Primary headache and epilepsy: a multicenter cross-sectional study

The prevalence and characteristics of interictal headache, epilepsy and headache/epilepsy comorbidity were assessed in 858 women and 309 men aged 18-81 years from headache and epilepsy centers in Italy. The research hypothesis was that comorbidity among patients with either disorder would be expected to be higher than in the general population. Interictal headache was diagnosed in 675 cases (migraine 482; tension-type headache 168; other types 25), epilepsy in 336 (partial 171; generalized 165) and comorbidity in 156 (1.6% from headache centers; 30.0% from epilepsy centers). Patients with epilepsy, headache and comorbidity differed in a number of demographic and clinical aspects. However, for both headache and epilepsy, a family history of the same clinical condition was equally prevalent in patients with and without comorbidity. These findings do not support the purported association between headache and epilepsy.

Cisplatinum Sensitivity of BRCA1-Mutated HCC1937 Breast Cancer Cells Is Linked to Impairment of Notch Signaling and Is Increased by γ-Secretase Inhibitors

BRCA1 plays a critical role in DNA-damage repair mechanisms elicited by cell exposure to anti-tumor agents. HCC1937 is a BRCA1-defective breast cancer cell line which discloses higher sensitivity to cisplatinum (CDDP) as compared to the BRCA1 full-length cDNA transfected clone, HCC1937/wtBRCA1. By cDNA microarray whole gene expression profile and Ingenuity Pathway Analysis (IPA) software, we found a differential modulation of Notch signaling after CDDP exposure in HCC1937 cell line as compared to BRCA1-reconstituted clone with a strong down-regulation of Notch1, 2 and 3 expression together with other genes involved in the Notch signaling network, including Hes1 and Jag1. Notch pathway was not affected by CDDP exposure in BRCA1-reconstituted cells. By Western Blot analysis, we next analyzed if the different trascriptional response of the two cell lines to CDDP occurred together with down-regulation of Notch protein in BRCA1-defective cells. We found enhanced expression of BRCA1 in BRCA1-transfected cells. We then analyzed the Notch 3 protein's expression in HCC1937 and HCC1937/wtBRCA1. By Western blot analysis, we demonstrated a significant reduction of Notch 3 protein's expression following CDDP exposure at the IC50 dose for 12, 18 and 24 hours, in HCC1937 as compared to HCC1937/wtBRCA1, consistently with gene expression results. In the aim of evaluating the role of Notch signaling in the regulation of the pharmacological response to CDDP in BRCA1-defective cells, we exposed HCC1937 cells to the pan-Notch inhibitor, γ-secretase inhibitor XII (GSI-XII), alone or in combination with CDDP, and we elvaluated, by MTT assay, in vitro growth effects on cell survival. We observed a time and dose dependent decrease of cell growth of HCC1937 following GSI-XII exposure as compared to BRCA1-reconstituted clone, with an IC50 between 25 and 35 microM as single agent, while HCC1937/wtBRCA1 where highly resistant to the drug. The combination of GSI-XII plus CDDP produced a significant sinergistic antitumor effect at 48 hours in HCC1937 which did not occurred in HCC1937/wtBRCA1. Our findings suggest that the high sensitivity of BRCA1-defective cells to CDDP exposure may be related not only to depression of the DNA-damage repair machinery but also to down-modulation of the Notch survival pathway. Moreover, our data indicate that the antitumor activity of CDDP is enhanced by combination with the Notch inhibitor GSI-XII suggesting that γ-secretase inhibitors may represent a potential and novel therapeutic tool in this specific setting.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3128.

Frequency of headaches in patients over 80. A preliminary report

We evaluated 44 old patients (mean age 84 years) in order to study the frequency of headaches. The frequency found in our sample is higher in comparison to other studies. Further studies including a larger number of patients are needed to obtain more incisive results.

Comparison of allergen immunotherapy and drug treatment in seasonal rhinoconjunctivitis: a 3-years study

Drug treatment and specific immunotherapy (SIT) are both effective in seasonal rhinoconjunctivitis, but the former acts only on allergic symptoms while the latter modifies the natural history of the disease. Only a few studies compared the clinical efficacy of the two treatments with contrasting results. We planned a study to compare the efficacy of SIT (15 patients) and drug treatment (15 patients) in moderate to severe seasonal rhinoconjunctivitis caused by sensitization to grass pollen. SIT was performed by a 5-grass extract standardized in IR and absorbed onto calcium phosphate (Phostal, Stallergénes, Antony, France) using the conventional build-up phase in 12 weeks and a maintenance treatment with monthly injection for three years. Drug treatment was done with cetirizine as antihistamine, mometasone furoate as nasal topical steroid, and levocabastine eyedrops. All patients registered during the pollen season their symptoms and drug consumption. After one year 12 of 15 patients treated with SIT had less symptoms and drug consumption in respect to baseline compared to none in drug treated group (p = 0.021) and after three years 15 of 15 were improved in group A compared to one of 15 in group B (p = 0.008). These findings indicate an higher efficacy of SIT in patients with seasonal rhinitis not only in the long term but also in the first year of treatment.

