Hungarian Radiology

[Calendar of the Society of Hungarian Radiologists, 2011]

DECEMBER 27, 2010

Hungarian Radiology - 2010;84(04)



Further articles in this publication

Hungarian Radiology

[The end of an era, and at the horizons of a new one]


Hungarian Radiology

[Lesions resembling radial scar of the breast - Is preoperative biopsy of the radial scar needed?]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, TÓTH Dezső, BÁGYI Péter

[INTRODUCTION - The radial sclerosing lesion is one of the most common benign breast lesions. It can mimic malignant tumours on mammogram in many cases. In one third of the cases invasive tumour or in situ carcinoma occur in radial sclerosing lesion, therefore surgical excision is mandatory. The aim of our work is to diagnose the malignant cases with preoperative biopsy (FNAB, core biopsy) when radial scar morphology lesion is detected in order to avoid two-step surgical procedure. PATIENTS AND METHODS - Forty-five patients were examined with the same method. In all cases of radial sclerosing morphology lesions a mammography, complementary radiograms, ultrasonography (US) and synchronous US guided FNAB and core biopsy were performed. Postoperative pathological findings were compared to the results of preoperative biopsies. RESULTS - In 6 of 45 cases (13%) malignant tumours mimicked radial scar in morphology. All of them were diagnosed preoperatively with core biopsy (B5). The FNAB was nondiagnostic (C1) in 2 patients, suspicious for malignancy (C4) in 2 patients and was positive in 2 cases (C5). Radial scars or complex sclerosing lesions were diagnosed in 39 patients preoperatively. In 28 cases (72%), malignancy was not detected with postoperative pathological examination. In 8 cases (20%) DCIS and, in 3 cases (8%), malignant tumours were found associated to radial scar. Neither FNAB nor core biopsy gave false positive results in the non-malignant group. In the patients with DCIS associated to radial scar, core biopsy proved malignancy in 5 cases and FNAB in only 1 case. In 3 cases of invasive malignant tumour associated with radial scar core biopsy was positive in 1 patient, while FNAB was negative or non-diagnostic in all of them. CONCLUSION - According to the latest publications vacuum- assisted large-core needle biopsy (VLNB) performed with 11G needle (12) is the safest procedure to justify or exclude malignancy in the radial scar. Observation would be enough in the non-malignant cases and this procedure has therapeutic potential as well. In case where these methods are not available, as in Hungary, all radial scar cases require surgical excision. Therefore, preoperative core biopsy is recommended in order to avoid a two-step surgical procedure.]

Hungarian Radiology

[The effect of the orientation of the distal femur on the correction of axis after closing-wedge high tibial osteotomy - Short-medium term radiological assessment]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[Introduction - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The clinical result is affected by the correction of the varus malalignment. The degree of correction appears to be dependent not only on correction performed on tibia but also on the orientation of the distal femur. The valgus orientation of the distal femur can be associated with postoperative over-correction and varus orientation of the distal femur with postoperative under-correction. Patients and methods - We performed radiological assessment of 82 knees preoperatively and after closing wedge high tibial osteotomy (CWO) in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (23-54 months) on a standing weight-bearing anteroposterior radiograph. Pre- and postoperatively we measured the orientation of the distal femur, described as the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FC-FS). We subdivided the knees into 3 groups based on the orientation of the distal femur. In group A the FC-FS was 83-85° (normal orientation of the distal femur), in group B the FC-FS was £82° (valgus orientation of the distal femur) in group C the FC-FS was ³86° (varus orientation of the distal femur). Pre- and postoperatively we measured the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP) in all groups. We determined the anatomical femorotibial angle (FTA) as a sum of FC-FS, TP-TS and FC-TP. Results - In the first ten postoperative weeks - with significant osseous correction happened in the three groups - the articular component also decreased significantly in groups A and B, but did not change in group C. Between the postoperative 10th and the final follow-up examinations we did not notice significant osseous correction loss in any groups. In groups A and B the articular correction loss was not significant, at the same time in group C we noted significant articular correction loss. Conclusion - At valgus orientation of the distal femur the CWO results in greater correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This additional correction equals the (preoperatively unpredictable) amount of the articular correction. At varus orientation of the distal femur the CWO results in less correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This difference equals the (preoperatively unpredictable) loss of articular correc- tion.]

Hungarian Radiology

[Necrotizing enterocolitis in neonatology: comparing the role of X-ray and ultrasonographic examinations]


[INTRODUCTION - The authors’ purpose was to analyse the role of abdominal ultrasonography (US) in the diagnosis of necrotizing enterocolitis (NEC). They have compared the sensitivity of the current standard diagnostic modalities for this clinical entity: plain abdominal radiography and abdominal US. For a more objective comparison, they created an US scale along with utilising the score system based on abdominal radiography which was published recently. PATIENTS AND METHODS - 46 out of 76 neonates having both clinical and radiological diagnosis of NEC had comparable radiographic and sonographic examinations between June 2006 and October 2009. The authors created a 10-grade US score system, in which sonographic signs of NEC are listed in order of severity, corresponding, where possible with the radiographic scale that was available. The findings were scored individually, then the distribution of scores and their relationship to each other were analysed. For further analysis four groups of severity based on the scores were created with the following categories: mild, moderate, severe and very severe. After graphical representation of the groups, the relationship of the groups created on the basis of scoring the findings by the two diagnostic methods were examined. RESULTS - According to this analysis both abdominal radiographs and sonographs are suitable for diagnosing NEC, which has been justified with statistical data. When analysing the severity groups the authors proved that the two methods diverge in judging groups 3 and 4, thus severe and very severe. The distributions of severity groups formed by the two imaging modalities are different, (P<0,01); and the proportion of group 3 and group 4 is different in case of US and radiographic examinations (P=0.003). CONCLUSIONS - Abdominal sonography and radiography are equally suitable diagnostic methods for diagnosing NEC, and the two methods match each other very well. In cases of mild state, the severity of the disease was found to be the same with both methods, but US allows more sensitive differentiation of serious cases. It is very sensitive in detecting perforations, so it could play a role in determining the indication of surgery.]

Hungarian Radiology

[Surgical treatment of scoliosis: pre- and postoperative follow-up with whole-body EOS radiography]


[Currently, Cotrel-Dubousset spondylodesis is the treatment of choice in orthopaedics. It allows for correction of deformity in three-dimensions allowing for stable fixation. EOS (Extended Orthopedic System) is an ultra low dose X-ray imaging system, simultaneously acquiring images of the whole body in two planes. Examinations with the EOS system is not only indicated in cases related to orthopaedics but in multiple other conditions owing to its low level of emitted radiation with rapid and cost-effective imaging. The importance of EOS examination is emphasized in systemic skeletal disorders, thus allowing itt o be used in various other clinical fields.]

All articles in the issue

Related contents

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]


Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[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

[A short chronicle of three decades ]


[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[History of vaccine production in Hungary ]


[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]


[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]