Predicting clinical progression and cognitive decline in patients with relapsing-remitting multiple sclerosis: a 6-year follow-up study.

INTRODUCTION: Cognitive impairment occurs from the earliest stages of multiple sclerosis (MS) and progresses over time. The introduction of disease modifying therapies (DMTs) has changed the prognosis for MS patients, offering a potential opportunity for improvement in the cognitive arena as well. MATERIAL AND METHODS: 41 patients with relapsing-remitting multiple sclerosis (MS) were recruited to the study. Thirty patients were available for final follow-up and were included in the analysis. Baseline (BL) brain MRI including volumetry and neuropsychological tests were performed. Blood samples were collected at BL and follow-up (FU) and were tested for: vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM1), soluble platelet-endothelial CAM-1 (sPECAM1), and soluble intercellular CAM-1 (sICAM-1). Patients were invited for a final neuropsychological follow-up after a median of 6 years. Disease activity (relapses, EDSS increase, new/active brain lesions on MRI) was analysed between BL and FU. RESULTS: The study group deteriorated in the Rey-Osterrieth Complex Figure (ROCF) test (p = 0.001), but improved significantly in three other tests, i.e. semantic fluency test (p = 0.013), California Verbal Learning Test (CVLT, p = 0.016), and Word Comprehension Test (WCT, p < 0.001). EDSS increase correlated negatively with semantic fluency and WCT scores (r = -0.579, p = 0.001 and r = -0.391, p = 0.033, respectively). Improvements in semantic fluency test and WCT correlated positively with baseline deep grey matter, grey matter, and cortical volumes (p < 0.05, r > 0). Higher EDSS on FU correlated significantly negatively with baseline left and right pallidum, right caudate, right putamen, right accumbens, and cortical volume (p < 0.05, r < 0). No significant relationship was found between the number of relapses and EDSS on FU or neuropsychological deteriorations. Improvements in WCT and CVLT correlated positively with baseline sPECAM1 and sVCAM1 results, respectively (r > 0, p < 0.05). Deterioration in ROCF test correlated significantly with higher levels of baseline VEGF and sVCAM1 (p < 0.05). CONCLUSIONS: Brain volume is an important predictor of future EDSS and cognitive functions outcome. MS patients have a potential for improving in neuropsychological tests over time. It remains to be established whether this is related to successful disease modification with immunotherapy. Baseline volumetric measures are stronger predictors of cognitive performance than relapse activity, which yet again highlights the importance of atrophy in MS prognosis.

Texture analysis of chest X-ray images for the diagnosis of COVID-19 pneumonia.

Purpose: Medical imaging is one of the main methods of diagnosing COVID-19, along with real-time reverse trans-cription-polymerase chain reaction (RT-PCR) tests. The purpose of the study was to analyse the texture parameters of chest X-rays (CXR) of patients suspected of having COVID-19. Material and methods: Texture parameters of the CXRs of 70 patients with symptoms typical of COVID-19 infection were analysed using LIFEx software. The regions of interest (ROIs) included each lung separately, for which 57 para-meters were tested. The control group consisted of 30 healthy, age-matched patients with no pathological findings in CXRs. Results: According to the ROC analysis, 13 of the tested parameters differentiate the radiological image of lungs with COVID-19 features from the image of healthy lungs: GLRLM_LRHGE (AUC 0.91); DISCRETIZED_Q3 (AUC 0.90); GLZLM_HGZE (AUC 0.90); GLRLM_HGRE (AUC 0.89); DISCRETIZED_mean (AUC 0.89); DISCRETIZED_Q2 (AUC 0.61); GLRLM_SRHGE (AUC 0.87); GLZLM_LZHGE (AUC 0.87); GLZLM_SZHGE (AUC 0.84); DISCRETIZED_Q1 (AUC 0.81); NGLDM_Coarseness (AUC 0.70); DISCRETIZED_std (AUC 0.64); CONVENTIONAL_Q2 (AUC 0.61). Conclusions: Selected texture parameters of radiological CXRs make it possible to distinguish COVID-19 features from healthy ones.

