Magnetic resonance and the diagnosis of short stature of hypothalamic-hypophyseal origin

Magnetic resonance imaging was performed in 23 patients with short stature (7 had multiple pituitary hormone defect, 11 had isolated growth hormone deficiency and 5 had normal variant short stature) to investigate if there is a relation between magnetic resonance findings and results of endocrine tests. Magnetic resonance imaging of patients with multiple pituitary hormone deficiency or with serious isolated growth hormone deficiency (growth hormone < 3 micrograms/l) revealed an interrupted pituitary stalk and ectopic neurohypophysis or a mass. In patients with less serious isolated growth hormone deficiency (growth hormone > 3 micrograms/l) or with normal variant short stature, the technique revealed a normal or hypoplastic hypophysis. Magnetic resonance appears to be a useful second-level diagnostic tool in defining the type of alteration in growth defects of endocrine origin.

[Comparison of MR and CT in a radiological study of Cushing's syndrome. A report on 16 cases]

In 16 patients with high cortisol plasma levels MRI and CT investigation of adrenal gland region was performed; 13 also had the pituitary region examined. CT and MRI results in Cushing's Syndrome due to adrenal glands etiology (8 cases) are overlapping. The morphological criteria utilized consist in the radiological finding of bilateral adrenal hyperplasia or adrenal mass (adenoma, carcinoma). The great amount of retroperitoneal fat increases the normal contrast with both techniques. In the pituitary Cushing's Syndrome MRI was more sensible than CT as far as it concerns ACTH producing pituitary lesion assessment; this technique may show 5 mm diameter adenomas for their high signal intensity.

Effectiveness and tolerability of long term treatment with cabergoline, a new long-lasting ergoline derivative, in hyperprolactinemic patients

Cabergoline (CAB) is a new oral dopaminergic compound showing a very long-lasting PRL-lowering activity and reported to be well tolerated. The efficacy and tolerability of chronic treatment with CAB in 30 female hyperprolactinemic patients, aged 18-52 yr (6 microadenomas, 3 macroadenomas, and 21 functional hyperprolactinemias), were studied. In a group of 10 patients who received CAB (0.8 mg once weekly or 0.4 mg twice weekly) for 8 weeks PRL levels normalized while on treatment and remained normal (8 patients) or greatly reduced (1 patient) for 1-2 months after discontinuation of the drug. Twenty-six patients underwent chronic treatment (6-12 months) with an initial dose of 0.5 mg once weekly, subsequently increased to 1-2 mg in 10 patients and decreased in the other 2. Due to severe side-effects CAB was discontinued in 3 patients, in 1, 8, and 12 weeks. A significant reduction of PRL levels was already observed after the first week of treatment (mean +/- SEM basal values, 90.1 +/- 13.3 vs. 29.5 +/- 6.3 micrograms/L; P less than 0.001). Twenty-two patients had normal PRL levels in 1-36 weeks (mean, 6 weeks) with 0.5-2 mg CAB. Twenty-two patients resumed regular menses; 2 patients became pregnant after 3-11 months of treatment. Thirteen patients complained of side-effects (nausea, hypotension, headache, gastric pain, dizziness, and weakness) that disappeared with time in 10 of them. The comparison with a previous bromocriptine treatment regimen in 20 patients had shown that the number of patients requiring discontinuation of the latter drug was significantly higher (7 vs. 3 patients; P less than 0.001). However, 2 patients who needed to discontinue CAB were able to tolerate bromocriptine therapy. A computed tomographic scan performed after 12 months of therapy in 7 patients showed a significant reduction (50%) of the adenoma in 5. In conclusion, our results show that CAB is a well tolerated new dopamine agonist with long-lasting activity that represents an advance in chronic medical treatment of hyperprolactinemic conditions.

Is magnetic resonance imaging more sensitive than computed tomography in the location of corticotropin secreting pituitary adenomas?

Two cases of pituitary-dependent Cushing's syndrome are described in which the computed tomography (CT) examination was negative; as the hormone dynamic investigations were directed towards the presence of corticotropin (ACTH) secreting pituitary formations, magnetic resonance imaging (MRI) of the pituitary was performed, which evidenced the presence of such lesions; subsequent neurosurgery confirmed in both cases the location indicated by MRI. In conclusion, the higher sensitivity of MRI compared to CT in the diagnosis of ACTH secreting pituitary adenomas can be noted.

