Hungarian Radiology

[Entertainment ultrasound]

HARKÁNYI Zoltán

JUNE 10, 2005

Hungarian Radiology - 2005;79(03)

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Hungarian Radiology

[Comparison of the results of lung helical CT and lung scintigraphy in pulmonary embolism]

WENINGER Csaba, BODROGI Gabriella, BOROS Szilvia, SCHMIDT Erzsébet, UDVAROS Eszter, ZÁMBÓ Katalin

[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

Hungarian Radiology

[Medal of commemoration Mihály Erdélyi 2005]

BOHÁR László

Hungarian Radiology

[Interventional radiology of multiple biliary stenoses]

ROSTÁS Tamás, BATTYÁNY István, HADJIEV Janaki

[INTRODUCTION - In palliative treatment of malignant bile duct obstruction the endoscopic and the percutaneous methods are the possible options. In multiple lesions the percutaneous method must be preferable. Decrease of the bilirubin level to normal gives an opportunity for further treatment of the oncology patients. CASE REPORT - Authors report three patients’ case history, when following an unsuccessful endoscopic retrograde cholangiopancreatography, percutaneous cholangiography revealed multiple biliary stenoses. In all cases successful stent implantations were performed (three stents in one patient, two stents in two patients). The bilirubin levels decreased rapidly and the quality of life improved in all cases. Following the stent implantation selective cytostatic treatment (one patient) and systemic cytostatic treatment (one patient) were performed. The mean survival time was 300 days. CONCLUSION - In the case of multiple biliary stenoses the percutaneous stent implantation is an acceptable palliative method, which permit the possibilities of further interventional radiological or oncological treatments.]

Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2005]

Hungarian Radiology

[Stable, since it is changing]

KUHN Endre

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[Role of ultrasound in the diagnosis of Crohn’s disease]

KUKLA Edit, BEVÍZ József, MAKULA Éva, PALKÓ András, VÁRKONYI Ágnes, FÜZESI Kristóf

[INTRODUCTION - The peak incidence of Crohn’s disease is the second and third decades of life. Twenty-five percent of new cases occur in individuals less than 20 years of age. Typically the clinical presentation of Crohn’s disease is not different in children from in adults. The sudden onset of the disease with serious symptoms is not rare in pediatric patients The signs of acute abdomen, the rapid deterioration of the patient's physical condition needs urgent surgical intervention. Ultrasound is the first imaging method of choice can reveal specific signs of the disease and early accurate diagnosis can be established. The radiation burden can be decreased on this way and the unnecessary surgical intervention can be avoided. CASE REPORT - A child who presented typical signs of acute appendicitis was investigated first by ultrasound. Based on this investigation the diagnosis of Crohn’s disease was suspected, but unfortunately the adequate diagnosis was established only 5 months later after appendectomy and right sided hemicolectomy. CONCLUSION - Authors draw the attention to the importance of the ultrasound investigation in the diagnosis of Crohn’s disease in the childhood.]

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[Zsófia Farbaky: Basics of musculoskeletal ultrasound]

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[Necrotising sarcoid granulomatosis: imitator in the chest]

AGÓCS Ágnes, ZIBOTICS Hilda, GREXA Erzsébet

[INTRODUCTION - Both intra and extrapulmonary manifestation of necrotising sarcoid granulomatosis is very rare. It is characterised by variable pulmonary radiological picture, typical histology and benign clinical course CASE REPORT - A young male patient was admitted to our hospital due to a mass lesion in the right apex of the lung suspicious of tuberculosis discovered on plain chest X-ray. Antituberculotic therapy resulted no change of radiological picture. Cytological sample taken by ultrasound guided fine needle aspiration contained no tumor cells. Finally necrotising sarcoid granulomatosis was confirmed by histological examination of the mass removed by atypical surgical resection. CONCLUSION - Intrapulmonary necrotising sarcoid granulomatosis has a variable picture. It has no typical radiological pattern or localisation, therefore it is impossible to diagnose by X-ray morphology. Final diagnosis is based on histology.]

Hungarian Radiology

[Role of the first ultrasound examination in the diagnosis of hilar cholangiocarcinoma]

LUKOVICH Péter, WINTERNITZ Tamás, KÁRTESZI Hedvig, ILLYÉS György, KUPCSULIK Péter

[INTRODUCTION - Hilar cholangiocarcinoma (Klatskin tumour) rarely causes obstructive jaundice, because rarely thought of that cause during medical examinations. Because the small size of the tumour in the biliary duct and the proximity of other components of the porta hepatis tumour cannot be detected by ultrasound, CT and MRI examinations in a significant part of the cases, which makes the diagnosis more difficult. PATIENTS, METHODS AND RESULTS - In the present study we have analysed the findings of the first abdominal ultrasound examination carried out on 38 patients who had undergone resection due to hilar cholangiocarcinoma during the period 1991-2002. The presence of the tumour could be proved only in 18.2% of the cases. The recognition of the secondary symptoms (dilated intrahepatic biliary ducts, choledochus of normal diameter) is also considered very low (68.2% and 50% respectively). From the viewpoint of the operability of the Klatskin tumour the relationship between the tumour and the blood vessels is important. Only one researcher has made declaration in this sense. The difficulty of detecting the tumour and the incorrect evaluation of the secondary signs led to the wrong ultrasound diagnosis in 82% of the cases, leading the examination astray. CONCLUSIONS - The correctly interpreted ultrasound examination accompanied by a Doppler study - even if it cannot document the tumour - provides evidence of a proximity biliary duct constriction and based on the secondary signs it defines the diagnosis of the Klatskin tumour. In order to judge operability MR-cholangiography is the next modality of choice. In lack of obvious sign of inoperability surgical exploration is justified. In case of an early diagnosis the 25-45% rate of 5-year survival, which is considered a very good result in gastrointestinal tumours, improves further.]

Hungarian Radiology

[Pelvic computed tomography in staging of prostate cancer before surgery]

BERCZI Csaba, TÓTH György, VARGA Attila, FLASKÓ Tibor, KOLLÁR József, TÓTH Csaba

[PURPOSE - The aim of the study was to measure the sensitivity and specificity of computed tomography for local staging in patients underwent radical perineal prostatectomy. PATIENTS AND METHODS - 160 patients were involved in the study. Rectal digital examination, measurement of prostate specific antigen, prostate biopsy, CT, ultrasound, chest X-ray examination and bone scintigraphy were performed in every case before radical prostatectomy. RESULTS - The average preoperative prostate specific antigen concentration was 15.8 ng/ml before surgery. The average Gleason score of biopsies was 3.19. CT showed extraprostatic infiltration in 14 patients (pericapsular invasion n: 6, seminal vesicula n: 3, bladder infiltration n: 5, lymph node metastasis n: 2). The histological examination proved extraprostatic invasion of the tumour in 35 cases (pericapsular invasion n: 35, seminal vesicula n: 25, bladder infiltration n: 5). The cancer was localized in the prostate in 125 patients. Sensitivity and specificity of CT for pericapsular invasion were 14% and 98%, for infiltration of seminal vesicula 12% and 100%, and for bladder infiltration 20% and 97%. There was not a significant difference between the prostate specific antigen values (p=0.94) in cases when the tumour was confined to the prostate and when the cancer showed extraprostatic infiltration. There was significant difference between the Gleason score values between the two groups (p=0.008). CONCLUSION - The sensitivity of CT for local spread of prostate cancer is very low, thus CT is not a suitable method for the local staging before surgery.]