Magnetic resonance imaging in patients with implanted cardiac electrotherapy devices: a statement from experts of the Polish Medical Society of Radiology, the Polish Society of Cardiology, and the Polish Society of Electroradiology.

The year 2023 marks 60 years since the first pacemaker was implanted in Poland. The number of implantable cardiac electrotherapy devices (CIEDs), including pacemakers, cardioverter-defibrillators, and resynchronization therapy systems, has been systematically increasing in the subsequent decades. It is estimated that nearly 500,000 Poles have an implanted cardiac electrotherapy device, making optimal diagnostic imaging with the use of magnetic resonance imaging (MRI) a clinically and epidemiologically important issue. MRI has become a gold diagnostic standard in many disease states. In this situation, it is believed that 50-70% of patients who have a cardiac electrotherapy device may have indications for an MRI examination later in life. For many years, an implanted cardiac electrotherapy device was considered a definite contraindication to MRI. However, MRI has become possible in most patients with CIED if certain procedures and precautions are followed. In these guidelines, we describe the basic rules that should be followed in order to perform a safe MRI examination in patients with different CIEDs. Despite all the risks and organizational factors described in the text, it seems that for many MRI departments, MRI in patients with CIEDs is achievable and should be implemented immediately. A second important issue is the need for dedicated financial support for these procedures from public health insurance.

The use of intravascular contrast media in patients with impaired kidney function - joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology.

Radiological procedures utilising intravascular contrast media (ICM) are fundamental to modern medicine, enhancing diagnostics and treatment in diverse medical fields. However, the application of ICM has been constrained in patients with compromised kidney function due to perceived nephrotoxic risks, called contrast-induced nephropathy or contrastinduced acute kidney injury. Historical evidence marked ICM as a possible contributor to kidney damage. This led to restrictive guidelines advocating limited ICM use in patients with impaired renal function, preventing crucial radiographic interventions in patients with acute kidney injury (AKI) and chronic kidney disease. Recent advances challenge these traditional views. In particular, no direct causal relationship has been confirmed between contrast admi-nistration and elevated serum creatinine concentrations in humans. Furthermore, contemporary research models and meta-analyses do not associate AKI with contrast usage. This paper, prepared by a cross-disciplinary team of nephrologists and radiologists, presents updated guidelines for ICM application amid renal function impairments, emphasising the reduced nephrotoxic risks currently understood and loosening the previous restrictive approach in patients with renal dysfunction.

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view.

In recent years, lung ultrasound (LUS) has developed rapidly, and it is growing in popularity in various scenarios. It has become especially popular among clinicians. There are constant attempts to introduce it in new fields, with quite a strong resistance in the radiological community. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemic. Unfortunately, this has led to many misconceptions. The aim of this review is to discuss lines, signs, and phenomena that can be seen in LUS in order to create a single, easily available compendium for radiologists and promote consistency in LUS nomenclature. Some simplified suggestions are presented.

Influence of augmentation on the performance of the double ResNet-based model for chest X-ray classification.

Purpose: A pandemic disease elicited by the SARS-CoV-2 virus has become a serious health issue due to infecting millions of people all over the world. Recent publications prove that artificial intelligence (AI) can be used for medical diagnosis purposes, including interpretation of X-ray images. X-ray scanning is relatively cheap, and scan processing is not computationally demanding. Material and methods: In our experiment a baseline transfer learning schema of processing of lung X-ray images, including augmentation, in order to detect COVID-19 symptoms was implemented. Seven different scenarios of augmentation were proposed. The model was trained on a dataset consisting of more than 30,000 X-ray images. Results: The obtained model was evaluated using real images from a Polish hospital, with the use of standard metrics, and it achieved accuracy = 0.9839, precision = 0.9697, recall = 1.0000, and F1-score = 0.9846. Conclusions: Our experiment proved that augmentations and masking could be important steps of data pre-processing and could contribute to improvement of the evaluation metrics. Because medical professionals often tend to lack confidence in AI-based tools, we have designed the proposed model so that its results would be explainable and could play a supporting role for radiology specialists in their work.

