High-resolution 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for pituitary adenoma detection in Cushing disease

Prashant Chittiboina, Blake K. Montgomery, Corina Millo, Peter Herscovitch, Russell R. Lonser

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


OBJECT: High-resolution PET (hrPET) performed using a high-resolution research tomograph is reported as having a resolution of 2 mm and could be used to detect corticotroph adenomas through uptake of 18F-fluorodeoxyglucose (18F-FDG). To determine the sensitivity of this imaging modality, the authors compared 18F-FDG hrPET and MRI detection of pituitary adenomas in Cushing disease (CD). METHODS:Consecutive patients with CD who underwent preoperative 18F-FDG hrPET and MRI (spin echo [SE] and spoiled gradient recalled [SPGR] sequences) were prospectively analyzed. Standardized uptake values (SUVs) were calculated from hrPET and were compared with MRI findings. Imaging findings were correlated to operative and histological findings. RESULTS:Ten patients (7 females and 3 males) were included (mean age 30.8 ± 19.3 years; range 11-59 years). MRI revealed a pituitary adenoma in 4 patients (40% of patients) on SE and 7 patients (70%) on SPGR sequences. 18F-FDG hrPET demonstrated increased 18F-FDG uptake consistent with an adenoma in 4 patients (40%; adenoma size range 3-14 mm). Maximum SUV was significantly higher for 18F-FDG hrPET-positive tumors (difference=5.1, 95% CI 2.1-8.1; p=0.004) than for 18F-FDG hrPET-negative tumors. 18F-FDG hrPET positivity was not associated with tumor volume (p=0.2) or dural invasion (p=0.5). Midnight and morning ACTH levels were associated with 18F-FDG hrPET positivity (p=0.01 and 0.04, respectively) and correlated with the maximum SUV (R=0.9; p=0.001) and average SUV (R=0.8; p=0.01). All 18F-FDG hrPET-positive adenomas had a less than a 180% ACTH increase and 18F-FDG hrPET-negative adenomas had a greater than 180% ACTH increase after CRH stimulation (p=0.03). Three adenomas were detected on SPGR MRI sequences that were not detected by 18F-FDG hrPET imaging. Two adenomas not detected on SE (but no adenomas not detected on SPGR) were detected on 18F-FDG hrPET. CONCLUSIONS:While 18F-FDG hrPET imaging can detect small functioning corticotroph adenomas and is more sensitive than SE MRI, SPGR MRI is more sensitive than 18F-FDG hrPET and SE MRI in the detection of CD-associated pituitary adenomas. Response to CRH stimulation can predict 18F-FDG hrPET-positive adenomas in CD. Clinical trial registration no.: NCT01459237 (clinicaltrials.gov)

Original languageEnglish
Pages (from-to)791-797
Number of pages7
JournalJournal of neurosurgery
Issue number4
StatePublished - Apr 2015


  • Cushing disease
  • Magnetic resonance imaging
  • Pituitary adenoma
  • Pituitary surgery
  • Positron emission tomography


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