cushing’s Syndromementioning

confidence: 99%

Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

Raff

Sharma

Nieman

2014

Comprehensive Physiology

127

105

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The hypothalamic-pituitary-adrenal (HPA) axis is a classic neuroendocrine system. One of the best ways to understand the HPA axis is to appreciate its dynamics in the variety of diseases and syndromes that affect it. Excess glucocorticoid activity can be due to endogenous cortisol overproduction (spontaneous Cushing’s syndrome) or exogenous glucocorticoid therapy (iatrogenic Cushing’s syndrome). Endogenous Cushing’s syndrome can be subdivided into ACTH-dependent and ACTH-independent, the latter of which is usually due to autonomous adrenal overproduction. The former can be due to a pituitary corticotroph tumor (usually benign) or ectopic ACTH production from tumors outside the pituitary; both of these tumor types overexpress the proopiomelanocortin gene. The converse of Cushing’s syndrome is the lack of normal cortisol secretion and is usually due to adrenal destruction (primary adrenal insufficiency) or hypopituitarism (secondary adrenal insufficiency). Secondary adrenal insufficiency can also result from a rapid discontinuation of long-term, pharmacological glucocorticoid therapy because of HPA axis suppression and adrenal atrophy. Finally, mutations in the steroidogenic enzymes of the adrenal cortex can lead to congenital adrenal hyperplasia and an increase in precursor steroids, particularly androgens. When present in utero, this can lead to masculinization of a female fetus. An understanding of the dynamics of the HPA axis is necessary to master the diagnosis and differential diagnosis of pituitary-adrenal diseases. Furthermore, understanding the pathophysiology of the HPA axis gives great insight into its normal control.

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Section: Clinical Features Of Cushing’s Syndromementioning

confidence: 99%

Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

Raff

Sharma

Nieman

2014

Comprehensive Physiology

127

105

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“…13,16 However, differential enhancement within the pituitary gland may best be visible during the first 10 to 20 seconds. 10 The ESC can potentially allow the fast acquisition of higher resolution sellar images.…”

Section: Discussionmentioning

confidence: 99%

“…Obtaining higher resolution images during dynamic imaging may improve the detection of smaller adenomas by preventing the tissue averaging seen in thicker slices. 13,24 …”

Section: Discussionmentioning

confidence: 99%

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Chittiboina

Talagala²,

Merkle

et al. 2016

JNS

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OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing’s disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC. The ESC (a double-turn, 12-mm-diameter surface coil made from 1-mm-diameter copper wire) was developed to obtain images in a 1.5-T MR scanner. The ESC was placed (via a standard sublabial TSS approach) on the anterior sella face. Clinical MR scans were obtained using the 8-channel head coil and ESC as the receiver coils. Using the ESC, ultra–high-resolution, 3D, balanced fast field echo (BFFE) and T1-weighted imaging were performed at resolutions of 0.25 × 0.25 × 0.50 mm3 and 0.15 × 0.15 × 0.30 mm3, respectively. RESULTS Region-of-interest analysis indicated a 10-fold increase in the signal-to-noise ratio (SNR) of the pituitary when using the ESC compared with the 8-channel head coil. ESC-related improvements (p < 0.01) in the SNR were inversely proportional to the distance from the ESC tip to the anterior pituitary gland surface. High-resolution BFFE MR imaging obtained using ESC revealed a number of anatomical features critical to pituitary surgery that were not visible on 8-channel MR imaging, including the pituitary capsule, the intercavernous sinus, and microcalcifications in the pars intermedia. These ESC imaging findings were confirmed by the pathological correlation with whole-mount pituitary sections. CONCLUSIONS ESC can significantly improve SNR in the sellar region intraoperatively using current 1.5-T MR imaging platforms. Improvement in SNR can provide images of the sella and surrounding structures with unprecedented resolution. Clinical use of this ESC may allow for MR imaging detection of previously occult pituitary adenomas and identify microscopic invasion of the dura or cavernous sinus.

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“…Another concern is the MR image quality of the current study. Previous studies reported exhibiting 66%-100% sensitivity in detecting ACTHsecreting microadenoma 6,7 with the aid of DCE-MR imaging. The sensitivity of the current study for detecting ACTH-secreting microadenomas was as low as 32%, which may suggest that MR images of the current study might have been suboptimized compared with the past literature reports.…”

Section: Discussionmentioning

confidence: 99%

Pituitary-Targeted Dynamic Contrast-Enhanced Multisection CT for Detecting MR Imaging–Occult Functional Pituitary Microadenoma

Kinoshita

Tanaka

Arita³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Although resection of a tumor by trans-sphenoidal surgery is considered the criterion standard for successful surgical treatment of functional pituitary microadenoma, MR imaging occasionally fails to visualize and identify the tumor and supplementary imaging modalities are necessary. We tested the possibility of dynamic contrast-enhanced multisection CT of the pituitary gland accompanying image reconstruction of contrast agent dynamics to identify the localizations of microadenomas and compared the diagnostic performance with conventional pituitary-targeted MR imaging.

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Volume interpolated 3D‐spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for MRI detection of corticotropin secreting pituitary microadenomas

Abstract: VI-SGE MR sequence was better for localization of pituitary microadenomas particularly when DC-SE MR sequence is negative or equivocal and should be used in addition to DC-SE MR sequence for the evaluation of ACTH-dependent CS.

Cited by 53 publications

References 18 publications

Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Pituitary-Targeted Dynamic Contrast-Enhanced Multisection CT for Detecting MR Imaging–Occult Functional Pituitary Microadenoma

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