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09:36
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Published on: October 3, 2016
Image Negative (MR negative) Cushing Disease: A Call to Standardize the Term and Guide to Convey Imaging Certainty
Jamie J Van Gompel1, Yuki Shinya2, Sandhya Palit2
1From the Departments of Neurosurgery (J.J.V.G., Y.S., S.P.), Neuroradiology (T.J.K., J.L., D.D., I.M.), Endocrinology (I.B.), Mayo Clinic, Rochester, MN, USA. Vangompel.jamie@mayo.edu.
AJNR. American Journal of Neuroradiology
|August 11, 2026
Summary
Interpreting MRI for Cushing disease pituitary adenomas is challenging, showing poor agreement among experts. A standardized confidence scale is needed to improve surgical planning and patient outcomes.
Area of Science:
- Endocrinology
- Radiology
- Neurosurgery
Background:
- Magnetic resonance imaging (MRI) is crucial for locating pituitary adenomas in Cushing disease (CD).
- Accurate localization via MRI improves surgical outcomes, while indeterminate findings pose challenges.
- Advances in MRI may lead to misinterpretation of subtle abnormalities as definite tumors.
Purpose of the Study:
- To illustrate the diagnostic challenges in interpreting MRI for pituitary microadenomas in CD.
- To propose a standardized framework for communicating MRI confidence levels.
- To guide surgical planning and multidisciplinary decision-making in CD cases.
Main Methods:
- Retrospective cohort study of 14 CD patients with indeterminate MRI findings and confirmed tumors.
- Independent review of MRI scans by three blinded, board-certified neuroradiologists.
- Assessment of interrater agreement and confidence levels in tumor localization.
Main Results:
- Fair overall interrater agreement (mean weighted κ = 0.22) for MRI interpretations.
- Moderate agreement between two readers (κ = 0.48), but only slight agreement with the third reader (κ = 0.06-0.11).
- 100% of neuroradiologists agreed on the need for a system to convey certainty in MR reports.
Conclusions:
- Interpreting MR imaging for pituitary microadenomas in CD is inherently difficult.
- Significant interrater variability exists, potentially impacting surgical and radiation planning.
- Communicating diagnostic confidence levels can aid clinicians in optimizing treatment strategies.
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