Zastosowanie badania rezonansu magnetycznego w onkologii

Magnetic resonance imaging (MRI) is nowadays increasingly used and widely applied also in oncology patients. The recent advances in MRI technology, resulted in both increased sensitivity of this technique in diagnosing neoplastic lesions and broadening of its applications in this group of patients. This article presents utilization of MRI in diagnosis of neoplasms, with particular emphasis on new techniques introduced in recent years.Badanie rezonansem magnetycznym (MR) jest metodą o coraz większej dostępności, powszechnie stosowaną również w diagnostyce pacjentów onkologicznych. Rozwój techniki MR, do jakiego doszło w ostatnich latach,przyczynił się zarówno do zwiększenia czułości metody w wykrywaniu zmian nowotworowych, jak i do poszerzenia wskazań do jej stosowania w tej grupie chorych. W artykule przedstawiono spektrum zastosowań MR w diagnostyce nowotworów ze szczególnym uwzględnieniem nowych technik wprowadzonych w ostatnim czasie do obrazowania

Diagnostyka obrazowa guzów nadnerczy

The differentiation of adrenal nodules is wide and varies from primary benign neoplasia, through hormone secreting lesions, to primary and secondary malignant masses. With the rapid development of cross-sectional imaging, incidental detection of adrenal nodules has become an everyday practice, leaving clinicians with the necessity of further investigation. In this article, we present the current possibilities of adrenal gland imaging and we propose a diagnostic schema for differential diagnosis of incidentaloma. Non-contrast enhanced computer tomography (CT) is a modality of choice used for the differential diagnosis of adrenal lesions. It allows the detection of 95% of adrenal masses, and the characterisation of most of them. Magnetic resonance imaging (MRI) is a good modality for cases in which CT examination cannot determine the character of an adrenal tumour. Nuclear medicine study with the use of Iodine-131 meta iodobenzylguanidine(MIBG) is helpful in the diagnosis of pheochromocytoma. Positron Emission Tomography–Computed Tomography (PET–CT) is considered a useful method in patients with a known malignancy history. Ultrasound has a low sensitivity for the detection of small lesions and is not capable of reliable characterisation of visualised masses. However, this technique plays an important role in the follow-up of non-hypersecreting adrenal lesions.Diagnostyka różnicowa guzów nadnerczy jest dość szeroka, od łagodnych, pierwotnych zmian, przez zmiany hormonalnie czynne, aż po zmiany złośliwe, pierwotne i wtórne. Wraz z szybkim rozwojem technik obrazowania, codziennością stało się przypadkowe wykrycie guzków nadnerczy. Stawia to klinicystę w potrzebie różnicowania tych zmian. W tym artykule przedstawiamy przegląd współczesnych możliwości obrazowania gruczołów nadnerczowych oraz proponujemy schemat diagnostyczny w przypadku przypadkowo wykrytego guzka nadnercza (tzw. incidentaloma). W zarysie, tomografia komputerowa bez podania środka kontrastowego jest metodą obrazowania z wyboru w diagnostyce różnicowej zmian w nadnerczach. Pozwala ona na wykrycie 95% zmian i scharakteryzowanie większości z nich. Rezonans magnetyczny jest dobrą techniką u pacjentów, u których nie udało się określić charakteru zmiany za pomocą tomografii komputerowej. Techniki medycyny nuklearnej z zastosowaniem specyficznych znaczników są przydatne w diagnostyce guza chromochłonnego. Z kolei stosowanie pozytonowej tomografii emisyjnej jest wskazane u pacjentów z rozpoznaną chorobą nowotworową. Ultrasonografia nie pozwala na wykrycie małych zmian oraz nie daje możliwości scharakteryzowania stwierdzonej zmiany, ale jest dobrą i niedrogą techniką sprawdzającą się w badaniach kontrolnych

Ultrasound-guided percutaneous aspiration of adventitial cysts in the occluded popliteal artery – clinical results and MR findings at 5-year follow-up

