26 research outputs found
What you cannot get from routine MRI of MS patient and why – The growing need for atrophy assessment and seeing beyond the plaque
Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients’ disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients’ clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results
Small volume of the posterior cranial fossa and arterial hypertension are risk factors of hemifacial spasm
Objectives
So far, there are only two studies evaluating the relation between the small volume of the posterior cranial fossa (VPCF) and the occurrence of HFS, both on Asian population. The aim of the study was to determine small VPCF and arterial hypertension (AH), as risk factors for hemifacial spasm (HFS) and their relation to neurovascular conflict (NVC) in Polish Caucasian-origin patients.
Materials and methods
The study included 60 patients with idiopathic HFS and 60 healthy volunteers matched by sex and age. AH was defined according to WHO. The VPCF measured the volume of the prepontine, prespinal and both cerebellopontine angle cisterns in MRI scans.
Results
There were no significant differences between occurrence of AH and the VPCF of patients and controls but the mean VPCF in women was significantly smaller than in men, In the multivariate regression analysis model only NVC was the statistically significant. In the subgroup of >50-year-old patients the most dominant risk factor was NVC (OR 71.09; 95% CI 21.08–239.77; p=0.0000), followed by the AH duration (OR 1.07; 95% CI 1.00–1.16; p=0.047). In the subgroup of <50 years, NVC was also the dominant risk factor, followed by the lower VPCF (Walad test: OR 0.4; 95% CI 0.16–1.04; p=0.045).
Conclusion
There was no significant difference in VPCF and in frequency of AH diagnosis in HFS patients and age- and sex-related controls, but the logistic regression analysis showed that small VPCF and AH duration are risk factors of HFS in younger and older patients respectively
Guidelines of the Polish Medical Society of radiology for the routinely used MRI protocol in patients with multiple sclerosis
Magnetic resonance imaging is widely used in diagnosing multiple sclerosis as a basic method for detecting and monitoring the disease.
Introduction: Polish Medical Society of Radiology presents the second version of the recommendations for the routinely conducted MRI in multiple sclerosis, which include new data and practical remarks for radiographers and radiologists. The recommended protocol aims to improve the imaging procedure and, most importantly, to standardize conducting MRI scans in all MRI departments. This is crucial for monitoring the patients with MS, which directly contributes to essential clinical decisions.
Aim of the guidelines: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system (CNS) with its etiology still unknown. The fundamental requirement of the disease is the CNS destruction process disseminated in time (DIT) and space (DIS). MR imaging detects focal lesions in white and gray matter with high sensitivity and is the best way to assessbrainatrophy in MS patients. It isunquestionably the best diagnostic tool to follow-up the clinical course of the disease and treatment of MS patients. However, to achieve a diagnosis based on MRI scans, and follow-up MS patients according to the latest standards, an MRI scan has to meet certainquality criteria that are the subject of this work
Small volume of the posterior cranial fossa and arterial hypertension are risk factors of hemifacial spasm
Objectives: So far, there are only two studies evaluating the relation between the small
volume of the posterior cranial fossa (VPCF) and the occurrence of HFS, both on Asian
population. The aim of the study was to determine small VPCF and arterial hypertension
(AH), as risk factors for hemifacial spasm (HFS) and their relation to neurovascular conflict
(NVC) in Polish Caucasian-origin patients.
Materials and methods: The study included 60 patients with idiopathic HFS and 60 healthy
volunteers matched by sex and age. AH was defined according to WHO. The VPCF measured
the volume of the prepontine, prespinal and both cerebellopontine angle cisterns in MRI
scans.
Results: There were no significant differences between occurrence of AH and the VPCF of
patients and controls but the mean VPCF in women was significantly smaller than in men, In
the multivariate regression analysis model only NVC was the statistically significant. In the
subgroup of >50-year-old patients the most dominant risk factor was NVC (OR 71.09; 95% CI
21.08–239.77; p = 0.0000), followed by the AH duration (OR 1.07; 95% CI 1.00–1.16; p = 0.047).
In the subgroup of <50 years, NVC was also the dominant risk factor, followed by the lower
VPCF (Walad test: OR 0.4; 95% CI 0.16–1.04; p = 0.045).
Conclusion: There was no significant difference in VPCF and in frequency of AH diagnosis in
HFS patients and age- and sex-related controls, but the logistic regression analysis showed
that small VPCF and AH duration are risk factors of HFS in younger and older patients
respective
Complex diagnostic imaging of acute ischemic stroke - case study
Wstęp. Udar niedokrwienny jest trzecią pod względem częstości przyczyną zgonów w krajach rozwiniętych. W obliczu
możliwości leczenia trombolitycznego istotna jest prawidłowa kwalifikacja pacjentów, a najlepszymi kandydatami do trombolizy
są ci chorzy, u których strefa penumbry znacznie przewyższa obszar zawału.
