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Purpose: Graft parenchyma perfusion disturbances (GPPD) in transplanted kidneys are common in the early postoperative period. Rapid and accurate diagnosis can guide proper treatment, preventing graft dysfunction. Methods: One hundred and eighty patients, who underwent kidney transplantation (KTx), were examined in the immediate postoperative period using real-time ultrasonography (B-mode) with color and power Doppler (US-CD/PD) and B-flow ultrasound, as well as with an additional protocol of contrast-enhanced ultrasonography (CE-US). Regions of GPPD were localized and measured. The number and size of these areas were compared between the two acquisition techniques. Follow-up examinations were carried out 6 months postoperatively. Results: CE-US revealed more GPPDs and showed them more precisely than the B+US-CD/PD/B-flow technique. Moreover, in the CE-US examination, ischemic foci had statistically significant higher echogenicity in comparison to normal parenchyma, were larger and better visualized (better circumscribed) than in B+US-CD/PD/B-flow. Conclusion: CE-US allows the visualization of GPPD caused by occlusion of small arteries. It is a noninvasive, safe, real-time method, which has many advantages over standard B+US-CD/PD/B-flow examinations, and we recommend it as a routine diagnostic procedure in the early postoperative period following KTx.

Background Routine B-mode ultrasound examination (rB-US) is a current standard for the assessment of the transplanted kidney(KTx) in the early post-operative period. The alteration of perirenal hematoma (PH) echostructure over time limits their detectability and size assessment with rB-US. The aim of this study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CE-US) in diagnosing PH of KTx in the early post-operative period. Method Routine B-US and CE-US of KTx, performed in 102 patients in the early post-operative period, were analyzed. CE-US was performed after intravenous administration of 2.4 mL of sulfur hexafluoride solution. The data were analyzed with respect to the occurrence and thickness of PH. Result The difference in echogenicity between PH and kidney parenchyma was modest in rB-US (mean of 5.7 dB). However, in CE-US, the difference in echogenicity was significantly increased (mean of 31.4 dB). Routine B-US did not allow PH to be recognized in 18 patients. The application of CE-US results in a twofold increase in PH detection when compared with rB-US (33.3% vs. 15.7%). Conclusion US-CE examination is a valuable method for detection and assessment of PH size. Compared with rB-US, this technique may substantially increase the detectability of hemorrhagic complications in the direct post-operative period.

Introduction: The aim of this study was to analyze the diagnostic potential of contrast enhanced ultrasound (CEUS) for the recognition of focal lesions of the spleen and liver in patients suffering from sarcoidosis. Material and methods: We analyzed the outcome of diagnostic imaging in a group of 21 patients treated for pulmonary sarcoidosis, searching for the systemic infiltration of the liver and/or spleen. All the participants are patients with inactive disease, who are monitored every 6 months at the Pulmonology Clinic. Apart from the check-up high-resolution computed tomography (HR-CT)—every 2 years, patients underwent an initial ultrasound examination (US) and if there was a suspicion of systemic infiltration, abdominal CT and/or magnetic resonance imaging (MRI) and CEUS were performed. Results: In 18 patients suffering from pulmonary sarcoidosis diagnostic imaging revealed no systemic infiltration. In three patients, the use of CEUS exposed the presence of lesions in the parenchymal organs. In all cases, the images from CEUS were consistent with those from CT/MRI. Conclusions: CEUS has the potential to become a reliable and safe screening tool for systemic infiltration in patients with sarcoidosis. It may also be an important method of monitoring the effects of therapy.

BACKGROUND Transplant renal artery stenosis (TRAS) is a serious vascular complication due to non-specific clinical manifestations, causing serious diagnostic difficulties. Contrast-enhanced ultrasound (CE-US) can complement standard sonographic examination in evaluation of TRAS. MATERIAL AND METHODS Standard ultrasound B presentation, extended with color Doppler assessment of the flow spectrum and CE-US, was carried out in the early postoperative period in a group of 180 patients who underwent kidney transplantation. In CE-US analysis, the maximum contrast agent perfusion to the cortex and renal pyramids was evaluated. In 15 patients with sonographically diagnosed TRAS, magnetic resonance angiography and computer tomography angiography were performed to confirm the diagnosis. RESULTS In patients with TRAS, significantly longer time of contrast agent (CE) inflow was observed in comparison to patients without perfusion disturbances (3.47 s vs. 1.5 s, p

A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

Background Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that predominantly affects lungs and intrathoracic lymph nodes; in rare cases (approx. 10%), infiltration of the spleen and liver may be observed. In order to identify hepatosplenic infiltration, MRI/CT of the abdomen and different ultrasound techniques (PD US, US D) are usually performed. Contrast enhanced ultrasound (CEUS) is a new technique in this diagnostic algorithm, but the fact that this is a safe, accurate, and widely available method opens a new perspective for the detection of abdominal lesions in sarcoidosis. Case reports We report 2 cases of hepatosplenic sarcoidosis - a 41-year-old woman with splenic lesions and a 46-year-old man with liver infiltration. Results On the basis of these 2 cases we intended to show the diagnostic potential of contrast enhanced ultrasound for the recognition of focal lesions of the spleen and liver in patients suffering from sarcoidosis.

Summary Background: During routine ultrasonographic examination in B presentation, performed as a standard diagnostic procedure during the early post-operative period, the most important problem with the interpretation of the images of perirenal haematoma is their ability to change in time. The aim of this work was to assess the echogenicity and the size of perirenal haematomas in patients after kidney transplant during routine examinations in B presentation and during examinations enhanced with a contrast medium (CE-US). Material/Methods: Thirty-seven patients after kidney transplant were examined using standard examination in B presentation. Sixteen patients (7 women and 9 men) with isoechogenic and hypoechogenic areas visualized within the renal parenchyma, who were suspected of perirenal haematoma, underwent a CE-US examination after intravenous administration of sculpture hexafluoride (dose: 2.4 ml/ examination). Using time-intensity curves (TIC), changes in the values were analysed for two areas of interest (ROI): in the renal parenchyma and in the areas identified during standard US as haematomas. Identical examination protocols and dynamic data loops allowed the acquisition of identical kidney cross-sections and enabled measuring the echogenicity and thickness of the abnormalities at the same location. Results: During the routine B presentation examination, the average difference between haematoma and the renal cortex was 5 dB. When performing US-CE examination, a significantly greater difference in echogenicity was observed and reached 31 dB. In six patients, the size of haematomas was comparable using both techniques, whereas in ten patients lesions visualized in B presentation were smaller than in the US-CE examination. Conclusions: The US-CE examination demonstrated a greater, statistically significant, difference in the echogenicity of perirenal haematomas compared to the routine examination in B presentation. This method enabled a more detailed assessment of the size of haematomas in the perirenal space that appeared during early post-operative period.

