{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:35:55Z","timestamp":1783654555636,"version":"3.55.0"},"reference-count":49,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Accurate presurgical localization of microadenomas in Cushing\u2019s disease (CD) leads to improved remission rates and decreased adverse events. Volumetric gradient recalled echo (3D-GRE) MRI detects pituitary microadenomas in CD in up to 50%\u201380% cases as a focus of hypointensity due to delayed contrast wash-in. The authors have previously reported that postcontrast FLAIR imaging may be useful in detecting otherwise MRI-negative pituitary microadenomas as foci of hyperintensity. This reflects theoretically complementary imaging of microadenomas due to delayed contrast washout. The authors report on the diagnostic accuracy and clinical utility of FLAIR imaging in the detection of microadenomas in patients with CD.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors prospectively analyzed imaging findings in 23 patients (24 tumors) with biochemically proven CD who underwent transsphenoidal surgery for CD. Preoperatively, the patients underwent pituitary MRI with postcontrast FLAIR and postcontrast 3D-GRE sequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Postcontrast FLAIR hyperintensity was detected in macroadenomas, and in 3D-GRE\u2013positive or \u2013negative microadenomas. Overall, 3D-GRE was superior in detecting surgically and histopathologically confirmed, location-concordant microadenomas. Of 24 pituitary adenomas, 18 (75%; sensitivity 82%, positive predictive value 95%) were found on 3D-GRE, and 13 (50% [1 was false positive]; sensitivity 55%, positive predictive value 92%) were correctly identified on FLAIR. The stand-alone specificity of 3D-GRE and FLAIR was similar (50%). These results confirm the superiority of 3D-GRE as a stand-alone imaging modality. The authors then tested the utility of FLAIR as a complementary tool to 3D-GRE imaging. All 5 patients with negative 3D-GRE MRI displayed a distinct focus of FLAIR enhancement. Four of those 5 cases (80%) had location-concordant positive histopathological results and achieved postsurgical biochemical remission. The remaining patient was not cured, because resection did not include the region of FLAIR hyperintensity.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>This study suggests that delayed microadenoma contrast washout may be detected as FLAIR hyperintensity in otherwise MRI-negative CD cases. The authors propose adding postcontrast FLAIR sequences to complement 3D-GRE for surgical planning in patients with CD.<\/jats:p><jats:p>Clinical trial registration no.: NIH protocol 03-N-0164, NCT00060541 (clinicaltrials.gov)<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.4.jns17234","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T13:59:19Z","timestamp":1507903159000},"page":"620-628","source":"Crossref","is-referenced-by-count":38,"title":["Potential utility of FLAIR in MRI-negative Cushing\u2019s disease"],"prefix":"10.3171","volume":"129","author":[{"given":"Gr\u00e9goire P.","family":"Chatain","sequence":"first","affiliation":[{"name":"Neurosurgery Unit for Pituitary and Inheritable Diseases, and"},{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Patronas","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Smirniotopoulos","sequence":"additional","affiliation":[{"name":"Department of Radiology, George Washington University, Washington, DC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Piazza","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Benzo","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhik","family":"Ray-Chaudhury","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susmeeta","family":"Sharma","sequence":"additional","affiliation":[{"name":"Pituitary Endocrinology Section, MedStar Washington Hospital Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Lodish","sequence":"additional","affiliation":[{"name":"Section on Endocrinology and Genetics, Pediatric Endocrinology Inter-Institute Training Program,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette","family":"Nieman","sequence":"additional","affiliation":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantine