Anthropometric dimensions provide reliable estimates of abdominal adiposity: A validation study

Abdominal fat accumulation is a major risk factor for cardiometabolic morbidity and mortality. The purpose of the study is to assess the possibility of developing accurate estimation equations based on body measurements to determine total abdominal (TFA), subcutaneous (SFA) and visceral fat area (VFA). Hungarian volunteers (n=198) aged between 20 and 81 years were enrolled in the study, which was conducted between July and November 2014. All persons underwent anthropometric measurements and computer tomographic (CT) scanning. Sex-specific multiple linear regression analyses were conducted in a subgroup of 98 participants to generate estimation models, then Bland-Altman's analyses were applied in the cross-validation group to compare their predictive efficiency. The variables best predicting VFA were hip circumference, calf circumference and waist-to-hip ratio (WHR) for males (R²=0.713; SEE=5602.1mm²) and sagittal abdominal diameter (SAD), WHR, thigh circumference and triceps skinfold for females (R²=0.845; SEE=3835.6mm²). The SFA prediction equation included SAD, thigh circumference and abdominal skinfold for males (R²=0.848; SEE=4124.1mm²), body mass index and thigh circumference for females (R²=0.861; SEE=5049.7mm²). Prediction accuracy was the highest in the case of TFA: hip circumference and WHR for males (R²=0.910; SEE=5637.2mm²), SAD, thigh circumference and abdominal skinfold for females (R²=0.915; SEE=6197.5mm²) were used in the equations. The results suggested that deviations in the predictions were independent of the amount of adipose tissue. Estimation of abdominal fat depots based on anthropometric traits could provide a cheap, reliable method in epidemiologic research and public health screening to evaluate the risk of cardiometabolic events.

Unusual spinal tuberculosis in an Avar Age skeleton (Csongrád-Felgyő, Ürmös-tanya, Hungary): A morphological and biomolecular study

The paleopathological analysis of a well-preserved young adult female skeleton from the AD 7-8th century (Avar Age) in Hungary revealed multiple lytic lesions in all of the thoracic and lumbar vertebral bodies. The lesions were characterized by smooth marginal zones and space-occupying mass appearance. The considerable loss of spongy bone in the thoracolumbar vertebrae resulted in angular deformity and fusion, characteristic of the healing stage of TB. Osteolytic lesions were also observed on the vertebral processes, ribs and sternum. On the endocranial surface, abnormal blood vessel impressions were revealed, indicating some kind of meningitis. The X-ray and CT analysis of the affected bones detected abnormal structures and cystic zones of destruction. The lesions were however not always bordered by areas of increased density, which is typical in cystic TB. Vertebral remains were also subjected to biomolecular analysis in two different laboratories, which attested the presence of Mycobacterium tuberculosis complex (MTBC) DNA and supported the paleopathological diagnosis of TB. Spoligotyping analysis confirmed the presence of MTBC DNA and more specifically an infection caused by bacteria belonging to the M. tuberculosis lineage. This case study provides new data for the paleoepidemiology of TB in this geographical area and historical period, and draws attention to the great variability of TB lesions in the human skeleton.

[Magnetic resonance imaging in the diagnosis of breast diseases]

