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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(3): 194-204, mar. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-188148

RESUMO

Background: Dopamine agonists (DA) are the first-line therapy in prolactinomas, but they fail to decrease prolactin (PRL) levels and/or tumor size in some of these tumors, which are labeled as resistant prolactinomas (RP). To date, risk factors for DA resistance are not fully understood and management of DA-RP is not well established. Methods: We retrospectively recorded clinical, biochemical and radiological features, as well as management and outcome, of all cabergoline (CAB)-RP attended at the Endocrinology department of a tertiary hospital between 1995 and 2016. CAB resistance was defined as the failure to normalize PRL (biochemical resistance, BR) or reduce tumor size by at least 50% (morphological resistance, MR) with a CAB dose up to 2 mg/week (or 3 mg/week in cases where lower doses were not tested) for at least 3 months. Results: Ten CAB-RP were found. The mean age of the cohort was 30.6 years and 50% of subjects were male. The average tumor size was 1.78 cm (80% macroadenomas). The mean maximal dose of CAB was 3.8 mg/week. Five patients showed isolated MR, four combined MR + BR and only one isolated BR. MR patients were more often males and older than MR + BR patients. Transsphenoidal surgery achieved normalization of PRL and/or disappearance of tumor in three of seven patients. At the end of follow up all patients had controlled PRL levels (with or without CAB) and most of them bore a visible although stable tumor. Conclusions: Isolated MR and combined MR + BR are the most frequent patterns of DA resistance whereas isolated BR seems to be uncommon. Our data support a high tumor size but not male gender as a risk factor for DA resistance


Contexto: Los agonistas dopaminérgicos (AD) son el tratamiento de elección de los prolactinomas, pero en algunos casos no logran normalizar los niveles de prolactina (PRL) o disminuir el tamaño del tumor, y estos casos se etiquetan como prolactinomas resistentes (PR). Los factores de riesgo de resistencia a los AD y el manejo de los PR no están bien establecidos. Métodos: Analizamos retrospectivamente las características clínicas, bioquímicas y radiológicas, así como el manejo y evolución de los PR a cabergolina (CAB) atendidos en el departamento de Endocrinología de un hospital terciario entre 1995 y 2016. La resistencia a CAB se definió como persistencia de PRL elevada (resistencia bioquímica, RB) o reducción tumoral inferior al 50% (resistencia morfológica, RM) tras al menos 3 meses de tratamiento con una dosis de CAB de hasta 2 mg/semana (o 3 mg/semana en los casos que no recibieron dosis inferiores) Resultados: Se incluyeron 10 pacientes, edad media 30.6 años, 50% varones. El tamaño medio del tumor fue 1.78 cm (80% macroadenomas) y la dosis máxima media de CAB 3.8 mg/semana. Cinco pacientes presentaron RM aislada, cuatro RM + RB y uno RB aislada. La prevalencia de sexo masculino y la edad fueron superiores en el grupo RM comparado con el grupo RM + RB. La cirugía transesfenoidal logró normalización de PRL y/o desaparición del tumor en tres de siete pacientes. Al final del seguimiento la PRL era normal (con o sin CAB) en todos los casos y la mayoría presentaba un tumor visible de tamaño estable. Conclusiones: la RM aislada y la RM+RB combinadas son los patrones más frecuentes de resistencia a los AD. Nuestros datos apoyan la asociación del tamaño tumoral pero no del sexo masculino con la resistencia a los AD


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Prolactinoma/tratamento farmacológico , Cabergolina/administração & dosagem , Prolactinoma/diagnóstico , Prolactina/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Fatores de Risco , Estudos Retrospectivos , Prolactinoma/patologia , Prolactinoma/cirurgia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Hipogonadismo/etiologia
2.
Sci Rep ; 10(1): 1207, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988389

RESUMO

Adolescence is a vulnerable time for personality development. Especially neuroticism with its link to the development of psychopathology is of interest concerning influential factors. The present study exploratorily investigates neuroanatomical signatures for developmental trajectories of neuroticism based on a voxel-wise whole-brain structural equation modelling framework. In 1,814 healthy adolescents of the IMAGEN sample, the NEO-FFI was acquired at three measurement occasions across five years. Based on a partial measurement invariance second-order latent growth curve model we conducted whole-brain analyses on structural MRI data at age 14 years, predicting change in neuroticism over time. We observed that a reduced volume in the pituitary gland was associated with the slope of neuroticism over time. However, no relations with prefrontal areas emerged. Both findings are discussed against the background of possible genetic and social influences that may account for this result.


