Orbital size measurement based on computed tomography imaging for surgical safety

Determining the orbital size makes it possible to manoeuvre safely within theorbit during a surgical procedure. Based on the measurements performed ona multi-layer head computed tomography images, the length was determined of the medial, superior, inferior and lateral orbital walls. Also angles were determined between the superior and inferior walls, between the medial and lateral walls, between the inferior wall and Frankfurt plane and between the anterior and posterior segments of the orbital wall. With these measurements it was possible to establish that the safe space for surgical exploration of the orbit (that is the space between the orbital margin and optic canal) is approximately 40 mm. Moreover, it was determined that the medial wall is parallel to the vertical axis of the body and that the angle between the inferior wall and the Frankfurt plane is 19.7°. The angle between the posterior segment of the inferior wall (posterior to the inferior orbital fissure) and the anterior segment is 130.8°. These data will significantly increase the safety of orbital surgeries

Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study.

The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks-16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children

Neuroimaging of acute ischaemic stroke in clinical practice

Metody neurobrazowania stanowią wiodący element diagnostyki nadostrej fazy udaru niedokrwiennego mózgu i odgrywają kluczową rolę w kwalifikacji chorych do terapii trombolitycznej — najskuteczniejszej metody leczenia udaru niedokrwiennego mózgu. Do standardowych metod diagnostycznych stosowanych w pierwszych godzinach od wystąpienia udaru mózgu należą: tomografia komputerowa (CT), rezonans magnetyczny (MRI,), angiografia CT i MRI (angio-CT/MRI), badania doplerowskie oraz opcjonalnie angiografia subtrakcyjna. Zastosowanie tych metod pozwala w sposób czuły i specyficzny diagnozować ostre incydenty mózgowo-naczyniowe. Szczególną przydatnością w diagnostyce wczesnych zmian niedokrwiennych cechuje się badanie MRI z oceną perfuzji i dyfuzji, pozwalające wykryć ognisko niedokrwienia już w pierwszych minutach choroby. Spośród metod czynnościowej oceny przepływu mózgowego szczególnie pomocna jest przezczaszkowa ultrasonografia doplerowska (TCD), która pozwala na nieinwazyjną ocenę przepływu krwi w naczyniach mózgowych w czasie rzeczywistym. W niniejszym artykule autorzy przedstawiają szczegółowy przegląd metod neuroobrazowania aktualnie stosowanych w diagnostyce i terapii ostrej fazy udaru niedokrwiennego mózgu.Neuroimaging techniques are the leading element in the diagnosis of acute ischaemic stroke and play the key role in qualifying patients for thrombolytic therapy, which is the most effective method for the treatment of ischaemic stroke. Diagnostic standards for the acute phase of ischaemic stroke recommend the use of CT (computer tomography), MRI (magnetic resonance imaging), angio-CT/MRI (CT/MRI angiography), Doppler ultrasound and, optionally, DSA (digital subtraction angiography). The use of these techniques allows for a detailed and specific diagnosis of acute cerebrovascular episodes. Diffusion- and perfusion-weighted MRI, enabling the detection of ischaemia at the very early stages of the disease is particularly useful in the diagnosis of the acute phase of ischaemic stroke. One of the useful methods for the functional assessment of cerebral flow is transcranial Doppler (TCD), which enables real-time non-invasive monitoring of blood flow in the brain vessels. In this paper the authors present a detailed overview of neuroimaging techniques currently used for the diagnosis and treatment of the acute phase of ischaemic stroke

An algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion-weighted magnetic resonance images: a retrospective analysis of 158 cases

Background: To verify the usefulness of a new algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion- -weighted magnetic resonance imaging (MRI). Materials and methods: The retrospective analysis included 158 consecutive surgical patients with parotid tumours. Aside from ultrasound-guided fine needle biopsy, the protocol of preoperative evaluation included dynamic and diffusion-weighted MRI. According to the new diagnostic algorithm, the result of fine needle biopsy was considered only in the case of lesions with time to peak enhancement (Tpeak) > 60 s and washout rate (WR) ≤ 30% on dynamic MRI and apparent diffusion coefficient (ADC) ≤ 1.7 × 103 mm/s2 on diffusion-weighted MRI, or those presenting with concomitant lymphadenopathy. The accuracy of this algorithm was verified against final histopathological diagnoses. Results: The new algorithm gave 10 true positive and 2 false positive results, as well as 132 and 14 true and false negative results, respectively. Its sensitivity and specificity (41.7% and 98.5%, respectively) were the same as in the case of fine needle biopsy alone. None of the 59 tumours that were qualified as benign solely on the basis of preoperative MRI turned out to be malignant on postoperative histopathological examination. Conclusions: Interpreted together, dynamic and diffusion-weighted MRIs provide the same accuracy in preoperative differential diagnostics of parotid tumours as fine needle biopsy. This substantiates the use of diagnostic algorithms in which biopsy would serve mostly as a secondary test to verify selected ambiguous radiological diagnoses. (Folia Morphol 2018; 77, 1: 29–35)