A.","family":"Stratakis","sequence":"additional","affiliation":[{"name":"Section on Endocrinology and Genetics, Pediatric Endocrinology Inter-Institute Training Program,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Chittiboina","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit for Pituitary and Inheritable Diseases, and"},{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Best Pract Res Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.beem.2011.06.003","article-title":"Evidence-based endocrinology: illustrating its principles in the management of patients with pituitary incidentalomas","volume":"26","author":"Bancos I","year":"2012","unstructured":"Bancos I, Natt N, Murad MH, Montori VM: Evidence-based endocrinology: illustrating its principles in the management of patients with pituitary incidentalomas. Best Pract Res Clin Endocrinol Metab 26:9\u201319, 20122230544910.1016\/j.beem.2011.06.003"},{"key":"b2","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2454","DOI":"10.1210\/jc.2007-2734","article-title":"Treatment of adrenocorticotropin-dependent Cushing\u2019s syndrome: a consensus statement","volume":"93","author":"Biller BMK","year":"2008","unstructured":"Biller BMK, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, : Treatment of adrenocorticotropin-dependent Cushing\u2019s syndrome: a consensus statement. J Clin Endocrinol Metab 93:2454\u20132462, 20081841342710.1210\/jc.2007-2734"},{"key":"b3","series-title":"J Clin Endocrinol Metab","first-page":"3114","article-title":"Factors influencing the immediate and late outcome of Cushing\u2019s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing\u2019s Disease Survey Group","volume":"80","author":"Bochicchio D","year":"1995","unstructured":"Bochicchio D, Losa M, Buchfelder M: Factors influencing the immediate and late outcome of Cushing\u2019s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing\u2019s Disease Survey Group. J Clin Endocrinol Metab 80:3114\u20133120, 19957593411"},{"key":"b4","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1148\/radiology.149.1.6611921","article-title":"Dynamic computed tomography of the pituitary gland: the \u201ctuft sign\u201d","volume":"149","author":"Bonneville JF","year":"1983","unstructured":"Bonneville JF, Cattin F, Moussa-Bacha K, Portha C: Dynamic computed tomography of the pituitary gland: the \u201ctuft sign\u201d. Radiology 149:145\u2013148, 1983661192110.1148\/radiology.149.1.6611921"},{"key":"b5","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"791","DOI":"10.3171\/2014.10.JNS14911","article-title":"High-resolution 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for pituitary adenoma detection in Cushing disease","volume":"122","author":"Chittiboina P","year":"2015","unstructured":"Chittiboina P, Montgomery BK, Millo C, Herscovitch P, Lonser RR: High-resolution 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for pituitary adenoma detection in Cushing disease. J Neurosurg 122:791\u2013797, 201510.3171\/2014.10.JNS1491125479121"},{"key":"b6","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1111\/j.1365-2265.2009.03646.x","article-title":"A change in pituitary magnetic resonance imaging protocol detects ACTH-secreting tumours in patients with previously negative results","volume":"72","author":"Chowdhury IN","year":"2010","unstructured":"Chowdhury IN, Sinaii N, Oldfield EH, Patronas N, Nieman LK: A change in pituitary magnetic resonance imaging protocol detects ACTH-secreting tumours in patients with previously negative results. Clin Endocrinol (Oxf) 72:502\u2013506, 201010.1111\/j.1365-2265.2009.03646.x19500112"},{"key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"817","article-title":"Gadolinium-DTPA and MR imaging of pituitary adenoma: a preliminary report","volume":"8","author":"Davis PC","year":"1987","unstructured":"Davis PC, Hoffman JC Jr, Malko JA, Tindall GT, Takei Y, Avruch L, : Gadolinium-DTPA and MR imaging of pituitary adenoma: a preliminary report. AJNR Am J Neuroradiol 8:817\u2013823, 1987"},{"key":"b8","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/j.1365-2265.1994.tb02448.x","article-title":"Pituitary