Hungarian Radiology

[Computed tomography brain perfusion in the management of acute stroke]

BAGI Róbert, SZABÓ Tünde, MONOKI Erzsébet

OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)

[INTRODUCTION - The multidetector CT-technology made the application of perfusion CT-examination in the diagnosis of vascular brain damages possible in recently. The purpose of this study was to introduce the method and to assess the importance of computed tomography brain perfusion in emergency patient care and early diagnosis of brain ischemia. PATIENTS AND METHODS - We perform brain perfusion examinations with a 2 slice multidetector computer tomography (General Electric Highspeed NX/i, 2004) in our hospital. We examined the results of native and perfusion CT of 27 patients who underwent CT brain perfusion examination during emergency patient care in our department between 2004 January and 2006 December. We also examined if the patients got systemic thrombolysation and the patients’ condition after therapy. RESULTS - The perfusion software can make quantitative colour maps of parameters (CBF, CBV, MTT) and can visualize mean value and percentil decrease of measuring parameters. There were 18 positive and 8 negative CTbrain perfusion examinations in the examined period. One examination was technically unvaluable. CONCLUSION - By measuring blood flow's decrease the CT-brain perfusion examination can separate the reversible and irreversible damage of brain parenchyma. The examination protocol of brain vascular damages are native CT-scan, postcontrast perfusion CT-examination and CTangiography by the recommendation of international literature. Despite the multidetector CT-s and CT-perfusion technic is available for years, the CT-brain perfusion examination is not a routine process in the emergency patient care in our country.]

COMMENTS

0 comments

Further articles in this publication

Hungarian Radiology

[Tarsal coalitions in our adult patients]

SZÁNTÓ Dezső

[INTRODUCTION - Tarsal coalition is an abnormal bony, cartilaginous or fibrous union between two or three bones of the mid and hindfoot. It occurs mostly (90%) in the calcaneonavicular and talocalcaneal joints. Coalitions are usually detected in the second decade of life, but several cases are noted in children and in later adulthood. Estimated incidence is 1-2% of the total population. CASE REPORTS - Cases of unilateral tarsal coalitions (five calcaneonavicular, three talocalcaneal) in four male and three female patients are presented. The average age of the patients is 30 years. The radiologic diagnosis was based on the secondary signs seen on the lateral plain films of the feet. These signs are parallel with clinical symptoms, in contrary to the primary radiologic signs. The two types of the anomaly coexisted in a female patient. CONCLUSION - Routine lateral not-magnified pedal radiographs are valuable screening tool for tarsal coalitions.]

Hungarian Radiology

[The pledge of the radiology residents in honour of 1st May, 1951]

MÓZSA Szabolcs

Hungarian Radiology

[MRI-guided prostate brachytherapy: First Hungarian experiences based on a canine study]

LAKOSI Ferenc, ANTAL Gergely, VANDULEK Csaba, KOTEK Gyula, KOVÁCS Árpád, GARAMVÖLGYI Rita, PETNEHÁZY Örs, HADJIEV Janaki, BAJZIK Gábor, BOGNER Péter, REPA Imre

[INTRODUCTION - Modern radical radiotherapy can be an effective alternative of radical prostatectomy in low risk patients with prostate tumor. Our objective was to demonstrate the feasibility of transperineal MR-guided prostate interventions in an open MR unit and to present our early clinical experiences on canines. METHODS AND MATERIALS - The procedures were performed on 5 canines in an open-configuration 0.35T MR scanner. For interventions an MR compatible custom-made device was used. The canines were placed in the right lateral decubitus position. Template reconstruction, trajectory planning, target and OAR delineation were based on T2 FSE images. For image guidance and target confirmation, fast spoiled gradient-echo (FSPGR) sequence was used. MR compatible coaxial needles were inserted through the perineum to the base of the prostate. After satisfactory position was confirmed, brachytherapy catheters were placed through the coaxial needles, which were then removed. RESULTS - Mean and standard deviation of the needle displacements was 2.2 mm±1.2 mm, with a median of 2 mm. 96% of the errors were less than 4.0 mm. Implantation induced prostate motion was measured with a mean of 10.3 and 2.3 mm in cranio-caudal and transverse directions. Significant movement was only observed during the first 4 needle insertions. The average time needed for each step was: anesthesia 15 minutes, setup and positioning 15 minutes, initial imaging 15 minutes, template registration and projection 15 minutes, contouring, trajectory planning, insertion of 10 needles 60 minutes. CONCLUSION - Based on our canine model experiences our method seems to be a promising approach for performing feasible, accurate, reliable and high-quality prostate MR guidance within a reasonable time span. We plan to introduce MR-guided biopsy and brachytherapy in human patients in the near future.]

Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS]

Hungarian Radiology

[XII. Congress of the Hungarian Radiographers]

TIHANYI Gyöngyi, VANDULEK Csaba

All articles in the issue

Related contents

Lege Artis Medicinae

[Antiatherosclerotic effect of ACE inhibitor drugs]

CZURIGA István

[Based on animal and human research data, it is likely that renin-angiotensin-aldosteron system has an important role in the pathogenesis and progression of atherosclerosis. It has been demonstrated in several large clinical trials that ACE inhibitors reduce the risk of ischemic events in patients with left ventricular dysfunction. Whereas some benefits of ACE inhibitors may be related to the lowering of blood pressure, other specific effects on vasculature have also been proposed. ACE inhibitors appear to possess unique cardioprotective and vasculoprotective properties even for patients without hypertension or left ventricular dysfunction. Recent data suggest that most patient with atherosclerotic cardiovascular disease should be considered for ACE inhibitor therapy, unless they are intolerant or have contraindication for the drug. The goal of this article is to review the data from clinical trials that support the anti-atherosclerotic and antiischemic effects of ACE inhibitors.]

