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Contrast-Enhanced CISS/FIESTA Imaging for Increased Conspicuity of Pituitary Microadenomas in Cushing Disease

Ian T Mark1, Jamie Van Gompel2, Maria Peris Celda2

  • 1From the Department of Radiology (I.T.M., E.S., J.L., D.R.J., S.A.M.), Mayo Clinic, Rochester, Minnesota Mark.Ian@mayo.edu.

AJNR. American Journal of Neuroradiology
|November 21, 2024
PubMed
Abstract

Insights

Contrast-enhanced CISS/FIESTA-C MRI sequences significantly improve the detection and visualization of pituitary microadenomas in Cushing disease patients. This advanced imaging technique offers superior conspicuity compared to standard T1-weighted MRI.

Area of Science:

  • Radiology
  • Endocrinology
  • Neurosurgery

Background:

  • Pituitary microadenomas are difficult to detect on MRI, especially when small.
  • Accurate detection is crucial for Cushing disease management, as surgery is the standard treatment.
  • Preoperative localization of adenomas directly impacts surgical outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of contrast-enhanced CISS/FIESTA with cycling (FIESTA-C) for identifying pituitary microadenomas in patients with Cushing disease.
  • To compare the diagnostic utility of FIESTA-C with standard T1-weighted MRI sequences.

Main Methods:

  • Retrospective review of pituitary MR images from Cushing disease patients who underwent postcontrast CISS/FIESTA-C.
  • Evaluation of lesion conspicuity (margins) and signal intensity (SI) of adenomas and the pituitary gland.
  • Calculation of normalized SI difference and correlation with diagnostic findings.

Main Results:

  • CISS/FIESTA-C identified 94% of adenomas, compared to 65% on T1-weighted imaging.
  • The mean normalized SI difference was significantly higher with FIESTA-C (0.512) than with T1-weighted imaging (0.242).
  • Sixteen out of seventeen adenomas were discrete on FIESTA-C.

Conclusions:

  • Contrast-enhanced CISS/FIESTA-C imaging detects more pituitary microadenomas with better conspicuity than standard T1-weighted MRI.
  • This technique may be particularly valuable for Cushing disease patients, as up to 50% may not show a detectable lesion on conventional MRI.
  • FIESTA-C can serve as a valuable additional sequence for improved preoperative localization.

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