scholarly journals High-resolution18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for pituitary adenoma detection in Cushing disease

2015 ◽  
Vol 122 (4) ◽  
pp. 791-797 ◽  
Author(s):  
Prashant Chittiboina ◽  
Blake K. Montgomery ◽  
Corina Millo ◽  
Peter Herscovitch ◽  
Russell R. Lonser
Keyword(s):  
Pituitary Adenoma ◽  
High Resolution ◽  
Pituitary Adenomas ◽  
Imaging Modality ◽  
Spin Echo ◽  
Mri Findings ◽  
Cushing Disease ◽  
Standardized Uptake Values ◽  
Adenoma Detection ◽  
Corticotroph Adenomas

OBJECT High-resolution PET (hrPET) performed using a high-resolution research tomograph is reported as having a resolution of 2 mm and could be used to detect corticotroph adenomas through uptake of18F-fluorodeoxyglucose (18F-FDG). To determine the sensitivity of this imaging modality, the authors compared18F-FDG hrPET and MRI detection of pituitary adenomas in Cushing disease (CD). METHODS Consecutive patients with CD who underwent preoperative18F-FDG hrPET and MRI (spin echo [SE] and spoiled gradient recalled [SPGR] sequences) were prospectively analyzed. Standardized uptake values (SUVs) were calculated from hrPET and were compared with MRI findings. Imaging findings were correlated to operative and histological findings. RESULTS Ten patients (7 females and 3 males) were included (mean age 30.8 ± 19.3 years; range 11–59 years). MRI revealed a pituitary adenoma in 4 patients (40% of patients) on SE and 7 patients (70%) on SPGR sequences.18F-FDG hrPET demonstrated increased18F-FDG uptake consistent with an adenoma in 4 patients (40%; adenoma size range 3–14 mm). Maximum SUV was significantly higher for18F-FDG hrPET–positive tumors (difference = 5.1, 95% CI 2.1–8.1; p = 0.004) than for18F-FDG hrPET–negative tumors.18F-FDG hrPET positivity was not associated with tumor volume (p = 0.2) or dural invasion (p = 0.5). Midnight and morning ACTH levels were associated with18F-FDG hrPET positivity (p = 0.01 and 0.04, respectively) and correlated with the maximum SUV (R = 0.9; p = 0.001) and average SUV (R = 0.8; p = 0.01). All18F-FDG hrPET–positive adenomas had a less than a 180% ACTH increase and18F-FDG hrPET–negative adenomas had a greater than 180% ACTH increase after CRH stimulation (p = 0.03). Three adenomas were detected on SPGR MRI sequences that were not detected by18F-FDG hrPET imaging. Two adenomas not detected on SE (but no adenomas not detected on SPGR) were detected on18F-FDG hrPET. CONCLUSIONS While18F-FDG hrPET imaging can detect small functioning corticotroph adenomas and is more sensitive than SE MRI, SPGR MRI is more sensitive than18F-FDG hrPET and SE MRI in the detection of CD-associated pituitary adenomas. Response to CRH stimulation can predict18F-FDG hrPET–positive adenomas in CD.

scholarly journals Folate receptor overexpression can be visualized in real time during pituitary adenoma endoscopic transsphenoidal surgery with near-infrared imaging

2018 ◽  
Vol 129 (2) ◽  
pp. 390-403 ◽  
Author(s):  
John Y. K. Lee ◽  
Steve S. Cho ◽  
Ryan Zeh ◽  
John T. Pierce ◽  
Maria Martinez-Lage ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Real Time ◽  
Pituitary Adenomas ◽  
Near Infrared ◽  
Folate Receptor ◽  
Mri Findings ◽  
Null Cell ◽  
Postoperative Mri ◽  
Visual Contrast ◽  
Nir Imaging

