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Aleksandra Chyrek-Tomaszewska,1,2 Alicja Katarzyna Popiołek,1,3 Małgorzata Piskunowicz,1 Alina Borkowska,1 Jacek Budzyński,4 Maciej Kazimierz Bieliński1,2 1Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland; 2Department of Cardiac Rehabilitation and Experimental Cardiology, Władysław Biegański’s Regional Specialist Hospital, Grudziądz, Poland; 3Department of Internal Diseases, Jan Biziel’s University Hospital No. 2, Bydgoszcz, Poland; 4Department of Vascular and Internal Diseases, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, PolandCorrespondence: Aleksandra Chyrek-Tomaszewska, Department of Cardiac Rehabilitation and Experimental Cardiology, Władysław Biegański’s Regional Specialist Hospital in Grudziądz, Poland, ul. Rydygiera 15/17, 86-168, Grudziądz, Poland, Tel/fax +48 52 585 37 03, Email aleksandrachyrek@wp.plPurpose: This study aimed to assess the prevalence of depressive and anxiety symptoms in peripheral artery disease (PAD) patients, correlating these symptoms with clinical parameters and examining affective temperaments within the study group.Material and Methods: A total of 159 PAD patients, predominantly male, admitted for vascular surgery due to lower limb atherosclerosis, participated in this cross-sectional study. Various assessments were conducted, including the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) for affective temperaments, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression symptoms, and the Numerical Rating Scale (NRS) for pain intensity. Additionally, the Ankle-Brachial Index (ABI) was measured to assess circulation in the legs.Results: The findings revealed a higher prevalence of depressive and anxiety symptoms in the PAD patient group compared to the control group. Notably, depressive and anxiety symptoms correlated with the severity of PAD, as indicated by lower ABI values in the operated leg. Patients undergoing surgical revascularizations exhibited higher depressive symptoms than those undergoing endovascular procedures. Furthermore, correlations were observed between depressive symptoms and the number of previous vascular procedures and amputations, alongside increased pain levels at admission. Clinical factors such as diabetes, hypertension, heart failure, ischemic heart disease, previous revascularization procedures, amputations, and the intensity of affective temperaments did not correlate with HADS scores.Discussion: The study highlighted the intricate relationship between mood disorders and PAD severity, emphasizing the potential prognostic implications of untreated depression and anxiety in PAD patients. These findings suggest the importance of closely monitoring and addressing psychological well-being in PAD management. However, the study encountered limitations such as varying assessment timing and sample size discrepancies among comorbidities, impacting the observation of associations between mood disorders and certain conditions.Conclusion: In conclusion, depressive and anxiety symptoms are often in PAD. Further research is needed to explore therapeutic interventions targeting mental health and pain management to improve the course and outcomes of PAD.Keywords: chronic limb ischaemia, mood disorders, affective temperament, behavioral profiles, pain

Abstract Ultrasound practice is a longstanding tradition for radiology departments, being part of the family of imaging techniques. Ultrasound is widely practiced by non-radiologists but becoming less popular within radiology. The position of ultrasound in radiology is reviewed, and a possible long-term solution to manage radiologist expectations is proposed. An international group of experts in the practice of ultrasound was invited to describe the current organisation of ultrasound within the radiology departments in their own countries and comment on the interaction with non-radiologists and training arrangements. Issues related to regulation, non-medical practitioners, and training principles are detailed. A consensus view was sought from the experts regarding the position of ultrasound within radiology, with the vision of the best scenario for the continuing dominance of radiologists practising ultrasound. Comments were collated from nine different countries. Variable levels of training, practice, and interaction with non-radiologist were reported, with some countries relying on non-physician input to manage the service. All experts recognised there was a diminished desire to practice ultrasound by radiologists. Models varied from practising solely ultrasound and no other imaging techniques to radiology departments being central to the practice of ultrasound by radiologists and non-radiologist, housed within radiology. The consensus view was that the model favoured in select hospitals in Germany would be the most likely setup for ultrasound radiologist to develop and maintain practice. The vision for 20 years hence is for a central ultrasound section within radiology, headed by a trained expert radiologist, with non-radiologist using the facilities. Critical relevance statement The future of ultrasound within the radiology department should encompass all ultrasound users, with radiologists expert in ultrasound, managing the ultrasound section within the radiology department. The current radiology trainees must learn of the importance of ultrasound as a component of the ‘holistic’ imaging of the patient. Key points: 1. Ultrasound imaging within radiology departments precedes the introduction of CT and MR imaging and was first used over 50 years ago. 2. Non-radiology practitioners deploy ultrasound examinations to either ‘problem solve’ or perform a comprehensive ultrasound examination; radiologists provide comprehensive examinations or use ultrasound to direct interventional procedures. 3. Radiology does not ‘own’ ultrasound, but radiologists are best placed to offer a comprehensive patient-focused imaging assessment. 4. A vision of the future of ultrasound within the radiology department is encompassing all ultrasound users under radiologists who are experts in ultrasound, positioned within the radiology department. 5. The current radiology trainee must be aware of the importance of ultrasound as a component of the ‘holistic’ imaging of the patient.

