Despite the high resolution of magnetic resonance imaging (MRI) of the pituitary gland, up to 40% of cases of Cushing’s disease
(CD) have normal MRI. Fused images of positron emission tomography and computed tomography (PET-CT) may have a potential diagnostic
role in CD in general and in such cases in particular. Objective of this study is to explore the diagnostic potential of PET-CT
for localization of adrenocorticotropin-secreting pituitary adenomas in CD. PET-CT was performed in 12 cases with de novo
(7 cases) or persistent CD (5 cases) that were proven to have CD on biochemical, radiological and/or histopathological findings.
These cases had a definite CD confirmed on histopathological and immunostaining examination of the subsequent transphenoidal
surgical specimens (10 cases) and/or bilateral inferior petrosal sinus sampling (IPSS, 4 cases). PET-CT was positive in 7
of the 12 cases of CD (58%) showing a focal area of uptake in the pituitary gland. In these seven cases, MRI was positive
in six (85.7%) but negative in one case (14.3%). In the other five cases with negative PET-CT, MRI was positive in two and
negative in three cases. Of four cases with negative MRI, PET-CT was positive in one case (25%). We conclude that PET-CT is
positive in around 60% of the cases of CD. Although the majority of cases with positive PET-CT had positive MRI, PET-CT may
detect some cases with negative MRI and thus provides important diagnostic information. If these findings are confirmed in
larger studies, PET-CT might become an important diagnostic technique, especially when the more invasive and technically demanding
procedure of IPSS is not available or inconclusive.
Keywords Cushing’s syndrome - Cushing’s disease - Positron emission tomography - Pituitary gland