Is whole-body trauma MDCT justified in patients in good clinical condition but with dangerous trauma mechanism?

Background: To assess whether whole body MDCT is justified in patients in good clinical condition yet with dangerous trauma mechanism. Material/Methods: The study included 81 patients who were examined between January and July 2008 with wholebody trauma CT protocol. Inclusion into the study was based on a dangerous trauma mechanism and the possibility of an unbiased calculation of the weighted revised trauma score (RTSw). All examinations were performed with 16 row MDCT scanner located in emergency department. The cut off of the RTSw over 6.0 was used to separate the patients in good clinical condition. The CT examinations and medical records of patients were reviewed to assess the number of significant injuries, the need for emergency surgery and other types of medical treatment, the number of negative CT examinations, the number of patients admitted to hospital, and mortality. Results: 28 life-threatening injuries were found in 21 of 61 patients with RTS over 6.0 (34.4%). Only two of those patients required emergency surgery (laparotomy). CT studies were negative for traumatic injuries in 22 patients from this group (36.0%). Conclusions: Whole-body MDCT may detect injuries in patients in good clinical condition, with some of them demanding medical treatment. Still, further studies are required to balance the advantages of MDCT and potentially harmful effects of radiation dose, especially better triage systems and lowdose protocols are needed

Brain activity underlying response induced by SNARC-congruent and SNARC-incongruent stimuli

At least three well‑documented phenomena indicate a relationship between numbers and the internal representation of space. They are shifting attention in accordance with the localization of numbers on the mental number line (MNL); the spatial‑numerical association of response codes (SNARC) effect, which manifests as faster responses to high numbers with the right hand than with the left, and vice versa for low numbers; and the processing of both numbers and space primarily in the parietal cortex. Some EEG studies have pointed to the response selection stage as a locus of this effect. However, this explanation has yet to be corroborated by the fMRI experiments.The goal of this study was to investigate the functional anatomy underlying response selection induced by SNARC‑congruent and SNARC-incongruent stimuli in a spatial visual cueing task. Healthy adult volunteers responded to a pair of target stimuli consisting of digits, non-digit symbols, or a mix of both. In each trial, the stimuli were preceded by a centrally presented numerical or non-numerical cue stimulus which was required to be memorized. One of the target stimuli that then appeared would be identical to the cue; the task was to determine which side it was presented on, within the pair. In the case of numerical stimuli, the side was congruent with its localization on the MNL in one‑half of the trials. In the other half of the trials, it was incongruent. The behavioral results revealed the SNARC effect, as well as a faster reaction to low numbers than to high numbers. The fMRI responses to the target stimuli showed engagement of regions implicated in number processing but also in sensory-motor areas. This suggests that the motor response selection or execution stage may be the locus of the SNARC effect. Yet, the activation pattern obtained in the congruent and incongruent conditions did not allow us to determine, indisputably, the neural correlates of the mechanisms involved in the SNARC effect. Moreover, we did not observe any stimulus-specific responses to cues

Profil hormonalny u kobiet chorych na stwardnienie rozsiane w powiązaniu z aktywnością choroby — doniesienie wstępne