Duplex kidney is a urinary tract anomaly commonly associated with a wide range of primary and secondary parenchymal structural abnormalities. We present a unique comparison of US and MRI findings with histopathology following partial resection of duplex kidneys due to nephropathy. We examined a group of 21 children with duplex kidneys who were qualified for heminephrectomy (24 kidney units (KU)). All patients underwent US and MRI prior to the surgery. The imaging results were compared with histopathologic findings. In 21/24 KU, dysplastic changes were found on histopathology, including all with obstructive nephropathy and 7/10 specimens with refluxing uropathy. The loss of corticomedullary differentiation on US and increased signal on T2-weighted images (T2WI) on MRI were the imaging findings that best correlated with fibrosis. In children with megaureter, there were no statistical differences in histopathological findings between primary megaureter, megaureter with ureterocele, and megaureter with ectopia (p > 0.05). The extent of dysplasia of the affected pole correlated negatively with residual function in MRI. Kidney dysplasia and inflammation in the kidney with obstructive nephropathy are the most important histopathologic findings of this study. US is a valuable screening tool, and MRI enables morphologic and functional assessments of the nephropathy in duplex kidneys.

Background: Computed tomography (CT) contributes significantly to the collective dose from medical sources, raising concerns about potential health risks. However, existing radiation dose estimation tools, such as volume computed tomography dose index (CTDIvol), dose-length product (DLP), effective dose (ED), and size-specific dose estimate (SSDE), have limitations in accurately reflecting patient exposure. This study introduces a new parameter, size-specific dose-length product (DLPss), aiming to enhance the precision of radiation dose estimation in real-life scenarios. Methods: A retrospective analysis of 134 chest CT studies was conducted. Relationships between CTDIvol and anthropometric parameters were examined, and SSDE was calculated based on effective diameter. Additionally, the novel parameter, DLPss, was introduced, considering scan length and cross-sectional dimensions. Results: Analysis reveals variations in scan length, effective diameter, and CTDIvol between genders. Strong correlations were observed between CTDIvol and effective diameter, particularly in men. The average CTDIvol for the entire group was 7.83 ± 2.92 mGy, with statistically significant differences between women (7.38 ± 3.23 mGy) and men (8.30 ± 2.49 mGy). SSDE values showed significant gender differences, with men exhibiting higher values. The average SSDE values for women and men were 9.15 ± 2.5 mGy and 9.6 ± 2.09 mGy, respectively, with a statistically significant difference (p = 0.03). The newly introduced DLPss values ranged around 343.90 ± 81.66 mGy·cm for the entire group, with statistically significant differences between women (323.53 ± 78.69 mGy·cm) and men (364.89 ± 79.87 mGy·cm) (p < 0.05), providing a comprehensive assessment of total radiation dose. Conclusion: The study highlights the need for accurate radiation dose estimation, emphasizing the impact of CT examination parameters on dose variability. The proposed DLPss parameter offers a promising approach to enhancing precision in assessing radiation risk during CT scans. Further research is warranted to explore additional parameters for a comprehensive understanding of radiation exposure and to optimize imaging protocols for patient safety.

