Hungarian Radiology

[Imre Kaszás, Magor Babos: CT-MR Investigational Technique]

PALKÓ András

DECEMBER 15, 2008

Hungarian Radiology - 2008;82(07-08)

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Hungarian Radiology

[A Deliberate Violation of Symmetry My Entry for the Ig Nobel Prize]

LOMBAY Béla

Hungarian Radiology

[Radiology of pancreas: review from the last year - Gastro Update 2007]

FORRAI Gábor

[PURPOSE - To demonstrate the recent results in radiological diagnostics of pancreas, and the actual place of the imaging and interventional methods. METHOD - Systematic review of the most recent articles from the last year in the following subjects: acute, chronic and autoimmune pancreatitis, pancreatic cancer and other tumors, PET and special imaging problems in pancreas transplantation. RESULTS - Annually, experience in pancreatic diagnostical methods are accumulating rapidly. Therefore, there is a continuous change in the examination algorithm with new diagnostic and therapeutic modalities making their way into the daily routine. Some of the algorithms become obsolete within a few years and their further application is considered mismanagement. Some other methods become obligatory steps in the diagnostics. These are the reasons why up-to-date knowledge of the literature is mandatory.]

Hungarian Radiology

[Role of contrast enhanced ultrasound in clinical practice]

HARKÁNYI Zoltán

[Ultrasound contrast agents consist of micro bubbles which can be visualized during their short intravascular and parenchymal transit time. An US system with special software, a small amount of intravenous contrast agent and a skilled operator is necessary to produce a successful study. This method can also be introduced into the clinical practice in our country. Careful indications and well performed studies can reduce the number of unnecessary CT and MR studies and biopsies. Contrast enhanced US has special clinical significance in the detection and characterization of focal liver masses, monitoring drug and local treatment effects of different abdominal tumors and in the case of injury of abdominal parenchymal organs.]

Hungarian Radiology

[Evaluation of cystic renal masses with MDCT]

BATA Pál, MIKUSI Regina, KARLINGER Kinga, BÉRCZI Viktor, SZENDRŐI Attila, ROMICS Imre

[Modern CT and MRI scanners can give an exact and rapid diagnosis in the case of most cystic renal masses. Dilemma in their diagnosis is whether or not the changes need surgical intervention. The question of follow-up is decided with the use of the Bosniak classification. To characterize the cystic changes excellent quality, multiphasic MDCT examination is necessary with the following parameters: 80-120 mls. of non-ionic iodinated intravenous contrast material given with an injector at 3 ml/sec flow-rate with saline flush technique, unenhanced and post-contrast scans obtained at 35 and 70 seconds, with more scans at 120-300 seconds, as deemed necessary. A collimation of 16x1.5 mm with an overlap of 50% should be aimed for. Through the primary data we perform a reconstruction of 2 mm, with an option to create volume-rendered image sin the post-processing phase, as necessary. With the help of this CT protocol we can measure the different criterions of Bosniak classification in the cystic masses like minimal, smooth or irregular wall thickening, with or without enhancement. We can recognize hairline thin or thickened septa, fine or irregular (thick or nodular) calcifications, solid component with or without contrast enhancement. Using these criteria each cystic mass can be assigned to a Bosniak cystic category (I, II, IIF, III and IV)]

Hungarian Radiology

[High resolution sonography for the examination of peripheral nerves]

JOSEF Böhm

[High-frequency sonography is an important method for the imaging of the peripheral nerves, even though it is rarely used. For the examination of superficially located nerves, currently available transducers with frequencies between 12-17 MHz offer a better axial resolution than even MRI. Sonography is superior to MRI especially for the examination of nerves of the upper extremity. Main indications for the sonography of the nerves are entrapment syndromes, traumatic injuries of the nerves, tumors, polyneuropathies and sonographically-guided interventions. The sensitivity of sonography and electrophysiology in the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome are comparable. The combination of ultrasonography with electrophysiological studies increases the diagnostic yield in carpal and cubital tunnel syndromes. Sonography provides information for planning of peripheral nerve surgery and is helpful in evaluating postoperative complications. In selected cases, sonography can detect nerve lesions that require operative therapy earlier than electrophysiology. With technical enhancements, highfrequency ultrasonography is gaining increasing importance in the routine diagnostics of peripheral nerves lesions.]

