Hungarian Radiology

[Role of the first ultrasound examination in the diagnosis of hilar cholangiocarcinoma]

LUKOVICH Péter, WINTERNITZ Tamás, KÁRTESZI Hedvig, ILLYÉS György, KUPCSULIK Péter

OCTOBER 20, 2003

Hungarian Radiology - 2003;77(05)

[INTRODUCTION - Hilar cholangiocarcinoma (Klatskin tumour) rarely causes obstructive jaundice, because rarely thought of that cause during medical examinations. Because the small size of the tumour in the biliary duct and the proximity of other components of the porta hepatis tumour cannot be detected by ultrasound, CT and MRI examinations in a significant part of the cases, which makes the diagnosis more difficult. PATIENTS, METHODS AND RESULTS - In the present study we have analysed the findings of the first abdominal ultrasound examination carried out on 38 patients who had undergone resection due to hilar cholangiocarcinoma during the period 1991-2002. The presence of the tumour could be proved only in 18.2% of the cases. The recognition of the secondary symptoms (dilated intrahepatic biliary ducts, choledochus of normal diameter) is also considered very low (68.2% and 50% respectively). From the viewpoint of the operability of the Klatskin tumour the relationship between the tumour and the blood vessels is important. Only one researcher has made declaration in this sense. The difficulty of detecting the tumour and the incorrect evaluation of the secondary signs led to the wrong ultrasound diagnosis in 82% of the cases, leading the examination astray. CONCLUSIONS - The correctly interpreted ultrasound examination accompanied by a Doppler study - even if it cannot document the tumour - provides evidence of a proximity biliary duct constriction and based on the secondary signs it defines the diagnosis of the Klatskin tumour. In order to judge operability MR-cholangiography is the next modality of choice. In lack of obvious sign of inoperability surgical exploration is justified. In case of an early diagnosis the 25-45% rate of 5-year survival, which is considered a very good result in gastrointestinal tumours, improves further.]

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[The possibilities of CT and MR imaging in hydrocarbon research]

BOGNER Péter, FÖLDES Tamás, ZÁVODA Ferenc, REPA Imre

[INTRODUCTION - Cross-sectional medical imaging techniques were applied on geological samples (cores) in order to reveal their morphological and functional properties. Our aim was to reveal those CT and MRI methods that are capable to characterize certain petrophysical parameters and can be correlated with core morphology. MATERIALS AND METHODS - Similarly to pre- and postcontrast scanning in human diagnostic imaging CT scans of core samples were obtained in dry and flooded state, that helped to define and calculate morphological and functional parameters. Several MRI sequences were also tested, mainly spin-echos with short echo time. RESULTS - Several hundred meters of core samples have been examined in the last three years. Effective porosity can be calculated from CT data, that characterizes oil/gas storage capacity of the given geological formation. CT information is superior to conventional petrophysical methods due to its spatial resolution. Nevertheless, we can not quantify permeabilty yet, but describe it qualitatively. We found only limited use of medical MR imaging methods. DISCUSSION - Cross-sectional imaging, primarily CT scanning was introduced to the Hungarian oil and gas industry in the last three years. It seems that the method will be used more and more frequently through the entire process of oil/gas exploitation. Our further goals include the implementation of the CT measurements in other areas like environment control, and further develope measurement conditions.]

Hungarian Radiology

[Ultrasound is not a stetoscope]

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[Introduction of the small size, portable ultrasound machines opened new opportunities in ultrasound imaging. The optimal application of these equipments and the new problems related to the use are widely discussed in the literature. This brief review summarizes the advantages, main indication and limitations of the method. The single most important aspect for the patient is that emergency ultrasound examination should be available regardless of the profession of the doctors. The most difficult question is how to provide and control an optimal education and training for the doctors. Possible solutions are also discussed. It is predictable that the availablity of the portable ultrasound studies will significantly increase the number of examinations, therefore economical consequences must also be considered. The author disagree with the conception, which states that ultrasound machine can be used as a stetoscop in the doctor's pocket.]

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