title: Silent, but not unseen: multimicrocystic aspect on T2-weighted MRI in silent corticotroph adenomas.
abstract: OBJECTIVE
  Silent corticotroph adenomas (SCAs) present as nonfunctional pituitary tumours in routine pre-operative evaluation. The objective of this study was to evaluate the diagnostic accuracy of MRI T2-weighted sequences for detecting the corticotroph subtype pre-operatively.
  
  
  METHODS
  The pre-operative T2-weighted MRI sequences were retrospectively evaluated in patients with SCA and two control groups: clinically manifest corticotroph macroadenomas (CSMs) and nonfunctional gonadotroph macroadenomas (NFGMs). All were selected from a registry of 1096 patients in whom transsphenoidal surgery was performed in the same tertiary reference centre. T2-weighted MRI sequences were independently classified by one senior endocrinologist and one senior radiologist who were blinded to the clinical and histological features.
  
  
  METHODS
  Seventeen patients with SCA, 14 with CSM and 60 with NFGM were included in this study.
  
  
  METHODS
  Pituitary MRI with T2-weighted sequences. Two aspects were retained: multiple microcysts (MMs) and the absence of microcysts. Hormonal data included plasma prolactin, IGF-1, testosterone or oestradiol, LH, FT4, TSH, morning plasma cortisol and an ACTH-stimulation test, when available.
  
  
  RESULTS
  Multiple microcysts were present in 76% (13/17) of SCAs, 21% (3/14) of CSMs and 5% (3/60) of NFGMs. The presence of MMs in clinically nonfunctioning macroadenomas had a sensitivity of 76% and a specificity of 95% for predicting SCA.
  
  
  CONCLUSIONS
  The presence of MMs in T2-weighted MRI is a good diagnostic tool to suggest the corticotroph subtype in an apparently nonfunctional pituitary tumour.
authors.affiliation: Department of Endocrinology, CHU Ambroise Pare, Assistance Publique Hôpitaux de Paris, Boulogne, France; EA 2493, Versailles Saint Quentin University, Montigny-le-Bretonneux, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Cazabat
authors.forename: Martin
authors.initials: M
authors.lastname: Dupuy
authors.forename: Anne
authors.initials: A
authors.lastname: Boulin
authors.forename: Michèle
authors.initials: M
authors.lastname: Bernier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Baussart
authors.forename: Luc
authors.initials: L
authors.lastname: Foubert
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Raffin-Sanson
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.forename: Stéphan
authors.initials: S
authors.lastname: Gaillard
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone