Hungarian Radiology

[Régnier: Vanitas - Unusual story of a painting depicting a breast cancer woman]

GÖBLYÖS Péter, DRAGON Zoltán

MAY 15, 2010

Hungarian Radiology - 2010;84(01)

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Hungarian Radiology

[Leaping forward - Hungarian Radiology Online has started!]

LOMBAY Béla

Hungarian Radiology

[Breast malignancies: review of the year 2008/2009 radiological diagnostics and therapy news - Onco Update, 2010]

FORRAI Gábor

[Systematic review of the recent articles of the years 2008/2009 about breast tumours’ radiological diagnostics and guided therapy, the actual place of the imaging and interventional methods are presented.]

Hungarian Radiology

[Dual energy computed tomography - dual-source CT]

WENINGER Csaba, CSETE Mónika, SZUKITS Sándor, DÉRCZY Katalin, VÁRADY Edit, BATTYÁNY István

[The authors describe fundamentals of computed tomography (CT) examination performed by dual-source, dual energy CT scanner. The special applications of dual energy acquisition are demonstrated, e. g. examination of pulmonary perfusion in case of embolism, bone subtraction during CT angiography, differentiation of various stones and calcifications. The dual energy acquisition can improve the accuracy and sensitivity of the radiological diagnosis.]

Hungarian Radiology

[Radiological assessment of the combined high tibial osteotomy in the frontal plane]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[INTRODUCTION - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The main principle of HTO is to achieve a transfer of loading from diseased, arthritic areas of the joint to areas with relatively intact, healthly cartilage. This stress reduction can be achieved with correction of the loading axis. A stress reduction occurs in the medial compartment of the knee when the loading axis is transferred from the medial compartment to just lateral to the center of the joint. PATIENTS AND METHODS - We performed radiological assessment of 52 knees preoperatively and after combined high tibial osteotomy (CO) in the 10th postoperative week, in the 12th postoperative month and in the 5th postoperative year on a standing weight-bearing anteroposterior radiograph. CO involved performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge was transferred to the gap on the medial side. Pre- and postoperatively we measured the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FCFS), the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP). We determined the FTA as a sum of FC-FS, TP-TS and FC-TP. RESULTS - The FC-TP, the TP-TS and the FTA decreased significantly after CO according to data measured in the 10th postoperative week. We achieved the planned correction (FTA 171-169°) in 77% of cases. Undercorrection (FTA ≥172°) was detected in 7, overcorrection (FTA ≤168°) was noted in 5 cases. We detected significant loss of correction between the 10th postoperative week and the 12th postoperative month (the FTA increased significantly, the loss of correction was 1° in 26 cases, 2° in 7 cases). The valgus alignment did not increase in any case. The articular component did not change in 36 cases. We did not note significant loss of correction and the valus alignment did not increase in any case between the 12th postoperative month and 5th postoperative year. We noted the recurrence of varus deformity in 1 case. We detected loss of correction due to increasing articular component in further 4 cases. The FC-FS did not change during the first 5 postoperative years. CONCLUSION - If we achieved the planned correction (FTA 171-169°) according to data measured in the 10th postoperative week on a standing weight-bearing anterposterior radiographs, we did not detect recurrence of varus deformity in any case during the first 5 postoperative years. If the articular component (FC-TP) did not change between the 12th postoperativ month and the 5th postoperative year (in 61.5% of cases), in our opinion we achieved the optimal correction.]

Hungarian Radiology

[Functional disorders of the pharynx associated with gastroesophageal reflux disease]

SZÁNTÓ Dezső

[The reduced tone of the lower esophageal sphincter, hypomotility of esophagus and dilatory evacuation of stomach are causes of gastroesophageal reflux disease (GERD). Primary damages of esophageal motility lead to regurgitation of gastric content. The evolution of various disorders of esophagus, pharyngoesophageal junction and hypopharynx depend on regurgitant volume gastric and bile acids. The barium swallow well detects mucosal abnormalities and uncordinated contractions of pharyngeal constrictor and levator muscles moreover dyskinesia of upper and lower esophageal sphincters. According to the database of evidence-based medicine (Cochrane Library), sensitivity of barium pharyngo-esophagograms is in mild grade cases 72-74%, in moderate and in severe ones 88-93% and 100%, respectively. Till now laryngeal stasis, penetration and aspiration, dysmyotonia of lateral wall, cricopharyngeal bar, waterfall, vallecular balloon, besides double anterior wall signs of pharyngeal malfunctions were reviewed. We have to also consieder respiratory, cardiovascular and neurological manifestations.]

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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.