Przydatność poszczególnych faz wielofazowej spiralnej tomografii komputerowej w wykrywaniu przerzutów nowotworowych do wątroby

Background: In view of the constant progress in methods of treating liver metastases, new standards for radiological examinations must be developed. The purpose o f this study was to evaluate the ability of sequential phases of multiphase spiral CT (sCT) to detect liver metastases and their segmental localization. Material/Methods: sCT was performed on 100 patients with hepatic metastases. sCT included unenhanced scans (NC) and those o f the hepatic arterial-dominant (HAP), portal venous-dominant (PVP), and equilibrium phases (EP). In each phase, the number, size o f detectable lesions, and the accuracy of the topographic report of lesion location in liver segments were evaluated. Patients with primary cancer of the gastrointestinal tract constituted almost 70% of the group. Results: A total of 354 liver metastases were detected by sCT. PVP revealed 346 (97.7%), HAP 298 (84.2%), and EP 241 (68.1%) secondary lesions. NC scans revealed 195 metastases (55.1%) when evaluated in the 'abdominal window'. The exact localization of metastases in liver segments was established in PVP in 88% o f cases, in HAP 76%, in EP 70%, and in the NC phase in 71% of cases. Lesion diameter ranged from 4 to 127 mm (median: 21 mm). Lesions of more than 30 mm in diameter were clearly detectable in each phase of the CT examination. Conclusions: PVP in sCT has the highest sensitivity in detecting liver metastases and contributes to the most adequate segmental localization. In the standard diagnosis of liver metastases, biphasic examination including HAP and PVP should be performed

Imaging methods in hepatocellular carcinoma

Hepatocellular cancer (HCC) is the third most common cause of cancer-related death. Ultrasonography reveals 75–90% of HCC lesions in cirrhotic patients. Ambiguous and non-characteristic appearance of HCC lesions in this examination results in low efficacy of early detection. Multiphase computer tomography (CT) is a recommended method of assessment of HCC. Arterial and venous-portal phases allow to visualize most of HCC and equilibrium phase provides prognostic information. Dynamic contrast- enhanced magnetic resonance imaging (MR) after contrast medium administration is conducted similarly to computer tomography examination. Arterial phase allows to detect hipervascular lesions, as most of HCC, and venous-portal phase permits to assess lesions with poor arterial supply. The sensitivity of MR examination is slightly higher than CT’s and rises after hepatotropic contrast medium infusion. Enhancement in hepatocyte-specific phase is possible only within normal hepatocytes, thus no enhancement expose pathological liver cells. Moreover, 20% of HCC lesions smaller than 2 cm has non typical arterial phase enhancement and their identification is possible only in hepatocyte-specific phase. Barcelona Clinic Liver Cancer Group guidelines allow to diagnose HCC in cirrhotic patients, without the need for biopsy, on basis of typical radiological features in dynamic CT-scan or MR study: intensive enhancement in arterial phase and persistent ‘washout’ of contrast medium from HCC lesion in venous-portal and equilibrium phases. Onkol. Prak. Klin. 2011; 7, 2: 73–83Rak wątrobowokomórkowy (HCC) jest trzecią pod względem częstości przyczyną zgonów z powodu choroby nowotworowej. Czułość rozpoznawania HCC w ultrasonografii u chorych z marskością wątroby ocenia się na poziomie 75–90%. Trudności wczesnego rozpoznania HCC w tym badaniu wynikają z braku jednoznacznych różnicujących cech tego nowotworu, zwłaszcza gdy rozwija się on w przebiegu marskości. Polecanym badaniem w wykrywaniu HCC jest tomografia komputerowa (CT) z obrazowaniem w fazach tętniczej, żylnej wrotnej i równowagi. Fazy tętnicza i żylna wykrywają większość HCC, a faza równowagi służy ocenie dodatkowych czynników prognostycznych. Badanie dynamiczne rezonansu magnetycznego (MR) po dożylnym podaniu środka kontrastującego przeprowadza się analogicznie do badania CT: faza tętnicza służy do uwidocznienia zmian dobrze unaczynionych, do których należy większość HCC, zaś żylna wrotna do oceny ognisk ubogo unaczynionych. Czułość badania MR jest nieznacznie większa od czułości CT i wzrasta po zastosowaniu hepatotropowych środków kontrastowych. Wzmocnienie w fazie hepatocytarnej dotyczy prawidłowych hepatocytów, a jego brak jest objawem występowania patologicznych komórek wątrobowych. Dwadzieścia procent HCC o wymiarze mniejszym niż 2 cm nie ulega wzmocnieniu w sposób typowy w fazie tętniczej, ale dzięki niskiemu sygnałowi w fazie hepatocytarnej możliwe jest ich rozpoznanie. Kryteria barcelońskie pozwalają na rozpoznanie HCC u chorych z marskością wątroby bez konieczności wykonywania biopsji, jedynie na podstawie cech radiologicznych w badaniu dynamicznym CT albo MR (intensywne wzmocnienie w fazie tętniczej i wypłukiwania środka kontrastującego z ogniska HCC w fazie żylnej wrotnej lub równowagi). Onkol. Prak. Klin. 2011; 7, 2: 73–8