Sonographic analysis of the ankle in patients with psoriatic arthritis

Foot involvement is very frequent in patients affected by psoriatic arthritis (PsA). However, evaluation of the painful foot can be problematic, because it is often difficult to distinguish between arthritis, tenosynovitis, and enthesopathy. Plain radiographs can show bone erosion or other features of joint involvement, but give little information about the soft tissues. We therefore studied foot involvement in 31 PsA patients using high resolution sonography, and compared the results with the findings on x-ray and clinical examination. Ultrasound revealed pathological findings in a large proportion of the patients, most of whom exhibited no clinical (pain or swelling) or radiological signs of foot involvement at the time of the study. Our data suggest that involvement of the tendons and entheses may be more frequent in PsA patients than has thus far been supposed, even in cases of not particularly aggressive disease, and that clinical evaluation tends to underestimate these manifestations.

MR cholangiopancreatography: value of axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences

OBJECTIVE

To compare axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences with three-dimensional (3D) maximum intensity projection (MIP) images in patients with suspected pancreaticobiliary obstruction.

MATERIAL AND METHODS

MR cholangiopancreatography (MRCP) was performed in 108 consecutive patients with a non-breath-hold, fat-suppressed, 2D, heavily T2-weighted fast spin-echo sequence in coronal plane. Axial T1- and T2-weighted images were previously obtained. In addition, 3D reconstructions of the coronal images were analysed separately by using a MIP algorithm. Both two-dimensional (2D) (axial and coronal) and 3D MIP images were separately evaluated by two readers in conference and their results were compared with that of endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, surgery and/or imaging follow-up. Statistical analysis of 2D and 3D MRCP images in diagnosing the level and probable cause of pancreaticobiliary obstruction were separately calculated.

RESULTS

106/108 of MRCP examinations were judged diagnostic by the two reviewers for adequacy of visualisation of the biliary and pancreatic ducts. Sensitivity, specificity, positive predictive value, negative predictive value and global diagnostic accuracy of 2D (axial and coronal) and 3D MRCP images in diagnosing the pancreaticobiliary obstruction were 94 and 57%,, 95 and 93%, 97 and 92%, 91 and 60%, 94 and 72% respectively.

CONCLUSION

Our results do indicate a higher global accuracy for axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences versus 3D MIP images in diagnosis of the level and probable cause of pancreaticobiliary obstruction and stress the limitations of 3D images in depiction of small intraductal pathology such as calculi and biliary neoplastic.

Choledocolithiasis: diagnostic accuracy of MR cholangiopancreatography. Three-year experience

The purpose of this study was to evaluate the diagnostic accuracy of MR cholangiopancreatography (MRCP) in the detection of common bile duct stones. A series of 286 consecutive patients were referred for MRCP, that was performed with a 1.5 T MR unit, through a non-breath-hold, respiratory-triggered, fat-suppressed, two-dimensional, heavily T2-weighted fast spin-echo sequence in the coronal plane. Axial T1 and T2-weighted sequences were first obtained. Axial, coronal, and Maximum Intensity Projection images were evaluated by three independent readers, who were asked to determine whether stones were present or not inside the biliary tract. The findings of MRCP images were compared with endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, intra-operative cholangiography, surgical, or imaging follow-up findings. Two-hundred and seventy-eight out of 286 MRCP examinations were judged diagnostic by the three reviewers. Among the 278 patients included in our study group, biliary tract lithiasis was proved in 76 cases (27%). On the basis of reviewers' reading, MRCP had sensitivity 92-93%, specificity 97-98%, positive predictive value 91-93%, negative predictive value 97-98%, and the diagnostic accuracy ranged between 95% and 96% in the detection of calculi. Interobserver agreement was excellent (K = 0.84, kappa statistic). MRCP showed a high diagnostic accuracy and an excellent inter-observer agreement in the detection of common bile duct stones.