Lege Artis Medicinae

[PRECONDITIONING AND CARDIOPROTECTION WITH VOLATILE ANESTHETICS]

SZÉKELY Andrea, BREUER Tamás

[A rapidly growing body of experimental evidence indicates that volatile anesthetics protect the myocardium against reversible and irreversible ischemia and reperfusion injury. Volatile anesthetics exerted preconditioning effects, resembling to ischemic preconditioning in different animal models. This results in direct protection against ischemic damage, or an indirect enhancement of the ability of myocardial mitochondrial KATP channels to open in response to an agonist. In addition, volatile anesthetics also reduce the severity of reperfusion injury when administered only during reperfusion. These findings might expand our clinical possibilities in the perioperative management of ischemic cardiac dysfunction. Indeed, several recent publications reported on improved postoperative hemodynamic function and lowered level of ischemic cardiac biomarkers in patients anesthetized with volatile anesthetics during coronary artery bypass grafting. The potential applicability of these finding is subject of further research.]

Clinical Neuroscience

[DIZZINESS - VERTIGO WARNING SYMPTOMS IN VERTEBROBASILAR ISCHEMIA PART II.]

FAZEKAS András

[Dizziness and vertigo - like headache - are the most common complaints which lead patients to visit the doctor. In spite of the headache - which may be primary (e.g. migraine) or symptomatic - dizziness and vertigo do not appear to be a separate nosologic entity but rather the symptoms of several neurological disorders. For differential diagnosis, interdisciplinary thinking and activity is needed because the vestibular, neurological and psychiatric disorders might have a common role in the development of symptoms and further overlapping can also occur. The vascular disorders of the vertebrobasilar system are discussed in detail in this review. The importance, occurrence and causes of vertigo as a warning symptom is in the focus. The author draws attention to life-threatening conditions with acute onset in cases of the posterior scale ischemia and emphasizes the importance of the correct and early diagnosis. The author tries to clear up the nihilistic aspect in treating of stroke and stresses the necessity of thrombolysis and interventional radiological procedures which may be the only chance for the recovery of the patients. The pharmacological prevention of recurrent vascular events is also important and obligatory for the clinicians.]

Clinical Neuroscience

[Neuroprotection in brain ischemia - doubts and hopes]

ZÁDOR Zsolt, BENYÓ Zoltán, LACZA Zsombor, HORTOBÁGYI Tibor, HARKÁNY Tibor

[In ischaemic stroke the two major potential therapeutic strategies are aimed at either improving cerebral blood flow or directly interacting with the cytotoxic cascade - a large body of evidence gained from animal studies is in support of them. In clinical trials direct neuroprotection by blocking the neurotoxic cascade remained ineffective, although there are several clinical trials still in progress. We summarize the experimental data and present the results of clinical trials and also discuss why so many drugs, which were effective in animal studies, failed in human trials. It is emphasized, that 1. in most animal studies the reduction of infarct size, i.e. the amount of saved penumbral tissue, was the outcome measure, whereas neurological function remained unassessed; 2. the recovery of intellectual performance and higher cortical functions are of major importance in the future quality of life in stroke victims; however, it is impossible to examine these parameters appropriately in animal studies; 3. in many clinical trials the patient population was rather heterogenous and low in number, the study protocol was not optimal and the critical analysis of the subacute and chronic phase was lacking or insufficient. We present the major experimental stroke models, discuss their similarities, differencies and limitations as compared to the human pathophysiological processes. The pitfalls of extrapolating data from animal studies to clinical practice are also summarized. The complex network of functional and morphological intercellular connections, the long timescale of neurotoxic and reparative events and the lessons learned from clinical trials suggest, that the use of drug combinations (therapeutic cocktails) targeting multiple steps of the neurotoxic cascade would hopefully result in more effective treatment of ischaemic stroke. Strategies to facilitate brain plasticity and regeneration is an additional promising tool to enhance recovery in brain ischaemia.]

Clinical Neuroscience

[OXYGEN-GLUCOSE DEPRIVATION-INDUCED CHANGES IN ORGANOTYPIC CULTURES OF THE RAT HIPPOCAMPUS]

BALI Balázs, NAGY Zoltán, KOVÁCS J. Krisztina

[Introduction - (-)Deprenyl is an irreversible inhibitor of type B monoamine oxidase (MAO-B), which is now used for treatment of Parkinson’s or Alzheimer’s diseases. Evidence suggests that the neuroprotective effect of deprenyl may not be related exclusively to the inhibition of the enzyme MAO-B. Methods - To test the impact of deprenyl on ischemiainduced changes in vitro, we followed the time course of propidium iodide (PI) uptake as an indicator of neuronal cell death as well as the expression of apoptotic factors in organotypic hippocampal slice cultures exposed to oxygen- glucose deprivation (OGD) for 45 min. Results - The first signs of neuronal death were detected 2 hours after OGD and were extended to all subfields of the hippocampus by 24 hours post-injury. Presence of deprenyl (10-9 M) significantly delayed the cell death induced by the insult. Exposure of control cultures to deprenyl significantly increased the abundance of Bcl-2 and Bcl-xl mRNAs as revealed by RT-PCR. OGD resulted in an elevation of anti-apoptotic factors, while the expression of pro-apoptotic bax remained unchanged. Conclusion - These data suggest that deprenyl is neuroprotective in an in vitro model of ischemia. Although deprenyl upregulates the expression of Bcl-2 under basal conditions, its effect on anti-apoptotic factors is not significantly manifested during OGD.]