OBJECTIVEPituitary adenomas account for approximately 10% of intracranial tumors and have an estimated prevalence of 15%–20% in the general US population. Resection is the primary treatment for pituitary adenomas, and the transsphenoidal approach remains the most common. The greatest challenge with pituitary adenomas is that 20% of patients develop tumor recurrence. Current approaches to reduce recurrence, such as intraoperative MRI, are costly, associated with high false-positive rates, and not recommended. Pituitary adenomas are known to overexpress folate receptor alpha (FRα), and it was hypothesized that OTL38, a folate analog conjugated to a near-infrared (NIR) fluorescent dye, could provide real-time intraoperative visual contrast of the tumor versus the surrounding nonneoplastic tissues. The preliminary results of this novel clinical trial are presented.METHODSNineteen adult patients who presented with pituitary adenoma were enrolled. Patients were infused with OTL38 2–4 hours prior to surgery. A 4-mm endoscope with both visible and NIR light capabilities was used to visualize the pituitary adenoma and its margins in real time during surgery. The signal-to-background ratio (SBR) was recorded for each tumor and surrounding tissues at various endoscope-to-sella distances. Immunohistochemical analysis was performed to assess the FRα expression levels in all specimens and classify patients as having either high or low FRα expression.RESULTSData from 15 patients (4 with null cell adenomas, 1 clinically silent gonadotroph, 1 totally silent somatotroph, 5 with a corticotroph, 3 with somatotrophs, and 1 somatocorticotroph) were analyzed in this preliminary analysis. Four patients were excluded for technical considerations. Intraoperative NIR imaging delineated the main tumors in all 15 patients with an average SBR of 1.9 ± 0.70. The FRα expression level of the adenomas and endoscope-to-sella distance had statistically significant impacts on the fluorescent SBRs. Additional considerations included adenoma functional status and time from OTL38 injection. SBRs were 3.0 ± 0.29 for tumors with high FRα expression (n = 3) and 1.6 ± 0.43 for tumors with low FRα expression (n = 12; p < 0.05). In 3 patients with immunohistochemistry-confirmed FRα overexpression (2 patients with null cell adenoma and 1 patient with clinically silent gonadotroph), intraoperative NIR imaging demonstrated perfect classification of the tumor margins with 100% sensitivity and 100% specificity. In addition, for these 3 patients, intraoperative residual fluorescence predicted postoperative MRI results with perfect concordance.CONCLUSIONSPituitary adenomas and their margins can be intraoperatively visualized with the preoperative injection of OTL38, a folate analog conjugated to NIR dye. Tumor-to-background contrast is most pronounced in adenomas that overexpress FRα. Intraoperative SBR at the appropriate endoscope-to-sella distance can predict adenoma FRα expression status in real time. This work suggests that for adenomas with high FRα expression, it may be possible to identify margins and to predict postoperative MRI findings.

scholarly journals Acromegaly without Imaging Evidence of Pituitary Adenoma

2010 ◽  
Vol 95 (9) ◽  
pp. 4192-4196 ◽  
Author(s):  
Russell R. Lonser ◽  
Bogdan A. Kindzelski ◽  
Gautam U. Mehta ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Pituitary Adenoma ◽  
Mr Imaging ◽  
Pituitary Adenomas ◽  
Spin Echo ◽  
Tertiary Care ◽  
Breath Hold ◽  
Slice Thickness ◽  
Surgical Exploration ◽  
Imaging Sequence ◽  
Tertiary Care Centers

Context: GH-secreting pituitary adenomas are nearly always visible on conventional magnetic resonance (MR) imaging. However, management and outcome of acromegalic patients lacking imaging evidence of GH-secreting pituitary adenomas are undefined. Objective: The aim was to evaluate surgical exploration for MR-invisible GH-secreting pituitary adenomas. Design and Setting: We conducted a retrospective review at two tertiary care centers. Patients or Other Participants: Consecutive acromegalic patients without imaging evidence of a pituitary adenoma on pre- and postcontrast, spin echo T1-weighted MR imaging and who lacked evidence of an ectopic (nonpituitary) source causing GH excess were included. Interventions: Surgical exploration with identification and resection of a pituitary adenoma was performed. Main Outcome Measures: Laboratory values (GH, IGF-I), surgical findings, and clinical outcome were analyzed. Results: Six patients (three males, three females; 3% of all patients) with suspected GH-secreting adenomas did not demonstrate imaging evidence of pituitary adenoma on conventional MR imaging. Three patients underwent a postcontrast, volumetric interpolated breath-hold examination MR-imaging sequence (1.2-mm slice thickness), which revealed a 4-mm pituitary adenoma not seen on the spin echo T1-weighted MR imaging in one patient. A pituitary adenoma was identified and removed in all patients (mean diameter, 5.6 mm; range, 5 to 6.7 mm). Histological analysis confirmed that the lesions were GH-secreting adenomas. All patients achieved biochemical remission after surgical resection. Conclusion: Acromegaly can be caused by GH-secreting pituitary adenomas that are not evident on conventional MR imaging. Adenomas in some of these patients become evident using volumetric interpolated breath-hold examination MR imaging. Surgical exploration of the pituitary gland in acromegalic patients with endocrine findings consistent with a GH-secreting adenoma but negative MR imaging can lead to identification and removal of an adenoma.