Purpose. To assess the usefulness of contrast-enhanced ultrasonography (CE-US) in the visualization of a kidney graft following a biopsy that was complicated by an arteriovenous fistula (AVF). Methods. Four postrenal transplant patients who had developed AVFs following graft biopsy were examined using standard US and CE-US. Additionally, follow-up examinations were conducted using CE-US, at 4–6 weeks and 10–12 weeks following fistula closure. Results. The fistulas were detected using color Doppler US, Power Doppler US, and B-flow technique. Reduced parenchymal flow was only detected in one case using standard flow visualization techniques. CE-US allowed for the visualization of regions of disturbed parenchymal perfusion that were not visible in the standard examinations. At follow-up, B-mode ultrasound and standard flow examinations appeared normal. However, all contrast-enhanced images showed clearly demarcated residual regions of reduced parenchymal perfusion, in areas where the fistulas had been previously present. Conclusions. A posttraumatic AVF reduces parenchymal perfusion in the affected region. CE-US examination may help in monitoring fistulas during the active phase and following spontaneous closure. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Diabet. Med. 28, 833–837 (2011) Abstract Aim The objective of this study was to assess the effect of age on vascular reactivity in patients with Type 1 diabetes. Methods Forty-five patients with Type 1 diabetes and 71 healthy control subjects, divided into three age groups (18–30, 31–45 and 46–60 years old), underwent assessment of vascular reactivity based on ultrasound examination of a brachial artery after nitric oxide donor administration. Results The vasodilative and haemodynamic effect was most pronounced in the youngest control subjects, where lumen widening of 0.51 ± 0.16 mm (13.9 ± 4.2%) and increase in early velocity of 28.4 ± 6.5 cm/s (237 ± 55%) were observed, while, in the control subjects from the middle and oldest age groups, the increase in artery diameter was 0.4 ± 0.11 and 0.22 ± 0.12 mm (9.8 ± 2.6 and 5.0 ± 2.6%), respectively. In the youngest patients with diabetes, lumen widening by 0.35 ± 0.13 mm (8.6 ± 3.4%) and increase in early diastolic velocity by 16.9 ± 5.6 cm/s (158 ± 52%) were noted (P

The necessity for identification of risk factors for Anterior Cruciate Ligament, ACL injury has challenged many investigators. Many authors have reported lower Notch Width Index, NWI measured on radiographs in patients with midsubstance ACL lesions compared to control groups. Since a narrow intercondylar notch has been implicated as a possible risk factor related to ACL injury we decided to compare NWI measured on MRI scans between age-matched groups with acute ACL injury with those of the normal population. The purpose of this study was to measure intercondylar notch width on MRI scans in an immature population to determine if there was a difference between the population with ACL tears and a control group. We also wanted to assess age as a risk factor in an ACL injury population. We retrospectively analysed the MRI scans of 46 patients with ACL injuries and 44 patients with normal MRI findings who served as a control group for NWI measurements. For the ACL injury group we collected information from medical charts including age at the time of injury, gender, mechanism of injury, type of activity practised at the time of injury and prevalence of meniscal injury. Demographic data of the control group were comparable with those from the study group. We found a statistically significant (p

Aims Endothelial dysfunction in chronic heart failure (CHF) contributes to vasoconstriction. Underlying atherosclerosis may increase vascular abnormalities in ischaemic CHF. We aimed to compare flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery between patients with ischaemic and non-ischaemic CHF. Methods and results A total of 57 patients with systolic CHF participated in the study (mean age 59 ± 8 years, 81% male). Patients were in stable NYHA class II (40 patients, 70%) and III (17 patients, 30%). Ischaemic aetiology of CHF was confirmed by coronary angiography in 34 (60%) patients and ruled out in 23 (40%). Flow-mediated dilation and NMD of the brachial artery was assessed by high-resolution ultrasound. Endothelium-dependent vasodilation was markedly reduced in patients with ischaemic CHF compared with those with non-ischaemic aetiology of CHF—mean absolute change in artery diameter (Δd) 0.09 ± 0.07 mm in ischaemic group vs. 0.18 ± 0.07 mm in non-ischaemic (P < 0.0001). Nitroglycerin-mediated vasodilation was also significantly different—Δd = 0.14 ± 0.06 mm in ischaemic vs. 0.31 ± 0.10 mm in non-ischaemic CHF (P < 0.0001). Conclusion Endothelium-dependent and -independent vascular response is more attenuated in ischaemic than in non-ischaemic CHF.

PURPOSE. To determine the clinical usefulness of the numerical segmentation image technique (NSI) in estimating the volume of extraocular muscles and to compare this value to widely used measurements of single diameters of the muscles. METHODS, Forty-five patients underwent magnetic resonance examinations in 1.5-T scanner SE T1 sequences in transversal and coronal planes were provided and data were sent to a personal computer where the degree of exophthalmos, horizontal diameter of medial rectus muscles, and vertical diameter of inferior rectus muscles were determined on the basis of two-dimensional images. The quantity estimation of all eye muscles volumes using NSI application in three-dimensional space was carried out with use of level set segmentation algorithm. RESULTS. A strong correlation between the total eye muscle volume and degree of exophthalmos was determined. The usefulness of measuring single diameters for estimating the muscles' enlargement was confirmed. The difference between a single muscle's volume and Its width also was confirmed. Estimates of muscle volume correlate with the degree of exophthalmos more accurately than measurements of single diameters. CONCLUSIONS. The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. It allows an objective estimation of the pathologic processes leading to exophthalmos and may be especially helpful In monitoring discrete changes In the muscles volume during treatments.

Background Arterial stiffness is an early marker of atherosclerosis. The carotid arteries are easily accessible by ultrasound and are commonly used for the evaluation of atherosclerosis development. However, this stiffness assessment is based on the elastic properties of the artery, which may be influenced by the adjacent internal jugular vein (IJV). The aim of the present study is to evaluate the influence of internal jugular vein morphology on the stiffness of the common carotid artery. Methods Bilateral carotid ultrasound was performed in 248 individuals. When no carotid plaque was detected (90.9 % cases), the distensibility coefficient and β - stiffness index were calculated. The global and segmental circumferential strain parameters of the carotid wall were evaluated with 2D-Speckle Tracking. The cross-sectional area of the IJV and degree of its adherence to the carotid wall (angle of adherence) were measured. Results The morphology of the IJV did not influence the standard stiffness parameters nor the global circumferential strain. However, segmental analysis found the sector adjacent to the IJV to have significantly higher strain parameters than its opposite counterpart. In addition, the strain correlated significantly and positively with IJV cross-sectional area and angle of adherence. Conclusions The movement of the carotid artery wall caused by the passage of the pulse wave is not homogeneous. The greatest strain is observed in a segment adjacent to the IJV, and the degree of wall deformation is associated with the size of the vein and the degree of its adherence.

