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Lege Artis Medicinae

FEBRUARY 14, 2014

[Treatment of hungarian chronic hepatitis C genotype 1 patients with severe fibrosis or compensated cirrhosis in the international telaprevir Early Access Program: Interim analysis of the week 16 results]

TORNAI István, BÁNYAI Tivadar, GERVAIN Judit, HORVÁTH Gábor, MAKARA Mihály, MARTYIN Tibor, NEMES Zsuzsanna, PÁR Alajos, PÁR Gabriella, PÉTERFI Zoltán, SZALAY Ferenc, SZINKU Zsolt, TÓTH Tamás, VINCZE Áron, ISABELLE Lonj

[The approval of the first two direct acting antiviral agents, boceprevir and telaprevir, has been a major step forward in the treatment of chronic hepatitis C. Both protease inhibitors must be added to the dual peginterferon and ribavirin combination therapy. The triple combination therapy resulted in significantly higher rates of recovery both in naive patients and in those previously unresponsive to therapy. Following the approval of telaprevir, an Early Access Program has been initiated in 16 countries. In Hungary 132 patients were enrolled into this program. In the first interim analysis, data from the first 16 weeks of treatment of 92 patients are included. Liver cirrhosis (F4) was detected in 70% of the patients and severe fibrosis (F3) was found in the other 30%, on the basis of either liver biopsy or transient elastography. During their previous antiviral treatment, 64% of the patients were non-responders (partial and nullresponders), 26% were relapsers, and only 10% were treatment naives. The efficacy of the triple combination was excellent, as 82% of the patients had undetectable HCV RNA at week 12. Further - more, 48% had negative HCV RNA at week 4 as well as at week 12. Cessation of i.e. negative HCV RNA at week 4 through week 12. Only 5.4% of the patients had virologic failure and needed to stop therapy prematurely. The most frequent adverse event was anemia, hemoglobin level decreased below 100 g/l in 40% of the patients. In the majority of these patients ribavirin dose reduction was sufficient to treat anemia, only 16% needed blood transfusion. The rate of severe rash was 6%. Although this group of patients represents a difficult-to-treat population, both efficacy and safety data are similar to published data in international clinical trials. A very effective, triple combination therapy with telaprevir, peginterferon and ribavirin can be provided for patients with advanced liver disease, to reduce the risk of liver failure and hepatocellular carcinoma.]

Hungarian Radiology

DECEMBER 21, 2009

[Cervical space occupying lesions: diagnosis at sonoelastography]


[Among cervical (neck) region tumours, the thyroid lesions and the metastatic lymph nodes are the most detectable with conventional B-mode ultrasonography (US). The use of MRI and CT scans are limited because of the cost, and in case of CT, the radiation. With the introduction and constant development of sonoelastography, we have in our hands a new imaging procedure which is cheap, fast and harmless, yet giving more information to the examiner than conventional US. The elastographic examination of thyroid lesions is a more explored area than the elastographic visualisation of cervical lymph nodes. The ‘off-line’ elastography showed the highest accuracy allowing to calculate and analyse the strain index of cervical lymph nodes - strain index > 1.5 (85% sensitivity, 98% specificity) - but the ‘off-line’ processing of US elastograms is still too time consuming to be used in busy clinical settings. During the examinations of the thyroid gland both real-time and off-line processed strain imaging were used. An Italian team made a great leap forward as they standardized the degree of distorsion under the application of the external force. Then using the Ueno and Itoh elasticity score they achieved remarkable accuracy with real-time sonoelastography (P <0.0001). On the other hand only those organs are suitable for the US elastography characterization which can be slightly compressed, consequently the examination of a lesion with calcified shell cannot give useful information. Near to the pulsating arteries substantial amounts of decorrelation noise may appear and the examiner has to pay attention what structures are in the ROI box since the sonoelastography method assumes computations relative to the average strain inside the box. To detect a follicular carcinoma in the thyroid gland remains a big challenge. Despite of the limitations most researchers agree on the fact that sonoelastography is a perfect tool to use in addition to the conventional US examination. B-mode US combined with sonoelastography raised the accuracy in differentiation in all cases. With this modality it is also possible to deduce the number of cases when healthy lymph nodes or tissue peaces are taken for biopsy during FNAB.]

