Evaluation and treatment decision of pancreatic tumors by use of MRI with MRCP imaging

Background: Pancreatic cancer is one of the most malignant tumors. Symptoms are usually nonspecific and insidious such that the cancer is advanced by the time of diagnosis. The aim of our work was to investigate the use of MRI and MRCP in diagnosis of the patients suspected of pancreatic carcinoma and to determine the role of these methods in the evaluation of resectability of pancreatic cancer in comparison to surgical findings. Material/Methods: Forty-nine patients (33 men and 16 women) aged 44-82 had undergone to MRI and MRCP imagination of the upper abdomen on 1.5 T system with use of a standard flexible surface coil. The results of those radiological diagnostic tests were compare to the surgical findings and histopathological examination. The capacity of MR and MRCP to detect pathological mass, assess disease process nature and accuracy of assessment of the resectability of the malignant lesion were evaluated. In the statistical analysis test X2 and Fisher's precise test were performed. Results: A statistical analysis determined 88% sensitivity, 95% specifity and 94% exactness of MRI and MRCP in the evaluation of nature of tumors within the pancreas and 100% sensitivity, 91% specificity and 95% accuracy in determining the resectability of the lesion. The positive predictive value came to 83%, while the negative predictive value to 100%. The Kappa compatibility index in comparison with a surgical findings came to 0.85714. Conclusions: MR and MRCP appears an important stage in diagnosis and in assessment of pancreatic tumors. By the estimation of tumor respectability it aids clinical management

The influence of the vascularisation of the follicular thyroid nodules on the proliferative activity of the follicular cells

The enlargement of the thyroid is, in general, benign in origin and due to nodular goitre. Follicular cellular proliferation of thyroid nodules has been increasingly observed recently. With fine needle aspiration biopsy (FNAB) this is classified as a follicular tumour. These lesions present various patterns of vascularisation in ultrasound examination. The aim of the study was to establish the relation between follicular nodule vascularisation and the proliferative activity of various types of follicular cell. According to the manner of proliferation, patients were divided into groups as follows: (I) patients with hyperplastic nodules (46 cases), (II) patients with follicular adenoma (42 cases), and (III) patients with follicular cancer (9 cases). In each case B-mode sonography, Power Doppler, sonographically guided FNAB (S-FNAB), morphological examination and morphometry were performed. The proliferative activity was detected with immunohistochemical methods (PCNA, Ki 67 and MPM2) to determine the so-called “proliferative index”. The study revealed increased proliferative activity in tumours of malignant origin and increased vascularisation in coexistence with increased proliferation of the follicular cells. As assessed by Power Doppler, an increased flow pattern in the centre of the nodules correlates with increased proliferative activity. The results suggest that Power Doppler examination could be helpful in selecting nodules for FNAB, especially in multinodular goitre

The influence of patients preparation on the diagnostic value of radiographs episode back-cross the spine

Diagnostyka radiologiczna jest współcześnie kluczowym narzędziem w rozpoznawaniu wielu chorób i ma ważną rolę w kontroli leczenia. Zdjęcie rentgenowskie jest łatwo dostępnym, szybkim i tanim sposobem oceny kręgosłupa w odcinku lędźwiowo-krzyżowym (LS). Uzyskanie prawidłowego i dokładnego obrazu kręgosłupa lędźwiowego, a także innych struktur anatomicznych znajdujących się w tej okolicy, należy poprzedzić usunięciem z dolnego odcinka przewodu pokarmowego gazów jelitowych oraz mas kałowych. Przygotowanie pacjenta do wykonania zdjęcia RTG kręgosłupa w odcinku LS wymaga wprowadzenia kontrolowanej diety wykluczającej oraz łagodnych środków przeczyszczających i/lub redukujących wzdęcia w celu oczyszczenia przewodu pokarmowego z mas kałowych i gazów jelitowych.The radio graphics have been still crucial diagnosis tools to detect many diseases and have important role in the treatments control. The X-ray picture is available, quick and cheap diagnostics method to evaluation the lumbar-sacral spine (LS) abnormalities. To obtain the right and exact lumbar-sacral spine and other surrounded anatomical structures images, the preceded by the removal from the lower section of the gastrointestinal intestinal gases and faecal masses should be done. The special patients preparation before X-ray exam of LS requisites the introduction of controlled diet excludes and mild laxatives and/or reduce bloating pills in order to cleanse the digestive tract of the faecal masses and intestinal gases

How should we prepared patient before lumbra-sacral X-ray examination?

