Overweight and obesity status from the prenatal period to adolescence and its association with non-alcoholic fatty liver disease in young adults: cohort study.

OBJECTIVE: To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood. DESIGN: Cohort study. SETTING: ELEMENT Cohort in Mexico City. POPULATION: Pregnant women with singleton births (n = 97). METHODS: We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood. MAIN OUTCOME: Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood. RESULTS: Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (ß = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (ß = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status. CONCLUSION: We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring. TWEETABLE ABSTRACT: There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.

Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: finding the best thresholds.

AIM: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. MATERIALS AND METHODS: Fifty-five patients with symptomatic hyperacute (first 6h) or acute (7-24h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. RESULTS: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385×10(-6)mm(2)/s, MTT at 109.5%, TTP at 3.05s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p<0.001). CONCLUSIONS: Based on the present findings, hyperacute penumbra is reliably defined with a TTP >3s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke.

Whole-body (18)F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration.

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms.

(18)F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis.

Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose ((18)F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. (18)F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented.

Whole-body 18F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration

Paciente mujer de 82 años con hipotiroidismo y tiroiditis de Hashimoto, observó desde hace tres años la presencia de un bocio asimétrico pequeño (izquierdo > derecho). Sin embargo, un crecimiento rápido de la glándula en un periodo de 3-6 meses causó disfagia y respiración corta. La ecografía y la gammagrafía tiroidea mostraron imágenes consistentes con bocio multinodular con un nódulo hiperfuncionante en el lóbulo derecho. Por la historia previa de tiroiditis de Hashimoto y el aumento rápido en el tamaño de la glándula tiroides, se consideró un diagnóstico de linfoma tiroideo y cáncer tiroideo anaplásico. Se realizó tiroidectomía en un hospital externo para aliviar los síntomas compresivos. La aspiración con aguja fina fue insuficiente para el diagnóstico, y en la pieza de la tiroidectomía se confirmó el diagnóstico de un linfoma difuso de células grandes tipo B. En nuestro centro se realiza un rastreo con FDG-PET/CT para estadificación, mostrando metástasis intra y extraganglionares. La quimioterapia con ciclofosfamida, vincristina y dexametasona (COP modificado), produjo una respuesta dramática del tumor y una resolución completa de los síntomas compresivos

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms

18F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis

El cáncer pancreático es una neoplasia con un pronóstico extremadamente pobre. Menos del 3 % de los pacientes están vivos cinco años después del diagnóstico. Las neoplasias del páncreas representan una etiología posible pero rara en la invasión de la vena porta. Es importante diferenciar la naturaleza del trombo, si este es un trombo blando o si es una extensión tumoral directa. La captación intensa de fluordesoxiglucosa f18 (18F-FDG) ya ha sido reportada en los casos de trombosis tumoral de la vena porta. Presentamos un caso de adenocarcinoma pancreático con síntomas clínicos de hipertensión portal debido a trombosis de la vena porta. La evaluación con 18F-FDG PET/TC descartó la trombosis tumoral; presentamos los hallazgos por imagen del tumor pancreático y el tumor blando en la vena porta

Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose (18F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. 18F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented

Tomographic findings in traumatic globe evulsion caused by blunt head trauma.

Evulsion of the globe as a result of trauma is a rarity; to the best of our knowledge, only four "evulsions of the globe" have been described. We present the case of a 35-year-old Hispanic woman with traumatic evulsion of the right eye and subarachnoid haemorrhage. The management of brain injury was the priority over preservation of globe structures. We briefly describe the tomographic features of this uncommon situation and the proposed "evulsion" mechanism.

Panaortitis diagnosed by 18F-FDG PET/CT scan in a patient with diffuse large B-cell lymphoma

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Non-resected solid papillary epithelial tumor of the pancreas: 18F-FDG PET/CT evaluation at 5 years after diagnosis

El tumor sólido papilar del páncreas (TSPP) es una masa abdominal encapsulada de lento crecimiento que nodemuestra evidencia de invasión capsular, afectación linfática regional o metástasis distal. Presentamos el caso de un hombre hispánico de 68 años diagnosticado de TSPP 5 años antes del rechazo de escisión quirúrgica. Ahora, se le ha realizado una 18 F-FDG PET/TC (tomografía por emisión de positrones/ tomografía computarizada) de rastreo completo. Aunque el tamaño del tumor, locación y rasgos en la TC no parece mostrar cambios significativos, la FDG-PET fue útil para enseñar persistente actividad tumoral. Se presenta unarevisión corta del diagnótico diferencial y de la utilidad de la FDG-PET en el TSPP (neoplasia pancreática de lento crecimiento)