[CT and MR compared in the study of hypophysis]

Normal CT and MR anatomy was studied in two series (53 and 25 cases respectively) of young volunteers of both sexes, asymptomatic and certainly without lesions of the pituitary gland. 115 other pathological cases (73 hyperprolactinemias, 8 acromegalies, 15 Cushing syndromes, 2 hyperthyroidisms, 17 nonsecreting adenomas) were examined using both CT and MRI. Both an accurate review of the relative literature and the results of our own series prove that MR is superior to CT in diagnosing pituitary microadenomas (3.2% not diagnosed with MRI and 25.8% not diagnosed with CT), in the follow-up of prolactinomas subjected to medical therapy and in the study of extrasellar involvement of pituitary adenomas, particularly with regard to the demonstration of compression of the optic chiasma.

[Percutaneous needle biopsy of the lung. Critical review of 496 cases]

Between February 1979 and December 1986, 618 lung biopsies were performed on 496 patients (122 with double puncture, using Tru-cut and 19-20 G needles). Overall diagnostic accuracy was 84.5%; the 77 patients examined in the past 18 months only underwent thin needle (19-20 G) biopsies--which were carried out by an experienced radiologist--and more sophisticated cyto-histological techniques were employed. Such a procedure gave better results (sensitivity 94.1%, accuracy 94.8%) than did the use of larger caliber needles in the past years; moreover, no complications occurred in these patients. In conclusion, 19-20 G needles are to be preferred to bigger ones, provided that the operator be experienced and cyto-histology be correctly performed.

[Percutaneous biopsy (PB) of solid thoraco-abdominal formations with instrumental guidance. The authors' experience]

The results are reported of 283 percutaneous biopsies performed on solid thoracic and abdominal masses. Indications to biopsy are examined at first, which are relatively limited in number if compared to other authors' opinion on the subject--i.e., when the tumor cannot be characterized with any other methodology, or in case of neoplasms whose histological type is to be known in order to plan therapy. The techniques employed are then evaluated, with a special emphasis on the needle caliber and the guidance method (US, radioscopy and CT). Correct samplings have been obtained in more than 90% of cases. Minor complications were observed in less than 10% of cases, while major complications were totally absent. In conclusion, percutaneous biopsy proves useful in those cases where exam indication is respected and an accurate selection is previously performed.

[MR tomography in adrenal pathology. Preliminary report on 25 histologically controlled cases]

Twenty-five patients affected by adrenal glands pathology underwent CT and MRI: 6 non-functioning adenomas, 2 Cushing's adenomas, 2 Conn's adenomas, 6 metastases, 3 cysts, 2 carcinomas (Cushing's syndrome), 1 lymphoma and 3 pheochromocytomas. Diagnosis was subsequently confirmed either at surgery, or autopsy, or with needle biopsy. In all cases normal adrenal glands and pathological lesions were showed by MRI. T1 signal intensity and mass diameter were compared with T2 signal intensity, represented by the intensity ratio between the adrenal mass vs normal hepatic parenchyma. MRI signal intensity, usually high in case of malignancy and low in adenomas, shows a mean value which is much wider than that referred to mass diameter evaluation (carcinoma is larger than adenoma); for this reason those findings have proved to be insufficiently accurate for adrenal tissue characterization, even for the evaluation of cysts and pheochromocytomas. In the same cases CT showed higher accuracy.

[A possible role of magnetic resonance in the follow-up of renal transplants]

The authors discuss the possible role of Magnetic Resonance Imaging (MRI) in the follow-up of renal transplants. Its diagnostic accuracy is compared with Ultrasounds (US), which is considered the method of choice in postoperative monitoring of renal transplants. Thirty-two patients (transplant life ranging from 5 days to 37 months) were examined in the same day with both MRI and US. Sonographic evaluation is based on a group of signs related to renal alterations and unanimously ascertained; the identification of MR patterns of normally functioning kidney or renal rejection might give way to more extensive clinical applications of the method, with the advantages of multiplanarity and no X-ray use. MR diagnostic accuracy in the diagnosis of normally functioning transplant or renal rejection was 82.7% (vs. US: 68.9%); even though specificity was the same (84.6%). MRI had higher sensibility than US (82.25% vs. 656.25%). MRI is more sensitive in demonstrating renal pathology in transplanted kidneys, and its diagnostic accuracy is superior. Still, US must be considered the methodology of choice in instrumental research when there is a clinical suspicion of renal rejection, due to its sufficient diagnostic accuracy, to its being easy to perform in continuous follow-up, to its low cost and to the short execution time. MRI is nevertheless suggested in the follow-up of renal transplants both in questionable cases and when biopsy cannot be performed.

