The value of the heavily T2-weighted sequence in evaluation of the cisternal and petroclival segment of the abducent nerve

The purpose of the study was to evaluate the usefulness of magnetic resonance (MR) in imaging of the cisternal and petroclival segments of the abducent nerve. Heavily T2-weighted submillimetric 3D sequence in axial plane, T1-weighted 3D, 1.5 mm slice thickness sequence in axial plane and TOF sequence were performed on 16 volunteers. Additionally the reformatted T2-weighted images in sagittal and in oblique parasagittal plane parallel to the abducent nerve in the pontine cistern were performed. The heavily T2-weighted sequence provides high contrast between fluid and other structures. High signal intensity of the cerebrospinal fluid is a kind of background for cranial nerves, vessels, meninges as well as for bony and fibrous structures. The authors identified the abducent nerve in at least one plane of the submillimetric, heavily T2-weighted sequences in 84.4% cases (in 84.4% in axial plane, 68.8% in sagittal and 84.4% parasagittal parallel to the VI-th cranial nerve in the pontine cistern). Dorello™s canal was identified in 27/32 abducent nerves (84.4%) on the submillimetric, heavily T2-weighted sequence in parasagittal parallel to the abducent nerve in the pontine cistern plane. In 71.9% (23/32) of cases, the abducent nerve was in contact with the arterial vessel in pontine cistern

The role of magnetic resonance imaging in the diagnosis of breast cancer

MR mammography is a highly sensitive (> 98%) and slightly lower specificity (> 80%) method of detecting breast cancer. The sensitivity of MR mammography in detecting low or medium grade DCIS is lower than in detecting inva­sive carcinomas and high grade DCIS. Achieving the high efficacy of MR mammography is only possible with a very good quality MR examination; this however is not always easy to accomplish. According to EUSOBI 2015 recommendations, the indications for breast MRI are: screening women with a high risk of breast cancer; preoperative staging of newly diagnosed breast cancer; evaluating the response to neoadjuvant chemotherapy; occult primary breast carcinoma (searching for breast cancer in patients with metastases and negative mammography and breast ultrasound); suspected local recurrence whenever needle biopsy proves impossible; assessing breast implants; further characterisation of equivocal lesions found by mammography/breast ultrasound, whenever needle biopsy proves impossible. The introduction of Digital Breast Tomosynthesis (DBT) and contrast-enhanced spectral mammography (CESM) into daily clinical practice in the recent years has created the need to re-analyse the indications for MR mammography and to develop a new breast cancer diagnostic imaging algorithm

The role of longitudinal shortening in the general pattern of heart left ventricle contraction

This paper constitutes a report of our experience in the assessment of left ventricle contraction using MRI (Philips 0,5T Gyroscan T5/II) and includes a suggestion of the study method directed towards establishing the role of different patterns of ventricle contraction in general ventricle function. In 29 patients, 22 men and 7 women, (average age 55.3) with history of myocardial infarction, electrocardiographically gated MR images encompassing the entire heart in the anatomic long and short axis planes were acquired. Significant positive correlations between long axis shortening and area length ejection fraction were found on four chamber view images: r = 0.605 at