tumour localization in patients with Cushing\u2019s disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling?","volume":"40","author":"de Herder WW","year":"1994","unstructured":"de Herder WW, Uitterlinden P, Pieterman H, Tanghe HL, Kwekkeboom DJ, Pols HA, : Pituitary tumour localization in patients with Cushing\u2019s disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling? Clin Endocrinol (Oxf) 40:87\u201392, 199410.1111\/j.1365-2265.1994.tb02448.x"},{"key":"b9","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1148\/radiology.163.2.3562821","article-title":"Pituitary adenomas in patients with Cushing disease: initial experience with Gd-DTPA-enhanced MR imaging","volume":"163","author":"Dwyer AJ","year":"1987","unstructured":"Dwyer AJ, Frank JA, Doppman JL, Oldfield EH, Hickey AM, Cutler GB, : Pituitary adenomas in patients with Cushing disease: initial experience with Gd-DTPA-enhanced MR imaging. Radiology 163:421\u2013426, 198710.1148\/radiology.163.2.35628213562821"},{"key":"b10","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1148\/radiology.189.1.8372195","article-title":"Varied microcirculation of pituitary adenomas at rapid, dynamic, contrast-enhanced MR imaging","volume":"189","author":"Finelli DA","year":"1993","unstructured":"Finelli DA, Kaufman B: Varied microcirculation of pituitary adenomas at rapid, dynamic, contrast-enhanced MR imaging. Radiology 189:205\u2013210, 1993837219510.1148\/radiology.189.1.8372195"},{"key":"b11","series-title":"Horm Metab Res","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1055\/s-2007-980192","article-title":"Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing\u2019s syndrome and should be part of the initial workup","volume":"39","author":"Friedman TC","year":"2007","unstructured":"Friedman TC, Zuckerbraun E, Lee ML, Kabil MS, Shahinian H: Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing\u2019s syndrome and should be part of the initial workup. Horm Metab Res 39:451\u2013456, 200710.1055\/s-2007-980192"},{"key":"b12","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s00247-003-1057-8","article-title":"Post-contrast FLAIR MR imaging of the brain in children: normal and abnormal intracranial enhancement","volume":"33","author":"Goo HW","year":"2003","unstructured":"Goo HW, Choi CG: Post-contrast FLAIR MR imaging of the brain in children: normal and abnormal intracranial enhancement. Pediatr Radiol 33:843\u2013849, 20031455175610.1007\/s00247-003-1057-8"},{"key":"b13","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"817","DOI":"10.7326\/0003-4819-120-10-199405150-00001","article-title":"Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population","volume":"120","author":"Hall WA","year":"1994","unstructured":"Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH: Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 120:817\u2013820, 199410.7326\/0003-4819-120-10-199405150-000018154641"},{"key":"b14","series-title":"Tutor Quant Methods Psychol","doi-asserted-by":"publisher","first-page":"23","DOI":"10.20982\/tqmp.08.1.p023","article-title":"Computing inter-rater reliability for observational data: an overview and tutorial","volume":"8","author":"Hallgren KA","year":"2012","unstructured":"Hallgren KA: Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8:23\u201334, 20122283377610.20982\/tqmp.08.1.p023"},{"key":"b15","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3171\/JNS\/2008\/108\/01\/0009","article-title":"Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years","volume":"108","author":"Hofmann BM","year":"2008","unstructured":"Hofmann BM, Hlavac M, Martinez R, Buchfelder M, M\u00fcller OA, Fahlbusch R: Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years. J Neurosurg 108:9\u201318, 20081817330510.3171\/JNS\/2008\/108\/01\/0009"},{"key":"b16","series-title":"Endocrine","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1007\/s12020-013-9876-3","article-title":"Double pituitary adenomas","volume":"43","author":"Iacovazzo D","year":"2013","unstructured":"Iacovazzo D, Bianchi A, Lugli F, Milardi D, Giampietro A, Lucci-Cordisco E, : Double pituitary adenomas. Endocrine 43:452\u2013457, 