Hungarian Radiology

[Radiation protection during diagnostic radiological examinations]

PELLET Sándor

OCTOBER 15, 2010

Hungarian Radiology - 2010;84(03)

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Hungarian Radiology

[Our future]

LOMBAY Béla

Hungarian Radiology

[Emergency imaging in pregnant women]

BORBÉLY Krisztina, KATHIA Chaumoître, FORRAI Gábor

[The use of adequate imaging protocol reduces morbidity and mortality in emergency cases of pregnant women. The least harmful, but sufficiently informative imaging method should be chosen that provides us with the diagnosis in the shortest delay. Although the reduction of harmful effects is important, life threatening complications can be avoided by an indicated and well effectuated imaging method using ionizing radiation.]

Hungarian Radiology

[Pulmonary abnormalities in haematological malignancies - The role of imaging in differential]

GYŐRI Gabriella, MAGYAR Péter, KOVÁCS Balázs, BÉRCZI Viktor, BALASSA Katalin, DEMETER Judit

[Patients with hematological malignancies may develop a wide range of pulmonary abnormalities due to the hematological disease itself as well as in response to therapy. Immunosuppression and intensive chemotherapy induced severe neutropenia hold a high risk of infection. Infectionrelated morbidity and mortality are still high. One of the most common infectious complications is invasive mycosis, which is lethal in a high percentage of cases if not treated immediately and adequately. Non-infectious complications, such as secondary pulmonary lymphoma, thromboembolism, hemorrhage or drug induced fibrosis may develop during the course of the disease. Sometimes it is difficult to make a definitive diagnosis. As invasive methods (bronchoscopy, bronchoalveolar lavage, biopsy) are mostly contraindicated in these patients with severe neutropenia and thrombocytopenia, imaging techniques are especially important. It is a great challenge to differentiate infectious and noninfectious processes. CT and HRCT play an essential role in differential diagnosis. An early and accurate diagnosis is sometimes the only chance for survival.]

Hungarian Radiology

[Differential diagnosis of malignant cervical lymph nodes with real-time ultrasonographic elastography and Doppler ultrasonography]

ARDA Kemal, CILEDAG Nazan, GUMUSDAG Demir Pelin

[PURPOSE - Real-time ultrasonographic elastography is a new imaging technique which is used in characterizing the difference in hardness between pathologic and normal tissue. The purpose of our study was to evaluate the diagnostic performance of real-time ultrasonographic elastography and Doppler ultrasonography (DUS) individually and combined in differentiation of benign and malignant cervical lymph nodes (LN). PATIENTS AND METHODS - Fifty-one patients (12 men, 39 women) referred for fine-needle aspiration or surgical biopsies of suspected cervical lymph nodes were examined with gray scale ultrasonography, power DUS, and realtime ultrasonographic elastography. During DUS examination vascularity and resistance index (RI) values were evaluated. A five-group elastographic colour code pattern was used to evaluate the ultrasonographic elastograms for LN (pattern 1, an absent or a very small hard area; pattern 2, hard area <45%; pattern 3, hard area ≥45%; pattern 4, peripheral hard and central soft areas; pattern 5, hard area occupying entire solid component with or without soft rim). In addition, strains of LN and surrounding muscles were measured on elastograms, and the muscle-to-LN ratio (strain index) was calculated. Real-time ultrasonographic elastography and DUS results were compared with the final diagnosis obtained by fine-needle aspiration cytology analysis and/or by surgical pathology. The diagnostic potential of the examined criteria for malignancy was evaluated with univariate analysis and multivariate generalized estimating equation regression p≤0.05 indicated statistical significance. RESULTS - A strain index higher than 2.45 and colour pattern 4-5 had high utility in malignant LN classification with 93.8% sensitivity, 89.5% specificity (p<0.001). The results were significantly better than those obtained by using DUS characterization - that is, RI greater than 0.57 - which had 78.9% sensitivity (p<0.001). CONCLUSION - Real-time ultrasonographic elastography had 93.8% sensitivity and 89.5% specificity in the differentiation of benign and malignant cervical LN in patients referred for fine-needle aspiration or surgical biopsies with suspicion of malignancy. Real-time ultrasonographic elastography and DUS in addition to gray scale ultrasonography may improve the differential diagnosis of LN.]

Hungarian Radiology

[Interdisciplinary mummy research - Paleoradiology and paleopathology research of the Archbishop of Kalocsa Pál Széchényi’s mummy]

KRISTÓF Lilla Alida, POHÁRNOK László, KERÉNYI Tibor, TÓTH Vilmos, ISTÓK Roland, HARGITTAI Péter, FORNET Béla, PAP Ildikó, PÁLFI György

[Purpose - The scientific study of Pál Széchényi’s mummy was carried out by our research team composed of the members of several institutions in 2007 April. The scientific examinations represented a milestone, since up till now it was unclear whether it was a natural or artificial mummy and the century-old question whether Pál Széchényi was in fact a victim of arsenic poisoning in 1710 or it was only a legend could also be answered. Methods - The non-invasive examinations were carried out with multislice CT, traditional X-ray, biopsy, toxicology, energy-dispersive X-ray, X-ray fluorescens analysis, 3D optical digitalization indicator system, endoscope and 3D rapid-prototyping printing. Results - The examinations proved that Archbishop Pál Széchényi’s death was natural, and his body was artificially mummified. The CT examinations were carried out in a slice thickness of under 1 mm facilitating printed skull copy made by 3D rapid-prototyping method which provided the exact and detailed basis for the facial reconstruction.]

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Clinical Neuroscience

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.

Lege Artis Medicinae

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

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.]

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]