Usefulness of conventional and low-dose hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy.

PURPOSE: The aim of this retrospective study was to evaluate the usefulness of hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy. MATERIAL AND METHODS: The study involved 40 patients with a diagnosis of gastric tumor established by histopathology who underwent endoscopy and conventional or low-dose hydro-CT. Hydro-CT images were retrospectively analyzed based on the consensus of two radiologists who were blinded to the endoscopy findings. The diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric tumors was evaluated using the results of the histopathological examination as the reference standard. RESULTS: Histopathology confirmed the presence of gastric cancer in 28 patients (70%), while gastrointestinal stromal tumors (GISTs) were recognized in the remaining 12 cases (30%). Correct diagnoses of the type of gastric tumor in hydro-CT were obtained in 37 patients (92.5%). This was not significantly different from the 85% accuracy of endoscopy. Further analysis showed that the correctness of GIST diagnosis in endoscopy and hydro-CT also did not differ significantly (91.7% and 100% respectively). The percentage of correctly diagnosed malignant lesions in hydro-CT was lower than for GISTs at 89.29%, while in endoscopy it was insignificantly lower (82.14%). The diagnostic accuracy of conventional and low-dose hydro-CT in the diagnosis of gastric tumors (95% and 90% respectively) was not significantly different. CONCLUSIONS: Conventional and low-dose hydro-CT may be a valuable non-invasive diagnostic method in the diagnosis of gastric tumors for patients who have contraindications to endoscopy or who are unable to undergo gastric biopsy.

Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function.

BACKGROUND: Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change of anatomical conditions. It depends also on numerous other factors, including: size and expansion of a tumour before surgery, type of surgical access, quality and volume of filling material used and time of its resorption.The aim of the study was to compare MR image of the pituitary gland after surgery with clinical findings and to establish a correlation between MRI presentation of spared pituitary and its hormonal function. MATERIAL/METHODS: 124 patients after resection of pituitary adenomas - 409 MRI results in total - were studied. With a 1.5-T unit, T1-weighted sagittal and coronal, enhanced and unenhanced images were obtained. RESULTS: The pituitary gland seemed to be normal in MRI in 11 patients, 8 of them had completely regular pituitary function but in 3 of them we noticed a partial hypopituitarism. In 99 patients only a part of the pituitary gland was recognised, 53 of them had hypopituitarism but 46 of them were endocrinologically healthy. 14 patients seemed to have no persistent pituitary gland in MRI, in comparison to hormonal studies: there was panhypopituitarism in 6 and hypopituitarism in 8 cases. CONCLUSIONS: MRI presentation of post - surgical pituitary gland doesn't necessarily correlate with its hormonal function - there was a significant statistical difference. Some patients with partial pituitary seems normal hormonal function. In some cases the pituitary seem normal in MRI but these patients have hormonal disorders and need substitution therapy.

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy.

BACKGROUND: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. MATERIAL/METHODS: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm(3) (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. RESULTS: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. CONCLUSIONS: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV.

MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours.

BACKGROUND: Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change in anatomical conditions. It depends also on numerous other factors, including: size and expansion of the tumour before surgery, type of surgical access, quality and volume of implanted materials and time of its resorption. The purpose was to demonstrate the characteristics of the implanted materials on MRI performed after transsphenoidal resection of pituitary tumours and to identify imaging criteria helpful in differential diagnosis of masses within the sellar region. MATERIAL/METHODS: One hundred and fifty-four patients after transsphenoidal resection of pituitary tumours were included in the study. In general, 469 MRI examinations were performed with a 1.5T scanner. We obtained T1-weighted sagittal and coronal, enhanced and unenhanced images. In 102 cases, additional T2-weighted coronal, unenhanced images with 1.5 T unit were obtained as well. RESULTS: The implanted materials appeared in 95 patient: fat in 86 and muscle with fascia in 3 patients. We could recognise implanted muscle and fascia in T2-weighted images, because of high signal intensity of the degenerating muscle and the line of low signal representing fascia. The implanted titanium mesh was found in 4 patients. Haemostatic materials were visible only in 2 patients in examinations performed at an early postoperative stage (1 month after the procedure). CONCLUSIONS: The knowledge of MRI characteristics of the materials implanted at the sellar region is very important in postoperative diagnosis of pituitary tumours and may help discriminate between tumorous and non-tumorous involvement of the sellar region. Some implanted materials, like fat, could be seen on MRI for as long as 10 years after the operation, others, like haemostatic materials, for only 1 month after surgery. T2-weighted imaging is a useful assessment method of the implanted muscle and fascia for a long time after surgery.

[A case of hypophyseal and pineal germinoma]. / Przypadek rozrodczaka podwzgórza i szyszynki.

A case of 19-year-old male with idiopathic diabetes insipidus diagnosed 9 years ago. 1.5 years from the onset of the disease vision disturbances, neurologic deficiencies and symptoms of hypopituitarism showed up. MRI examination revealed an advanced hypophyseal and pineal gland tumor--germinoma. Total regression was achieved with radio- and chemotherapy. For 7 years from the end of treatment patient has not declared any complains except for vision disturbances and hypopituitarism has been substituted successfully. The case puts on the necessity of a strict endocrinologic and radiologic follow-up in patients with idiopathic diabetes insipidus due to the possibility of existing potentially curable disease ie. intracranial tumor.

[The role of brain magnetic resonance studies in the diagnostics of central nervous system lesions in HIV-1 positive patients]. / Rola rezonansu magnetycznego mózgowia w diagnostyce zmian w osrodkowym ukladzie nerwowym u pacjentów zakazonych HIV-1.

