High resolution pituitary gland MRI at 7.0 tesla: a clinical evaluation in Cushing’s disease

AbstractObjectiveTo evaluate the detection of pituitary lesions at 7.0 T compared to 1.5 T MRI in 16 patients with clinically and biochemically proven Cushing’s disease.MethodsIn seven patients, no lesion was detected on the initial 1.5 T MRI, and in nine patients it was uncertain whether there was a lesion. Firstly, two readers assessed both 1.5 T and 7.0 T MRI examinations unpaired in a random order for the presence of lesions. Consensus reading with a third neuroradiologist was used to define final lesions in all MRIs. Secondly, surgical outcome was evaluated. A comparison was made between the lesions visualized with MRI and the lesions found during surgery in 9/16 patients.ResultsThe interobserver agreement for lesion detection was good at 1.5 T MRI (κ = 0.69) and 7.0 T MRI (κ = 0.62). In five patients, both the 1.5 T and 7.0 T MRI enabled visualization of a lesion on the correct side of the pituitary gland. In three patients, 7.0 T MRI detected a lesion on the correct side of the pituitary gland, while no lesion was visible at 1.5 T MRI.ConclusionThe interobserver agreement of image assessment for 7.0 T MRI in patients with Cushing’s disease was good, and lesions were detected more accurately with 7.0 T MRI.Key Points• Interobserver agreement for lesion detection on 1.5 T MRI was good; • Interobserver agreement for lesion detection on 7.0 T MRI was good; • 7.0 T enabled confirmation of unclear lesions at 1.5 T; • 7.0 T enabled visualization of lesions not visible at 1.5 T.

[1]  F. Esposito,et al.  Early Morning Cortisol Levels as a Predictor of Remission After Transsphenoidal Surgery for Cushing’s Disease , 2006 .

[2]  X. Bertagna,et al.  Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease , 1993, Clinical endocrinology.

[3]  A. Ba-Ssalamah,et al.  Application of three-tesla magnetic resonance imaging for diagnosis and surgery of sellar lesions. , 2004, Journal of neurosurgery.

[4]  S. Hetts,et al.  Cavernous and inferior petrosal sinus sampling and dynamic magnetic resonance imaging in the preoperative evaluation of Cushing’s disease , 2014, Journal of Neuro-Oncology.

[5]  M. Molitch.  Pituitary incidentalomas. , 1997, Endocrinology and metabolism clinics of North America.

[6]  J. Drouillard,et al.  Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease , 1998, Clinical endocrinology.

[7]  A. Grossman,et al.  The management of Cushing's disease - from investigation to treatment. , 2013, Endokrynologia Polska.

[8]  Peter R Luijten,et al.  Ultrahigh-field magnetic resonance imaging: the clinical potential for anatomy, pathogenesis, diagnosis, and treatment planning in brain disease. , 2012, Neuroimaging clinics of North America.

[9]  W. Davis,et al.  Dynamic contrast‐enhanced MR imaging of the pituitary gland with fast spin‐echo technique , 1994, Journal of magnetic resonance imaging : JMRI.

[10]  J. Vézina,et al.  Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications , 2012, Surgical neurology international.

[11]  J. Karis,et al.  Preliminary Experience with 3-Tesla MRI and Cushing's Disease , 2007, Skull base : official journal of North American Skull Base Society ... [et al.].

[12]  A. Ba-Ssalamah,et al.  The value of high-field MRI (3T) in the assessment of sellar lesions. , 2005, European journal of radiology.

[13]  N. Patronas,et al.  Pituitary Magnetic Resonance Imaging in Normal Human Volunteers: Occult Adenomas in the General Population , 1994, Annals of Internal Medicine.

[14]  S. Yamada,et al.  Surgical management and outcomes in patients with Cushing disease with negative pituitary magnetic resonance imaging. , 2012, World neurosurgery.

[15]  Y. Shibamoto,et al.  Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus. , 2006, Journal of neurosurgery.

[16]  Ewald Moser,et al.  7‐T MR—from research to clinical applications? , 2012, NMR in biomedicine.

[17]  P. Witek,et al.  Predictive value of preoperative magnetic resonance imaging of the pituitary for surgical cure in Cushing's disease. , 2012, Turkish neurosurgery.

[18]  W. Bartynski,et al.  Dynamic and conventional spin-echo MR of pituitary microlesions. , 1997, AJNR. American journal of neuroradiology.

[19]  M Forsting,et al.  7 Tesla MR Imaging: Opportunities and Challenges , 2013, Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.

[20]  F. Esposito,et al.  Clinical review: Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing's disease. , 2006, Journal of Clinical Endocrinology and Metabolism.

[21]  J. Doppman,et al.  Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging detection of adrenocorticotropin-secreting pituitary tumors. , 2003, The Journal of clinical endocrinology and metabolism.

[22]  Anja G. van der Kolk,et al.  Feasibility of high-resolution pituitary MRI at 7.0 tesla , 2014, European Radiology.

[23]  A. Grossman,et al.  The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. , 1998, Endocrine reviews.

[24]  Y. Shibamoto,et al.  Efficacy of magnetic resonance imaging at 3 T compared with 1.5 T in small pituitary tumors for stereotactic radiosurgery planning , 2013, Japanese Journal of Radiology.

[25]  T. Cox,et al.  A comparison of CT and MRI in the assessment of the pituitary and parasellar region. , 1991, Clinical radiology.

[26]  P. Chanson,et al.  Pituitary magnetic resonance imaging findings do not influence surgical outcome in adrenocorticotropin-secreting microadenomas. , 2004, The Journal of clinical endocrinology and metabolism.

[27]  J. Bishop,et al.  Detection of pituitary microadenomas: comparison of dynamic keyhole fast spin-echo, unenhanced, and conventional contrast-enhanced MR imaging. , 1994, AJR. American journal of roentgenology.

[28]  H. Brueckmann,et al.  Detailed imaging of the normal anatomy and pathologic conditions of the cavernous region at 3 Tesla using a contrast-enhanced MR angiography , 2011, Neuroradiology.

[29]  W. Huk,et al.  The accuracy of CT and MR evaluation of the sella turcica for detection of adrenocorticotropic hormone-secreting adenomas in Cushing disease. , 1993, AJNR. American journal of neuroradiology.

[30]  M. Buchfelder,et al.  Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery: a retrospective study by the European Cushing's Disease Survey Group. , 1995, The Journal of clinical endocrinology and metabolism.

[31]  D. Lüdecke,et al.  Cushing's disease: a surgical view; This Publication is dedicated to our professor emeritus Dr. med. Rudolf Kautzky , 2001, Journal of Neuro-Oncology.

[32]  Initial experience of 3 Tesla versus conventional field strength magnetic resonance imaging of small functioning pituitary tumours , 2011, Clinical endocrinology.