Arterial spin labeling in neonatal magnetic resonance imaging - first experience and new observations.

PURPOSE: Arterial spin labeling (ASL) is a noninvasive non-contrast technique of perfusion imaging that uses endogenous water from the blood as the perfusion tracer, with very scant data on its use in neonates. The authors present the added value of ASL in the examined babies in their own material and discuss it in the light of the existing literature. MATERIAL AND METHODS: During the first 10 months after the purchase of a new magnetic resonance imaging (MRI) scanner, 123 neonates were examined using it in an MR-compatible incubator, 117 of them had brain MRI, and in 104 ASL was incorporated in the routine protocol, which resulted in prolongation of the study time by approximately 4 minutes. 3D ASL sequence uses Pulsed Continuous Arterial Spin Labeling (PCASL; aka pseudo continuous) technique. RESULTS: The quality of the cerebral blood flow (CBF) maps was good in all cases but 2 because all the babies were sedated. Apart from the knowledge about normal perfusion patterns in the preterm and term neonatal brains, the use of ASL sequence provided important additional information in 11 cases (10.8%): increased CBF correlating with electroencephalographic seizure localization in otherwise normal MRI (n = 1), increased CBF in the cortex without clinical information about seizures and with posthaemorrhagic changes (n = 1), increased CBF in the brain stem and decreased in the upper parts of the brain (n = 2), probably reflecting the homeostatic mechanism which allows preferential perfusion of the vital structures of the brain stem, hypoperfusion (n = 1) or hypoperfusion with peripheral hyperperfusion (n = 1) in the area of stroke, hypoperfusion of the posterior areas of the brain in the presence of subarachnoid or epidural haemorrhage (n = 3), significantly increased CBF in the presumed nidus of arteriovenous malformation causing haemorrhage (n = 1), and lack of perfusion in the supratentorial compartment in a case of suspected brain death (n = 1). CONCLUSIONS: Our short experience but relatively large volume of material encourages the use of ASL in routine neonatal MRI as a useful and non-time-consuming tool providing additional important clinical information in a significant percentage of cases.

Seventeen years of prenatal magnetic resonance imaging at the Institute of Mother and Child in Warsaw.

PURPOSE: The purpose of this paper is to summarise and to present the experience of the main Polish centre for prenatal magnetic resonance imaging (MRI) and to discuss the place and role of MRI in antenatal diagnosis, management, and counselling. MATERIAL AND METHODS: Retrospective analysis of the examinations performed in the years 2001-2017. RESULTS: In total, 1221 medical records and/or image files were collected. The full documentation of ultrasonography and MRI referrals, reports, and images was not available in every case. During the first three years 98 pregnant women were examined (approximately 33 per year, one study per fortnight). After purchase of own MR scanner, the number of examinations grew constantly, reaching 208 in 2017, which means almost one per day, and the highest number was eight in one day. We examined 45 pairs of twins, including three pairs of conjoined twins. CONCLUSIONS: MRI at our Institute is a practically used second-line foetal imaging tool, necessary to confirm, complete, or correct sonographic diagnoses, with important impact on clinical decisions concerning management of pregnancy and of the neonate, termination of pregnancy, choice of the time, place, and mode of delivery, and neonatal care, as well as on counselling. In experienced hands, MRI is to date the last and the best non-invasive method of diagnosis in utero. It is frequently requested by the interdisciplinary team for foetal diagnosis and therapy and routinely performed in everyday practice.

Imaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors.

