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ACTH secreting pituitary microadenomas disclosed only by gadolinium DTPA enhanced MRI
B Boleaga1, G Fanghänel, L Cortinas
1Hypothalamus-Hypophysis Clinic, Hospital General de México, D.F.
Purpose:
To assess the usefulness of Gd-DTPA enhancement in disclosing microadenomas of the pituitary gland that had not been demonstrated by non enhanced MRI in patients with Cushing's disease.
Methods:
Six patients with Cushing's disease underwent pre and post enhancement MRI scanning and the findings were correlated at surgery and confirmed by histological and immunohistochemistry studies of the surgical specimen.
Results:
In all cases post enhancement MR scans demonstrated circumscribed hypointense foci that corresponded well with the location and extension of the adenomatous tissue found at surgery. Selective removal of the microadenomas failed to improve the clinical and laboratory abnormalities in two of the six patients. Such cases did not present residual hypointense foci in the post-operative Gd-DTPA enhanced MRI.
Conclusion:
Results suggest that Gd-DTPA enhanced MRI is useful to detect pituitary microadenomas; however, the abnormalities of the pituitary tissue may extend beyond the abnormal imaging.
Insights
Gadolinium-DTPA enhanced MRI is useful for detecting pituitary microadenomas in Cushing's disease patients. However, imaging may not fully capture the extent of pituitary abnormalities.
Area of Science:
- Radiology
- Endocrinology
- Oncology
Background:
- Cushing's disease is often caused by pituitary microadenomas.
- Non-enhanced MRI may fail to detect small pituitary adenomas.
- Accurate detection is crucial for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of Gadolinium-DTPA (Gd-DTPA) enhanced Magnetic Resonance Imaging (MRI) in identifying pituitary microadenomas.
- To compare enhanced MRI findings with non-enhanced MRI in patients with Cushing's disease.
Main Methods:
- Six patients with Cushing's disease underwent pre- and post-contrast enhanced MRI.
- Surgical findings were correlated with MRI results.
- Histological and immunohistochemistry studies confirmed surgical specimens.
Main Results:
- Post-enhancement MRI successfully identified circumscribed hypointense foci corresponding to adenomas in all cases.
- Two patients showed persistent clinical and laboratory abnormalities despite selective microadenoma removal.
- Post-operative MRI in these two cases did not reveal residual hypointense foci.
Conclusions:
- Gd-DTPA enhanced MRI is a valuable tool for detecting pituitary microadenomas.
- Pituitary tissue abnormalities may extend beyond the visible imaging findings.
- Further research is needed to understand the full extent of disease in Cushing's syndrome.