Hungarian Radiology

[Thoughts on PET-CT]


OCTOBER 10, 2005

Hungarian Radiology - 2005;79(05)



Further articles in this publication

Hungarian Radiology

[Board Meeting of the Hungarian College of Radiology]

PALKÓ András, FORRAI Gábor

Hungarian Radiology



Hungarian Radiology

[The role of MRI in the clinical examination following breast cancer screening]


[INTRODUCTION - Breast cancer screening was performed in 27 325 female patients at the National Institute of Oncology from 1st of January 2002 to May 30th of 2005. Complementary examinations were necessary in 1876 women. MR-mammography was performed in 65 of these cases. We were curious about in which cases MR mammography helps to make the diagnosis more accurate, how does it influence the therapy. We also studied, whether the number of surgical interventions because of benign breast lesions decreases due to MR mammography. PATIENTS AND METHODS - In 65 patients MR mammography was performed using non-contrast axial and coronal T1W and STIR sequences. After the injection of gadolinium four series of 3D FLASH (fast low angle shot) dynamic gradiens echo sequences were also applied. Subtraction of the non-contrast and contrast enhanced series were evaluated in addition to the intensity curves of the postcontrast series. RESULTS - MR mammography helped to evaluate dense breasts in 21 cases, to identify multifocal lesions in 6 cases and to differentiate the malignant-benign processes. In the course of the 65 post-screening examinations, malignant processes [BI-RADS IV-V (Breast Imaging Reporting and Data System)] were diagnosed in 21 cases, benign processes (BI-RADS II-III) or negative results were found in 44 patients. CONCLUSION - MR mammography increased diagnostic accuracy, decreased the number of benign lesion-related surgical procedures and increased the accuracy in determining surgical radicality and establishing a therapeutic plan.]

Hungarian Radiology

[The force transmission of the distal endings of stent delivery systems]


[INTRODUCTION - In cases of endovascular treatment of internal carotid artery stenosis, one of the most important aspects is to minimise embolic complications. Dislodging emboli may be influenced by the shape and size of tapered endings of stent delivery systems. Our team performed measurements and calculations on the emergence of force of the various tapered endings. MATERIAL AND METHOD - Five different commercially available stent dilivery systems were investigated. The thickness of the devices were measured and taking 5 mm normal artery diameter, the lumen size was calculated, above which the delivery system should dilate the lumen mechanically. By means of geometrical computer-constructions and measurements, we analysed the forces directed ahead and laterally, emerging on the surface of tapered endings during the passing through the stenosis. RESULTS - The stent delivery systems were between 5.0 and 5.9 F in diameter, and even the stent delivery system of lowest profile would dilate a stenosis of over 89%. The different endings are tapered with variable lengths. The force transmission on the vessel wall of different directions was distinct at the various points of the cone surfaces. The forces directed ahead were less than those directed laterally on the larger part of a cone surface. Irregularity of the cone surfaces distributed the forces unfavorably. Considering the features of tapered endings, the atraumatic introduction of the devices required a range of upper limits of stenoses between 89.76-98.04%, which are more feasible values than those deternined by shaft sizes. CONCLUSIONS - Our experimental work suggests, that the shape and size of the endings of stent delivery systems influence the forces affecting vessel wall plaques, and in this manner, embolic complications, during carotid stenting. The lowest risk of embolisation could be induced by using the longest and smoothest tapered endings.]

Hungarian Radiology

[Acromesomelic dysplasia du Pan]

KAISSI Al Ali, GHACHEM Ben Maher, CHEHIDA Ben Farid, KOZLOWSKI Kazimierz

[INTRODUCTION - Cartilage derived morphogenic protein (CDMP1) mutations account for several related disorders, ranging from prenatal lethal to very mild entities such as brachydactyly C. Two similar severe manifestations of CDMP1 mutations are du Pan and Hunter-Thompson syndromes. CASE REPORTS - We report two second degree relatives with du Pan syndrome. Clinical history and full skeletal surveys were analysed and compared with the data from the literature. Frequent spontaneous abortions - probably manifestation of the lethal forms of CDMP1 mutations - were present in both families. Skeletal surveys of the patients showed similar acromesomelic abnormalities consistent with du Pan syndrome. CONCLUSION - The rare publications of du Pan syndrome present usually insufficient radiographic documentation. Better radiographic imaging is necessary to establish clear-cut criteria of differentiation between du Pan and Hunter-Thompson syndrome.]