Assuntos
Imagem por Ressonância Magnética , Modelos Neurológicos , Neuroticismo , Hipófise/diagnóstico por imagem , Adolescente , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Masculino , Pacientes Desistentes do Tratamento , Prognóstico , Autorrelato , Adulto Jovem
3.
World Neurosurg ; 136: 326, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31996340

RESUMO

A potential application of near-infrared (NIR) fluorescence imaging using second-window indocyanine green (SWIG) is demonstrated. We hypothesized that because the pituitary lacks a blood-brain barrier, we might visualize the pituitary stalk using SWIG. A 52-year-old, right-handed man presented to our clinic for evaluation of progressive loss of vision. Physical examination was significant for loss of right peripheral vision and near-complete loss of left field vision. Prolactin was high-normal at 16.2 mg/dL. Brain magnetic resonance imaging demonstrated a 36-mm sellar mass extending superiorly and laterally crossing the intracranial left internal carotid artery, consistent with a nonfunctional pituitary macroadenoma. We elected to pursue left pterional craniotomy for resection. The patient was eligible for our SWIG clinical trial and consented to the study. SWIG is a novel, investigational technique using Food and Drug Administration-approved indocyanine green to enhance visualization of neoplastic tissue intraoperatively.1-7 The patient received 2.5 mg/kg of indocyanine green intravenously approximately 24 hours preoperatively. Intraoperatively, under white-light microscopy, the tumor was easily identified and distinguished from the optic nerves and internal carotid artery. After debulking of the gross tumor, NIR visualization using a laser-equipped endoscope8 demonstrated strong NIR fluorescence in the pituitary stalk. Despite the distorted anatomy, this technique enabled us to confidently identify and preserve the pituitary stalk. Postoperatively, the patient had persistently high urine output that normalized in 24 hours without desmopressin (sodium 139-140 mmol/L); after uneventful recovery, he was discharged with mild improvement in visual function. This case demonstrated a potential use of our SWIG protocol. As the stalk demonstrates strong NIR fluorescence after high-dose indocyanine green administration, surgeons may be able to better localize and preserve the stalk even in complex skull base tumor cases where the anatomy may be significantly distorted.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Adenoma/cirurgia , Fluorescência , Corantes Fluorescentes , Humanos , Verde de Indocianina , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Óptica , Neoplasias Hipofisárias/cirurgia , Neoplasias da Base do Crânio/complicações , Espectroscopia de Luz Próxima ao Infravermelho , Resultado do Tratamento , Transtornos da Visão/etiologia
4.
Radiol Med ; 125(3): 319-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863360

RESUMO

Hypophysitis (HP) is a rare acute or chronic inflammatory condition of the pituitary gland. The greatest challenge in the management of HP is establishing a diagnosis through clinical criteria and non-invasive methods and predicting the patients' clinical outcome. The aim of this review is to describe the neuroradiological findings of this rare disease, providing some information regarding the possible differential diagnosis in order to avoid unnecessary surgery. Gadolinium-enhanced pituitary magnetic resonance imaging (MRI) is considered the neuroradiological investigation of choice. The features suggestive for HP include an enlarged triangular- or dumbbell-shaped gland with a thickened and not obviously deviated stalk, further supported by the absence of posterior pituitary bright spot on T1weighted images, particularly in patients presenting with diabetes insipidus. Contrast enhancement pattern is quite variable; dural enhancement has been reported in some cases after intravenous contrast administration. The characterization of the unusual sellar mass is not straightforward and generally results in a wide differential. HP should be primarily differentiated from pituitary adenomas (including pituitary apoplexy), from pituitary metastases, and from other sellar and parasellar tumors, e.g., craniopharyngiomas, germinomas, gliomas, lymphomas, meningiomas, pituicytomas, chordomas, teratomas, dermoids and epidermoids, Rathke's cleft cysts, and abscesses. In patients suspected for secondary forms related to systemic pathology, additional imaging is helpful in identifying other involved sites. Neuroradiologists need to know MRI appearance of this rare disease, as well as its typical symptoms and serological markers. A strict collaboration with endocrinologists and neurosurgeons is mandatory in order to reach a definitive diagnosis, allowing to promptly initiating an appropriate treatment.


