Cushing’s Disease: The Grail of the Radiologist

Half of pituitary corticotropic adenomas responsible of Cushing’s disease are more than 5 mm in diameter and could be easily demonstrated on MRI. Cavernous sinus invasion is a prognostic factor. Half of ACTH-secreting PitNETs could be hard to show, particularly those less than 3 mm named picoadenomas. Nevertheless, their localization is crucial before surgery to hope a cure of this severe disease. After a first negative pituitary MRI, in the setting of an ACTH-dependent hypercorticism, it could be reasonable to assign the patient to a center of expertise. A 3.0 T scanner is to be preferred. 3D imaging is superior to 2D imaging. Volumetric acquisitions provide thin slices, minimize partial volume effects, and permit multiplanar reformats. Immediate or late post-gadolinium 3D T2 FLAIR (fluid-attenuated inversion recovery) sequences can be interesting.