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Review
. 2022 Oct;25(5):709-712.
doi: 10.1007/s11102-022-01236-w. Epub 2022 Jun 6.

Modern imaging in Cushing's disease

W A Bashari #  1 , D Gillett #  1   2 , J MacFarlane  1 , A S Powlson  1 , A G Kolias  3   4 , R Mannion  4 , D J Scoffings  5 , I A Mendichovszky  2   5 , J Jones  5 , H K Cheow  2   5 , O Koulouri  1 , M Gurnell  6
Affiliations
Review

Modern imaging in Cushing's disease

W A Bashari et al. Pituitary. 2022 Oct.

Abstract

Management of Cushing's disease is informed by dedicated imaging of the sella and parasellar regions. Although magnetic resonance imaging (MRI) remains the investigation of choice, a significant proportion (30-50%) of corticotroph tumours are so small as to render MRI indeterminate or negative when using standard clinical sequences. In this context, alternative MR protocols [e.g. 3D gradient (recalled) echo, with acquisition of volumetric data] may allow detection of tumors that have not been previously visualized. The use of hybrid molecular imaging (e.g. 11C-methionine positron emission tomography coregistered with volumetric MRI) has also been proposed as an additional modality for localizing microadenomas.

Keywords: MRI; Molecular / functional imaging; PET; Pituitary Cushing's.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MRI and Met-PET findings with 3D reconstruction of the sella and parasellar regions in a patient with ACTH-dependent Cushing’s syndrome. A–C Pre- and post-contrast coronal T1w SE MRI (A, B) and FSPGR (volumetric) MRI (C) demonstrate equivocal appearances, with subtle deviation of the infundibulum to the left, but minor downward sloping of the floor of the sella on the left side. No discrete microadenoma is readily visualized. D Met-PET/MRCR reveals both central (white arrow) and right-sided (yellow arrow) radiotracer uptake in the gland. E, F 3D reconstructed images, combining PET, CT and FSPGR MRI datasets, allows appreciation of the location of the tumor (yellow) with respect to the normal gland (turquoise) and other adjacent structures including the intracavernous carotid arteries (red) and optic chiasm (green). G Profiling of 11C-methionine uptake across the sella reveals two peaks consistent with uptake by normal gland and a corticotroph microadenoma. At transsphenoidal surgery, a microadenoma was resected from the right side of the gland and confirmed histologically to be a corticotroph adenoma. Postoperatively the patient achieved complete clinical and biochemical remission and remains eupituitary. Key: CT computed tomography; FSPGR fast spoiled gradient recalled echo; Gad gadolinium; Met-PET/MRCR 11C-methionine PET-CT coregistered with volumetric (FSPGR) MRI; MRI magnetic resonance imaging; PET positron emission tomography; SE spin echo; T1w T1-weighted
See this image and copyright information in PMC

References

    1. Senanayake R, Gillett D, MacFarlane J, Van de Meulen M, Powlson A, Koulouri O, et al. New types of localization methods for adrenocorticotropic hormone-dependent Cushing’s syndrome. Best Pract Res Clin Endocrinol Metab. 2021 doi: 10.1016/j.beem.2021.101513. - DOI - PubMed
    1. Bonneville J, Potorac I, Petrossians P, Tshibanda L, Beckers A. Pituitary MRI in Cushing’s disease-an update. J Neuroendocrinol. 2022 doi: 10.1111/jne.13123. - DOI - PubMed
    1. Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR, et al. Consensus on diagnosis and management of Cushing’s disease: a guideline update. Lancet Diabetes Endocrinol. 2021;9:847–875. doi: 10.1016/S2213-8587(21)00235-7. - DOI - PMC - PubMed
    1. Erickson D, Erickson B, Watson R, Patton A, Atkinson J, Meyer F, et al. 3 Tesla magnetic resonance imaging with and without corticotropin releasing hormone stimulation for the detection of microadenomas in Cushing’s syndrome. Clin Endocrinol (Oxf) 2010;72:793–799. doi: 10.1111/j.1365-2265.2009.03723.x. - DOI - PubMed
    1. Kasaliwal R, Sankhe SS, Lila AR, Budyal SR, Jagtap VS, Sarathi V, et al. Volume interpolated 3D-spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for MRI detection of corticotropin secreting pituitary microadenomas. Clin Endocrinol (Oxf) 2013;78:825–830. doi: 10.1111/cen.12069. - DOI - PubMed

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