Abstract Background Sarcopenia, defined as loss of skeletal muscle mass, is a novel term associated with adverse outcomes in children. Magnetic Resonance Imaging (MRI) is a safe and precise technique for measuring tissue compartments and is commonly used in most routine paediatric imaging protocols. Currently, there is a lack of MRI‐derived normative data which can help in determining the level of sarcopenia. This study aimed to introduce reference values of total psoas muscle area (tPMA), total paraspinal muscle area (tPSMA), and total macroscopic fat infiltrations of the PSMA (tMFI). Methods In this retrospective study, the local database was searched for abdominal and pelvic region MRI studies of children aged from 1 to 18 years (mean age (standard deviation (SD)) of 9.8 (5.5) years) performed in the years 2010–2021. Children with chronic diseases and a history of surgical interventions were excluded from the analysis. Finally, a total of 465 healthy children (n = 233 girls, n = 232 boys) were enrolled in the study. The values of the tPMA, tPMSA, and tMFI were measured in square centimetres (cm2) at the level of the L4/L5 intervertebral disc as the sum of the left and right regions. Age‐specific and sex‐specific muscle, fat, and body mass index percentile charts were constructed using the LMS method. Inter‐observer agreement and intra‐observer reproducibility were assessed using the Bland–Altman plots. Results Both tPMA and tPSMA showed continuous increases in size (in cm2) throughout all age groups. At the age of 18, the median tPMA areas reached 26.37 cm2 in girls and 40.43 cm2 in boys. Corresponding tPSMA values were higher, reaching the level of 40.76 cm2 in girls and 56.66 cm2 in boys. The mean value of tMFI within the paraspinal muscles was 5.0% (SD 3.65%) of their total area in girls and 3.5% (SD 2.25%) in boys with the actual difference between sexes up to 0.96 cm2. Excellent intra‐observer reproducibility and inter‐observer agreement were noted. Actual mean differences for tPMA were at the level of 0.43 and 0.39 cm2, respectively. Mean bias for tPSMA was 0.1 cm2 for inter‐observer and 0.05 cm2 for intra‐observer measurements. Conclusions Our findings demonstrate novel and highly reproducible sex‐specific MRI‐derived reference values of tPMS, tPSMA, and tMFI at the level of the L4/L5 intervertebral disc for children from 1 to 18 years old, which may guide a clinician in the assessment of sarcopenia, a prognostic outcome marker in children.

Alicja Popio&lstrok;ek,1,2 Bartosz Brzoszczyk,3 Piotr Jarzemski,3 Ma&lstrok;gorzata Piskunowicz,1 Marcin Jarzemski,3 Alina Borkowska,1 Maciej Bieli&nacute;ski1 1Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toru&nacute;, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland; 2Department of Internal Diseases, Jan Biziel University Hospital No.2 in Bydgoszcz, Bydgoszcz, Poland; 3Clinic of Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, Bydgoszcz, PolandCorrespondence: Alicja Popio&lstrok;ek, Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toru&nacute;, Collegium Medicum in Bydgoszcz, Ul. Sk&lstrok;odowskiej-Curie 9, Bydgoszcz, 85-094, Poland, Tel/fax +48 52 585 37 03, Email popiolek.ala@gmail.comPurpose: Prostate cancer (PC) is one of the most common malignancies in men. The population of PC survivors is growing, and understanding the roles of different factors that affect quality of life (QoL) is important. We investigated the effects of affective temperament on the QoL of PC patients.Patients and Methods: All subjects (n=100) underwent medical evaluation [including demographic data, medical history, physical examination, biochemical tests, and assessment of urinary incontinence (ICIQ-UI SF scale) and erectile dysfunction (ED) (IIEF-5 and subjective ED scale)] and psychological evaluation [including assessment of affective temperament using the TEMPS-A scale, depression and anxiety (using HADS), and QoL (EORTC-QLQ-C30 and EORTC-PR25)]. The relationships between individual variables were examined.Results: Erection quality after treatment was associated with better QoL in most parameters. Similar strong relationships were observed between the urinary incontinence scale and QoL. Depressive, cyclothymic, irritable, and anxious temperaments were associated with decreased QoL. On the EORTC-PR25 scale, associations were observed between a depressive temperament and worse sexual function and urinary symptoms, between a cyclothymic temperament and worse urinary symptoms, and between an irritable temperament and worse sexual functioning. Multivariate analysis identified the severity of anxiety and depression symptoms measured by HADS as the most important psychological factors affecting QoL.Conclusion: QoL in PC survivors depends on many factors, including age, interval since diagnosis, tumor stage, treatment, complications, and affective temperament profile. Depressive, cyclothymic, irritable, and anxious temperaments were associated with poorer QoL in selected domains, which was not observed for a hyperthymic temperament. The temperament profile of patients was associated with mood and anxiety level, which were important determinants of a poorer QoL.Keywords: quality of life, prostate cancer, complications, prostatectomy, affective temperament

