T2-Weighted signal intensity of functional pituitary adenomas: correlation with clinicopathological findings and response to treatment

Background: Perianal Crohn’s fistula and their response to anti-tumour necrosis factor (TNF) therapies are best assessed with magnetic resonance imaging (MRI), but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume. Methods: Retrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post-biologic MRI scans were used with varying time intervals. A total of two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated Open Source segmentation software. A total of three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans. Results: A total of 18 cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; intra-class correlation (ICC) 0.95 [95% confidence interval (CI) 0.91–0.98] and 0.95 (95% CI 0.90–0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95% CI 0.97–0.99) and 0.98 (95% CI 0.95–0.99) respectively. Average time taken to measure fistula volume was 202 s and 250 s for readers 1 and 2. Agreement between three specialist radiologists was good [kappa 0.69 (95% CI 0.49–0.90)] for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response ( p = 0.001). Median volume change for improved, stable or worsening fistula response was −67% [interquartile range (IQR): −78, −47], 0% (IQR: −16, +17), and +487% (IQR: +217, +559) respectively. Conclusion: Quantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fistula and response to treatment.

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Low-Grade Alimentary Lymphoma: Clinicopathological Findings and Response to Treatment in 17 Cases

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2009.05.021 ◽

2009 ◽

Vol 11 (8) ◽

pp. 692-700 ◽

Cited By ~ 60

Author(s):

Amy E. Lingard ◽

Katherine Briscoe ◽

Julia A. Beatty ◽

Antony S. Moore ◽

Ann M. Crowley ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Complete Remission ◽

Abdominal Mass ◽

Clinical Signs ◽

Oral Prednisolone ◽

Response To Treatment ◽

High Dose ◽

Low Grade ◽

Mesenteric Lymph ◽

Clinicopathological Findings

Low-grade alimentary lymphoma (LGAL) was diagnosed by histological and immunohistochemical evaluation of full-thickness biopsies from multiple regions of the gastrointestinal tract collected during exploratory laparotomy in 17 cats. The most common clinical signs were weight loss ( n=17) and vomiting and/or diarrhoea ( n=15). Clinical signs were chronic in 11 cases. Abdominal palpation was abnormal in 12 cats, including diffuse intestinal thickening ( n=8), an abdominal mass due to mesenteric lymph node enlargement ( n=5) and a focal mural intestinal mass ( n=1). The most common ultrasonographic finding was normal or increased intestinal wall thickness with preservation of layering. Ultrasound-guided fine-needle aspirates of mesenteric lymph nodes ( n=9) were incorrectly identified as benign lymphoid hyperplasia in eight cats, in which the histological diagnosis from biopsies was lymphoma. There was neoplastic infiltration of more than one anatomic region of the gastrointestinal tract in 16/17 cats. The jejunum (15/15 cats) and ileum (13/14 cats), followed by the duodenum (10/12 cats), were the most frequently affected sites. Twelve cats were treated with oral prednisolone and high-dose pulse chlorambucil, two with a modified Madison–Wisconsin multiagent protocol and three with a combination of both protocols. Thirteen of the 17 cats (76%) had complete clinical remission with a median remission time of 18.9 months. Cats that achieved complete remission had significantly longer median survival times (19.3 months) than cats that did not achieve complete remission ( n=4) (4.1 months; P=0.019). The prognosis for cats with LGAL treated with oral prednisolone in combination with high-dose pulse chlorambucil is good to excellent.

