Implementation of a standardized lung ultrasound protocol for respiratory distress in a neonatal intensive care unit: an observational study.

OBJECTIVE: To assess the feasibility of implementing a simple point-of-care lung ultrasound (LU) evaluation and reporting protocol in a neonatal intensive care unit (NICU) and its effect on patient management. STUDY DESIGN: Retrospective observational study of LU examinations performed in a level III NICU. Each examination was performed according to a standardized protocol. An independent radiologist-assessed chest X-ray (CXR) was used to compare the LU diagnosis. The impact on patient management was also evaluated. RESULT: A total of 206 LU studies in 158 neonates were reviewed. There was significant agreement between LU and CXR diagnoses (84.95%, 95% CI 80.07-89.83%). LU affected patient management in 87.8% of the cases (95% CI 83.33-92.28%). CONCLUSION: Implementation of a simplified, sign-based protocol for LU in the NICU is feasible. LU is not inferior to CXR studies and supports patient management as an imaging modality.

Assessment of the Effectiveness of Knee Joints Treatment With the Use of 90 Y : Prospective Ultrasound and Clinical Analysis.

PURPOSE: The purpose of this prospective study was to assess the effectiveness of knee joints treatment by radiosynoviorthesis with the use of 90 Y based on ultrasound and clinical analysis. MATERIALS AND METHODS: Ninety-seven patients were qualified for treatment from October 2016 to June 2017, and observation period lasted until December 2017. Bioethics Committee of the Medical University of Silesia approved this study. The effectiveness of knee joints treatment with the use of 90 Y was based on 927 ultrasound measurements of fluid and 927 synovial thickness in 3 sites of the suprapatellar recess, 309 assessments of patient's disability documented in Lequesne questionnaire, 309 assessments of pain on visual analog scale, as well as 103 overall self-assessment. Statistical methods were used to process the results. RESULTS: A reduction in fluid was found in 62.14% of the knees; synovial thickness reduction was observed in 97.09% of all knees. The greatest benefit from the therapy was experienced by patients complaining of morning stiffness lasting more than 15 minutes (in 85.71% of joints). There was reduction in pain at rest in 94.52% of knee joints and in 80.39% of joints with pain while walking. At the second follow-up visit after treatment, the percentage of improvement in self-assessment was 74.76%. CONCLUSIONS: Statistically significant decreases in the amount of fluid and thickness of the synovial membrane as well as the level of disability and the intensity of pain after radiosynoviorthesis 90 Y treatment were demonstrated.

Severe bronchiectasis and inflammatory lung disease in a patient with anorexia nervosa and severe and enduring malnutrition - a case report.

BACKGROUND: Persistent structural changes of the lungs in anorexia nervosa (AN) patients are rarely described in contemporary medical literature. The objective of our paper is to report a rare case of severe bronchiectasis and inflammatory changes to the lungs resulting from chronic malnutrition in a AN patient. CASE PRESENTATION: We describe a patient with severe inflammatory lung disease caused by malnutrition, resulting in persistent bronchiectasis accompanying AN. We performed an analysis of the patient's medical records including radiological findings and laboratory results. A review of available literature shows very little data available on this topic. CONCLUSION: Bronchiectasis and other structural changes of the lungs are rare, but severe complications of severe, chronic malnutrition. As exemplified by our case report, they may require extensive differential diagnosis and pose a significant clinical challenge due to their non-reversible character. A successful treatment relies heavily on the patient's compliance and may be hard to achieve. Clinicians managing patients with anorexia nervosa should be wary of early respiratory tract dysfunction-related symptoms and always consider malnutrition bronchiectasis as a differential diagnosis option.

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.

Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children.

PURPOSE: Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. METHODS: Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. RESULTS: The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12-13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. CONCLUSIONS: ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively. LEVEL OF EVIDENCE: Level III, diagnostic 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.

Evaluation of subarachnoid space and subarachnoid cisterns in children and teenagers based on computed tomography studies.

