Inter- and intra-observer variability in detection and progression assessment with MRI of microadenoma in Cushing’s disease patients followed up after bilateral adrenalectomy

Bahurel-Barrera, H.; Assié, Guillaume; Silvera, S.; Bertagna, Xavier; Coste, Joël; Legmann, P.

doi:10.1007/s11102-008-0123-5

Cited by 18 publications

(8 citation statements)

References 14 publications

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“…However, the 55% threshold was based on studies published at the time PRIMARYS was designed (7); none of these trials used the same design, and populations were commonly a mixture of patients with micro- and macroadenomas, possibly enriching study populations with responders. Moreover, tumor volume measurements are greatly influenced by inter- and intra-reader variabilities (23). Although considerable efforts were made to minimize variabilities in PRIMARYS, with three-quarters of scan measurements for the primary endpoint adjudicated because they differed by ≥ 10%, we cannot rule out that residual variability influenced the findings.…”

Section: Discussionmentioning

confidence: 99%

Tumor Shrinkage With Lanreotide Autogel 120 mg as Primary Therapy in Acromegaly: Results of a Prospective Multicenter Clinical Trial

Caron

Bevan

Petersenn³

et al. 2014

The Journal of Clinical Endocrinology &Amp; Metabolism

164

132

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Context:Methodological shortcomings often compromise investigations into the effects of primary somatostatin-analog treatment on tumor size in acromegaly. There are also limited data for the long-acting lanreotide formulation.Objective:The aim of the study was to better characterize the effects of primary lanreotide Autogel treatment on tumor size in patients with GH-secreting macroadenomas.Design:PRIMARYS was a 48-week, multicenter, open-label, single-arm study.Setting:The study was conducted at specialist endocrine centers.Patients:Treatment-naïve acromegalic patients with GH-secreting macroadenomas participated in the study.Intervention:Lanreotide Autogel 120 mg was administered sc every 28 days (without dose titration).Outcome Measures:The primary endpoint was the proportion of patients with clinically significant (≥20%) tumor volume reduction (TVR) at week 48/last post-baseline value available using central assessments from three readers. The null hypothesis (H0) for the primary endpoint was that the proportion with TVR was ≤55%. Secondary endpoints included: TVR at other time points, GH and IGF-1, acromegalic symptoms, quality of life (QoL), and safety.Results:Sixty-four of 90 (71.1%) patients completed the study. Clinically significant TVR at 48 weeks/last post-baseline value available was achieved by 62.9% (95% confidence interval, 52.0, 72.9) of 89 patients in the primary analysis (intention-to-treat population; H0 not rejected) and 71.9–75.3% in sensitivity (n = 89) and secondary analyses (n = 63) (H0 rejected). At 12 weeks, 54.1% had clinically significant TVR. Early and sustained improvements also occurred in GH and IGF-1, acromegalic symptoms, and QoL. No patients withdrew due to gastrointestinal intolerance.Conclusions:Primary treatment with lanreotide Autogel, administered at 120 mg (highest available dose) without dose titration, in patients with GH-secreting macroadenomas provides early and sustained reductions in tumor volume, GH and IGF-1, and acromegalic symptoms, and improves QoL.

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Section: Discussionmentioning

confidence: 99%

Tumor Shrinkage With Lanreotide Autogel 120 mg as Primary Therapy in Acromegaly: Results of a Prospective Multicenter Clinical Trial

Caron

Bevan

Petersenn³

et al. 2014

The Journal of Clinical Endocrinology &Amp; Metabolism

164

132

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“…This group of patients commonly has migraine due to changes in estradiol levels, so it is important not to incorrectly attribute migraine to a normal pituitary lesion in this situation. Pituitary microadenomas appear as low-density lesions on MRI and there is wide inter-and intraobserver variation between radiologists when commenting on the presence or absence of a microadenoma [29]. Radiological artefact due the partial volume effect may give the optical illusion of a low-density lesion within the pituitary gland on MRI.…”

