• Dalia Batista, Nickolas A Courkoutsakis, Edward H Oldfield, Kurt J Griffin, Meg Keil, Nickolas J Patronas, and Constantine A Stratakis.
• Section on Endocrinology and Genetics, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, Room 10N262, 10 Center Drive, MSC 1862, Bethesda, Maryland 20892-1862, USA.
• J. Clin. Endocrinol. Metab. 2005 Sep 1;90(9):5134-40.

ContextWe recently showed that pre- and postcontrast spoiled gradient-recalled acquisition in the steady-state (SPGR) was superior to conventional pre- and postcontrast T-1 weighted spin echo (SE) acquisition magnetic resonance imaging (MRI) for the diagnostic evaluation of pituitary tumors in adult patients.ObjectiveThe present investigation assessed the use of SPGR vs. SE-MRI in the diagnostic evaluation of ACTH-secreting tumors in children and adolescents with Cushing disease.DesignData were analyzed retrospectively from a series of patients seen over 7 yr (1997-2004).SettingThe setting for this study was a tertiary care referral center.PatientsThirty children with Cushing disease (13 females and 17 males with a mean age of 12 +/- 3 yr) were studied.Interventions And Outcome MeasuresImaging results were compared with surgical and pathological findings and the clinical outcome.ResultsTwenty-eight patients had microadenomas, and two had macroadenomas; the latter were identified by both MRI techniques. Precontrast SE and SPGR-MRI identified four and six of the microadenomas, respectively. Postcontrast SPGR-MRI identified the location of the tumor in 18 of 28 patients, whereas postcontrast SE-MRI identified the location and accurately estimated the size of the tumor in only five patients (P < 0.001).ConclusionsWe conclude that conventional MRI, even with contrast enhancement, mostly failed to identify ACTH-secreting microadenomas in children and adolescents with Cushing disease. Postcontrast SPGR-MRI was superior to SE-MRI and should be used in addition to conventional SE-MRI in the pituitary evaluation of children and adolescents with suspected Cushing disease.

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