Reformatted Sagittal Images in the Differential Diagnosis of Meningiomas and Pituitary Adenomas with Suprasellar Extension

Neurosurgery ◽  
1986 ◽  
Vol 18 (5) ◽  
pp. 555-558 ◽  
Author(s):  
Craig W. Clark ◽  
James D. Acker ◽  
Jon H. Robertson ◽  
Frank Eggers ◽  
Michael S. Muhlbauer
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Pituitary Adenoma ◽  
High Resolution ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Suprasellar Extension

Abstract Approximately 3 to 4 times a year, a tumor with suprasellar extension escapes classification on high resolution coronal and transaxial computed tomography. When arteriography failed to determine the diagnosis, the differential choices were usually meningioma or pituitary adenoma. The authors report the use of sagittal reformatted images in this differential diagnosis and conclude that these images may aid in the distinction between pituitary tumors with suprasellar extension and meningiomas located in this area.

scholarly journals Familial Isolated Pituitary Adenomas (FIPA) and the Pituitary Adenoma Predisposition due to Mutations in the Aryl Hydrocarbon Receptor Interacting Protein (AIP) Gene

2013 ◽  
Vol 34 (2) ◽  
pp. 239-277 ◽  
Author(s):  
Albert Beckers ◽  
Lauri A. Aaltonen ◽  
Adrian F. Daly ◽  
Auli Karhu
Keyword(s):  
Pituitary Adenoma ◽  
Aryl Hydrocarbon Receptor ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Carney Complex ◽  
Cushing Disease ◽  
Interacting Protein ◽  
Aryl Hydrocarbon ◽  
Serious Disease ◽  
Aip Gene

Abstract Pituitary adenomas are one of the most frequent intracranial tumors and occur with a prevalence of approximately 1:1000 in the developed world. Pituitary adenomas have a serious disease burden, and their management involves neurosurgery, biological therapies, and radiotherapy. Early diagnosis of pituitary tumors while they are smaller may help increase cure rates. Few genetic predictors of pituitary adenoma development exist. Recent years have seen two separate, complimentary advances in inherited pituitary tumor research. The clinical condition of familial isolated pituitary adenomas (FIPA) has been described, which encompasses the familial occurrence of isolated pituitary adenomas outside of the setting of syndromic conditions like multiple endocrine neoplasia type 1 and Carney complex. FIPA families comprise approximately 2% of pituitary adenomas and represent a clinical entity with homogeneous or heterogeneous pituitary adenoma types occurring within the same kindred. The aryl hydrocarbon receptor interacting protein (AIP) gene has been identified as causing a pituitary adenoma predisposition of variable penetrance that accounts for 20% of FIPA families. Germline AIP mutations have been shown to associate with the occurrence of large pituitary adenomas that occur at a young age, predominantly in children/adolescents and young adults. AIP mutations are usually associated with somatotropinomas, but prolactinomas, nonfunctioning pituitary adenomas, Cushing disease, and other infrequent clinical adenoma types can also occur. Gigantism is a particular feature of AIP mutations and occurs in more than one third of affected somatotropinoma patients. Study of pituitary adenoma patients with AIP mutations has demonstrated that these cases raise clinical challenges to successful treatment. Extensive research on the biology of AIP and new advances in mouse Aip knockout models demonstrate multiple pathways by which AIP may contribute to tumorigenesis. This review assesses the current clinical and therapeutic characteristics of more than 200 FIPA families and addresses research findings among AIP mutation-bearing patients in different populations with pituitary adenomas.