Indications for imaging studies in SARS-CoV-2 infected patients - recommendations of the Polish Medical Society of Radiology.

The pandemic involving COVID-19 caused by the SARS-CoV-2 coronavirus, due to its severe symptoms and high transmission rate, has gone on to pose a control challenge for healthcare systems all around the world. We present the third version of the recommendations of the Polish Medical Society of Radiology (PMSR), presuming that our knowledge on COVID-19 will advance further rapidly, to the extent that further supplementation and modification will prove necessary. These recommendations involve rules of conduct, procedures, and safety measures that should be introduced in radiology departments, as well as indications for imaging studies.

Atherosclerosis attacks in patients with psoriasis vulgaris but without a relationship with the severity and course of the disease.

INTRODUCTION: In recent years numerous research studies have indicated that chronic inflammation in psoriasis can be associated with an increased risk of developing atherosclerosis. AIM: The presented study was aimed at demonstrating whether patients suffering from psoriasis vulgaris are at a greater risk of developing atherosclerosis depending on the presence of selected cardiovascular risk factors and the course and severity of the disease. MATERIAL AND METHODS: Sixty-two patients with diagnosed psoriasis vulgaris and 42 healthy volunteers were included in the study. All the patients underwent carotid ultrasound with the assessment of the common carotid artery intima-media thickness (IMT) and the computed tomography with determination of coronary artery calcification (CAC). RESULTS: The IMT was significantly higher in the study group (1.030 ±0.303 mm vs. 0.838 ±0.151 mm, p < 0.0001). We also found a significantly increased severity of Calcium Score (CS) in Agatston units (168.20 ±309.63 vs. 24.52 ±43.21, p = 0.0207) of CAC in patients with psoriasis. There was no significant correlation between the degree of atherosclerosis and psoriasis severity determined in the PASI (Psoriasis Area and Severity Index) scale, duration of the disease, number of exacerbations per year or C-reactive protein values. CONCLUSIONS: The study showed an increased risk of developing atherosclerosis in patients diagnosed with psoriasis vulgaris, but no correlation was found between the degree of atherosclerosis and the severity of the disease.

Cortical presentation of language functions in patients after total laryngectomy: a fMRI study.

PURPOSE: The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy. METHODS: Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients' post-operative speech rehabilitation sessions was five (range of 3-8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction. RESULTS: In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca's area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca's area in volunteers and a stronger activation of the left premotor cortex in patients. CONCLUSION: This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.

Consensus-based technical recommendations for clinical translation of renal BOLD MRI.

Harmonization of acquisition and analysis protocols is an important step in the validation of BOLD MRI as a renal biomarker. This harmonization initiative provides technical recommendations based on a consensus report with the aim to move towards standardized protocols that facilitate clinical translation and comparison of data across sites. We used a recently published systematic review paper, which included a detailed summary of renal BOLD MRI technical parameters and areas of investigation in its supplementary material, as the starting point in developing the survey questionnaires for seeking consensus. Survey data were collected via the Delphi consensus process from 24 researchers on renal BOLD MRI exam preparation, data acquisition, data analysis, and interpretation. Consensus was defined as ≥ 75% unanimity in response. Among 31 survey questions, 14 achieved consensus resolution, 12 showed clear respondent preference (65-74% agreement), and 5 showed equal (50/50%) split in opinion among respondents. Recommendations for subject preparation, data acquisition, processing and reporting are given based on the survey results and review of the literature. These technical recommendations are aimed towards increased inter-site harmonization, a first step towards standardization of renal BOLD MRI protocols across sites. We expect this to be an iterative process updated dynamically based on progress in the field.

Recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology for a protocol concerning routinely used magnetic resonance imaging in patients with multiple sclerosis.