Rola mammografii metodą rezonansu magnetycznego w diagnostyce raka piersi

Mammografia MR jest metodą o wysokiej czułości (> 98% ) i niższej swoistości (> 80%) w wykrywaniu raka piersi. Czułość mammografii MR w wykrywaniu DCIS o niskim i pośrednim stopniu złośliwości jest niższa niż w wykrywaniu raka inwazyjnego i DCIS o wysokim stopniu złośliwości. Warunkiem wysokiej skuteczności mammografii MR jest bardzo dobra — niestety, nie zawsze łatwa do uzyskania — jakość badania. Główne wskazania do mammografii MR (Rekomendacje EUSOBI 2015) to: skrining kobiet z grup wysokiego ryzyka zachorowania na raka piersi; przedoperacyjna ocena stopnia zaawansowania zmian w piersiach u kobiet z rozpozna­nym rakiem piersi; ocena skuteczności neoadiuwantowej chemioterapii; poszukiwanie raka piersi u kobiet mających przerzuty, negatywny wynik mammografii i USG — ukryty rak piersi (occult primary breast cancer); podejrzenie wznowy miejscowej — jeżeli nie może być wykonana biopsja; ocena implantów; lepsza charakterystyka zmian niejednoznacznych w mammografii i USG, jeżeli nie może być wykonana biopsja. Wprowadzenie w ostatnich latach do codziennej praktyki klinicznej tomosyntezy (DBT — digital breast tomosynthesis) oraz mammografii spektralnej po dożylnym podaniu jodowego środka kontrastującego wymaga ponownego prze­analizowania wskazań do mammografii MR oraz określenia algorytmu diagnostycznego u kobiet z podejrzeniem lub rozpoznaniem raka piersi

Rola czynnościowego rezonansu magnetycznego w ograniczeniu pooperacyjnych deficytów neurologicznych u chorych na guzy mózgu

Background and purpose The purpose of the study was to compare the results of operative treatment of tumours located in the sensory-motor cortex guided with functional magnetic resonance imaging (fMRI) combined with the neuronavigation system to the results of classical operative treatment. Material and methods The studied group comprised 28 patients with a tumour located in the sensory-motor cortex area who underwent surgery guided with fMRI and the neuronavigation system. A control group comprised 30 patients with the same clinical diagnosis, operated on without functional neuronavigation. Results The use of functional neuronavigation allowed for an 18% reduction in the intensity of neurological deficits after surgical treatment in patients from the studied group, compared to the subjects from the control group (p = 0.0001). In the patients with diagnosed high-grade glioma, improvement in the neurological condition in the studied group was 16% (p = 0.03). The initial neurological condition and the results of surgical treatment in patients with a tumour located less than 5 mm from the sensory-motor cortex, determined in fMRI examination, are worse than in patients with a tumour located more than 5 mm. Conclusions In patients with a diagnosed brain tumour in the sensory-motor cortex who have neurological deficits, fMRI provides valuable imaging data on active areas. Tumour location of more than 5 mm from the fMRI active area of the sensory-motor cortex is connected with a considerably lower risk of postoperative neurological deficits. Removing a tumour in the sensory-motor cortex region, guided with fMRI and the neuronavigation system, considerably lowers the risk of postoperative development or exacerbation of neurological deficits.Wstęp i cel pracy Celem pracy było porównanie wyników leczenia chorych z guzami okolicy kory czuciowo-ruchowej operowanych przy użyciu czynnościowego rezonansu magnetycznego (fMRI) i neuronawigacji z wynikami uzyskanymi przed wprowadzeniem tych metod. Materiał i metody Grupa badana składała się z 28 chorych z guzem mózgu w okolicy kory czuciowo-ruchowej, których operowano z wykorzystaniem fMRI w połączeniu z systemem neuronawigacji. Grupę kontrolną stanowiło 30 chorych z analogicznym rozpoznaniem, operowanych bez użycia neuronawigacji czynnościowej. Wyniki Zastosowanie neuronawigacji czynnościowej pozwoliło na zmniejszenie o 18% częstości występowania deficytów neurologicznych pojawiających się po operacji w grupie badanej w porównaniu z chorymi z grupy kontrolnej (p = 0,0001). W grupie chorych z nisko zróżnicowanymi guzami pochodzenia glejowego wyniki pod względem pooperacyjnego stanu neurologicznego były lepsze o 16% (p = 0,03). Wykazano także, że wyjściowy stan neurologiczny i wyniki leczenia operacyjnego są gorsze u chorych z guzem położonym w odległości mniejszej niż 5 mm od pola aktywności kory ruchowej wyznaczonej w fMRI. Wnioski Czynnościowy rezonans magnetyczny pozwala na uzyskanie klinicznie przydatnych obrazów pól aktywności u pacjentów z guzami w okolicy kory czuciowo-ruchowej mózgu. Lokalizacja guza w odległości ponad 5 mm od pola aktywności wiąże się ze zmniejszeniem ryzyka wystąpienia pooperacyjnych deficytów neurologicznych. Zastosowanie neuronawigacji z fMRI w znaczący sposób zmniejsza ryzyko wystąpienia lub nasilenia się w okresie pooperacyjnym deficytów neurologicznych

Can the application of computed tomography laser mammography (CTLM) in dense breast (category 3,4 according to ACR) examinations combined with x-ray mammography enhance the detection of breast cancer?

