| A radiologic score to distinguish autoimmune hypophysitis from nonsecreting pituitary adenoma preoperatively. | |
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MedLine Citation:
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PMID: 19628625 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Autoimmune hypophysitis (AH) mimics the more common nonsecreting pituitary adenomas and can be diagnosed with certainty only histologically. Approximately 40% of patients with AH are still misdiagnosed as having pituitary macroadenoma and undergo unnecessary surgery. MR imaging is currently the best noninvasive diagnostic tool to differentiate AH from nonsecreting adenomas, though no single radiologic sign is diagnostically accurate. The purpose of this study was to develop a scoring system that summarizes numerous MR imaging signs to increase the probability of diagnosing AH before surgery. MATERIALS AND METHODS: This was a case-control study of 402 patients, which compared the presurgical pituitary MR imaging features of patients with nonsecreting pituitary adenoma and controls with AH. MR images were compared on the basis of 16 morphologic features besides sex, age, and relation to pregnancy. RESULTS: Only 2 of the 19 proposed features tested lacked prognostic value. When the other 17 predictors were analyzed jointly in a multiple logistic regression model, 8 (relation to pregnancy, pituitary mass volume and symmetry, signal intensity and signal intensity homogeneity after gadolinium administration, posterior pituitary bright spot presence, stalk size, and mucosal swelling) remained significant predictors of a correct classification. The diagnostic score had a global performance of 0.9917 and correctly classified 97% of the patients, with a sensitivity of 92%, a specificity of 99%, a positive predictive value of 97%, and a negative predictive value of 97% for the diagnosis of AH. CONCLUSIONS: This new radiologic score could be integrated into the management of patients with AH, who derive greater benefit from medical as opposed to surgical treatment. |
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Authors:
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A Gutenberg; J Larsen; I Lupi; V Rohde; P Caturegli |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-07-23 |
Journal Detail:
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Title: AJNR. American journal of neuroradiology Volume: 30 ISSN: 1936-959X ISO Abbreviation: AJNR Am J Neuroradiol Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-09 Completed Date: 2010-01-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8003708 Medline TA: AJNR Am J Neuroradiol Country: United States |
Other Details:
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Languages: eng Pagination: 1766-72 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Georg August University G??ttingen, G??ttingen, Germany. agutenberg@med.uni-goettingen.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenoma
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diagnosis* Adult Aged Aged, 80 and over Autoimmune Diseases / diagnosis* Diagnosis, Differential Female Humans Male Middle Aged Pituitary Neoplasms / diagnosis* Radiographic Image Interpretation, Computer-Assisted / methods* Reproducibility of Results Sensitivity and Specificity Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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DK080351/DK/NIDDK NIH HHS; DK55670/DK/NIDDK NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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