MR virtual endoscopy of the pancreaticobiliary tract: a feasible technique?

To evaluate the feasibility of magnetic resonance (MR) virtual endoscopy of the pancreaticobiliary tract by using MR cholangiopancreatography (MRCP) data sets as source images, we retrospectively reviewed MRCP data sets of 120 patients with Navigator software (GE/Medical Systems, Milwaukee, WI) that allowed display of inner views by surface rendering the internal wall of the bile ducts with simulated light and shadow.

Diagnosis of adrenal adenoma: value of central spot of high-intensity hyperintense rim sign and homogeneous isointensity to liver on gadolinium-enhanced fat-suppressed spin-echo MR images

Eighty-nine patients with 108 adrenal masses, either adenomas (n = 88) or malignant lesions (n = 20), underwent magnetic resonance imaging (MRI) of the abdomen at 0.5 T for the purpose of determining whether adrenal adenomas could be differentiated from malignant lesions on gadolinium-enhanced fat-suppressed T1-weighted spin-echo (SE) images (Gd-E FS T1WI) and on T2-weighted SE images. The imaging protocol included conventional unenhanced SE T1- and T2-weighted sequences and Gd-E FS T1WI. Three observers independently evaluated signal intensity on unenhanced and enhanced images and also the presence of structures of high signal intensity in the outer margin [hyperintense rim sign (HRS)] or in the center [hyperintense central spot (HCS)] of the adrenal masses. Forty-one (46.5%) of 88 adenomas were homogeneously isointense to liver in unenhanced and enhanced T1-weighted sequences and in T2WI. HCS and HRS were observed in 33/88 (37.5%) and 15/88 (17%) adenomas, respectively, on Gd-E FS T1WI; in contrast, these signs were never revealed in any case of malignant lesions. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in classifying lesions as suggestive of adenoma were 93%, 90%, 98%, 75%, and 93%, respectively. Visual evaluation of details of tumor structures on Gd-E FS T1WI allows good characterization of adrenal masses. HCS, HRS, and homogeneous isointensity to liver are characteristic signs of adrenal adenomas.

Magnetic resonance appearance of asbestos-related benign and malignant pleural diseases

OBJECTIVES

This study describes the magnetic resonance findings of benign and malignant pleural diseases in asbestos-exposed subjects.

METHODS

Thirty patients with a history of asbestos exposure and pleural lesions in chest X-rays and computed tomography scans were examined with a 0.5- and a 1.5-T magnetic resonance unit. The examination protocol included cardiac-gated proton density and T2-weighted images, unenhanced and enhanced (Gd-DTPA; 0.1 mmol/ kg) T1-weighted images in the axial plane and sometimes in another orthogonal plane (sagittal or coronal or both). All the magnetic resonance images were reviewed by 3 experienced observers, who visually evaluated morphologic features, signal intensity, and contrast enhancement of pleural lesions. The diagnosis was established by means of percutaneous biopsy, thoracotomy, and combined clinical and radiological follow-up for at least 3 years.

RESULTS

Eighteen patients affected with multiple pleural plaques showed low signal intensity on both unenhanced and enhanced T1-weighted and proton density and T2-weighted images. In 2 of these patients an acute pleural effusion was observed. All the malignant lesions (11 mesotheliomas) and a solitary benign pleural plaque revealed high signal intensity on the proton density and T2-weighted images and inhomogeneous contrast enhancement in the postcontrast T1-weighted images. The sensitivity, specificity, and diagnostic accuracy of the magnetic resonance imaging in classifying a lesion as suggestive of malignancy were 100%, 95% and 97%, respectively.

CONCLUSIONS

The results point out 2 magnetic resonance signal intensity patterns for asbestos-related pleural lesions: (i) low-signal intensity on unenhanced and enhanced T1-weighted and proton density and T2-weighted images for benign plaques and (ii) nonhomogeneous hyperintensity in T2-weighted and enhanced T1-weighted images for malignant mesotheliomas.

