Hungarian Radiology

[Radiation protection belongs to patient’s right]

SZÁNTÓ Dezső

OCTOBER 20, 2004

Hungarian Radiology - 2004;78(05)

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Hungarian Radiology

[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.]

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.]

Hungarian Radiology

[PACS-seeing in Nancy - Study-tour, September, 2004]

FORRAI Gábor, BARTA Miklós

Hungarian Radiology

[Breast cancer screening in Hold street started twenty five years ago]

GÖBLYÖS Péter, TANKA Ida, GRÉGER Judit

Hungarian Radiology

[Dr. Márton Lányi]

GÖBLYÖS Péter

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT

KOCATÜRK Mehtap, KOCATÜRK Özcan

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNCT/SUNA) is a rare severe headache. At the time of an attack, it can hinder a patient from eating and requires acute intervention. The sphenopalatine ganglion is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. Sphenopalatine ganglion block has long been used in the treatment of headache, particularly when conventional methods have failed. Here, we present a patient who was resistant to intravenous lidocaine, but responded rapidly to sphenopalatine ganglion block during an acute episode of SUNCT/SUNA.

Clinical Neuroscience

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.