Cystic adventitial disease is a rare disorder that occurs in peripheral arteries. Calf claudica­tion caused by compression of the popliteal artery is a typical presentation of this disease. This is a report of two cases of occluded popliteal artery decompression by percutaneous ultrasound-guided cyst aspiration. In both cases, decompression of the artery was achieved with a significant decrease in the size of adventitial cysts and restoration of flow. Both pa­tients reported complete resolution of symptoms and no calf pain 5 years after the proce­dure. MR findings and resolution of symptoms in these two patients show the efficacy of percutaneous adventitial cyst aspiration in a 5-year follow-up

Management of patients with COVID-19 in radiology departments, and indications regarding imaging studies : recommendations of the Polish Medical Society of Radiology

The pandemic involving COVID-19 caused by the SARS-CoV-2 coronavirus, due to its severe symptoms and high transmission rate, has gone on to pose a control challenge for healthcare systems all around the world. We present the second version of the Recommendations of the Polish Medical Society of Radiology, presuming that our knowledge on COVID-19 will advance further rapidly, to the extent that further supplementation and modification will prove necessary. These Recommendations involve rules of conduct, procedures, and safety measures that should be introduced in radiology departments, as well as indications for imaging studies

Jednostronna laparoskopowa adrenalektomia w połączeniu z częściowym przezklinowym usunięciem gruczolaka przysadki wydzielającego ACTH- operacją ratującą życie pacjentce z chorobą Cushinga

Introduction: Cushing’s disease is the most common cause of endogenous hypercortisolemia, in 90% of cases due to microadenoma. Macroadenoma can lead to atypical hormonal test results and complete removal of the tumour is unlikely. Case report: A 77-year-old woman with diabetes and hypertension was admitted because of fatigue, proximal muscles weakness, lower extremities oedema, and worsening of glycaemic and hypertension control. Physical examination revealed central obesity, ‘moon’-like face, supraclavicular pads, proximal muscle atrophy, and skin hyperpigmentation. Biochemical and hormonal results were as follows: K 2.3 mmol/L (3.6–5), cortisol 8.00 86 μg/dL (6.2–19.4) 23.00 76 μg/dL, ACTH 8.00 194 pg/mL (7.2–63.3) 23.00 200 pg/mL, DHEAS 330 μg/dL (12–154). CRH stimulation test showed lack of ACTH stimulation > 35%, overnight high dose DST revealed no suppression of cortisol. Chest and abdominal CT as well as somatostatin receptor scan didn’t show ectopic tumour responsible for ACTH oversecretion. MRI revealed a pituitary macroadenoma (28 × 20 × 17 mm) extending towards the left cavernous sinus. After partial transsphenoidal adenomectomy, serum cortisol of 40 μg/dL was obtained. The patient’s condition was still very poor, so unilateral adrenalectomy was performed. After surgery, serum morning cortisol level dropped to 20 μg/dL and the patient’s condition improved significantly. 26 months after the operations, the patient remains in remission. Because her life expectancy exceeds the prognosed duration of remission with the presence of pituitary tumour remnants and intact left adrenal gland, the patient was qualified to radiosurgery with a Gamma Knife. Conclusion: In selected cases, unilateral, laparascopic adrenalectomy may serve as a life-saving procedure in a patient with ACTHdependent Cushing’s syndrome.Wstęp: Choroba Cushinga stanowi najczęstszą przyczynę endogennej hiperkortyzolemii, w 90 % w przebiegu mikrogruczolaka przysadki. W przypadku makrogruczolaków rozpoznanie może być utrudnione z powodu nietypowych wyników testów hormonalnych a radykalne usunięcie guza często niemożliwe. Opis przypadku: 77-letnia, otyła chora z cukrzycą i nadciśnieniem tętniczym została przyjęta z powodu postępującego osłabienia mięśni kończyn dolnych, obrzęków kończyn dolnych, pogorszenia kontroli glikemii i nadciśnienia tętniczego. W badaniu przedmiotowym stwierdzono otyłość centralną, zaokrąglenie twarzy, nadobojczykowe tłuszczowe poduszeczki, hiperpigmentację skóry. W badaniach biochemicznych: K 2,3 mmol/l (3,6–5), kortyzol 8.00 86 μg/dl (6,2–19,4) 23.00 76 μg/dl, ACTH 8.00 194 pg/ml (7,2–63,3) 23.00 200 pg/ml, DHEAS 330 μg/dl (12–154). W teście z CRH nie uzyskano stymulacji ACTH > 35 % a w teście z 8 mg deksametazonu nie uzyskano supresji kortyzolu > 50 %. Wykonano badanie CT klatki piersiowej i jamy brzusznej oraz scyntygrafię receptorów somatostatynowych nie znajdując ekotopowego źródła nadmiernej produkcji ACTH. W MRI przysadki stwierdzono makrogruczolak 28 × 20 × 17 mm. Chora została zakwalifikowana do przezklinowej resekcji guza. Po częściowej adenomektomii stężenie kortyzolu wynosiło 40 μg/dl ale z uwagi na utrzymujące się objawy ciężkiej hiperkortyzolemii zadecydowano o jednostronnej adrenalektomii ze wskazań życiowych. Po operacji stężenie kortyzolu wynosiło 20 μg/dl i stan chorej ulegał stopniowej poprawie. Po 26 miesiącach od operacji chora pozostaje w remisji. Z uwagi na przewidywany okres przeżycia przekraczający prognozowaną długość remisji, wobec obecności resztki guza przysadki i lewego nadnercza Chora została zakwalifikowana do leczenia radiochirurgicznego z użyciem Gamma Knife. Wniosek: W wybranych przypadkach jednostronna laparoskopowa adrenalektomia może być operacją ratującą życie u chorych z ciężkim ACTH-zależnym zespołem Cushinga

