University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Freiburgstrasse 4, Bern, Switzerland.
Neuroradiology. 2012 May;54(5):495-503. doi: 10.1007/s00234-011-0915-6. Epub 2011 Aug 2.
Conventional MRI may still be an inaccurate method for the non-invasive detection of a microadenoma in adrenocorticotropin (ACTH)-dependent Cushing's syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) with ovine corticotropin-releasing hormone (oCRH) stimulation is an invasive, but accurate, intervention in the diagnostic armamentarium surrounding CS. Until now, there is a continuous controversial debate regarding lateralization data in detecting a microadenoma. Using BIPSS, we evaluated whether a highly selective placement of microcatheters without diversion of venous outflow might improve detection of pituitary microadenoma.
We performed BIPSS in 23 patients that met clinical and biochemical criteria of CS and with equivocal MRI findings. For BIPSS, the femoral veins were catheterized bilaterally with a 6-F catheter and the inferior petrosal sinus bilaterally with a 2.7-F microcatheter. A third catheter was placed in the right femoral vein. Blood samples were collected from each catheter to determine ACTH blood concentration before and after oCRH stimulation.
In 21 patients, a central-to-peripheral ACTH gradient was found and the affected side determined. In 18 of 20 patients where transsphenoidal partial hypophysectomy was performed based on BIPSS findings, microadenoma was histologically confirmed. BIPSS had a sensitivity of 94% and a specificity of 67% after oCRH stimulation in detecting a microadenoma. Correct localization of the adenoma was achieved in all Cushing's disease patients.
BIPSS remains the gold standard in the detection of a microadenoma in CS. Our findings show that the selective placement of microcatheters without venous outflow diversion might further enhance better recognition to localize the pituitary tumor.
在促肾上腺皮质激素（ACTH）依赖性库欣综合征（CS）中，常规 MRI 可能仍然是一种不准确的方法来进行微腺瘤的非侵入性检测。双侧岩下窦采样（BIPSS）结合羊促肾上腺皮质激素释放激素（oCRH）刺激是 CS 诊断方法中的一种有创但准确的干预措施。到目前为止，在检测微腺瘤时，关于侧化数据一直存在持续的争议。我们使用 BIPSS 评估了微导管的高度选择性放置而不转移静脉流出是否可以提高垂体微腺瘤的检测率。
我们对 23 名符合 CS 的临床和生化标准且 MRI 结果不确定的患者进行了 BIPSS。BIPSS 时，双侧股静脉用 6-F 导管，双侧岩下窦用 2.7-F 微导管进行置管。右侧股静脉置管第三根导管。在 oCRH 刺激前后从每个导管采集血样以确定 ACTH 血浓度。
在 21 名患者中，发现了中心到外周的 ACTH 梯度，并确定了受影响的一侧。在根据 BIPSS 结果进行的 20 名患者中的 18 名患者中，经蝶窦部分垂体切除术证实存在微腺瘤。在检测微腺瘤时，BIPSS 在 oCRH 刺激后具有 94%的敏感性和 67%的特异性。在所有库欣病患者中，均正确定位了腺瘤。
BIPSS 仍然是 CS 中检测微腺瘤的金标准。我们的发现表明，微导管的选择性放置而不转移静脉流出可能进一步增强对肿瘤定位的识别能力。
