title: Usefulness of dynamic MRI enhancement measures for the diagnosis of ACTH-producing pituitary adenomas.
abstract: OBJECTIVE
  The distinction between corticotropin (ACTH)-producing pituitary adenomas and occult ectopic ACTH neoplasms is a challenge and frequently complicated by the detection of nonfunctioning pituitary adenomas on dynamic magnetic resonance imaging (DMRI). Herein, we explored quantitative differences in DMRI measures from ACTH-producing pituitary adenomas.
  
  
  METHODS
  Fifty-five patients with pathology confirmed ACTH-producing and 44 with nonfunctioning pituitary adenomas were analysed in this retrospective pilot study. The intensities of adenomas and of adjacent pituitary tissue were measured by drawing a region of interest. Time-intensity curves were then constructed, and quantitative analysis included: enhancement time, enhancement peak and prepeak slope (PPS). Multivariable logistic analysis and receiver operating characteristic curves (ROC) were used to evaluate the parameters.
  
  
  RESULTS
  Quantitative analysis showed that tumour PPS in ACTH-producing adenomas was markedly lower than that in nonfunctioning adenomas (P = 0·0042) and that the PPS of the adjacent pituitary gland was not different (P = 0·2441). The PPS was >3·0 in 59·1% of nonfunctioning adenomas and ≤3·0 in 69·1% of ACTH-producing adenomas (P = 0·0049). Logistic analysis revealed lower tumour PPS levels (P = 0·0123, OR 1·24, 95% CI: 1·05-1·52) were associated with ACTH-producing adenomas. The optimal PPS cut-off determined by ROC analysis was 2·89, with a sensitivity of 69% and specificity of 70%. No significant difference was found between the two groups in enhancement time or enhancement peak.
  
  
  CONCLUSIONS
  Enhancement parameters in DMRI can help distinguishing ACTH producing from nonfunctioning pituitary adenomas, which could be useful in the differential diagnosis between ACTH-producing pituitary adenomas and ectopic ACTH syndrome complicated with nonfunctioning pituitary adenoma.
authors.affiliation: Division of Endocrinology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Guo
authors.forename: William F
authors.initials: WF
authors.lastname: Young
authors.forename: Dana
authors.initials: D
authors.lastname: Erickson
authors.forename: Bradley
authors.initials: B
authors.lastname: Erickson
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis*; D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium