Application of the apparent diffusion coefficient in magnetic resonance imaging in an assessment of the early response to treatment in Hodgkin's and non-Hodgkin's lymphoma - pilot study.

PURPOSE: Lymphoproliferative neoplasms are the largest and most frequently diagnosed entities in the group of haematological malignancies. The aim of the study was to assess whether apparent diffusion coefficient (ADC) measured on the first day of the second cycle of chemotherapy could be a predictor of prognosis and of the final treatment's outcome. MATERIAL AND METHODS: The study included 27 patients with diagnosed Hodgkin's and non-Hodgkin's lymphoma, who had magnetic resonance (MR) performed with diffusion weighted imaging/apparent diffusion coefficient (DWI/ADC) before and on the first day of the second cycle of chemotherapy. Imaging was performed using a 1.5 T MR scanner. ADC was measured in lymphoma infiltration in the area of the lowest signal in the ADC map and the highest signal on ß 800 images in post-treatment study. After that, the corresponding area was determined in a pre-treatment study and an ADC value was measured. RESULTS: The difference between ADC values in pre-treatment (ADC = 720 mm2/s) and post-treatment (ADC = 1059 mm2/s) studies was statistically significant (p < 0.001). Cutoff values for estimating response to treatment were established at the level of ADC 1080 mm2/s, and ADC to muscle ratio at 0.82 in post-treatment study. Patients with ADC > 752 mm2/s before treatment manifested lower probability of progression than patients with ADC < 752 mm2/s. CONCLUSIONS: ADC measurement's before treatment and on the first day of the second cycle of chemotherapy can be used as a prognostic marker in lymphoma therapy. ADC values lower than 1080 mm2/s and an increase of the ratio after the treatment can be considered as a marker of disease progression.

Evaluation of temporal bone computed tomography and paranasal sinuses magnetic resonance images in acromegalic patients.

OBJECTIVE: Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly. CONCLUSIONS: 1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly.

MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours.

BACKGROUND: Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change in anatomical conditions. It depends also on numerous other factors, including: size and expansion of the tumour before surgery, type of surgical access, quality and volume of implanted materials and time of its resorption. The purpose was to demonstrate the characteristics of the implanted materials on MRI performed after transsphenoidal resection of pituitary tumours and to identify imaging criteria helpful in differential diagnosis of masses within the sellar region. MATERIAL/METHODS: One hundred and fifty-four patients after transsphenoidal resection of pituitary tumours were included in the study. In general, 469 MRI examinations were performed with a 1.5T scanner. We obtained T1-weighted sagittal and coronal, enhanced and unenhanced images. In 102 cases, additional T2-weighted coronal, unenhanced images with 1.5 T unit were obtained as well. RESULTS: The implanted materials appeared in 95 patient: fat in 86 and muscle with fascia in 3 patients. We could recognise implanted muscle and fascia in T2-weighted images, because of high signal intensity of the degenerating muscle and the line of low signal representing fascia. The implanted titanium mesh was found in 4 patients. Haemostatic materials were visible only in 2 patients in examinations performed at an early postoperative stage (1 month after the procedure). CONCLUSIONS: The knowledge of MRI characteristics of the materials implanted at the sellar region is very important in postoperative diagnosis of pituitary tumours and may help discriminate between tumorous and non-tumorous involvement of the sellar region. Some implanted materials, like fat, could be seen on MRI for as long as 10 years after the operation, others, like haemostatic materials, for only 1 month after surgery. T2-weighted imaging is a useful assessment method of the implanted muscle and fascia for a long time after surgery.

[Vestibulo-cochlear disturbances in the course of vaso-neural conflict of vestibule-cochlear nerve--diagnostic and therapeutic problems]. / Zespól zaburzen przedsionkowo-slimakowych na podlozu konfliktu naczyniowo-nerwowego nerwu przedsionkowo-slimakowego--problemy diagnostyczno-terapeutyczne.

INTRODUCTION: Symptoms encompassing sensorineural hearing loss, tinnitus and vertigo occur in many diseases of various origin. The diagnostics in such cases is especially difficult and often requires interdisciplinary cooperation. Despite of that many cases remain unexplained. MATERIAL AND METHOD: The two cases with above mentioned symptoms (52 year-old woman and 46 year-old man) with differentiated clinical course were presented. The woman for one year experienced left sided, extreme tinnitus with paroxysmal vertigo and dizziness. The man with sudden monolateral hearing loss and tinnitus that disappeared after corticosteroid therapy, complained about recurrence of fluctuating hearing loss and tinnitus accompanied by chronic instability. The diagnostics of hearing and balance organs was performed (pure tone audiometry, impedance audiometry, DPOAE, ABR, ENG) complemented with computed tomography and Nuclear Resonance. RESULTS: Female patient presented bilateral mild sensorineural hearing loss, more intensive on the left side, male patient right sided sensorineural hearing loss in the frequencies from 250 to 1500 Hz. The elongation of some peak values in ABR test (with bilaterally proper otoacoustic emissions) as well as partial canal paresis on the hearing loss side suggested primary diagnosis of neoplasmatic process. It was an indication to perform radiological diagnostics. The radiologic findings revealed the contact of vestibulo-cochlear nerve with the loop of cerebellar inferior anterior artery within the internal acoustic canal. CONCLUSIONS: The course of the disease and diagnostic tests do not provide characteristic data that let diagnose neuro-vascular conflict. One has to be aware of such possibility in patients with intensive vertigo and dizziness that do not improve after treatment when other causes do not justify the symptoms.