PURPOSE: The aim of the study was to develop the normative values of linear indices to the diagnosis of changes in size of the subarachnoid space. MATERIAL AND METHODS: Retrospective studies were conducted based on 507 head computed tomography (CT) examinations in children from 0-18 years of age. In total 381 tests were selected for correct reference values. Patients were divided into age groups. For each group, linear indices were calculated, taking into account the size of the fluid spaces in relation to the size of the skull and then the mean with standard deviation, median, as well as 10th and 90th percentile were calculated. The range between the 10th and the 90th percentiles was defined as the reference value. RESULTS: Obtained normative values, minimum and maximum for all groups: index of basal cistern size to the size of the skull - 0.129-0.197; index of basal cistern transverse dimension to the size of the skull - 0.173-0.255; index of basal cistern sagittal dimension to the size of the skull - 0.086-0.150; index of prepontine cistern - 0.034-0.067; index of interhemispheric fissure width - 0.044-0.127; index of Sylvian fissure - 0.036-0.085; index of insular cistern width - 0.020-0.074; index of subarachnoid space - 0.017-0.081. CONCLUSIONS: The linear indices can be calculated based on images achieved during routine CT examination. The reference values allow us to determine if the size of the subarachnoid space is within the normal range for a given age group. The results from the oldest age group can also be referred to the adults.

The Use of Indomethacin with Complete Amniotic Fluid Replacement and Classic Hysterotomy for the Reduction of Perinatal Complications of Intrauterine Myelomeningocele Repair.

OBJECTIVE: This study presented outcomes of classical hysterotomy with modified antiprostaglandin therapy for intrauterine repair of foetal myelomeningocele (fMMC) performed in a single perinatal centre. STUDY DESIGN: Forty-nine pregnant women diagnosed with fMMC underwent classic hysterotomy with anti-prostaglandin management, complete amniotic fluid replacement and high dose indomethacin application. RESULTS: The average gestational age (GA) at delivery was 34.4 ± 3.4 weeks, with no births before 30 weeks GA. There were 2 foetal deaths. Complete reversal of hindbrain herniation (HH), assessed in magnetic resonance imaging at 30-31 weeks GA was found in 72% of foetuses (mostly with HH grade I prior to fMMC repair). Our protocol resulted in rare use of magnesium sulphate (6%), low incidence of chorioamniotic membrane separation - chorioamniotic membrane separation (6%), preterm premature rupture of membranes - preterm premature rupture of membranes (pPROM; 15%) and preterm labour - preterm labour (PTL; 17%). The postoperative wound continuity of the uterus was usually stable (in 72% of patients), with low frequency of scar thinning (23%). CONCLUSION: Our protocol results in rare use of tocolytics, and the low occurrences of CMS, pPROM and PTL in relation to other study cohorts: Management of Myelomeningocele Study, Children's Hospital of Philadelphia, and Vanderbilt University Medical Centre.

Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke.

PURPOSE: Leukoaraiosis (LA), according to the latest classification, is white matter hyperintensity - morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy. MATERIAL AND METHODS: We retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements. RESULTS: Statistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis. CONCLUSIONS: The results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity.

Radiological features of sacrococcygeal teratomas in fetal magnetic resonance imaging and computed tomography - a case report.

PURPOSE: Sacrococcygeal teratomas (SCT) can be detected in ultrasonography as early as in the first trimester. Currently, prenatal ultrasonography enables a thorough examination of tumors, but it is not always sufficient. The purpose of this study was to determine the most important features of SCTs in fetal magnetic resonance imaging and to confront them with postnatal computed tomography (CT). CASE REPORT: Between 2009 and 2013, 5 cases of sacrococcygeal teratomas were diagnosed in our hospital using fetal magnetic resonance imaging (3 female and 2 male infants). Three of the affected newborns underwent postnatal CT before surgery. In each case, tumor size, its content, mass effect, and classification according to the Altman's criteria were determined and compared with other features. Fetal magnetic resonance imaging (MRI) and postnatal CT were in excellent agreement with respect to tumor classification using the aformentioned criteria. MRI better characterizes tumor content and its extent compared to ultrasound, and enables a precise structural assessment of the central nervous system. Postnatal CT is complementary to fetal MRI and optional. CONCLUSIONS: Fetal MRI may help in the prenatal diagnosis of SCTs as it overcomes the limitations of obstetric ultrasound. Postnatal computed tomography is useful in determining tumor vascularity or calcifications, and it can depict the surrounding bone structures.

