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3 Tesla magnetic resonance imaging with and without corticotropin releasing hormone stimulation for the detection of microadenomas in Cushing’s syndrome
Author(s) -
Erickson Dana,
Erickson Bradley,
Watson Robert,
Patton Alice,
Atkinson John,
Meyer Fredric,
Nippoldt Todd,
Carpenter Paul,
Natt Neena,
Vella Adrian,
Thapa Prabin
Publication year - 2010
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2009.03723.x
Subject(s) - medicine , magnetic resonance imaging , stimulation , lesion , corticotropin releasing hormone , cushing syndrome , adrenocorticotropic hormone , hormone , nuclear medicine , endocrinology , radiology , pathology
Summary 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.