ABSTRACT
INTRODUCTION: Cortical vein thrombosis (CVT) is a rare disorder, and its diagnosis is challenging. The aim of our study was to evaluate the value of different imaging modalities for the detection of CVT. METHODS: Thirteen patients with CVT, either isolated (n = 3) or in combination with sinus thrombosis (n = 10), and 20 control patients without any venous pathologies were included in this study. The analysis was performed independently by three blinded readers who evaluated the following imaging modalities and sequences separately: non-enhanced computed tomography (NCCT); multi-detector row CT angiography (MDCTA); diffusion-weighted (DWI), T1-weighted (T1w), PD-weighted (PDw), T2*-weighted (T2*w), and fluid-attenuated inversion recovery-weighted (FLAIRw) magnetic resonance (MR) sequences; as well as venous MR angiography (vMRA). The sensitivity, specificity, positive (PPV) and negative predictive values, and interobserver agreement of the different modalities were calculated. RESULTS: T2*w showed the highest sensitivity for the detection of CVT (97.4%), followed by T1w (70%). FLAIRw and vMRA had a sensitivity of 50% and 41.7%, respectively, whereas the sensitivity of NCCT, MDCTA, DWI, and PDw was below 30%. The specificity and PPV of all modalities was 100%, with good to perfect interobserver agreement. CONCLUSION: T2*w was the superior MR imaging sequence for diagnosing CVT. Besides T2*w, only T1w reached a sensitivity of over 50% for CVT, followed by FLAIRw, and vMRA. On the contrary, our results suggest that NCCT but also MDCTA might not be suitable for diagnosing CVT.
Subject(s)
Cerebral Angiography/methods , Cerebral Veins/diagnostic imaging , Cerebral Veins/pathology , Intracranial Thrombosis/diagnosis , Magnetic Resonance Angiography/methods , Tomography, X-Ray Computed/methods , Venous Thrombosis/diagnosis , Adult , Child , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
CONTEXT: Clinical and biochemical remission in acromegaly can frequently be achieved with the recombinant GH receptor antagonist pegvisomant, even when other treatments fail. However, increases in tumor volume have been reported. OBJECTIVE: Because previous studies suffer from inhomogenous magnetic resonance imaging (MRI) protocols, this prospective study examined the long-term course of adenoma volume during pegvisomant therapy by standardized MRI. DESIGN: Five centers in Germany participated. High-resolution MRI was performed at baseline and 6, 12, and 24 months after enrollment. SETTING/PATIENTS: Patients were outpatients, and pegvisomant is third-line therapy in most of the cases. MAIN OUTCOME MEASURES: The primary end point was tumor volume at 24 month follow-up, measured by a single, double-blinded rater. RESULTS: Forty-five of 61 patients completed 24 months' follow-up (73.8%). Tumor volume increase greater than 25% during the study was observed in three of 61 patients (4.9%), all during the first year of enrollment. All three patients had had octreotide treatment before initiation of pegvisomant; none of them had had radiotherapy. All volumetric findings were comparable with clinical radiological interpretations. ANOVA revealed no significant change in tumor volume after 24 months (n = 45). CONCLUSIONS: This study shows that pegvisomant therapy infrequently coincides with tumor growth during long-term treatment of acromegaly. Because all significant tumor volume increases occurred during the first year, these changes might correlate to the change of medication and thus be the result of a rebound from somatostatin-induced shrinkage.
