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Lege Artis Medicinae

FEBRUARY 20, 2009

[Asymptomatic hepatic giant haemangioma]

KOVÁCS GÁBOR, NYIKOS Orsolya, GERVAIN Judit

[INTRODUCTION - Haemangioma is the most common type of benign hepatic tumors. Haemangiomas are usually asymptomatic, except for those that exceed five centimeters in size and are called “giant” haemangiomas. Malignant transformation has not been noted and therefore only regular follow-up is recommended for smaller haemangiomas. Surgical intervention becomes necessary only if symptoms or complications occur. Nevertheless, atypical presentation can cause a significant differential diagnostic problem. CASE REPORT - The authors report the case of a 51-year old woman with a focal hepatic abnormality diagnosed during a routine abdominal ultrasound examination. Results of the subsequent computed tomography scan suggested a multiple hepatocellular carcinoma based on the morphological appearance. Following oncology consultation, she was admitted to our department for liver biopsy. Histology did not reveal any malignancy. This result together with the lack of symptoms and complaints and the normal laboratory test results shifted the likely diagnosis towards a benign haemangioma. Blood-pool scintigraphy confirmed this diagnosis. CONCLUSIONS - Haemangiomas are benign hepatic tumors. They are often diagnosed accidentally, by routine abdominal ultrasound examination. If an abdominal ultrasound raises suspicion of haemangioma, abdominal MRI scan or blood-pool scintigraphy is recommended to be performed in order to exclude malignancy for lesion sizes of <2 cm or >2 cm, respectively. The reported case is considered important because of the differential diagnostic problems the large size and the atypical presentation of the given haemangioma imposed. Ultrasound-guided liver biopsy via fine-needle aspiration has previously been contraindicated. This invasive procedure can be performed in patients with focal hepatic pathology if diagnosis cannot be established by non-invasive tests, especially if malignancy is suspected. It can be performed conditional on the localization of the tumor, the patient’s general condition, the laboratory results, and if there is a therapeutic consequence of the biopsy results.]

Lege Artis Medicinae

SEPTEMBER 20, 2005

[MAGNETIC RESONANCE IMAGING IN ABDOMINAL DIAGNOSTICS]

PALKÓ András

[Magnetic resonance imaging (MRI) plays more and more important role in the abdominal imaging diagnostics since fast measurement sequences have become available making it possible to avoid movement artifacts and resulting in better quality and more informative images of the abdominal parenchymal organs and most segments of the gastrointestinal tract. The greatest advantage of MRI is that it is able to create images of adequate geometric resolution and excellent tissue characterization capacity without the use of ionizing radiation and iodinated contrast media. Today MRI is applied mostly in those cases when previous data suggest that computed tomography will not be informative or the results of recent imaging examinations (x-ray, ultrasound, computed tomography) do not provide sufficient diagnosis. Presumably MRI will be used with increasing frequency as the first or single best method of choice in the near future. Beased on these facts in abdominal diagnostics, MRI may be considered as a problem-solving modality which plays an outstanding role in the detection, differential diagnosis, staging and follow-up of many neoplastic and inflammatory lesions.]

Hungarian Radiology

AUGUST 20, 2004

[Recent results of breast diagnostics - Onco update 2004]

FORRAI Gábor

[The purpose of this overview is to demonstrate the recent results of breast diagnostics and the place of the imaging and interventional methods. Review of the most recent articles (September 2002- December 2003) in the following subjects: breast screening, digital mammography, computer assisted diagnosis, breast ultrasound, breast MRI, scintimammography, positron emission tomography, guided biopsies, other interventions, new diagnostical methods, percutaneous tumour ablation. Experiences about breast 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 routine. These are the reasons why the up-to-date knowledge of the literature is mandatory.]

Hungarian Radiology

OCTOBER 20, 2009

[Role of imaging in the managment of colorectal cancer]

JEDERÁN Éva, GŐDÉNY Mária

[Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer death in Hungary. Diagnosis requires the examination of the entire large bowel by means of radiological and/or endoscopic techniques. Colorectal cancer primarily develops from adenomatous polyp over a period of 10-15 years. Tumour staging is crucial for the prognosis and for the planning of the most suitable anticancer therapy. The role of imaging in colorectal cancer is increasing with the change in complex tumour therapy. With advances in ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) techniques accuracy of imaging has improved. The accuracy of CT improved with the advent of the multislice technique (MDCT). Sensitivity and specificity of CT colonography (CTC) in colon polyps and cancer is over 90%, therefore it is one of the screening tools. Accuracy of the CTC is comparable to the optical colonoscopy, complements conventional colonoscopy well and it is an effective tool in the right hands. Endorectal US (ERUS) depicts the anatomic layers of the rectal wall with high degree of accuracy, therefore it is the best method for the evaluation of the lower tumour stage. High resolution MRI is the most suitable technique for predicting rectal tumor stage, therefore it has been established as the standard for preoperative assessment of rectal cancer.]

