TY - JOUR
T1 - 3 Tesla magnetic resonance imaging with and without corticotropin releasing hormone stimulation for the detection of microadenomas in Cushing's syndrome
AU - Erickson, Dana
AU - Erickson, Bradley
AU - Watson, Robert
AU - Patton, Alice
AU - Atkinson, John
AU - Meyer, Fredric
AU - Nippoldt, Todd
AU - Carpenter, Paul
AU - Natt, Neena
AU - Vella, Adrian
AU - Thapa, Prabin
PY - 2010/6
Y1 - 2010/6
N2 - Objective We sought to determine if higher resolution 3 Tesla (T) magnetic resonance imaging (MRI) with or without ovine corticotropin releasing hormone (o-CRH) stimulation would increase the sensitivity for detection of pituitary microadenomas in ACTH-dependent Cushing's syndrome (CS). Design and patients We prospectively identified 23 patients over a 2-year period with clinical and biochemical evidence of ACTH-dependent CS with no lesion (n = 11) or equivocal lesion (n = 10) on 1·5T MRI. Subsequently, two additional MRIs were performed in random order: 3T nonstimulated MRI or 3T MRI with o-CRH in all patients. Three neuroradiologists reviewed all examinations in a randomized blinded fashion. Patients were divided into four groups, depending on the outcome of their evaluation and treatment for CS. Two patients had to be excluded, and so we report on 21 subjects. Measurements and results Both 3T MRI without (P < 0·016) and with o-CRH stimulation (P < 0·013) was significantly more sensitive for detection of pituitary microadenomas than 1·5T MRI for Group 1 (definitive proof of Cushing's disease, n = 10). Group 2 (those in group 1, plus three patients where dynamic/invasive testing suggested pituitary source) also showed a significant (P < 0·012) advantage for 3T. There was no difference between the 3T and the 3T o-CRH examinations for any of the pulse sequences. We did not observe a statistically significant difference in other patient groups [patients with recurrent CD (n = 6) and patients with ectopic CS (n = 2)]. Conclusions The results of our prospective blinded studies suggest that 3T MRI of pituitary gland should be considered in evaluation of patients with ACTH-dependent CD when 1·5T imaging is negative or equivocal.
AB - Objective We sought to determine if higher resolution 3 Tesla (T) magnetic resonance imaging (MRI) with or without ovine corticotropin releasing hormone (o-CRH) stimulation would increase the sensitivity for detection of pituitary microadenomas in ACTH-dependent Cushing's syndrome (CS). Design and patients We prospectively identified 23 patients over a 2-year period with clinical and biochemical evidence of ACTH-dependent CS with no lesion (n = 11) or equivocal lesion (n = 10) on 1·5T MRI. Subsequently, two additional MRIs were performed in random order: 3T nonstimulated MRI or 3T MRI with o-CRH in all patients. Three neuroradiologists reviewed all examinations in a randomized blinded fashion. Patients were divided into four groups, depending on the outcome of their evaluation and treatment for CS. Two patients had to be excluded, and so we report on 21 subjects. Measurements and results Both 3T MRI without (P < 0·016) and with o-CRH stimulation (P < 0·013) was significantly more sensitive for detection of pituitary microadenomas than 1·5T MRI for Group 1 (definitive proof of Cushing's disease, n = 10). Group 2 (those in group 1, plus three patients where dynamic/invasive testing suggested pituitary source) also showed a significant (P < 0·012) advantage for 3T. There was no difference between the 3T and the 3T o-CRH examinations for any of the pulse sequences. We did not observe a statistically significant difference in other patient groups [patients with recurrent CD (n = 6) and patients with ectopic CS (n = 2)]. Conclusions The results of our prospective blinded studies suggest that 3T MRI of pituitary gland should be considered in evaluation of patients with ACTH-dependent CD when 1·5T imaging is negative or equivocal.
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U2 - 10.1111/j.1365-2265.2009.03723.x
DO - 10.1111/j.1365-2265.2009.03723.x
M3 - Article
C2 - 19811509
AN - SCOPUS:77952593352
SN - 0300-0664
VL - 72
SP - 793
EP - 799
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 6
ER -