High-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing's syndrome
High-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing's syndrome
复制标题
大剂量地塞米松抑制试验鉴别诊断ACTH依赖性库欣综合征的效果不如垂体动态增强MRI
DOI：
10.1007/s12020-021-02891-y
复制
发表时间：
2021-10-04
期刊：
影响因子：
3.7
通讯作者：
Yang, Yan
中科院分区：
文献类型：
--
作者：
Shi, Xiaoli;Du, Tingting;Yang, Yan
目的促肾上腺皮质激素（ACTH）依赖性库欣综合征的鉴别诊断一直是临床上的难题。本研究旨在评估垂体动态对比增强磁共振成像（dMRI）、大剂量地塞米松抑制试验（HDDST）以及两种试验联合应用对ACTH依赖性库欣综合征患者的诊断性能。方法119例经手术证实的ACTH依赖性库欣综合征患者，其中101例为库欣病，18例为异位ACTH综合征。所有患者均行垂体dMRI和HDDST检查。确定了垂体dMRI、HDDST以及两者联合检测的敏感性和特异性。结果垂体dMRI诊断库欣病的敏感性为80.2%，特异性为83.3%，阳性预测值为96.4%。HDDST的敏感性和特异性分别为70.3%和77.8%，阳性预测值为94.7%。两项试验的组合显示，HDDST时血清皮质醇抑制超过50%和垂体dMRI结果阳性的组合标准产生了94.4的高特异性和59.4%的敏感性。HDDST抑制率超过68%和/或垂体dMRI结果阳性的综合标准的敏感性为86.1%，特异性为83.3%。结论在ACTH依赖性库欣综合征的鉴别诊断中，PHDdMRI比HDDST具有上级优势。推荐HDDST与垂体dMRI联合使用，以建立诊断过程，因为联合使用可显著提高特异性。
Purpose The differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome remains a challenge in clinical practice. The present study was aimed at assessing the diagnostic performance of pituitary dynamic contrast-enhanced magnetic resonance imaging (dMRI), high-dose dexamethasone suppression test (HDDST), and a combination of both tests for patients with ACTH-dependent Cushing's syndrome. Methods A total of 119 consecutive patients with ACTH-dependent Cushing's syndrome confirmed surgically were enrolled: 101 with proven Cushing's disease and 18 with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and specificity of pituitary dMRI, HDDST, and a combination of both tests were determined. Results The sensitivity and specificity of pituitary dMRI for diagnosing Cushing's disease were 80.2 and 83.3%, respectively, with a positive predictive value of 96.4%. The sensitivity and specificity of HDDST were 70.3 and 77.8%, respectively, with positive predictive value of 94.7%. A combination of both tests showed that the combined criteria of more than 50% suppression of serum cortisol on HDDST and a positive pituitary dMRI finding yielded a high specificity of 94.4 and sensitivity of 59.4%. The combined criteria of more than 68% suppression on HDDST and/or a positive pituitary dMRI finding yielded a sensitivity of 86.1% and specificity of 83.3%. Conclusions Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing's syndrome. HDDST is recommended in combination with pituitary dMRI to establish a diagnosis process because of the significantly increased specificity with the combination.