Hungarian Radiology

MARCH 22, 2008

[Initial experiencies with sonoelastography in the examinations of breast diseases]


[INTRODUCTION - Recently the ultrasound examination of the strain of circumscribed breast diseases has been introduced in the non-invasive breast examination, called sonoelastography. In Hungary, the authors had the first possibility to start with this method. They report on their initial experiences. MATERIAL AND METHODS - 61 circumscribed breast lesions in 41 patients sonoelastographic examinations were performed by Hitachi EUB 6500 system using a EZUTE3 real-time elastography unit. 48 lesions strain-ratio was calculated. 22 masses were verified pathologically (18 benign and 4 malignant) and 39 were considered benign upon the findings of clinical mammography and by follow up. They classified them on the basis of patterns published by Itoh, et al. The examinations were done by three experienced radiologists. The classification was done by consensus. RESULT - The all lesions which were verified pathologically or on the basis of examinations or follow ups were thought benign showed the pattern type from 1 to 3. Most of the cystic lesions showed the streaky cystic pattern. There were small number of malignant lesions in their material, and all of them gave the elastic pattern of 4 and 5. The numbers of strain-ratio of zone lesions with pattern 3 overlapping with the lesions of malignant ones. CONCLUSION - The first results showed that both the coloured elastographic pattern and the quantitative strainratio could be used well in the non-invasive diagnostic procedure of breast lesions. It could increase the diagnostic safety. Larger number of examinations are necessitated to find the exact diagnostic role of this method.]

Hungarian Radiology

MAY 15, 2010

[Breast malignancies: review of the year 2008/2009 radiological diagnostics and therapy news - Onco Update, 2010]


[Systematic review of the recent articles of the years 2008/2009 about breast tumours’ radiological diagnostics and guided therapy, the actual place of the imaging and interventional methods are presented.]

Hungarian Radiology

OCTOBER 15, 2010

[Differential diagnosis of malignant cervical lymph nodes with real-time ultrasonographic elastography and Doppler ultrasonography]

ARDA Kemal, CILEDAG Nazan, GUMUSDAG Demir Pelin

[PURPOSE - Real-time ultrasonographic elastography is a new imaging technique which is used in characterizing the difference in hardness between pathologic and normal tissue. The purpose of our study was to evaluate the diagnostic performance of real-time ultrasonographic elastography and Doppler ultrasonography (DUS) individually and combined in differentiation of benign and malignant cervical lymph nodes (LN). PATIENTS AND METHODS - Fifty-one patients (12 men, 39 women) referred for fine-needle aspiration or surgical biopsies of suspected cervical lymph nodes were examined with gray scale ultrasonography, power DUS, and realtime ultrasonographic elastography. During DUS examination vascularity and resistance index (RI) values were evaluated. A five-group elastographic colour code pattern was used to evaluate the ultrasonographic elastograms for LN (pattern 1, an absent or a very small hard area; pattern 2, hard area <45%; pattern 3, hard area ≥45%; pattern 4, peripheral hard and central soft areas; pattern 5, hard area occupying entire solid component with or without soft rim). In addition, strains of LN and surrounding muscles were measured on elastograms, and the muscle-to-LN ratio (strain index) was calculated. Real-time ultrasonographic elastography and DUS results were compared with the final diagnosis obtained by fine-needle aspiration cytology analysis and/or by surgical pathology. The diagnostic potential of the examined criteria for malignancy was evaluated with univariate analysis and multivariate generalized estimating equation regression p≤0.05 indicated statistical significance. RESULTS - A strain index higher than 2.45 and colour pattern 4-5 had high utility in malignant LN classification with 93.8% sensitivity, 89.5% specificity (p<0.001). The results were significantly better than those obtained by using DUS characterization - that is, RI greater than 0.57 - which had 78.9% sensitivity (p<0.001). CONCLUSION - Real-time ultrasonographic elastography had 93.8% sensitivity and 89.5% specificity in the differentiation of benign and malignant cervical LN in patients referred for fine-needle aspiration or surgical biopsies with suspicion of malignancy. Real-time ultrasonographic elastography and DUS in addition to gray scale ultrasonography may improve the differential diagnosis of LN.]