Hungarian Radiology

[Board meeting of the Hungarian College of Radiology]

PALKÓ András, FORRAI Gábor

MARCH 20, 2006

Hungarian Radiology - 2006;80(01-02)

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Further articles in this publication

Hungarian Radiology

[REVIEW OF THE LITERATURE]

GYENES György

Hungarian Radiology

[Diagnostic pitfalls and artifacts of multislice CT]

BARANYAI Tibor

[There is a spectacular development in diagnostic radiology in the last one and a half decades. State-of-the-art US, CT and MR appliances and the dynamic software developments has improved diagnostic safety by order of magnitude, which resulted in the reduction of possible errors and misinterpretations. The advent of MSCT resulted in shorter scanning times, the submillimeter collimation and the subsecond scan time improves the spatial resolution of the image, the motion artifacts are reduced and the evaluation of the parenchymal organs improves. However, the new technology of MSCT raises new questions. Due to faster data collection the acquisition time decreases, that is why the tracing of the contrast material must be accurately timed. The high contrast material density that appears suddenly in pulsing vessels makes a disturbing effect on its environment, thus making way to erroneous interpretation. The performance of a secondary reconstruction (2D and 3D reconstructions) may diminish the possibility of diagnostic pitfalls and artifacts. Reconstruction increments made from appropriately overlapping thin slices are required for good image quality and spatial resolution, otherwise the image quality is deteriorating, some vessels might “disappear”, they are not depicted. We are struggling with several problems using MIP CTangiography. The proper elimination of the bones, the improper selection of VOI (volume of interest) might lead to false positive result, and the assessment of small vessels might become impossible. The differentiation of soft plaque and vessel thrombus can also be a problem, and the hard plaque may imitate a constriction. The knowledge of breath and pulsating motion artifacts, beam-hardening artifacts and flow-related artifacts is essential. Differentiating difficulties during virtual endoscopy, the partial volumen effect, the interpretation of various post-operative conditions, the disturbing effects of implants may cause diagnostic and differential diagnostic problems. The author gives a summary of possible errors, misinterpretations and artifacts that may occur with the application of MSCT even if examination protocols are followed.]

Hungarian Radiology

[The 20th Sopron Ultrasound Days - Review of the last 20 years]

BARANYAI Tibor

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[CALENDAR OF RADIOLOGICAL EVENTS, 2006]

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[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

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[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

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[Worldwide, screening in the general population detects an increase in serum uric acid levels in both sexes. This growth trend is also valid for hypertension. Authors studied the incidence of serum uric acid levels and its correlation with age, risk factors, anthropological, metabolic characteristics, blood pressure, blood pressure target, organ damage, age-related co-morbidity and drug therapy in 47,372 hypertensive patients (22,688 males, 24,684 women). In the first part of their analysis they present the method of analysis and the basic correlations. The uric acid level is higher in men than in women, with the advancement of age increasing. Increases in systolic and diastolic blood pressure are associated with increases in serum uric acid levels, with a tendency for systolic pressure to be significantly higher. For ladies, the rising trend is smaller and always lower in uric acid values. The uric acid value is higher in patients with the non-target blood pressure. The presence of co-morbidity significantly increases serum uric acid levels.]

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