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Primary Bacterial Septic Peritonitis in Cats: 13 Cases

Journal of the American Animal Hospital Association ◽

10.5326/0450268 ◽

2009 ◽

Vol 45 (6) ◽

pp. 268-276 ◽

Cited By ~ 15

Author(s):

Cassandra M. Ruthrauff ◽

Julie Smith ◽

Leigh Glerum

Keyword(s):

Clinical Signs ◽

Clinical Findings ◽

Response To Treatment ◽

Microbial Culture ◽

Specific Mechanism ◽

Radiographic Findings ◽

Clinicopathological Findings ◽

Laboratory Results ◽

Septic Peritonitis ◽

Overall Mortality

The purpose of this paper is to describe the signalment, clinical signs, laboratory results, culture results, and response to treatment for primary septic peritonitis in cats. This is a retrospective study of 12 client-owned animals. Medical records were reviewed for clinical findings, laboratory results, microbial culture results, radiographic findings, diagnosis, treatment, and outcome. The overall mortality rate for this group of cats was 31%, consistent with previous reports of septic peritonitis in cats. All cats that were both bradycardic and hypothermic on presentation did not survive. Other clinicopathological findings were consistent with previously reported cases of septic peritonitis in cats. Results suggest that clinicopathological findings and outcomes in cats with primary septic peritonitis are similar to those in cats with septic peritonitis from a determined cause. A specific mechanism of inoculation has yet to be determined, but an oral source of bacteria is suggested for cats with primary bacterial septic peritonitis.

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Transnasal hypophysectomy in conchal sella: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164822 ◽

2016 ◽

Vol 3 (1) ◽

pp. 156

Author(s):

Archana Arora ◽

Manish Munjal ◽

Damanpreet Singh

Keyword(s):

Case Report ◽

Pituitary Adenomas ◽

Signal Intensity ◽

Sphenoid Sinus ◽

Anatomical Variations ◽

Anterior Wall ◽

Previous Surgery ◽

Mri Brain ◽

Surgical Access ◽

Suprasellar Region

The trans-sphenoid access to the pituitary gland is the most common approach for pituitary adenomas. The different routes to the sella ultimately traverse the sphenoid sinus. Therefore the anatomical variations of the sphenoid sinus have major impact on the surgical access. The conchal non-pneumatized sphenoid was always considered to be a contraindication to the trans-sphenoid approach to the sella. The preset study was conducted on a 50 year old male with conchal sella with chief complains of headache and associated loss of vision in left eye is being reported. MRI brain and sella (with contrast) showed evidence of well-defined altered signal intensity in sellar and suprasellar region 12×18×15 mm. DNE showed posterior septectomy defect from previous surgery. Anterior wall of sphenoid was thick and no other landmark was identified. Keeping in midline using the sphenoid rostrum as landmark, drilling was started in 1×0.5 cm area and continued till a depth of around 1 cm till dura was visualized. Intra operative confirmation of the sphenoid and sella was done using C-ARM. It can be utilized to confirm surgical landmarks to access the sella through the sphenoid sinus accurately even in poorly pneumatized sphenoid.

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Clinical Features and Response to Treatment of Prolactinomas in Children and Adolescents: A Retrospective Single-Centre Analysis and Review of the Literature

Hormone Research in Paediatrics ◽

10.1159/000486280 ◽

2018 ◽

Vol 89 (3) ◽

pp. 157-165 ◽

Cited By ~ 6

Author(s):

Thomas Breil ◽

Catherine Lorz ◽

Daniela Choukair ◽

Janna Mittnacht ◽

Ioana Inta ◽

...

Keyword(s):