Solid and papillary epithelial neoplasm of the pancreas (SPEN) is an encapsulated, slowly enlarging abdominal mass that generally shows no evidence of capsular invasion, regional lymph node involvement, or distal metastases. We present a 68 years old Hispanic male diagnosed with SPEN 5 years earlier that refused surgical excision. Presently he underwent a whole-body 18 F-FDG PET/CT. Although tumor size, location and CT features did not seem to depict significant changes, FDG-PET was useful showing persistent tumoral activity. A brief review of the differential diagnosis as well as the usefulness of FDG-PET in SPEN (a slow growing pancreatic neoplasm) is presented (AU)

Non-resected solid papillary epithelial tumor of the pancreas: 18F-FDG PET/CT evaluation at 5 years after diagnosis.

Solid and papillary epithelial neoplasm of the pancreas (SPEN) is an encapsulated, slowly enlarging abdominal mass that generally shows no evidence of capsular invasion, regional lymph node involvement, or distal metastases. We present a 68 years old Hispanic male diagnosed with SPEN 5 years earlier that refused surgical excision. Presently he underwent a whole-body 18F-FDG PET/CT. Although tumor size, location and CT features did not seem to depict significant changes, FDG-PET was useful showing persistent tumoral activity. A brief review of the differential diagnosis as well as the usefulness of FDG-PET in SPEN (a slow growing pancreatic neoplasm) is presented.

Incidental finding of horseshoe kidneys in whole-body 18F-FDG PET/CT evaluation

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Early MRI findings of central pontine myelinolysis following "rapid" correction of hyponatraemia during diabetic ketoacidosis. A curious pontine lesion (2003:12b).

We describe a diabetic patient with hyponatraemia and ketoacidosis who developed central pontine myelinolysis (CPM) after a very rapid correction of serum sodium. In diabetic ketoacidosis, the marked shifts in osmolarity make these patients more susceptible to the development of CPM. The dramatic early MRI findings (after three weeks) should raise awareness of the risk of permanent damage to the brain associated with hydration therapy in this susceptible group. Magnetic resonance imaging might be a useful investigation at presentation and follow-up of diabetic patients with extreme metabolic derangements.

Asymptomatic true gallbladder duplication: a case report and review of the literature.

Gallbladder duplication is a rare event, with an incidence at autopsy of about 1/4000, with very few documented symptomatic cases reported. Preoperative diagnosis and differentiation of this malformation are important to prevent inadvertent damage to the biliary system, a complicated postoperative course, and repeat surgery. We present a case of true gallbladder duplication found incidentally during abdominal ultrasonography (US). The diagnosis was made with US and the Y-type duplication was demonstrated with magnetic resonance cholangiopancreatography (MRCP).

[Pulmonary thromboembolism associated with glioblastoma multiforme: imaging diagnosis of a case and a review of the literature]. / Tromboembolia pulmonar asociada a glioblastoma multiforme: diagnóstico por imagen de un caso y revisión de la bibliografía.

INTRODUCTION: The incidence of deep vein thrombosis and pulmonary embolism in patients with cerebral neoplasia has been estimated at 120/100,000 (the second highest rate for any kind of malignant neoplasia). A timely diagnosis is an indispensable requisite in the clinical evaluation of neurological patients. Patients suffering from glioblastoma multiforme present a generalized state of hypercoagulability with a deep vein thrombosis incidence after surgery of between 3 and 60%. The incidence with which pulmonary embolism occurs is 5% in patients following neurosurgical operations, with a mortality rate of between 9 and 50%. CASE REPORT: We report the case of a 64 year old male patient with a suspected diagnosis of pulmonary thromboembolism and thrombosis of the right lower limb. Clinical studies included a simple chest X ray, a Doppler ultrasound recording of the lower limbs, a spiral computed tomography (CAT) scan of the thorax, and a magnetic resonance (MR) scan of the head. The spiral CAT scan showed filling defects in the main pulmonary arteries, a tram track appearance and central filling defects. All these findings are compatible with an imaging diagnosis of pulmonary thromboembolism. CONCLUSIONS: The main aim of this study was to describe the use of spiral CAT scanning as a primary tool in the diagnosis of a case. The concurrence of the spiral scan image, the abnormal increase in D dimer and the clinical information left no doubts about the diagnosis. The clinical manifestations of pulmonary thromboembolism are not specific and therefore the patient s life is at risk. In addition, few reports have been published about the association between glioblastoma multiforme and the later appearance of pulmonary thromboembolism (a search was conducted in the medical literature from the last 10 years using MEDLINE), and hence we have presented a communication dealing with this pathological association together with a brief review of the clinical diagnosis of pulmonary thromboembolism and its physiopathogenic mechanisms.

