The evolution of pituitary cysts in growth hormone-treated children.

OBJECTIVES: We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children. METHODS: Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included. The percent of the pituitary gland occupied by the cyst (POGO) was calculated, and a cyst with a POGO of ≤15% was considered small, while a POGO >15% was considered large. RESULTS: Thirty-five cysts were small, and 14 were large. Five of the 35 small cysts grew into large cysts, while 6 of the 14 large cysts shrunk into small cysts. Of 4 cysts that fluctuated between large and small, 3 presented as large and 1 as small. Small cysts experienced greater change in cyst volume (CV) (mean=61.5%) than large cysts (mean=-0.4%). However, large cysts had a greater net change in CV (mean=44.2 mm3) than small cysts (mean=21.0 mm3). Older patients had significantly larger mean pituitary volume than younger patients (435.4 mm3 vs. 317.9 mm3) and significantly larger mean CV than younger patients (77.4 mm3 vs. 45.2 mm3), but there was no significant difference in POGO between groups. CONCLUSIONS: Pituitary cyst size can vary greatly over time. Determination of POGO over time is a useful marker for determining the possibility of a pathologic effect on pituitary function since it factors both cyst and gland volume. Large cysts should be monitored closely, given their extreme, erratic behavior.

Dual-layer spectral CT virtual-non-contrast images aid in parathyroid adenoma analysis and radiation dose reduction: confirmation of findings from dual-energy CT.

4D-parathyroid CT scans have become a mainstay in the evaluation and pre-surgical planning for parathyroid adenomas. Most protocols typically rely on non-contrast images, prior to the arterial and delayed phases. Previous reports with dual-energy CT imaging have highlighted the utility of virtual non-contrast images to help reduce radiation dose while maintaining diagnostic accuracy. Herein, we report two cases of surgically proven parathyroid adenomas diagnosed with 4D-parathyroid CT scans performed on dual-layer spectral scanners, and in retrospect highlight the utility of virtual non-contrast images. To our knowledge, this report provides the first description of virtual non-contrast images from dual-layer spectral CT scanners that could aid in the diagnosis of parathyroid adenomas, confirming similar findings described with dual-energy CT scanners.

Retrograde cysto-myelogram: Case Report.

BACKGROUND: In the scenario of blunt trauma with suspected bladder injury, conventional retrograde cystography is the gold standard for accurate diagnosis. CASE DESCRIPTION: The authors report the case of a 54-year-old patient who presented with pelvic and sacral fractures and a ruptured bladder after being hit by a vehicle. A retrograde computed tomography cystogram demonstrated extraperitoneal extravasation of the contrast agent, which traversed violated sacral nerve roots, resulting in contrast entering the subarachnoid space at the left sacral ala predominantly through the left L5 and S1 nerve roots. CONCLUSIONS: This is the first known report of an accidental myelogram imaging performed through a retrograde cystogram.

Early angiographic occlusion of ruptured blister aneurysms of the internal carotid artery using the Pipeline Embolization Device as a primary treatment option.

BACKGROUND: Data on the timing, durability and occlusion rate of treating ruptured blister cerebral aneurysms using the Pipeline Embolization Device (PED) are limited. CLINICAL PRESENTATION: Three patients who presented with subarachnoid hemorrhages from ruptured blister aneurysms of the internal carotid arteries were treated with the PED. RESULTS: Aneurysmal occlusion with reconstruction of the parent vessels occurred angiographically using the PED as a primary treatment modality. All three patients were treated successfully without immediate or delayed complications and remained neurologically intact during the 6-month follow-up period. CONCLUSIONS: Complete occlusion of a ruptured blister aneurysm can occur immediately after PED placement. In ruptured blister aneurysms with contrast stagnation after PED treatment, early angiographic occlusion was confirmed as early as 6 weeks and continued with medium-term durability.

Late-onset neurodegeneration with brain iron accumulation with diffusion tensor magnetic resonance imaging.

INTRODUCTION: Neuroferritinopathy is an autosomal dominant neurodegenerative disorder that includes a movement disorder, cognitive decline, and characteristic findings on brain magnetic resonance imaging (MRI) due to abnormal iron deposition. Here, we present a late-onset case, along with diffusion tensor imaging (DTI). CASE PRESENTATION: We report the case of a 74-year-old Caucasian female with no significant past medical history who presented for evaluation of orofacial dyskinesia, suspected to be edentulous dyskinesia given her history of ill-fitting dentures. She had also developed slowly progressive dysarthria, dysphagia, visual hallucinations as well as stereotypic movements of her hands and feet. RESULTS: The eye-of-the-tiger sign was demonstrated on T2 MRI. Increased fractional anisotropy and T2 hypointensity were observed in the periphery of the globus pallidus, putamen, substantia nigra, and dentate nucleus. T2 hyperintensity was present in the medial dentate nucleus and central globus pallidus. DISCUSSION: The pallidal MRI findings were more typical of pantothenate kinase-associated neurodegeneration (PKAN), but given additional dentate and putamenal involvement, lack of retinopathy, and advanced age of onset, PKAN was less likely. Although the patient's ferritin levels were within low normal range, her clinical and imaging features led to a diagnosis of neuroferritinopathy. CONCLUSION: Neurodegeneration with brain iron accumulation (NBIA) is a rare cause of orofacial dyskinesia. DTI MRI can confirm abnormal iron deposition. The location of abnormal iron deposits helps in differentiating NBIA subtypes. Degeneration of the dentate and globus pallidus may occur via an analogous process given their similar T2 and DTI MRI appearance.