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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

JULY 20, 2004

[THE GENETICS OF DIABETES MELLITUS]

KORÁNYI LÁSZLÓ, PÁNCZÉL Pál

[The number of diabetic patients will be doubled in the coming decades reaching 300 million for year 2025. The number of type 1 diabetics will also be increased but the majority of it will result from the increased number of type 2 diabetics. All types of diabetes are the consequence of a combination of genetic susceptibility and environmental factors, meaning that the prevention of diabetes epidemic cannot be done without the clarification of the genetic background. Significant progression has happened in the discovery of the genetic background of type 1 diabetes mellitus. It was helped by the etiologic classification of the disease: with the new classification the patient groups became more homogeneous. The HLA system is responsible for about 50-70% of the genetic risk while the effects of other genetic factors contribute 1-2% of the genetic susceptibility, respectively. Presently 25 gene regions are known as the different genetic factors of type 1 diabetes mellitus. Regarding the HLA system, the genes and pathomechanism causing the disease are not known. The classification of diabetes mellitus can be based on the HLA type while the predictability of type 1 diabetes mellitus is helped by the HLA type and the INS-VNTR. Much less is known about the genetic background of the polygenic type 2 diabetes mellitus. Its manifestation is now happening at younger age before. The best-fit genetic model consists of only a few genes with moderate effect superimposed on a polygenic background. Several „candidate” genes participating in the impaired insulin secretion and insulin action have already been investigated as the genes responsible for type 2 diabetes. These data showed the specificity in the population and most showed mild or modest association with the disease. Genomewide scans have resulted a number of significant diabetes susceptibility genes specific for a variety of populations, but these investigations have only resulted in the isolation of one gene (calpain 10) that is thought to contribute to type 2 diabetes. Most recent genomewide scans found loci on chromosome 20 in two different populations with significant segregation of type 2 diabetes. These loci are near to the region harboring the transcription factor hepatocyte nuclear factor genes. The transcription regulator HNF family is responsible for the regulation of the expression of several genes participating in the function of liver and pancreatic islet becoming a strong candidate for being a diabetes gene.]

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.]

Lege Artis Medicinae

MAY 20, 2004

[IDENTIFYING HELICOBACTER PYLORI WITH DNA-BASED ASSAYS]

RUZSOVICS Ágnes, MOLNÁR Béla, TULASSAY Zsolt

[The DNA-based assays have the potential to be a powerful diagnostic tool given its ability to specifically identify H. pylori DNA. Markers used include general H. pylori structures and pathogenetic factors like ureaseA, cagA, vacA, iceA. DNA or bacterial RNA for polymerase chain reaction (PCR) assays can be collected from gastric biopsy, gastric juice, stool, buccal specimens. PCR can yield quantitative and genotyping results with sensitivity and specificity that approaches 100%. A clear trend in the direction of the determination of quantitative H. pylori infection by real-time PCR can be observed. Fluorescent in situ hybridisation (FISH) and restriction fragment length polymorphism (RFLP) are suggested for routine antibiotic resistance determination. To identify the DNA structure of organism and its virulence factors may be feasible by using oligonucleotide microarray specifically recognising and discriminating bacterial DNA and various virulence factors. DNA based H. pylori diagnosis yields higher sensitivity, however, specificity requires sophisticated labour environment and associated with higher costs.]

Hungarian Radiology

DECEMBER 21, 2009

[Cervical space occupying lesions: diagnosis at sonoelastography]

UJLAKI Mátyás, MAGYAR Péter, KARLINGER Kinga

[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

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.]

Lege Artis Medicinae

DECEMBER 20, 2010

[Misleading tumor markers in pulmonary carcinomas]

CIFRA János, BOGNER Barna, HELF László, SZÉKELYI Katalin, KÁLMÁN Endre, SÁPI Zoltán

[Lung cancers are the leading cause of tumorous mortality and the most frequent tumor in the 40- 70 years age range. The chance for cure in lung cancers is much higher in the early stage of disease so the early diagnosis has a paramount importance. Although many tumor markers are used in the diagnosis of malignant tumors, their specificity raise some doubts. The increased level of hCG is traditionally connected with choriocarcinomas and the CA 19-9 antigen is connected with gastrointestinal carcinomas. The production of hCG and CA19-9 is extremely rare but well established fenomenon in pulmonary carcinomas. In some cases of pulmonary cancers various tumor markers are produced, causing differential diagnostic difficulties. Through our cases and literature review we wanted to draw the attention of the organ unspecificity of these tumor markers.]

