0 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; and Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center; National Institutes of Health, Bethesda, Maryland
✓ Microadenomas of the pituitary vary in size, particularly those related to Cushing's disease. They are often not visualized on preoperative magnetic resonance (MR) imaging and may be difficult to find during surgical exploration of the pituitary. To enhance intraoperative localization of pituitary adenomas, we assessed the feasibility of using ultrasound to detect and localize pituitary tumors. Intraoperative ultrasound (IS) in the axial and sagittal planes was performed with an Intrascan system using a 12-MHz mechanically oscillating, end-firing transducer. Interpretation of the scans was performed by two individuals, who were usually blinded to the results of preoperative MR imaging or petrosal sinus sampling.
Twenty-eight patients were examined. Eighteen of these patients had microadenomas (1.5–7 mm), all with Cushing's disease; nine had macroadenomas (10–20 mm), three of which were adrenocorticotropic hormone—secreting, three growth hormone—secreting, two thyroid-stimulating hormone—secreting, and one nonfunctioning; and one patient had an intrasellar craniopharyngioma. Normal sellar and parasellar structures, such as intrapituitary cysts, the intracavernous carotid arteries, and the diaphragma sella were easily visualized. Twenty-three of the 28 tumors, including 13 of the 18 microadenomas, were detected on IS (82% sensitivity). Tumors were seen as hyperechoic masses in 19 patients, mixed echogenicity in three, and isoechoic in one. In most macroadenomas IS allowed visualization of the interface between the tumor and the normal pituitary gland. These results indicate the potential of IS to aid the intraoperative localization and definition of pituitary tumors.
BuchfelderMNistorRFahlbuschRet al: The accuracy of CT and MR evaluation of the sella turcica for the detection of adrenocorticotrophic hormone—secreting adenomas in Cushing disease.AJNR14:1183–11901993Buchfelder M Nistor R Fahlbusch R et al: The accuracy of CT and MR evaluation of the sella turcica for the detection of adrenocorticotrophic hormone—secreting adenomas in Cushing disease. AJNR 14:1183–1190 1993
DoppmanJLFrankJADwyerAJet al: Gadolinium DTPA enhanced MR imaging of ACTH-secreting microadenomas of the pituitary gland.J Comput Assist Tomogr12:728–7351988Doppman JL Frank JA Dwyer AJ et al: Gadolinium DTPA enhanced MR imaging of ACTH-secreting microadenomas of the pituitary gland. J Comput Assist Tomogr 12:728–735 1988
HallWALucianoMGDoppmanJLet al: Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population.Ann Intern Med120:817–8201994Hall WA Luciano MG Doppman JL et al: Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 120:817–820 1994
KernKAShawkerTHDoppmanJLet al: The use of high-resolution ultrasound to locate parathyroid tumors during reoperations for primary hyperparathyroidism.World J Surg11:579–5851987Kern KA Shawker TH Doppman JL et al: The use of high-resolution ultrasound to locate parathyroid tumors during reoperations for primary hyperparathyroidism. World J Surg 11:579–585 1987
NewtonDRDillonWPNormanDet al: Gd-DTPA-enhanced MR imaging of pituitary adenomas.AJNR10:949–9541989Newton DR Dillon WP Norman D et al: Gd-DTPA-enhanced MR imaging of pituitary adenomas. AJNR 10:949–954 1989
NortonJAShawkerTHDoppmanJLet al: Localization and surgical treatment of occult insulinomas.Ann Surg212:615–6201990Norton JA Shawker TH Doppman JL et al: Localization and surgical treatment of occult insulinomas. Ann Surg 212:615–620 1990
OldfieldEHDoppmanJLNiemanLKet al: Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome.N Engl J Med325:897–9051991Oldfield EH Doppman JL Nieman LK et al: Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome. N Engl J Med 325:897–905 1991
PeckWWDillonWPNormanDet al: High-resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing's disease.AJR152:145–1511989Peck WW Dillon WP Norman D et al: High-resolution MR imaging of pituitary microadenomas at 1.5 T: experience with Cushing's disease. AJR 152:145–151 1989
RichardWD: A new time-gain correction method for standard B-mode ultrasound imaging.IEEE Trans Med Imaging8:283–2851989Richard WD: A new time-gain correction method for standard B-mode ultrasound imaging. IEEE Trans Med Imaging 8:283–285 1989