Magnetic resonance imaging (MRI) is a widely used method for the diagnosis of multiple sclerosis that is essential for the detection and follow-up of the disease. OBJECTIVE: The Polish Medical Society of Radiology (PLTR) and the Polish Society of Neurology (PTN) present the second version of their recommendations for investigations routinely conducted in magnetic resonance imaging departments in patients with multiple sclerosis. This version includes new data and practical comments for electroradiology technologists 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 necessary for establishing a diagnosis, as well as for MS patient monitoring, which directly translates into significant clinical decisions. INTRODUCTION: Multiple sclerosis (MS) is a chronic immune mediated inflammatory demyelinating disease of the central nervous system (CNS), the aetiology of which is still unknown. The nature of the disease lies in a CNS destruction process disseminated in time (DIT) and space (DIS). MRI detects focal lesions in the white and grey matter with high sensitivity (although with significantly lower specificity in the latter). It is also the best tool to assess brain atrophy in patients with MS in terms of grey matter volume (GMV) and white matter volume (WMV) as well as local atrophy (by measuring the volume of thalamus, corpus callosum, subcortical nuclei, and hippocampus) as parameters that correlate with disability progression and cognitive dysfunctions. Progress in MR techniques, as well as advances in postprocessing the obtained data, has driven the dynamic development of computer programs that allow for a more repeatable assessment of brain atrophy in both cross-sectional and longitudinal studies. MR imaging is unquestionably the best diagnostic tool available to follow up the course of the disease and support clinicians in choosing the most appropriate treatment strategy for their MS patient. However, to diagnose and follow up MS patients on the basis of MRI in accordance with the latest standards, the MRI study must adhere to certain quality criteria. Such criteria are the subject of this paper.

Management of patients with COVID-19 in radiology departments, and indications regarding imaging studies - recommendations of the Polish Medical Society of Radiology.

The pandemic involving COVID-19 caused by the SARS-CoV-2 coronavirus, due to its severe symptoms and high transmission rate, has gone on to pose a control challenge for healthcare systems all around the world. We present the second version of the Recommendations of the Polish Medical Society of Radiology, presuming that our knowledge on COVID-19 will advance further rapidly, to the extent that further supplementation and modification will prove necessary. These Recommendations involve rules of conduct, procedures, and safety measures that should be introduced in radiology departments, as well as indications for imaging studies.

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.

Grey matter activation by caloric stimulation in patients with unilateral peripheral vestibular hypofunction.

PURPOSE: A combination of the caloric test with functional magnetic resonance imaging (fMRI) is a promising method for a comprehensive diagnostics of pathologies of the vestibular system. The aim of this study was to investigate the potential pattern of grey matter local activation in fMRI using cold and hot caloric stimulation in patients presenting unilateral peripheral vestibular injury. METHODS: Forty right-handed participants aged 27 to 56 with the diagnosis of right-sided peripheral vestibular hypofunction were included. Stimulation was performed separately for the right and the left ear with cold (C, 14-15 °C) stimulus and hot (H, 48-49 °C) stimulus. Grey matter activation was assessed in BOLD technique using a 3T scanner. RESULTS: We observed activity within the parieto-insular vestibular cortex (PIVC), thalamus, insula and retroinsular area, hippocampus, and cerebellum, as well as oculomotor centers located in the precentral gyrus, superior temporal gyrus, and intraparietal sulcus. Cold stimulus resulted in more areas of activation in response to the right ear activation rather than to the left ear. The ipsilateral activity was noted for insular cortex and intraparietal sulcus. The differences between hot and cold stimuli were noted for the right ear. CONCLUSIONS: In this preliminary study, the combination of the caloric test and fMRI allowed to present specific pattern of grey matter activation in patients with unilateral peripheral vestibular injury. Further studies are necessary to develop patterns or cortical maps differentiating various balance disorders and to analyze the dynamics of cortical plasticity after the injury.

Monoexponential and Biexponential Fitting of Diffusional Magnetic Resonance Imaging Signal Analysis for Prediction of Liver Fibrosis Severity.

