Modern imaging in Cushing’s disease
Waiel Bashari, Daniel Gillett, James MacFarlane, Andrew Powlson, Angelos G. Kolias, Richard Mannion, Daniel Scoffings, Iosif Mendichovszky, Jeremy Jones, H.K. Cheow, Olympia Koulouri, Mark Gurnell
Abstract
Abstract Management of Cushing’s disease is informed by dedicated imaging of the sella and parasellar regions. Although magnetic resonance imaging (MRI) remains the investigation of choice, a significant proportion (30–50%) of corticotroph tumours are so small as to render MRI indeterminate or negative when using standard clinical sequences. In this context, alternative MR protocols [e.g. 3D gradient (recalled) echo, with acquisition of volumetric data] may allow detection of tumors that have not been previously visualized. The use of hybrid molecular imaging (e.g. 11 C-methionine positron emission tomography coregistered with volumetric MRI) has also been proposed as an additional modality for localizing microadenomas.