Hungarian Radiology

[Development of CT - Is there a limit? Conversation with professor Mathias Prokop]

HARKÁNYI Zoltán

DECEMBER 20, 2006

Hungarian Radiology - 2006;80(07-08)

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Hungarian Radiology

[Initial experiences with TOF MR and contrastenhanced MR angiography of the supraaortic arteries]

TASNÁDI Tünde, KARDOS Klára

[INTRODUCTION - 95 MR angiographic examinations of the supraortic arteries were performed at the Rethy Pal Hospital, Bekescsaba between February 2003 and May 2005. The aim of this publication is to analyse the clinical benefit of contrast-enhanced MR angiography compared to duplex ultrasound and to evaluate the role of TOF MR angiography in the diagnostics of the carotid arteries. We compared the results of contrast-enhanced MR angiography, TOF MR angiography and duplex ultrasound. MATERIAL AND METHOD - 95 patients were examined by CE MR angiography following carotid duplex US in 59 cases and TOF MR angiography in 88 cases. Duplex US was done using LOGIQ 400 PRO system, MR angiography were performed by 1.5 T Siemens Magnetom Symphony unit. RESULTS - Stenosis of the internal carotid artery was confirmed in 67 cases and stenosis of the common carotid artery was seen in 10 cases. Bilateral ICA stenoses were detected in 17 patients and bilateral CCA stenoses could be revealed in 3 cases. The ICA stenosis was mild in 22 (33%), moderate in 18 (27%), and serious in 27 cases (40%). Occlusion was seen in 10 cases (15%). CE MR angiography showed stenosis at the origin of the CCA in 5 patients, at the origin of the vertebral and the subclavian artery in 10-10 cases that could not be detected by duplex ultrasound. Subclavian artery stenosis was seen in 15 patients, 7 of them presented subclavian steal syndrome. 13 patients had vertebral artery stenosis, 7 of them bilateral. 13 of the 20 VA stenoses were mild, 4 were found to be moderate and 3 were serious. In four patients the vertebral arteries were occluded. In six questionable cases MR angiography solved the problem. Reversed flow could be detected in 5 cases with duplex ultrasound suggestive of subclavian steal syndrome, which was later confirmed by TOF and CE MR angiography. TOF MR angiography showed stenosis on reconstructed images, which was not confirmed by neither duplex US or CE MR angiography. Paraganglioma was detected in one patient. CONCLUSION - In case of calcified plaques and abnormal arterial-course CE MR angiography contributes significantly to the detection of the stenosis. In cases with moderate and serious stenosis duplex ultrasound and MR angiography provided similar results. In case of occlusions the results of the two modalities were the same. The contrast-enhanced MR angiography gives the possibility to show the aortic origin of the supraaortic arteries in contrast to the duplex US and TOF MR angiography. To establish the diagnosis of subclavian steal syndrome the directional sensitivity of TOF MR angiography and duplex US is helpful adjunct to CE MR angiography.]

Hungarian Radiology

[Computer tomography based planning by personal computer in surgery of forefoot]

HUSZANYIK István, HEGEDŰS Franciska, RÓDE László

[BACKGROUND - In contradiction to traditional osteographic registrations CT pictures give the possibility of precise and size proportional measurements. Three-dimensional reconstructions can help in imaging of stereoscopic structures, however later reediting is not possible. Authors elaborated a CT based system for planning surgical interventions with personal computer. MATERIALS AND METHODS - The new method is described using a forefoot surgery model. The measurements were based on three subcapital osteotomy of 1st metatarsus. The length of 1st metatarsus, the 1st-2nd metatarsus index, the 1st-2nd intermetatarsal angle, and dorsoplantar movement of 1st-2nd metatarsal head were determined. RESULTS - The postoperative result of correction and pathologic bone movement can also precisely determined by this method. CONCLUSION - This method seems to be practical for elaboration of other new operating techniques, predicting and verifying their results before clinical use.]

Hungarian Radiology

[Measurements on radiologic equipments for quality and safety - 3rd Interdisciplinary Forum]

GÁSPÁRDY Géza

Hungarian Radiology

[The role of static MR-urography in diagnostics of urinary obstruction]

KIS Zsuzsanna, FAZEKAS Péter, KULCSÁR Dániel, KÖTELES Márta, KOVÁCS Annamária, MAGYAR Klára

[INTRODUCTION - The idea and methodology of MRurography has just crystallized recently due to the development of technology. The traditional MRU technology means the strongly T2 weighted sequence, suitable for depicting stationary liquid spaces. Its use is independent of the functional status of the kidneys thus it is suitable for depicting dilatated ureters in case of nonfunctioning kidneys, too. Authors's aim was to define the role of sMRU in the diagnostics of obstructive urinary diseases. PATIENTS AND METHODS - 60 sMRU examinations were performed on 59 patients using a 1.5 T Siemens Symphony MR scanner in the CT-MR Laboratory of the Markhot Ferenc County Hospital between May 1, 2003 and October 31, 2005. The sMRU was performed with 2D T2 TSE sequence with angiographic character. In each case, the examinations were completed with conventional sequences in multiple planes. The role of gadolinium enhanced T1-weighted MR urography in the same diseases was not studied. In 7 cases, low-dose thin slice CT examination was performed to reveal the precise cause of obstruction. The examinations were preceded by abdominal ultrasound or intravenous urography (IVU). RESULTS - Out of the 60 sMRU examinations uretery dilatation were observed in 50 cases. In the background of obstruction, stone could be detected in 13 patients, dilatation was observed in 4 patients and MR did not indicate stone. In 7 cases with known neoplastic disease, associated urinary obstruction could be detected. In the background of obstruction primary neoplasm was found in 10 patients unknown prior the MR examination. Other benign obstruction occurred in 13 cases. Obstruction was not proved in 10 patients. In these cases the examination was justified by uncertain ultrasound findings together with abnormal renal function parameters. Follow up sMRU was performed in one patient. False diagnosis was established in two patients, the cause of dilatation was not found in one patient. CONCLUSIONS - The sMRU examination can provide more precise detection of the causes of severe urinary obstructions. It helps to define the level of obstruction in case of known malignant tumors. The grade of urinary dilatation could be also evaluated. The sMRU examination in conjunction with conventional sequences in multiple planes made possible to set up a correct therapy plan.]

Hungarian Radiology

[Professors for European Hungary - Professional Conference]

LOMBAY Béla

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SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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[The role of sleep in the relational memory processes ]

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[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

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Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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