Assuntos
Hipofisite/diagnóstico por imagem , Imagem por Ressonância Magnética , Neurorradiografia , Hipófise/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Hipofisite Autoimune/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Gadolínio , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
5.
Molecules ; 24(19)2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31590270

RESUMO

Pituitary adenomas are neoplasia of the anterior pituitary gland and can be subdivided into hormone-producing tumors (lactotroph, corticotroph, gonadotroph, somatotroph, thyreotroph or plurihormonal) and hormone-inactive tumors (silent or null cell adenomas) based on their hormonal status. We therefore developed a line scan Raman microspectroscopy (LSRM) system to detect, discriminate and hyperspectrally visualize pituitary gland from pituitary adenomas based on molecular differences. By applying principal component analysis followed by a k-nearest neighbor algorithm, specific hormone states were identified and a clear discrimination between pituitary gland and various adenoma subtypes was achieved. The classifier yielded an accuracy of 95% for gland tissue and 84-99% for adenoma subtypes. With an overall accuracy of 92%, our LSRM system has proven its potential to differentiate pituitary gland from pituitary adenomas. LSRM images based on the presence of specific Raman bands were created, and such images provided additional insight into the spatial distribution of particular molecular compounds. Pathological states could be molecularly differentiated and characterized with texture analysis evaluating Grey Level Cooccurrence Matrices for each LSRM image, as well as correlation coefficients between LSRM images.


Assuntos
Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Análise Espectral Raman/instrumentação , Algoritmos , Humanos , Interpretação de Imagem Assistida por Computador , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Análise de Componente Principal
6.
Clin Nucl Med ; 44(11): 873-875, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584488

RESUMO

Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a rare nonneoplastic histiocytic disorder that often involves the lymph nodes and occasionally the central nervous system or skeleton. However, the presence of extranodal Rosai-Dorfman lesions without lymphadenopathy is extremely rare. Here we present a case of a pathological confirmed Rosai-Dorfman disease with pituitary and skeletal involvement without lymph nodes involvement.


Assuntos
Osso e Ossos/patologia , Fluordesoxiglucose F18 , Histiocitose Sinusal/diagnóstico por imagem , Hipófise/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Osso e Ossos/diagnóstico por imagem , Criança , Histiocitose Sinusal/patologia , Humanos , Masculino , Hipófise/diagnóstico por imagem
7.
Brain Struct Funct ; 224(8): 2587-2601, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31432271

RESUMO

The pituitary gland (PG) is a key component of the essential endocrine systems in humans and animals, including the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-gonadal, and hypothalamic-pituitary-thyroid axes. Structural changes in the PG are observed in a number of psychiatric disorders. Psychiatric disorders are typically characterized by subtle, time-dependent anatomical changes in the brain, and their study necessitates highly powered, longitudinal investigations. Structural magnetic resonance imaging (MRI) is a non-invasive technology that is ideally suited to detect changes in anatomical structures over time. In this paper, we will review the main findings on pituitary function and structure in the context of healthy development and of psychiatric disorders, with particular emphasis on MRI studies. The latter have not always succeeded in providing a clear theoretical framework of mental disorders, which may be explained by low resolution and differences in preprocessing methods, imprecise segmentation rules that do not account for the anatomical and functional specificity of the anterior and posterior lobes of the PG, and inadequate categorization of clinical subjects. We review those limitations and propose solutions for future research.


