Value of pituitary gland MRI at 7 T in Cushing’s disease and relationship to inferior petrosal sinus sampling: Case report

Meng Law, Regina Wang, Chia Shang J. Liu, Mark S. Shiroishi, John D. Carmichael, William J. Mack, Martin Weiss, Danny J.J. Wang, Arthur W. Toga, Gabriel Zada

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4 Citations (Scopus)


Cushing’s disease is caused by adrenocorticotrophic hormone (ACTH)–secreting pituitary adenomas, which are often difficult to identify on standard 1.5-T or 3-T MRI, including dynamic contrast imaging. Inferior petrosal and cavernous sinus sampling remains the gold standard for MRI-negative Cushing’s disease. The authors report on a 27-year-old woman with Cushing’s disease in whom the results of standard 1.5-T and 3-T MRI, including 1.5-T dynamic contrast imaging, were negative. Inferior petrosal sinus sampling showed a high central-to-peripheral ACTH ratio (148:1) as well as a right-to-left ACTH gradient (19:1), suggesting a right-sided pituitary microadenoma. The patient underwent 7-T MRI, which showed evidence of a right-sided pituitary lesion with focal hypoenhancement not visualized on 1.5-T or 3-T MRI. The patient underwent an endoscopic endonasal transsphenoidal operation, with resection of a right-sided pituitary mass. Postoperatively, she developed clinical symptoms suggestive of adrenal insufficiency and a nadir cortisol level of 1.6 μg/dl on postoperative day 3, and hydrocortisone therapy was initiated. Permanent histo-pathology specimens showed Crooke’s hyaline change and ACTH-positive cells suggestive of an adenoma. MRI at 7 T may be beneficial in identifying pituitary microadenoma location in cases of standard 1.5-T and 3-T MRI-negative Cushing’s disease. In the future, 7-T MRI may preempt inferior petrosal sinus sampling and help in cases of standard and dynamic contrast 1.5-T and 3-T MRI-negative Cushing’s disease.

Original languageEnglish
Pages (from-to)347-351
Number of pages5
JournalJournal of Neurosurgery
Issue number2
Publication statusPublished - 1 Feb 2019
Externally publishedYes


  • 7-T MRI
  • Cushing’s disease
  • Pituitary surgery

Cite this

Law, M., Wang, R., Liu, C. S. J., Shiroishi, M. S., Carmichael, J. D., Mack, W. J., Weiss, M., Wang, D. J. J., Toga, A. W., & Zada, G. (2019). Value of pituitary gland MRI at 7 T in Cushing’s disease and relationship to inferior petrosal sinus sampling: Case report. Journal of Neurosurgery, 130(2), 347-351.