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation

Ocena przydatności hepatotropowego środka kontrastowego Teslascan (Mn-DPDP) w wykrywaniu zmian ogniskowych w wątrobie

Background: The purpose of our study was to evaluate the usefulness of the hepatotropic contrast agent Teslascan (Mn-DPDP) in the detection of focal hepatic lesions. Material/Methods: A prospective study was performed in 24 patients (12 men, 12 women) with 82 confirmed focal hepatic lesions, in whom the hepatotropic contrast agent Mn-DPDP (Teslascan) was administered. The examinations were performed on a 1.5T unit (Philips Gyroscan). The sensitivity of hepatic lesions detection were compared in T2W, TSE, T2W STIR, T1W GRE, and T1W GRE sequences, 15-30 minutes after intravenous administration of Mn-DPDP. Results: In T2W TSE sequences 64 focal lesions were detected (sensitivity 78%); in T2W STIR sequences, 70 lesions (sensitivity 85%); in T1W GRE sequences, 65 lesions (sensitivity 79%); in T1W GRE sequences after Mn-DPDP administration, 77 lesions (sensitivity 94%). The combined sensitivity of evaluation using all the sequences obtained before Mn-DPDP administration (T2W TSE, T2W STIR, T1W GRE) was 88%. Conclusions: MR examination with the use of MN-DPDP yielded higher sensitivity in hepatic lesion detection compared to unenhanced T2W TSE, T2W STIR and T1W GRE sequences

Differentiation of focal hepatic lesions in MR imaging with the use of combined quantitative and qualitative analysis