Assuntos
Transtornos Mentais/diagnóstico por imagem , Transtornos Mentais/patologia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Animais , Humanos , Imagem por Ressonância Magnética , Transtornos Mentais/fisiopatologia , Hipófise/fisiopatologia
8.
Radiologe ; 59(11): 982-991, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31321467

RESUMO

BACKGROUND: In this article, the most common pituitary gland tumors and the various differential diagnoses with focus on (neuro-)radiological diagnostic criteria are presented. MATERIALS AND METHODS: An intensive, selective search of the literature in PubMed was carried out. RESULTS: Pituitary adenomas account for approximately 10-15% of all intracranial brain tumors and are the most common tumors of the sellar region. Beyond a size of 10 mm they are called macroadenomas, under 10 mm microadenomas. They can be distinguished into hormone-active and non-active adenomas. Most of the hormone-active adenomas secrete prolactin (50%), more rarely somatotropin (10%) or corticotropin (5%). Tumors in the sellar region can arise from various tissues. Due to the anatomically complex location, local adjacent structures can be affected or compressed by the tumors. Particularly in case of suprasellar extension, visual impairment due to pressure on the optic chiasm is common. Important differential diagnoses for sellar tumors include craniopharyngiomas, meningiomas, metastases, aneurysms and Rathke cleft cysts. The task of image diagnostics is the early detection of the lesions as well as the proliferation pattern into perifocal structures. Gold standard is the thin-section, contrast-enhanced MRI examination. Dynamic contrast administration is crucial for the diagnosis of the microadenoma and the specific enhancement characteristic of some other tumors. CONCLUSION: A highly focused imaging protocol is important for the diagnosis of sellar lesions such as pituitary tumors. The current favored modality is contrast-enhanced MRI, preferably with dynamic contrast-enhanced T1-weighted sequences. Early detection of the lesions and identification of the precise anatomical location are of great importance for diagnosis and therapy.


Assuntos
Adenoma , Neoplasias Encefálicas , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias , Neoplasias da Base do Crânio , Adenoma/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica , Neoplasias da Base do Crânio/diagnóstico por imagem
9.
World Neurosurg ; 130: 110-114, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284058

RESUMO

BACKGROUND: Intracranial epidermoid cysts are benign, congenital, keratinizing, squamous epithelial-lined cysts filled with keratin. They are uncommon and often pose a surgical challenge owing to the adherence to surrounding structures. They are typically found at the cerebellopontine angle or in the parasellar region, where they are associated with abnormal development of the Rathke pouch; involvement of the pituitary stalk is rare. CASE DESCRIPTION: The patient's electronic health record was queried for relevant data. A systematic review of the literature using dedicated search terms for cases of infundibular epidermoid cysts was conducted. We present a unique case of a 55-year-old male who presented with vision changes and was found to have a parasellar epidermoid cyst confined to the pituitary stalk. The patient underwent endoscopic transsphenoidal resection, and gross total resection was achieved. The patient's postoperative course was significant for possible chemical meningitis and the development of panhypopituitarism. The patient's vision subjectively improved after surgery. CONCLUSIONS: Although 3 other cases of epidermoid cysts involving the pituitary stalk were identified, our patient's tumor was unique in that it was confined to the stalk. Our patient's case highlights a surgical approach to parasellar epidermoid cysts and the possible complications associated therewith.


Assuntos
Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Aerosp Med Hum Perform ; 90(8): 740-743, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331427
11.
Intern Med J ; 49(6): 785-788, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31185522

