Multi-spectral Imaging as a Measure of Facial Plethora in Cushing Disease

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-92
Maya Beth Lodish*1, Yasaman Ardeshirpour1, Evgenia Gourgari2, Margaret Keil2, Ali Afshari1, Elena Belyavskaya1, Charalampos Lyssikatos1, Victor Chernomordik1, Amir Gandjbakhche1 and Constantine A Stratakis1
1NIH, 2National Institutes of Health (NIH), Bethesda, MD
Objective: It has been clinically observed that patients with Cushings Disease (CD) often present with facial plethora; loss of facial plethora may be an early sign of cure after transphenoidal surgery (TSS). We used non- invasive multi-spectral imaging (MSI) to quantify facial vascularity as an indirect measurement of facial plethora before and after TSS.

Methods: Five patients with CD, (4 F, mean age 26.4 ± 16.7y) were studied. Four of the 5 patients were surgically cured of disease with post-operative measurements of plasma cortisol < 2 μg/dl as previously described (1). MSI was performed on the right cheek of the patient prior to TSS and a mean of 7 ± 3 days after surgery using 4 wavelengths (700,750, 800 and 850nm) with a Near Infrared CCD  based system. Spectral analysis using the two layers skin model along with a curvature correction algorithm are used to quantify the fraction of blood volume as well as the oxygenation of the tissue (2). Data are presented as mean ± SD.

Results: The mean value of total blood fraction per unit volume (2mm3) captured from the right cheek of patients significantly decreased when measured before and after TSS in the 4 patients who entered remission for their CD (0.16. ± 0.02 to 0.12 ± 0.01, p = 0.012). In contrast, in the one patient who was not surgically cured, the fraction of blood volume increased from pre to post operative measurements (0.13 to 0.18). Pre-op UFC and AM cortisol values were elevated at 125.8 ± 56.6 μg/dL /24hr/m2 and 19.1± 5.4 μg/dL, respectively. In the 5 patients tested, there was not a significant correlation between pre-surgical UFC or serum cortisol and degree of facial plethora as measured by MSI. Post-op AM cortisol in the 4 cured patients was 1.2 ± 0.2 μg/dL, whereas the AM cortisol in the patient with persistent disease was 12.5 μg/dL.

Conclusions: In this pilot study, preliminary data indicate that a decrease in facial plethora after TSS correlates with cure of CD. This novel technology is very promising as a marker of early cure of Cushing disease after TSS, along with biochemical data.

1. Batista DL, Oldfield EH, Keil MF, Stratakis CA 2009 Postoperative testing to predict recurrent Cushing disease in children. J Clin Endocrinol Metab 94:2757–276.   2. Kainerstorfer JM, Riley JD, Ehler M, Najafizadeh L, Amyot F, Hassan M, Pursley R, Demos SG, Chernomordik V, Pircher M, Smith PD, Hitzenberger CK, Gandjbakhche AH. Quantitative principal component model for skin chromophore mapping using multi-spectral images and spatial priors Biomed Opt Express. 2011 Apr 1;2(5):1040-58.

Nothing to Disclose: MBL, YA, EG, MK, AA, EB, CL, VC, AG, CAS

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: This work was supported by the intramural research division of the Eunice Kennedy Shriver National Institute of Child Health and Human Development