Hungarian Radiology

[Application of radiostereometry]


JUNE 10, 2005

Hungarian Radiology - 2005;79(03)



Further articles in this publication

Hungarian Radiology

[Entertainment ultrasound]


Hungarian Radiology

[Past, present and future of Department of Radiology of Pécs]


Hungarian Radiology

[Prevention of thrombotic complications in vascular interventional procedures]


[Procedures of vascular interventional radiology is linked inevitably a certain amount of risk of thrombotic complications, like intimal and vascular wall injuries, increased thrombotic risk caused by the catheter itself, etc. The first approach of thrombotic prevention was achieved by acetyl salicylic acid in case of peripheral arteries, this treatment was later replaced by long-term anticoagulation. Opportunities were provided by the recognition of risky blood characteristics in relation to thrombotic complications. Consequently, a well performed preparation and premedication of the patients could reasonably decrease the risk. The most important steps are the cessation of smoking, normalization of hemoconcentration and antithrombotic premedication. Better understanding of the nature of atherosclerotic progression led to the introduction of long-term fibrinolytic inhibition therapy. In the past decades beside patients with vascular stenosis, the oncology patients are also treated by different radiological interventions, like intraarterial chemotherapy and chemoembolization. The use of several-day-long infusion represent a new challenge, the treated vessels, the lumen and the surface of the catheter must be prevented of thrombosis. For this purpose a few suitable drugs can be applied with mild anticoagulant and fibrinolytic stimulating effect. We use the sodium pentosan polysulphate.]

Hungarian Radiology

[Comparison of the results of lung helical CT and lung scintigraphy in pulmonary embolism]

WENINGER Csaba, BODROGI Gabriella, BOROS Szilvia, SCHMIDT Erzsébet, UDVAROS Eszter, ZÁMBÓ Katalin

[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

Hungarian Radiology

[The possibilities of invasive radiological therapy of deep venous thrombosis and in vitro experimental examination of therapeutic factors affecting the treatment]


[INTRODUCTION - The first part of this paper is an overview on the possibilities of invasive radiology treatment of deep venous thrombosis. In the next part an in vitro experiment is described demonstrating the basics of mechanical and pharmaco-mechanical catheters applied in deep venous thrombosis. MATERIALS AND METHODS - The in vitro haemodinamic model of the iliocaval veins contained a thermostat and an engine responsable for pulsing circulation according to the venous system. We tested the chance of driftage of thrombus in different age according to the state of the collateral system. Thrombectomy was made by mechanical (Simpson-catheter) and pharmaco-mechanical (Pulsespray catheter) ways. The weight of the non-drifted thrombi was measured. RESULTS - All the 16 thrombus were flown while collateral system was closed and none of them were flown while the collateral system was open but the rate of their solubility was different. The efficacy of the thrombus-removal by Simpson catheter was better than by Pulse-spray catheter and fresh thrombus-fragments were more soluble than older ones. CONCLUSION - By this in vitro experiment we opened the way for using mechanical and pharmaco-mechanical catheters in deep venous thrombosis.]

All articles in the issue

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, ERDEN Simsek Nazan, YULUG Burak

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.


[New findings in the cortical bone biology and its role in bone fractures]


[The authors surveyed the already known factors responsible for the osteoporotic bone fragility. Then the results of using modern imaging techniques (micro-CT, high-resolution peripheral computed quantitative tomograph - HR-pQCT) and advanced computer analytic methods (finite element analysis, FEA) are presented. These data - beyond the already known fracture risk factors (age, risk of falling, bone mineral density - BMD, and fine structure damage of trabecular bone) are stressing the importance of the (micro)damage of cortical bone as a fracture risk factor, which has been still underrated. The cortical thickening and increased porosity - verified on various population samples - are increasing the risk of fractures in certain subgroups of subjects having identical BMD values, even among those, who are considered only osteopenic by the earlier classification based on BMD values. Backed with modern software batteries, the new imaging techniques are expected to enter clinical application in the near future. Pharmacologic agents with stronger cortical effect are already available and research is continuing to find new drugs to use in the management of osteoporotic patients of high fracture risk.]