Objective: The Endocrine Society Clinical Guidelines recommend measuring 24-h urinary free cortisol (UFF) levels using a highly accurate method as one of the first-line screening tests for the diagnosis of Cushing's Syndrome (CS). We evaluated the performance of UFF, urinary free cortisone (UFE), and the UFF:UFE ratio, measured using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Subjects and methods: The LC-MS/MS was used to analyze UFF and UFE levels in 43 surgically confirmed CS patients: 26 with Cushing's disease (CD, 16 de novo and ten recurrences), 11 with adrenal CS and six with ectopic CS; 22 CD patients in remission; 14 eu-cortisolemic CD patients receiving medical therapy; 60 non-CS patients; and 70 healthy controls. Sensitivity and specificity were determined in the combined groups of non-CS patients, healthy controls, and CD in remission. Results: UFFO170 nmol/24 h showed 98.7% specificity and 100% sensitivity for de novo CS, while sensitivity was 80% for recurrent CD patients, who were characterized by lower UFF levels. The UFF:UFE and UFFCUFE showed lower sensitivity and specificity than UFF. Ectopic CS patients had the highest UFF and UFF:UFE levels, which were normal in the CD remission patients and in those receiving medical therapy. Conclusions: Our data suggest high diagnostic performance of UFF excretion measured using LC-MS/MS, in detecting de novo CS. UFF:UFE and UFFCUFE assessments are not useful in the first step of CS diagnosis, although high levels were found to be indicative of ectopic CS.

Provoked thrombotic events pose a major problem in the management of CD patients after surgery, regardless of the procedure's outcome. The prophylactic regimen proposed in this paper afforded an efficacy prophylaxis against postoperative VTE in patients with CD. Due to the rarity of CD, a multicenter study on a larger sample of cases would be warranted in order to collect more thrombotic events.

Although CD is less frequent in male patients, in this gender, it presents with more florid clinical manifestations and may imply more diagnostic difficulties.

Cushing's syndrome (CS) is associated with an incidence of venous thromboembolism (VTE) about ten times higher than in the normal population. The aim of our study was to develop a model for identifying CS patients at higher risk of VTE. We considered clinical, hormonal, and coagulation data from 176 active CS patients and used a forward stepwise logistic multivariate regression analysis to select the major independent risk factors for thrombosis. The risk of VTE was calculated as a 'CS-VTE score' from the sum of points of present risk factors. VTE developed in 20 patients (4 pulmonary embolism). The group of CS patients with VTE were older (p < 0.001) and had more cardiovascular events (p < 0.05), infections and reduced mobility (both p < 0.001), higher midnight plasma cortisol levels (p < 0.05), and shorter APTT (p < 0.01) than those without. We identified six major independent risk factors for VTE: age ≥69 years and reduced mobility were given two points each, whereas acute severe infections, previous cardiovascular events, midnight plasma cortisol level >3.15 times the normality and shortened APTT were given one point each. A CS-VTE score <2 anticipated no risk of VTE; a CS-VTE score of two mild risk (10 %); a CS-VTE score of three moderate risk (46 %); a CS-VTE score ≥4 high risk (85 %). Considering a score ≥3 as predictive of VTE, 94 % of the patients were correctly classified. A simple score helps stratify the VTE risk in CS patients and identify those who could benefit from thromboprophylaxis.

Background Grading of meningiomas is important in the choice of the most effective treatment for each patient. Purpose To determine the diagnostic accuracy of a deep convolutional neural network (DCNN) in the differentiation of the histopathological grading of meningiomas from MR images. Study Type Retrospective. Population In all, 117 meningioma‐affected patients, 79 World Health Organization [WHO] Grade I, 32 WHO Grade II, and 6 WHO Grade III. Field Strength/Sequence 1.5 T, 3.0 T postcontrast enhanced T1 W (PCT1W), apparent diffusion coefficient (ADC) maps (b values of 0, 500, and 1000 s/mm2). Assessment WHO Grade II and WHO Grade III meningiomas were considered a single category. The diagnostic accuracy of the pretrained Inception‐V3 and AlexNet DCNNs was tested on ADC maps and PCT1W images separately. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to asses DCNN performance. Statistical Test Leave‐one‐out cross‐validation. Results The application of the Inception‐V3 DCNN on ADC maps provided the best diagnostic accuracy results, with an AUC of 0.94 (95% confidence interval [CI], 0.88–0.98). Remarkably, only 1/38 WHO Grade II–III and 7/79 WHO Grade I lesions were misclassified by this model. The application of AlexNet on ADC maps had a low discriminating accuracy, with an AUC of 0.68 (95% CI, 0.59–0.76) and a high misclassification rate on both WHO Grade I and WHO Grade II–III cases. The discriminating accuracy of both DCNNs on postcontrast T1W images was low, with Inception‐V3 displaying an AUC of 0.68 (95% CI, 0.59–0.76) and AlexNet displaying an AUC of 0.55 (95% CI, 0.45–0.64). Data Conclusion DCNNs can accurately discriminate between benign and atypical/anaplastic meningiomas from ADC maps but not from PCT1W images. Level of evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1152–1159.