An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series

Matur, Abhijith V.; Body, Alaina; Johnson, Mark D.; Smith, Matthew J.; Bhabhra, Ruchi; Lester, Emily J.; Stahl, Trisha L.; Grossman, Aaron W.; Shirani, Peyman; Forbes, Jonathan A.; Prestigiacomo, Charles J.

doi:10.3171/case21374

Cited by 2 publications

(1 citation statement)

References 21 publications

(41 reference statements)

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“…Previous studies have shown that IPSS results are inaccurate for predicting tumor lateralization due to factors such as intracranial venous system ow patterns [22,23] . A retrospective study of 30 patients by Sun et al found that cavernous sinus sampling results were not associated with intraoperative tumor lateralization ndings [24] .Factors such as asymmetric or dysplastic IPS anatomy and excessive differences in bilateral ductal entry locations have been suggested to in uence the incorrect prediction of tumor lateralization [21,25] .…”

Section: Discussionmentioning

confidence: 99%

Effect of intercavernous sinus drainage pattern on exactness of bilateral inferior petrosal sinus sampling results in foretell the area of Cushing’s disease tumors

Jiao

et al. 2023

Preprint

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Background Cushing’s disease(CD) is originatedfromimmoderatedischarge of adrenocorticotropic hormone (ACTH) from tumor cells, which leads to adrenal cortical hyperplasia and excessive glucocorticoid secretion, resulting in disordered metabolism of various substances, and hypercortisolism. The purpose of this research was to assess the effect of the intercavernous sinus drainage pattern on ability of bilateral inferior petrosal sinus sampling (BIPSS) to predict tumor location in patients with CD. Methods The clinical data of 50 patients with CD who experienced BIPSS in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University between August 2018 and April 2022 were retrospectively analyzed. Data included the patients’ basic preoperative clinical data, preoperative dynamic contrast-enhanced MRI of the pituitary gland, BIPSS results, grading of the intercavernous sinus drainage pattern, and intraoperative determination of tumor location. A chi-square test was performed to evaluate the correlates with the actual tumor lateralization during transsphenoidal surgery in both symmetric and asymmetric intercavernous sinus drainage patterns. In the asymmetric drainage pattern, a chi-square goodness-of-fit test was conducted for two classified variables: whether the mean nondominant side/peripheral ACTH ratio was greater than 1, and whether the tumor was located on the nondominant side. The mean nondominant side/peripheral ACTH ratio was defined as a. Results BIPSS results showed that the right side of the intercavernous sinus drainage pattern was much more likely to be the dominant side [21 cases (42.0%)] than the left side [11 cases (22.0%)]. In symmetric drainage patterns, BIPSS prediction of tumor lateralization waslargelyrelatedto intraoperative tumor location (p < 0.001). In asymmetric drainage patterns, tumor lateralization was related to a (p = 0.034). The tumor was located on the nondominant side when a was greater than 1 and on the dominant side when a was less than 1. Conclusion The intercavernous sinus drainage pattern influences the accuracy of BIPSS for prediction of tumor location in Cushing’s disease. The combination of intercavernous sinus drainage pattern and the comparison of nondominant IPSS with the peripheral ACTH gradient can be used for accurate prediction of tumor location CD.

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Section: Discussionmentioning

confidence: 99%

Effect of intercavernous sinus drainage pattern on exactness of bilateral inferior petrosal sinus sampling results in foretell the area of Cushing’s disease tumors

Jiao

et al. 2023

Preprint

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Accuracy of the 10 μg desmopressin test for differential diagnosis of Cushing syndrome: a systematic review and meta-analysis

Giampietro,

Cabral,

Pereira

et al. 2024

Front. Endocrinol.

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We evaluated the accuracy of the 10 μg desmopressin test in differentiating Cushing disease (CD) from non-neoplastic hypercortisolism (NNH) and ectopic ACTH syndrome (EAS). A systematic review of studies on diagnostic test accuracy in patients with CD, NNH, or EAS subjected to the desmopressin test obtained from LILACS, PubMed, EMBASE, and CENTRAL databases was performed. Two reviewers independently selected the studies, assessed the risk of bias, and extracted the data. Hierarchical and bivariate models on Stata software were used for meta-analytical summaries. The certainty of evidence was measured using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation Working Group) approach. In total, 14 studies were included: 3 studies on differentiated CD versus NNH and 11 studies on differentiated CD versus EAS. Considering ΔACTH in 8 studies involving 429 patients, the pooled sensitivity for distinguishing CD from EAS was 0.85 (95% confidence interval [CI]: 0.80–0.89, I2 = 17.6%) and specificity was 0.64 (95% CI: 0.49–0.76, I2 = 9.46%). Regarding Δcortisol in 6 studies involving 233 participants, the sensitivity for distinguishing CD from EAS was 0.81 (95% CI: 0.74–0.87, I2 = 7.98%) and specificity was 0.80 (95% CI: 0.61–0.91, I2 = 12.89%). The sensitivity and specificity of the combination of ΔACTH > 35% and Δcortisol > 20% in 5 studies involving 511 participants were 0.88 (95% CI: 0.79–0.93, I2 = 35%) and 0.74 (95% CI: 0.55–0.87, I2 = 27%), respectively. The pooled sensitivity for distinguishing CD from NNH in 3 studies involving 170 participants was 0.88 (95% CI: 0.79–0.93) and the specificity was 0.94 (95% CI: 0.86–0.97). Based on the desmopressin test for differentiating CD from EAS, considering ΔACTH, Δcortisol, or both percent increments, 15%, 19%, or 20% of patients with CD, respectively, would be incorrectly classified as having EAS. For CD versus NNH, 11% of patients with CD would be falsely diagnosed as having NNH, whereas 7% of patients with NNH would be falsely diagnosed as having CD. However, in all hierarchical plots, the prediction intervals were considerably wider than the confidence intervals. This indicates low confidence in the estimated accuracy, and the true accuracy is likely to be different.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85634, identifier CRD42018085634; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68317, identifier CRD42017068317.

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An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series

Cited by 2 publications

References 21 publications

Effect of intercavernous sinus drainage pattern on exactness of bilateral inferior petrosal sinus sampling results in foretell the area of Cushing’s disease tumors

Effect of intercavernous sinus drainage pattern on exactness of bilateral inferior petrosal sinus sampling results in foretell the area of Cushing’s disease tumors

Accuracy of the 10 μg desmopressin test for differential diagnosis of Cushing syndrome: a systematic review and meta-analysis

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