MR virtual endoscopy of the pancreaticobiliary tract

PURPOSE

To evaluate the feasibility of surface-rendered magnetic resonance virtual endoscopy (MRVE) of magnetic resonance cholangiopancreatography (MRCP) data sets. We retrospectively reviewed MR cholangiopancreatography data sets of 120 patients with biliary stone (n=40), inflammatory ampullary stenosis (n=12), pancreatic tumor (n=8), cholangiocarcinoma (n=7), stenosis of surgical bilio-enteric anastomosis (n=4), extrinsic localized common bile duct stenosis (n=2), ampullary carcinoma (n=2), pancreatic duct stone (n=1), tumor of the gallbladder (n=1), and normal pancreaticobiliary tree (n=43). MRVE views were generated with Navigator software. Segmentation of the acquired data sets was performed with a thresholding technique. Navigation sequences were simulated through the entire biliary tract. MRVE was obtained in 27 (63%) of the 43 normal patients. Endoscopic views were generated in all 77 patients with partial or complete obstruction of the pancreaticobiliary tree. Among these, three groups of patterns were identified: 36 (47%) endoluminal masses (polyp-like masses), 17 (22%) luminal stenoses, 24 (31%) luminal occlusion. In 29 cases, hole artifacts through the internal wall were observed and interpreted as mistakes of segmentation. MRVE proved to show the internal anatomy of the biliary tract and endoluminal changes due to pathological condition. Further investigations are needed to test the usefulness and the potentialities of this technique.

Normal volumetric bone mineral density and bone turnover in young men with histories of constitutional delay of puberty

It has been suggested that an appropriate timing of puberty is necessary for normal bone mineral density (BMD) acquisition, which may not be achievable in children with constitutional delay of puberty (CDP). To assess the effect of pubertal delay on BMD, we measured areal BMD (aBMD) at lumbar spine, by dual-energy x-ray absorptiometry (DEXA), in a group of patients with CDP (n=21; mean age, 21.8+/-1.7 yr) at final height and in healthy controls (n=12; mean age, 19.3+/-1.3 yr). A subset of seven patients (group a) were untreated, whereas six subjects (group b) had received im testosterone depot (100 mg/month, for 6-12 months) and 8 boys (group c) oral oxandrolone (1.25-2.5 mg/daily, for 6-28 months) for their pubertal delay. Volumetric BMD (vBMD) was calculated from DEXA measurements. aBMD was reduced in patients with CDP (1.101+/-0.134 g/cm2), in comparison with controls (1.222+/-0.091 g/cm2; P < 0.009); no significant differences were found among the groups (group a, 1.089+/-0.133 g/cm2; group b, 1.111+/-0.118 g/cm2; group c, 1.103+/-0.160 g/cm2). vBMD was not significantly different in patients with CDP (0.327+/-0.021 g/cm3) and in controls (0.337+/-0.017 g/cm3; P= not significant); no significant differences were found among the groups (group a, 0.326+/-0.016 g/cm3; group b, 0.332+/-0.022 g/cm3; group c, 0.330+/-0.021 g/cm3). No differences were found in mineral metabolism and in bone markers between patients and controls; patients did not report an increased fracture rate, compared with controls. Our data indicate that: 1) men with CDP have normal vBMD; 2) the reduced aBMD may be the result of uncritical use of DEXA measurements in subjects with altered growth pattern; and 3) androgen administration during pubertal years did not improve BMD in young men with a history of CDP.

Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females

To evaluate the effect of central precocious puberty (CPP) and its treatment with gonadotropin-releasing hormone (GnRH) analogues on final height and peak bone mass (PBM), we measured lumbar bone mineral density (BMD) in 23 girls at final height. Patients were distributed in two groups. Group 1: 14 patients with progressive CPP were treated with GnRH analogues; seven patients received buserelin (1600 microg/daily), subsequently switched to depot triptorelin (60 microg/kg/26-28 days); seven patients were treated with depot triptorelin (60 microg/kg/26-28 days); mean age of treatment was 6.2 years (range 2.7-7.8 years); the treatment was discontinued at the mean age of 10.1 years (range 8.7-11.3 years); final height was reached at the mean age 13.4 years (range 12.0-14.9 years). Group 2: 9 patients (mean age 6.5 years, range 4.8-7.7 years) with a slowly progressing variant of CPP were followed without treatment; final height was reached at the mean age 13.6 years (range 12.5-14.8 years). Lumbar BMD (L2-L4 by dual energy X-ray absorptiometry) was measured in all patients at final height. In group 1, final height (158.9+/-5.4 cm) was significantly greater than the pre-treatment predicted height (153.5+/-7.2 cm, P < 0.001), but significantly lower than mid-parental height (163.2+/-6.2 cm, P < 0.005). Subdividing the girls of group 1 according to the bone age at discontinuation of therapy (i.e. < or =11.5 years, n=5, or > or =12.0 years, n=9), the former patients had a final height significantly higher than the latter (163.7+/-3.9 cm vs 156.5+/-4.6 cm, P < 0.02). In group 2, final height (161.8+/-4.6 cm) was similar to the pre-treatment predicted height (163.1+/-6.2 cm, P=NS) and was not significantly different from mid-parental height (161.0+/-5.9 cm). BMD values (group 1: 1.11+/-0.14 g/cm2, group 2: 1.22+/-0.08 g/cm2) were not significantly different from those of a control group (1.18+/-0.10 g/cm; n=20, age 16.3-20.5 years) and the patients' mothers (group 1: 1.16+/-0.07 g/cm2, n=11, age 32.9-45.1 years; group 2: 1.20+/-0.08 g/cm2, n=7, age 33.5-46.5 years). In group 1, the girls who stopped therapy at a bone age < or =11.5 years had significantly higher BMD (1.22+/-0.10 g/cm2) compared to those who discontinued therapy at a bone age > or =12.0 years (1.04+/-0.12 g/ cm2, P < 0.05).