Background: The aim of this study was an attempt to answer the question whether laser mammography in dense breast (classified as category 3,4 according to ACR) examination together with x-ray mammography can enhance the detection of breast cancer. Material/Method: 248 women who had undergone a CTLM examination and mammography in the Department of Radiology of Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in the years 2005-2007 were analyzed retrospectively. In these examinations, x-ray mammography did not reveal lesions (BIRADS 1, category 3 and 4 according to ACR). An interval between CTLM and mammography did not exceed 30 days. The examination result was verified by cytology/histopathology or observation after a minimum of 12 months provided a regular result. CTLM visualizes normal and pathological blood vessels and tissues which are rich in blood, because laser rays used in CTLM (808nm) are more absorbable by hemoglobin than by the surrounding tissue, making it possible to show a malignant tumor by its accompanying angiogenesis. The result of CTLM mammography was qualified either as the presence (+) or absence (–) of angiogenesis. Results: Among 248 women, angiogenesis was discovered by CTLM in 48 cases, in the CTLM (+) Group 13/48 women were diagnosed with breast cancer, whereas 35/48 were diagnosed with benign lesions. Angiogenesis was not identified in 200 women, in the CTLM (-) group 13/200 were diagnosed finally with cancer, with 187/200 patients having no malignancy. Ultimately, in the group of 248 women (with dense breast, category 3 and 4 according to ACR), in whom x-ray mammography did not reveal malignant processes (BIRADS 1), 26 cancers were detected out of which 13 were revealed with CTLM Conclusions: Computed Tomography Laser Mammography, when used as an adjunct to x-ray mammography, enhances the detection of breast cancer in women with dense breast tissue

Surgical treatment and prognosis of adult patients with brainstem gliomas

The paper presents 47 adult patients who were surgically treated due to brainstem gliomas. Thirteen patients presented with contrast-enhancing Grades III and IV gliomas, according to the WHO classification, 13 patients with contrast-enhancing tumours originating from the glial cells (Grade I; WHO classification), 9 patients with diffuse gliomas, 5 patients with tectal brainstem gliomas and 7 patients with exophytic brainstem gliomas. During the surgical procedure, neuronavigation and the diffusion tensor tractography (DTI) of the corticospinal tract were used with the examination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) with direct stimulation of the fundus of the fourth brain ventricle in order to define the localization of the nuclei of nerves VII, IX, X and XII. Cerebellar dysfunction, damage to cranial nerves and dysphagia were the most frequent postoperative sequelae which were also the most difficult to resolve. The Karnofsky score established preoperatively and the extent of tumour resection were the factors affecting the prognosis. The mean time of progression-free survival (14 months) and the mean survival time after surgery (20 months) were the shortest for malignant brainstem gliomas. In the group with tectal brainstem gliomas, no cases of progression were found and none of the patients died during the follow-up. Some patients were professionally active. Partial resection of diffuse brainstem gliomas did not prolong the mean survival above 5 years. However, some patients survived over 5 years in good condition

Surgical treatment of adult patients with thalamic tumors with the aid of tractography, fMRI, transcranial electrical stimulation and direct electrical stimulation of the subcortical white matter