Tromboembolia pulmonar asociada a glioblastoma multiforme: diagnóstico por imagen de un caso y revisión de la bibliografía / Pulmonary thromboembolism associated to glioblastoma multiforme: imaging diagnosis of a case and a review of the literature

Introducción. La incidencia de trombosis venosa profunda y embolismo pulmonar en pacientes con una neoplasia cerebral se ha estimado en 120/100.000 (la segunda tasa más alta para cualquier neoplasia maligna). El diagnóstico oportuno es un requisito indispensable en la valoración clínica del paciente neurológico .Los pacientes con glioblastoma multiforme presentan un estado de hipercoagulabilidad generalizada con una incidencia de trombosis venosa profunda después de la cirugía del 3 al 60 por ciento. La embolia pulmonar tiene una incidencia del 5 por ciento en pacientes a los que se ha practicado un procedimiento neuroquirúrgico, con una tasa de mortalidad de entre el 9 y el 50 por ciento. Caso clínico. Paciente varón de 64 años, con diagnóstico de sospecha de tromboembolia pulmonar y trombosis del miembro pélvico derecho. Se obtuvo la placa simple del tórax, la ecografía Doppler de los miembros pélvicos, una tomografía computarizada (TAC) helicoidal del tórax y una resonancia magnética (RM) del cráneo. La TAC helicoidal mostró defectos de llenado en las arterias pulmonares principales, imágenes en el riel y defectos de llenado centrales. Todos estos hallazgos son compatibles con un diagnóstico por imagen de tromboembolia pulmonar. Conclusiones. El objetivo principal de este trabajo fue describir el uso de la TAC helicoidal como herramienta primaria en el diagnóstico de un caso. La conjunción de la imagen helicoidal, el aumento desproporcionado del dímero D y la información clínica no dejó dudas sobre el diagnóstico. Debido a que el tromboembolismo pulmonar no presenta unas manifestaciones clínicas específicas y pone en riesgo la vida del paciente, y ante la falta de publicaciones de casos con la asociación del glioblastoma multiforme y la aparición posterior de tromboembolia pulmonar (realizamos una búsqueda en la bibliografía medica de los últimos 10 años mediante MEDLINE), presentamos un comunicado de esta asociación patológica, junto con una breve revisión del diagnóstico clínico de la tromboembolia pulmonar y sus mecanismos fisiopatogénicos (AU)

Introduction. The incidence of deep vein thrombosis and pulmonary embolism in patients with cerebral neoplasia has been estimated at 120/100,000 (the second highest rate for any kind of malignant neoplasia). A timely diagnosis is an indispensable requisite in the clinical evaluation of neurological patients. Patients suffering from glioblastoma multiforme present a generalized state of hypercoagulability with a deep vein thrombosis incidence after surgery of between 3 and 60%. The incidence with which pulmonary embolism occurs is 5% in patients following neurosurgical operations, with a mortality rate of between 9 and 50%. Case report. We report the case of a 64-year-old male patient with a suspected diagnosis of pulmonary thromboembolism and thrombosis of the right lower limb. Clinical studies included a simple chest X-ray, a Doppler ultrasound recording of the lower limbs, a spiral computed tomography (CAT) scan of the thorax, and a magnetic resonance (MR) scan of the head. The spiral CAT scan showed filling defects in the main pulmonary arteries, a ‘tram track’ appearance and central filling defects. All these findings are compatible with an imaging diagnosis of pulmonary thromboembolism. Conclusions. The main aim of this study was to describe the use of spiral CAT scanning as a primary tool in the diagnosis of a case. The concurrence of the spiral scan image, the abnormal increase in D-dimer and the clinical information left no doubts about the diagnosis. The clinical manifestations of pulmonary thromboembolism are not specific and therefore the patient’s life is at risk. In addition, few reports have been published about the association between glioblastoma multiforme and the later appearance of pulmonary thromboembolism (a search was conducted in the medical literature from the last 10 years using MEDLINE), and hence we have presented a communication dealing with this pathological association together with a brief review of the clinical diagnosis of pulmonary thromboembolism and its physiopathogenic mechanisms (AU)

