Hungarian Radiology

[Thoughts on PET-CT]

GALUSKA László

OCTOBER 10, 2005

Hungarian Radiology - 2005;79(05)

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Hungarian Radiology

[Networks]

LOMBAY Béla

Hungarian Radiology

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

SZABÓ Éva, BIDLEK Mária, GŐDÉNY Mária

[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]

SZIKRA Péter, VÖRÖS Erika, SZTRIHA László, SZÓLICS Alex, CSIKÁSZ Tamás

[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.]

Hungarian Radiology

[Quality cost in radiology: the cost of repeated examinations]

KIS Zsuzsanna

[INTRODUCTION - The aim of the author is to describe the definition and types of quality cost in the health care services especially in the field of radiology. The proportion of the quality cost is based on the author's data and data from the literature. The ways of reduction of the quality cost is also discussed. MATERIAL AND METHODS - The author made a research based on a prior multicentric study to determine the loss derived from the excessive use of films used during the repeated radiological examination. The cost of wrong services nationwide is calculated on the basis of the loss per 1000 German point. RESULTS - Our short research showed that 300 000 Ft HUF + VAT per year was paid because of the excessive use of the films during the repeated examination points within the given period of time. The loss percentage per 1000 German points can be calculated based on the points generated during a given time. In this way there was more than 300 million HUF spent on defective services nationwide in 2002. CONCLUSION - The cost of defective services and resulting moral and financial losses justify the need for finding and reducing the costs. Quality control and quality improvement can be used to achieve the aims of controlling the processes by the right indicators. By discussing them the processes will improve, the costs will be lower and quality also improves. The patients and insurance companies who buy our services also have the same expectations.]

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[Radiological response evaluation of targeted therapy]

KALINA Ildikó, OSZLÁNSZKY György

[The objective assessment of the changes in the tumor burden along with cancer therapy has essential importance. Recently, the quantitative evaluation of the radiological tumor response was undergone several changes. For conventional chemotherapy of solid tumors the standard procedure has been RECIST since 2000. The targeted therapies trigger other pathophysiological changes in the cells than the cytotoxic agents, accordingly the morphological changes show a new picture. Therefore the targeted therapies require a new evaluation system, that takes into consideration not only the tumor size, but other changes as well, the changes of attenuation that corresponds with the proportion of the viable cells. In case of the targeted therapies in substantial clinical was experienced even without signifi cant morphological changes in the tumour size. As a consequence, the traditional, size-based criteria system can underestimate the effi ciency of the new types of treatments. To eliminate this problem new evaluation systems were created taking the tumortypes and treatment protocolls into consideration. The estimation of the early tumor response to targeted therapy also has high importance. In assessment of the response functional imaging methods are used more frequently. The role of PET has already been defi ned in numerous tumortypes, however the determination of the position of some promising functional examinations still require further studies.]

Hungarian Radiology

[Az emlődaganatok radiológiai vizsgálatának újdonságai Onco Update, 2007]

FORRAI Gábor, BODOKY György

[Experiences about the breast diagnostic methods are accumulating year-to-year, rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering into the daily practice. Some of them became obsolete, so far their application is becoming a faulty decision. Some other methods become obligatory steps in the diagnostics. These are the reasons why the up-to-date knowledge of the literature is mandatory. Systematic review of the most recent articles of the last two years (January 2005-December 2006) of breast radiological diagnostics and the actual place of the imaging and interventional methods are presented. The following topics are summarized: breast cancer screening with conventional and digital mammography, computer assisted diagnostics (CAD), high risk patients' screening, US, MRI, MSCT, PET/CT, diagnostic interventions, differential diagnostics, percutaneous tumour ablation, therapy-related questions in the diagnostic work up.]

Lege Artis Medicinae

[ANALYIS OF MOTIVATIONS OF SMOKING CESSATION]

SUSÁNSZKY Éva, SZÁNTÓ Zsuzsa, KOPP Mária

[INTRODUCTION - The aim of the study was to explore the differences in motivations between successful quitters and smokers who just consider quitting. Self-reported motivations of exsmokers' smoking cessation and the reasoning of current smokers who consider quitting were analyzed. SUBJECTS AND METHODS - The study is based on Hungarostudy Health Panel conducted in 2005, which is the second wave of Hungarostudy 2002, a national representative health survey of the adult Hungarian population. Of the subjects involved in this follow-up study, data from 3701 persons could be analyzed. RESULTS - About half of the respondents had never smoked, one fifth of them had quitted and 28 percent smoked. More than half of the current smokers (52%) contemplated on giving up smoking. Among ex-smokers and contemplating current smokers alike (38-40%), disease prevention was mentioned as the single most important reason of cessation. Financial reasons were mostly mentioned by current smokers; ex-smokers were more likely to explain their decision with deteriorating health, the occurrence of certain diseases. Among these, cardio-vascular morbidity played the most important role in smoking cessation while cancers, respiratory disease and diabetes also significantly increased the odds of quitting. Social pressure was a reason for quitting mostly among women and elderly persons. Among current smokers, those living in partner relationship and the better-off tended to entertain thoughts of quitting because of social pressure. CONCLUSION - The results confirm the importance of cardiovascular diseases in smoking cessation: although people emphasize primary preventive purposes of their cessation efforts, in fact secondary prevention, i.e., existing circulatory and heart problems play the major role both in actual cessation and in quitting considerations.]

Clinical Oncology

[Novelties in the management of Hodgkin lymphoma]

ILLÉS Árpád, MOLNÁR Zsuzsa, MILTÉNYI Zsófia

[Hodgkin lymphoma is a lymphoproliferativ disease, it is about 12-18% of all lymphomas. It has typical morphologic, clinical and therapeutic features, which can distinguish from other lymphoma types. Due to risk- and PET/CT adapted treatment Hodgkin lymphoma is a curable lymphoma with an 80-90% long-term survival, however, refracter- and relapsed patients’ therapy is a great challange. Cure rate can increase due to the development of the diagnostic and treatment modalities, but the use of standard recommendation is necessary. The aim of this review is to show new WHO 2016 lymphoma classifi cation, role of the new diagnostic options, especially 18FDG-PET/CT, Lugano classifi cation and fi rst-line and salvage therapeutic possibilities and to introduce the immunotherapy, like brentuximab vedotin and PD1 inhibitors. Certain points of hemopoietic stem cell transplantation will be also covered.]

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[Pregnancy and cancer]

NAGY Zsuzsanna, SZILLER István, VALTINYI Dorottya, HORVÁTH Orsolya

[The joint appearance of pregnancy and cancer is rare. It is highly recommended that the tumorous pregnant should be managed by a multidisciplinary team. The early diagnosis is very important, but it is not easy, because the symptoms of pregnancy and cancer are rather similar. Imaging diagnosis has to avoid ionizing radiation (e.g. PET/CT). The same is true for chemotherapy in the fi rst trimester, due to the increased risk of developmental abnormalities. Consequently, radiation therapy is not allowded throughout the pregnancy, and the chemotherapy in the fi rst trimester is a strong indication for the interruption of pregnancy. Surgery, with good practice, usually can be performed without complications. Chemotherapy, given in the second and third trimester generally follows the standard protocols with a low frequency of developmental errors. Early delivery should not be encouraged, except the delay has a hazardous effect on the mother and/or on the child. The pregnant should be informed about all steps to be an active part of the fi nal decision.]