Modern imaging of pituitary adenomas

Bashari, Waiel; Senanayake, Russell; Fernández-Pombo, Antía; Gillett, Daniel; Koulouri, Olympia; Powlson, Andrew S; Matys, Tomasz; Scoffings, Daniel; Cheow, Heok; Mendichovszky, Iosif; Gurnell, Mark

doi:10.1016/j.beem.2019.05.002

Cited by 57 publications

(45 citation statements)

References 73 publications

(72 reference statements)

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“…2c and 4). This ability will enable phantoms to be made which mimic the anatomy and pathology seen clinically in investigations such as pituitary [5][6][7] and adrenal [8,9] adenoma localisation, that has not been possible before. They could also play a role in the development of partial volume correction (PVC) algorithms.…”

Section: Discussionmentioning

confidence: 99%

3D printing 18F radioactive phantoms for PET imaging

et al. 2021

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Purpose Phantoms are routinely used in molecular imaging to assess scanner performance. However, traditional phantoms with fillable shapes do not replicate human anatomy. 3D-printed phantoms have overcome this by creating phantoms which replicate human anatomy which can be filled with radioactive material. The problem with these is that small objects suffer to a greater extent than larger objects from the effects of inactive walls, and therefore, phantoms without these are desirable. The purpose of this study was to explore the feasibility of creating resin-based 3D-printed phantoms using 18F. Methods Radioactive resin was created using an emulsion of printer resin and 18F-FDG. A series of test objects were printed including twenty identical cylinders, ten spheres with increasing diameters (2 to 20 mm), and a double helix. Radioactive concentration uniformity, printing accuracy and the amount of leaching were assessed. Results Creating radioactive resin was simple and effective. The radioactive concentration was uniform among identical objects; the CoV of the signal was 0.7% using a gamma counter. The printed cylinders and spheres were found to be within 4% of the model dimensions. A double helix was successfully printed as a test for the printer and appeared as expected on the PET scanner. The amount of radioactivity leached into the water was measurable (0.72%) but not visible above background on the imaging. Conclusions Creating an 18F radioactive resin emulsion is a simple and effective way to create accurate and complex phantoms without inactive walls. This technique could be used to print clinically realistic phantoms. However, they are single use and cannot be made hollow without an exit hole. Also, there is a small amount of leaching of the radioactivity to take into consideration.

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Section: Discussionmentioning

confidence: 99%

3D printing 18F radioactive phantoms for PET imaging

et al. 2021

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“…MRI techniques for detection and depiction of pituitary adenomas have witnessed rapid evolution ranging from the non-contrast MRI scans to thin section contrast MRI scans [7,31] . Modern MRI device has led to a rise in detection of PM as it allows evaluation of sella and perisellar lesions with high soft tissue contrast and excellent anatomical resolution [32,33] .…”

Section: Discussionmentioning

confidence: 99%

“…Manual analysis of MRI data is usually difficult, biased and time-consuming, and the diagnostic accuracy is closely related to the radiologist’s experience. Therefore, MRI-based diagnosis for PM needs to be improved [6,7] . The increase in the demand for radiologist is an inevitable trend, but the supply of radiologist has not increased proportionally [8] .…”

Section: Introductionmentioning

confidence: 99%

Automatic detection of pituitary microadenoma from magnetic resonance imaging using deep learning algorithms

Zhu

Chen

et al. 2021

Preprint

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Pituitary microadenoma (PM) is often difficult to detect by MR imaging alone. We employed a computer-aided PM diagnosis (PM-CAD) system based on deep learning to assist radiologists in clinical workflow. We enrolled 1,228 participants and stratified into 3 non-overlapping cohorts for training, validation and testing purposes. Our PM-CAD system outperformed 6 existing established convolutional neural network models for detection of PM. In test dataset, diagnostic accuracy of PM-CAD system was comparable to radiologists with > 10 years of professional expertise (94% versus 95%). The diagnostic accuracy in internal and external dataset was 94% and 90%, respectively. Importantly, PM-CAD system detected the presence of PM that had been previously misdiagnosed by radiologists. This is the first report showing that PM-CAD system is a viable tool for detecting PM. Our results suggest that PM-CAD system is applicable to radiology departments, especially in primary health care institutions.

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“…In recent years, functional pituitary imaging has been proposed as a useful tool for identifying the site(s) of a pituitary adenoma in patients with inconclusive MRI findings [26]. 11 Carbon-methionine is an amino acid based PET tracer which, unlike the glucose-based tracer 18 F-fluorodeoxyglucose, is preferentially taken up by normal pituitary tissue [27] with relatively low uptake by background brain tissue.…”

Section: Discussionmentioning

confidence: 99%

A remarkable case of thyrotoxicosis initially caused by graves’ disease followed by a probable TSHoma – a case report

et al. 2020

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Background: Graves' disease is the commonest cause of thyrotoxicosis whilst thyrotropin (TSH)-producing pituitary adenomas (thyrotropinomas, TSHomas) are very rare and account for just 1-2% of all pituitary adenomas. Coexistence of a TSHoma and Graves' disease has been very rarely reported. Here, we report a case of a patient whose initial presentation with primary thyrotoxicosis due to Graves' disease, was subsequently followed by a relapse of thyrotoxicosis due to a probable TSHoma. Case: A sixty-eight year old woman was referred to our department with classical features of thyrotoxicosis. Initial biochemistry confirmed hyperthyroxinaemia [free thyroxine (fT4) 20.4 pmol/L (reference range 7.0-16.0)] and a suppressed TSH [< 0.02mIU/L (0.50-4.20)]. A technetium pertechnetate uptake scan was consistent with Graves' Disease. She was treated with carbimazole for 18 months and remained clinically and biochemically euthyroid. After stopping carbimazole her fT4 started to rise but TSH remained normal. Laboratory assay interference was excluded. A TRH stimulation test demonstrated a flat TSH response and pituitary MRI revealed a microadenoma. Remaining pituitary hormones were in the normal range other than a slightly raised IGF-1. An 11 C-methionine PET/CT scan coregistered with volumetric MRI (Met-PET-MRI CR) demonstrated high tracer uptake in the left lateral sella region suggestive of a functioning adenoma. The patient declined surgery and was unable to tolerate cabergoline or octreotide. Thereafter, she has elected to pursue a conservative approach with periodic surveillance. Conclusion: This is a very unusual case of thyrotoxicosis caused by two different processes occurring in the same patient. It highlights the importance of considering dual pathology when previously concordant thyroid function tests become discordant. It also highlights a potential role of Met-PET-MRI CR in the localisation of functioning pituitary tumours.

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Modern imaging of pituitary adenomas

Cited by 57 publications

References 73 publications

3D printing 18F radioactive phantoms for PET imaging

3D printing 18F radioactive phantoms for PET imaging

Automatic detection of pituitary microadenoma from magnetic resonance imaging using deep learning algorithms

A remarkable case of thyrotoxicosis initially caused by graves’ disease followed by a probable TSHoma – a case report

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