Authors report about the role of contrast medium enhanced magnetic resonance imaging in diagnosis of breast diseases, and experiences with this method. The aim of the study was to determine the diagnostic accuracy of the method. The results was correlated with the histopathological findings, and compared to the diagnostic accuracy of the conventional X-ray mammography in breast lesions. X-ray and MR-mammography were evaluated in 220 patients (238 breasts) scheduled for breast surgery. The breasts were examined with T1-weighted transversal images using contrast medium enhanced semidynamic technique with 3D fast low angle shot (FLASH) sequence. Each breast was given a routine examination with 3 mammographic views. Contrast enhanced MR-mammography is a highly sensitive method for the detection of breast cancer, it has a higher diagnostic accuracy (84.5%), than conventional X-ray mammography (82.4%). When MRI and conventional X-ray mammography were used together, very high sensitivity but a lower diagnostic accuracy (81.5%) was achieved. MRI was effective in revealing mammographically equivocal or occult lesions and multifocal tumors even in dense breasts, but it was less reliable for some invasive lobular cancers, non-invasive ductal carcinomas, fibroadenomas and hyperplastic breast changes. Presently accepted indications for MRI of the breast are: (1) patients with breast implants--to demonstrate prothesis complications and tumor relapses; (2) postoperative imaging in patients after tumorectomy and radiation therapy--in these cases MRI allows differentiation between tumor relapses and extensive scars; (3) proven axillary lymph node metastasis from an unknown primary carcinoma; (4) preoperative MR imaging in cases suspected or verified carcinomas within dense breasts to exclude multicentricity/multifocality; (5) follow-up in chemotherapy of breast cancer; (6) patients with high-risk constellation.

Thoracic core needle biopsy using ultrasound guidance

This article demonstrates the usefulness of ultrasound (US)-guided core needle biopsy in the diagnosis of thoracic lesions. Between January 1997 and June 2000, 45 US-guided core needle biopsies were performed in the department of radiology. This method was chosen in every case when the lesion abutted the chest wall. Conventional histologic examinations supplemented by immunohistochemical methods were performed. The location and size of the mass, the number of samplings, the needle size, the histologic results, and any complications were recorded. Twenty-two lesions reached the anterior, six reached the lateral, and 14 reached the posterior chest wall. Biopsies were performed on three masses from the supraclavicular region. The mean diameter was 4.5 cm and the number of passes was 1.8; 18-G, 16-G, and 14-G needles were used in 41, two, and two cases, respectively. In 43 of the 45 cases (95.68%), an exact histologic diagnosis could be provided. In two cases, only necrotic tissue was seen in the biopsy sample. No major complications occurred. Minor complications, including pain and collaptiform weakness, were documented in four patients. Ultrasound-guided core needle biopsy of thoracic lesions is a safe, quick, and accurate method. For diagnosing thoracic lesions, a single sample with an 18-G biopsy needle is sufficient to achieve a final diagnosis when using appropriate histologic methods.

Clinical value of technetium-99m-HMPAO-labeled leukocyte scintigraphy and spiral computed tomography in active Crohn's disease

OBJECTIVES

The diagnostic accuracy of technetium-99m-HMPAO-labeled leukocyte scintigraphy (LS) and spiral CT for the detection of inflammatory activity was assessed; the extent of the inflammation and the complications were compared with the clinical and laboratory parameters and with the endoscopic and radiological findings in patients with clinically active Crohn's disease (CD).

METHODS

Twenty-eight patients (13 men, 15 women, average age 32.5 yr, range: 18-59 yr) with an acute exacerbation of CD were enrolled in the study. The disease behavior type and the maximum extent of inflammation were established by means of endoscopy (jejunoscopy and colonoscopy) and enteroclysis. Nine patients with severe complications (abscess and stenosis) underwent operation. The GI tract was divided into five segments (small bowel, ascending colon, transverse colon, descending colon, and rectosigmoid), the LS, CT, endoscopic, and radiological pictures of all segments were graded (range: 0-3) and the scores were summed and compared.

RESULTS

The investigations indicated that LS and CT had sensitivities of 76.1% and 71.8%, specificities of 91.0% and 83.5%, and accuracies of 82.6% and 77.5%, respectively, for detection of segmental inflammatory activity. With regard to the disease behavior type, the sensitivities of LS and CT were, respectively, 77% and 100% in the penetrating-fistulizing, 80% and 73% in the stricturing, and 68% and 64% in the inflammatory form of CD. CT detected all abdominal abscesses, whereas the diagnostic value of LS for the detection of the complications of CD was lower. The inflammatory activity scores measured by LS displayed a closer correlation than that of CT with the Best index (r = 0.71, p < 0.0005 vs r = 0.63, p < 0.001), the van Hees index (r = 0.61, p < 0.005 vs r = 0.59, p < 0.005), the serum fibrinogen level (r = 0.67, p < 0.005 vs r = 0.59, p < 0.005), or the C-reactive protein level (r = 0.64, p < 0.005 vs r = 0.51, p < 0.01).