Zdjęcie rentgenowskie (RTG) kręgosłupa lędźwiowo-krzyżowego jest jednym z badań wymagających odpowiedniego przygotowania pacjenta. W tym celu należy oczyścić jelita z mas kałowych oraz gazów. Odpowiednie przygotowanie pacjenta do wykonania zdjęcia RTG przyczynia się do poprawy jakości diagnostycznej obrazu radiologicznego. Prawidłowe przygotowanie pacjenta zaczyna się już 2–3 dni przed planowanym terminem wykonania badania. Do jednych z kluczowych zaleceń należy odpowiednie nawodnienie poprzez spożycie około 3 litrów płynów dziennie oraz unikanie produktów wzmagających procesy fermentacji. Oprócz właściwej diety zaleca się zastosowanie środków przeczyszczających oraz preparatów redukujących wzdęcia. Uzyskanie wyniku badania obrazowego o pełnych wartościach diagnostycznych umożliwia radiologowi właściwą interpretację. Przyspiesza wdrożenie procesu leczniczego oraz redukuje ryzyko konieczności powtórnej diagnostyki rentgenowskiej.X-ray exam of lumbar-sacral spine is a one of the imaging which needs special patient preparation. It is obviously to clean bowel from fecal masses and gases. The patient preparation before the X-ray examination should be making for increase value of radiology diagnostics imaging. The patient preparation had been starting 2–3 days before planning examination. One of the basic recommendation is hydration — the patient ought to drink 3 l liquid per day and avoid products which increasing fermentation process. To special preparation it’s necessary to take laxative and gas reduction pills. Clinical outcomes with full diagnostic information helps radiologist to make an accurate diagnosis

Wolumetryczne badania struktur mózgowia metodą rezonansu magnetycznego u dzieci z zespołem Downa

Background and purpose Down syndrome (DS) is the most common genetic cause of mental retardation with deficits in language and memory. Mental retardation of varying degrees is the most consistent feature of DS. The objective of this study was to use high-resolution magnetic resonance imaging (MRI) techniques to investigate the volumes of the hippocampus, amygdala, and temporal and frontal lobes in children with DS compared with healthy children. Material and methods MRI of 49 patients was reviewed prospectively. The study included 23 children with DS (9 girls and 14 boys, mean age 6.7 ± 3.7 years) and 26 healthy children (11 girls and 15 boys, mean age 8.3 ± 2.4 years). Volumes of the right and left hippocampus, the right and left amygdala, temporal and frontal lobes and the total brain volume were measured by a radiologist who was unaware of the diagnosis. Results Total brain volume in children with DS was significantly lower compared with controls. It was associated with significantly lower volume of the frontal and temporal lobes. Children with DS had a significantly smaller right and left hippocampus volume and a significantly smaller right and left amygdala volume than did the control group. We also found a negative correlation between mental retardation and volume of the right hippocampus. Conclusions The presence of these abnormalities from an early age contributes to the specific cognitive and developmental deficits seen in children with DS.Wstęp i cel pracy Zespół Downa (ZD) jest najczęstszą genetyczną przyczyną upośledzenia umysłowego, deficytów mowy i pamięci. Upośledzenie umysłowe różnego stopnia to najbardziej stała cecha zespołu Downa. Celem pracy było wykorzystanie techniki badania rezonansu magnetycznego (RM) wysokiej rozdzielczości do porównania objętości hipokampów, ciał migdałowatych, płatów skroniowych i czołowych dzieci z ZD w porównaniu z dziećmi zdrowymi. Materiał i metody Ocenie poddano 49 badań RM. Badaniem objęto 23 dzieci z ZD (9 dziewczynek i 14 chłopców, średnia wieku: 6,7 ± 3,7 roku). Grupę kontrolną stanowiło 26 dzieci zdrowych (11 dziewczynek i 15 chłopców, średnia wieku: 8,3 ± 2,4 roku). Objętość prawego i lewego hipokampa, prawego i lewego ciała migdałowatego, płatów skroniowych i czołowych oraz całkowita objętość mózgu były mierzone manualnie przez radiologa nieznającego rozpoznania. Wyniki Całkowita objętość mózgu w grupie dzieci z ZD była istotnie mniejsza w porównaniu z grupą kontrolną. Wiązało się to z istotnie mniejszą objętością płatów czołowych i skroniowych. Grupa dzieci z ZD miała istotnie mniejszą objętość prawego i lewego hipokampa oraz prawego i lewego ciała migdałowatego w porównaniu z dziećmi zdrowymi. Wykazano jednocześnie ujemną korelację pomiędzy stopniem upośledzenia umysłowego a objętością prawego hipokampa. Wnioski Obecność opisanych zaburzeń od najmłodszych lat przyczynia się do konkretnych deficytów poznawczych i rozwojowych u dzieci z ZD

