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Abstract
Purpose
The purpose of this study is to compare the performance of the T1 3D subtraction technique and the conventional 2D dynamic contrast enhancement (DCE) technique in diagnosing Cushing's disease.
Materials and Methods
Twelve patients with clinically and biochemically proven Cushing's disease were included in the study. In addition, 23 patients with a Rathke's cleft cyst (RCC) diagnosed on an MRI with normal pituitary hormone levels were included as a control, to prevent non-blinded positive results. Postcontrast T1 3D fast spin echo (FSE) images were acquired after DCE images in 3T MRI and image subtraction of pre- and postcontrast T1 3D FSE images were performed. Inter-observer agreement, interpretation time, multiobserver receiver operating characteristic (ROC), and net benefit analyses were performed to compare 2D DCE and T1 3D subtraction techniques.
Results
Inter-observer agreement for a visual scale of contrast enhancement was poor in DCE (κ = 0.57) and good in T1 3D subtraction images (κ = 0.75). The time taken for determining contrast-enhancement in pituitary lesions was significantly shorter in the T1 3D subtraction images compared to the DCE sequence (P < 0.05). ROC values demonstrated increased reader confidence range with T1 3D subtraction images (95% confidence interval [CI]: 0.94–1.00) compared with DCE (95% CI: 0.70–0.92) (P < 0.01). The net benefit effect of T1 3D subtraction images over DCE was 0.34 (95% CI: 0.12–0.56). For Cushing's disease, both reviewers misclassified one case as a nonenhancing lesion on the DCE images, while no cases were misclassified on T1 3D subtraction images.
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Fig. 1.
Images of a 37-year-old female patient diagnosed with Cushing disease. On conventional dynamic contrast enhanced images (a), both reviewers recorded the visual scale as 1 (suspicious enhancement) (arrows). On subtraction image (b), there is definite contrast enhancement of the lesion, which was defined as having a higher value compared to the subtracted temporal white matter. Both reviewers recorded the visual scale as 2 (definite contrast enhancement) (arrow).
Fig. 2.
Images of a 32-year-old female patient diagnosed with Rathke's cleft cyst. On conventional dynamic images (a), reviewer 1 recorded the visual scale as 1 (suspicious contrast enhancement) and reviewer 2 recorded the visual scale as 2 (definite contrast enhancement) (arrows). On subtraction image (b), there is no contrast enhancement of the lesion and both reviewers recorded the visual scales as 0 (no contrast enhancement) (arrow).
Table 1.
Imaging Parameters for the Conventional Dynamic Enhancement and T1 3D Fast Spin Echo Sequences
Table 2.
Interpretati of Contrast Enhance on Time (second) Taken for Deterrmination
| DCE | T1 3D subtraction | P value | |
|---|---|---|---|
| Cushing + RCC (n = 3 | 35) 17.9 ± 12.0 | 8.1 ± 5.2 | < 0.001 |
| Cushing (n = 12) | 23.5 ± 15.2 | 9.5 ± 6.7 | < 0.001 |
| RCC (n = 23) | 15.0 ± 8.7 | 7.4 ± 4.2 | < 0.001 |
Table 3.
Interpretation Results for Diagnosis of Cushing Disease and RCC on DCE and Subtraction Images
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