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Bilateral Inferior Petrosal Sinuses Sampling in the Routine Investigation of Cushing's Syndrome: A Comparison with MRI

Ioannis S. Kaskarelis1, Emmanouela G. Tsatalou1, Stylianos V. Benakis1, Katerina Malagari2, Ioannis Komninos3, Dimitra Vasiliadou3, Stylianos Tsagarakis3 and Nikolaos Thalassinos3

1 Department of Radiology, Evangelismos General Hospital, 11 Amasias St., Athens, Greece 11634.
2 Second Department of Radiology, University of Athens, Athens, Greece.
3 Department of Endocrinology, Evangelismos General Hospital, Athens, Greece.


Figure 1
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  		Fig. 1 —50-year-old man with Cushing's disease. During insertion of catheters for bilateral inferior petrosal sinuses sampling (BIPSS), small amount of nonionic contrast medium is injected to verify correct catheter placement into both inferior petrosal sinuses.

 

Figure 2
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  		Fig. 2 —25-year-old woman with Cushing's disease. In bilateral inferior petrosal sinuses sampling (BIPSS), catheters are manipulated into both inferior petrosal sinuses. Blood samples (6 mL) are collected simultaneously from both catheters and peripheral vein.

 

Figure 3
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  		Fig. 3 —Flow chart showing diagnostic confirmation and classification of 78 patients evaluated with bilateral inferior petrosal sinuses sampling (BIPSS). TSS = transsphenoidal surgery, ACTH = adrenocorticotropic hormone.

 

Figure 4
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  		Fig. 4 —32-year-old woman with histologically proven adrenocorticotropic hormone (ACTH)-secreting microadenoma. Sagittal T1-weighted pituitary MRI obtained after gadolinium injection shows small hypointense area visible in midline of pituitary gland and corresponds to microadenoma.

 

Figure 5
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  		Fig. 5 —Flow diagram displaying diagnostic approach we used in 78 patients with Cushing's syndrome (CS). Actual biochemical investigation preceded both MRI and bilateral inferior petrosal sinuses sampling (BIPSS) (single asterisk). Diagnostic confirmation was performed as described in detail in text (double asterisk).

ACTH = adrenocorticotropic hormone; BCh = biochemical investigation; TSS = transsphenoidal surgery.

 

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