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PNA Medical Corner: MRI for Cushing’s

7T MRI for Cushing’s Disease: A Single Institutional Experience and Literature Review

PMID: 38365424   DOI: 10.3174/ajnr.A8209

Abstract

Background and purpose: Cushing disease is typically caused by a pituitary adenoma that frequently is small and challenging to detect on conventional MRI. High field strength 7T MRI can leverage increased signal-to-noise and contrast-to-noise ratios compared to lower-field strength MRI to help identify small pituitary lesions. We aim to describe our institutional experience with 7T MRI in patients with Cushing disease and perform a review of the literature.

Materials and methods: A retrospective analysis of 7T MRI findings in patients with pathology proven cases of Cushing disease from a single institution, followed by a review of the literature on 7T MRI for Cushing disease.

Results: Our institutional experience identified Cushing adenomas in 10/13 (76.9%) patients on 7T, however only 5/13 (38.5%) lesions were discrete. Overall, the imaging protocols used were heterogeneous in terms of contrast dose as well as type of post-contrast T1-weighted sequences (Dynamic, 2D vs 3D, and type of 3D sequence). From our institutional data, specific post-gadolinium T1-weighted sequences were helpful in identifying a surgical lesion as follows: Dynamic Contrast Enhanced 2/7 (28.6%), 2D FSE 4/8 (50%), 3D SPACE 5/6 (83.3%), and 3D MPRAGE 8/11 (72.7%). The literature review identified Cushing adenomas in 31/33 (93.9%) patients on 7T.

Conclusions: 7T MRI for pituitary lesion localization in Cushing disease is a new technique with imaging protocols that varied widely. Further comparative research is needed to identify the optimal imaging technique as well as to assess the benefit of 7T over lower-field strength MRI.

Abbreviations: MRI = Magnetic Resonance Imaging, CT = Computed Tomography, 7T = 7 Tesla, DCE = Dynamic Contrast Enhanced.

© 2024 by American Journal of Neuroradiology.

    Featured News and Updates

    News Articles February 2025

    Pituitary journey: woman learns to slow down while facing melanoma, pituitary inflammation

    Blogger Amanda Goodwin is a hard-charging businesswoman, who was forced to slow down and “embrace the sick” as she battled melanoma in her lungs, liver and brain, and suffered from inflammation of the pituitary. Read more here: https://substack.com/home/post/p-156259244?utm_campaign=post&utm_medium=web

     

    Study: Cushing’s patients develop cataracts at younger ages

    An article in Cushing’s Disease News examines a study published in Graefe’s Archive for Clinical and Experimental Ophthalmology, that finds that Cushing’s patients are at higher risk of developing cataracts at a younger age compared to non-Cushing’s patients.  They developed them at an average age of 48.1. Patients with Cushing’s Syndrome “being 34% more likely to develop cataracts than the general population. For those with Cushing’s disease, the risk was 39% higher.” Read more: https://cushingsdiseasenews.com/news/cushings-patients-higher-risk-developing-cataracts-younger-age/

     

    Pituitary Journey: British celebrity astrologer recounts battle with pituitary tumor

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    Houston Hospital gets $2 million in donations for pituitary research

    Houston Methodist hospital announced it has commitments to receive 2 million dollars to support its Kenneth R. Peak Brain & Pituitary Treatment Center. $1.5 million comes from the Henry J.N. Taub Foundation and is paired with an anonymous $500,000 donation. Read more: https://philanthropynewsdigest.org/news/houston-methodist-receives-1.5-million-for-brain-pituitary-research

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    Kilci F, Sarikaya E, Murat NÖ, Deniz A.Endocrine. 2025 Feb 2. doi: 10.1007/s12020-025-04176-0. Online ahead of print.

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    Zhang S, Xie B, He Y, Zhang X, Gong G, Li M, Chen Y, Tang G, Zhang C, Qin C, Liu Q.J Cancer Res Clin Oncol. 2025 Jan 31;151(2):57. doi: 10.1007/s00432-025-06104-1.

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    Zhou Y, Qian M, Wang S, Zhou X, Zhou M, Gu Z, Sun M, Yang T.Eur J Oncol Nurs. 2025 Jan 28;74:102815. doi: 10.1016/j.ejon.2025.102815. Online ahead of print.

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    Giant and irregular pituitary neuroendocrine tumors surgery: comparison of simultaneous combined endoscopic endonasal and transcranial and purely endoscopic endonasal surgery at a single center.

    Fu J, Luo W, Zhang C, Wang Z, Fan W, Lin Y, Kang D, Song J, Jiang C, Yan X.Chin Neurosurg J. 2025 Feb 3;11(1):3. doi: 10.1186/s41016-025-00389-4.PMID: 39894800

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    Khaleghi M, Shahid AH, Suggala S, Dyess G, Hummel UN, Chason DN, Butler D, Thakur JD.Neurosurg Focus. 2025 Feb 1;58(2):E6. doi: 10.3171/2024.11.FOCUS24733.

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    Lasica N, Lesha E, Beckfort NS, Arnautovic KI.Neurosurg Focus. 2025 Feb 1;58(2):E3. doi: 10.3171/2024.11.FOCUS24665.

    Multicenter study on 2-year outcomes of dual application of hydroxyapatite cranioplasty and a nasoseptal flap following endoscopic endonasal surgery for tuberculum sellae meningiomas or craniopharyngiomas.

    Kong DS, Kim YH, Hong SD, Ryu G, Kim JH, Hong CK, Kim YH.Neurosurg Focus. 2025 Feb 1;58(2):E2. doi: 10.3171/2024.11.FOCUS24624.


    Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma.

    Petito G, Hu A, Zhang G, Min S, Tripathi SH, Kumar A, Shukla G, Shah S, Phillips KM, Jana S, Forbes JA, Zuccarello M, Andaluz NO, Sedaghat AR.J Neurol Surg B Skull Base. 2024 Feb 2;86(1):39-45. doi: 10.1055/a-2235-7419. eCollection 2025 Feb.PMID: 39881750

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    Count on your Xeris CareConnection™ Team for unparalleled Cushing’s Support

    Cushing’s can be challenging, but there is support so patients can feel like themselves again. The main goal of treating Cushing’s is to get cortisol levels back to normal. This Pituitary Awareness Month, Xeris Pharmaceuticals® is highlighting the importance of one-on-one support for patients living with Cushing’s Syndrome and support for HCPs treating Cushing’s Syndrome.

    Sign up to get dedicated support:

    Patients: Sign up for support | Recorlev® (levoketoconazole)

    HCP’s: Connect with Xeris support | RECORLEV® (levoketoconazole)

    Have more questions? Call for more support at 1-844-444-RCLV (7258)

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