Dysfunction of the glutamatergic system, the main stimulating system in the brain, has a major role in pathogenesis of schizophrenia. The frontal white matter (WM) is partially composed of axons from glutamatergic pyramidal neurons and glia with glutamatergic receptors. The natural amino acid sarcosine, a component of a normal diet, inhibits the glycine type 1 transporter, increasing the glycine level. Thus, it modulates glutamatergic transmission through the glutamatergic ionotropic NMDA (N-methyl-d-aspartate) receptor, which requires glycine as a co-agonist. To evaluate the concentrations of brain metabolites (NAA, N-acetylaspartate, Glx, complex of glutamate, glutamine, and γ-aminobutyric acid (GABA), mI, myo-inositol, Cr, creatine, Cho, choline) in the left frontal WM, Proton Nuclear Magnetic Resonance (1H-NMR) spectroscopy was used. Twenty-five patients randomly chosen from a group of fifty with stable schizophrenia (DSM-IV-TR) and dominant negative symptoms, who were receiving antipsychotic therapy, were administered 2 g of sarcosine daily for six months. The remaining 25 patients received placebo. Assignment was double blinded. 1H-NMR spectroscopy (1.5 T) was performed twice: before and after the intervention. NAA, Glx and mI were evaluated as Cr and Cho ratios. All patients were also assessed twice with the Positive and Negative Syndrome Scale (PANSS). Results were compared between groups and in two time points in each group. The sarcosine group demonstrated a significant decrease in WM Glx/Cr and Glx/Cho ratios compared to controls after six months of therapy. In the experimental group, the final NAA/Cr ratio significantly increased and Glx/Cr ratio significantly decreased compared to baseline values. Improvement in the PANSS scores was significant only in the sarcosine group. In patients with schizophrenia, sarcosine augmentation can reverse the negative effect of glutamatergic system overstimulation, with a simultaneous beneficial increase of NAA/Cr ratio in the WM of the left frontal lobe. Our results further support the glutamatergic hypothesis of schizophrenia.

Managing affective, negative, and cognitive symptoms remains the most difficult therapeutic problem in stable phase of schizophrenia. Efforts include administration of antidepressants. Drugs effects on brain metabolic parameters can be evaluated by means of proton nuclear magnetic resonance (1H-NMR) spectroscopy. We compared spectroscopic parameters in the left prefrontal cortex (DLPFC), the left frontal white matter (WM) and the left hippocampus and assessed the relationship between treatment and the spectroscopic parameters in both groups. We recruited 25 patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms and in stable clinical condition, who were treated with antipsychotic and antidepressive medication for minimum of three months. A group of 25 patients with schizophrenia, who were taking antipsychotic drugs but not antidepressants, was matched. We compared metabolic parameters (N-acetylaspartate (NAA), myo-inositol (mI), glutamatergic parameters (Glx), choline (Cho), and creatine (Cr)) between the two groups. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). In patients receiving antidepressants we observed significantly higher NAA/Cr and NAA/Cho ratios within the DLPFC, as well as significantly higher mI/Cr within the frontal WM. Moreover, we noted significantly lower values of parameters associated with the glutamatergic transmission—Glx/Cr and Glx/Cho in the hippocampus. Doses of antipsychotic drugs in the group treated with antidepressants were also significantly lower in the patients showing similar severity of psychopathology.

Managing affective, negative, and cognitive symptoms remains the most difficult therapeutic problem in stable phase of schizophrenia. Efforts include administration of antidepressants. Drugs effects on brain metabolic parameters can be evaluated by means of proton nuclear magnetic resonance (¹H-NMR) spectroscopy. We compared spectroscopic parameters in the left prefrontal cortex (DLPFC), the left frontal white matter (WM) and the left hippocampus and assessed the relationship between treatment and the spectroscopic parameters in both groups. We recruited 25 patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms and in stable clinical condition, who were treated with antipsychotic and antidepressive medication for minimum of three months. A group of 25 patients with schizophrenia, who were taking antipsychotic drugs but not antidepressants, was matched. We compared metabolic parameters (N-acetylaspartate (NAA), myo-inositol (mI), glutamatergic parameters (Glx), choline (Cho), and creatine (Cr)) between the two groups. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). In patients receiving antidepressants we observed significantly higher NAA/Cr and NAA/Cho ratios within the DLPFC, as well as significantly higher mI/Cr within the frontal WM. Moreover, we noted significantly lower values of parameters associated with the glutamatergic transmission--Glx/Cr and Glx/Cho in the hippocampus. Doses of antipsychotic drugs in the group treated with antidepressants were also significantly lower in the patients showing similar severity of psychopathology.

Summary Background The suprascapular notch (SSN) is the most common site of suprascapular nerve neuropathy, which may be brought on by the presence of a deep, narrow SSN and structures restricting the space for the nerve. The anterior coracoscapular ligament (ACSL) is a fibrous band extending on the anterior side of the suprascapular notch. As it may tighten the osteo-fibrous tunnel for the nerve, it has been proposed as a new anatomical risk factor in its entrapment. However, this structure occurs in up to 60% of patients, many of whom do not demonstrate any nerve injury. The aim of this work is to evaluate the association between the occurrence of the ACSL and SSN morphology. Materials and methods The suprascapular notch region was dissected in 100 formalin-fixed, cadaveric shoulders. The ACSL (if present) and the SSN were assigned to a classification based on their morphology and diameters. Statistical analysis was performed. Results The ACSL was present in 52 scapulae (52%) and in all cases, the suprascapular nerve travelled superior to the ACSL. Mechanically relevant types of ACSL were found to occur significantly more often when deeper notches were present ( p = 0.0018). Conclusions The mechanically efficient ACSL is more common in deep and narrow SSNs, which are associated with suprascapular nerve neuropathy. Thus, by supporting the nerve, the ACSL can protect against its injury.