Hungarian Radiology

OCTOBER 20, 2004

[Pelvic computed tomography in staging of prostate cancer before surgery]

BERCZI Csaba, TÓTH György, VARGA Attila, FLASKÓ Tibor, KOLLÁR József, TÓTH Csaba

[PURPOSE - The aim of the study was to measure the sensitivity and specificity of computed tomography for local staging in patients underwent radical perineal prostatectomy. PATIENTS AND METHODS - 160 patients were involved in the study. Rectal digital examination, measurement of prostate specific antigen, prostate biopsy, CT, ultrasound, chest X-ray examination and bone scintigraphy were performed in every case before radical prostatectomy. RESULTS - The average preoperative prostate specific antigen concentration was 15.8 ng/ml before surgery. The average Gleason score of biopsies was 3.19. CT showed extraprostatic infiltration in 14 patients (pericapsular invasion n: 6, seminal vesicula n: 3, bladder infiltration n: 5, lymph node metastasis n: 2). The histological examination proved extraprostatic invasion of the tumour in 35 cases (pericapsular invasion n: 35, seminal vesicula n: 25, bladder infiltration n: 5). The cancer was localized in the prostate in 125 patients. Sensitivity and specificity of CT for pericapsular invasion were 14% and 98%, for infiltration of seminal vesicula 12% and 100%, and for bladder infiltration 20% and 97%. There was not a significant difference between the prostate specific antigen values (p=0.94) in cases when the tumour was confined to the prostate and when the cancer showed extraprostatic infiltration. There was significant difference between the Gleason score values between the two groups (p=0.008). CONCLUSION - The sensitivity of CT for local spread of prostate cancer is very low, thus CT is not a suitable method for the local staging before surgery.]

Clinical Neuroscience

JULY 30, 2007

[PROTEIN BIOMARKERS IN EXPERIMENTAL MODELS AND IN THE CLINICAL CARE FOR TRAUMATIC BRAIN INJURY]

LÜCKL János, FARKAS Orsolya, PÁL József, KÖVESDI Erzsébet, CZEITER Endre, SZELLÁR Dóra, DÓCZI Tamás, KOMOLY Sámuel, BÜKI András

[Traumatic brain injury is the leading cause of mortality in Hungary in the population under 40 years of age. In Western societies, like the United Sates, traumatic brain injury represents an extreme social-economic burden, expected to become the third leading cause of mortality until 2020. Despite its’ epidemiological significance, experimental therapeutic modalities developed in the last few decades did not prove efficient in the clinical care of severe traumatic brain injury. The reason for such a lack of success in terms of translating experimental results to clinical treatment at least partially could be explained by the paucity and the low sensitivity and specificity of clinical parameters endowing us to monitor the efficacy of the therapy. The drive for finding clinical parameters and monitoring tools that enable us to monitor treatment efficacy as well as outcome focused recent attention on biomarkers (and) surrogate markers that are based on rational pathological processes associated with/operant in traumatic brain injury. This review summarizes those biomarkers that could purportedly be used to monitor the treatment of the severely head injured while also providing information on salvageability facilitating the conduction of more rationally designed clinical studies.]

Lege Artis Medicinae

OCTOBER 20, 2003

[THE USE OF EARLY BIOMARKERS IN PREVENTION. - THE MARKERS OF THE EXPOSITION, EARLY EFFECT AND INDIVIDUAL SENSITIVITY]

EMBER István, KISS István, SÁNDOR János, FEHÉR Katalin, NÉMETH Katalin, LUKÁCS Péter

[The molecular and predictive epidemiology plays more and more important role in the prevention of cancer. With the help of early biomarkers, high risk population could be identified for primary preventive intervention modalities. It uses both molecular biological methods and elements of risk assessment plus a testing system based on animal experiments. Its specificity is not high enough to establish the diagnosis but it can be used to monitor the disease and to follow the effectivity of the therapy (e.g. "minimal residual disease") and the preventive interventions. It is also suitable for risk assessment with the markers of individual susceptibility. As to everyday practice there are many problems because of limited therapeutic possibilities, but we hope that the molecular and predictive epidemiology becomes an important part of medicine in the near future.]