Hungarian Radiology

[Esophageal perforation in pneumectomized patient]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

OCTOBER 20, 2004

Hungarian Radiology - 2004;78(05)

[INTRODUCTION - In 58 per cent of cases the fistulas and perforations are developing in middle third part of the esophagus. CASE REPORT - A 58 year old male patient's left lung was surgically removed due to drug-resistant actinomycosis. The pneumectomy has induced mediastinal dislocation and fibrothorax. Six years later the patient complained of odyno-dysphagia and of swallowing cough. On chest plain film we observed left-sided hydrothorax and barium swallows showed perforation of esophagus at the ipsilateral side. Esophageal adenocarcinoma and exudative pleuritis were confirmed by endoscopy and by histology following thoracocentesis. CONCLUSION - In case of pneumectomized patient with swallowing cough, dysphagy and recently development of pleural fluid collection the diagnosis of esophageal perforation is likely. The pleural pain is usually missing due to postoperative indurative pleurisy.]

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[In vitro optimization of sequences applicable for the MR examination of the gastrointestinal tract with respect to certain contrast materials]

BABOS Magor, PALKÓ András, KARDOS Lilla, CSERNAY László

[PURPOSE - Optimization of gradient-echo and spin-echo sequences in order to visualize oral contrast media for magnetic resonance imaging (MRI) of the small bowel using a 1-T unit. MATERIAL AND METHODS - Authors investigated the optimal appearance of four different potential oral contrast media (rosehip syrup, blackcurrant extract, iron(III)-desferrioxamine, cocoa) with different spin-echo and gradientecho sequences using a simple plastic model. They were searching the optimal solution by changing the parameters of the chosen sequences keeping an eye in every case on the signal-to-noise ratio, the contrast, the resolution, the artifacts and the signal intensity of the contrast materials. RESULTS - The gradient-echo sequences are suitable for imaging of the small bowel. Too short echo time should be avoided because of the increased formation of artifacts. A lot of artifacts can be eliminated using fat saturation. T2*- weighted gradient-echo sequences provide good appearance for the cocoa drink, as well as the three-dimensional gradient-echo sequence. The use of sequential gradientecho acquisition methods is advisable only in non-cooperating patients, because of their low signal-to-noise ratio. The iron(III)-desferrioxamine solution, the rosehip syrup and the blackcurrant extract are potential positive contrast agents on T1-weighted sequences. On the single-shot fast spin-echo (SSFSE) sequence the rosehip syrup and the blackcurrant extract appear as negative contrast materials. CONCLUSIONS - Authors could select and optimize the sequences suitable for each contrast material and effective in small bowel MRI. The substances used in their experimental model are not harmful for humans when administered orally, so determination of additives is the only problem remained before their use in the clinical practice.]

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[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.]

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