Glutamatergic system, the main stimulating system of the brain, plays an important role in the pathogenesis of schizophrenia. Hippocampus, a structure crucial for memory and cognitive functions and rich in glutamatergic neurons, is a natural object of interest in studies on psychoses. Sarcosine, a glycine transporter (GlyT-1) inhibitor influences the function of NMDA receptor and glutamate-dependent transmission. The aim of the study was to assess the effects of sarcosine on metabolism parameters in the left hippocampus in patients with schizophrenia. Assessments were performed using proton nuclear magnetic resonance ((1)H NMR) spectroscopy (1.5T). Fifty patients diagnosed with schizophrenia (DSM-IV-TR), with dominant negative symptoms, in stable clinical condition and stable antipsychotics doses were treated either with sarcosine (n=25) or placebo (n=25). Spectroscopic parameters were evaluated within groups and between two groups before and after 6-month intervention. All patients were also assessed with the Positive and Negative Syndrome Scale (PANSS). In the sarcosine group, after 6-month treatment, we found significant decrease in hippocampal Glx/Cr (Glx-complex of glutamate, glutamine and GABA, Cr-creatine) and Glx/Cho (Cho-choline), while N-acetylaspartate (NAA), myo-inositol (mI), Cr and Cho parameters remained stable along the study and also did not differ significantly between both groups. This is the first study showing that a pharmacological intervention in schizophrenia, particularly augmentation of the antypsychotic treatment with sarcosine, may reverse the pathological increase in glutamatergic transmission in the hippocampus. The results confirm involvement of glutamatergic system in the pathogenesis of schizophrenia and demonstrate beneficial effects of GlyT-1 inhibitor on the metabolism in the hippocampus and symptoms of schizophrenia.

The most common site of suprascapular nerve compression and injury is the suprascapular notch. The aim of this study was to assess the sensitivity and specificity of sonography in determining the type of suprascapular notch (SSN). Thirty randomized patients (60 upper extremities) underwent USG examination of the shoulder area. The results were further compared with three-dimensional reconstructions of the scapulae obtained through CT examination to place the SSNs within a fivefold classification. For identification of type I, the sensitivity was 73.3% and the specificity 97.8%. For identification of type III, the values was 96.9% and 85.7%, respectively. Type II was not found in USG examination. Discrimination between type IV and V was not possible. The mean distance between the line connecting the edges of the SSN and the skin was 38 mm in right-handed patients and 34 mm in ambidextrous subjects. Ultrasonographic examination of the SSN is characterized by high specificity for type I, and high sensitivity for type III SSN. Discrimination between type IV and V of the SSN is not recommended based on sonographic evaluation.

The glutamatergic system is a key point in pathogenesis of schizophrenia. Sarcosine (N-methylglycine) is an exogenous amino acid that acts as a glycine transporter inhibitor. It modulates glutamatergic transmission by increasing glycine concentration around NMDA (N-methyl-d-aspartate) receptors. In patients with schizophrenia, the function of the glutamatergic system in the prefrontal cortex is impaired, which may promote negative and cognitive symptoms. Proton nuclear magnetic resonance (1H-NMR) spectroscopy is a non-invasive imaging method enabling the evaluation of brain metabolite concentration, which can be applied to assess pharmacologically induced changes. The aim of the study was to evaluate the influence of a six-month course of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate, Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA), mI, myo-inositol, Cr, creatine, Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) in patients with stable schizophrenia. Fifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned to administration of sarcosine (25 patients) or placebo (25 patients) for six months. Metabolite concentrations in DLPFC were assessed with 1.5 Tesla 1H-NMR spectroscopy. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). The first spectroscopy revealed no differences in metabolite concentrations between groups. After six months, NAA/Cho, mI/Cr and mI/Cho ratios in the left DLPFC were significantly higher in the sarcosine than the placebo group. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also significantly increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. The addition of sarcosine to antipsychotic therapy for six months increased markers of neurons viability (NAA) and neurogilal activity (mI) with simultaneous improvement of clinical symptoms. Sarcosine, two grams administered daily, seems to be an effective adjuvant in the pharmacotherapy of schizophrenia.

Congenital anomalies of systemic veins are usually asymptomatic and found incidentally during ultrasonography, computed tomography (CT) or magnetic resonance examinations performed for other clinical indications. Persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC) is the congenital aberration in the thoracic venous system which occurs in only 0.09%to 0.13% of patients who have congenital heart defects. In this paper, we present the extremely rare case of a 72-year-old male with PLSVC associated with an absence of RSVC, referred for coronary CT angiography. Multidetector CT angiography is a powerful tool for the detection of venous anomalies, which is essential before invasive procedures such as the implantation of pacemakers.

The purpose of this study was to evaluate the development of intercondylar notch width in children using MRI and assesse the relationship between the cruciate ligaments and the width of the intercondylar notch during growth.We reviewed MRIs and medical records of 76 children (age range 3.8-16.9) without derangements of the knee. Cases with knee joint instability and/or major trauma were excluded. On a standardized coronal image, measurements of the width of the intercondylar notch, knee, ACL and PCL were performed using image analysis software. The notch width index (NWI), ACL/notch, ACL/knee width, PCL/notch, and PCL/knee width were calculated.NWI showed statistical correlation with age. The highest values were found in the youngest children, and the lowest in the oldest group. While ACL/knee width, and PCL/knee width ratios remained proportional over time, the ACL/notch, and PCL/notch ratios increased with the age of the patient.NWI changes with age and decreases from childhood to adolescence. A relative decrease in NWI accounts for an increase in the ACL/notch and PCL/notch ratios with age. Studies about NWI in children should consider age as a cofactor for analysis.

The most important risk factor of suprascapular nerve entrapment is probably the shape of the suprascapular notch (SSN). The aim of the study was to perform a radiological study of the symmetry of SSN. Included in the study were 311 patients (137 women and 174 men) who underwent standard computed tomography investigation of the chest. A total of 622 computed tomography scans of scapulae were retrospectively analyzed to classify suprascapular notches into five types. Suprascapular notch was recognized as a symmetrical feature in 53.45% of the patients. Symmetry was more frequently seen in females (54.0% versus 52.9%), but not to any significant degree (P=0.8413). Type III was the most commonly noted symmetrical feature (66.9%) and type II was less common (0.6%). Type III was the most symmetrical type of suprascapular notch, occurring significantly more often as a symmetrical feature in comparison with type I (P<0.0001), type II (P=0.00137), or type IV (P=0.001). Our investigation did not show that the suprascapular notch is a symmetrical feature. However, symmetry was recognized more frequently in the case of type III SSN. No significant differences in symmetry were found with regard to sex.

