The clinical outcomes of imaging modalities for surgical management Cushing's disease - A systematic review and meta-analysis

Cushing's disease presents major diagnostic and management challenges. Although numerous preoperative and intraoperative imaging modalities have been deployed, it is unclear whether these investigations have improved surgical outcomes. Our objective was to investigate whether advances in imagin...

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Published in:Frontiers in endocrinology (Lausanne) 2023-01, Vol.13, p.1090144-1090144
Main Authors: Koh, Chan Hee, Khan, Danyal Z, Digpal, Ronneil, Layard Horsfall, Hugo, Ali, Ahmad M S, Baldeweg, Stephanie E, Bouloux, Pierre-Marc, Dorward, Neil L, Drake, William M, Evanson, Jane, Grieve, Joan, Stoyanov, Danail, Korbonits, Márta, Marcus, Hani J
Format: Article
Language:English
Subjects:
cushing
Cushing’s disease
Endocrinology
Humans
imaging
Magnetic Resonance Imaging
MRI
PET
pituitary
Pituitary ACTH Hypersecretion - diagnostic imaging
Pituitary ACTH Hypersecretion - surgery
Radiography
Radiology
Treatment Outcome
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Summary:Cushing's disease presents major diagnostic and management challenges. Although numerous preoperative and intraoperative imaging modalities have been deployed, it is unclear whether these investigations have improved surgical outcomes. Our objective was to investigate whether advances in imaging improved outcomes for Cushing's disease. Searches of PubMed and EMBASE were conducted. Studies reporting on imaging modalities and clinical outcomes after surgical management of Cushing's disease were included. Multilevel multivariable meta-regressions identified predictors of outcomes, adjusting for confounders and heterogeneity prior to investigating the effects of imaging. 166 non-controlled single-arm studies were included, comprising 13181 patients over 44 years.The overall remission rate was 77.0% [CI: 74.9%-79.0%]. Cavernous sinus invasion (OR: 0.21 [CI: 0.07-0.66]; p=0.010), radiologically undetectable lesions (OR: 0.50 [CI: 0.37-0.69]; p
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2022.1090144