The diagnostic value of fused positron emission tomography/computed tomography in the localization of adrenocorticotropin-secreting pituitary adenoma in Cushing’s disease
- 22 April 2009
- journal article
- Published by Springer Science and Business Media LLC in Pituitary
- Vol. 12 (4), 309-314
- https://doi.org/10.1007/s11102-009-0180-4
Abstract
Despite the high resolution of magnetic resonance imaging (MRI) of the pituitary gland, up to 40% of cases of Cushing’s disease (CD) have normal MRI. Fused images of positron emission tomography and computed tomography (PET-CT) may have a potential diagnostic role in CD in general and in such cases in particular. Objective of this study is to explore the diagnostic potential of PET-CT for localization of adrenocorticotropin-secreting pituitary adenomas in CD. PET-CT was performed in 12 cases with de novo (7 cases) or persistent CD (5 cases) that were proven to have CD on biochemical, radiological and/or histopathological findings. These cases had a definite CD confirmed on histopathological and immunostaining examination of the subsequent transphenoidal surgical specimens (10 cases) and/or bilateral inferior petrosal sinus sampling (IPSS, 4 cases). PET-CT was positive in 7 of the 12 cases of CD (58%) showing a focal area of uptake in the pituitary gland. In these seven cases, MRI was positive in six (85.7%) but negative in one case (14.3%). In the other five cases with negative PET-CT, MRI was positive in two and negative in three cases. Of four cases with negative MRI, PET-CT was positive in one case (25%). We conclude that PET-CT is positive in around 60% of the cases of CD. Although the majority of cases with positive PET-CT had positive MRI, PET-CT may detect some cases with negative MRI and thus provides important diagnostic information. If these findings are confirmed in larger studies, PET-CT might become an important diagnostic technique, especially when the more invasive and technically demanding procedure of IPSS is not available or inconclusive.Keywords
This publication has 19 references indexed in Scilit:
- The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2008
- 18Flurodeoxyglucose positron emission tomography in the localization of ectopic ACTH‐secreting neuroendocrine tumoursClinical Endocrinology, 2006
- Diagnosis and Management of Cushing’s Syndrome: Results of an Italian Multicentre Study1Journal of Clinical Endocrinology & Metabolism, 1999
- EffectivenessVersusEfficacy: The Limited Value in Clinical Practice of High Dose Dexamethasone Suppression Testing in the Differential Diagnosis of Adrenocorticotropin-Dependent Cushing’s SyndromeJournal of Clinical Endocrinology & Metabolism, 1997
- High-resolution, dynamic pituitary MR imaging: standard of care or academic pastime?American Journal of Roentgenology, 1994
- A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome.Journal of Clinical Endocrinology & Metabolism, 1994
- Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's diseaseClinical Endocrinology, 1993
- Petrosal Sinus Sampling with and without Corticotropin-Releasing Hormone for the Differential Diagnosis of Cushing's SyndromeThe New England Journal of Medicine, 1991
- Positron emission tomography of pituitary macroadenomasNeurosurgery, 1991
- Positron Emission Tomography of Pituitary Macroadenomas: Hormone Production and Effects of TherapiesNeurosurgery, 1991