Thickening and increase of area of cartilage have been proposed as two alternative mechanisms of cartilage functional adaptation. The latter has been reported in endurance sportsmen. In weightlifters, extreme strain applied to the articular surfaces can result in other forms of adaptation. The aim of this research is to determine whether cartilage thickness is greater in elite weightlifters than in physically inactive men. Weightlifters (13) and 20 controls [age and body mass index (BMI) matched] underwent knee Magnetic Resonance Imaging (MRI). A single sagittal slice of the knee was taken and cartilage thickness was measured in five and six regions of the medial and lateral femoral condyles, respectively. The analyzed segments represented weight-bearing and nonweight-bearing regions. The tibia cartilage in the weight-bearing area was also measured. The time of training onset and its duration in the weightlifter group were recorded. The cartilage was found to be significantly thicker in weightlifters in most of the analyzed regions. The distribution of cartilage thickness on the medial and lateral femoral condyles was similar in both groups. The duration of training was not associated with cartilage thickness, but the time of training onset correlated inversely with cartilage thickness. It is possible that in high-strain sports, joint cartilage can undergo functional adaptation by thickening. Thus, mechanical loading history could exert a postnatal influence on cartilage morphology.

Purpose The shape and size of the suprascapular notch (SSN) is one of the most important risk factors in suprascapular nerve entrapment. The aim of the study was to perform a morphological study of SSN variations. Methods A total of 616 computer tomography scans of scapulae were retrospectively analysed in 308 patients. The examination focused on the suprascapular region. The type of suprascapular notch was determined by using a classification based on three geometrical measurements: maximal depth (MD), superior (STD) and middle (MTD) transverse diameters. Results In the scans, five types of SSN were noted. In type I (24.18 %) maximal depth was greater than superior transverse diameter. Type II (1.95 %) has equal MD, STD and MTD. In type III (56.16 %) the superior transverse diameter was greater than the maximal depth. Scapulae with bony foramen were classified as type IV (4.72 %). In type V a discrete notch (12.99 %) was found. Additionally, types I and III were divided into three subtypes: A, B and C. The frequency of type I and IV was lower in females than in males, but type III was more common in females than males. Distribution of other types of SSN in both groups was similar. Conclusion Knowledge of the anatomical variations of the suprascapular notch described in this study should be helpful in endoscopic and open procedures of the suprascapular region and also may increase the safety of operative decompression of the suprascapular nerve.

Autosomal dominant polycystic kidney disease produces symptoms mainly in adulthood. Renal cysts and/or elevated blood pressure can be the first signs of the disease in children. Because of the lack of a targeted therapy, early diagnosis and implementation of actions to slow its progression are the essence of treatment. Aim: The aim of the study was to assess the clinical course of autosomal dominant polycystic kidney disease in children. Material and methods: The study involved the assessment of 28 patients with autosomal dominant polycystic kidney disease diagnosed before the age of 18. The disease was diagnosed during a routine abdominal ultrasound scan in 24 patients and during a scan conducted due to abdominal pain reported by patients in 4 cases. Two patients had the disease diagnosed based on the Ravine criteria, whereas an ultrasound image and family history helped establish the diagnosis in 26 cases. The children enrolled had blood pressure measured, serum creatinine concentration determined and general urinalysis performed. Results: The median age at the diagnosis was 5 years. The family history was positive in 89.3% (25) of patients. Siblings had the disease in 46.43% (13) of cases. None of the children presented with abnormalities in urinalysis or creatinine levels. Two patients were diagnosed with arterial hypertension and in 1 child blood pressure was elevated above the 97th percentile. Urine albumin-to-creatinine ratio exceeding 30 mg/g was observed in 20.8% of children. Conclusions: Autosomal dominant polycystic kidney disease in children is asymptomatic. There are no irregularities either in urinalysis or renal function parameters. An abdominal ultrasound examination, which is inexpensive and non-invasive, is worth considering in all children of parents with autosomal dominant polycystic kidney disease in order to implement early nephroprotection.

IntroductionSarcosine - glycine transporter inhibitor - increases glycine concentration around NMDA (N-methyl-D-aspartate) receptors. Function of the glutamatergic system in the prefrontal cortex and hippocampus is impaired in schizophrenia, which may lead to negative and cognitive symptomatology.AimsWe evaluated the influence of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) and left hippocampus in patients with stable schizophrenia.MethodsFifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned (25 patients in each group) to administration of sarcosine (2 g) or placebo for six months. 1H-NMR spectroscopy (1.5 T) in both localisations and clinical evaluation (PANSS) was performed before and after sarcosine addition.ResultsInitially we noted no differences in metabolite concentrations between groups. In the left DLPFC, NAA/Cho, mI/Cr and mI/Cho ratios were significantly higher in the sarcosine than the placebo group after six months. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. In the left hippocampus Glx/Cr and Glx/Cho decreased in sarcosine group at the end of our study.ConclusionsThe addition of sarcosine to antipsychotic therapy for six months caused increase of neurons viability (NAA) and neurogilal activity (mI) markers in the left DLPFC and decrease of hyperglutamatergic overstimulation parameters in the left hippocampus with simultaneous improvement of clinical parameters including negative symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P

Analysis of cystic fluid may be useful in distinguishing between benign and malignant cysts which has significant impact on their management. The aim of our study was to assess the diagnostic utility of carcinoembryonic antigen (CEA) and K-ras gene mutation in pancreatic cysts fluid.The study included 56 patients with pancreatic cystic fluid collected for analysis. The cysts were classified as benign (simple cysts, pseudocysts, serous cystadenoma) - 39 patients or premalignant/malignant (mucinous cystadenoma, IPMN, cystadenocarcinoma) - 17 patients. The patients history, CEA fluid concentrations and presence of K-ras mutation were analyzed.CEA were higher in patients with malignant cysts (mean levels 238 ± 12.5 ng/ml; range 32.8-4985 ng/ml) compared to benign lesions (mean levels 34.5 ± 3.7 ng/ml; range 3.9-693 ng/ml; p 0.001). K-ras mutation correctly classified 11 of 17 patients with premalignant/malignant lesions. It was also detected in 1 patient with final diagnosis of benign cyst (the sensitivity 64.7% and the specificity 97.4%; p 0.01). If CEA and molecular analysis were combined in that cysts with either CEA level45 ng/ml or presence of K-ras mutation, than 16 of 17 premalignant/malignant cysts were correctly identified (94.1%).Molecular analysis of pancreatic cyst fluid adds diagnostic value to the preoperative diagnosis and should be considered when cyst cytologic examination is negative for malignancy.