[Magnetic resonance in renal transplants]

The authors report their experience in the study of renal transplant recipients by MR, in order to determine its clinical potentials. The main purpose of this work is to focus on MR patterns in relation to clinical findings of rejected or normally functioning kidney. Twenty-four patients were examined with a 0.5 T superconductive magnet, body coil, spin-echo pulse sequence (SE) and inversion-recovery (IR). MRI patterns could be seen in normally functioning kidneys and transplant rejections, while variable MRI findings were observed in transplants with acute tubular necrosis (ATN). In the normally functioning transplanted kidney there is a clear corticomedullary differentiation (CMD), and the extent of vascular penetration into the renal parenchyma is clearly seen. In transplant rejection, CMD is either diminished or absent, and there is no vascular penetration into the parenchyma; to differentiate acute from chronic rejections, the increase/decrease in renal size and the change in renal shape (spherical shape in acute transplant rejection) respectively must be observed. MRI proves thus to be useful in the study of renal transplants, even in case of questionable clinical findings, and in patients in whom renal biopsy is contraindicated.

[Disorders of heart rhythm during urography studied with Holter monitoring. Comparison of ionic and non-ionic contrast media]

Given the disagreements in the literature over the extent of cardiac complications during urography it was decided to assess any arrhythmias following the injection of ionic and non-ionic contrast media and a placebo by means of 24 hours dynamic Holter monitoring. The results were subjected to meticulous statistical analysis and showed no connection between electrocardiographic alterations and the substance injected. The absence of statistical significance and the variability of the results suggest that alterations in the physiological parameters and/or arrhythmias arising during the administration of contrast media should be assessed with extreme caution.

[Magnetic resonance in the study of the adrenal glands]

Current usage of MR in the clinical study of adrenal pathology is assessed with a review of the advantages and limitations of this new imaging technique and a critical analysis of data deriving both from the literature and from personal experience. The possibility of a multiplanar study offered by MR permits a more accurate anatomical-topographical definition of the adrenal masses though it is not yet capable of the tissue characterisation that would diagnose the nature of the lesion, though it can differentiate between inert adenomas and metastases.

[Percutaneous treatment of ureteral obstructions with an internal double-J prosthesis. Initial long-term results]

Percutaneous insertion of ureteral stents is a widely accepted method for ureteral obstructions treatment. From 1981 to february 1986, we introduced 78 endoprostheses in 60 patients. Fifty-six with malignant tumours and 4 with benign stenoses. In 48 of those 60 patients follow-up is complete. In the patients with malignant obstructions the mean time of survival was 198 days. Twelve patients were still alive in february 1986, with a mean time of survival over 300 days. In 12 patients (25%) the stent became obstructed in a mean time of 96.8 days. The placement of ureteral stents offers an alternative treatment to the palliative urologic surgery.

[Percutaneous pancreato-gastrostomy in the treatment of pancreatic pseudocysts. Presentation of 2 cases]

The authors describe a new method for the treatment of pancreatic pseudocysts using a personal technique: the percutaneous pseudocystogastrostomy. Under US and fluoroscopy guidance at first a percutaneous drainage is introduced in the pseudocyst using a transgastric approach. For seven days the drainage catheter is flushed with antibiotic solution (Rifocin), then under fluoroscopy and endoscopy guidance doubled pig-tail catheter is placed with its curlend ends in the lumen of the stomach and pseudocyst respectively. After 60 days the double pig-tail catheter is removed endoscopically. Two patients with pancreatic pseudocysts were treated successful by this method. No complications or recurrences were observed.

[Diagnostic accuracy of sequential angio-urography with the spot-camera in clinical practice]

In this perspective study the authors examined 57 patients to evaluate diagnostic accuracy of sequential angiourography (AUS) using spot-camera and image subtraction for the visualization of the vascular phase of the renal arteries. All the subjects underwent surgery or follow-up with other clinical and radiological methods. The results obtained with this technique, of low cost and simple execution, were satisfactory: accuracy 98%, sensitivity 100%, specificity 98%.

[Fissures in biliary calculi. Personal contribution (author's transl)]

In a series of 70 patients suffering from biliary lithiasis, the roentgenologic findings of fissures in the calculi was observed in 5 cases examined by means of cholecystography and in 7 cases who underwent cholangiocholecystography. Fissures were demonstrated 11 times in calculi after surgery. The "Mercedes-Benz" sign was never observed at the abdominal examination without contrast medium. The presence of fissures may be an additional sign in the radiologic diagnosis of biliary calculi, but its value is not determinant.