Quiste coloide del tercer ventrículo: descripción de un caso y revisión de la bibliografía / Colloid cyst of the third ventricle: case description and survey of the literature

Introducción. Los quistes coloides son lesiones intracraneales con una incidencia calculada en tres individuos por millón de personas en un año. Son tumores benignos de la porción anterosuperior del tercer ventrículo. El flujo normal del líquido cefalorraquídeo puede ser interrumpido por un gran quiste que obstruya el foramen de Monro. Los signos y síntomas asociados engloban un espectro amplio de características, desde una cefalea no específica hasta datos de hipertensión intracraneal; algunos quistes coloides se dan en el comienzo agudo de una hidrocefalia y pueden llevar a una muerte súbita. Caso clínico. Presentamos el caso de un paciente con un quiste coloide en el techo anterior del tercer ventrículo, con una válvula de derivación ventriculoperitoneal disfuncional que se había colocado tres años antes. Ambos eventos contribuyeron al desarrollo de una hidrocefalia con manifestaciones clínicas de hipertensión intracraneal. Laimagen de la resonancia magnética (RM) mostró la presencia de una masa hiperintensa de densidad variable en el techo del tercer ventrículo y en su cara rostral; la imagen era hiperintensa en T1 e isointensa enT2. Al paciente se le sometió a una cisternoventriculostomía endoscópica para realizar el drenaje quirúrgico del quiste coloide, y se continuó su manejo en la consulta externa del Servicio de Neurocirugía. Conclusiones. En este artículo comentamos las características principales del quiste coloide y algunas consideraciones sobre su presentación en la RM. Asimmismo, realizamos una breve revisión de la bibliografía (AU)

Introduction. Colloid cysts are intracranial lesions with an estimated incidence of three individuals per million people per year. They are benign tumours in the anterosuperior portion of the third ventricle. The normal flow of cerebrospinal fluid may be interrupted by a large cyst that obstructs the foramen of Monro. The associated signs and symptoms cover a wide range of features, from non-specific headaches to intracranial hypertension data; some colloid cysts occur at the acute onset of hydrocephalus and can lead to a sudden death. Case report. We present the case of a patient with a colloid cyst in the anterior roof of the third ventricle, with the presence of a dysfunctional ventriculo-peritoneal bypass valve, which had been introduced three years earlier. Both events contributed to the development of a hydrocephalus with clinical manifestations of intracranial hypertension. The images obtained by magnetic resonance (MR) revealed the presence of a hyperintense mass of variable density in the roof of the third ventricle and in its rostral face; the image was hyperintense in T1 and isointense in T2. The patient was submitted to an endoscopic cisternoventriculostomy to allow the surgical drainage of the colloid cyst, and management was continued in the outpatients department of the Neurosurgery Service. Conclusions. In this paper we discuss the main characteristics of the colloid cyst, some considerations on its presentation in MRI are presented and a brief survey of the literature is also conducted (AU)

[Colloid cyst of the third ventricle: case description and survey of the literature]. / Quiste coloide del tercer ventrículo: descripción de un caso y revisión de la bibliografía.

INTRODUCTION: Colloid cysts are intracranial lesions with an estimated incidence of three individuals per million people per year. They are benign tumours in the anterosuperior portion of the third ventricle. The normal flow of cerebrospinal fluid may be interrupted by a large cyst that obstructs the foramen of Monro. The associated signs and symptoms cover a wide range of features, from non specific headaches to intracranial hypertension data; some colloid cysts occur at the acute onset of hydrocephalus and can lead to a sudden death. CASE REPORT: We present the case of a patient with a colloid cyst in the anterior roof of the third ventricle, with the presence of a dysfunctional ventriculo peritoneal bypass valve, which had been introduced three years earlier. Both events contributed to the development of a hydrocephalus with clinical manifestations of intracranial hypertension. The images obtained by magnetic resonance (MR) revealed the presence of a hyperintense mass of variable density in the roof of the third ventricle and in its rostral face; the image was hyperintense in T1 and isointense in T2. The patient was submitted to an endoscopic cisternoventriculostomy to allow the surgical drainage of the colloid cyst, and management was continued in the outpatients department of the Neurosurgery Service. CONCLUSIONS: In this paper we discuss the main characteristics of the colloid cyst, some considerations on its presentation in MRI are presented and a brief survey of the literature is also conducted.