Background and purpose The influence of sex hormones on immune system activity in multiple sclerosis (MS) has been suggested by clinical evidence. The aim of the study was to analyse the pattern of sex hormones in MS women and to correlate the hormone pattern abnormalities to the disease course as well as to the magnetic resonance imaging (MRI) results. Material and methods We studied the serum level of the progesterone, β-oestradiol and prolactin in 46 women with clinical definite MS aged from 19 to 65; mean disease duration was 11.80 ± 9.86 years. The evaluation of the intensity of hormonal changes was done using a scoring system (0–3). On the brain MRI, the presence of brain atrophy, of hypothalamic demyelination as well as demyelination intensity (or degree) were analysed. The evaluation of the degree of demyelination and brain atrophy was done using a scoring system (0–4). Results The main hormonal abnormalities consisted of decreased progesterone level, increased oestradiol level or both. The sex hormone pattern was abnormal in 56% of patients. Hypothalamic lesions were found on MRI in 53% of cases. The abnormal hormonal pattern correlated with intensity of MR changes (p < 0.05, Fisher's exact test), but neither with presence of hypothalamic changes nor with disease parameters (Expanded Disability Status Scale, relapse rate, disease duration). Conclusions It is important to check the hormonal pattern in MS women because according to our results it may be related to the disease activity and probably affects the type of therapeutic intervention. This pilot study will be extended in a larger population.Wstęp i cel pracy Dane z piśmiennictwa sugerują częste występowanie zaburzeń hormonalnych u kobiet chorych na stwardnienie rozsiane (SR). Celem pracy była analiza profilu hormonalnego w zakresie hormonów płciowych u kobiet z SR w powiązaniu z przebiegiem klinicznym i obrazem rezonansu magnetycznego (RM) mózgowia. Materiał i metody Badano stężenie progesteronu, β-estradiolu i prolaktyny w surowicy u 46 pacjentek z klinicznie pewnym SR, w wieku od 19 lat do 65 lat, o średnim czasie trwania choroby 11,80 ± 9,86 roku, niestosujących żadnej terapii hormonalnej. Stopień zmian w profilu hormonalnym oceniano półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—3).W analizie RM brano pod uwagę obecność ognisk demielinizacji w obrębie struktur podwzgórza, nasilenie demielinizacji w obrębie mózgowia oraz współistnienie zaniku mózgu. Stopień zmian w RM oceniano także półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—4). Wyniki Nieprawidłowe stężenia hormonów stwierdzono u 26 pacjentek (56%). Nieprawidłowości polegały na zmniejszonym stężeniu progesteronu, zwiększonym stężeniu 17-β-estradiolu bądź na łącznym występowaniu obu tych zaburzeń. W badaniu RM w 53% przypadków stwierdzono obecność zmian demielinizacyjno-zapalnych w obrębie podwzgórza. Stopień zaburzeń hormonalnych oceniany półilościowo korelował ze stopniem zmian w RM mózgowia (p < 0,05; test dokładny Fishera), nie był natomiast związany z obecnością zmian w obrębie podwzgórza czy parametrami klinicznymi (punktacja w Expanded Disability Status Scale, częstość rzutów, czas trwania choroby). Wnioski Stan hormonalny kobiet chorych na SR powinien być brany pod uwagę w analizie klinicznej choroby i przy decyzjach terapeutycznych, gdyż wydaje się mieć związek z aktywnością SR. Badania te, w celu potwierdzenia uzyskanych wyników, należy kontynuować na szerszym materiale

Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma : is it useful?

Purpose: Primary fallopian tube carcinoma (PFTC) is the rarest form of female genital malignancy. The imaging applied for suspected adnexal masses includes transvaginal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), but the vast majority of PFTC is recognised intraoperatively. Material and methods: The study group consisted of seven women with postoperatively histopathological diagnosis of PFTC. To recognise characteristic findings for PFTC, retrospective analysis of preoperative MRI was performed. All patients underwent MRI of the pelvis and abdomen using a 1.5T MR system. Based on the results of the above imaging, suspected adnexal masses were recognised. MRI protocol contained T2-weighted images, fat-suppressed T2-weighted, T2-TIRM, DW EPI, pre- and postcontrast dynamic 3D T1 GRE in transverse orientation, with diffusion weightings of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2. Regions of interest were outlined by a radiologist, who documented the character of adnexal masses on diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps. Results: In all seven patients with PFTC unilateral tumour was found. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of solid parts of tumour were significantly higher than the mean signal intensities of normal ovarian tissue (p = 0.0001). There were no statistically significant differences between eight b values applied for ADC calculations. Conclusions: Preoperative diagnostics of PFTC is difficult and mainly based on morphological features. Previous research did not show characteristics of PFTC in post-contrast dynamic imaging. In our material a clear increasing of signal intensity in DW imaging occurred independently of the b value

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%

Diffusion-Weighted Imaging of Small Peritoneal Implants in “Potentially” Early-Stage Ovarian Cancer

Introduction. MRI is established modality for the diagnosis of ovarian malignancies. Advances in MRI technology, including DW imaging, could lead to the further increase in the sensitivity of MRI for the detection of peritoneal metastases. The aim of this study was to assess the accuracy of DW imaging for detection of peritoneal metastatic disease in patients suspected of having potentially early ovarian cancer and secondly to evaluate ADC values of peritoneal implants. Materials and Methods. The prospective study group consisted of 26 women with sonographic or/and CT diagnosis of suspected ovarian tumor. Based on the results of the above imaging, in none of them was extraovarian spread of disease or ascites recognized. All patients underwent MRI with DW imaging. Results. Overall, 18 extraovarian peritoneal lesions were found on DW images in 10 from 26 examined patients. All implants had diameter ≤10 mm. The presence of all lesions diagnosed by MRI was confirmed intraoperatively. Histopathologic findings in 17 proofs confirmed ovarian cancer. PPV was 94%. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of peritoneal lesions were significantly higher than the mean signal intensities of normal adjacent tissue (p=0.000001)

