Hungarian Radiology

[The 2008 Lányi Márton award went to dr. Éva Szabó]

GÖBLYÖS Péter

APRIL 07, 2009

Hungarian Radiology - 2009;83(01)

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Hungarian Radiology

[With renewed outlook and new fortitude]

LOMBAY Béla

Hungarian Radiology

[Self-expanding metallic stents in intrahepatic biliary strictures after liver transplantation]

DOROS Attila, NÉMETH Andrea, HARTMANN Erika, DEÁK Pál Ákos, JUHAROSI Gyöngyi, LÉNÁRD Zsuzsa, KOZMA Veronika, GÖRÖG Dénes, GERLEI Zsuzsa, FEHÉRVÁRI Imre, NEMES Balázs, KÓBORI László

[INTRODUCTION - Bile duct complications remain a key problem of liver transplantation. Two main types are recognized: anastomotic and intrahepatic. In cases of anastomotic strictures good results can be achieved with surgery or minimally invasive therapy. Intrahepatic stenosis usually requires retransplantation. In this report the results of intrahepatic metallic stent placements are analyzed. PATIENTS AND METHODS - Since 1995, 20 patients with intrahepatic bile strictures were referred for percutaneous treatment. Of 34 percutaneous transhepatic cholangiography, 33 successful drainages were performed and 58 balloon dilatations were employed to overcome. In 13 patients, 20 metallic stents were implanted. One bleeding complication was successfully treated with selective embolization. RESULTS - The average follow up time was 35 months. 14 patients have no symptoms, 12 of them after metallic stent placements and 4 of them after retransplantation (2 patients had metallic stents at retransplantation). One patient has metallic stent and an external drain waiting for retransplantation. Three patients died after 7 retransplantations. Two patients died on the waiting list, one with and one without external drain. There were no deaths after successful metallic stent placement. CONCLUSION - After meticulous preparations metallic stent placement is safe and effective in intrahepatic biliary stenosis after liver transplantation. The patients can be stabilized till the retransplantation, or it can even be avoided.]

Hungarian Radiology

[Xanthogranulomatous cholecystitis]

BERÉNYI Zsolt, MORVAY Zita, PALKÓ András

[INTRODUCTION - The xanthogranulomatous cholecystitis is a rare and benign form of lesions associated with diffuse thickening of the gall bladder wall. It is important to recognize it radiologically because it can be mistaken easily for gall bladder carcinoma. The characteristic US, CT and MR findings, however, may be helpful in the differential diagnosis. CASE REPORT - We present the cases of two middleaged female patients suffering from right upper quadrant, radiating abdominal pain for several weeks without occurrence of fever. In both patients, the ultrasound examination revealed marked thickening of the gall bladder wall containing hypoechoic nodules. Further, non-specific sign such as cholecystolithiasis and fine infiltration of the adipose tissue surrounding the gall bladder and dilatation of extrahepatic or intrahepatic bile ducts were visible. On the post contrast CT images, rim enhancement was detectable. MR/MRCP examination showed a sharp delineation of the gall bladder from the liver parenchyma. Both patients underwent cholecystectomy. The pathological examination excluded malignancy and confirmed the diagnosis of xanthogranulomatous cholecystitis. CONCLUSION - The characteristic features of xanthogranulomatous cholecystitis (hypoechoic xanthogranulomas in the markedly thickened gall bladder wall and the presence of calculi) can be detected by ultrasound examination. CT or MRI may play an important role in confirmation of the diagnosis of an inflammatory process and provide useful information in exclusion of gall bladder carcinoma.]

Hungarian Radiology

[Transjugular intrahepatic portosystemic shunt implantation in a patient with severe dilatative cardiomyopathy]

SZALÁNCZY Katalin, LÁZÁR István, STEFÁN János, KALÓ Emil

[INTRODUCTION - Indications for TIPS (transjugular intrahepatic portosystemic shunt) are usually portal hypertension induced by alcoholic or viral cirrhosis. Reported patient underwent TIPS because of a rare indication where his rapidly progressing heart failure lead to rapid deterioration of the splanchnic hypertension. CASE REPORT - A 51 years old male was admitted with severe dilatative cardiomyopathy and atrial fibrillation, generalized edema refractory to conservative treatment, and rapidly worsening hepatic laboratory test results. TIPS implantation achieved improvement of all clinical signs, decreased edema and the patient could finally be discharged. CONCLUSION - TIPS can result in improved quality of life not only in primary hepatic cirrhosis but in other clinical circumstances with portal hypertension.]

Hungarian Radiology

[Difficulties in the diagnosis of ectopic ureter]

KONCZ Júlia, RÉTI Gyula, NYÁRI Edit, SHAIKH M. Shoaib

[INTRODUCTION - Ureter ectopy refers to the distal opening of the ureter at the site of the bladder neck or lower. 70-80% of the ectopic ureters are associated with pyelectasia and duplicated ureters. The incidence of this is 2-3 times higher in females. CASE REPORT - Following is a case report of a boy who was diagnosed with left-sided pyelectasia during a prenatal ultrasound scan. The postnatal ultrasound revealed a duplicated pelviceal cavity and ureter. The upper pole ureter and the pelvis demonstrated dilatation. At 8 months of age a left side heminehprectomy was performed. Two years postoperatively a follow-up ultrasound revealed a dilatation of the ureteral stump on the left side, which progressed. On MCUG the ureteral stump was identified inserting on to the proximal urethra. Cystography and MR urography demonstrated a ureteral stump which inserted on to the urethra. A repeat surgery was performed to remove the stump. Patient is symptom-free ever since. CONCLUSION - In ectopic, non-refluxing ureters long-term follow-up is necessary following heminephrectomy. A ureter stump besides the bladder can cause serious diagnostical difficulties. Also, it is possible that a dilating stump may lead to a reflux not identified earlier. MCUG and MR urography can help to clear delineate the pathology.]