Pulmonary involvement is the most common complication in patients with predominantly antibody deficiencies (PADs). Therefore, patients require repeated imaging tests. Unlike high-resolution computed tomography (HRCT), lung ultrasonography (LUS) does not expose patients to X-rays or contrast agents, and can be performed even at the bedside. This study aimed to evaluate lung lesions using simultaneous LUS and HRCT in a group of patients with PADs. Twenty-nine adult patients (13 women and 16 men) diagnosed with PADs according to the ESID criteria (23 Common variable immunodeficiency, 2 X-linked agammaglobulinemia, 2 IgG subclass deficiencies, and 2 Unspecified hypogammaglobulinemia) were included in the study. The mean age was 39.0 ± 11.9 years. The mean time elapsed between the first symptoms of PADs and the examination was 15.4 ± 10.1 years. Lung ultrasonography and high-resolution computed tomography were performed simultaneously according to a defined protocol during the clinic visits. In both examinations, lesions were compared in the same 12 regions: for each lung in the upper, middle, and lower parts, separately, front and back. A total of 435 lesions were described on LUS, whereas 209 lesions were described on HRCT. The frequencies of lesions in the lung regions were similar between LUS and HRCT. In both examinations, lesions in the lower parts of the lungs were most often reported (LUS 60.9% vs. HRCT 55.5%) and least often in the upper parts of the lungs (LUS 12.7% vs. HRCT 12.0%). The most frequently described lesions were LUS consolidations (99; 22.8%) and HRCT fibrosis (74; 16.5%). A statistically significant relationship was found in the detection of fibrosis in 11 of the 12 regions (phi = 0.4−1.0). Maximum values of the phi coefficient for the upper part of the left lung were recorded. Compared with HRCT, LUS is an effective alternative for evaluating and monitoring pulmonary lesions in adult patients with PADs, especially for pulmonary fibrosis.

MR urography can be an alternative to other imaging methods of the urinary tract in children. However, this examination may present technical problems influencing further results. Special attention must be paid to the parameters of dynamic sequences to obtain valuable data for further functional analysis. The analysis of methodology for renal function assessment using 3T magnetic resonance in children. A retrospective analysis of MR urography studies was performed in a group of 91 patients. Particular attention was paid to the acquisition parameters of the 3D-Thrive dynamic with contrast medium administration as a basic urography sequence. The authors have evaluated images qualitatively and compared contrast-to-noise ratio (CNR), curves smoothness, and quality of baseline (evaluation signal noise ratio) in every dynamic in each patient in every protocol used in our institution. Quality analysis of the image (ICC = 0.877, p < 0.001) was improved so that we have a statistically significant difference in image quality between protocols (χ2(3) = 20.134, p < 0.001). The results obtained for SNR in the medulla and cortex show that there was a statistically significant difference in SNR in the cortex (χ2(3) = 9.060, p = 0.029). Therefore, the obtained results show that with the newer protocol, we obtain lower values of standard deviation for TTP in the aorta (in ChopfMRU: first protocol SD = 14.560 vs. fourth protocol SD = 5.599; in IntelliSpace Portal: first protocol SD = 15.241 vs. fourth protocol SD = 5.506). Magnetic resonance urography is a promising technique with a few challenges that arise and need to be overcome. New technical opportunities should be introduced for everyday practice to improve MRU results.

