Lang Min, Habboub Ghaith, Moon Doksu, Bandyopadhyay Abin, Silva Danilo, Kennedy Laurence, Kshettry Varun R, Recinos Pablo F
School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States.
Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States.
J Neurol Surg B Skull Base. 2018 Dec;79(6):593-598. doi: 10.1055/s-0038-1642032. Epub 2018 May 10.
T1-weighted magnetic resonance imaging (MRI) remains the standard pituitary imaging sequence. However, up to 50% of pituitary adenomas are missed with standard imaging in Cushing's disease (CD) patients. Utility of other imaging sequences needs be explored. To compare a T2-gradient echo sequence, constructive interference in steady state (CISS), with a contrast-enhanced (CE) T1-weighted sequence, volume-interpolated breath-hold examination (VIBE), in the detection of pituitary adenomas in CD patients. Retrospective analysis of CD patients who underwent endoscopic transsphenoidal pituitary adenomectomy at our institution. Twelve patients were included in the study. Two neuroradiologists, who were blinded to the patients' clinical and surgical findings, independently reviewed the CE-VIBE and CISS images. Localization of pituitary adenoma from imaging was compared with intraoperative localization. The averaged sensitivity of detecting pituitary adenoma in CD patients was not significantly different between CE-VIBE sequence (63%) and CISS sequence (54%). The positive predictive value was 75% (Observer A) and 100% (Observer B) with CE-VIBE sequence, and 64% (Observer A) and 100% (Observer B) with CISS sequence. In two patients, pituitary adenoma was easily localized with CISS sequence but hard to detect with CE-VIBE sequence. In two other patients, the adenoma was much better delineated on CE-VIBE sequence. In our series, the addition of CISS sequence to T1-weighted MRI imaging protocols improved the detection of pituitary adenomas in CD patients. CISS sequence may be a useful adjunct to T1-weighted pituitary MRI protocols and an appropriate alternative for patients with gadolinium contraindications.
T1加权磁共振成像（MRI）仍然是垂体成像的标准序列。然而，在库欣病（CD）患者中，标准成像会漏诊高达50%的垂体腺瘤。其他成像序列的效用有待探索。
为比较T2梯度回波序列（稳态构成性干扰序列，CISS）与对比增强（CE）T1加权序列（容积内插屏气检查序列，VIBE）在检测CD患者垂体腺瘤中的效果。
对在我们机构接受内镜经蝶窦垂体腺瘤切除术的CD患者进行回顾性分析。
12名患者纳入研究。两名对患者临床和手术结果不知情的神经放射科医生独立审查CE-VIBE和CISS图像。将成像中垂体腺瘤的定位与术中定位进行比较。
CE-VIBE序列（63%）和CISS序列（54%）检测CD患者垂体腺瘤的平均敏感性无显著差异。CE-VIBE序列的阳性预测值为75%（观察者A）和100%（观察者B），CISS序列的阳性预测值为64%（观察者A）和100%（观察者B）。在两名患者中，CISS序列容易定位垂体腺瘤，但CE-VIBE序列难以检测到。在另外两名患者中，CE-VIBE序列对腺瘤的描绘要好得多。
在我们的系列研究中，在T1加权MRI成像方案中增加CISS序列可提高CD患者垂体腺瘤的检测率。CISS序列可能是T1加权垂体MRI方案的有用辅助手段，也是钆造影剂禁忌患者的合适替代方案。