OBJECTIVE: The objective of this study is to compare the value of monoexponential and biexponential approach to the diffusion-weighted magnetic resonance imaging signal in the prediction of the liver fibrosis. METHODS: Forty patients with hepatitis C were included. Quantification of the apparent diffusion coefficient (ADC) and pure molecular diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) was performed using 9 b values (b = 0, 20, 50, 100, 200, 400, 600, 800, 1000 s/mm). RESULTS: Significant fibrosis was found in 14 subjects. Monoexponentally derived ADC parameters were significantly correlated. Apparent diffusion coefficient calculated from all b values and ADC based on high b values were significantly related to the fibrosis grade (P < 0.02), and none of intravoxel incoherent motion parameters presented such an association. Apparent diffusion coefficient based on high b values was the best predictor of significant fibrosis with area under the curve of 0.81, sensitivity of 0.57, and specificity of 0.92. CONCLUSION: Intravoxel incoherent motion parameters did not allow for prediction of the liver fibrosis. Apparent diffusion coefficient calculated based on high b values presents considerable specificity in predicting significant fibrosis.

Improved imaging of colorectal liver metastases using single-source, fast kVp-switching, dual-energy CT: preliminary results.

PURPOSE: Computed tomography remains the first-choice modality for assessment of colorectal cancer liver metastases (CRLM). Dual-energy computed tomography (DECT) is a relatively new technique that is becoming increasingly available. One of the advantages of DECT is the ability to maximise iodine detection. Our aim was to test whether single-source, fast kVp-switching DECT can improve imaging quality of CRLM compared to conventional (polychromatic) CT. MATERIAL AND METHODS: Twenty consecutive patients were enrolled into a preliminary prospective study. The scanning protocol consisted of four phases: non-contrast with standard 120 kV tube voltage and three post-contrast phases with rapid voltage switching. As a result, three sets of images were reconstructed: pre- and postcontrast polychromatic (PR), monochromatic (MR), and iodine concentration map (IM). To compare the sensitivity of the tested reconstructions, the number of CRLMs and the maximum diameter of the largest lesion were calculated. Objective image quality was measured as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The radiation dose was expressed as CTDIvol. RESULTS: Imaging was successfully performed in all patients. The number of detected lesions was significantly lower on PR images than on IM and MR 50-70 keV (mean number: 4.20 and 4.45, respectively). IM and MR at 70 keV presented the highest quality. SNR was significantly higher for IM and 70 keV images than for other reconstructions. The mean radiation dose was 14.61 mGy for non-contrast 120 kV scan and 17.89 mGy for single DECT scan (p < 0.05). CONCLUSIONS: DECT is a promising tool for CRLM imaging. IM and low-photon energy MR present the highest differences in contrast between metastases and the normal liver parenchyma.

Noninvasive evaluation of renal tissue oxygenation with blood oxygen level-dependent magnetic resonance imaging early after transplantation has a limited predictive value for the delayed graft function.

PURPOSE: The aim of this study was to evaluate the feasibility of renal oxygenation assessment using blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) in the early period after kidney transplantation and to estimate its prognostic value for delayed graft function. MATERIAL AND METHODS: Examinations were performed in 50 subjects: 40 patients within a week after the kidney transplantation and 10 healthy controls, using T2*-weighted sequence. Measurements in transplant patients were correlated to basic laboratory parameters in the early period after transplantation and at follow-up. RESULTS: Examinations of seven patients (18%) were rejected due to their poor technical quality. Mean R2* values in transplant recipients were lower than in controls (11.6 vs. 15.9 Hz; p = 0.0001). An R2* value of 0.28 Hz was calculated as the minimal detectable change. There was no relation between R2* values and laboratory parameters. However, patients eGFR ≥ 40 ml/min/1.73 m2 presented higher R2* values than recipients eGFR < 40 ml/min/1.73 m2 (12.0 vs. 11.1 Hz; p = 0.0189). In ROC analysis R2* of ≤ 11.7 predicted an early reduced graft function with 0.82 sensitivity and 56% specificity (AUC = 0.708; p = 0.024) but was not useful for delayed graft function prediction (p > 0.7). CONCLUSIONS: Evaluation of renal graft oxygenation using BOLD MRI is technically challenging in the early period after transplantation. An R2* value of 0.28 Hz may in practice be considered as the minimal detectable change. The delayed graft function seems not to be dependent on early oxygenation values. Further, large-scale studies are necessary to confirm the latter observation.