CONCLUSIONS

Both LS and CT are valuable noninvasive diagnostic methods in cases involving severe, active CD. LS seemed better for the detection of segmental inflammatory activity, whereas CT displayed excellent suitability for the recognition of complications: abdominal abscesses were diagnosed with 100% efficiency.

[Uterine artery embolization for the conservative management of leiomyoma]

Uterine leiomyoma, a benign, monoclonal tumor derived from a single myometrial cell, is one of the most frequent diseases in the female reproductive system. However, the factors involved in its initiation and growth remain poorly understood. Most commonly, it results in dysmenorrhea, menorrhagia, urinary tract and neurological symptoms, and abdominal distension. Additionally, it may cause infertility, late miscarriage or other severe complications in pregnancy. The conventional treatment for fibroids has been hysterectomy. However, many women do not like to lose their uterus and potential fertility. Myomectomy and medical treatment with GnRH analogue are accepted as alternative organ-conserving methods with limited efficacy. Selective embolization of uterine arteries might therefore have a significant role in the management of the disease. The purpose of this study was to determine the effectiveness of uterine embolization as primary therapy in the management of myomas. Uterine arterial embolization was performed in 3 patients with symptomatic leiomyomas. The uterus and fibroids were objectively evaluated with ultrasound and MRI. The efficacy and safety convinced the authors that this promising technique is at present the only reasonable alternative method in organ-conserving therapy. It is less invasive than surgery, it can restore fertility, it is well tolerated and the recovery time is shorter than that following surgical procedures. This preliminary experience is sufficient to encourage gynecologists to introduce the method in Hungary.

Three-dimensional time-of-flight MR angiography in trigeminal neuralgia on a 0.5-T system

The goal of this study was to analyze the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), performed on a 0.5-T system in the detection of neurovascular compression in patients with trigeminal neuralgia (TN). One hundred seventy-two TN patients were examined using plain and contrast-enhanced 3D TOF MRA on a 0.5-T system. Maximum intensity projection (MIP) reconstruction was performed in three standard planes. Both the original and the reconstructed images were studied to search for vascular compression shown by close neurovascular contact and/or dislocation of the trigeminal nerve. Forty-two TN patients underwent surgical exploration of the posterior fossa. Results of MRA were compared with clinical data in all cases and to result of surgery in the surgically treated cases. Neurovascular contact at the root entry zone of the trigeminal nerve was detected on the symptomatic side in 94 patients, and on the asymptomatic side in 12 patients. Sensitivity, specificity, accuracy, as well as positive and negative predictive value of 3D TOF MRA in the detection of neurovascular compression in the patient group undergoing surgery, were 97.6, 92.5, 95.0, 93.0, and 97.4%, respectively. Three-dimensional TOF MRA performed on a 0.5-T system appears to be not less effective than similar examinations by higher field strength devices in the detection of neurovascular contact. This sequence accurately demonstrates the presence of neurovascular compression, and in this way valuable information may be achieved for the planning of surgical therapy of patients with trigeminal neuralgia.

[Multidisciplinary therapy of colorectal cancer]

A multidisciplinary program for the treatment of colorectal cancer is described. The main objective of the authors has been to define uniform up to date guidelines based on recent progress in the treatment of colorectal cancer. Preoperative diagnostic procedures are summarized which advance determination of clinical stage and prognosis. These information essentially determine care. Sequences of surgical methods, preoperative and postoperative radiotherapy and medical treatments are discussed according to tumor stages. Guidelines for surveillance following active treatment and recommendation for the screening of population at high risk for colorectal cancer are presented.

