Hungarian Radiology


SEPTEMBER 20, 2008

Hungarian Radiology - 2008;82(05-06)



Further articles in this publication

Hungarian Radiology

[Sixty years, fourty years - milestones in ultrasound diagnostics]


Hungarian Radiology

[Radiological diagnostics in bone metastases]


[Imaging plays a crucial role in defining bone metastases, and thus, therapy planning. We are responsible for accurate data collection, pre-treatment evaluation, evaluation of therapy response and post-treatment evaluation. Precision highly depends on the expertise and experience of the evaluating radiologist, and therefore, being familiar with the latest literature is essential. The bone status can be detected well by bone scan, analysed by conventional X-ray examination and by the cross sectional digital imaging modalities. The whole body PET/CT functional imaging is becoming increasingly popular in the metastatic workup of patients and for monitoring response to therapy. MRI has been found to be the most accurate method for bone metastasis in most comparative evaluations in the literature. This article is a review of the latest papers focusing on the clinical significance of the imaging results in bone metastasis diagnostics.]

Hungarian Radiology

[Rheumatoid arthritis: significance and methodology of cervical spine X-rays in everyday practice]


[Cervical spine joint destruction in rheumatoid arthritis may lead to progressive vertebral instability. It is a severe risk factor for cord compression, which may even lead to sudden death. Many patients with atlantoaxial subluxation may have no symptoms referable to the neck. True degree of subluxation may occur during anaesthesia when the neck muscles are relaxed and protective spasm is absent. The cervical deformities can be visualised on conventional, transoral and functional lateral view in the flexion and extension positions of the neck. The aim of our study is to demonstrate the usefulness of cervical dynamic X-ray for patients suffering from rheumatoid arthritis. This is the first classical radiological imaging method in the diagnosis and in radiographic follow-up. It is a very important method in the preoperative evaluation to prevent definitive neurologic injury. We describe the method for screening, measuring and grading cervical subluxations and instability in our everyday routine.]

Hungarian Radiology

[Role of radiofrequency ablation in the treatment of malignant liver tumors - Possibilities and limitations]


[Radiofrequency tumour therapy is a minimally invasive procedure. It has been used in several specialities independently of the type and location of the tumour, and has shown its worth. In primary hepatic malignancies, radiofrequency ablation (RFA) is a curative procedure. Recent publications reveal that hepatocellular carcinomas which were of cirrhotic origin and not larger than 5 cm have shown similar responses to both RFA and surgery. In cases of metastatic hepatic tumours, RFA showed slightly poorer results as compared to surgery. But, in tumour foci less than 3 cm or in patients in whom the perioperative risks were high (and they presented with tumor foci less than 3 cm and 3 foci), RFA proved to be a better alternative to surgery. RFA, when used percutaneously, is a cheaper procedure as compared to surgical resection. It can be performed on an out-patient basis with a maximum of 24 hours of observation. Local anesthetic or slight sedation may be employed. Greatest advantage of RFA is its ability to cause tumour degradation. Its results are not well known in our country. Under the existing financial system, RFA is not feasible.]

Hungarian Radiology

[Use of plain and intravenous contrast material multidetector CT examinations in acute abdomen]


[Through most of Europe, multidetector computed tomography is used as the first-line modalitiy for examining the acute abdomen. Acute abdominal pain, symptoms referring to abnormal bowel movements, gastrointestinal bleeding, worsening general state, and other typical clinical signs require quick and precise diagnosis since these conditions are frequently life-threatening. The sensitivity and specificity of CT examinations have significantly improved due to the development of the machinary. Thus, the scope of indications are also expanding. Almost all acute abdominal disorders, that may lead to an acute surgical procedure, can be diagnosed with the help of multidetector CT. Unnecessary surgical procedures, the risk to the patients and also the cost of hospitalization can be reduced using multidetector CT examination.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]


[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.]

Journal of Nursing Theory and Practice

[Use of the ankle-brachial index in occupational healthcare]

SZOBOTA Lívia, HIRDI Henriett Éva

[Elevated risk of fatal and non-fatal cardiovascular events is associated with high prevalence of peripheral arterial disease (PAD). Nurses working in occupational healthcare are ideally situated to identify individuals with undiagnosed PAD. The aim of the study: This study aimed to demonstrate that the ankle-brachial index (ABI) is a tool to be used by occupational health nurses in prevention of cardiovascular disease (CVD). A cross-sectional study was carried out with patients (N=638) from an occupational healthcare setting in 2021. The ABI was measured with an oscillometric blood pressure device. The measurements were analysed with the help of SPSS 22.0; descriptive statistics were calculated. A total of 638 patients were included. Mean age of the population studied was 46.5 ± 8.2 years; 38.4% were men and 61.6% were women. Mean ABI were 1.08 in right legs, 1.06 in left legs. Only 11 subjects (1.72%) had an ABI < 0.90. Occupational health nurses are able to identify key factors related to PAD, including use of the ABI, and to identify individuals with the disease. The determination of ABI using an oscillometric blood pressure device is feasible and easy to implement in occupational healthcare.]

Clinical Neuroscience

TikTok and tics: the possible role of social media in the exacerbation of tics during the COVID lockdown

NAGY Péter , CSERHÁTI Helga , ROSDY Beáta , BODÓ Tímea, HEGYI Márta , SZAMOSÚJVÁRI Judit , FOGARASI Joseph Dominic , FOGARASI András

Over the past year, many cases with newly onset or significantly exacerbated tic disorders were observed worldwide, where some aspects of the clinical presentation or the symptomatology were atypical for established tic diagnoses. Our purpose was to describe the atypical cases and raise relevant diagnostic issues. Consecutive cases with atypical tic presentations were documented. Five atypical tic cases are described. These cases shared some common characteristics, most notably the fact that all of them had been exposed to online presentation of ticking behaviour on social media platforms prior to the de novo development or exacerbation of their tics. Even though the order of events suggests causality and therefore the diagnosis of a functional tic disorder, unambiguous criteria for classifying atypical tics as functional symptoms are lacking. Differentiating neurodevelopmental and functional tics in childhood is currently problematic. Based on the currently unresolved issues in differential diagnosis, the importance of watchful waiting and behavioural interventions is highlighted to avoid unwarranted pharmacotherapy.

Clinical Neuroscience

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.

Clinical Neuroscience

Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.