title: Pituitary-Targeted Dynamic Contrast-Enhanced Multisection CT for Detecting MR Imaging-Occult Functional Pituitary Microadenoma.
abstract: OBJECTIVE
  Although resection of a tumor by trans-sphenoidal surgery is considered the criterion standard for successful surgical treatment of functional pituitary microadenoma, MR imaging occasionally fails to visualize and identify the tumor and supplementary imaging modalities are necessary. We tested the possibility of dynamic contrast-enhanced multisection CT of the pituitary gland accompanying image reconstruction of contrast agent dynamics to identify the localizations of microadenomas and compared the diagnostic performance with conventional pituitary-targeted MR imaging.
  
  
  METHODS
  Twenty-eight patients with surgically confirmed functional pituitary microadenomas (including growth hormone-, adrenocorticotropic hormone-, and prolactin-secreting adenomas) who underwent pituitary-targeted dynamic contrast-enhanced multisection CT were retrospectively investigated. We undertook image reconstruction of the dynamics of the contrast agent around the pituitary gland in a voxelwise manner, visualizing any abnormality and enabling qualification of contrast dynamics within the tumor.
  
  
  RESULTS
  Fifteen cases were correctly diagnosed by MR imaging, while dynamic contrast-enhanced multisection CT correctly diagnosed 26 cases. The accuracy of localization was markedly better for adrenocorticotropic hormone-secreting microadenomas, increasing from 32% on MR imaging to 85% by dynamic contrast-enhanced multisection CT. Compared with the normal pituitary gland, adrenocorticotropic hormone-secreting adenoma showed the least difference in contrast enhancement of the different functional microadenomas. Images acquired at 45-60 seconds after contrast agent injection showed the largest difference in contrast enhancement between an adenoma and the normal pituitary gland.
  
  
  CONCLUSIONS
  Dynamic contrast-enhanced multisection CT combined with image reconstruction of the contrast-enhanced dynamics holds promise in detecting MR imaging-occult pituitary microadenomas.
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.) Department of Neurosurgery (M.K.), Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kinoshita
authors.affiliation: Radiology (H.T., Y.W.), Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.).
authors.forename: H
authors.initials: H
authors.lastname: Arita
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.).
authors.forename: Y
authors.initials: Y
authors.lastname: Goto
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.).
authors.forename: S
authors.initials: S
authors.lastname: Oshino
authors.affiliation: Radiology (H.T., Y.W.), Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.).
authors.forename: T
authors.initials: T
authors.lastname: Yoshimine
authors.affiliation: From the Departments of Neurosurgery (M.K., H.A., Y.G., S.O., T.Y., Y.S.) Department of Neuromodulation and Neurosurgery (Y.S.), Osaka University Graduate School of Medicine, Center of Medical Innovation and Translational Research, Osaka, Japan. neurosaitoh@mbk.nifty.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Saitoh
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media