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[Current questions of multiple sclerosis: the secunder progressive form of the disease]


[Recent data suggest that long-term worsening is common in relapsing-remitting multiple sclerosis patients and is largely independent of relapses or new lesion formation on brain MRI. The current definition of secunder progressive multiple sclerosis is worsening of disability independent of relapses over at least 6-month interval. Early focal inflammatory disease activity and spinal cord lesion are predictors of very-long term disease outcomes in relapse - onset multiple sclerosis. The potential of PET imaging to visualize hidden inflammation in MS brain in vivo is an important contribution for better understanding the progression of the disease. Therefore, PET imaging is a promising tool in detecting the conversion from relapsing remitting multiple sclerosis to secunder progressive form of multiple sclerosis. Furthermore, neuro-axonal damage is the pathological substrate of permanent disability in different neurological disorders including multiple sclerosis. The neurofilament proteins have promise in this context because their levels rise upon neuro-axonal damage not only in the cerebrospinal fluid but also in blood. Patients with increased serum levels of neurofilament at baseline, independent of other clinical and MRI variables, experience significantly more brain and spinal cord volume loss over 2 years and 5 years of follow-up. The kynurenine-pathway abnormalities may be associated with the swich from early-mild stage multiple sclerosis to debilitating progressive forms of the disease. Analysis of these metabolites in serum may have application as multiple sclerosis disease biomarkers. Free radical action has been suggested as a causal factor in the illness. Increased free radical production and consumption of the scavenger molecules were found during the active phase of the disease. Based on the clinical findings (EXPAND Study) and pathomechanism of the disease siponimod is approved by the US Food and Drug Administration for the treatment of relapsing remitting forms of multiple sclerosis, to include secunder progressive multiple sclerosis with active disease, relapsing-remitting multiple sclerosis and clinically isolated syndrome.]

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[Mentalizing deficit among patients with traumatic brain injury ]

TAMÁS Viktória, BÜKI András, HEROLD Róbert

[Mentalization or theory of mind as an aspect of our social cognition, is our ability to infer mental states of others (intentions, desires, thoughts, emotions) and to predict their behavior accordingly. This function significantly affects our participation and orientation in the social world and plays an important role in conversational situations, social interactions, social integ­ration and adaptation. The brain regions that serve as the basis for mind-reading function can be damaged as a consequence of traumatic brain injury, which frequently occurs among the younger population. Traumatic brain injury can cause focal or diffuse cerebral injuries, often leading to theory of mind deficit. In this topic such publications were researched that compared theory of mind ability between traumatic brain injury patients and control subjects (comparative case-control studies). We searched for the studies in the following internet based/online databases: PubMed, Web of Science, ScienceDirect, Google Scholar, APA PsycNET (PsycARTICLES) and EBSCO Host. The search was performed using the following key word combinations: theory of mind or mentalizing or social cognition AND traumatic brain injury or head/brain injury or diffuse axonal injury. Based on the results of the included and processed studies (21 pc), traumatic brain injury often leads to mentalization deficit with different severity. With this present review we aim to draw attention to the fact that the appearance and severity of mind reading dysfunction can considerably affect the outcome of the disease, the length of rehabilitation time and the prognosis of traumatic brain injury patients. Besides this, with this review, we aim to take sides in whether theory of mind ability is domain-specific or domian-general based on studies including traumatic brain injury patients.]