[Treatment of renal artery stenoses with stent implantation]

The authors report on their experience with the treatment of renovascular hypertension by stent implantation. In the past 4 years different types of stents (Palmaz [9], Palmaz-Corinthian [4], Memotherm [1] and AVE [1]) were implanted into 15 renal arteries of 11 patients. The indication was primary in 8 cases, and secondary in 3 patients, because of restenosis of a previously dilated renal artery. 14 stents were implanted into narrowed renal arteries, and in the remaining one case a stent was placed in an occluded renal artery immediately after recanalization. The technical success was 100%. In all but the recanalized case in which the renal artery was occluded, stents are still open. On the basis of this experience and the literature, the authors suggest the more extensive usage of this less invasive method.

Water enema CT examination of rectum cancer by reduced amount of water

OBJECTIVE

To define whether volume of water, administered during water enema CT (WE-CT) for local staging of rectal cancer, may be reduced without compromising the diagnostic value of the examination.

MATERIALS AND METHODS

29 patients with rectum cancer underwent preoperative WE-CT. Contrast-enhanced CT (equilibrium phase) measurements were performed after i.v. injection of smooth muscle relaxant and rectal administration of 400-500 ml lukewarm tap water. Quality of the obtained scans was evaluated and the images were analyzed for depth of tumor invasion. Results of the CT examinations were compared to findings at surgery.

RESULTS

Despite reduced dose of water enema, 19/29 examinations were of excellent quality, 6/29 good, and 4/29 poor, but still diagnostic. We achieved sensitivity (90.1), specificity (70.1) and accuracy (86.2) in differentiating tumors confined to the bowel wall from those extending beyond it.

CONCLUSION

Large volume of water enema administered during CT examination of the rectum may cause complaints and increases the risk of complications. Our results prove that using lower amount of water does not impair the quality of examination and accuracy of local staging of rectum carcinomas.

Primary renal and retroperitoneal actinomycosis

A case of the rare condition of renal and retroperitoneal actinomycosis is presented. The clinical and imaging (ultrasonography and computed tomography) findings are described and attention is drawn to the diagnostic difficulties in this rare disease.

[Total mesorectal excision with ultrasonic coagulation knife ("UltraCision") in surgery of rectal cancer]

The authors report a total of 62 middle and low third rectal cancer cases operated on by total mesorectal excision by the method of Heald. The oncological basis of this procedure is the horizontal regional metastatization of rectal cancer. The total mesorectal excision facilitates, the low anterior resections and preservation of sphincter with an ultra-low colorectal, or coloanal anastomosis using the double stapling technique. In the authors' experience, the "UltraCision" cutting-coagulating device permits an atraumatic, bloodless and oncologically correct dissection. Using the double stapling technique, we succeeded in 60% of our middle- and low-third rectal cancer patients to perform a sphincter preserving low anterior resection. In 9 (28%) of the low third rectal cancer patients, preservation of the sphincter was possible with oncologically correct anterior resection and an ultra-low colo-anal anastomosis. Three anastomotic insufficiencies occurred, two of them healed on lotion-suction drainage, and one on the application of transient protective ileostomy. The literature data suggest a lower local recurrency rate after radical rectal cancer surgery, if total mesorectal excision is performed.

The place of magnetic resonance and ultrasonographic examinations of the parotid gland in the diagnosis and follow-up of primary Sjögren's syndrome

OBJECTIVE

The aim was to determine the place of magnetic resonance imaging (MRI) and ultrasonographic (US) examination in the diagnosis and follow-up of Sjögren's syndrome (SS).

METHODS

Parotid MRI and US examinations were carried out on 44 primary SS patients and 52 controls of similar age.

RESULTS

The most important structural changes in SS were different degrees of parenchymal inhomogeneity, which could be detected by both methods, and were found more frequently in the SS patients than in the controls (MRI: 95.4 vs 17. 3%; US: 88.6 vs 7.7%; P<0.001). There was good agreement between the MRI and US findings both in the SS cases (93.2%) and in the controls (86.5%). In one SS patient who developed parotid lymphoma, the US examination showed a hypoechoic 'cobblestones'-like inhomogeneous internal pattern which was coupled with an almost homogeneous MRI pattern.