Clinical Features ◽

Pituitary Adenomas ◽

Clinical Symptoms ◽

Hormone Deficiency ◽

Response To Treatment ◽

Treatment Modalities ◽

Pituitary Hormone ◽

Single Centre ◽

Paediatric Patients ◽

Pubertal Delay

Background: Paediatric prolactinomas are rare. The aim of this study was to investigate the clinical features and outcome of paediatric patients with prolactinomas. Methods: In this single-centre retrospective analysis, clinical, biochemical, and radiological features of all paediatric patients with pituitary adenomas diagnosed between 2000 and 2016 were evaluated. Results: Among 21 patients with pituitary adenomas, 12 patients with prolactinomas (median age 14.2 years, range 11–16.6 years, 8 females, 4 males) were identified (7 macro- and 5 microprolactinomas). The most common clinical symptoms were headaches (67%) and pubertal delay (67%). All patients with macroprolactinomas with prolactin concentrations >10,000 mU/L had at least 1 pituitary hormone deficiency. Cabergoline as first-line treatment (n = 11, median follow-up of 37 months, range 12–89 months) induced normoprolactinemia (n = 8), reduced the mean tumour volume by 80%, and ameliorated headaches (p = 0.016) and pubertal delay (p = 0.031), whereas intermittent moderate side effects occurred in 55%. Conclusion: Adolescents with headaches and pubertal delay should be investigated for prolactinomas. Treatment with cabergoline is well tolerated and effective in reducing clinical symptoms and prolactin concentrations was well as inducing tumour shrinkage. Further clinical prospective studies are needed to standardize paediatric treatment modalities.

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Differentiating skull base chordomas and invasive pituitary adenomas with conventional MRI

Acta Radiologica ◽

10.1177/0284185118757576 ◽

2018 ◽

Vol 59 (11) ◽

pp. 1358-1364

Author(s):

Ankang Gao ◽

Jie Bai ◽

Jingliang Cheng ◽

Xiao Cheng ◽

Shujian Li ◽

...

Keyword(s):

Skull Base ◽

Contrast Enhancement ◽

Pituitary Adenomas ◽

Signal Intensity ◽

Clinical Manifestations ◽

Tumor Location ◽

Time Signal ◽

Dynamic Contrast Enhancement ◽

Magnetic Resonance Imaging Mri ◽

Skull Base Chordomas

Background It is difficult to distinguish between invasive pituitary adenomas (IPAs) and skull base chordomas based on tumor location and clinical manifestations. Purpose To investigate the value of the apparent diffusion coefficient (ADC), T2-weighted (T2W) imaging, and dynamic contrast enhancement (DCE) in differentiating skull base chordomas and IPAs. Material and Methods Data for 21 patients with skull base chordomas and 27 patients with IPAs involving the paranasal sinus were retrospectively reviewed, and all diagnoses were pathologically confirmed. Each patient underwent conventional 3.0 T magnetic resonance imaging (MRI), including, ADC, T2W imaging, and DCE sequences. Regions of interest were drawn in the mass and in normal white matter on ADC maps and T2W imaging. The mean ADC, normal ADC, T2W imaging signal intensity (SI), and relative T2-weighted (rT2W) imaging values were measured. DCE parameters, including types of time signal-intensity curves (TIC), enhancement peak (EP), and maximum contrast enhancement ratio (MCER), were calculated. Differences between skull base chordomas and IPAs were evaluated using the independent samples t-test. Receiver operating characteristic (ROC) curve analyses were also performed. Results When comparing IPAs and chordomas, there were significant differences in mean ADC, normal ADC, rT2W imaging values, TIC, EP, and MCER ( P < 0.01). The areas under curves in the ROC analyses for normal ADC, mean ADC, T2W imaging, rT2W imaging, TIC, EP, and MCER were 1.0, 0.996, 1.0, 0.81, 0.987, and 0.987, respectively. Conclusion ADC, T2W imaging SI, and DCE-related parameters can contribute to the differential diagnosis of skull base chordomas and IPAs.

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Prolactinoma - is there a relationship between T2W signal intensity in MRI and response to treatment with dopamine agonists?

Endocrine Abstracts ◽

10.1530/endoabs.63.p1076 ◽

2019 ◽

Author(s):

Ana Ferreira ◽

Guilherme Oliveira ◽

Filipa Bastos ◽

Cordeiro Maria Carlos ◽

Julia Duarte ◽

...

Keyword(s):

Signal Intensity ◽

Dopamine Agonists ◽

Response To Treatment

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Clinicopathological significance of baseline T2-weighted signal intensity in functional pituitary adenomas

Pituitary ◽

10.1007/s11102-018-0877-3 ◽

2018 ◽

Vol 21 (4) ◽

pp. 347-354 ◽

Cited By ~ 10

Author(s):

Sema Ciftci Dogansen ◽

Gulsah Yenidunya Yalin ◽

Seher Tanrikulu ◽

Sakin Tekin ◽

Nihan Nizam ◽

...