201310.1007\/s12020-013-9876-323325364"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"531","DOI":"10.3171\/2008.8.JNS08339","article-title":"Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease","volume":"111","author":"Jagannathan J","year":"2009","unstructured":"Jagannathan J, Smith R, DeVroom HL, Vortmeyer AO, Stratakis CA, Nieman LK, : Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease. J Neurosurg 111:531\u2013539, 20091926752610.3171\/2008.8.JNS08339"},{"key":"b18","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1111\/cen.12069","article-title":"Volume interpolated 3D-spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for MRI detection of corticotropin secreting pituitary microadenomas","volume":"78","author":"Kasaliwal R","year":"2013","unstructured":"Kasaliwal R, Sankhe SS, Lila AR, Budyal SR, Jagtap VS, Sarathi V, : Volume interpolated 3D-spoiled gradient echo sequence is better than dynamic contrast spin echo sequence for MRI detection of corticotropin secreting pituitary microadenomas. Clin Endocrinol (Oxf) 78:825\u2013830, 20132306177310.1111\/cen.12069"},{"key":"b19","series-title":"J Magn Reson Imaging","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1002\/jmri.20331","article-title":"Relationship between contrast enhancement on fluid-attenuated inversion recovery MR sequences and signal intensity on T2-weighted MR images: visual evaluation of brain tumors","volume":"21","author":"Kubota T","year":"2005","unstructured":"Kubota T, Yamada K, Kizu O, Hirota T, Ito H, Ishihara K, : Relationship between contrast enhancement on fluid-attenuated inversion recovery MR sequences and signal intensity on T2-weighted MR images: visual evaluation of brain tumors. J Magn Reson Imaging 21:694\u2013700, 200510.1002\/jmri.2033115906343"},{"key":"b20","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"671","DOI":"10.2214\/ajr.163.3.8079866","article-title":"Detection of pituitary microadenomas: comparison of dynamic keyhole fast spin-echo, unenhanced, and conventional contrast-enhanced MR imaging","volume":"163","author":"Kucharczyk W","year":"1994","unstructured":"Kucharczyk W, Bishop JE, Plewes DB, Keller MA, George S: Detection of pituitary microadenomas: comparison of dynamic keyhole fast spin-echo, unenhanced, and conventional contrast-enhanced MR imaging. AJR Am J Roentgenol 163:671\u2013679, 199410.2214\/ajr.163.3.80798668079866"},{"key":"b21","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1148\/radiology.161.3.3786729","article-title":"Pituitary adenomas: high-resolution MR imaging at 1.5 T","volume":"161","author":"Kucharczyk W","year":"1986","unstructured":"Kucharczyk W, Davis DO, Kelly WM, Sze G, Norman D, Newton TH: Pituitary adenomas: high-resolution MR imaging at 1.5 T. Radiology 161:761\u2013765, 198610.1148\/radiology.161.3.3786729"},{"key":"b22","series-title":"Korean J Radiol","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3348\/kjr.2016.17.1.127","article-title":"Importance of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging in various intracranial pathologic conditions","volume":"17","author":"Lee EK","year":"2016","unstructured":"Lee EK, Lee EJ, Kim S, Lee YS: Importance of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging in various intracranial pathologic conditions. Korean J Radiol 17:127\u2013141, 20162679822510.3348\/kjr.2016.17.1.127"},{"key":"b23","series-title":"Eur Radiol","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1007\/s00330-011-2291-3","article-title":"Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas","volume":"22","author":"Lee HB","year":"2012","unstructured":"Lee HB, Kim ST, Kim HJ, Kim KH, Jeon P, Byun HS, : Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas. Eur Radiol 22:514\u2013518, 20122194748610.1007\/s00330-011-2291-3"},{"key":"b24","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1210\/jc.2011-0456","article-title":"The postoperative basal cortisol and CRH tests for prediction of long-term remission from Cushing\u2019s disease after transsphenoidal surgery","volume":"96","author":"Lindsay JR","year":"2011","unstructured":"Lindsay JR, Oldfield EH, Stratakis CA, Nieman LK: The postoperative basal cortisol and CRH