Thin-section CT of Cushing's disease

Using 1.5 mm contiguous sections with a GE CT/T 8800 scanner, we investigated the sellar regions of 22 cases of Cushing's diseases which had been diagnosed endocrinologically. Each sellar turcica was normal in size, and in only 5 cases were there significant findings on 2 mm-thick sellar-floor polytomography. Nine tumors appeared as regions of a hypodense area, and three tumors were diagnosed by indirect signs, for example, stalk deviation and diaphragmatic plane asymmetry. The other 10 cases, especially those previously operated on or irradiated, were diagnosed as falsely positive or negative. Because it is best of the microadenomas appear hypodense within the strongly contrast-enhanced anterior pituitary glands, it is better for scans to be obtained immediately after rapid intravenous contrast infusion. Hypodense areas of microadenomas are best demonstrated on direct coronal scans or reversed scans of 1.5 mm-thickness thin-slice sections. By these methods, microadenomas, if they are over 5-6 mm in diameter, can appear as hypodense. Sellar floor findings by means of thin-section CT were more sensitive than those of polytomography and had more advantages in local diagnosis. If the tumor were over 4 mm in diameter, local changes in the sellar floor could be demonstrated by thin-section CT, but by polytomography no changes in the sellar floor could be demonstrated until the tumor size reached 6 mm. (author)