Introduction The aim of this study was to evaluate the usefulness of contrast-enhanced ultrasound (US-CE) to diagnose acute renal vein thrombosis (ARVT), acute rejection episodes (ARE), or acute tubular necrosis (ATN) in kidney grafts. Materials and methods We analyzed 171 US-CE among kidney transplantation patients in the early postoperative period. Patients underwent US-CE following a standard diagnostic protocol including real-time ultrasound (B-mode) and color Doppler ultrasound with spectral flow analysis. Tissue perfusion was analyzed based upon time-intensity curves for two regions: the renal cortex and the renal pyramids. Results Of 14 patients, in whom standard ultrasound showed high resistance parameters in the renal artery, three showed ARVT and 11 had ATN or ARE, which were confirmed by biopsy. Among patients with ARVT, the US-CE showed a lack of contrast perfusion into the cortex and renal pyramids. Patients with ARE/ATN showed slower contrast inflow into the parenchyma with reduced but still present perfusion. The differences in mean signal intensity values were significant for both the cortex and the renal pyramids: cortex: −53.8 ± 5.4 dB versus −35.0 ± 3.5 dB ( P P Conclusion US-CE is a noninvasive method that provides easy, reliable differentiation of ARVT from ARE/ATN.

The aim of this study was to assess the disturbances in perfusion of transplanted kidneys (KTx) following an acute occlusion of 1 of the supernumerary renal arteries (SRA). We compared the differences in echogenicity and the size of ischemic areas between routine B mode ultrasonography with Doppler evaluation (US-CD) and contrast-enhanced ultrasound examination (CE-US).We present 4 KTx patients in whom we observed an occlusion of the SRA. After the initial diagnosis of occlusion of SRA in routine B mode with US-CD, the CE-US examination following intravenous contrast administration was performed. The disturbances of tissue perfusion in regions of interest, the level of signal intensity, and the size of the infarct were analyzed.The renal parenchyma in the routine B mode was characterized by low echogenicity. After the contrast medium administration, we observed increased echogenicity (-53.75±5.3 dB vs. -28.75±3.8 dB, p0.001). The echogenicity between the focus of the infarct and normal parenchyma in the routine B mode and US-CD was small, but the difference was larger for analogous areas in the CE-US (the mean signal intensity: -2.75±1.5 dB in the B mode/US-CD vs. -24.25±3.9 dB in CE-US, p0.001). The size of the ischemic areas in the B mode and Doppler examinations were underestimated due to poor separation of the ischemic foci, and were much better visualized in the CE-US (-25.5±7.3 mm vs. -38.5±9.7 mm, p0.001).CE-US may enable a precise evaluation of a graft's ischemic foci due to occlusion of SRA in the early post-transplant period.

The aim of this study was to assess the usefulness of a new ultrasound technique - contrast-enhanced ultrasound examination (US-CE) - using sulphur hexafluoride in the early post-transplant assessment of graft perfusion. Time-intensity curves (TIC) were compared with hemodynamic flow parameters (resistive index: RI) in patients with good early graft function (EGF) and acute rejection (AR) or acute tubular necrosis (ATN) as a cause of delayed graft function (DGF).US-CE was conducted in order to assess graft perfusion in the early period after kidney transplantation (72-120 hours) in 63 kidney allograft recipients: 35 with EGF and 28 with DGF. The DGF patients were later diagnosed based on graft biopsy as AR (n = 10) or ATN (n = 18). Time-intensity curves were compared with hemodynamic flow parameters typically assessed in post-operative graft diagnostics (e.g., RI).In the examination with US-CE in EGF patients, the regular inflow of contrast medium was demonstrated in all regions of the graft. In patients with DGF, a delay in the inflow of the contrast medium was observed, as well as significant differences in the time of inflow to the regions of interest between those 2 groups. There was a significantly longer inflow time of the contrast medium to the cortex and renal pyramids in patients with AR than in ATN recipients.US-CE may be a valuable diagnostic tool in the determination of the cause of DGF.

At present, endothelial dysfunction is best assessed in vivo with measurement of flow-mediated dilatation (FMD) with Doppler ultrasound scanning. This test, however, does not account for the subject's age and is uncomfortable for patients. The aim of the study was to compare a new test for endothelium function assessment using hand exercise load.The study group comprised 31 male patients with type 1 diabetes and 72 healthy men as controls. The subjects in both groups were subdivided into three age groups: 18-30 (subgroup A), 31-45 (subgroup B), and 46-60 (subgroup C) years. FMD of the brachial artery with induction of hand ischemia was conducted in all the subjects. Afterwards, an originally designed test using standardized hand exercise with the use of a training device was performed.In the youngest group of type 1 diabetes patients the effect of hand ischemia on brachial artery diameter was greater than in the two older age subgroups: baseline artery diameter increased by 0.23 +/- 0.11 mm (5.7%), 0.19 +/- 0.09 mm (4.3%), and 0.13 +/- 0.02 mm (2.8%), respectively (P0.01). In the hand exercise test, artery diameter increased in the youngest subjects by 0.39 +/- 0.11 mm (9.5%) and in the two older groups by 0.26 +/- 0.07 mm (5.6%) and 0.18 +/- 0.09 mm (4.5%) (P0.05), respectively. In subgroups A, B and C, vasodilation after hand exercise test was greater by 67%, 30%, and 32% (P0.01), respectively, compared with the effect of the ischemic test. In the controls similar effects and relationship between ischemic and hand exercise tests were noted, however, with a smaller difference between the two tests.The hand exercise test results in a greater difference in vessel diameter before and after the test stimulus, which might substantially improve its feasibility. The hand exercise test could be a useful alternative tool for endothelial function assessment, especially in type 1 diabetes subjects.

