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Background: Remission rates of 76, 69.5 and 64.3% have been reported in patients with nontumoural hyperprolactinaemia (NTH), microprolactinoma and macroprolactinoma, respectively, 2-5 years after cabergoline (CAB) withdrawal., Objective: To report the estimated recurrence rate at 24-96 months after CAB withdrawal and indicate predictors of disease remission., Design: Observational, analytical, prospective., Patients: Of 381 previously untreated de novo patients with hyperprolactinaemia, 221 (58%) (173 women, 48 men; 27 with NTH, 115 with micro-, and 79 with macroprolactinoma) were studied., Measurements: Using multiple regression analysis the diagnostic accuracy of nadir PRL levels (t = 7.6, P < 0.0001) and nadir maximal tumour diameter at CAB withdrawal (t = 3.9, P < 0.001) was analysed using receiver operating characteristic (ROC) curves., Results: The recurrence of hyperprolactinaemia was 25.9, 33.9 and 53.1% in patients with NTH, micro- or macroprolactinoma, respectively. To predict the last PRL level after withdrawal, the optimum cut-off of nadir PRL levels at withdrawal was 162 mU/l (5.4 microg/l) [sensitivity (95% CI) 76% (67-84%), specificity 65% (51-77%)] and that of nadir maximal tumour diameter was 3.1 mm [sensitivity 52% (41-63%), specificity 86% (79-91%)]. The patients achieving both nadir PRL levels

Several studies have reported that patients (pts) with severe aortic stenosis and similar pressure gradients or even similar aortic valve areas may have quite different symptomatic status and clinical outcomes suggesting that other factors might have a significant impact on the pathophysiology of this disease. Our purpose was to assess the severity of subendocardial wall dysfunction in symptomatic and asymptomatic pts with aortic stenosis using tissue Doppler imaging (TDI), strain rate imaging (SRI) and cyclic variation of integrated backscatter (IB). We studied 68 pts with aortic valvar stenosis and 46 subjects with no signs of heart disease. SRI/IB indexes were calculated in the apical four chambers views at endocardial level. Early diastolic endocardial strain rate showed the best correlation with transvalvar pressure gradients and valve areas. Compared with controls, symptomatic pts showed a more marked decrease in endocardial strain, strain rate and cyclic variation of IB. Receiver operating characteristic (ROC) curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were >/=60 mm Hg for the pressure gradient, less than 0.60 cm(2)/m(2) for aortic valve area, less than 20% for strain, less than 2.0 s(-1) for strain rate and less than 3.0 dB for cyclic variation. The combination of pressure gradient, aortic valve area and SRI/IB parameters resulted in an improvement of the overall performance for predicting the symptomatic state. Thus, SRI/IB parameters have an incremental value in differentiating symptomatic and asymptomatic pts with aortic stenosis compared with conventional hemodynamic parameters.

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported. They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

Hippocampal abnormalities correlated with mesial temporal sclerosis (MTS) are well documented. MTS may be associated with extrahippocampal anomalies involving limbic structures along a known neuroanatomic pathway (Papez circuit). We report a patient with MTS and thalamic changes. Seizure-related thalamic damage could have been caused by abnormal electric discharges from the mamillary body to the anterior thalamus through the mamillothalamic tract. This suggests that MTS is not limited to the temporal lobe but could represent a limbic system pathology.

Perineural tumor spread (PNS) of head and neck malignancies is a well-known form of metastatic disease in which a lesion can migrate away from the primary site along the endoneurium or perineurium. MR imaging is considered the primary method for evaluating patients with symptoms related to the trigeminal nerve in most clinical settings. Both CT and MR imaging can detect perineural spread, but MRI is the modality of choice because of its capability to detect direct signs (nerve enlargement and enhancement) and indirect signs (neuropathic muscular atrophy, obliteration of fat planes). In addition, MRI is more sensitive because of its superior soft-tissue contrast, its multiplanar capability and decreased artifacts from dental hardware. Fat suppression images after contrast injection are mandatory to better detect nerve enhancement. CT is useful in detecting foraminal enlargement or more destructive bone patterns. Nerve function can be perserved until later in the course of the disease: patients with perineural spread demonstrated at radiologic or pathologic examination may have normal or nonspecific nerve function at clinical examination (patients are misdiagnosed with Bell's palsy or trigeminal neuralgia). Hence MRI assessment of perineural tumor location and extension is important.