BACKGROUND: Tumors of the developmental age are an important problem in clinical practice. Primary bone tumors constitute 1-1.5% of all tumors, and 7% of all tumors diagnosed in the developmental age. The aim of the study was to assess the capabilities of imaging methods in diagnosing complications of limb endoprostheses in children with osteoarticular tumors. MATERIAL/METHODS: We included 155 patients with limb endoprostheses, aged 7-26 years. There were 113 patients with knee prostheses, 1 patient with bilateral knee prostheses, 16 patients with shoulder prostheses, 14 patients with hip prostheses, 11 patients with hip and knee prostheses, and 1 patient with a femoral prosthesis. All patients underwent plain radiography and an ultrasound study. RESULTS: Complications were found in 50 patients (32% of all patients). The following complications were seen - inflammatory changes in soft tissues and bones (12 patients, 7.7%), stump fractures (11 patients, 7%), lack of elongation effect or shortening of the prosthesis (7 patients, 4.5%), prosthesis fractures (4 patients, 2.5%), crural fractures (4 patients, 2.5%), loosening of the prosthesis (3 patients, 1.9%), joint dislocation (2 patients, 1.3%), stump and prosthesis fracture (1 patient, 0.6%) and local recurrence (6 patients, 3.9%). Prostheses were exchanged for the following reasons - fractures (5 patients, 3.2%), inflammation (2 patients with 3 exchanges, 1.9%). Local recurrence and inflammation were confirmed by a biopsy. CONCLUSIONS: Radiography and ultrasonography are of crucial importance in monitoring patients after implantation of limb endoprostheses. The findings did not require confirmation in additional studies: CT and MRI. Suspicion of local recurrence and inflammation required a biopsy confirmation.

Fetal MRI versus postnatal imaging in the MR-compatible incubator.

INTRODUCTION: One of the aims of fetal magnetic resonance imaging (MRI) is to avoid postnatal scanning. However, clinicians sometimes wish to have postnatal confirmation of prenatal findings. This study's purpose was to check whether there was indeed the added value of neonatal MRI performed in the MR-compatible incubator (INC) after fetal examination. MATERIALS AND METHODS: Material consists of 25 neonates (14 girls) who underwent prenatal and postnatal MRI in a 1.5 T scanner, the latter in INC. Mean time of prenatal MRI was 30th gestational week, of postnatal MRI-16th day of life. RESULTS: In 14 cases (56 %) postnatal findings were the same as prenatal ones. In 11 (44 %) postnatal MRI showed some different/new/more precise results, in two the differences were attributed to other factors than the advantage of postnatal MRI over prenatal one. Altogether then postnatal results were partly discordant with prenatal ones in 9/25 cases (36 %). CONCLUSIONS: In most cases there was no added value of postnatal MRI as compared to prenatal one. This value lied in small details that could not have been noticed on prenatal MRI or required contrast medium administration to be noticed. On the other hand, MR examination performed with use of the dedicated neonatal coils in the MR-compatible incubator is a safe and reliable method of visualization of these small details with better spatial resolution thus helping to establish final diagnosis, treatment plan and prognosis.

First Experience with Neonatal Examinations with the Use of MR-Compatible Incubator.

BACKGROUND: Since 2003, very few publications have described brain examinations using neonatal MR-compatible incubator (INC). The authors present their first experience in these examinations, not limited to brain scans, with the use of an incubator equipped not only with head coil, but also with a coil designed for examinations of the spinal canal and spinal cord as well as the whole body, at the Institute of Mother and Child in Warsaw. MATERIAL/METHODS: Examinations were performed in 27 newborns (12 girls, 15 boys). Most of the neonates were prematurely born: 19 (70.4%) were born at gestational age of 23-37 weeks, mean of 30 weeks. They were examined at the corrected age of 26 weeks-1 month, mean of 36 weeks. Body weight of the newborns on the day of the study was 600-4,300 g, mean of 2,654 g. The study was performed with a GE Signa HDxT 1.5 T system with the use of a Nomag IC 1.5 incubator by Lammers Medical Technology Co., equipped with three coils: an eight-channel, phased-array head coil and a twelve-channel phased-array coil for the whole body, consisting of an eight-channel coil integrated in the incubator and a separate four-channel surface coil. RESULTS: Of the 27 children, 25 (92.6%) required a brain scan. Two children (7.4%) were referred to MRI for assessment of the spinal canal and the abdomen. We compared the results of transfontanelle ultrasound and MRI scans in 21 children. MRI provided significantly more diagnostic information in 18 cases (85.7%); in 3 cases (14.3%), no additional knowledge about the pathology was provided by the exam. CONCLUSIONS: The MR-compatible incubator increases the availability of MRI to newborns, especially premature newborns and those with low and extremely low body weight, for whom MR examinations are necessary to determine the extent of changes, not limited to the central nervous system, as well as to establish prognosis. Dedicated neonatal coils integrated with the incubator permit more accurate diagnosis than the previously used adult coils.

