Acromegaly with joint pain as an initial symptom: A case report.

BACKGROUND: Acromegaly is caused by the long-term excessive secretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). It can cause excessive hyperplasia of bone, cartilage, and soft tissue. CASE PRESENTATION: A 50-year-old woman had a history of joint pain and swelling for more than 1 year. She visited a local primary care clinic, but her illness was not diagnosed by a primary care physician. After relevant examination in our hospital, we excluded inflammatory arthritis such as rheumatoid arthritis, immune disease-related arthritis, and infectious arthritis, and considered osteoarthritis or endocrine-metabolic arthritis. When we examined her again, we found that her fingers and toes were enlarged. She was diagnosed with acromegaly after IGF-1 test, and pituitary magnetic resonance imaging. Her joint symptoms were significantly relieved and her prognosis was good after surgery in another hospital. CONCLUSIONS: Acromegaly is a complex and rare disease, which is difficult to diagnose. When a patient presents with arthralgia, it is easily misdiagnosed as a rheumatic disease, and the diagnosis and treatment are delayed.

Diagnostic value of curved planar reformation of MRI for lumbosacral nerve roots in the localization of nerve roots for adult lumbar degenerative scoliosis.

PURPOSE: To compare the diagnostic value of curved planar reformation of MRI (MRI-CPR) and 2D MRI in determining the responsible nerve in patients with adult lumbar degenerative scoliosis (ALDS). METHOD: A total of 45 patients diagnosed with ALDS were included in the study. All patients underwent MRI-CPR and 2D MRI and subsequently received surgery. These two diagnostic methods were compared with the results of surgical exploration to assess nerve root compression. RESULTS: The sensitivity and accuracy of MRI-CPR are higher than 2D MRI (93.8% vs 80.0%; 92.8% vs 77.7%, respectively). And the specificity of MRI-CPR is higher than 2D MRI (87.5% vs 68.8%). Besides, the PPV and NPV of MRI-CPR are higher than 2D MRI (96.8% vs 91.2%; 7.8.% vs 45.8%). The area (AUC) under the receiver operating characteristic curve (ROC) for MRI-CPR and 2D MRI was 0.74 and 0.91, respectively. The judgement was made by two independent radiologists, while the consistency tests for 2D MRI and MRI-CPR with Kappa values were 90.6% and 82.2%, respectively. CONCLUSIONS: The clinical diagnostic value of MRI-CPR was better than 2D MRI in the determination of the responsible nerve root. Moreover, MRI-CPR sequence images can clearly show the route of lumbosacral nerve roots and their relationship with adjacent tissues. Therefore, MRI-CPR can be an important complement to conventional 2D MRI in the diagnosis of responsible nerve roots in patients with ALDS.

A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula.

To explore a comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula to evaluate its morphology changes.Forty-six patients with anal fistula were enrolled. Each patient acquired a 3.0T magnetic resonance imaging (MRI) routine sequence, diffusion-weighted imaging (DWI) sequence and fat suppression T1 weighted imaging (FS T1WI) contrast enhancement (CE) scanning. To record the morphology performances of the internal orifice and the fistulas on the transverse images of fat suppression T2 weighted imaging (FS T2WI), DWI, FS T2WI combined with DWI, FS T1WI Gd-CE, with the standard of the surgical pathology results. Two observers evaluated images in consensus. The conspicuity and the diagnostic performance rate were compared between the 4 imaging data sets.The consistencies of interobservers about the conspicuity scores and the diagnostic performance rates of the internal orifice and the fistula were good. The conspicuity of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The diagnostic performance rate of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The conspicuity of the fistula was higher for the set of FS T2WI+DWI and FS T1WI+CE than FS T2WI or DWI. There were no significantly differences between the 4 sets of FS T2WI, DWI, FS T2WI+DWI, and FS T1WI+CE in the diagnostic performance rate of the fistula.The set of FS T2WI combined with DWI was comparable to FS T1WI CE in evaluation of anal fistula morphology changes.