Objectives: To evaluate carotid body visibility in contrast-enhanced magnetic resonance (MR) studies and to compare the results to contrast-enhanced computed tomography (CT). Methods: Two observers separately evaluated MR and CT examinations of 58 patients. MR scans were acquired with contrast-enhanced isometric T1-weighted water-only Dixon sequence. CT examinations were performed 90 s after contrast agent administration. Carotid bodies’ dimensions were noted and their volumes calculated. To quantify the agreement between both methods, Bland–Altman plots were computed. Receiver operating characteristic (ROC) and its localization-oriented variant (LROC) curves were plotted. Results: Of the 116 expected carotid bodies, 105 were found on CT and 103 on MR at least by a single observer. Significantly more findings were concordant in CT (92.2%) than in MR (83.6%). The mean carotid body volume was smaller in CT (19.4 mm3) than in MR (20.8 mm3). The inter-observer agreement on volumes was moderately good (ICC (2,k) 0.42, p < 0.001), but with significant systematic error. The diagnostic performance of the MR method added up to 88.4% of the ROC’s area under the curve and 78.0% in the LROC algorithm. Conclusions: Carotid bodies can be visualized on contrast-enhanced MR with good accuracy and inter-observer agreement. Carotid bodies assessed on MR had similar morphology as described in anatomical studies.

IntroductionMegaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge. Magnetic resonance urography (MRU) appears as a promising method in urinary tract imaging, providing both anatomical and functional information. There are several postprocessing tools to assess renal function (including differential renal function) and severity of ureteral obstruction based on MRU. Still, the place of this method in the diagnostic algorithm of ureteropelvicalyceal dilatation with megaureter remains underestimated. Analysis of imaging findings in a group of children diagnosed with megaureter was done.Material and MethodsA retrospective analysis of magnetic resonance urography (MRU) was performed in 142 consecutive patients examined from January 2013 to September 2019. Twenty-five patients meeting the criteria of megaureter (dilatation more than 7 mm) in MRU were included in the further analysis. The MRU, ultrasound (US), and scintigraphy results were compared and analyzed together and compared with clinical data.ResultsThe sensitivity and specificity of US was comparable to the MRU in the assessment of upper urinary tract morphology (p > 0.05). In five out of 25 children, megaureter was found in each kidney; in a single case, both poles of a duplex kidney were affected. In the diagnosis of ureter ectopia, the MRU was superior to the US for which sensitivity did not exceed 16%. The US showed limited value in the diagnostics of segmental ureter dysplasia as a cause of primary megaureter when compared with MRU. Four cases were visualized in MRU studies, whereas the US examination was negative (all confirmed during surgery). There was a moderate correlation between relative renal function between fMRU and scintigraphy (t = 0.721, p = 0.477) and in the severity of obstruction assessment between both methods (r = 0.441, p < 0.05). However, in 10 kidneys with megaureter, the results in scintigraphy were inconclusive due to the signal from the megaureter imposing on the renal field.ConclusionsMRU seems to be a preferred method in the diagnostic algorithm for megaureter, providing both anatomical and functional information. MRU is superior to US and scintigraphy in diagnosing urinary tract anomalies with megaureter.