Opis przypadku. W pracy przedstawiono opis przypadku pacjenta hospitalizowanego z powodu objawów udaru niedokrwiennego
w obszarze unaczynienia tętnicy środkowej mózgu (MCA, middle cerebral artery) lewej. Przeprowadzono u niego
badanie tomografii komputerowej (CT, computed tomography) głowy, a następnie perfuzji CT, dyfuzji rezonansu magnetycznego
(DWI, diffusion-weighted imaging) oraz angiografii MR (angio-MR). W badaniu CT uwidoczniono wczesne cechy udaru
niedokrwiennego; w perfuzji CT stwierdzono, że penumbra znacznie przeważa nad zawałem; w angio-MR uwidoczniono
upośledzenie przepływu w tętnicy szyjnej wewnętrznej (ICA, internal carotid artery) i MCA po stronie lewej. Na podstawie
wykonanej serii badań zrezygnowano z trombolizy systemowej na rzecz dotętniczej.
Wnioski. Protokół diagnostyczny zawierający badanie podstawowe (CT), funkcjonalne (np. perfuzji CT) oraz naczyniowe
(angiografia CT, angio-MR) pozwala zobrazować rozległość zaburzeń niedokrwiennych (penumbra/zawał) i patologię dotyczącą
naczyń, co jest pomocne w kwalifikacji do trombolizy, a zwłaszcza w podjęciu decyzji o sposobie podania preparatu
trombolitycznego.Introduction. Ischemic stroke is the third most frequent cause of death in developed countries. Nowadays, when thrombolytic
treatment is available, a proper qualification of patients is very important and the best candidates to thrombolysis are
the patients in whom area of penumbra is larger than area of stroke.
Case report. We present a case of patient hospitalized due to symptoms of acute ischemic stroke in area of left middle
cerebral artery (MCA) territory. The patient underwent brain computed tomography (CT) followed by perfusion CT (CTP),
magnetic resonance diffusion (DWI) and magnetic resonance angiography (MRA). CT revealed early signs of ischemic
stroke; CTP demonstrated area of penumbra, which predominated over area of infarction; MRA revealed loss of flow within
left internal carotid artery (ICA) and left MCA. Based on performed examinations intraarterial thrombolytic treatment was
indicated, instead of systemic thrombolysis.
Conclusions. Diagnostic protocol consisting of basic (CT), functional (e.g. CTP) and vascular examinations (CT angiography
or MRA) may show extent of ischemic lesion (penumbra/infarction) and vascular pathology, that is helpful in qualification to
thrombolytic treatment, particularly when undertaking decision, which method of thrombolysis should be used
Is hypertension a risk factor of hemifacial spasm?
Objectives
The published data on the relation between arterial hypertension (AH) and hemifacial spasm (HFS) are controversial. The aim of the study was to determine the prevalence of AH in HFS patients and the relation of AH and compression of the brainstem at the region of vasomotor center.
Materials and methods
The study included 60 of primary HFS patients and 60 healthy controls matched by age. AH was defined according to WHO criteria. The vessel compression of the brainstem was measure on MRI scans in selected region of vasomotor center located in the ventro-lateral medulla (VLM), between the pontomedullary junction, retro-olivary sulcus and the root entry zone (REZ) of the IX and X nerves. Modeling and compression severity of the VLM was graded in the 0–3 scale.
Results
The prevalence of AH in HFS patients did not differ significantly from the control group (61.6% vs 45.0%, p=ns). VML compression by vessel was frequently found in HFS patients with AH than without AH (97.2% vs 60.9%, χ2=11.0, p=0.0009). A similar relation was also found in the control group. The higher rate of VML vascular compression was related to the presence of AH in both, HFS patients and control group.
