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MRI for Cushing Disease: A Systematic Review.

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Magnetic resonance (MR) imaging is crucial for diagnosing Cushing disease. Detecting adenomas with MR imaging significantly improves remission rates, highlighting the need for optimized imaging protocols.

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Area of Science:

  • Radiology
  • Endocrinology
  • Oncology

Background:

  • Magnetic resonance (MR) imaging is central to diagnosing Cushing disease.
  • The diagnostic sensitivity and prognostic value of MR imaging in Cushing disease remain incompletely understood.

Purpose of the Study:

  • To systematically evaluate the sensitivity of MR imaging for detecting Cushing disease adenomas.
  • To determine the prognostic significance of MR imaging-negative findings in Cushing disease.

Main Methods:

  • A systematic review and meta-analysis of 57 cohort studies (5651 patients) from MEDLINE and PubMed.
  • Assessment of study quality using the Methodological Index for Non-Randomized Studies criteria.
  • Pooled analysis of sensitivity and subgroup analyses were performed.

Main Results:

  • Overall MR imaging sensitivity for adenoma detection was 73.4% (95% CI, 68.8%-77.7%), with 70.6% for microadenomas.
  • Higher sensitivity was associated with more recent studies, higher-field-strength scanners, thinner sections, and gadolinium-enhanced dynamic sequences.
  • MR imaging detection increased remission rates by 2.63-fold for microadenomas compared to MR imaging-negative cases.

Conclusions:

  • MR imaging detection of adenomas enhances the likelihood of successful surgical resection in Cushing disease.
  • Advancements in MR imaging technology have improved adenoma detection sensitivity.
  • Further optimization of MR imaging protocols is warranted due to the prognostic importance of accurate localization.