Background: To evaluate the efficacy of the protocol of combined quantitative-qualitative analysis for the differentiation of focal hepatic lesions. Material/Methods: The study group included 168 patients with 292 hepatic lesions confirmed by histology (n =138) or follow-up (n =154). Lesions were divided into: benign lesions treated conservatively (group A, 120 lesions), malignant tumors and benign lesions treated surgically (group B, 172 lesions). MR imaging (1.5-T) consisted of sequences: T2 double-echo TSE, T2 STIR, T1 GRE and of dynamic study. During the first part of differentiation process, quantitative analysis, based on lesions T2 relaxation times (derived from T2 double-echo TSE sequence), was performed in order to discriminate non-solid lesions (hemangiomas, cysts, abscesses; n = 88) from solid tumors (n = 204). Subsequently, all tumors defined as solid underwent qualitative evaluation based on visual assessment of lesions signal intensities in all sequences and patterns of their contrast enhancement. The aim of this part of analysis was to discriminate benign lesions (FNH and focal fatty infiltration) from other solid tumors. The remaining tumors were characterized as group B lesions. Results: Statistically significant difference between mean T2 relaxation time of solid tumors (84.1 ms) and non-solid lesions (250.5 ms) was noted, allowing diagnosis of solid tumors with sensitivity of 96% and specificity of 93% (at the threshold of 116 ms). Overall 202 lesions were defined as solid (196 true positive, 8 false negative, 6 false positive results). Qualitative analysis of these lesions was performed allowing correct characterization of all 7 focal fatty infiltrations and 21 of 24 FNH. Six lesions were falsely diagnosed as FNH. Remaining 168 lesions were defined as group B lesions. Both parts of differentiation protocol yielded sensitivity and specificity of 92%, allowing correct characterization of 158 of 172 group B lesions. Fourteen false negative and 10 false positive results (3 FNH, 1 focal inflammation, 6 hemangiomas) were obtained. Conclusions: Combined protocol of quantitative and qualitative analysis enabled discrimination of group B lesions (malignant tumors and benign lesions treated surgically) with high sensitivity and specificity of 92%

Reproducibility of intravoxel incoherent motion of liver on a 3.0T scanner : free-breathing and respiratory-triggered sequences acquired with different numbers of excitations

Purpose: To optimise the intravoxel incoherent motion (IVIM) imaging of the liver on a 3.0T scanner by assessing parameter reproducibility on free-breathing (FB) and respiratory-triggered (RT) sequences acquired with different numbers of signal averages (NSA). Material and methods: In this prospective study 20 subjects (M/F: 10/10; age: 25-62 years, mean: 39 years) underwent IVIM magnetic resonance imaging (MRI) on a 3.0T scanner using an 18-channel phase-arrayed coil and four different echo-planar sequences, each with 10 b values: 0, 10, 30, 50, 75, 100, 150, 200, 500, and 900 s/mm2. Images were acquired with FB and RT with NSA = 1-4 (FBNSA1-4, RTNSA1-4) and with NSA = 3-6 (FBNSA3-6, RTNSA3-6). Subsequently, for the assessment of reproducibility of IVIM-derived parameters (f, D, D*), each subject was scanned again with an identical protocol during the same session. IVIM parameters were calculated. The distribution of IVIM-parameters for each DWI sequence were given as the median value with first and third quartile. Inter-scan reproducibility for each IVIM parameter was evaluated using coefficient of variance and Bland-Altman difference. Differences between FB sequence and RT sequence were tested using non-parametric Wilcoxon signed-rank test. Results: Mean coefficient of variance (%) for f, D, and D* ranged from 60 to 64, from 58 to 84, and from 82 to 99 for FBNSA1-4 sequence; from 50 to 69, from 41 to 97, and from 80 to 82 for RTNSA1-4 sequence; from 22 to 27, 15, and from 70 to 80 for FBNSA3-6 sequence; and from 21 to 32, from 12 to, and from 50 to 80 for RTNSA3-6 sequence, respectively. Conclusions: Increasing the number of signal averages for IVIM acquisitions allows us to improve the reproducibility of IVIM-derived parameters. The sequence acquired during free-breathing with NSA = 3-6 was optimal in terms of reproducibility and acquisition time