Miliary brain metastases from papillary adenocarcinoma of the lung - unusual MRI pattern with histopathologic correlation.

Miliary brain metastases are very rarely described in the literature but if they are, they are quite obvious on magnetic resonance imaging (MRI) and enhance after intravenous administration of the contrast medium. The authors presented a case of miliary metastatic spread to the brain which was invisible on computed tomography and hardly visible on MRI, i.e. as countless, tiny, slightly T1-hyperintense foci that did not enhance. The authors discussed a few T1-hyperintense brain lesions which did not include metastases (except for metastatic melanoma which was a radiological suggestion after brain MRI). Autopsy revealed papillary adenocarcinoma of the lung with numerous metastatic lesions in both cerebral and cerebellar hemispheres and the meninges.

Postradiotherapeutic changes and their evolution in MRI in children with aggressive soft tissue tumors.

BACKGROUND: Magnetic resonance imaging is a commonly used method of monitoring of soft tissue tumours. The aim of the work was to describe precisely the typical changes within soft tissues and bones occurring after radiotherapy in children treated for sarcomas and other soft tissue tumours. With time, the changes undergo evolution and their characteristics and comparison with previous examinations help in a difficult differentiation between tumour lesions and posttherapeutic changes. MATERIAL/METHODS: Fifteen children and young adolescents (9 boys and 6 girls) aged between 2 and 22 years (mean age of 13.4 years) with diagnosed aggressive soft tissue tumours, were treated with radiotherapy. There were 102 MRI examinations analysed in the period from February 2004 to February 2008. The examinations were performed with a 1.5T MRI scanner in the following sequences: SE T1, SE T1+fatsat, before and after gadolinium administration (Gd), FSE T2 and STIR in three planes, and, in some selected cases, a dynamic gadolinium-enhanced (DCE MRI) examination with FAME sequence. HISTOPATHOLOGICAL EXAMINATIONS SHOWED: rhabdomyosarcoma (RMS) in 8 cases, synovial sarcoma - 3, agressive desmoid fibroma - 3, mesenchymoma mal. - 1. MRI examinations were performed at different postradiotherapeutic stages, several times in one patient (12 times at the most). RESULTS: Every postirradiation stage revealed a typical picture of posttherapeutic changes. We distinguished four stages and described changes in different sequences within soft tissues and bones, as well as features of contrast enhancement and enhancement curves in a dynamic study. The stages included: I stage - early, up to 3 months after rth, II stage - chronic, from 3 months to 12 months after rth, with some differences between the following periods: • 3-9 months; 9-12 months; III stage - late, from 1 to 3 years after rth, IV stage - distant, more than 3 years after rth. In the early stage, there were 2 cases with a suspicious, equivocal image of postradiotherapeutic changes. In the chronic stage, there was one recurrence and one case of increasing changes after the therapy. However, the changes resolved in subsequent examinations. In the distant stage, we found two cases of a local recurrence. CONCLUSIONS: 1. MRI is a method of choice in the monitoring of treatment of aggressive soft tissue tumours and in diagnosis of recurrence. 2. To interpret the examination results, it is very important to know the MRI characteristics of changes after radiotherapy and their evolution with time. 3. Interpretation of MRI images and differentiation between postradiotherapeutic and neoplastic changes is difficult, especially at an early postradiotherapeutic stage. 4. A dynamic MRI examination may be useful in the differentiation between postradiotherapeutic and neoplastic changes but it may be unreliable at an early postradiotherapeutic stage. 5. When interpreting the results, it is very important to compare the image with the previous ones. It is therefore indicated to carry out a baseline MRI in the early postradiotherapeutic stage, and then further follow-up images, at several-month intervals.

Pneumococcal Meningitis and Its Sequelae - A Devastating CNS Disease.