Independent component analysis (ICA) is a powerful technique for the multivariate, non-inferential, data-driven analysis of functional magnetic resonance imaging (fMRI) data-sets. The non-inferential nature of ICA makes this a suitable technique for the study of complex mental states whose temporal evolution would be difficult to describe analytically in terms of classical statistical regressors. Taking advantage of this feature, ICA can extract a number of functional connectivity patterns regardless of the task executed by the subject. The technique is so powerful that functional connectivity patterns can be derived even when the subject is just resting in the scanner, opening the opportunity for functional investigation of the human mind at its basal "default" state, which has been proposed to be altered in several brain disorders. However, one major drawback of ICA consists in the difficulty of managing its results, which are not represented by a single functional image as in inferential studies. This produces the need for a classification of ICA results and exacerbates the difficulty of obtaining group "averaged" functional connectivity patterns, while preserving the interpretation of individual differences. Addressing the subject-level variability in the very same framework of "grouping" appears to be a favourable approach towards the clinical evaluation and application of ICA-based methodologies. Here we present a novel strategy for group-level ICA analyses, namely the self-organizing group-level ICA (sog-ICA), which is used on visual activation fMRI data from a block-design experiment repeated on six subjects. We propose the sog-ICA as a multi-subject analysis tool for grouping ICA data while assessing the similarity and variability of the fMRI results of individual subject decompositions.

Context: Primary treatment with depot octreotide and lanreotide induces tumor shrinkage in newly diagnosed patients with acromegaly., Objective: The objective of the study was to evaluate clinical predictors of tumor shrinkage., Design: This was an analytical, observational, open, prospective study., Subjects: The study included 99 patients: 13 with microadenoma and 86 with macroadenoma (25 enclosed, 32 extrasellar, 29 invasive)., Main Outcome Measures: Age, gender, estimated disease duration, body mass index, GH and IGF-I levels, and tumor volume at diagnosis and after 12 months of treatment were measured. Percentage of GH, IGF-I, and tumor size changes from baseline were also analyzed. Tumor changes were scored as absent (+/- 0-25%), mild (+/- 25.1-50%), moderate (+/- 50.1-75%), or notable (75%)., Interventions: Sixty patients (60.6%) received depot octreotide im (20-30 mg every 28 d), and 39 patients (39.4%) received lanreotide im (60-90 mg every 28 d)., Results: Basal tumor volume and maximal tumor diameter correlated with age, disease duration, and GH levels. After 12 months, GH levels were controlled (

Background: The purpose of the present study was to assess the accuracy of quantitative segmental analysis by strain rate imaging (SRI) technique during dobutamine test for detecting myocardial recovery after revascularization in patients with chronic ischemic regional left ventricular (LV) dysfunction and compare results with those of 2-dimensional echocardiography (2D) and tissue Doppler imaging (TDI) as well as rest-4 hours-24 hours redistribution thallium SPECT (Tl SPECT)., Methods and Results: Forty-one patients with chronic ischemic regional LV dysfunction (EF 29 +/- 8%) underwent dobutamine 2D/TDI/SRI and Tl SPECT before and after myocardial revascularization. The sensitivity, specificity, and accuracy for the recovery of regional LV function were 73%, 81%, and 77% for dobutamine 2D; 77%, 82%, and 80% for dobutamine TDI; 86%, 88%, and 85% for dobutamine SRI; and 94%, 76%, and 84% for Tl tomography. The area under the ROC curve (AUC), which reflects the overall performance for the prediction of recovery, was 0.79 for systolic-SR, 0.81 for Tl SPECT, 0.83 for postsystolic strain, and 0.87 for isovolumic-SR. If both systolic and postsystolic SRI indexes were combined with Tl SPECT, the AUC was improved to 0.94., Conclusions: Dobutamine SRI is more accurate than TDI in identifying hibernating myocardium. Systo-diastolic values obtained using dobutamine SRI echocardiography and values derived from nuclear perfusion techniques may be complementary in assessing myocardial viability.