Aim: Both vascular calcification and atherosclerosis are highly prevalent in patients with end-stage renal disease (ESRD) and have been associated with increased cardiovascular morbidity. Because those two phenomena might be only coincidentally related in chronic haemodialysis (HD) patients, in this study, coronary artery calcification (CAC), common carotid artery intima media thickness (CCA-IMT) and thickness of atherosclerotic plaques in the carotid artery were simultaneously measured. Methods: In a cross-sectional study of 47 HD patients (31 male, mean age 56.8 ± 11.4 years, and 16 female, mean age 56.0 ± 7.5 years) without history of major cardiovascular complications. CCA-IMT and presence and thickness of atherosclerotic plaques were measured with ultrasound and CAC with multidetector computed tomography. Results: The CAC were present in 70.2% of patients. The mean CAC was 1055 ± 232, the mean CCA-IMT was 0.96 ± 0.21. The atherosclerotic plaques in the common carotid arteries were visualized in 38 patients (80.1%), the mean thickness of the atherosclerotic plaque was 1.61 ± 0.8 mm. We found a significant positive correlation between CAC and CCA-IMT (r = 0.70, P

Background: The aim of this prospective cohort study was to evaluate the progression of coronary artery calcification (CAC), and atherosclerosis in hemodialysis (HD) patients and to relate them to novel biomarkers, i.e. serum osteoprotegerin (OPG) and fibroblast growth factor 23 (FGF-23). Material and Methods: Forty-seven HD patients were followed up for 30 months or until death. Intima media thickness (CCA-IMT), atherosclerotic plaques and CAC were assessed at baseline and after 30 months. Serum mineral parameters, lipids, OPG and plasma FGF-23 were also measured. Results: At baseline, 70% HD patients presented detectable CAC. The patients without calcification at baseline remained calcification free at 30 months and presented lower serum OPG and FGF-23 than those with CAC. A 64.4% progression of CAC was observed in all patients with CAC at baseline. In parallel, a 13% increase in CCA-IMT was found. Both ΔCAC and ΔCCA-IMT correlated positively with baseline and follow-up serum OPG. The patients who died had significantly higher baseline CAC and serum OPG. Conclusion: The plasma level of OPG could serve as a surrogate marker of progression of atherosclerosis and calcification in patients with end-stage renal disease. Therefore, the serum OPG may be a candidate biomarker of cardiovascular complications and poor outcome among dialysis patients.

Measurement of the degree of exophthalmos is one of the main methods used in the assessment of pathological processes that occur in the orbital space and is widely used. However, this only provides initial information about the volume relations between the intraorbital structures. The aims of our work were as follows: to draw up a new computer application, namely the numerical segmentation image (NSI) technique, for the automatic calculation of the volume of the intraorbital structures on the basis of magnetic resonance imaging (MRI) images, to determine its usefulness in the segmentation of fatty tissue and the eyeball and to estimate their volume in relation to the degree of exophthalmos.A total of 45 patients (90 orbits) were included in the study. All the patients underwent MRI examination of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. Quantitative assessment of the eyeball and fatty tissue was made using an NSI application.The influence of fatty tissue volume on the degree of exophthalmos was determined as being statistically significant (r = 0.367, p = 0.000374) but was smaller in comparison with the relationship between total eye muscle volume and degree of exophthalmos; eyeball volume was found to have the least influence (r = 0.344, p = 0.000374). Two eyeballs of significantly smaller volume were found in the group of 90 orbits analysed.The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. A credible protocol for estimating the degree of exophthalmos on the basis of the NSI technique should include the eye muscle volume, fatty tissue volume and, in cases where eyeball pathologies coexist, the eyeball volume as well.

In recent years the use of computer systems has allowed numerical analysis of medical images to be introduced and has speeded up the conversion of numerical data into clinically valuable information. The creation of a software application that could almost automatically calculate the volume of anatomical structures imaged by MRI has seemed possible. The aim of our study was to determine the clinical usefulness of an numerical segmentation image technique (NSI) software application in estimating the volume of extraocular muscles.The study group was formed of 45 patients (90 orbits). All the patients underwent MRI examinations of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. The quantitative assessment of all eye muscles was carried out using the NSI application, a new software program introduced by the authors.A close correlation between muscle volume and the degree of exophthalmos was revealed and confirmed by statistical analysis (r = 0.543, p = 3.13396E-08) in agreement with other papers.The NSI software program is an application which offers a reliable and precise estimation of eye muscle volume. It is therefore useful in the diagnosis of the pathological processes leading to exophthalmos. It has special clinical value for monitoring discrete volume changes of muscles during treatment.

The aim of the study is to evaluate the reliability of the diffusion-weighted vs. FLAIR MR imaging in the cases of hyper acute brain stroke.CT and MR standard and diffusion images observed in 29 patients affected with early brain stroke and reference CT in all the patients. Reference CT was performed 3-5 days later in all patients.The pre- and post-contrast CT in 23 patients did not reveal any brain lesions. In contrary to CT areas of pathologic high signal were visualized well in diffusion MR in 20 of these patients, which supported early diagnosis. Discrete hiperintense lesions of the same locations were seen also in the FLAIR MR imaging in 19 of them. In the 6 patients CT revealed only discrete hipodense areas, which were seen more pronounced in the FLAIR and diffusion MR imaging. In the 3 cases even the second CT did not reveal stroke.The diffusion MR imaging in patients suspected of acute brain stroke reveals ischemic lesions earlier and more clearly than FLAIR imaging, which discrete presented the same pathological areas.

It is accepted that T2-weighted imaging can demonstrate the extent of an inflammatory process in Graves' ophthalmopathy (GO). This aim of this study was a comparative evaluation of the most commonly used indicators of extraocular muscle pathophysiology, i.e. signal intensity (SI) and T2-time (T2-t) in correlation with muscle volume (MV), and to determine the need to make the above indicators objective with regards to clinical practice.MRI examinations in a 1.5 T scanner of 40 orbits formed the study group. Quantitative assessment of the muscles was carried out using a numerical segmentation imaging technique (NSI). SI and T2-t were measured for each muscle. A standardization algorithm was applied based on T2-t and IS from the ipsilateral white matter of the frontal lobes.The correlation between T2-t and MV for the medial rectus and inferior rectus muscles (IRM) was at a comparatively high level (R: 0.49 and 0.47), with a value as high as R=0.58 for the superior rectus muscle. Correlation between SI and volume for these muscles was found to be at R-levels of 0.37, 0.48, and 0.46. Correction of the T2-t and SI values with use of a standardization algorithm in most cases did not change the above correlations, except for IRM.The parameter with the higher correlation to the symptoms of GO is T2 The value of SI as an indicator of disease intensity in GO that can be used without the use of multiple echo sequences was confirmed. It is necessary to make the above parameters objective relative to white matter when calculating IS for the inferior rectus muscle.