INTRODUCTION: In countries where Haemophilus influenzae type B vaccine is used, Streptococcus pneumoniae is the most common cause of bacterial meningitis in young children and notable cause of morbidity/mortality. The authors present material of magnetic resonance imaging (MRI) of patients with pneumococcal meningitis from archive of Department of Diagnostic Imaging of Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: We performed 27 brain MRI scans and 1 follow-up computed tomography (CT) in 10 children (2 girls and 8 boys) aged from neonate to 5 years at disease onset with proven pneumococcal infection. RESULTS: Follow-up period range was 0-12 years. Two children underwent only one MRI, one of them died before follow-up and the other was lost from further observation. There was one case of relatively benign disease course with mild changes on MRI. In another seemingly benign case, acute transient hydrocephalus was observed. Six children developed hydrocephalus, and two required ventriculoperitoneal shunting complicated by neuroinfection, shunt malfunction and revisions. Two patients developed epilepsy. In six children, spastic paresis of various severity was diagnosed, up to quadriplegia in one who is under the longest observation (>12 years) and survived in vegetative state. Three other children suffer from delayed psychomotor development to severe intellectual disability. CONCLUSIONS: MRI shows perfectly the degree of central nervous system (CNS) damage during and after pneumococcal invasion. Despite appropriate treatment, disease course may be unpredictably serious. Attempts to eliminate the obligation to vaccinate are extremely irresponsible taking into account potential danger of death, vegetative state or another form of severe damage to CNS. Social and financial costs of care of survivors are very high with shunts placements and changes, (neuro)infections, rehabilitation, families breakdown, etc.

Neonatal brain and body imaging in the MR-compatible incubator.

BACKGROUND: The use of a specialized MR-compatible incubator (INC) is very poorly described in the literature and only with regard to brain imaging. OBJECTIVES: To present our own experience with brain and body magnetic resonance imaging (MRI) in the INC in a large cohort of neonates. MATERIAL AND METHODS: A total of 555 examinations were performed in 530 newborns with the use of a 1.5T system and Nomag IC 1.5 incubator, equipped with head and body coils. RESULTS: More than half of neonates (54%) were prematurely born at 22 + 6-36 + 6 gestational weeks. They were examined from the first to 153 days of life (median: 18.5, mean: 37.7) with body weights 600-5000 g (mean: 3051 g), 23% of less than 2500 g. The proportion of brain MRIs to other body regions was 533:85 = 86%:14%. In 36.6% of cases, MRI showed more abnormalities than ultrasound (USG), in a further 21.8%, MRI diagnosis was completely different, in 4.7%, a pathology described on a USG was ruled out on MRI. The superiority of MRI over USG was 63.1%. CONCLUSIONS: MR-compatible incubator significantly increased the availability of MRI to newborns, especially to premature and unstable newborns. The integration of body coils into the INC increased the spectrum of examinations and made possible the scanning not only of the brain but also the body. Dedicated neonatal coils improved image quality and allowed more accurate diagnosis than the previously used adult coils. Immobilization of the babies in the INC by means of Velcro belts and head fixation inserts is better than in adult coils. The closed space of the INC isolates newborns to a greater extent from the negative influence of noise in the MR environment.

Magnetic resonance imaging as a diagnostic tool in case of ovarian masses in girls and young women.

BACKGROUND: Gynecological examination and transvaginal ultrasound are difficult or impossible in girls and young women who have not started their sexual life. CT is not a method of choice in this age group because of the ionizing radiation and iodine-containing contrast media. MRI is chosen then. MATERIAL/METHODS: Pelvic MRI was performed in 15 patients aged 9-19 years with suspected ovarian mass after they had had unclear gynecological and sonographic examinations. 1.5 T MRI systems were used. SE,T(F)SE and SPIR sequences were applied in T1- and T2-weighted images in three planes. Contrast media were administered in 7 patients. RESULTS: In a group of 3 girls with acute abdominal pain, polycystic ovaries, ovarian hemorrhagic cyst, and fibroma of the ovary were diagnosed. In a group of 11 patients with chronic abdominal pain, dermoid cysts of the ovaries were found in 7 cases, in one bilateral and accompanied by ectopic kidney. In 2 patients, serous cysts were diagnosed. In 2 cases an ovarian origin of the mass was excluded: multilocular cystic lesion in the presacral region and a hydatid mole were revealed. A neoplastic ovarian mass was diagnosed in a girl with increasing circumference of the abdomen. The accuracy of MRI in localizing lesions was 100%. Its accuracy in precisely characterizing lesions was 83.3%. CONCLUSIONS: Magnetic resonance imaging, with its noninvasiveness, high spatial resolution, and tissue specificity, is a method of choice in the diagnosis or exclusion of ovarian pathology in children and adolescents.