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The effects of the level of spinal cord injury on life satisfaction and disability

GULSAH Karatas, NESLIHAN Metli, ELIF Yalcin, RAMAZAN Gündüz, FATIH Karatas, MÜFIT Akyuz

Introduction - Spinal Cord Injury (SCI) may often lead to significant disability in affected individuals and reduce life satisfaction. Herein we aimed to investigate the effects of the level of injury on disability and life satisfaction as well as the relation between life satisfaction and disability. Methods - Patients with at least one-year history of SCI were included. Demographic-clinical data of patients were recorded. The Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) was used for quantifying the degree of patients’ disability. Life satisfaction was assessed by the Satisfaction with Life Scale (SWLS). Results - Of the 76 patients, 21 (27.6%) were tetraplegic and 55 (72.4%) were paraplegic. SWLS was found to be similar in tetraplegic vs. paraplegic patients (P=0.59), whereas CHART parameters such as physical independence, mobility, occupation, and total CHART value were significantly higher in paraplegic patients (P=0.04, P=0.04, P=0.001 and P=0.01, respectively). Social integration was found similarly high in both groups. There was a positive correlation between elapsed time after the injury and CHART physical independence, occupation and the level of economic sufficiency (P<0.01, P<0.01, P=0.01). Excluding the economic sufficiency (P=0.02), there was not any other association between the rest of CHART parameters and SWLS. Conclusions - According to our findings, although the level of injury seems to be influential on disability, it seems to have no significant effect on life satisfaction. Since the only thing that positively affects life satisfaction is economic sufficiency, more emphasis should be placed on regulations that increase the return to work in patients.

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

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The yield of electroencephalography in syncope

NALBANTOGLU Mecbure, TAN Ozturk Ozlem

Introduction - Syncope is defined as a brief transient loss of consciousness due to cerebral hypoperfusion. Although the diagnosis of syncope is based on a thorough history and examination, electroencaphalography (EEG) is also an important investigational tool in the differential diagnosis in this group of patients. In this study we aimed to identify the diagnostic value of EEG in patients with syncope. Methods - We retrospectively examined EEG recordings of 288 patients with the diagnosis of syncope referred to the Cankiri State Hospital EEG laboratory, from January 2014 to January 2016. The EEG findings were classified into 6 groups as normal, epileptiform discharges (spike and sharp waves), generalized background slowing, focal slowing, hemispherical asymmetries, and low amplitude EEG tracing. The EEGs were separated according to gender and age. Results - Total of 288 patients were included in this study, 148 were females (51.4%) and 140 (48.6%) were males. Among all the EEG reports, 203 (70.5%) were normal, 8 of them (2.8%) showed generalized background slowing and 7 (2.4%) demonstrated focal slow waves. Epileptiform discharges occured among 13 patients (4.5%). Hemispherical asymmetries were detected in 10 patients (3.5%) and low amplitude EEG tracing in 47 patients (16.3%). There was no significant difference between age groups in EEG findings (p=0.3). Also no significant difference was detected in EEG results by gender (p=0.2). Discussion - Although the diagnosis of syncope, epilepsy and non-epileptic seizures is clinical diagnosis, EEG still remains additional method

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[Results of epidemiological studies indicate the atherosclerotic renal artery stenosis is a common condition, thus development of its diagnostics and therapy has significant importance. Renal artery narrowing can cause hypertension, renal function decline, cardiac failure and the increased cardiovascular risk seriously affects survival perspective of the patients. The evolution of MR technology has a prominent role in renovascular diagnostics. Beyond the detection of arterial stenosis this technique is capable of the functional characterization of the stenosis and the detailed description of the regional kidney tissue damage. Based on the results of clinical studies the relevance of revascularization of the renal artery stenosis remains uncertain. The trials focusing on this issue show methodological imperfections. It remains to be elucidated whether these methodological problems will be tackled in the future based on the present information. This review focuses on the actual findings corresponding to these problems.]