Pituitary MRI standard and advanced sequences: role in the diagnosis and characterization of pituitary adenomas

2021 ◽  
Author(s):  
Mônica R Gadelha ◽  
Monique Alvares Barbosa ◽  
Elisa Baranski Lamback ◽  
Luiz Eduardo Wildemberg ◽  
Leandro Kasuki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pituitary Adenomas ◽  
Imaging Modality ◽  
Spin Echo ◽  
Sella Turcica ◽  
Fast Spin Echo ◽  
Standard Protocol ◽  
Cavernous Sinus Invasion ◽  
Mri Features

Abstract Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas and aneurysms. High-quality imaging is fundamental for diagnosis, characterization and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted (T1w) spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing. A systematic MRI approach to the pituitary region generally provides information that includes the size and shape of the PA, the presence of cysts or hemorrhage within the tumor, its relationship with the optic pathways and surrounding structures, potential cavernous sinus invasion, sphenoid sinus pneumatization type, and differential diagnosis with other sellar lesions. The standard protocol is sufficient for the evaluation of most cases; however, some advanced techniques (susceptibility imaging, diffusion-weighted imaging, 3D T2w high-resolution sequences, magnetic resonance elastography, perfusion-weighted imaging) may render additional information, which may be important for some cases. In this “Approach to the Patient” manuscript we will discuss the use of standard and advanced MRI sequences in the diagnosis and characterization of PAs, including MRI features associated with treatment response that may aid in presurgical evaluation and planning, and red flags that may point to an alternative diagnosis.

scholarly journals Cushing Disease Due to Ectopic Pituitary Adenoma.

2019 ◽  
pp. 1-5
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Adrenocorticotropic Hormone ◽  
Pituitary Tumors ◽  
Pituitary Stalk ◽  
Cushing Disease ◽  
Ectopic Acth ◽  
Common Cause ◽  
Ectopic Pituitary Adenoma ◽  
Acth Secreting

Abstract Adrenocorticotropic hormone (ACTH) - secreting pituitary adenomas are the most common cause of Cushing disease. A pituitary adenoma is rarely ectopic and suprasellar dependent (ectopic) ACTH -secreting pituitary tumors are extremely rare, with few cases described in the literature. Therefore, this study aimed to report the case of a patient with a diagnosis of Cushing disease because of a suprasellar ACTH-secreting tumor attached to the pituitary stalk, requiring a craniotomy.

Magnetic Resonance Imaging in the Evaluation and Characterisation of Sellar and Juxtasellar Lesions

2021 ◽  
Vol 8 (14) ◽  
pp. 915-919
Author(s):  
Kaushal B ◽  
Chandrashekar H.M ◽  
Shobhalakshmi C.S ◽  
Vijakumar K.R
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pituitary Adenomas ◽  
Imaging Modality ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Medical College ◽  
Imaging Characteristics ◽  
Hospital Patients ◽  
Mri Study

