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Abstract

The Diagnostic Accuracy of Preoperative CT Scanning in the Evaluation of Pituitary ACTH-Secreting Adenomas

S. Marcovitz, R. Wee, J. Chan and J. Hardy
American Journal of Neuroradiology July 1987, 8 (4) 641-644;
S. Marcovitz
1Division of Endocrinology, Montreal General Hospital, McGill University. 1650 Cedar Ave., Montreal, Quebec, Canada H3G 1A4. Address reprint requests to S. Marcovitz
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R. Wee
2Department of Radiology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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J. Chan
2Department of Radiology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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J. Hardy
3Department of Neurosurgery, Montreal General Hospital, McGill University and Hopital Notre Dame, Universite de Montreal, Montreal, Quebec, Canada
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Abstract

Between 1980 and 1985, 35 patients (26 women and nine men) who had coronal CT scans of the sella turcica for suspected ACTH-secreting pituitary adenoma underwent transsphenoidal exploration. The CT examinations were performed with a fourth-generation EMI scanner (CT 7070). The reports of the preoperative CT examinations were compared with the findings at transsphenoidal exploration; in cases with negative CT scans, the decision to operate was based on biochemical evidence of Cushing's disease. In 27 patients, distinct adenomas were found at surgery; in the eight others, total hypophysectomy (four cases) or resection of the central core of the pituitary gland (four cases) was performed. Three patients had macroadenomas, all of which had been identified correctly on preoperative CT scan. Among the 24 microadenomas (<10 mm diameter), 14 had been correctly identified on preoperative CT scan while 10 were found in patients with negative scans. The CT examinations in these 35 patients showed probable adenomas in 20 cases, of which 17 (85%) were confirmed at surgery. In the other three cases (15%), adenomas were not found. Among the 15 patients with negative CT scans, 10 (66.6%) had distinct adenomas found at surgery. Coronal CT scans for ACTH-secreting adenomas had a sensitivity of 63%, a specificity of 62.5%, and an overall accuracy rate of 62.8%. Thus, in our experience, CT scanning with current state-of-the-art equipment has poor diagnostic accuracy in Cushing's disease. The possible reasons for this are that most of the adenomas in this series were microadenomas less than 6 mm in diameter, and that ACTH microadenomas probably show almost the same degree of enhancement with contrast medium as the surrounding normal pituitary tissue.

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American Journal of Neuroradiology
Vol. 8, Issue 4
1 Jul 1987
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S. Marcovitz, R. Wee, J. Chan, J. Hardy
The Diagnostic Accuracy of Preoperative CT Scanning in the Evaluation of Pituitary ACTH-Secreting Adenomas
American Journal of Neuroradiology Jul 1987, 8 (4) 641-644;

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The Diagnostic Accuracy of Preoperative CT Scanning in the Evaluation of Pituitary ACTH-Secreting Adenomas
S. Marcovitz, R. Wee, J. Chan, J. Hardy
American Journal of Neuroradiology Jul 1987, 8 (4) 641-644;
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