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Hungarian Radiology

FEBRUARY 20, 2004

[Theoretical basis of tumor staging The significance of imaging in oncological diseases]

GŐDÉNY Mária

[The general goal for staging patients with any cancer is to determine the overal extent of disease prior to choice of therapy. It has been well documented that biological behavior of any cancer and, therefore, the prognosis of the patient is strongly linked to the extent of the tumor, the presence or absence of lymphatic dissemination as well as systemic metastases. The staging systems have undergone a number of modifications. Classifications of TNM system identifies the depth of tumor invasion (T), the status of regional lymph nodes (N) and the distant metastases. These three parameters are then incorporated into the final clinical stage. There are further modifications which influence the patient survival, e.g. biological, genetical, hystological factors, tumor grade. All cancer cells show dysregulation of cell cycle controll. As the cancer proliferates and the tumor reaches approximately 1-2 mm in diameter further growth recquires the development of new blood vessels (neo-angiogenesis). Intensity of tumor growth has a prognostic influence to the patient's life and depends on the tumor doubling time, which classifies tumors into slow, intermadiate and rapid growing types. The diagnostic impact of imaging is based on the ability of a technique to detect and evaluate the cancer accurately. The very high accuracy and reproducibility of cross-sectional imaging, paticularly computed tomography (CT) and magnetic resonance imaging (MRI) make these methods extremely important in the detection, staging and in the evaluation of the tumors. The revolutionary advances in detection and treatment of malignant disease have led to an increasing role of the radiologist as a member of the multidisciplinary cancer team.]

Clinical Neuroscience

NOVEMBER 30, 2006

[BIOMECHANICS OF INTRACRANIAL ANEURYSMS]

FARKAS István, NYÁRY István, RAFFAI Gábor, ZILAHY G, MONOS Emil

[Introduction - Viscoelastic parameters of circumferential and meridional strips of ruptured and silent aneurysms were investigated (considered clinical and histological data either) in order to advance the prediction of risk of aneurysm rupture. Method - In our clinical practice, aneurysms managed by microsurgery aneurysm clipping were removed. Meridional and circumferential strips were cut. Strips were investigated by an uniaxial biomechanical instrument: distending force was recorded as the length of the strips was increased in steps. Normal stress-relaxation patterns were detected. The shape of strain curves well overlapped with the Standard Linear Solid Model curve, as had been expected. The viscosity, serial and parallel elastic moduli of the model were then computed. Results - Linear correlation was demonstrated amongst peek distending force detected and aneurysm strip thickness. Steric inhomogenity was detected at the meridional and circumferential strips. Strain-stress behaviour of ruptured and silent aneurysm specimen showed significant difference. Values of strips originated from patients suffered from hypertension as well as strips originated from aneurysms had been histologically found inflamed were higher. Discussion - Results of these observations are going to be used to set three dimensional computer model in cooperation with IT team of Budapest University of Technology and Economics to advance rupture risk prediction.]

Clinical Neuroscience

SEPTEMBER 30, 2010

[Devic syndrome - case report, diagnostic and therapeutic principles]

ILJICSOV Anna, BARSI Péter, VÁRALLYAY György, TÁTRAI Erika, SOMFAI Gábor Márk, BERECZKI Dániel, RUDAS Gábor, SIMÓ Magdolna

[Neuromyelitis optica (NMO, Devic-syndrome) is a rare, relapsing autoimmun disease of the central nervous system, which is distinguished from other demyelinating disorders by a recently identified, specific autoantibody. By demonstrating the anti-aquaporin-4 IgG in the serum, a heterogenous group of syndromes can be defined, called NMO-spectrum. In the future, optical coherence tomography may support this diagnosis besides the clinical features, imaging examinations and presence of serum antibody. Early recognition and treatment can improve clinical outcome even in serious condition. Long-term immunosuppressive therapy is advised to prevent further relapses and to stabilize or improve clinical status. Hereby, we report a case of a 51-year-old woman, under treatment for 1.5 years. We summarize the up-to-date knowledge about the pathomechanism, diagnostic strategy and therapy of neuromyelitis optica. We review recent findings and the diagnostic value of a new, non-invasive ophtalmological examination, the optical coherence tomography. According to the first results, this method may be helpful in the early differential diagnosis of optic neuritis.]

Hungarian Radiology

APRIL 10, 2005

[Radiological diagnostics of the pancreas neoplasms - Onco Update 2005]

FORRAI Gábor, BODOKY György

[Authors reviewed the recent results of pancreas tumour radiological diagnostics and the place of the imaging and interventional methods. Systematical review of the most recent articles were summarized (July 2003-December 2004) in the following subjects: the etiology and clinico-pathology, general diagnostic and therapeutical questions of early pancreatic neoplasms, abdominal ultrasound, computed tomography, multidetector computed tomography, magnetic resonance imaging, MR-cholangiopancreatography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, intraductal ultrasound, endoscopic ultrasound-guided cytology, percutaneous biopsy, positron emission tomography, positron emission tomography - computed tomography, special pancreatic tumours. Experiences about the pancreas diagnostic methods are accumulating year-to-year rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering in the daily practice. These are the reasons why the up-to-date knowledge of the literature is mandatory.]

