An Overview of Diagnosis of Primary Autoimmune Hypophysitis in a Prospective Single-Center Experience.

BACKGROUND: Autoimmune hypophysitis is a rare disease with a natural progression that is not well known. AIM: To collect representative data on clinical features of autoimmune hypophysitis and better characterize the disease. PATIENTS AND METHODS: A prospective single-center study was designed. Autoimmune hypophysitis-affected patients evaluated from 2011 at our tertiary care Pituitary Unit were enrolled. After ruling out other pituitary masses and secondary causes of hypophysitis, autoimmune hypophysitis was the diagnosis of exclusion. Autoimmune hypophysitis was classified as adenohypophysitis, panhypophysitis, and infundibuloneurohypophysitis according to clinical and neuroradiological findings. RESULTS: A total of 21 patients met the inclusion criteria: 9 were diagnosed with adenohypophysitis, 4 with panhypophysitis, and 8 with infundibuloneurohypophysitis. The frequency of secondary hypoadrenalism was similar in adenohypophysitis, panhypophysitis, and infundibuloneurohypophysitis. Growth hormone deficit and secondary hypogonadism occurred more frequently in infundibuloneurohypophysitis than in adenohypophysitis and panhypophysitis (p = 0.009; p = 0.04). All cases of multiple pituitary secretion deficits occurred in cases of infundibuloneurohypophysitis (p = 0.04). No correlations between hypophysitis subtype and anti-pituitary and anti-hypothalamus autoantibodies were found. A higher frequency of extractable nuclear antigens (ENA) and anti-nuclear antibodies (ANA) was found in cases of panhypophysitis (OR 5.0, 95% CI 0.86-28.8, p < 0.001, and OR 1.8, 95% CI 1.1-3.2, p = 0.02, respectively) as compared to adenohypophysitis and infundibuloneurohypophysitis. CONCLUSION: Infundibuloneurohypophysitis should be taken into account in the etiological diagnosis of hypopituitarism, particularly if it is associated with diabetes insipidus and in cases of growth hormone deficit, secondary hypogonadism, or multiple hormone deficits. Contrast-enhanced MRI is crucial for the clinical and noninvasive diagnosis of hypophysitis. Screening for autoantibodies, particularly anti-ENA and anti-ANA, is strongly suggested in the clinical context of hypophysitis.

Preliminary Results in Unresectable Head and Neck Cancer Treated by Radiofrequency and Microwave Ablation: Feasibility, Efficacy, and Safety.

PURPOSE: To retrospectively determine whether the application of thermal ablation to recurrent and advanced head and neck cancer (HNC) could allow for local tumor control. MATERIALS AND METHODS: From 2002 to 2014, 22 patients (17 men and 5 women; mean age, 64 y; age range, 42-88 y) with unresectable HNC lesions treated with thermal ablation were evaluated. Patients were followed at 3 and 6 months after treatment, every 6 months for 5 years, and yearly thereafter with computed tomography and/or magnetic resonance imaging. The mean follow-up period was 32.2 months (range, 3-51 mo). RESULTS: Three of 22 patients with primary lesions are still alive; two of these patients were treated with radiofrequency (RF) ablation and one was treated with microwave (MW) ablation. Of the 19 remaining patients, four were treated with MW ablation and 15 were treated with RF ablation. Imaging revealed partial response in eight patients, and complete response was observed in the remaining 14. There were two major complications after ablation treatment. The mean survival time was 32.9 months ± 3.205 (standard error; 95% confidence interval [CI], 26.6-39.2 mo). The survival time for MW ablation cases (36 mo ± 5.185; 95% CI, 25.8-46.16 mo) was longer than for RF ablation (32.2 mo ± 3.911; 95% CI, 24.5-39.8 mo), although the CI overlap between the groups is large. CONCLUSIONS: Percutaneous thermal ablation is a promising alternative treatment for local control of incurable HNC.

Uveal melanoma: evaluation of extrascleral extension using thin-section MR of the eye with surface coils.

PURPOSE: This study was done to evaluate the role of high-resolution magnetic resonance (MR) imaging with special surface coils in selecting the correct therapeutic approach (eye enucleation or follow-up) in patients with suspected extrascleral extension of uveal melanoma. MATERIALS AND METHODS: This prospective study involved 12 patients with suspected extrascleral extension of uveal melanoma on orbital ultrasonography. All patients were studied with thin-section MR imaging of the eye using surface coils. RESULTS: High-resolution MR imaging of the eye excluded extrascleral extension of disease in 8/12 patients: in 4/8 cases it revealed vascular ectasia and in the other 4/8 cases the linear hypointensity of the sclera was unbroken. Seven of these eight patients were followed up by ultrasound, which showed stability of melanoma for at least 2 years, while the last patient underwent enucleation, and the histological examination confirmed the MR diagnosis. In 4/12 patients, high-resolution MR suggested a diagnosis of extrascleral extension of melanoma, which was confirmed at histological examination after enucleation. CONCLUSION: High-resolution MR imaging of the eye with surface coils allowed us to evaluate extrascleral extension of uveal melanoma and choose the correct therapeutic approach, avoiding unnecessary enucleation in 7/12 patients.

Bib Sign in Proximal Descending Thoracic Aorta Rupture on CT Angiography: Presentation of a Paradigmatic Case.

Thoracic aortic rupture may present with subtle clinical and CT-angiography findings. Recognition of the imaging features of early rupture is key for timely diagnosis and treatment. This report presents a new sign of incipient proximal thoracic aortic rupture on CT-angiography.

Whole-Body Low-Dose Multidetector-Row CT in Multiple Myeloma: Guidance in Performing, Observing, and Interpreting the Imaging Findings.

Multiple myeloma is a hematological malignancy of plasma cells usually detected due to various bone abnormalities on imaging and rare extraosseous abnormalities. The traditional approach for disease detection was based on plain radiographs, showing typical lytic lesions. Still, this technique has many limitations in terms of diagnosis and assessment of response to treatment. The new approach to assess osteolytic lesions in patients newly diagnosed with multiple myeloma is based on total-body low-dose CT. The purpose of this paper is to suggest a guide for radiologists in performing and evaluating a total-body low-dose CT in patients with multiple myeloma, both newly-diagnosed and in follow-up (pre and post treatment).