Comparison of Constructive Interference in Steady-State and T1-Weighted MRI Sequence at Detecting Pituitary Adenomas in Cushing's Disease Patients

Min Lang; Ghaith Habboub; Doksu Moon; Abin Bandyopadhyay; Danilo Silva; Laurence Kennedy; Varun R. Kshettry; Pablo F. Recinos

doi:10.1055/s-0038-1642032

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2018; 79(06): 593-598
DOI: 10.1055/s-0038-1642032

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Comparison of Constructive Interference in Steady-State and T1-Weighted MRI Sequence at Detecting Pituitary Adenomas in Cushing's Disease Patients

Authors

Min Lang

¹School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

²Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
Ghaith Habboub

²Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, United States
Doksu Moon

⁴Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, United States
Abin Bandyopadhyay

⁴Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, United States
Danilo Silva

²Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, United States
Laurence Kennedy

⁵Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, Ohio, United States
Varun R. Kshettry

²Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, United States

⁶Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
Pablo F. Recinos

²Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, United States

⁶Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States

Abstract

Background T1-weighted magnetic resonance imaging (MRI) remains the standard pituitary imaging sequence. However, up to 50% of pituitary adenomas are missed with standard imaging in Cushing's disease (CD) patients. Utility of other imaging sequences needs be explored.

Objective To compare a T2-gradient echo sequence, constructive interference in steady state (CISS), with a contrast-enhanced (CE) T1-weighted sequence, volume-interpolated breath-hold examination (VIBE), in the detection of pituitary adenomas in CD patients.

Design Retrospective analysis of CD patients who underwent endoscopic transsphenoidal pituitary adenomectomy at our institution.

Patients and Measurement Twelve patients were included in the study. Two neuroradiologists, who were blinded to the patients' clinical and surgical findings, independently reviewed the CE-VIBE and CISS images. Localization of pituitary adenoma from imaging was compared with intraoperative localization.

Results The averaged sensitivity of detecting pituitary adenoma in CD patients was not significantly different between CE-VIBE sequence (63%) and CISS sequence (54%). The positive predictive value was 75% (Observer A) and 100% (Observer B) with CE-VIBE sequence, and 64% (Observer A) and 100% (Observer B) with CISS sequence. In two patients, pituitary adenoma was easily localized with CISS sequence but hard to detect with CE-VIBE sequence. In two other patients, the adenoma was much better delineated on CE-VIBE sequence.

Conclusion In our series, the addition of CISS sequence to T1-weighted MRI imaging protocols improved the detection of pituitary adenomas in CD patients. CISS sequence may be a useful adjunct to T1-weighted pituitary MRI protocols and an appropriate alternative for patients with gadolinium contraindications.

Keywords

Cushing's syndrome - hypercortisolism - FIESTA - endoscopic pituitary surgery - transsphenoidal surgery - imaging - diagnosis

Full Text

References

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