Hungarian Radiology

[XII. Congress of the Hungarian Radiographers]

TIHANYI Gyöngyi, VANDULEK Csaba

OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)

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Hungarian Radiology

[MRI-guided prostate brachytherapy: First Hungarian experiences based on a canine study]

LAKOSI Ferenc, ANTAL Gergely, VANDULEK Csaba, KOTEK Gyula, KOVÁCS Árpád, GARAMVÖLGYI Rita, PETNEHÁZY Örs, HADJIEV Janaki, BAJZIK Gábor, BOGNER Péter, REPA Imre

[INTRODUCTION - Modern radical radiotherapy can be an effective alternative of radical prostatectomy in low risk patients with prostate tumor. Our objective was to demonstrate the feasibility of transperineal MR-guided prostate interventions in an open MR unit and to present our early clinical experiences on canines. METHODS AND MATERIALS - The procedures were performed on 5 canines in an open-configuration 0.35T MR scanner. For interventions an MR compatible custom-made device was used. The canines were placed in the right lateral decubitus position. Template reconstruction, trajectory planning, target and OAR delineation were based on T2 FSE images. For image guidance and target confirmation, fast spoiled gradient-echo (FSPGR) sequence was used. MR compatible coaxial needles were inserted through the perineum to the base of the prostate. After satisfactory position was confirmed, brachytherapy catheters were placed through the coaxial needles, which were then removed. RESULTS - Mean and standard deviation of the needle displacements was 2.2 mm±1.2 mm, with a median of 2 mm. 96% of the errors were less than 4.0 mm. Implantation induced prostate motion was measured with a mean of 10.3 and 2.3 mm in cranio-caudal and transverse directions. Significant movement was only observed during the first 4 needle insertions. The average time needed for each step was: anesthesia 15 minutes, setup and positioning 15 minutes, initial imaging 15 minutes, template registration and projection 15 minutes, contouring, trajectory planning, insertion of 10 needles 60 minutes. CONCLUSION - Based on our canine model experiences our method seems to be a promising approach for performing feasible, accurate, reliable and high-quality prostate MR guidance within a reasonable time span. We plan to introduce MR-guided biopsy and brachytherapy in human patients in the near future.]

Hungarian Radiology

[Computed tomography brain perfusion in the management of acute stroke]

BAGI Róbert, SZABÓ Tünde, MONOKI Erzsébet

[INTRODUCTION - The multidetector CT-technology made the application of perfusion CT-examination in the diagnosis of vascular brain damages possible in recently. The purpose of this study was to introduce the method and to assess the importance of computed tomography brain perfusion in emergency patient care and early diagnosis of brain ischemia. PATIENTS AND METHODS - We perform brain perfusion examinations with a 2 slice multidetector computer tomography (General Electric Highspeed NX/i, 2004) in our hospital. We examined the results of native and perfusion CT of 27 patients who underwent CT brain perfusion examination during emergency patient care in our department between 2004 January and 2006 December. We also examined if the patients got systemic thrombolysation and the patients’ condition after therapy. RESULTS - The perfusion software can make quantitative colour maps of parameters (CBF, CBV, MTT) and can visualize mean value and percentil decrease of measuring parameters. There were 18 positive and 8 negative CTbrain perfusion examinations in the examined period. One examination was technically unvaluable. CONCLUSION - By measuring blood flow's decrease the CT-brain perfusion examination can separate the reversible and irreversible damage of brain parenchyma. The examination protocol of brain vascular damages are native CT-scan, postcontrast perfusion CT-examination and CTangiography by the recommendation of international literature. Despite the multidetector CT-s and CT-perfusion technic is available for years, the CT-brain perfusion examination is not a routine process in the emergency patient care in our country.]

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[Technical aspects of MR urography based on two cases]

HORVÁTH László, BOGNER Péter, NAGY Gyöngyi, BAJZIK Gábor, VANDULEK Csaba, REPA Imre

[Intravenous urography has been the gold standard in diagnostic radiology studying the urogeintal system. However, ultrasound and other cross-sectional imaging methods have brought major change in this area. Beside modern (multislice) CT examinations the methods of MR urography are more frequently applied making possible both static and dynamic examinations beyond the wellknown advantages of MR imaging. The authors describe two complemetary methods of MR urography which provide a complete evaluation of the urinary system. The first method is aimed to image stationary fluid by using heavily T2 weighted turbo spin echo pulse sequences. This measurement well depicts the dilations of the excretory system even with little or no excretion of urine. The second method is analogous with the traditional IVU, as the excretion of a less nephrotoxic gadolinium based contrast medium followed by a T1 weighted gradient echo pulse sequence (possibly dynamic) helps to visualise the renal cavities and the urinary pathways. Normal renal function is a prerequisite when using this technique in order to visualise normal and obstructed urinary pathway disorders. The use of MR urography together with traditional MR methods may significantly reduce the number of invasive examinations and methods based on X-ray radiation exposure. MR urography may be exceptionally important in the uroradiological study of distensions of renal cavities in pediatric cases, pregnant women and renal transplant patients or in case of contrast material allergy.]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

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