CNS Metastases from Bone and Soft Tissue Sarcomas in Children, Adolescents, and Young Adults: Are They Really So Rare?

Purpose. To check whether primary involvement of brain/spinal cord by bone/soft tissue sarcomas' metastases in children is as rare as described and to present various morphological forms of bone/soft tissue sarcomas' CNS metastases. Methods. Patients with first diagnosis in 1999-2014 treated at single center were included with whole course of disease evaluation. Brain/spinal canal magnetic resonance imaging (MRI)/computed tomography were performed in cases suspicious for CNS metastases. Extension from skull/vertebral column metastases was excluded. Results. 550 patients were included. MRI revealed CNS metastases in 19 patients (incidence 3.45%), 14 boys, aged 5-22 years. There were 12/250 osteosarcoma cases, 2/200 Ewing's sarcoma, 1/50 chondrosarcoma, 3/49 rhabdomyosarcoma (RMS), and 1/1 malignant mesenchymoma. There were 10 single metastases and 7 cases of multiple ones; in 2 RMS cases only leptomeningeal spread in brain and spinal cord was found. Calcified metastases were found in 3 patients and hemorrhagic in 4. In one RMS patient there were numerous solid, cystic, hemorrhagic lesions and leptomeningeal spread. Conclusions. CNS metastases are rare and late in children with bone/soft tissue sarcomas, although in our material more frequent (3.45%) than in other reports (0.7%). Hematogenous spread to brain and hemorrhagic and calcified lesions dominated in osteosarcoma. Ewing sarcoma tended to metastasize to skull bones. Soft tissue sarcomas presented various morphological forms.

[New method of scoring lung changes using computed tomography in patients with cystic fibrosis]. / Nowa Metoda Punktowej Oceny Zmianw Plucach W Tomografii Komputeroweju Chorych Z Mukowiscydoza.

AIM: 1. Introducing our own modification of the scoring system in high resolution computed tomography (HRCT) to evaluate changes in the lungs of patients with cystic fibrosis. 2. Comparison between scoring systems based on conventional chest radiography and HRCT in our own modification. MATERIAL AND METHODS: The material consists of 50 children: 28 girls and 22 boys aged 5-17 years. Chest X-rays in P-A projection and HRCT (Picker PQS) were performed in all the children. Chest X-rays were evaluated using the Brasfield and Northern scores. In the Brasfield scoring system both lungs are assessed together. The Northern scoring system assesses each lung separately. In our own modification of the HRCT scoring system each lung was divided into six parts. Bronchiectases, bronchial wall thickness, mucous plugs, atelectases, emphysema, cysts and mosaic perfusion were assessed in each part of the lungs. RESULTS: The analysis using the Brasfield score showed: minimal changes in 9 patients (18%; grading scale 20-24 points), mild changes in 23 (46%; 15-19 points), acute findings in 18 (36%; 7-14 points). The analysis using the Northern score showed: no changes in 1 patient (2%; grading scale 0 points), pathological findings were seen in the right lung in 49 patients (98%), while in the left lung in 48 (96%). Pathological changes in both lungs were seen in 96% of the patients. HRCT exams were evaluated based on our own modification of Bhalla and Maffesanti scores. Bronchial wall thickening was seen in all the patients examined, bronchiectases in 40 (80%), atelectasis, emphysema, bullas in 34 (68%), mosaic perfusion in 20 (40%). Central mucous plugs were seen in 34 patients (68%), peripheral plugs in 40 (80%). Both central and peripheral mucous plugs were observed in 33 patients (66%). There were no mucous plugs in 9 children (18%). The extent of lung lesions was compared using the Brasfield score and the HRCT score in our own modification. There were no extensive changes in 8 patients (16%) on chest X-ray evaluated by Brasfield score and only in 1 patients (2%) on HRCT. Using the Northern score 1 patient was assessed as having normal lungs. In HRCT assessment there was no patient with normal lungs. There were no mucous plugs in 23 patients (46%) on chest X-ray evaluation. In HRCT mucous plugs were not found only in 9 patients (18%). 8 children had two HRCT exams in 1-6 year intervals. In all of them the progression of lung lesions was observed on HRCT. In conventional radiography the progression of the disease was seen in 3 patients evaluated in the Northern score and in 4 children evaluated using the Brasfield score. CONCLUSIONS: 1. Our own modification of the HRCT scoring system in patients with cystic fibrosis simplified the evaluation of the lung lesions and made it possible to adapt it to the practical needs of physiotherapists. The assessment of the central and peripheral mucous plugs is very important for planning individual physiotherapy for every child. 2. HRCT has an advantage over conventional chest X-rays in the evaluation of the stage and progression of lung disease in patients with cystic fibrosis. Plain films do not allow exact evaluation of the mucous plugs that obstruct the bronchial tree. 3. In spite of this advantage, due to the radiation dose involved in CT, one should carefully assess the indications to use this method in routine evaluation of the disease in children with cystic fibrosis.