BACKGROUND The sellar and juxtasellar region is a complex area where varied pathologies can occur. Differentiation among various pathologies may not always be easy, since many of these lesions mimic pituitary adenomas on clinical presentation, endocrinologic and radiologic examinations. The study intends to describe the imaging characteristics of the spectrum of pathological conditions affecting these regions using magnetic resonance imaging (MRI). METHODS The main source of data for the study were patients from hospitals attached to Bangalore Medical College and Research Institute, Bengaluru viz. Victoria Hospital, Bowring and Lady Curzon Hospital and Vani Vilas Hospital. Patients with suspected sellar and juxtasellar pathology on clinical examination referred to the Department of Radiodiagnosis from November 2017 to May 2019 underwent MRI study using Siemens 1.5-T Magnetom Avanto MR system. Magnetic resonance imaging was done in all patients according to the pituitary protocol. RESULTS Among the 50 patients, there were 16 males and 34 females. Most of the patients were in the third to fifth decade of life. The various abnormalities on MRI included neoplastic (68 %), malformative (8 %), vascular (6 %), granulomatous, infectious and inflammatory (18 %) lesions. Pituitary adenomas (46 %) were the most common lesions in sellar and juxtasellar regions, followed by tuberculosis (10 %), craniopharyngioma (8 %), Rathke's cleft cyst (6 %), meningioma (6 %), internal carotid artery (ICA) aneurysm (4 %), epidermoid (2 %) and miscellaneous lesions. CONCLUSIONS MR imaging characteristics were sufficiently distinct to allow various sellar and juxtasellar pathologies to be differentiated from each other. The spectrum of MRI findings were related to neoplastic, malformative, infectious, inflammatory, granulomatous and vascular causes. Our study observed that MRI with appropriate imaging protocols is the essential imaging modality in evaluation of sellar and juxtasellar lesions. KEYWORDS Pituitary, Sellar, Juxtasellar, Magnetic Resonance Imaging

Functional information from magnetic resonance imaging

1995 ◽  
Vol 53 ◽  
pp. 84-85
Author(s):  
Alan P. Koretsky ◽  
Afonso Costa e Silva ◽  
Yi-Jen Lin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Cancer Biology ◽  
Imaging Modality ◽  
Magnetic Resonance Images ◽  
Great Success ◽  
Functional Information ◽  
Resonance Imaging ◽  
High Resolution Mri

Magnetic resonance imaging (MRI) has become established as an important imaging modality for the clinical management of disease. This is primarily due to the great tissue contrast inherent in magnetic resonance images of normal and diseased organs. Due to the wide availability of high field magnets and the ability to generate large and rapidly switched magnetic field gradients there is growing interest in applying high resolution MRI to obtain microscopic information. This symposium on MRI microscopy highlights new developments that are leading to increased resolution. The application of high resolution MRI to significant problems in developmental biology and cancer biology will illustrate the potential of these techniques.In combination with a growing interest in obtaining high resolution MRI there is also a growing interest in obtaining functional information from MRI. The great success of MRI in clinical applications is due to the inherent contrast obtained from different tissues leading to anatomical information.

Pituitary Adenoma after the Gamma-Knife Radiosugery: correlation of MRI findings with clinical manifestation

1998 ◽  
Vol 38 (6) ◽  
pp. 979
Author(s):  
Young Chan Kim ◽  
Woo Wuk Choi ◽  
Eui Jong Kim ◽  
Young Jin Lim ◽  
Joo Hyeong Oh ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Gamma Knife ◽  
Clinical Manifestation ◽  
Mri Findings

PTTG has a Dual Role of Promotion-Inhibition in the Development of Pituitary Adenomas

2019 ◽  
Vol 26 (11) ◽  
pp. 800-818
Author(s):  
Zujian Xiong ◽  
Xuejun Li ◽  
Qi Yang
Keyword(s):  
Cell Cycle ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Cell Cycle Progression ◽  
Key Factors ◽  
Cycle Progression ◽  
Sister Chromatids ◽  
Regulation Of Cell Cycle ◽  
Late Stages

Pituitary Tumor Transforming Gene (PTTG) of human is known as a checkpoint gene in the middle and late stages of mitosis, and is also a proto-oncogene that promotes cell cycle progression. In the nucleus, PTTG works as securin in controlling the mid-term segregation of sister chromatids. Overexpression of PTTG, entering the nucleus with the help of PBF in pituitary adenomas, participates in the regulation of cell cycle, interferes with DNA repair, induces genetic instability, transactivates FGF-2 and VEGF and promotes angiogenesis and tumor invasion. Simultaneously, overexpression of PTTG induces tumor cell senescence through the DNA damage pathway, making pituitary adenoma possessing the potential self-limiting ability. To elucidate the mechanism of PTTG in the regulation of pituitary adenomas, we focus on both the positive and negative function of PTTG and find out key factors interacted with PTTG in pituitary adenomas. Furthermore, we discuss other possible mechanisms correlate with PTTG in pituitary adenoma initiation and development and the potential value of PTTG in clinical treatment.

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