Keyword(s):

Pituitary Adenomas ◽

Signal Intensity ◽

Clinicopathological Significance

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A potentially misleading presentation and course of acute myelomonocytic leukemia in a dog

Journal of the American Animal Hospital Association ◽

10.5326/15473317-33-1-37 ◽

1997 ◽

Vol 33 (1) ◽

pp. 37-41 ◽

Cited By ~ 10

Author(s):

TK Graves ◽

CL Swenson ◽

MA Scott

Keyword(s):

Clinical Findings ◽

Lymphocytic Leukemia ◽

Response To Treatment ◽

Cytochemical Staining ◽

Clinicopathological Findings ◽

Mucous Membranes ◽

Chemotherapy Protocol ◽

Acute Myelomonocytic Leukemia ◽

Myelomonocytic Leukemia ◽

Tentative Diagnosis

A nine-year-old, castrated male golden retriever had lethargy, fever, massive peripheral lymphadenomegaly, hepatosplenomegaly, and pale mucous membranes. There was a marked leukocytosis (456.3 x 10(3) cells/microliter) with 99% blasts; a moderate, nonregenerative anemia; and marked thrombocytopenia. A tentative diagnosis of acute lymphocytic leukemia was made pending results of cytochemical staining. Despite the severity of the laboratory and clinical findings, the dog exhibited a partial response to an induction chemotherapy protocol commonly used for lymphoma. Subsequent cytochemical staining of the original blood and bone-marrow samples resulted in a revised diagnosis of acute myelomonocytic leukemia (AML-M4). Clinicopathological findings, response to treatment, and clinical outcome in this case of canine AML-M4 are discussed.

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The Application of Artificial Intelligence and Machine Learning in Pituitary Adenomas

Frontiers in Oncology ◽

10.3389/fonc.2021.784819 ◽

2021 ◽

Vol 11 ◽

Author(s):

Congxin Dai ◽

Bowen Sun ◽

Renzhi Wang ◽

Jun Kang

Keyword(s):

Artificial Intelligence ◽

Machine Learning ◽

Pituitary Adenomas ◽

Prediction Models ◽

Clinical Manifestations ◽

Medical Data ◽

Accurate Diagnosis ◽

Response To Treatment ◽

Complication Rates ◽

Individualized Care

Pituitary adenomas (PAs) are a group of tumors with complex and heterogeneous clinical manifestations. Early accurate diagnosis, individualized management, and precise prediction of the treatment response and prognosis of patients with PA are urgently needed. Artificial intelligence (AI) and machine learning (ML) have garnered increasing attention to quantitatively analyze complex medical data to improve individualized care for patients with PAs. Therefore, we critically examined the current use of AI and ML in the management of patients with PAs, and we propose improvements for future uses of AI and ML in patients with PAs. AI and ML can automatically extract many quantitative features based on massive medical data; moreover, related diagnosis and prediction models can be developed through quantitative analysis. Previous studies have suggested that AI and ML have wide applications in early accurate diagnosis; individualized treatment; predicting the response to treatments, including surgery, medications, and radiotherapy; and predicting the outcomes of patients with PAs. In addition, facial imaging-based AI and ML, pathological picture-based AI and ML, and surgical microscopic video-based AI and ML have also been reported to be useful in assisting the management of patients with PAs. In conclusion, the current use of AI and ML models has the potential to assist doctors and patients in making crucial surgical decisions by providing an accurate diagnosis, response to treatment, and prognosis of PAs. These AI and ML models can improve the quality and safety of medical services for patients with PAs and reduce the complication rates of neurosurgery. Further work is needed to obtain more reliable algorithms with high accuracy, sensitivity, and specificity for the management of PA patients.

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