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[Assessing Quality of life of Women with Cervical Cancer After Treatment]

KOZMANN Krisztina, JÁNOSNÉ PÁNKI Roxána, FERENCZY Mónika, KOMLÓSI Kálmánné, KARÁCSONY Ilona

[To assess sexual function, functionality and quality of life in women with cervical cancer. Descriptive, cross-sectional, quantitative, non-random, purposive sampling of women (N=91) with FIGO stage I/II/III cervical cancer, more than 5 months after last treatment. The study used standard questionnaires with self-designed questions. Data were analysed using Microsoft Excel, descriptive and mathematical statistics (p<0.05). Completers who received radiotherapy scored significantly higher in functional status (p<0.05) and emotional function than those who did not receive radiotherapy (p<0.05). Completers with lower levels of emotional well-being were significantly more likely to have lower levels of sexual function and higher levels of gynaecological problems (p<0.05). Women affected by cervical cancer often experience somatic and psychological disturbances that reflect on quality of life associated with the disease and treatment.]

Clinical Neuroscience

Acute transverse myelitis after inactivated COVID-19 vaccine

ERDEM Şimşek Nazan, DEMIRCI Seden, ÖZEL Tuğba , MAMADOVA Khalida, KARAALI Kamil , ÇELIK Tuğba Havva , USLU Ilgen Ferda, ÖZKAYNAK Sibel Sehür

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

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.

Clinical Neuroscience

Long-term follow-up results of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastoma multiforme patients. The importance of MRI information in survival: Single-center experience

LUKÁCS Gábor, TÓTH Zoltán, SIPOS Dávid, CSIMA Melinda, HADJIEV Janaki, BAJZIK Gábor, CSELIK Zsolt, SEMJÉN Dávid, REPA Imre, KOVÁCS Árpád

Introduction - Glioblastoma multiforme (GBM) is the most common malignant primary anomaly of central nervous system. The GBM infiltrates the nearly sturctures from the initial tumor and its metastatic attribution is well known. The aim of our single-centered retrospective study was to introduce the importance of postoperative medical imaging confirmation of total tumor resection for patient with GBM combined concomitant and adjuvant chemoradiotherapy on a 10 year long patient follow up. Methods - From January 2006 to April 2015 we registered 59 patients with newly diagnosed GBM at the University of Kaposvár Health Center Institute of Diagnostic Imaging and Radiation Oncology. The histological diagnosis was confirmed by a proficient neuropathologist (World Health Organisation WHO; grade IV astrocytoma). According to histological status if the ECOG performance status of patients allowed it the mutidisciplinary oncoteam recommended adjuvant chemoradiotherapy all features strictly by Stupp protocol. (60 Gy dose on the gross tumor volume and 2-3 cm margin for the clinical target volume with parallel 75 mg/m2 TMZ. Four weeks after monotherapial phase patients had to recieve 6 cycles of TMZ first cycle with 150 mg/m2 up to 200 mg/m2). The irradiation was carried out by a conformal three dimensional planning system. Results - 59 patients with the median age of 63 (range 17-84) year. Our sample counted 34 male patients and 25 woman patients. 14 patients underwent gross total tumor resection while, 39 patients underwent partial resection and the rest from our sample 6 patients passed through biopsy. Statistical analysis showed a lengthier survival among males than females, with a median survival of 13 months for males and females, the OS of 26.209 for males, meanwhile 15.625 for females. However, the difference is not considerable (log-rank p=0.203). Our study found that the estimated survival of patients at least 50 years old is significantly shorter at a median survival of 12 months (log rank p=0.027) than that of patients below 50 years of age at a median survival of 23 months. The longest estimated median survival was calculated with patients of ECOG '0' condition (16 months). However, no significant difference was found in the estimated survival of patients of different ECOG conditions (log-rank p=0.146). Based on the extent of surgery, complete resection resulted in the longest average survival of 36.4 months, followed by 21.5 months among patients with biopsy, and 15.8 months among patients with partial resection. Different surgical procedures, however, did not result in significant differences in survival (log-rank p=0.059). The overal survival of patients who had complete resection confirmed by MRI compared with the overal survival of patients with residual tumor confirmed by MRI as well we can estimate that there is significant difference between these two groups (p=0,004). Conclusion - Despite complex and intense treatment, recurrence is inevitable and causes relatively rapid death. In our analysis complete resection, as defined from the neurosurgeon’s report and postoperative MRI, resulted in an independently significant improvement in OS. Our results are the evidences that the treatment of patients with glioblastoma multiforme in Hungary is at least on the same level as any other developed European countries.