RESUMO

A 41-year-old man was diagnosed with hypogonadotropic hypogonadism managed with gonadotropins after routine fertility review. Eight months later he presented with new polydipsia and polyuria, lethargy and easy bruising. A full blood count showed 28% circulating blasts. A bone marrow biopsy confirmed a diagnosis of acute myeloid leukaemia with inv(3)(q21.3q26.2) with additional monosomy 7. Central diabetes insipidus (DI) was diagnosed following a water deprivation test. Pituitary magnetic resonance imaging showed a slightly thickened pituitary stalk, stable Rathke's cyst, and new absence of the pituitary bright spot. The patient was commenced on desmopressin and induction chemotherapy, subsequently requiring a bone marrow transplant. Bone marrow examination at 100 days post-transplant revealed cytogenetic remission. All symptoms of DI resolved and magnetic resonance imaging showed return of the posterior bright spot and a pituitary stalk of normal thickness. Biochemical hypogonadotropic hypogonadism persisted but was uninterpretable in the context of systemic illness and recent chemotherapy. DI is a rare complication of haematological malignancies, and the prevalence and pathophysiology of DI in this context are poorly understood. Pathogenic mechanisms proposed include leukaemic infiltration of the pituitary, interference with antidiuretic hormone synthesis, and abnormal thrombopoiesis influencing hormone levels. Particular cytogenetic abnormalities such as inv(3)(q21.3q26.2) and monosomy 7 appear to be more commonly associated with DI and also appear to confer worse outcomes. Aetiologies in the literature remain elusive but as DI is a recognised association of haematological malignancies it should be considered in a patient presenting with polydipsia and polyuria.


Assuntos
Cromossomos Humanos Par 7/genética , Diabetes Insípido/etiologia , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/patologia , Adulto , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/tratamento farmacológico , Humanos , Leucemia Mieloide Aguda/genética , Imagem por Ressonância Magnética , Masculino , Monossomia , Hipófise/diagnóstico por imagem
12.
Intern Med ; 58(21): 3125-3128, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243214

RESUMO

A 22-year-old Japanese woman consulted an endocrinologist due to persistent galactorrhea for the past 10 months. She had hyperprolacinemia and had previously been diagnosed with type 2 diabetes mellitus based on her glycohemoglobin level of 11.6%. After two months, she was admitted to our hospital and finally diagnosed with prolactinoma. For the treatment of prolactinoma, bromocriptine 2.5 mg/day was started. After seven days, her post-prandial blood glucose levels, homeostasis model assessment of insulin resistance and plasma C-peptide levels were significantly improved. These results indicate that traditional bromocriptine can be an effective therapeutic alternative in patients with prolactinoma complicated with type 2 diabetes.


Assuntos
Bromocriptina/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Amenorreia , Diabetes Mellitus Tipo 2/complicações , Feminino , Galactorreia/tratamento farmacológico , Galactorreia/etiologia , Humanos , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Adulto Jovem
13.
BMJ Case Rep ; 12(5)2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-31061177

RESUMO

Visual loss in pregnancy may be caused by a variety of reasons including pituitary adenomas. Prolactinomas (PRLs) are the most common hormone-secreting tumours in pregnant women. As most PRLs present with menstrual abnormalities, infertility or galactorrhoea, they are most commonly diagnosed before pregnancy. We present the case of a 30-year-old primigravida who presented at 36+5 weeks gestation with headaches and left-sided visual loss. MRI of the pituitary gland confirmed a 10×11 mm left suprasellar mass. Results of her anterior pituitary function were unremarkable for her gestational age. Postpartum, she underwent an endoscopic endonasal resection of the pituitary tumour. The histology was consistent with a PRL. Literature review reveals only one possible case of a new diagnosis of a PRL during pregnancy. It highlights the importance to consider a wide range of differential diagnoses when assessing visual loss in pregnancy.


Assuntos
Imagem por Ressonância Magnética , Hipófise/patologia , Neoplasias Hipofisárias/fisiopatologia , Complicações na Gravidez/fisiopatologia , Transtornos da Visão/fisiopatologia , Adulto , Feminino , Humanos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Neuroimagem , Procedimentos Neurocirúrgicos , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Resultado do Tratamento , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/cirurgia
16.
Int J Mol Sci ; 20(8)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30988269

RESUMO

Growth hormone deficiency (GHD) can be present from the neonatal period to adulthood and can be the result of congenital or acquired insults. In addition, GHD can be classified into two types: isolated growth hormone deficiency (IGHD) and combined pituitary hormone deficiency (CPHD). CPHD is a disorder characterized by impaired production of two or more anterior and/or posterior pituitary hormones. Many genes implicated in CPHD remain to be identified. Better genetic characterization will provide more information about the disorder and result in important genetic counselling because a number of patients with hypopituitarism represent familial cases. To date, PROP1 mutations represent the most common known genetic cause of CPHD both in sporadic and familial cases. We report a novel mutation in the PROP1 gene in an infant with CPHD and an enlarged pituitary gland. Close long-term follow-up will reveal other possible hormonal defects and pituitary involution.