tests for prediction of long-term remission from Cushing\u2019s disease after transsphenoidal surgery. J Clin Endocrinol Metab 96:2057\u20132064, 20112150812610.1210\/jc.2011-0456"},{"key":"b25","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1111\/j.1365-2265.2004.02115.x","article-title":"Cavernous and inferior petrosal sinus sampling in the evaluation of ACTH-dependent Cushing\u2019s syndrome","volume":"61","author":"Liu C","year":"2004","unstructured":"Liu C, Lo JC, Dowd CF, Wilson CB, Kunwar S, Aron DC, : Cavernous and inferior petrosal sinus sampling in the evaluation of ACTH-dependent Cushing\u2019s syndrome. Clin Endocrinol (Oxf) 61:478\u2013486, 20041547388110.1111\/j.1365-2265.2004.02115.x"},{"key":"b26","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1210\/jc.2012-3604","article-title":"Outcome of surgical treatment of 200 children with Cushing\u2019s disease","volume":"98","author":"Lonser RR","year":"2013","unstructured":"Lonser RR, Wind JJ, Nieman LK, Weil RJ, DeVroom HL, Oldfield EH: Outcome of surgical treatment of 200 children with Cushing\u2019s disease. J Clin Endocrinol Metab 98:892\u2013901, 20132337217310.1210\/jc.2012-3604"},{"key":"b27","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1148\/radiology.211.1.r99mr25257","article-title":"Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging","volume":"211","author":"Mathews VP","year":"1999","unstructured":"Mathews VP, Caldemeyer KS, Lowe MJ, Greenspan SL, Weber DM, Ulmer JL: Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 211:257\u2013263, 199910.1148\/radiology.211.1.r99mr2525710189481"},{"key":"b28","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/j.jocn.2015.01.001","article-title":"Different imaging characteristics of concurrent pituitary adenomas in a patient with Cushing\u2019s disease","volume":"22","author":"Mehta GU","year":"2015","unstructured":"Mehta GU, Montgomery BK, Raghavan P, Sharma S, Nieman LK, Patronas N, : Different imaging characteristics of concurrent pituitary adenomas in a patient with Cushing\u2019s disease. J Clin Neurosci 22:891\u2013894, 201510.1016\/j.jocn.2015.01.001"},{"key":"b29","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"803","DOI":"10.2214\/ajr.171.3.9725320","article-title":"Usefulness of optimized gadolinium-enhanced fast fluid-attenuated inversion recovery MR imaging in revealing lesions of the brain","volume":"171","author":"Melhem ER","year":"1998","unstructured":"Melhem ER, Bert RJ, Walker RE: Usefulness of optimized gadolinium-enhanced fast fluid-attenuated inversion recovery MR imaging in revealing lesions of the brain. AJR Am J Roentgenol 171:803\u2013807, 199810.2214\/ajr.171.3.97253209725320"},{"key":"b30","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1148\/radiology.185.1.1523298","article-title":"Neurologic complications of petrosal sinus sampling","volume":"185","author":"Miller DL","year":"1992","unstructured":"Miller DL, Doppman JL, Peterman SB, Nieman LK, Oldfield EH, Chang R: Neurologic complications of petrosal sinus sampling. Radiology 185:143\u2013147, 1992152329810.1148\/radiology.185.1.1523298"},{"key":"b31","series-title":"Best Pract Res Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/j.beem.2009.05.001","article-title":"Pituitary tumours: pituitary incidentalomas","volume":"23","author":"Molitch ME","year":"2009","unstructured":"Molitch ME: Pituitary tumours: pituitary incidentalomas. Best Pract Res Clin Endocrinol Metab 23:667\u2013675, 200910.1016\/j.beem.2009.05.00119945030"},{"key":"b32","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1210\/jc.2002-021753","article-title":"Cushing\u2019s disease, 70 years later\u2026and the beat goes on","volume":"88","author":"Moshang T Jr","year":"2003","unstructured":"Moshang T Jr: Cushing\u2019s disease, 70 years later\u2026and the beat goes on. J Clin Endocrinol Metab 88:31\u201333, 200310.1210\/jc.2002-021753"},{"key":"b33","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing\u2019s syndrome: an Endocrine Society Clinical Practice Guideline","volume":"93","author":"Nieman LK","year":"2008","unstructured":"Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM, : The diagnosis of