Introduction: Despite the significant increase in use of magnetic resonance imaging (MRI) in children, there is still a lack of normal reference values of renal size in this method and reference values are being interpolated from the ultrasound (US) studies. The study provides comparative analysis of agreement in renal length and volume measurements between MRI and ultrasound.Materials and Methods: Ninety-three children with a mean age of 8.0 ± 6.0 years, who had undergone both renal US and MRI exams, were included in the study. Participants were divided into three subgroups; each kidney was considered separately.Group 1 included 106 kidneys without any anomalies. Group 2 comprised 48 kidneys with a dilated collecting system. Group 3 included 32 kidneys with a duplicated collecting system. Measurements were taken in three dimensions, and renal volume was calculated from the ellipsoid formula.Results: We found no significant difference between US and MRI measurements in Group 1 and Group 2. In Group 3, the difference between measurements in both imaging methods was significant. The mean difference varied from 0.05% in Group 1, 2.95% in Group 2, to 4.99% in Group 3.Conclusion: The US and MRI are comparable methods in renal size measurements. The interpolation of sonographic renal length and volume reference values to the MRI in the pediatric population is justified, as there is a strong agreement between both methods. Both methods can be used interchangeably for following up of the renal size changes in the pediatric population.

The assessment of body composition in pediatric population is essential for proper nutritional support during hospitalization. However, currently available methods have limitations. This study aims to propose a novel approach for nutrition status assessment and introduce magnetic resonance imaging (MRI)-derived subcutaneous and visceral fat normative reference values. A total of 262 healthy subjects aged from 6 to 18 years underwent MRI examinations and anthropometric measurements. MRI images at the second lumbar vertebrae were used by two radiologists to perform the semi-automatic tissue segmentation. Based on obtained adipose tissue surface areas and body mass index (BMI) scores sex-specific standard percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th) and z-scores were constructed using LMS method. Additionally, 85th and 95th centiles of subcutaneous and visceral adipose tissue were proposed as equivalents of overweight and obesity. Bland-Altman plots revealed an excellent intra-observer reproducibility and inter-observer agreement. In conclusion, our findings demonstrate highly reproducible method and suggest that MRI-derived reference values can be implemented in clinical practice.

Introduction: Synthetic pyretroids are among the most common pesticides currently used worldwide. Animal studies suggest that exposure to pyrethroids could dysregulated the function of the ovary, mainly follicular development and/or synthesis of the reproductive hormone. Nevertheless data regarding the effect of exposure on female ovarian function is limited. So the aim of the present study is to assess the effect of exposure to synthetic pyrethroids on ovarian reserve. Materials and Methods: The study population consists of 511 females aged 25–39 years attending infertility clinics for diagnostic purposes, because of couples’ infertility. Validated gas chromatography ion-tap mass spectrometry method was used to assess the urinary concentrations of pyrethroid metabolites (CDDCA (cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid), TDDCA (trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid), 3PBA (3-phenoxybenzoic acid) and DBCA (cis-2,2-dibromovinyl-2,2-dimethylcyclopropane-1-carboxylic acid)). Ovarian reserve was assessed using parameters of ovarian reserve (antral follicle count and concentrations of hormones: AMH (anti-Mullerian hormone), FSH (follicle stimulating hormone) and E2 (estradiol)). Results: In the present analysis the association was found between urinary concentrations of 3-PBA and levels of AMH (p = 0.03), FSH (p = 0.04) and antral follicle count (p = 0.02). Urinary level of CDCCA, TDCCA and DBCA was not associated with any examined parameters of ovarian reserve. Conclusions: Synthetic pyrethroids may affect female ovarian reserve. As this is the first, preliminary study the results need confirmation in a further detailed investigations.

Objective: The aim of this study was to establish recommendations for the use of lung ultrasound in internal medicine, based on reliable data and expert opinions. Methods: The bibliography from the databases (Pubmed, Medline, OVID, Embase) has been fully reviewed up to August 2017. Members of the expert group assessed the credibility of the literature data. Then, in three rounds, a discussion was held on individual recommendations (in accordance with the Delphi procedure) followed by secret voting. Results: Thirty-eight recommendations for the use of lung ultrasound in internal medicine were established as well as discussed and subjected to secret voting in three rounds. The first 31 recommendations concerned the use of ultrasound in the diagnosis of the following conditions: pneumothorax, pulmonary consolidation, pneumonia, atelectasis, pulmonary embolism, malignant neoplastic lesions, interstitial lung lesions, cardiogenic pulmonary edema, interstitial lung diseases with fibrosis, dyspnea, pleural pain and acute cough. Furthermore, seven additional statements were made regarding the technical conditions of lung ultrasound examination and the need for training in the basics of lung ultrasound in a group of doctors during their specialization programs and medical students. The panel of experts established a consensus on all 38 recommendations.