Assuntos
Proteínas de Homeodomínio/genética , Hipopituitarismo/diagnóstico , Hipófise/diagnóstico por imagem , Pré-Escolar , Feminino , Deleção de Genes , Hormônio do Crescimento/uso terapêutico , Humanos , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/genética , Imagem por Ressonância Magnética , Tiroxina/uso terapêutico
17.
Magn Reson Imaging ; 60: 38-43, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30928387

RESUMO

Background and purpose To demonstrate the clinical feasibility of a novel MRI pulse sequence, Golden-angle radial sparse parallel MRI (GRASP) through comparison to the current imaging technique, dynamic T1- weighted contrast enhanced (DCE) imaging in terms of image quality and lesion depiction in the detection of microlesions (microadenomas and cysts) of the pituitary gland. MATERIALS AND METHODS: 16 patients (11 microadenomas, 5 cysts) underwent two MRI examinations (Siemens 1.5T and 3T) on separate dates, one using standard DCE (temporal resolution 30 s) and the other using GRASP (temporal resolution of 4.4 s). Two neuroradiologists separately recorded measures of image quality (Scale 1-5, 5 = best), lesion size and contrast arrival times in terms of first and best lesion conspicuity. RESULTS: In qualitiative analysis there were no significant differences in terms of average visual image sharpness (DCE 3.9 ±â€¯0.9, GRASP 3.9 ±â€¯0.9) or visual contrast scores (DCE 4.1 ±â€¯1.2, GRASP 4.4 ±â€¯0.8). Pearson's correlation coefficients for interreader lesion measurements (width and height, mm) ranged from substantial to almost perfect agreement (r = 0.73 to 0.88). Analysis of contrast arrival times revealed an average lesion first-conspicuity time of 60.7 ±â€¯16.7 s for DCE compared to 50.2 ±â€¯10.3 s for GRASP with a difference of 10.5 ±â€¯16.2 s (p = 0.023). CONCLUSION: Depiction of pituitary microlesions is feasible with GRASP, which has the potential to increase sensitivity through higher temporal resolutions combined with isotropic acquisition allowing for multi-planar reconstructions; this remains to be proven in larger cohorts.


Assuntos
Adenoma/diagnóstico por imagem , Meios de Contraste/química , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Adulto , Idoso , Cistos/diagnóstico por imagem , Feminino , Hormônio do Crescimento Humano/metabolismo , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Neoplasias Hipofisárias/diagnóstico por imagem , Prevalência , Prolactinoma/diagnóstico por imagem , Qualidade de Vida , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
Radiother Oncol ; 133: 35-42, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935579

RESUMO

PURPOSE: To explore for fatigue-related regions and the radiotherapy (RT) dose-fatigue relationship in nasopharyngeal cancer (NPC) survivors. METHODS: Eighty disease-free NPC survivors completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN) after RT. Fatigue was evaluated by the MDASI-HN fatigue item (MDASI-HN-F) and Common Terminology Criteria for Adverse Events v3.0 (CTC-AE), between 6 and 36 months after RT to determine the presence of chronic fatigue. Skull base MRIs and planning CT/RT dose were retrievable for 56 patients. Dosimetric data were extracted for 10 MRI-defined potential fatigue at-risk structures (FARS): brainstem (BS), pituitary gland (PG), hypothalamus (HT), basal ganglia, internal capsule, pineal gland, sub-thalamic nuclei, thalamus, substantia nigra, and hippocampus (HC). Recursive partitioning analysis (RPA) was used to identify dose-volume effects associated with chronic fatigue. RESULTS: 56 pts formed the cohort. Thirty patients (54%) reported any fatigue per MDASI-HN-F. Thirty-three pts (59%) had any fatigue by CTC-AE. The maximum point doses (Dmax) for PG, BS, HC, and HT were numerically higher in patients with fatigue. Dmax and Dmean of the PG were significantly higher in patients with chronic fatigue, p ≤ 0.01. A dose-volume threshold of PG V52 Gy ≥16% (LogWorth 2.4, AUC 0.7) was identified on RPA, and potential sensitivity to the PG doses was observed in younger patients (<53 years-old). CONCLUSION: A dose-fatigue relationship was identified for the pituitary gland, both patient-reported and observer ratings. We recommend limiting the Dmax of PG to <54 Gy and V52 Gy to <16%, particularly in young NPC patients, during plan optimization when achievable.