Cushing\u2019s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 93:1526\u20131540, 200810.1210\/jc.2008-0125"},{"key":"b34","series-title":"Clin Neurosurg","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1227\/NEU.0b013e3182269d3f","article-title":"Surgical management of Cushing\u2019s disease: a personal perspective","volume":"58","author":"Oldfield EH","year":"2011","unstructured":"Oldfield EH: Surgical management of Cushing\u2019s disease: a personal perspective. Clin Neurosurg 58:13\u201326, 20112191612410.1227\/NEU.0b013e3182269d3f"},{"key":"b35","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1056\/NEJM199109263251301","article-title":"Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing\u2019s syndrome","volume":"325","author":"Oldfield EH","year":"1991","unstructured":"Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA, : Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing\u2019s syndrome. N Engl J Med 325:897\u2013905, 199110.1056\/NEJM1991092632513011652686"},{"key":"b36","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3171\/jns.2006.104.1.7","article-title":"Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors","volume":"104","author":"Oldfield EH","year":"2006","unstructured":"Oldfield EH, Vortmeyer AO: Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. J Neurosurg 104:7\u201319, 20061650914210.3171\/jns.2006.104.1.7"},{"key":"b37","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1210\/jc.2002-021438","article-title":"Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging detection of adrenocorticotropin-secreting pituitary tumors","volume":"88","author":"Patronas N","year":"2003","unstructured":"Patronas N, Bulakbasi N, Stratakis CA, Lafferty A, Oldfield EH, Doppman J, : Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging detection of adrenocorticotropin-secreting pituitary tumors. J Clin Endocrinol Metab 88:1565\u20131569, 200310.1210\/jc.2002-02143812679440"},{"key":"b38","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s11102-012-0421-9","article-title":"Enhanced nestin expression and small blood vessels in human pituitary adenomas","volume":"16","author":"Perez-Millan MI","year":"2013","unstructured":"Perez-Millan MI, Berner SI, Luque GM, De Bonis C, Sevlever G, Becu-Villalobos D, : Enhanced nestin expression and small blood vessels in human pituitary adenomas. Pituitary 16:303\u2013310, 20132288668210.1007\/s11102-012-0421-9"},{"key":"b39","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"753","DOI":"10.3171\/jns.2000.93.5.0753","article-title":"Multiple pituitary adenomas in Cushing\u2019s disease","volume":"93","author":"Ratliff JK","year":"2000","unstructured":"Ratliff JK, Oldfield EH: Multiple pituitary adenomas in Cushing\u2019s disease. J Neurosurg 93:753\u2013761, 20001105965410.3171\/jns.2000.93.5.0753"},{"key":"b40","series-title":"Pathol Int","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/j.1440-1827.2010.02613.x","article-title":"Unusual double pituitary adenoma: a case report","volume":"61","author":"Rotondo F","year":"2011","unstructured":"Rotondo F, Khatun N, Scheithauer BW, Horvath E, Marotta TR, Cusimano M, : Unusual double pituitary adenoma: a case report. Pathol Int 61:42\u201346, 201110.1111\/j.1440-1827.2010.02613.x21166942"},{"key":"b41","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"3371","DOI":"10.1210\/jc.2003-031908","article-title":"Pituitary magnetic resonance imaging findings do not influence surgical outcome in adrenocorticotropin-secreting microadenomas","volume":"89","author":"Salenave S","year":"2004","unstructured":"Salenave S, Gatta B, Pecheur S, San-Galli F, Visot A, Lasjaunias P, : Pituitary magnetic resonance imaging findings do not influence surgical outcome in adrenocorticotropin-secreting microadenomas. J Clin Endocrinol Metab 89:3371\u20133376, 20041524061710.1210\/jc.2003-031908"},{"key":"b42","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1097\/00006123-200003000-00005","article-title":"Transsphenoidal surgery for Cushing\u2019s disease: outcome in patients with a normal magnetic resonance imaging scan","volume":"46","author":"Semple PL","year":"2000","unstructured":"Semple PL, Vance ML, Findling