The aim of this article is to review current research on relationship between physical activity and chosen aspects of psychological status of elderly adults. Among many psychological aspects cognitive functions and anxiety and depression as emotional aspects were chosen. The results suggest that physical activity correlates with higher cognitive performance and lower rates of anxiety and depression.

Background: The invasiveness and exposure to radiation in voiding cystourethrography led to the introduction of alternative methods of diagnosis of vesicoureteral reflux, including contrast enhanced voiding urosonography. While there is a limited number of studies comparing these methods using new generation ultrasound contrast agents, none of them compared both methods simultaneously. This study is aimed at assessing agreement between contrast enhanced voiding urosonography with second-generation ultrasound contrast agents and voiding cystourethrography. Methods: From April 2013 to May 2014, 83 children (37 female and 46 male), mean age 3.5 years, age range from 1 month to 17.5 years, underwent prospective simultaneous assessment by contrast enhanced voiding urosonography and voiding cystourethrography, with a total of 166 uretero-renal units evaluated. Results: The sensitivity of voiding cystourethrography and contrast enhanced voiding urosonography were comparable, amounting to 88%, however, neither reached 100% for the entire studied population. The negative predictive value of voiding urosonography and voiding cystourethrography was 97%, and there was no difference between both methods. Conclusion: Voiding cystourethrography and contrast enhanced voiding urosonography are comparable methods in diagnosis of vesicoureteral reflux, and can be performed alternatively. However, some limitations of contrast enhanced voiding urosonography must be remembered.

We present an additional sonographic sign of Hashimoto’s thyroiditis (HLT), increasing the specifi city of this method in pediatric populations. Methods: A total of 98 children (mean age 12.7 years, range 7–17 years) were selected from the registry of the endocrinology outpatient department. All subjects met the diagnostic criteria for HLT. All children underwent a prospective thyroid ultrasound examination with special attention paid to the presence of lymph nodes adjacent to the thyroid gland. In order to form a control group, we analyzed 102 healthy volunteers and 94 children with cervical lymphadenopathy, age- and sex-matched with the main study group. Results: The ultrasound of the thyroid revealed typical sonographic signs of autoimmune thyroid disease in all children with HLT and in none of the individuals in the control groups. In 96 children (98%) from the HLT group, at least 2 lymph nodes adjacent to the lower part of the thyroid gland lobes localized on one or both sides of the thyroid were detected. No lymph nodes adjacent to the lower part of the thyroid lobes were found in healthy children or children with cervical lymphadenopathy. Conclusions: Lymph nodes adjacent to the lower part of the thyroid lobes are an additional ultrasound sign of pediatric Hashimoto’s lymphocytic thyroiditis, with 98% sensitivity and 100% specifi city.

ObjectiveDespite numerous publications regarding nontoxic goiter (NTG) treatment and an increasing interest in patients’ quality of life, few studies present the outcome of 131-I treatment from the patients’ perspective. Our study’s main aim was to verify whether there is any improvement in life quality following 131-I treatment.Materials and methodsThirty-five patients with NTG qualified to participate in the study. All patients completed a Thyroid-Related Health-Related Quality of Life (Thy-R-HRQoL) questionnaire created by us and the Medical Outcomes Study 36-item Short Form (SF-36), right before and 1 year after 131-I.ResultsWe observed an improvement in six out of eight SF-36 and three out of seven Thy-R-HRQoL domains. In comparison with the control group, we observed worse results in two out of eight, prior to treatment, and one out of eight SF-36 afterward, as well as in all Thy-R-HRQoL domains. We did not find any correlation between improvement of Thy-R-HRQoL and SF-36 and goiter size reduction, except for Bodily Pain. There was also no correlation between improvement of SF-36 and Thy-R-HRQoL domains, and goiter size before treatment. The older the patient, the less noticeable improvement was observed in Physical and Social Functioning, and Vitality in SF-36, but age had no influence on the assessment by Thy-R-HRQoL.ConclusionRadioiodine treatment improves life quality in patients with NTG. Use of the Health-Related Quality of Life questionnaire should be taken into consideration when evaluating life quality of patients with NTG. Relentless pursuit of maximal goiter size reduction in 131-I treatment is worth consideration. In our study, life quality improvement did not depend directly on the goiter size reduction. Life quality improvement after 131-I might not depend on initial goiter size, and for certain domains of SF-36 might be less clearly expressed in older patients.