The value of magnetic resonance imaging in the early diagnosis of Creutzfeldt-Jakob disease - own experience.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a rare progressive neurodegenerative disorder, caused by the deposition of the pathological isoform of prion protein PrPsc in the central nervous system. The classic triad of symptoms consists of: rapidly progressive dementia, myoclonus and typical electroencephalographic findings (intermittent rhythmic delta activity and periodic sharp wave complexes). Detection of 14-3-3 protein in the cerebrospinal fluid plays an important diagnostic role as well. Magnetic resonance (MR) images of the brain have been recently incorporated into the diagnostic criteria of sporadic Creutzfeldt-Jakob disease. CASE REPORT: MR examinations were performed in a 65-year-old man and a 54-year-old woman with delusional disorder and cognitive dysfunction, respectively. Diffusion restriction (hyperintense signal in DWI) was shown in the cortex of the left parietal and occipital lobe in the first patient and symmetrically in the cortex of both cerebral hemispheres except for precentral gyri in the second one. In both cases, the first examinations were misread, with the suspicion of ischemic infarcts as the first differential diagnosis. Consultations and subsequent MR examinations in which lesions in subcortical nuclei appeared allowed for a diagnosis of probable CJD. In the first case it was confirmed by clinical picture, EEG and finally - autopsy. In the second case, EEG was not typical for CJD but the clinical course of the disease confirmed that diagnosis. CONCLUSIONS: The authors present the cases of two patients with characteristic MR images that allowed early diagnosis of probable Creutzfeldt-Jakob disease before the characteristic clinical picture appeared. Early diagnosis is nowadays important for the prevention of disease transmission and in the future - hopefully - for early treatment.

[Sonography of small bowel, colon and appendix in children with cystic fibrosis]. / Ocena ultrasonograficzna jelita cienkiego, grubego i wyrostka robaczkowego u pacjentów z mukowiscydoza.