Leukoaraiosis - new concepts and modern imaging.

Leukoaraiosis is a pathological appearance of the brain white matter, which has long been believed to be caused by perfusion disturbances within the arterioles perforating through the deep brain structures. Due to its complex etiopathogenesis and clinical relevance, leukoaroisosis has been investigated in a multitude of studies. As regards the clinical implications of leukoaraiosis, this neuroimaging finding is strongly related to ischaemic stroke, unfavourable course of ischaemic stroke in the acute phase, worse long-term outcomes, and cognitive disturbances. The morphological changes in the deep white matter that are collectively described as leukoaraiosis, despite a seemingly homogenous appearance, probably resulting from various causes, such as atherosclerosis, neurotoxic factors including radiation therapy and chemotherapy, and neuroinfections. Based on our experience and recent literature, we present the symptomatology of leukoaroisosis and similar radiological abnormalities of the cerebral white matter.

Novel Genetic Triggers and Genotype-Phenotype Correlations in Patients With Left Ventricular Noncompaction.

BACKGROUND: Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous disease and, although increasingly recognized in clinical practice, there is a lack of widely accepted diagnostic criteria. We sought to identify novel genetic causes of LVNC and describe genotype-phenotype correlations. METHODS AND RESULTS: A total of 190 patients from 174 families with left ventricular hypertrabeculation (LVHT) or LVNC were referred for cardiac magnetic resonance and whole-exome sequencing. A total of 425 control individuals were included to identify variants of interest (VOIs). We found an excess of 138 VOIs in 102 (59%) unrelated patients in 54 previously identified LVNC or other known cardiomyopathy genes. VOIs were found in 68 of 90 probands with LVNC and 34 of 84 probands with LVHT (76% and 40%, respectively; P<0.001). We identified 0, 1, and ≥2 VOIs in 72, 74, and 28 probands, respectively. We found increasing number of VOIs in a patient strongly correlated with several markers of disease severity, including ratio of noncompacted to compacted myocardium (P<0.001) and left ventricular ejection fraction (P=0.01). The presence of sarcomeric gene mutations was associated with increased occurrence of late gadolinium enhancement (P=0.004). CONCLUSIONS: LVHT and LVNC likely represent a continuum of genotypic disease with differences in severity and variable phenotype explained, in part, by the number of VOIs and whether mutations are present in sarcomeric or nonsarcomeric genes. Presence of VOIs is common in patients with LVHT. Our findings expand the current clinical and genetic diagnostic approaches for patients with LVHT and LVNC.

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography.

BACKGROUND The aim of the study was to determine the prevalence of petrosquamosal sinus (PSS) and other temporal bone (TB) anatomical variations in various patients using high-resolution computed tomography (CT). MATERIAL AND METHODS We reviewed clinical and consecutively obtained CT data for 276 TBs of 138 patients. The incidence of TB anatomical variations was compared among patients with radiological markers of chronic otitis media (RCOM) and non-RCOM. RESULTS The PSS incidence in our sample was 6.9%, and it was significantly higher in TBs with RCOM (14.6%). Selected anatomical variations of RCOM TBs were observed: lateral sigmoid sinus (14.5%), prominent sigmoid sinus (23.6%), PSS (14.6%), and high jugular bulb (17.3%). Lateral sigmoid sinus and prominent sigmoid sinus (p<0.01), high jugular bulb (p<0.05), and PSS (p<0.01) were observed more often in RCOM than in non-RCOM TBs. CONCLUSIONS The TB vascular and anatomical variations, including PSS, a high jugular bulb, and a laterally and prominent placed sigmoid sinus, were more often observed in TBs with RCOM. Presurgical imaging and CT-based navigation techniques for TB surgery can offer remarkable value for understanding the altered anatomy of this complex structure and can localize rare anatomical variations.