Assuntos
Sobreviventes de Câncer , Síndrome de Fadiga Crônica/etiologia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/etiologia , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos da radiação , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico por imagem , Neoplasias Nasofaríngeas/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Hipófise/efeitos da radiação , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Autorrelato , Adulto Jovem
19.
Pituitary ; 22(4): 362-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016554

RESUMO

BACKGROUND: Rathke's cleft cysts (RCCs) are common sellar lesions. Their management remains controversial, particularly when small or asymptomatic. Herein we review a consecutive series of RCC patients managed with surgery or observation. METHODS: All patients with a new diagnosis of presumed RCC, based on MRI, from February 2012-March 2018 were retrospectively divided into observational and surgical cohorts based on an intent-to-treat model. The cohorts were compared for clinical presentation, and cyst volume. The observational cohort was followed for change in cyst size. The surgical cohort was followed for changes in endocrinopathy, visual symptoms, headache and recurrence. RESULTS: Of 90 patients (mean age 36.7 ± 19.4 years; 68% female), 60% (n = 54) were in the observational cohort and 40% (n = 36) in the surgical cohort. Average follow-up was 13 ± 23 months in the observational cohort and 24 ± 19 months in the surgical group. In comparing the cohorts, mean ages were similar with more women in the surgical group (81% vs. 56%, p = 0.04). Most patients in the observational cohort had incidentally-discovered RCCs (n = 50, 88%) as opposed to the surgical cohort (n = 6, 17%). The surgical cohort had higher rates of headache (89% vs 26%, p < 0.001), endocrinopathy (36% vs 0%, p < 0.001), and visual dysfunction (19% vs 0%, p = 0.001). Mean cyst volume and maximal cyst dimensions were greater in the surgical cohort (0.94 ± 0.77 cm3 and 14.2 ± 4.1 mm), compared to the observational cohort (0.1 ± 0.14 cm3 and 6.4 ± 3 mm), (p < 0.001). Among the 53% (n = 30/54) of patients in the observational group with follow-up, 3 (10%) had spontaneous RCC shrinkage, 1 (3%) had modest asymptomatic growth (at 10 months from initial MRI), and 87% had stable cyst size. Of the 36 patients recommended to have surgery, 89% (n = 32) did so. Post-operatively, complete or partial resolution of headache, endocrinopathy and visual dysfunction were documented in 90% (n = 28/30), 75% (n = 10/12), and 100% (n = 7/7), respectively. On follow-up MRI, 8 (22%) patients had some cyst reaccumulation, of whom 3 (8%) were symptomatic and underwent uneventful reoperation. No major complications such as hematoma, CSF leak, new endocrinopathy or visual deficits occurred. CONCLUSION: From this consecutive series, a majority (60%) of RCCs do not appear to warrant surgical intervention and have a low risk of cyst progression. However, surgical cyst removal appears to be indicated and safe for patients with larger, symptomatic RCCs. Simple cyst drainage has a high rate of improvement in pituitary gland function, visual function and headache resolution with low complication rates and symptomatic recurrence risk. These findings stress the importance of careful case selection and potential utility of volumetric assessment for patients with RCCs.


Assuntos
Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Adulto , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/fisiologia , Estudos Retrospectivos , Adulto Jovem
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