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Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Novel structured MRI reporting system in neonatal hypoxic-ischemic encephalopathy - issues of development and first use experiences

LAKATOS Andrea, KOLOSSVÁRY Márton, SZABÓ Miklós, JERMENDY Ágnes, BAGYURA Zsolt, BARSI Péter, RUDAS Gábor, KOZÁK R. Lajos

Purpose - To develop an evidence-based, standardized structured reporting (SR) method for brain MRI examinations in neonatal hypoxic-ischemic encephalopathy (HIE) suitable both for clinical and research use. Materials and methods - SR template development was based on comprehensive review of the pertinent literature with the basic sections and subdivisions of the template defined according to MRI sequences (both conventional and diffusion-weighted, MR-spectroscopy (MRS), and T2*-weighted imaging), and the items targeted on age-related imaging patterns of HIE. In order to evaluate the usability of the proposed SR template we compared data obtained from the brain MR image analysis of 87 term and 19 preterm neonates with the literature. The enrolled 106 infants were born between 2013 and 2015, went through therapeutic hypothermia according to the TOBY criteria due to moderate to severe asphyxia and had at least one brain MRI examination within the first two weeks of life. Ethical approval was obtained for this retrospective study. Descriptive statistical analysis was also performed on data exported from the structured reporting system as feasibility test. Results - The mean gestational age of the study population was 38.3±2.2 weeks; brain MRI was performed on 5.8±2.9 day of life, hence in 78% of our patients after the conclusion of therapeutic hypothermia. Our main imaging findings were concordant to the pertinent literature. Moreover, we identified a characteristic temporal evolution of diffusion changes. Interestingly 18% (n=19/106) of the clinically asphyxiated infants had isolated axial-extraaxial haemorrhage without any imaging sign of HIE. Conclusion - In this article our approach of reporting HIE cases with our novel SR template is described. The SR template was found suitable for reporting HIE cases, moreover it uncovered time and location dependent evolution of diffusion abnormalities (and pseudonormalization, as well), suggesting its usefulness in clinical research applications. The high number of isolated intracranial haemorrhages, and the changing diffusion pattern emphasizes the importance of early imaging in HIE.

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[Clinical implication of arterial stiffness in the elderly]

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[Hypertension prevalence and cardiovascular risk gradually with age. However this aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome. Age and high blood pressure are the two main determinants of arterial stiffness which is the core of EVA: the impaired elasticity of the media layer of large elastic arteries (mainly the aorta), a process that can be measured by pulse wave velocity. In elderly hyperten­sives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. Arterial stiffness has predictive value for future CV e.g. events, coronary artery dis­ease, stroke, and vascular dementia and even all-cause mortality. The concepts of EVA (Early Vascular Aging) and SUPERNOVA (Super­normal Vascular Aging, the opposite phenotype of EVA) help to understand why early target-organ damages develop in some individuals and why others remain much more “younger” than their chronologic age. New drugs are being developed to treat EVA when lifestyle intervention and conven­tional risk factor controlling drugs are not enough.]

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A rare aetiology of stroke; myxomatous aneurysm caused by atrial myxoma

ACAR Erkan, OZDEMIR Zeynep, SELCUK Hakan Hatem, ÇOBAN Eda, SOYSAL Aysun

Atrial myxoma is a rare cause of stroke. In this report we present the case of a 52-year-old female patient who went to hospital suffering from a headache. Her neurological examination was normal except for a positive Babinski sign on the left. In the superolateral of the right, a Sylvian fissure consistent with a thrombosed aneurysm was detected using computerised tomography (CT). Diffusion MRI showed an acute infarction on the right MCA area. Transthorasic Echocardiography and ECG were normal. A -16×4 mm-sized fusiform perpendicular aneurysm on the M2 segment Sylvian curve of right MCA and a -6×4 mm-sized dissecting aneurysm on P3 segment of the left posterior cerebral artery (PCA) were observed in cerebral angiography. Transesophageal echocardiography (TEE) demonsrated a large mass with a suspected size of 2×2×1.5 cm on the left atrium. The mass was resected and on the eighth day after the operation, she had a temporary vision loss and hyperintensity on the T1 sequence was interpreted as laminary necrosis suspected on Cranial MRI. In follow up, she was stable with 300mg acetylsalicylic acid treatment. The main treatment is surgical resection in stroke caused by atrial myxoma.

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[Vast number of COVID-19 patient expected in the near future – Interview with Éva Rákóczi head of the infectious diseases and rheumatology post-COVID outpatient clinic of Debrecen University’s Clinical Centre]

KATONA Ferenc