Przydatność szarokopasmowego odwróconego w fazie obrazowania harmonicznego z wykorzystaniem Dopplera mocy w diagnostyce naczyniaków wątroby

Background: The purpose of this study was to assess the sensitivity of echo-enhanced phase-inversion power Doppler sonography (PI) in depicting the vascular enhancement of hemangiomas, thus confirming the exact diagnosis. Material/Methods: Twenty patients were examined. The presence of hemangioma was confirmed by surgical resection (n=2), two-phase (hepatic arterial and portal phases) contrast-enhanced spiral computed tomography (n=8), or sonographic follow-up, which showed no change in lesion size for at least 6 months (n=10). Prior to enhanced sonography, all patients had undergone both native B-mode and tissue harmonic imaging mode sonography, color Doppler, and power Doppler helical CT examinations. After injection of 2.5 g of Levovist intravenously, analysis of the arrival of contrast agent was performed by phase-inversion power Doppler sonography. Results: Evaluation of the 20 patients revealed 37 hemangiomas. Color and power Doppler sonography were non-specific for hemangioma in our examination. However, based on the phase-inversion power Doppler sonography findings, the 20 patients with the 37 hemangiomas were diagnosed. Typical features of hemangioma, such as peripheral globular and rim-like enhancement followed by a slow centripetal fill-in, were clearly visible. In 3 cases of small hemangiomas, computed tomography had failed to disclose the pathology, while phase-inversion sonographic images were completely suggestive of what was later confirmed at 6 months follow-up. Conclusions: Based on our results, we can recommend phase-inversion power Doppler sonography in the differential diagnosis of hemangioma by visualizing the characteristic rim-like enhancement pattern followed by a slow centripetal fill-in as an excellent diagnostic modality

The effect of levothyroxine on the proliferative activity of the thyroid follicular cells

Wstęp: Farmakologiczne leczenie nietoksycznego wola guzkowego lewotyroksyną wciąż pozostaje sprawą dyskusyjną. Celem pracy było określenie wpływu lewotyroksyny na aktywność proliferacyjną komórek pęcherzykowych tarczycy. Materiał i metody: Materiał cytologiczny uzyskano metodą biopsji aspiracyjnej cienkoigłowej (BAC) wykonanej pod kontrolą USG, przed i 6 miesięcy po leczeniu lewotyroksyną, od 32 kobiet w wieku 34-69 lat będących w stanie eutyreozy. Pacjentki podzielono na dwie grupy wiekowe: przed 45. rokiem życia (14 chorych) i po 45. roku życia (18 chorych). Aktywność proliferacyjną komórek pęcherzykowych oceniono poprzez określenie indeksu proliferacyjnego (PI, proliferative index), stanowiącego odsetek komórek pęcherzykowych z dodatnią reakcją z przeciwciałem Ki-67. Ocenę mikroskopową przeprowadzono, używając komputerowego programu morfometrycznego MicroImage InCD UDF (Olympus). Wyniki: Po 6 miesiącach leczenia wartość indeksu proliferacyjnego była znamiennie statystycznie niższa w obu badanych grupach (8,59 &plusmn; 3,07 vs. 6,51 &plusmn; 1,91; p < 0,001 u kobiet w wieku poniżej 45 lat i 7,72 &plusmn; 1,83 vs. 5,09 &plusmn; 1,51, p < 0,001 w starszej grupie wiekowej). Wnioski: Wyniki przeprowadzonej pracy wskazują, że lewotyroksyna wpływa na aktywność proliferacyjną komórek pęcherzykowych tarczycy, szczególnie u kobiet w wieku okołomenopauzalnym.Introduction: Pharmacological treatment of non-toxic nodular goitre with levothyroxine has caused a discussion about its effectiveness and safety. The aim of the study was to examine the influence of levothyroxine on the proliferative activity of the thyroid follicular cells. Material and methods: Cytological material was obtained from 32 euthyroid females, aged 34-69 years, by USG-guided Fine-Needle Aspiration Biopsy (FNAB), before and after 6 months treatment with levothyroxine. The patients were divided into 2 age groups: up to 45 years (14 patients) and above 45 years (18 females). Proliferative activity of the follicular cells was assessed by the proliferative index (PI), representing the percentage of follicular cells with positive reaction with the antibody Ki-67. Microscopic evaluation was carried out using morphometric computer system MicroImage InCD UDF (Olympus). Results: After 6-months of treatment IP values decreased significantly in both groups studied (8.59 &plusmn; 3.07 vs 6.51 &plusmn; &plusmn; 1.91; p < 0.001 in females aged < 45 years and 7.72 &plusmn; 1.83 vs 5.09 &plusmn; 1.51; p < 0.001 in the older group). Conclusion: Our results indicate that levothyroxine has an influence on the proliferative activity of the thyroid follicular cells, particularly in post-menopausal women