Section: Potential Pitfallsmentioning

confidence: 99%

The Association of Pituitary Tumors and Headache

Levy

2010

Curr Neurol Neurosci Rep

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Pituitary tumors may give rise to headache via numerous mechanisms. The traditional explanation for headache is dural stretch and cavernous sinus invasion, although this is not borne out by clinical studies. Certain functional pituitary tumors are associated with headache, notably growth hormone and prolactin-secreting tumors. The observation that somatostatin analogues can have a dramatic analgesic effect in acromegaly suggests that biochemical properties of the tumor may be important. The genetic predisposition of the patient to primary headache also determines whether headache occurs with pituitary tumors. This article attempts to outline the clinical features, management strategies, and key academic questions regarding the subject of pituitary tumors and headache.

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“…Moreover, inter-rater differences are not uncommon when assessing pituitary pathologies through imaging. 31,32 A limitation of our study is the cohort size. A larger patient cohort is necessary to better compare the sensitivities of CE-VIBE and CISS sequences to detect pituitary adenomas in CD patients.…”

Section: Discussionmentioning

confidence: 98%

Comparison of Constructive Interference in Steady-State and T1-Weighted MRI Sequence at Detecting Pituitary Adenomas in Cushing's Disease Patients

et al. 2018

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Background T1-weighted magnetic resonance imaging (MRI) remains the standard pituitary imaging sequence. However, up to 50% of pituitary adenomas are missed with standard imaging in Cushing's disease (CD) patients. Utility of other imaging sequences needs be explored. Objective To compare a T2-gradient echo sequence, constructive interference in steady state (CISS), with a contrast-enhanced (CE) T1-weighted sequence, volume-interpolated breath-hold examination (VIBE), in the detection of pituitary adenomas in CD patients. Design Retrospective analysis of CD patients who underwent endoscopic transsphenoidal pituitary adenomectomy at our institution. Patients and Measurement Twelve patients were included in the study. Two neuroradiologists, who were blinded to the patients' clinical and surgical findings, independently reviewed the CE-VIBE and CISS images. Localization of pituitary adenoma from imaging was compared with intraoperative localization. Results The averaged sensitivity of detecting pituitary adenoma in CD patients was not significantly different between CE-VIBE sequence (63%) and CISS sequence (54%). The positive predictive value was 75% (Observer A) and 100% (Observer B) with CE-VIBE sequence, and 64% (Observer A) and 100% (Observer B) with CISS sequence. In two patients, pituitary adenoma was easily localized with CISS sequence but hard to detect with CE-VIBE sequence. In two other patients, the adenoma was much better delineated on CE-VIBE sequence. Conclusion In our series, the addition of CISS sequence to T1-weighted MRI imaging protocols improved the detection of pituitary adenomas in CD patients. CISS sequence may be a useful adjunct to T1-weighted pituitary MRI protocols and an appropriate alternative for patients with gadolinium contraindications.

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Inter- and intra-observer variability in detection and progression assessment with MRI of microadenoma in Cushing’s disease patients followed up after bilateral adrenalectomy

Abstract: Pituitary MRI study of patients with Cushing disease treated by adrenalectomy remains difficult. In practice, interpretation of MRI studies by a well-experienced reader should be preferred, unless a final decision can be reached by consensus between two and several readers.

Cited by 18 publications

References 14 publications

Tumor Shrinkage With Lanreotide Autogel 120 mg as Primary Therapy in Acromegaly: Results of a Prospective Multicenter Clinical Trial

Tumor Shrinkage With Lanreotide Autogel 120 mg as Primary Therapy in Acromegaly: Results of a Prospective Multicenter Clinical Trial

The Association of Pituitary Tumors and Headache

Comparison of Constructive Interference in Steady-State and T1-Weighted MRI Sequence at Detecting Pituitary Adenomas in Cushing's Disease Patients

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