Clinical Neuroscience

JUNE 02, 2009

[99-mTc-HMPAO single photon emission computed tomography examinations in genetically determined neurometabolic disorders]

ARANKA László, AMBRUS Edit, VÖRÖS Erika, SVEKUS András, KÓBOR Jenõ, BEREG Edit, PALATKA János, PÁVICS László

[The aim of our study was to determine regional cerebral blood flow (rCBF) abnormalities in different types of enzymopathies. Patients and methods - Among the patients with genetically determined enzymopathies 3 patients had aminoacidopathies, and 11 had different types of encephalopathies, from which 10 had mitochondrial encephalomyopathy (MEMP), and 1 patient had hyperuricaemic encephalopathy. Besides the mentioned 14 patients, 1 had ceroid lipofuscinosis and another patient had tuberous sclerosis. The further distribution of the MEMP patients’ group was the following - 5 patients had MEMP with lactic acidosis, 5 had Leigh’s disease (subacute necrotizing encephalopathy), from which 1 had cytochrome-c-oxidase deficiency (COX). Additionally in all patients were performed cerebral MRI and SPECT examination 10 min. after intravenous administration of 20 Mbq/kg 99 mTc-HMPAO. Results - Fourteen out of 16 SPECT findings were pathologic, showing decreased focal frontal/temporal/temporoparietal cerebral blood perfusion. Aminoacidopathic group - all the 3 patients revealed pathologic signs from the aminoacidopathic patients’ group. Among them the ornithine transcarbamylase (OTC) heterozygous female patient with left-sided hemiparesis caused by hyperammonemic stroke at 10 month-age, showed right sided temporoparietal, occipital and left frontal hypoperfusion, nearly 6 years after the cerebral vascular attack. This finding might be resulted because of diaschisis. Mitochondrial encephalo-myopathic (MEMP) group - all the four patients with MEMP and lactic acidosis showed focal hypoperfusion in the temporal region, while the perfusion was normal in the COX deficient patient and in 2 Leigh’s disease (subacute necrotizing encephalopathy) patients. In the remaining 1 Leigh’s patient frontotemporal hypoperfusion was found. In all patients there were non specific structural abnormalities detected by MRI - cortical and subcortical atrophy, and scattered demyelination foci. In the case of ceroid lipofuscinosis the MRI showed cerebral atrophy and cerebellar hypoplasia, and the SPECT showed right frontal and occipital hypoperfusion, bilateral parietal physiological riping process. The patient with tuberous sclerosis showed bilateral temporo-occipital hypoperfusion. Conclusion - 1. SPECT images demonstrated hypoperfusion rCBF changes in 14 out of all 16 patients. 2. Regional cerebral/cerebellar hypoperfusion was detected by SPECT in mitochondrial encephalomyopathies, with lactate acidosis and aminoacidopathies giving high informative value about the cerebral perfusion.]

Hungarian Radiology

JUNE 20, 2006

[Radiological diagnosis of lung cancer - 2005 Literature review Onco Update 2005]

BALÁZS György

[Our aim is to review the radiologic literature of lung cancer of 2004 and some remarkable publications from 2003. There are three main groups in the recent publications dealing with lung cancer’s radiology. The first group comprises those reviews and metaanalyses which focus on the overall utility and reliability of routinely applied modalities such as CT and MRI. In the second group we find original articles reporting on the experience with new modalities. This group is dominated by publications dealing with positron emission tomography and the first clinical results of combined PET-CT technology. In the third part we review those articles dealing with lung cancer screening. Radiological lung cancer screening is in the focus of interest again, mainly due to the introduction of low-dose CT which is undoubtadly the most sensitive radiological modality for the early detection of lesions, however, its clinical utility is debated. The papers referred are basically sceptic, but this is not the end, because controlled long term follow-up studies are still in progress. Part of the publications report on the first clinical results of new methods, while others give valuable additional data regarding the performance of “well established” radiological modalities.]

Hungarian Radiology

DECEMBER 20, 2007

[Sarcoidosis involving liver and spleen, and with hypercalcemia]

TÓTH Mónika, WENINGER Csaba, MORÓ Zsuzsanna, SZOMOR Árpád

[INTRODUCTION - Sarcoidosis is a relatively common multisystemic disorder. Chest involvement is most frequent, but any organ can be involved. In case of abdominal lesions the suspicion of sarcoidosis rarely arises. CASE REPORT - A 53-year old female patient with a history of crural pain unresponsive to medications and weight loss of unknown origin was sent to the internist. Hypercalcemia and bone pain suggested multiple myeloma, however, this diagnosis could not be confirmed. Chest X-ray examination was negative. Splenomegaly and multiple hypodens splenic and hepatic lesions were detected by ultrasound and abdominal computed tomography. Finally, ultrasound guided biopsy of the liver proved stage II sarcoidosis. Steroid therapy was initiated and the splenic and hepatic lesions seen with ultrasound and CT scan disappeared. CONCLUSION - Sarcoidosis is usually suspected following chest X-ray or during chest CT examination. Nevertheless, our case demonstrates that multiple lesions in the spleen or liver may indicate sarcoidosis even in the absence of thoracic lesions. Biopsy taken from the lesions can lead to adequate diagnosis.]

Hungarian Radiology

SEPTEMBER 20, 2008

[Use of plain and intravenous contrast material multidetector CT examinations in acute abdomen]

TÓTH László, TÓTH Géza, TURUPOLI Emőke, LOMBAY Béla, PAVLIKOVICS Gábor

[Through most of Europe, multidetector computed tomography is used as the first-line modalitiy for examining the acute abdomen. Acute abdominal pain, symptoms referring to abnormal bowel movements, gastrointestinal bleeding, worsening general state, and other typical clinical signs require quick and precise diagnosis since these conditions are frequently life-threatening. The sensitivity and specificity of CT examinations have significantly improved due to the development of the machinary. Thus, the scope of indications are also expanding. Almost all acute abdominal disorders, that may lead to an acute surgical procedure, can be diagnosed with the help of multidetector CT. Unnecessary surgical procedures, the risk to the patients and also the cost of hospitalization can be reduced using multidetector CT examination.]