What you cannot get from routine MRI of MS patient and why - The growing need for atrophy assessment and seeing beyond the plaque.

Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients' disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients' clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results.

Assessment of Serum Nitrogen Species and Inflammatory Parameters in Relapsing-Remitting Multiple Sclerosis Patients Treated with Different Therapeutic Approaches.

The role of nitric oxide and its reactive derivatives (NO x ) is well known in the pathogenesis of multiple sclerosis, which is an inflammatory disease while NO x seems to be important in coordinating inflammatory response. The purpose of the present study was to assess serum NO x as one of the nitrogen species and inflammatory parameters in relapsing-remitting multiple sclerosis patients and to compare the effectiveness of various types of disease-modifying therapies that reduce nitric oxide and inflammatory biomarkers. Elevated NO x level was observed in patients who received the first-line disease-modifying therapy (interferons beta-1a and beta-1b) in comparison with the subjects treated with the second-line disease-modifying therapy (natalizumab; fingolimod) and healthy controls without significant differences in C-reactive protein and interleukin-1 beta. A negative correlation was observed between serum NO x level and the duration of multiple sclerosis confirmed in the whole study population and in subjects treated with the first-line agents. Only serum NO x , concentration could reveal a potential efficacy of disease-modifying therapy with a better reduction in NO x level due to the second-line agents of disease-modifying therapy.

Direct MRI fistulography with hydrogen peroxide in patients with recurrent perianal fistulas: a new proposal of extended diagnostics.

BACKGROUND: Perianal fistulas are malformations of the anorectal area. Accurate preoperative assessment of perianal fistula tract is a main assumption in diagnosis of the disease, affecting the operation efficiency. The aim of the study was to present our experience in application of a new diagnostic protocol based on the magnetic resonance imaging (MRI) examination using a mixture of hydrogen peroxide (HP) and gadolinium as a direct contrast medium in evaluation of recurrent fistulas tract. The method is referred to as HPMRI. MATERIAL AND METHODS: The study group consisted of 12 subjects operated on from 2011. Direct HPMRI fistulography was performed in all subjects before the operation. All types of fistulas were precisely evaluated by HPMRI examination. RESULTS: Intraoperative state confirmed complete course of fistulas in 11 cases. In 1 case, an internal opening was not found. CONCLUSIONS: We suggest that this new method of direct HPMRI fistulography may improve visualization of the tracts of recurrent fistulas and improve efficacy of surgical procedures.

Cerebral venous sinus thrombosis.

Diagnostic imaging in cerebral venous sinus thrombosis poses difficulties due to the relatively rare incidence of this pathology and its usually inconclusive clinical and radiological symptoms. The preliminary examination is usually performed using computed tomography, whereas magnetic resonance imaging (MRI) provides better visualisation of the lesion. Computed tomography and magnetic resonance imaging angiography enable the characterisation of the blood flow in the pathologically affected vessels in more detail. Familiarity with the anatomic variations of the venous system and with the advantages and limitations of computed tomography/magnetic resonance imaging enables faster diagnosis of the pathology. This is significant for treatment, which, in many cases, can be efficient only if introduced at a sufficiently early stage.

MR-guided focused ultrasound: a new generation treatment of Parkinson's disease, essential tremor and neuropathic pain.

The application of high intense focused ultrasound (HIFU) is currently the subject of many experimental and clinical trials. The combination of HIFU with MRI guidance known as MR-guided focused ultrasound (MRgFUS) appears to be particularly promising to ablate tissues located deep in the brain. The method can be the beginning of interventional neurology and an important alternative to neurosurgery. Studies conducted to date show the effectiveness of the method both in chronic diseases and in emergency cases. The safety and effectiveness of this method have been observed in parkinsonian and essential tremor as well as in neuropathic pain. The procedure does not require anaesthesia. Ionizing radiation is not used and there is no risk of cumulative dose. Such advantages may result in low complication rates and medical justification for further development of MRgFUS.

Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study.

OBJECTIVE: The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. METHODS: The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. RESULTS: High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. CONCLUSIONS: Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.