AIM: To assess the utility of sonographic examination in estimation of the incidence and character of pathological changes in different parts of the intestine and other abdominal organs in children with cystic fibrosis (CF). MATERIAL AND METHOD: The study group consisted of 182 children (94 girls, 88 boys), aged from 2 months up to 22 yrs, with diagnosed cystic fibrosis or its suspicion, confirmed later. The control group consisted of 20 children with mean age 8 yrs. Sonography was performed with Philips equipment: 4000 HDI and iU 22 using convex, microconvex and linear probes. 329 examinations were performed in 182 children in 2.5 years, 109 underwent second US and 38 patients were examined for the third time. RESULTS: In children with CF, changes in the intestines were observed in 108 patients (59.3%), in the colon in 97 patients (53.3%), and in the small intestine in 49 patients (26.9%). In the control group the wall thickness of large intestine did not surpass 1.6 mm, of small intestine--1.4 mm. In the tested group the maximum thickness of large intestine wall was 7 mm and of small intestine--4.3 mm. Layer structure of the ileum wall was found in 46 children (25%), enlarged appendix in 21 patients (11.6%). Enlarged mesenteric lymph nodes were observed in 84 pts (46%). Hyperaemia of the bowel wall was not observed on Power Doppler examination. In 71 patients (39%) changes in the structure of the liver were observed (cirrhosis, steatosis, enlargement) and in 114 (62.6%) there were changes in the pancreas. CONCLUSIONS: Sonographic examination in patients with cystic fibrosis revealed a high frequency of intestinal changes which confirms the need of including this examination in the annual follow-up of children with CF. In cases of unidentified CF, abdominal sonography leads to the diagnosis.

Glycosaminoglycans urinary excretion as a marker of the early stages of diabetic nephropathy and the disease progression.

BACKGROUND: Diabetes mellitus affects the metabolism of several components of extra-cellular matrix, including glycosaminoglycans (GAG). Alterations in the metabolism of GAG may play an important role in the development of diabetic complications. METHODS: Consequently, the relationship between diabetic nephropathy and urinary GAG excretion has been estimated in 86 diabetic patients (33 type 1 diabetes mellitus (DM), 53 type 2 DM) in comparison to 30 healthy controls (Figure 1). GAG concentration in 24-h urine samples has been determined by precipitation with cetylpyridinum chloride and potassium acetate in ethanol followed by a fluorometric test with 2-Hexadecyl-9H-pyrido(4,3b)indolium Bromide. RESULTS: Diabetic subjects excrete significantly more GAG than the control group (66.47 mg/24 h vs 50.11 mg/24 h). A marked difference in urinary GAG excretion between diabetic patients with nephropathy (74.66 +/- 7.5 mg/24 h) and without nephropathy (50.13 +/- 5.37 mg/24 h) has been detected. With diabetic nephropathy, patients with a longer history of GAG excretion experience an increase. An increased urinary GAG excretion has been detected in patients with microalbuminuria or macroalbuminuria. CONCLUSIONS: In conclusion, it can be stated that all patients with DM compared to the control group show an increase in GAG excretion independent of diabetes duration. Urinary GAG excretion positively correlates with the duration of diabetic nephropathy. The assessment of GAG excretion values may be useful for determining the early stages of diabetic nephropathy and the progression of the disease.

[The value of neuroimaging (MRI and CT) in the diagnostics of headaches in children and adults--own experience]. / Wartosc badan neuroobrazowych (MR i TK) w diagnostyce bólów glowy u dzieci i doroslych--badania wlasne.

AIM: to evaluate MRI and CT findings in children and adults presenting with headaches and to define the value of these methods in the diagnostics of headaches. MATERIALS/METHODS: 164 children and 317 adults with headaches were included in the trial. In all cases either MRI or CT was performed depending on the specialist's referral or the patient's request in case of MRI. RESULTS: in the group of children 40.9% showed no abnormalities on neuroimaging. The results with abnormal features have been considered as 'positive' and divided in two groups: 'significant' lesions requiring further diagnostic procedures or urgent neurosurgery and 'benign' lesions, where patient management did not change. In 2.4% 'significant' lesions were found. The remaining 56.7% had 'benign' lesions diagnosed (16 abnormalities occurring alone or in combination). Among the adults 67.5% had normal MRI or CT scans. In 32.5% neuroimaging revealed abnormalities: 2.2% described as 'significant' lesions and 30.3% described as 'benign' lesions. CONCLUSIONS: 1. Neuroimaging methods (MRI and CT) should not be routinely ordered in the initial diagnostics of headaches. 2. Patients suspected of neoplastic disease, vascular malformations, posttraumatic lesions or focal brain lesions must have these examinations performed. 3. The percentage of patients with headaches who require such extended diagnostics with MRI or CT is low.