Clinical Neuroscience

[F-DOPA PET/MR based target definiton in the 3D based radiotherapy treatment of glioblastoma multiforme patients. First Hungarian experiences ]

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

[Introduction - Radiotherapy plays important role in the complex oncological treatment of glioblastoma multiforme (GBM). The modern 3D radiotherapy treatments are based on cross-sectional CT and MR information, however more attention is being paid to functional hybrid imaging describing the biological and functional morphology of tumor lesions. 18F-DOPA is an amino acid tracer with high specificity and sensitivity, which may play an important role in the precise definition of target volume in the irradiation process of GBM patients. Our study presents the first experiences with 18F-DOPA based PET/CT/MR 3D irradiation planning process. Methods - In Hungary the 18F-DOPA radiotracer has been available for clinical use since September 2017. Between September 2017 and January 2018, at the Somogy County Kaposi Mór Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center 3 histologically verified glioblastoma multiforme patients received 18F-DOPA based 3D irradiation treatment. In the contouring process the native planning CT scanes were fused with the PET/MR series (T1 contrast enhanced, T2 and 18F-DOPA sequences). We defined 18F-DOPA uptake volume (BTV-F-DOPA), the T1 contrast enhanced MRI volume (GTV-T1CE), and the volume of the area covered by oedema on the T2 weighted MRI scan (CTV-oedema) in all patients. We also registered the BTV-F-DOPA volumes not covered by the conventional MR based target volumes. Results - Examining the 3 cases, the average volume of 18F-DOPA tumor was 22.7 cm3 (range 15.3-30.9; SD = 7.82). The average GTV T1 CE was found to be 8.7 cm3 (range 3.8-13.2; SD = 4.70). The mean CTV oedema volume was 40.3 cm3 (range 27.7-57.7; SD = 15.36). A non-overlapping target volume difference (BTV-F-DOPA not covered by CTV oedema area) was 4.5 cm3 (range 1-10.3; SD = 5.05) for PTV definition. Conclusion - Based on our results the tumor area defined by the amino acid tracer is not fully identical with the MRI defined T2 oedema CTV. 18F-DOPA defined BTV can modify the definiton of the PTV, and the radiotherapy treatment. ]

Clinical Neuroscience

Mental health of physicians - nationwide representative study from Hungary


Background and aim - Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international researches. Our aim is to give an overviewing analysis of Hungarian physicians’ mental health state. Methods - Representative, cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n=4784). The control group was formed by the population group of a national survey conducted by “Hungarostudy 2013” (n=2000). Results - Suicidal thoughts (18.8% vs. 9.6%, p<0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p<0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p=0.053) and BDI depression scores (7.9% vs. 29.5%, p<0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (<35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians. Conclusions - Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the physicians’ mental health researches is to investigate the most decisive risk factors, and to work out the prevention tools.

Clinical Neuroscience

Four cases of GABAB receptor encephalitis

SZŐTS Mónika, MORTEN Blaabjerg, KONDZIELLA Daniel, DIÓSZEGHY Péter, BAJZIK Gábor, BERKI Tímea, KÁLMÁN Endre, NAGY Ferenc, ILLÉS Zsolt

GABAB receptor (gamma-aminobutyric acid type B receptors - GABABR) encephalitis is a rare manifestation of autoimmune encephalitides. We report four cases - including the first two Hungarian patients - with some peculiar features. One patient developed subacute disorientation and almost complete loss of short-term memory, but no epilepsy. Without immunotherapy, his memory spontaneously improved up to mild cognitive impairment in six weeks. GABABR antibodies persisted in his serum, and 18 months later, FDG-PET detected abnormal mediastinal lymph nodes and small cell lung cancer (SCLC). Another patient had persistently decreased sodium content in the peripheral blood. In those three patients who died, CSF was abnormal, but CSF was not pathological in the patient, who spontaneously improved. Brain MRI indicated signal intensity changes in the medial temporal areas in three cases. SCLC was found in three patients. Only the patient, who spontaneously improved, survived for more than 24 months. In summary, our cases show that (i) GABABR encephalitis may develop without epilepsy; (ii) the severe short-term memory loss can spontaneously improve; (iii) persistent hyponatremia can be present in the blood; (iv) the patient with benign course without epilepsy and CSF abnormality survived; (v) spontaneously remitting encephalitis can precede SCLC by 1.5 year, which emphasizes that repeated search for cancer is of paramount importance even in cases with spontaneous improvement.