An audit of the use of CT pituitary scans to exclude a pituitary macroadenoma.

Lisa Douglas, James Caldwell, Mark Bolland
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Abstract

Background: Pituitary imaging is often required to exclude an adenoma suspected clinically or biochemically. Although magnetic resonance (MR) is the gold standard, computerised tomography (CT) is faster, cheaper and induces less claustrophobia. Our audit at Auckland City Hospital, New Zealand, investigated whether the use of CT of the pituitary as the first line imaging to assess for a pituitary macroadenoma reduces the need for MR.

Methods: We investigated the usefulness of CT pituitary imaging in the exclusion of pituitary macroadenoma between 2012 and 2020. A re-audit was then undertaken for a period of one year between March 2021 and March 2022 to assess outcomes once a departmental policy change was implemented. At Auckland City Hospital, 32 patients across eight years were eligible for this analysis, of which 31 had data available. In our re-audit, 29 patients were eligible for this analysis. We collected data on patient demographics, relevant hormone levels, indication for imaging and imaging results and subsequent management.

Results: After CT pituitary imaging, 28/31 (90%) of patients did not require further imaging because the clinical question had been addressed. One year after routine initial CT pituitary imaging was implemented by the Auckland City Hospital Endocrinology Department, 29 CT pituitary scans were performed to exclude a pituitary macroadenoma. Of these patients one required further imaging due to the finding of an expanded pituitary sella but not a pituitary macroadenoma.

Conclusion: CT pituitary imaging to exclude a pituitary macroadenoma is a useful test that may reduce the need for MR pituitary scans.

Trial registration: Not applicable. This was an audit as defined by the New Zealand National Ethics Advisory Committee guidelines. Please see 'Declarations' section.

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对使用垂体 CT 扫描排除垂体大腺瘤的审计。
背景:通常需要进行垂体成像,以排除临床或生化检查中怀疑的腺瘤。虽然磁共振(MR)是黄金标准,但计算机断层扫描(CT)更快、更便宜,而且不会引起幽闭恐惧症。我们在新西兰奥克兰市立医院进行的审计调查了使用垂体 CT 作为评估垂体大腺瘤的一线成像是否会减少对 MR 的需求:我们调查了 2012 年至 2020 年间 CT 垂体成像在排除垂体大腺瘤方面的实用性。然后在2021年3月至2022年3月期间进行了为期一年的重新审核,以评估部门政策改变后的结果。在奥克兰市立医院,有 32 名患者在 8 年中符合分析条件,其中 31 人有数据可用。在我们的重新审核中,有 29 名患者符合分析条件。我们收集了关于患者人口统计学、相关激素水平、成像指征、成像结果和后续处理的数据:CT垂体成像后,28/31(90%)的患者不需要进一步成像,因为临床问题已经得到解决。奥克兰市立医院内分泌科实施常规初次垂体 CT 成像检查一年后,共进行了 29 次垂体 CT 扫描以排除垂体大腺瘤。在这些患者中,有一名患者由于发现垂体蝶鞍扩大而非垂体大腺瘤,需要进一步进行造影检查:结论:通过CT垂体成像排除垂体大腺瘤是一种有用的检查方法,可减少对磁共振垂体扫描的需求:试验注册:不适用。根据新西兰国家伦理咨询委员会(New Zealand National Ethics Advisory Committee)的指导方针,这是一项审计项目。请参阅 "声明 "部分。
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来源期刊
自引率
0.00%
发文量
7
审稿时长
8 weeks
期刊介绍: Clinical Diabetes and Endocrinology is an open access journal publishing within the field of diabetes and endocrine disease. The journal aims to provide a widely available resource for people working within the field of diabetes and endocrinology, in order to improve the care of people affected by these conditions. The audience includes, but is not limited to, physicians, researchers, nurses, nutritionists, pharmacists, podiatrists, psychologists, epidemiologists, exercise physiologists and health care researchers. Research articles include patient-based research (clinical trials, clinical studies, and others), translational research (translation of basic science to clinical practice, translation of clinical practice to policy and others), as well as epidemiology and health care research. Clinical articles include case reports, case seminars, consensus statements, clinical practice guidelines and evidence-based medicine. Only articles considered to contribute new knowledge to the field will be considered for publication.
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