The Value of Magnetic Resonance Diffusion-Weighted Imaging and Dynamic Contrast Enhancement in the Diagnosis and Prognosis of Treatment Response in Patients with Epithelial Serous Ovarian Cancer

Background. The aim of our study was to describe the selected parameters of diffusion-weighted imaging (DWI) and perfusion dynamic contrast enhancement (DCE) MRI in primary tumors in patients with serous epithelial ovarian cancer (EOC), as well as in disease course prognosis and treatment response, including bevacizumab maintenance therapy. Materials and Methods. In total, 55 patients with primary serous EOC were enrolled in the study. All patients underwent MR imaging using a 1.5 T clinical whole-body MR system in preoperative DWI and DCE MRI selected parameters: apparent diffusion coefficients (ADC), time to peek (TTP) and perfusion maximum enhancement (Perf. Max. En.) were measured. The data were compared with histopathological and immunochemistry results (with Ki67 and VEGF expression) and clinical outcomes. Results. Higher mean ADC values were found in low-grade EOC compared to high-grade EOC: 1151.27 vs. 894,918 (p < 0.0001). A negative correlation was found between ADC and Ki67 expression (p = 0.027), and between ADC and VEGF expression (p = 0.042). There was a negative correlation between TTP and PFS (p = 0.0019) and Perf. Max. En. and PSF (p = 0.003). In the Kaplan–Meier analysis (log rank), a longer PFS was found in patients with ADC values greater than the median; p = 0.046. The Kaplan–Meier analysis showed a longer PFS (p = 0.0126) in a group with TTP below the mean value for this parameter in patients who received maintenance treatment with bevacizumab. Conclusions. The described relationships between PFS and DCE and DWI allow us to hope to include these parameters in the group of EOC prognostic factors. This aspect seems to be of particular interest in the case of the association of PFS with DCE values in the group of patients treated with bevacizumab

Sex, lies and fMRI--gender differences in neural basis of deception.

Deception has always been a part of human communication as it helps to promote self-presentation. Although both men and women are equally prone to try to manage their appearance, their strategies, motivation and eagerness may be different. Here, we asked if lying could be influenced by gender on both the behavioral and neural levels. To test whether the hypothesized gender differences in brain activity related to deceptive responses were caused by differential socialization in men and women, we administered the Gender Identity Inventory probing the participants' subjective social sex role. In an fMRI session, participants were instructed either to lie or to tell the truth while answering a questionnaire focusing on general and personal information. Only for personal information, we found differences in neural responses during instructed deception in men and women. The women vs. men direct contrast revealed no significant differences in areas of activation, but men showed higher BOLD signal compared to women in the left middle frontal gyrus (MFG). Moreover, this effect remained unchanged when self-reported psychological gender was controlled for. Thus, our study showed that gender differences in the neural processes engaged during falsifying personal information might be independent from socialization

Diffusion-Weighted Imaging of Small Peritoneal Implants in (Potentially) Early-Stage Ovarian Cancer

Introduction. MRI is established modality for the diagnosis of ovarian malignancies. Advances in MRI technology, including DW imaging, could lead to the further increase in the sensitivity of MRI for the detection of peritoneal metastases. The aim of this study was to assess the accuracy of DW imaging for detection of peritoneal metastatic disease in patients suspected of having potentially early ovarian cancer and secondly to evaluate ADC values of peritoneal implants. Materials and Methods. The prospective study group consisted of 26 women with sonographic or/and CT diagnosis of suspected ovarian tumor. Based on the results of the above imaging, in none of them was extraovarian spread of disease or ascites recognized. All patients underwent MRI with DW imaging. Results. Overall, 18 extraovarian peritoneal lesions were found on DW images in 10 from 26 examined patients. All implants had diameter ≤10 mm. The presence of all lesions diagnosed by MRI was confirmed intraoperatively. Histopathologic findings in 17 proofs confirmed ovarian cancer. PPV was 94%. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm 2 ) the mean signal intensities of peritoneal lesions were significantly higher than the mean signal intensities of normal adjacent tissue ( = 0.000001)