CONCLUSION

In girls with progressive CPP, long-term treatment with GnRH analogues improves final height. A subset of patients with CPP does not require treatment because good statural outcome (slowly progressing variant). In CPP, the abnormal onset of puberty and the long-term GnRH analogue treatment do not impair the achievement of PBM. In GnRH treated patients, the discontinuation of therapy at an appropriate bone age for pubertal onset may improve both final height and PBM.

[Villous-lipomatous proliferation of synovial membrane of the knee (lipoma arborescens). Magnetic resonance findings]

PURPOSE

We reviewed the imaging patterns of the villous-lipomatous proliferation of the knee synovial membrane (lipoma arborescens), with special reference to the role of MRI in the diagnosis of this rare condition.

MATERIAL AND METHODS

1994 to 1996, we examined four patients, none of them with a history of knee trauma. The clinical picture was characterized by moderate and painful suprapatellar swelling in three cases and by moderate suprapatellar swelling alone in one case. All patients were examined with conventional radiography and MRI; two were submitted to US and two to CT. The diagnosis of lipoma arborescens was suggested on the basis of imaging patterns and then confirmed by histologic findings.

RESULTS

Conventional radiography showed a roughly oblong slim opacity in the suprapatellar recess in all cases; the joint space was always preserved. US showed a villous lesion surrounded by fluid, but provided no specific data on its nature. CT and MRI not only provided better location and morphologic detailing and showed the relationships with articular structures better, but also permitted the direct identification of the fat nodules within the abnormal synovial reaction.

CONCLUSION

We stress the role of MRI in suggesting the correct diagnosis of lipoma arborescens, as it was subsequently confirmed in our series by histologic findings. In fact, fat-suppression sequences, after T1-weighted SE, can typify fat tissue.

Incidentally discovered adrenal masses: evaluation with gadolinium enhancement and fat-suppressed MR imaging at 0.5 T

The purpose of the study is to evaluate the ability of Gd-enhancement and fat-suppressed MR imaging operating at midfield strength to characterize incidentally discovered adrenal masses. Sixty patients with 72 adrenal masses incidentally discovered during US or CT exams were studied with a 0.51 MR unit following clinical and laboratory evaluation. After Gd-DTPA intravenous administration a modified three-point Dixon technique was performed in all patients. This technique provided three images sets: conventional T1-weighted SE images, fat-suppressed T1-weighted images and water-suppressed T1-weighted images. Diagnosis was established by means of surgery (11 lesions), fine-needle biopsy (21 lesions) and stability on ultrasonographic follow-up for at least 1 year (range, 12-87 months) from adrenal lesion discovery (40 masses). In most of adenomas (n = 55) an homogeneous enhancement was observed on postcontrast T1WI; however, 15 out of these lesions showed a small focal spot of high intensity in Gd-enhanced fat-suppressed images. On the contrary, malignant conditions (n = 6) and pheochromocytoma (n = 1), all had inhomogeneous signal intensities which were relatively higher after Gadolinium injection as compared with the liver. The fat suppression technique demonstrated areas of bright signal intensity related to high vascularity. The performance of three observers in order to differentiate malignant from benign conditions showed sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of 100, 88.5, 90, 50 and 100% on the basis of gadolinium enhancement only, by utilizing the Dixon technique. In conclusion, although Gd-enhancement and fat-suppressed sequence helped correctly differentiate among the groups of incidentally discovered adrenal masses, the degree of overlap suggests that it is still difficult to characterize individual patients. However, the modified three-point Dixon technique after contrast material administration appears to be a further capability of midfield MRI in the characterization of adrenal tissue.