J, Laws ERJ Jr: Transsphenoidal surgery for Cushing\u2019s disease: outcome in patients with a normal magnetic resonance imaging scan. Neurosurgery 46:553\u2013559, 20001071985010.1097\/00006123-200003000-00005"},{"key":"b43","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/BF01401467","article-title":"Raymond\u2019s syndrome following petrosal sinus sampling","volume":"131","author":"Seyer H","year":"1994","unstructured":"Seyer H, Honegger J, Schott W, K\u00fcchle M, Huk WJ, Fahlbusch R, : Raymond\u2019s syndrome following petrosal sinus sampling. Acta Neurochir (Wien) 131:157\u2013159, 1994770977910.1007\/BF01401467"},{"key":"b44","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1136\/jnnp.62.5.527","article-title":"A neurological complication of inferior petrosal sinus sampling during investigation for Cushing\u2019s disease: a case report","volume":"62","author":"Sturrock ND","year":"1997","unstructured":"Sturrock ND, Jeffcoate WJ: A neurological complication of inferior petrosal sinus sampling during investigation for Cushing\u2019s disease: a case report. J Neurol Neurosurg Psychiatry 62:527\u2013528, 1997915361510.1136\/jnnp.62.5.527"},{"key":"b45","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1046\/j.1365-2265.1998.00541.x","article-title":"Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing\u2019s disease","volume":"49","author":"Tabarin A","year":"1998","unstructured":"Tabarin A, Laurent F, Catargi B, Olivier-Puel F, Lescene R, Berge J, : Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing\u2019s disease. Clin Endocrinol (Oxf) 49:293\u2013300, 199810.1046\/j.1365-2265.1998.00541.x"},{"key":"b46","series-title":"AJNR Am J Neuroradiol","first-page":"1081","article-title":"Preliminary evaluation of fluid-attenuated inversion-recovery MR in the diagnosis of intracranial tumors","volume":"17","author":"Tsuchiya K","year":"1996","unstructured":"Tsuchiya K, Mizutani Y, Hachiya J: Preliminary evaluation of fluid-attenuated inversion-recovery MR in the diagnosis of intracranial tumors. AJNR Am J Neuroradiol 17:1081\u20131086, 1996"},{"key":"b47","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/BF03345118","article-title":"Microvascular density and vascular endothelial growth factor expression in normal pituitary tissue and pituitary adenomas","volume":"26","author":"Viacava P","year":"2003","unstructured":"Viacava P, Gasperi M, Acerbi G, Manetti L, Cecconi E, Bonadio AG, : Microvascular density and vascular endothelial growth factor expression in normal pituitary tissue and pituitary adenomas. J Endocrinol Invest 26:23\u201328, 20031260253010.1007\/BF03345118"},{"key":"b48","series-title":"Endocrine","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s12020-016-1038-y","article-title":"Pituitary magnetic resonance imaging in Cushing\u2019s disease","volume":"55","author":"Vitale G","year":"2017","unstructured":"Vitale G, Tortora F, Baldelli R, Cocchiara F, Paragliola RM, Sbardella E, : Pituitary magnetic resonance imaging in Cushing\u2019s disease. Endocrine 55:691\u2013696, 20172743559010.1007\/s12020-016-1038-y"},{"key":"b49","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"2285","DOI":"10.1210\/jc.2012-3943","article-title":"The lateralization accuracy of inferior petrosal sinus sampling in 501 patients with Cushing\u2019s disease","volume":"98","author":"Wind JJ","year":"2013","unstructured":"Wind JJ, Lonser RR, Nieman LK, DeVroom HL, Chang R, Oldfield EH: The lateralization accuracy of inferior petrosal sinus sampling in 501 patients with Cushing\u2019s disease. J Clin Endocrinol Metab 98:2285\u20132293, 201310.1210\/jc.2012-394323553862"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/3\/article-p620.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/3\/article-p620.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/3\/article-p620.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:19:38Z","timestamp":1743387578000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/3\/article-p620.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":49,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2017.4.jns17234","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]}}}