The aim of this study was to investigate the value of tissue Doppler imaging (TDI) using transesophageal echocardiography (TEE) in assessing the elastic properties of the thoracic aorta in patients with Marfan's syndrome. Aortic distensibility, stiffness index, and pulse-wave velocity were calculated using M-mode data in a TEE short-axis view in 31 patients with Marfan's syndrome and 22 normal controls. Acceleration time, maximum wall expansion velocity (Vmax), and wall strain were determined from TDI tracings. Indexes derived from TDI differed at a greater level of significance than M-mode-derived indexes in patients with dilated and normal aortas. Significant predictors of aortic dilation were systolic blood pressure, aortic stiffness index, Vmax, and strain. Decreased aortic strain and Vmax and increased stiffness index were predictive of aortic dissection (odds ratios 4.5, 3.3, and 2.2). In conclusion, the TDI assessment of aortic wall mechanics is complementary to standard M-mode measurements in discriminating normal subjects from patients with Marfan's syndrome and is accurate in predicting aortic dilation and dissection.

The purpose of the current study was to compare right ventricular (RV) myocardial wall velocities (tissue Doppler imaging) and strain rate imaging (SRI) parameters with conventional echocardiographic indices evaluating RV function in chronic obstructive pulmonary disease (COPD) patients. In total, 39 patients with COPD and 22 healthy subjects were included in the current study. Seventeen patients had pulmonary artery pressure <35 mmHg (group I) and 22 patients had pulmonary artery pressure >35 mmHg (group II). Tissue Doppler imaging, strain and strain rate (SR) values were obtained from RV free wall (FW) and interventricular septum. Respiratory function tests were performed (forced expiratory volume in one second/vital capacity (FEV(1)/VC) and carbon monoxide diffusion lung capacity per unit of alveolar volume (D(L,CO)/V(A))). Strain/SR values were reduced in all segments of group II patients compared with group I patients and controls with lowest values at basal FW site. A significant relationship was shown between peak systolic SR at basal FW site and radionuclide RV ejection fraction. A significant relationship was shown between peak systolic SR at basal FW site and D(L,CO)/V(A) and FEV(1)/VC. In conclusion, in chronic obstructive pulmonary disease patients, strain rate imaging parameters can determine right ventricular dysfunction that is complementary to conventional echocardiographic indices and is correlated with pulmonary hypertension and respiratory function tests.

Two personal cases of "de novo" aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of "de novo" aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the "de novo" aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous "de novo" aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of "de novo" aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a "de novo" aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for "de novo" aneurysm formation.

Diaphragma sellae meningiomas are unusual tumours often not distinguished from pituitary macroadenomas. Preoperative differentiation is essential, because the trans-sphenoidal approach is used for surgical removal of adenomas, while meningiomas are approached via a craniotomy. We reviewed five patients in whom a diaphragma sellae meningioma was initially diagnosed as a nonsecreting pituitary macroadenoma. MRI criteria for differential diagnosis are discussed. The main findings considered are visibility of the pituitary gland, contrast enhancement, the centre of the lesion and sellar enlargement. These criteria, applied to a blind review, allow correct identification of the tumours.

The normal laryngeal and perilaryngeal structures (neither nodal nor vascular) of 120 healthy and informed volunteers and of 46 patients with extralaryngeal neck conditions were studied with ultrasonography (US). The study was performed with a high-frequency linear probe on the transverse and sagittal planes; the patients were examined supine, with neck hyperextension, during quiet breathing, in inspiratory and expiratory breath-holding, during Valsalva maneuver or phonation. Axial scans clearly depict, in cranio-caudal direction, the base of the tongue, the hyoid and adjacent muscular structures. At the laryngeal vestibule epiglottis is always clearly demonstrated as a thin hypoechoic curvilinear rim and the pre-epiglottic space as a fat-filled and markedly echogenic structure. Pyriform sinuses are more difficult to study with US and should therefore be always distended by air during Valsalva because no suitable US contrast agent is available for their exploration yet. The ossification of thyroid laminae prevents or hinders the exploration of endolaryngeal structures because of consequent posterior acoustic shadow. In case of partial ossification or cartilaginous thyroid laminae, paraglottic spaces are easily demonstrated with US, as well as the false cords and, partially, arytenoids and posterior laryngeal wall muscles. The muscular structure of the true cords, their mobility in the M-mode and, in half of the cases, the thin vocal plicae joining anteriorly in the anterior commissure, are easily depicted with US. To conclude, US permits to demonstrate normal laryngeal anatomy by a quick and harmless examination in several breathing and phonation phases, which is an essential premise to the correct interpretation of abnormal US findings.