Usefulness of conventional and low-dose hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy.

PURPOSE: The aim of this retrospective study was to evaluate the usefulness of hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy. MATERIAL AND METHODS: The study involved 40 patients with a diagnosis of gastric tumor established by histopathology who underwent endoscopy and conventional or low-dose hydro-CT. Hydro-CT images were retrospectively analyzed based on the consensus of two radiologists who were blinded to the endoscopy findings. The diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric tumors was evaluated using the results of the histopathological examination as the reference standard. RESULTS: Histopathology confirmed the presence of gastric cancer in 28 patients (70%), while gastrointestinal stromal tumors (GISTs) were recognized in the remaining 12 cases (30%). Correct diagnoses of the type of gastric tumor in hydro-CT were obtained in 37 patients (92.5%). This was not significantly different from the 85% accuracy of endoscopy. Further analysis showed that the correctness of GIST diagnosis in endoscopy and hydro-CT also did not differ significantly (91.7% and 100% respectively). The percentage of correctly diagnosed malignant lesions in hydro-CT was lower than for GISTs at 89.29%, while in endoscopy it was insignificantly lower (82.14%). The diagnostic accuracy of conventional and low-dose hydro-CT in the diagnosis of gastric tumors (95% and 90% respectively) was not significantly different. CONCLUSIONS: Conventional and low-dose hydro-CT may be a valuable non-invasive diagnostic method in the diagnosis of gastric tumors for patients who have contraindications to endoscopy or who are unable to undergo gastric biopsy.

Middle-ear ceruminous adenoma as a rare cause of hearing loss and vertigo: case reports.

Middle-ear ceruminous adenomas are rare benign neoplasms arising from the epithelium of the middle ear. Progressive hearing loss, ear fullness and tinnitus are common symptoms of this tumour; facial nerve paresis and vestibular disturbances occur very infrequently. We present two cases of middle-ear ceruminous adenomas, one showed rapid unilateral hearing loss with aural fullness, followed by purulent aural discharge and vertigo. In the second case, the disease affected an already deaf ear and the only symptom of the disease was increasing vertigo. The clinical features, intraoperative findings, and histological and radiological findings are presented. The cases are compared to those described in the literature.

[Usefulness of imaging in the diagnosis of salivary gland diseases]. / Przydatnosc badan obrazowych w diagnostyce chorób gruczolów slinowych.

UNLABELLED: The aim of this study was to evaluate the value of modern imaging modalities in the diagnosis and management of different salivary gland diseases. MATERIAL AND METHODS: Material comprised of 135 patients (79 women and 56 men) at the age 14-70 (mean aged 35, 7). Ultrasonography (US) was basic examination in every case. Results of US examinations were compared with sialography, CT and MR imaging. Final diagnosis was established on the basis of histopathologic examination. RESULTS: The big usefulness of new visualization techniques, especially modem ultrasonography in detecting neoplastic and inflammatory processes of salivary glands was stated. CONCLUSION: US is the first, precious imaging modality to evaluate a small lesions (in diameter above 5 mm) of the parotid and submandibular gland. CT and MR is better to evaluate large tumors and should be performed whenever a malignancy is strongly suspected or has been assessed.

Peripheral blood lymphocytes and selected serum interleukins in workers operating X-ray equipment.

The objective of these studies was to determine the effect of low X-ray doses on peripheral blood lymphocytes in the workers operating X-ray equipment. In 30 workers and 18 persons who constituted the control group the absolute number of peripheral blood lymphocytes, the number of T CD4+ and T CD8+ lymphocytes, the ratio CD4+/CD8+ and the concentration of serum interleukins (IL-2, IL-4, IL-6) were tested. Subgroups with respect to sex and employment period were selected. A significant increase in IL-2 concentration in workers as compared to controls was observed and significantly decreased IL-4 level in operating X-ray equipment was revealed. The lowest levels of IL-4 were noted in the women subgroup. A high positive, statistically significant correlations between the number of lymphocytes and the concentration of IL-2 and the level of IL-4 were observed. Moreover, our studies revealed that lymphocyte number and interleukin concentrations in serum of X-ray operators do not depend on the assumed ranges of the length of employment period.

Femoral and iliac vein stenoses after prolonged femoral vein catheter insertion.

BACKGROUND/AIMS: Catheterization of the femoral vein is a safe and recommended method of temporary access for haemodialysis. In some patients, however, because of the lack of other possibilities, it is necessary to maintain long-term femoral cannulation. The aim of the study was to evaluate the frequency of stenosis after prolonged femoral cannulation. METHODS: The 24 patients incorporated in the study were divided into two groups. Group 1 consisted of 10 end-stage kidney failure patients (four females and six males, aged 32-75 years, average 55.6+/-13.6 years) in whom femoral catheters were maintained for less than 2 weeks (5-14 days, average 9.3+/-3.6 days). Group 2 included 14 chronic haemodialysis patients (six females and eight males aged 23-65 years, average 49.5+/-13.27 years). The time of catheter maintenance ranged from 2 to 16 weeks (average 6.4+/-4.2 weeks). Femoral and iliac vein status was evaluated using magnetic resonance imaging. RESULTS: A feature of venous stenosis of both the femoral and iliac veins was disclosed in four patients in whom femoral cannulation lasted more than 4 weeks. There were no stenoses in group 1. CONCLUSION: Long-term femoral cannulation for more than 4 weeks may be associated with a significant risk of stenosis in the femoral and/or external iliac veins.