Determining the predisposition to vasospastic reactions in a function test is important at the earliest possible stage of diagnosis. Thermography is an acknowledged procedure for monitoring function tests; however, its availability is limited. The aim of this study was to compare the progression of the cold immersion test in a thermal picture and an US-CD examination with the flow assessment of the small blood vessels of the hand.A group of 16 women declaring high cold tolerance of their hands was compared with a group of 24 women reporting hand complaints when exposed to the cold. The subjects underwent a test in which they immersed their right hand in ice-cold water (0 degrees C). Then images of the temperature distribution in the hand were recorded with a thermovisory camera. At the same time, spectral waveforms were registered in the proper palmar digital artery and in the radial artery at specified time intervals.Data analysis comprised temperature measurements at the level of the nail plate of the middle finger and at the wrist. There were differences between the groups at all the stages of the immersion test (efficient return of temperature to initial values in the reference group, delayed return in subjects with low tolerance to thermal stimuli). Flow resistance analysis using the Doppler method in the studied arteries revealed similar differences between the groups (swift flow normalization and efficient reperfusion in the reference group, higher flow resistance and low reperfusion in subjects with low tolerance to thermal stimuli).Changes in the parameters of hand warmth during the immersion test assessed by thermography and changes in the flow parameters observed by Doppler sonography demonstrated similar progression, which suggests the equivalence of both methods. Doppler sonography may thus serve as a method of monitoring function tests to establish a predisposition to vasospasm.

Progress in neurooncology suggests a need to combine information from anatomical-morphological and functional imaging in diagnosis and management. It is not always possible to establish a correct diagnosis using MRI imaging techniques alone, especially in the case of recurrent brain tumors. It is suggested that the results of different imaging techniques should be combined especially in these circumstances. The aim of this study was to evaluate the usefulness of fused post gadolinium MRI and single photon emission tomography (SPECT) images for planning 1H MRS.19 patients with a histopathological diagnosis of glial brain neoplasms were examined. SPECT was performed after i.v. administration of iodine-alpha-methyltyrozine (IMT). Fused SPECT and post Gd MR images were obtained on a peripheral console (Linux, PC), using a self developed technique. 1H MRS was performed on a 1.5 T scanner with the single voxel (SVS) technique using STEAM (TE 20 ms, TR 2000 ms) and (PRESS TE 136 TR 2000 ms) sequences.1H MRS with a volume of interest positioned in the most metabolically active areas on fused images, gave a more accurate diagnosis of tumor type and grade that was clinically relevant in 3 patients.The authors conclude that planning 1H MRS with the use of fused MRI and SPECT images improves the diagnosis.

Early detection and site location of recurrent cerebral glioma helps design optimum therapeutic regimen, which contributes to prolonged survival time of the patients. However, diagnosing the neoplastic growth at the post-resection site is a difficult process. The diagnostic modality to provide the most extensive morphological data is dynamic MR tomography. On the other hand, the tumour-related metabolic changes can be best diagnosed using the PET and SPECT techniques of nuclear medicine that employ radiolabelled amino acid 131 I-alpha-metyl-tyrosine (IMT) as the tracer. Thus, for comprehensive diagnostics of brain tumours, it is most effective to combine both the modalities and evaluate the fused images. The aim of the present study was to verify the usefulness of the calculated algorithm for a digital fusion of RM/SPECT images for the assessment of post-resection site of cerebral gliomas.The findings of MR and SPECT imaging for 21 patients who had surgery for cerebral glioma were subject to assessment. Diagnosis was based on histopathology results (8 cases of anaplastic astrocytoma and 13 cases of multiform glioblastoma). The site and size of the contrast enhancement areas from MR was compared with the hot focus location from SPECT.The study confirmed the feasibility of digital fusion of images yielded by SPECT and MR. The fused images reflect the non-homogeneity of the post-resection site of cerebral gliomas. Contrast enhancement areas only partially overlapped with the hot foci which, furthermore, were found to be substantially smaller.The consistency of tumour locations detected with MR and SPECT was higher for tumours of the anaplastic astrocytoma type than for multiform glioblastomas (higher polymorphism of pathological changes).

The causes of metabolic brain changes in patients with anorexia nervosa are still not fully explained. The purpose of this study was to use the 1H-MRS method in investigating metabolic changes in the brain of patients with anorexia nervosa. We studied 10 patients for visible alternations in brain metabolism and compared the results to healthy controls. 1H-MRS was acquired by the method of single voxels in white and grey matter. Proton MRS was performed after image guided localization using stimulated echo acquisition mode (STEAM) sequence with a short echo time of 20 ms. For data evaluation we used standard Siemens software and the additional PC. Choosing of the MRS sequences was related with particular interest in metabolites of short time echo: myoinositol and lipids. Besides this we evaluated peaks of: N-acetylaspartate (NAN), creatine (Cr) and choline (Cho). The results show significant differences in the levels of metabolites connected with fatty metabolism. In white matter we observed the reduction of lip-peak. The data was evaluated approximately and presented as lip:Cr. We did not observe any differences in other metabolites. As far as we know similar results had been reported and our study confirmed significant disorders in metabolism of these chemicals in patients with anorexia nervosa.

Early detection and diagnostic differentiation of neoplastic tissue from necrotic changes and scars following the treatment of cerebral gliomas is essential for determining further therapy and prognosis. The primary technique used for the diagnostics of recurrent neoplastic growth is the magnetic resonance imaging (MRI), which in some cases, however, does not allow one to identify the character of cerebral lesions. Recently, MRI has been supplemented with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) employing radiolabelled amino acids. e.g. tyrosine or methionine. The aim of the project was to assess the diagnostic potential of SPECT when iodine-131 alpha-methyl tyrosine (IMT), a Polish make of radiopharmaceutical (OBRI--POLATOM, Otwock-Rwierk, Poland), was applied. The use of 131I as a substitute for the more costly, imported iodine-123 has been justified in view of the nature and significance of the diagnostic problem on the one hand, and the possibility of 131-iodine application on a larger scale in CEE countries, on the other.MRI and SPECT were performed in 24 patients with a history of surgical treatment and radiotherapy of cerebral glioma (WHO grade II/IV). A SPECT was carried out 15 min after an i.v. injection of 74-111 MBq IMT. The tomograms were evaluated visually and in quantitative terms. The fused SPET/MR images were also analyzed. The obtained results were verified against histopathological findings, control MRI examinations and the clinical course of disease within 7-28 months of monitoring.In 19 patients, an increased IMT uptake indicative of a recurrent tumour was found, and the presence of the tumour was confirmed. In five patients no hot spots were detected which would indicate the neoplastic growth and verification did not provide any evidence for relapse.The examination employing iodine-131 IMT made it possible to confirm or exclude tumour recurrence in all the subjects, also in the cases when the CT/MR images were inconclusive. The MRI/SPECT fusion made it possible to more accurately identify the location of tumour recurrence as well as determine the area for spectroscopic MR analysis, for stereotactic biopsy and radiotherapy.