The aim of investigation was to assess treatment outcomes in adult patients with thalamic tumors, operated on with the aid of tractography (DTI) and monitoring of motor evoked potentials (MEPs) generated due to transcranial electrical stimulation (TES) and direct electrical stimulation (DES) of the subcortical white matter.38 subsequent patients with thalamic tumors were operated on using tractography (DTI)- integrated neuronavigation, transcranial electrical stimulation (TES) and direct electrical stimulation (DES). The volumetric method was used to calculate pre- and postoperative tumor volume.Total tumor resection (100%) was performed in 18 (47%) patients, subtotal in 9 (24%)(mean extent of resection 89.4%) and partial in 11 (29%) patients (mean extent of resection 77.18%). The mean extent of resection for all surgical patients was 86.5%.Two (5.2%) patients died postoperatively. Preoperative hemiparesis was present in 18(47%) patients. Postoperative hemiparesis was observed in 11 (29%) patients of whom only in 5 (13%) new paresis was noted due to surgical intervention. In patients with hemiparesis significantly more frequently larger tumor volume was detected preoperatively. Low mean normal fractional anisotropy (nFA) values in the internal capsule were observed statistically significantly more frequently in patients with preoperative hemiparesis as compared to the internal capsule of the unaffected hemisphere. Transcranial electrical stimulation helps to predict postoperative paresis of extremities. Direct electrical stimulation is an effective tool for intraoperative localization of the internal capsule thus helping to avoid postoperative deficit.In patients with tumor grade I and II the median time to tumor progression was 36months. In the case of patients with grades III and IV it was 14 months. The median survival time in patients with grades I and II it was 60 months. In patients with grades III and IV it was 18 months. Basing on our results, patients with glioma grade I/II according to WHO classification are the best candidates for surgical treatment of thalamic tumors. In this group of the patients more often resection is radical, median time to progression and survival time are longer than in patients with gliomas grade III and IV. Within a 7-year follow-up none of the patients with GI/GII grade glioma died

Localisation of focal liver lesions to specific hepatic segments - comparison of multiphase spiral CT and MR imaging

The purpose of this study was an evaluation of the ability of the mulitiphase spiral CT and MR imaging to localise focal liver lesions referring to specific hepatic segments. The authors studied prospectively 26 focal liver lesions in 26 patients who had undergone spiral CT and MRI before surgery. Multiphase spiral CT included noncontrast scans, hepatic arterial-dominant phase, portal venous - dominant phase and equilibrium phase. MRI was performed in all cases. The following sequences were performed: SE and TSE T1- and T2-weighted images, STIR and dynamic T1-weighted FFE study after i.v. administration of gadolinium (Gd-DTPA). The CT and MR scans were prospectively and independently reviewed by three radiologists for visualisation of hepatic and portal veins and segmental localisation of hepatic lesions. The authors used the right and left main portal veins along with transverse fissura, hepatic veins and gallbladder fossa as landmarks for the tumour localisation to specific hepatic segments. The primary segmental locations of the lesions were correctly determined with CT in 22 of 26 focal liver lesions (85%) and with MR imaging in 24 of 26 lesions (92%). The full extent of lesions was correctly described with sCT in 19 of 26 focal lesions and with MR in 21 of 26 tumours. MRI and CT were helpful preoperative tools for determining the segmental location of focal liver lesions and for planning the surgical approach

Do the asymmetry and the size of the structures of the temporal lobe persist in early stages of schizophrenia?

A total of 14 patients of various ages diagnosed with schizophrenia and, as an age-matched control group, 12 healthy subjects were examined using the MRI method of neuro-imaging. The volume of the following structures was evaluated in the right and left hemispheres: the superior temporal gyrus, the basolateral temporal area (the region including the middle temporal gyrus, inferior temporal gyrus and fusiform gyrus), the parahippocampal gyrus, the hippocampal head, the amygdaloid body and the inferior horn of the lateral ventricle. In schizophrenia a significant increase in the volume of the amygdaloid body on both the left and right sides was observed. In the patients, as in the control group, we noticed significant asymmetry between the left and right sides in the volume of the structures studied. The left amygdaloid body was significantly larger than the right, whereas the left hippocampal head and the temporal horn of the lateral ventricle were smaller than the right. Our findings suggest that in the early stages of schizophrenia, despite the increased volume of the amygdaloid body, the asymmetry between the structures of the temporal lobe is still present. However, the changes observed in the temporal lobe could be related to the functional disturbances observed in this disease