Low-level laser therapy (LLLT) does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism.

Low-level laser (light) therapy (LLLT) has been applied recently to body contouring. However the mechanism of LLLT-induced reduction of subcutaneous adipose tissue thickness has not been elucidated and proposed hypotheses are highly controversial. Non-obese volunteers were subject to 650nm LLLT therapy. Each patient received 6 treatments 2-3 days apart to one side of the abdomen. The contralateral side was left untreated and served as control. Subjects' abdominal adipose tissue thickness was measured by ultrasound imaging at baseline and 2 weeks post-treatment. Our study is to the best of our knowledge, the largest split-abdomen study employing subcutaneous abdominal fat imaging. We could not show a statistically significant reduction of abdominal subcutaneous adipose tissue by LLLT therapy. Paradoxically when the measurements of the loss of fat thickness on treated side was corrected for change in thickness on non treated side, we have observed that in 8 out of 17 patients LLLT increased adipose tissue thickness. In two patients severe side effect occurred as a result of treatment: one patient developed ulceration within appendectomy scar, the other over the posterior superior iliac spine. The paradoxical net increase in subcutaneous fat thickness observed in some of our patients is a rationale against liquefactive and transitory pore models of LLLT-induced adipose tissue reduction. LLLT devices with laser diode panels applied directly on the skin are not as safe as devices with treatment panels separated from the patient's skin.

Whole-organ and segmental stiffness measured with liver magnetic resonance elastography in healthy adults: significance of the region of interest.

PURPOSE: MR elastography (MRE) is a recent non-invasive technique that provides in vivo data on the viscoelasticity of the liver. Since the method is not well established, several different protocols were proposed that differ in results. The aim of the study was to analyze the variability of stiffness measurements in different regions of the liver. METHODS: Twenty healthy adults aged 24-45 years were recruited. The examination was performed using a mechanical excitation of 64 Hz. MRE images were fused with axial T2WI breath-hold images (thickness 10 mm, spacing 10 mm). Stiffness was measured as a mean value of each cross section of the whole liver, on a single largest cross section, in the right lobe, and in ROIs (50 pix.) placed in the center of the left lobe, segments 5/6, 7, 8, and the parahilar region. RESULTS: Whole-liver stiffness ranged from 1.56 to 2.75 kPa. Mean segmental stiffness differed significantly between the tested regions (range from 1.55 ± 0.28 to 2.37 ± 0.32 kPa; P < 0.0001, ANOVA). Within-method variability of measurements ranged from 14 % for whole liver and segment 8-26 % for segment 7. Within-subject variability ranged from 13 to 31 %. Results of measurement within segment 8 were closest to the whole-liver method (ICC, 0.84). CONCLUSIONS: Stiffness of the liver presented significant variability depending on the region of measurement. The most reproducible method is averaging of cross sections of the whole liver. There was significant variability between stiffness in subjects considered healthy, which requires further investigation.

Contrast-Enhanced Ultrasonography in Crohn's Disease Diagnostics.

The chronic nature of Crohn's disease (CD) implicates necessity of multiple control assessments throughout patient's life. It is accepted that in patients with CD requiring disease monitoring, magnetic resonance enterography (MRE) and computed tomography enterography (CTE) are--apart from endoscopy--imaging studies of first choice. In practice, diagnostic imaging of patients with CD is troublesome, since MRE is an expensive and complicated study, and CTE exposes patients to high doses of ionizing radiation. Therefore, there is a need for new, both non-invasive and effective, methods of imaging in CD. Contrast-Enhanced Ultrasonography (CEUS) is a relatively new method using gas-filled microbubbles serving as contrast agent. It allows for detailed assessment of blood perfusion within intestine wall and peri-intestinal tissues, which enables detection and monitoring of inflammation and its qualitative assessment. The purpose of this paper is to describe CEUS examination technique and its clinical applications in patients with Crohn's disease.