IntroductionMagnetic Resonance Imaging (MRI) is the best approach to investigate the hypothalamic-pituitary region in children with central precocious puberty (CPP). Routine scanning is controversial in girls aged 6-8 year, due to the overwhelming prevalence of idiopathic forms and unrelated incidentalomas. Cerebral lipomas are rare and accidental findings, not usually expected in CPP. We report a girl with CPP and an unusually shaped posterior pituitary gland on SE-T1w sequences.Case DescriptionA 7.3-year-old female was referred for breast development started at age 7. Her past medical history and physical examination were unremarkable, apart from the Tanner stage 2 breast. X-ray of the left-hand revealed a bone age 2-years ahead of her chronological age, projecting her adult height prognosis below the mid parental height. LHRH test and pelvic ultrasound were suggestive for CPP. Routine brain MRI sequences, SE T1w and TSE T2w, showed the posterior pituitary bright spot increased in size and stretched upward. The finding was considered as an anatomical variant, in an otherwise normal brain imaging. Patient was started on treatment with GnRH analogue. At a thorough revaluation, imaging overlap with adipose tissue was suspected and a new MRI scan with 3D-fat-suppression T1w-VIBE sequences demonstrated a lipoma of the tuber cinereum, bordering a perfectly normal neurohypophysis. 3D-T2w-SPACE sequences, acquired at first MRI scan, would have provided a more correct interpretation if rightly considered.ConclusionThis is the first evidence, to our knowledge, of a cerebral lipoma mimicking pituitary gland abnormalities. Our experience highlights the importance of considering suprasellar lipomas in the MRI investigation of children with CPP, despite their rarity, should the T1w sequences show an unexpected pituitary shape. 3D-T2w SPACE sequences could be integrated into standard ones, especially when performing MRI routinely, to avoid potential misinterpretations.
SummaryBackgroundPseudoaneurysm is a rare but potentially life-threatening vascular complication of acute pancreatitis, with a mortality rate of 20–43% in untreated patients. The treatment usually involves trans-arterial embolization or surgical resection.Case ReportA 44-year-old man with a history of acute pancreatitis developed a pseudoaneurysm of the pancreatic tail, diagnosed as a splenic artery pseudoaneurysm by CT. Selective arteriography performed with the purpose of embolization did not reveal the pseudoaneurysm.The day after, under CT guidance, human thrombin (1,000 IU) was injected inside the aneurysmatic sac with its complete occlusion. A control MRI 6 months later confirmed a complete resolution of the pseudoaneurysm.ConclusionsPercutaneous coagulation of a post-pancreatitis pseudoaneurysm is a relatively easy and safe procedure, and it can be considered as an alternative to trans-arterial embolization when the pseudoaneurysm cannot be visualized on selective arteriography.
Objective: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. Materials and Methods: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. Results: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. Conclusion: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.
Background The primary aim of this study was to provide additional data of neuroimaging features of coronavirus disease 2019 (COVID-19) in a large-scale population admitted in several northern Italy institutions. The secondary aim was to analyze acute cerebrovascular disease (CVD) prevalence in COVID-19. Methods A database of confirmed COVID-19 hospitalized patients who developed acute neurological symptoms and underwent any neuroimaging was retrospectively gathered from twelve institutions based in Lombardy from February 21st to July 10th. To assess the prevalence of CVD we conducted a scoping review following the PRISMA extension guidelines for scoping reviews. We searched PubMed/Medline, SCOPUS and EMBASE databases for peer-reviewed in-press or published studies from December to January 2021 reporting CVD in COVID-19 patients. Results Out of 90 COVID-19 patients who were referred to neuroimaging, 78 (87%) showed CVD, in particular 65 had acute ischemic strokes (AIS), 8 had intracerebral hemorrhages, 2 subarachnoid hemorrhages (SAH) and 3 showed clinical and imaging findings in keeping with posterior reversible encephalopathy syndrome (PRES); 6 patients (7%) showed clinical and imaging findings highly suggestive of encephalitis; 3 patients (3%) showed demyelinating diseases: 1 case of MS progression, 1 case of newly diagnosed MS and 1 case of acute disseminated encephalomyelitis (ADEM); 2 cases (2%) acuity of chronic subdural hematoma (cSDH); 1 patient (1%) with Guillain Barré syndrome. In addiction two patients with CVD developed cauda polyradiculitis and tetraparesis. In our scoping review out of 3275 studies, 24 satisfied the inclusion criteria: in a pooled total population of 136198 patients, the pooled prevalence of CVD was 0.9%. In particular 0.8% of AIS and 0.1% of ICH and 0.003% of PRES. Conclusions Our study shows a high prevalence of CVD among patients who developed acute neurological symptoms, which is in line with papers reporting data comparable to ours. The heterogeneity of clinical reports, however, constitutes a limitation when comparing our findings with those of the clinical papers. Nonetheless, CVD could be a frightening association with COVID-19, particularly in critically ill patients. Healthcare policymakers and clinicians should be prepared to a likely increase in workload and to rearrange the strategy of healthcare delivery.
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