The Effect of Contrast Medium SonoVue® on the Electric Charge Density of Blood Cells

The effect of contrast medium SonoVue® on the electric charge density of blood cells (erythrocytes and thrombocytes) was measured using a microelectrophoretic method. We examined the effect of adsorbed H+ and OH− ions on the surface charge of erythrocytes or thrombocytes. Surface charge density values were determined from electrophoretic mobility measurements of blood cells performed at various pH levels. The interaction between solution ions and the erythrocyte’s or thrombocyte’s surface was described by a four-component equilibrium model. The agreement between the experimental and theoretical charge variation curves of the erythrocytes and thrombocytes was good at pH 2–9. The deviation observed at a higher pH may be caused by disregarding interactions between the functional groups of blood cells

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

The comparison of efficacy of different imaging techniques (conventional radiography, ultrasonography, magnetic resonance) in assessment of wrist joints and metacarpophalangeal joints in patients with psoriatic arthritis

Background: Psoriatic arthritis is a chronic inflammatory disease of the joints. Application and diagnostic capabilities of radiography in the diagnostics of rheumatic diseases are widely recognized. The aim of this work is to compare diagnostic efficacy of modern imaging studies (x-ray, ultrasound, MR) in the diagnostics of psoriatic arthritis. Material/Methods: We assessed 50 patients with diagnosed psoriatic arthritis, including 24 women and 26 men aged 20-70 years. They were all subjected to x-ray and ultrasound examinations of carpal and carpometacarpal joints. MR examination of these joints was performed in 16 subjects. The following parameters were assessed: width of the articular gap, presence of synovial hyperplasia, erosions, periosteal reactions, calcifications or effusion. Results of those examinations were later compared. Results: All three methods allowed for similar assessment of articular gap width in the carpal joint (1.86 vs. 2.02 vs. 1.84 respectively for x-ray, ultrasound, MR). MR and ultrasound visualized synovial hyperplasia with similar efficacy. Synovial fold thickness in the carpal joint was 2.91 mm in ultrasound and 2.98 in MR. Assessment of effectiveness in the diagnosis of erosions, periosteal reactions and calcifications revealed superiority of ultrasound and MR over x-ray studies. From a group of 16 subjects, x-ray, ultrasound and MR visualized carpometacarpal erosions in 25% vs. 56.3% vs. 68.8% of patients respectively. Ultrasound and MR studies exhibited similar diagnostic efficacy in the diagnosis of articular effusions. Conclusions: Due to modern imaging techniques we are able to assess changes in the course of psoriatic arthritis earlier and more precisely. Diagnostic efficacy of ultrasound and MR studies in the diagnosis of articular inflammatory lesions is clearly superior to that of x-ray examination. It is particularly important in the beginning phase of the disease. Ultrasound should be used for the diagnostics and patient follow-up. MR examination, as its efficacy is superior to that of ultrasound, should be used for verification in doubtful cases. X-ray examination should remain a method of assessment of bone destruction in advanced, chronic phase of the disease