Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2002]

JUNE 20, 2002

Hungarian Radiology - 2002;76(03)

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Hungarian Radiology

[The guest of the guest]

Hungarian Radiology

[NEWS]

NAGY Gyöngyi

Hungarian Radiology

[NEWS]

PALKÓ András

Hungarian Radiology

[Remarks from the President Elect - A debate initiating letter to the members of the Society]

PALKÓ András

Hungarian Radiology

[MR-guided ultrasound surgery]

JÓLESZ Ferenc A., BÉRCZI Viktor, HÜTTL Kálmán, REPA Imre, HYNYNEN Kullervo

[The powerful union of focused ultrasound surgery and magnetic resonance imaging has created a new approach to noninvasive surgery. Using this integrated therapy delivery system the physician can achieve correct localisation of tumors, optimal targeting of acoustic energy, real time monitoring of energy deposition, and the means to accurately control the deposited thermal dose within the entire tumor volume. The advantages of MRI over ultrasound guidance in controlling focused ultrasound surgery lie in the more sensitive detection of tumor target, the real time detection of tissue temperature, and the confirmation of thermally-induced tissue changes - powerful features that eventually can replace the traditional surgical approach. Applying software that connects the therapy and imaging system, the physician can generate an entire plan from quantifying temperature changes to positioning the therapy transducer. The non-invasive debulking of tumors without disturbing adjacent, functionally intact structures is thereby accomplished. Ongoing clinical trials involving the treatment of breast fibroadenoma, localized breast cancers, and uterine fibroids have been most encouraging. But nowhere has the application of MRI-guided focused ultrasound surgery been more compelling than in brain, where not only tumor treatment is possible but also the focal, transient, reversible breakdown of the blood-brain-barrier. The implications of this mechanism for targeted intra-cerebral tumor therapy or other non-oncologic applications are clearly enormous. In addition to tumor treatment, MRI-guided focused ultrasound surgery has other potential clinical applications such as vascular occlusion, targeted drug delivery, and targeted gene therapy. FUS is not a new idea but the emergence of MRI based guidance has accelerated the progres of focused ultrasound surgery technology, certain weaknesses remain including excessively long treatment times, body and organ motion, and difficulties in finding acoustic windows at certain anatomic locations. Nevertheless, the successful clinical implementations of this method is already in progress.]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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Association of anterior thoracic meningocele and azygos lobe of the lung

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Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Hungarian Radiology

[The quality control of radiological equipments in Hungary]

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[Congress calendar]