Lege Artis Medicinae

SEPTEMBER 19, 2007

[NON-INVASIVE CORONARY ANGIOGRAPHY BY MULTISLICE COMPUTED TOMOGRAPHY]

PRÉDA István, KERECSEN Gábor, MAUROVICH-HORVAT Pál

[This review summarizes the diagnostic spectrum, ways of application and methodological difficulties of multislice computed tomographic (MSCT) coronary angiography. The non-invasive assessment of cardiac and coronary anatomy is now possible with computed tomographic coronary angiography using the modern 16 to 64-slice technology. This technique finds its main use today in the screening of patients with moderate probability of having coronary artery disease (atypical chest pain). Its negative predictive value varies between 97% and 99%, thus, a negative result of this non-invasive outpatient procedure can reduce the possibility of coronary artery disease to the minimum. Other important diagnostic applications include the follow-up of patients with coronary artery bypass, accurate diagnosis of coronary artery anomalies, and the simultaneous examination of the heart and great vessels. The future development of the technique is directed to coronary plaque characterization, particularly the detection of vulnerable plaques. The radiation exposure is relatively low (7-13 mSv), comparable with that of invasive coronary angiography.]

Lege Artis Medicinae

JANUARY 20, 2005

[CARCINOID TUMORS]

RÁCZ Károly

[Carcinoid tumors are rare neoplasms: they are traditionally divided into three subgroups (foregut, midgut and hindgut tumors). Despite their neuroendocrine cell origin and the similarities in their histological structure, the molecular background, pathogenesis, clinical features, diagnostic and therapeutic procedures, as well as the prognosis of carcinoid tumors located at different sites may be highly variable. Although sensitive biochemical markers (serum chromogranin A concentration, urinary 5- hydroxyindoleacetic acid excretion) and localization methods (somatostatin receptor scintigraphy, positron emission tomography) are available, a considerable number of patients are only diagnosed at the late stages of the disease. When surgical cure is not obtainable such as in cases with advanced metastatic disease, surgical procedures to reduce tumoral tissue should be still considered. At present, the most effective drugs for the symptomatic treatment of carcinoid tumors are somatostatin analogues (octreotide, lanreotide). In addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and rarely, tumor regression is produced. Radioisotope-labelled somatostatin analogues are presently under clinical evaluation, which may offer new therapeutic means for patients with carcinoid tumors.]

Clinical Neuroscience

MARCH 25, 2009

[Noninvasive imaging in the diagnosis of cerebral sinus thrombosis]

[Cerebral venous thrombosis is a severe, but potentially reversible disease, when it is promptly recognised and treated. Due to its varied and many aetiological factors and clinical manifestations, non-invasive radiological imaging plays a key role in the diagnostic procedure. Unenhanced and contrast-enhanced computer tomography (CT) and magnetic resonance (MR) imaging, CT angiography (CTA), MR angiography - such as time-of-flight (TOF) and phase-contrast (PC) angiography - are appropriate techniques for detecting cerebral venous flow and brain parenchymal changes. To achive adequate diagnosis timely it is necessary to have a correct knowledge of the venographic techniques, the temporally altering appearance of the thrombus, and the differential diagnostic problems that may occur. In our article, we summarized these characteristics by recent international publications and our own clinical observations and propose recommendations regarding the examination protocol of the dural sinus thrombosis.]

Hungarian Radiology

DECEMBER 20, 2006

[Computer tomography based planning by personal computer in surgery of forefoot]

HUSZANYIK István, HEGEDŰS Franciska, RÓDE László

[BACKGROUND - In contradiction to traditional osteographic registrations CT pictures give the possibility of precise and size proportional measurements. Three-dimensional reconstructions can help in imaging of stereoscopic structures, however later reediting is not possible. Authors elaborated a CT based system for planning surgical interventions with personal computer. MATERIALS AND METHODS - The new method is described using a forefoot surgery model. The measurements were based on three subcapital osteotomy of 1st metatarsus. The length of 1st metatarsus, the 1st-2nd metatarsus index, the 1st-2nd intermetatarsal angle, and dorsoplantar movement of 1st-2nd metatarsal head were determined. RESULTS - The postoperative result of correction and pathologic bone movement can also precisely determined by this method. CONCLUSION - This method seems to be practical for elaboration of other new operating techniques, predicting and verifying their results before clinical use.]

Hungarian Radiology

APRIL 20, 2004

[Endobronchial ultrasonography in the diagnosis of pulmonary and mediastinal malignancies]

MORÓCZ Éva, STRAUSZ János

[Endobronchial ultrasonography can be performed during conventional bronchofiberoscopy. The main indications are intrathoracic malignancies. Endobronchial ultrasonography has a great signficance in the diagnosis of mediastinal and lung processes and in staging of lung cancer. Endobronchial ultrasound is superior to computed tomography in evaluation of the disorders of tracheal and bronchial wall. The summary about this new modality is based on the international references and the authors’s own experiences.]

Clinical Neuroscience

NOVEMBER 30, 2009

[Myelination disturbance in a patient with hyperuricemia and hyperserotoninemia combined with 18q deletion syndrome]

LÁSZLÓ Aranka, VÖRÖS Erika, BUGA Klára, HORVÁTH Katalin, MAYER Péter, OSZTOVICS Magda†, PÁVICS László, SVEKUS András, PATTERSON C. Marc

[We previously reported a male patient with an 18q21.3 deletion, hyperuricemia and typical symptoms of the Lesch- Nyhan syndrome who lacked hypoxanthine-guanine-phosphoribosyl- transferase (HGPRT) deficiency. The patient developed progressive peripheral neuropathy in additon to his profound mental retardation and self-injurious behavior. At the age of 23 years MR imaging revealed globally delayed myelination with relative sparing of the corpus callosum and frontal lobes. They were focal hyperintensities suggestive of gliosis. Multimodality evoked potentials found evidence of impaired central and peripheral conduction. Single photon emission computed tomographic (SPECT) imaging demonstrated left frontal hyperperfusion and under it a temporoparietal hypoperfusion.]