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MRI predictive value for adenoma detection in Cushing's disease and reader dependence: a multi-observer study
Paul Eugène Constanthin1, Amandine Ferrière2, Francisco Sanchez-Gallardo1
11Department of Neurosurgery, Bordeaux University Hospital, Bordeaux.
Journal of Neurosurgery
|July 31, 2026
Summary
Magnetic Resonance Imaging (MRI) for Cushing's disease is reader-dependent. Consensus interpretation improves accuracy, and negative MRI findings correlate with lower remission rates, highlighting the need for optimized preoperative imaging strategies.
Area of Science:
- Endocrinology and Metabolism
- Neurosurgery
- Radiology
Background:
- Magnetic Resonance Imaging (MRI) detection of pituitary microadenomas in Cushing's disease (CD) shows variable consistency.
- The impact of MRI interpretation on surgical outcomes for CD remains a subject of debate.
- Reader expertise and interpretation strategies significantly influence diagnostic performance in pituitary MRI.
Purpose of the Study:
- To assess interrater agreement among expert readers interpreting pituitary MRI for Cushing's disease.
- To compare the diagnostic accuracy of MRI interpretation under various expert reading conditions.
- To evaluate the association between MRI interpretation and surgical outcomes, specifically remission rates.
Main Methods:
- Retrospective analysis of preoperative pituitary MRI scans from 90 surgically treated Cushing's disease patients.
- Independent interpretation by a pituitary neuroradiologist and two experienced neurosurgeons under five distinct reading conditions.
- Evaluation of interrater agreement (Cohen's κ) and diagnostic performance metrics (balanced accuracy, AUC-ROC, PLR, NLR); comparison of 3-month remission rates.
Main Results:
- Fair to moderate interrater agreement (κ = 0.34-0.44) was observed.
- Diagnostic performance varied significantly across reading conditions, with the highest accuracy achieved by one neurosurgeon and unanimous voting.
- MRI-positive interpretations in high-performance conditions were linked to better surgical adenoma identification and significantly higher 3-month remission rates (OR for remission 10.07-12.38).
Conclusions:
- MRI localization of corticotroph microadenomas in Cushing's disease is highly dependent on the interpreting reader.
- Consensus-based interpretation strategies enhance diagnostic performance for pituitary microadenomas.
- Negative MRI findings are associated with reduced remission rates, underscoring the importance of optimizing preoperative imaging protocols.
