Modern imaging in Cushing's disease

W A Bashari; D Gillett; J MacFarlane; A S Powlson; A G Kolias; R Mannion; D J Scoffings; I A Mendichovszky; J Jones; H K Cheow; O Koulouri; M Gurnell

doi:10.1007/s11102-022-01236-w

Modern imaging in Cushing's disease

Pituitary. 2022 Oct;25(5):709-712. doi: 10.1007/s11102-022-01236-w. Epub 2022 Jun 6.

Authors

W A Bashari^#¹, D Gillett^#^{1

2}, J MacFarlane¹, A S Powlson¹, A G Kolias^{3

4}, R Mannion⁴, D J Scoffings⁵, I A Mendichovszky^{2

5}, J Jones⁵, H K Cheow^{2

5}, O Koulouri¹, M Gurnell⁶

Affiliations

¹ Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
² Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
³ Department of Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
⁴ Department of Neurosurgery, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
⁵ Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
⁶ Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. mg299@medschl.cam.ac.uk.

^# Contributed equally.

Abstract

Management of Cushing's disease is informed by dedicated imaging of the sella and parasellar regions. Although magnetic resonance imaging (MRI) remains the investigation of choice, a significant proportion (30-50%) of corticotroph tumours are so small as to render MRI indeterminate or negative when using standard clinical sequences. In this context, alternative MR protocols [e.g. 3D gradient (recalled) echo, with acquisition of volumetric data] may allow detection of tumors that have not been previously visualized. The use of hybrid molecular imaging (e.g. ¹¹C-methionine positron emission tomography coregistered with volumetric MRI) has also been proposed as an additional modality for localizing microadenomas.

Keywords: MRI; Molecular / functional imaging; PET; Pituitary Cushing's.

Publication types

Review

MeSH terms

Adenoma* / diagnosis
Humans
Magnetic Resonance Imaging / methods
Methionine
Pituitary ACTH Hypersecretion* / diagnostic imaging
Pituitary Neoplasms* / diagnosis

Substances

Methionine

Grants and funding

BRC-1215-20014/NIHR Cambridge Biomedical Research Center