Conclusion
The prevalence of AH in HFS patients does not differ from controls. The VLM compression in HFS patients and controls is related to AH diagnosis. The association between AH and VLM compression is stronger in patients with higher degree of VLM compression
Perfuzja w raku stercza : korelacja pomiędzy p-TK a badaniem histologicznym : opis przypadku
Background: Prostate cancer is the second most common form of cancer among malignant neoplasm for men in Poland, next to lung cancer, as far as frequency is concerned. Incidence of this kind of neoplasm increases by about 3 % annually. In the last decade a growing number of this type of diseases has been observed and its detections are closely related to the development of biochemical (PSA - prostate-specific antigen) and diagnostic imaging technologies. Case Report: A 60-year-old patient was diagnosed in the Oncology Institute because of an increasing level of PSA in his blood. The PSA level in March 2005 was 10,4 ng/ml. There was a slight increase of PSA during the year, up to 1,5 ng/ml (this is less than 25% / year). The patient came for the following check up to repeat the core-needle sextant biopsy, to exclude neoplasmatic process. Before operation the patient's prostate was tested by p-CT. The parametric maps revealed some disturbances of blood flow parameters. Blood flow - BF, blood volume - BV, mean transit time - MTT and permeability surface - PS were noted in the form of their asymmetry within peripheral zone in the right lobe. A pathological focus with increased BF, BV, PS and decreased MTT was revealed on the right side. This examination suggested that neoplasmatic process might be localized in this area. Core needle biopsy taken from the suspicious region revealed prostate cancer. That was also confirmed in histopathology examination after radical prostatectomy. Conclusions: P-CT examination can be performed during classical CT exam and it leads to obtaining morphological and functional data at the same time. P-CT examination allowed us to localize pathological process and helped to continue its verification by other diagnostic methods
Prawostronny łuk aorty : opis dwóch przypadków
Background: A right aortic arch (RAA) is a rare congenital abnormality not always clinically manifested. The most common symptoms include dysphagia, dyspnoea on exertion, stridor, and bronchitis, resulting from a vascular ring around the trachea or esophagus. Asymptomatic cases may be viewed in adulthood. Case report: The report presents two cases of RAA found coincidentally in adult patients diagnosed using conventional chest X- ray and computed tomography (CT). Case 1 presents an abnormal course of the aortic arch, first manifested as dyspnoea in adulthood. Case 2 presents RAA with the right subclavian artery as a separate branch associated with an abnormal course of the left subclavian artery. Asymptomatic esophageal compression was also found. The abnormality was accompanied by numerous atherosclerotic lesions in peripheral vessels. Abnormal blood flow conditions might have contributed to a faster progression of atherosclerosis. Conclusions: RAA may remain asymptomatic for the entire life. Symptoms are caused by compression of the surrounding structures or impaired blood flow. RAA may be associated with malformations of its branches
Rak kory nadnerczy w przedoperacyjnych badaniach obrazowych
Background: Decisions concerning surgical treatment of patients with adrenocortical tumor without hormonal hyperactivity are based on tumor size exceeding 3-6 cm and morphological features of malignancy. The aim of the study was to analyze results of diagnostic imaging in patients with adrenocortical carcinoma (ACC). Material/Methods: Results of diagnostic imaging of 8 patients in whom postoperative pathological examination revealed ACC were analyzed. There were 3 women and 5 men in the analyzed group, with an age range of 32 to 75 years. Imaging was based on US and CT examination supported by MRI in 2 patients. The obtained results were compared with a group of 10 patients with adrenocortical adenoma (ACA). Results are presented as median values and 95% CI. Results: CT results of patients with ACC showed local spread into surrounding fat tissue in 87.5%, adjacent organ invasion in 75%, local lymph node enlargement in 75%, irregular tumor margins in 88%, and heterogeneous structure of all tumors. In patients with ACA, tumor heterogeneity was observed in 40% and local lymph node enlargement in 10%. ACC tumors were significantly larger than ACA ones [77 (66-97) vs. 31 (24-48) mm, respectively, p=0.0002] and more dense [60 (34-85) vs. 16 (10-26) HU, respectively, p=0.0007]. In arterial phase, enhancement of ACC tumors tended to be stronger compared with ACA [81 (29-162) vs. 55 (33-76), p=0.09]. On the basis of CT results, 1 patient was classified as stage II according to Mac Farlane, 6 as stage III, and 1 as stage IV. Intraoperative examination down-staged 2 patients from stage III to stage II. Conclusions: Computed tomography is a method that allows distinguishing adrenocortical adenoma from carcinoma as well as to determine the stage of adrenocortical carcinoma
Recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology for the routinely used magnetic resonance imaging protocol in patients with multiple sclerosis
Magnetic resonance imaging (MRI) is a widely used method for the diagnosis of multiple sclerosis (MS) that is essential for the detection and follow-up of the disease. The Polish Medical Society of Radiology (PLTR) and the Polish Society of Neurology (PTN) present the second version of the recommendations for examinations routinely conducted in magnetic resonance imaging departments in patients with MS, which include new data and practical comments for electroradiology technicians and radiologists. The recommended protocol aims to improve the MRI procedure and, most importantly, to standardise the method of conducting scans in all MRI departments. This is crucial for the initial diagnostics that are necessary to establish a diagnosis as well as monitor patients with MS, which directly translates into significant clinical decisions. MS is a chronic idiopathic inflammatory demyelinating disease of the central nervous system (CNS), the aetiology of which is still unknown. The nature of the disease lies in the CNS destruction process disseminated in time and space. MRI detects focal lesions in the white and grey matter with high sensitivity (with significantly less specificity in the latter). It is also the best tool to assess brain atrophy in patients with MS in terms of grey matter volume and white matter volume as well as local atrophy (by measuring the volume of thalamus, corpus callosum, subcortical nuclei, hippocampus) as parameters that correlate with disability progression and cognitive dysfunctions. Progress in magnetic resonance techniques, as well as the abilities of postprocessing the obtained data, has become the basis for the dynamic development of computer programs that allow for a more repeatable assessment of brain atrophy in both cross-sectional and longitudinal studies. MRI is unquestionably the best diagnostic tool used to follow up the course of the disease and to treat patients with MS. However, to diagnose and follow up the patients with MS on the basis of MRI in accordance with the latest standards, an MRI study must meet certain quality criteria, which are the subject of this paper