CONCLUSIONS

MRI appears unnecessary as a routine method in the diagnosis of SS; US examination is suitable both for the diagnosis and follow-up of SS. The above combination of the seemingly contradictory US and MRI findings is highly characteristic of lymphoma which has developed in the course of the disease.

Extra-abdominal desmoid mimicking malignant male breast tumor

A rare case of extra-abdominal desmoid tumor is reported. A palpable mass was detected in the right breast of a 47-year-old man. Mammography showed a stellate mass without calcification, and breast ultrasound examination revealed a solid, inhomogeneous, non-calcified lesion. The result of cytological examination of the fine-needle aspiration biopsy specimen was equivocal. Histology of the surgical specimen showed extra-abdominal desmoid tumor. Extra-abdominal presentation of this semimalignant tumor is rare and may mimic malignant breast tumor. Differential diagnosis is difficult and usually based on the result of the histological examination.

[Value of CT-guided biopsy compared to fluoroscopy-guided transthoracic biopsy and bronchoscopic sampling in the diagnosis of pulmonary nodules]

CT-guided histological sampling is nowadays used routinely in the differential diagnosis of focal lung diseases with no characteristic morphology. The aim of this study was to determine the value of the method. CT-guided core biopsy was performed in 25 patients with pulmonary nodules. 16 patients underwent bronchoscopy where cytological sampling was also carried out, while 5 patients underwent fluoroscopically guided biopsy. The histological diagnosis resulting from CT-guided biopsy specimens was compared with the findings from the other diagnostic procedures (bronchoscopy or fluoroscopically guided biopsy), with the results of surgery and/or chemotherapy and with the follow-up data. The result of CT-guided biopsy was true in 20/25 and falls in 5/25 cases. Of the 16/25 patients undergoing bronchoscopy, 13/16 gave negative results. In 11/16 cases, the result of the CT-guided biopsy was positive. The fluoroscopically guided biopsy was negative in 4/5 cases, and in 3/5 of these cases the diagnostic CT-guided biopsies proved positive. Our results demonstrate the better diagnostic value of CT-guided core biopsy relative to fluoroscopically guided biopsy or bronchoscopic sampling in those cases where the size and localization of the nodule make it inaccessible with the latter two methods.

[A case of spontaneous rupture of a cervical hematoma causing respiratory insufficiency]

The authors review a case of a patient with spontaneous cervical hematoma without trauma. The similar cases of the international literature, the causes (local and systemic vascular disorders, inflammatory and neoplastic disease of the surrounding tissues) are summarized and the importance of the computerized tomography in connection with the described case is emphasized.

[Diagnostic imaging of the subdiaphragmatic lymphatic system in malignant lymphoma: confusion of abundance?]

Staging of malignant lymphomas, monitoring of response to therapy and regular follow-up of treated patients can properly be performed by new diagnostic imaging modalities. Diagnosis of subdiaphragmatic nodal involvement by ultrasonography and computed tomography is based on enlargement of lymph nodes. Lymphography is the only method which can depict pathologic internal architecture in normal sized lymph nodes. Of 82 patients there were 72 on admission without known subdiaphragmatic nodal disease. Of these 22 (30.5%) were found to have nodal involvement in this region. Suggested diagnostic algorhythm is shown on flow diagram.

Renal cell carcinoma: value of imaging examinations in diagnosis and staging

Authors analyse the value of intravenous pyelography, ultrasonography, computed tomography, angiography and fine needle aspiration biopsy in the detection, differentiation and staging of renal space-occupying lesions, on the basis of examinations performed in 158 patients, in comparison with results of surgery and/or clinical follow up. Their conclusion is that ultrasonography plays a major role in the detection and differentiation of these lesions, intravenous pyelography is only a complementary method, while computed tomography can provide diagnosis in cases with uncertain ultrasonographic findings. Staging has to be based on computed tomography. The role of angiography and fine needle aspiration biopsy is limited they need to be performed in a few selected cases only.