UNLABELLED: Approximately 10% of persons infected with human immunodeficiency virus (HIV) and 75-90% patients with acquired immunodeficiency syndrome (AIDS) present neurological symptoms. This group causes the greatest diagnostic difficulties among AIDS patients. The purpose of the study was to demonstrate the usefulness of the magnetic resonance imaging (MR) of the central nervous system (CNS) in the diagnosis and differentiation of primary and secondary lesions. MATERIAL AND METHODS: Fifty one patients with the symptoms suggesting CNS involvement were enrolled into the study. In 40 of them AIDS diagnosis was established based on the picture of CNS lesions. MR studies were performed using EDGE-ECLIPSE 1.5 T unit with FSE sequences, T1- and T2-weighted images, before and after paramagnetic contrast agent injection, in sagittal, coronal and transverse planes. In almost all cases FLAIR technique was also used. Thirteen persons were examined several times. Altogether we executed 62 studies. Magnetic resonance results were compared with the results of laboratory tests and sometimes histopathological examination at autopsy. RESULTS: Pathological findings were visible on MR of CNS in 37 (92.5%) of 40 patients with AIDS. In 8 (20%) cases the diagnosis of AIDS dementia complex (ADC) was established. Toxoplasmosis was diagnosed in 9 (22.5%) cases, tuberculosis in 6 (15%), cryptococcosis in 5 (12.5%) patients, progressive multifocal leukoencephalopathy (PML) in 3 (7.5%) patients, primary lymphoma also in 3 (7.5%), and atypical mycobacteriosis in 2 patient. In 1 (2.5%) case we could not establish the final diagnosis. We described the patterns of MR appearance in the different types of lesions mentioned above based on our findings and the literature review. CONCLUSIONS: Magnetic resonance imaging has a high sensitivity in identifying lesions of the central nervous system. It is very useful, together with the results of other tests, in the final diagnosis of the lesions in the CNS. Magnetic resonance plays also an important role in the treatment planning and monitoring of the efficacy of therapy used in AIDS patients.

Diffuse malignant lymphoma type B with optic chiasm infiltration, visual disturbances, hypopituitarism, hyperprolactinaemia and diabetes insipidus. Case report and literature review.

The case is reported of a 55-year-old man with diffuse malignant lymphoma type B associated with transient optic chiasm infiltration and visual disturbances but with persistent hypopituitarism, hyperprolactinaemia and diabetes insipidus. The patient was administered chemotherapy and radiotherapy. Repeated MR and CT scans showed optic chiasm infiltration, which disappeared in the course of the chemotherapy but then recurred, changed its appearance and finally disappeared again. In the meantime visual disturbances occurred and disappeared during the therapy. Hypopituitarism, diabetes insipidus and hyperprolactinaemia were diagnosed and replacement therapy was administered. Later on abdominal pain occurred, and a CT scan revealed bilateral kidney masses and enlarged retroperitoneal lymph nodes. These were diffuse malignant lymphoma with regional lymphonodulitis in histology. Finally, hydrothorax and hydroretroperitoneum were diagnosed. The patient died as a result of systemic complications of the disease. The length of survival time documented following the hypothalamochiasmatic infiltration and diagnosis of lymphoma makes the case an unusual one for patients with CNS lymphoma. Hormonal disturbances accompanying the suprasellar region infiltration are very important from the practical point of view.

Immunoglobulin D myeloma--problems with diagnosing and staging (own experience and literature review).

Immunoglobulin D (IgD) myeloma is a rare disease accounting for about 2% of all myelomas. The distinctive features are the predominant occurrence in males and young patients, short survival time, uncertain appearance of M-component in serum electrophoresis, predominance of lambda light chains, frequent renal impairment, hypercalcemia and amyloidosis. The aim of the present study was to show diagnostic difficulties resulting from a variety of non-specific initial symptoms and laboratory findings as well as to compare the staging system proposed by Durie and Salmon with the new risk grouping by Shimamoto. Case histories of 7 patients were analyzed retrospectively. Five of them were diagnosed as IgD multiple myeloma (IgD MM), 1 as non-secretory IgD myeloma and 1 as solitary bone IgD plasmocytoma that evolved to an IgD MM. All patients were staged according to the Durie and Salmon classification and the new risk grouping by Shimamoto. We report diagnostic problems with IgD myeloma in our patients, with special emphasis on non-specific rheumatoidal and neurological symptoms in 1 case. There was a very good correlation of the Japanese classification with the severity of the disease and the risk of death. In conclusion, the initial symptoms of IgD myeloma can be very misleading. Wide differential diagnosis, including autoimmunological disorders of the connective tissue, is necessary. The new Japanese risk grouping seems to be of greater prognostic significance for IgD myeloma than the Durie and Salmon staging system.

Familial hypopituitarism associated with mosaic form of Turner syndrome.

We present herein an unusual coincidence of familial hypopituitarism associated with a mosaic form of Turner syndrome in two adult sisters (51 and 43 years old). Both patients had hypopituitarism diagnosed in childhood. They have never been administered growth hormone, and remained short in stature. They were not given long-term estrogen-progestin treatment, despite lack of menstruation. Early in childhood both received thyroid hormone substitution. Pituitary imaging revealed pituitary hypoplasia with partial empty sella in one sister, and pituitary hypoplasia in the other. Very recently, during endocrinological evaluation, they were diagnosed with a mosaic form of Turner syndrome, additionally to their hypopituitarism. In this paper, we place special emphasis on the results of hormonal analyses and discuss the differential diagnosis.