Background/Aims: The purpose of the present study was to compare the direct renin inhibitor aliskiren to the diuretic hydrochlorothiazide (HCTZ) in their ability to modulate renal tissue oxygenation in hypertensive patients. Methods: 24 patients were enrolled in this randomized prospective study and 20 completed the protocol. Patients were randomly assigned to receive either aliskiren 150-300 mg/d or HCTZ 12.5 - 25 mg/d for 8 weeks. Renal oxygenation was measured by BOLD-MRI at weeks 0 and 8. BOLD-MRI was also performed before and after an i.v. injection of 20 mg furosemide at week 0 and at week 8. BOLD-MRI data were analyzed by measuring the oxygenation in 12 computed layers of the kidney enabling to asses renal oxygenation according to the depth within the kidney and by the classical method of regions of interest (ROI). Results: The classical ROI analysis of the data showed no difference between the groups at week 8. The analysis of renal oxygenation according to the 12 layers method shows no significant difference between aliskiren and HCTZ at week 8 before administration of furosemide. However, within group analyses show that aliskiren slightly but not significantly increased oxygenation in the cortex and decreased medullary oxygenation whereas HCTZ induced a significant overall decrease in renal tissue oxygenation. With the same method of analysis we observed that the response to furosemide was unchanged in the HCTZ group at week 8 but was characterized by an increase in both cortical and medullary oxygenation in aliskiren-treated patients. Patients responding to aliskiren and HCTZ by a fall in systolic blood pressure of >10 mmHg improved their renal tissue oxygenation when compared to non-responders. Conclusion: With the classical method of evaluation using regions no difference were found between aliskiren and HCTZ on renal tissue oxygenation after 8 weeks. In contrast, with our new method that takes into account the entire kidney, within group analyses show that aliskiren slightly increases cortical and medullary renal tissue oxygenation in hypertensive patients whereas HCTZ decreases significantly renal oxygenation at trough.

The lack of registration of ultrasound contrast agents for use in patients below the age of 18 is a significant limitation of their usage. Despite this, examinations with the use of contrast agents are conducted in numerous centers, mainly as part of the diagnostic process of vesicoureteral reflux. Examinations after an intravenous administration of contrast agents are conducted rarely. The reason for this is not only the lack of registration, but also the lack of studies on their safety profile in paediatric patients or no guidelines concerning the dosage. It seems that imaging with the use of such agents could help solve certain clinical problems when other diagnostic methods fail. The paper presents selected cases of pediatric patients treated in oncological departments, in whom the examination with the use of ultrasound contrast agents had a considerable influence on the diagnostic and therapeutic process.

Meniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion.Knee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18-49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle) and the risk of extrusion.Analysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly.This was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (−9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT −16.09%, TTP −7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT −14.65%, TTP −7.46%) sides. PS decreased by almost half: ipsilateral −48.11%, contralateral −45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.

Experimentally renal tissue hypoxia appears to play an important role in the pathogenesis of chronic kidney disease (CKD) and arterial hypertension (AHT). In this study we measured renal tissue oxygenation and its determinants in humans using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) under standardized hydration conditions. Four coronal slices were selected, and a multi gradient echo sequence was used to acquire T2* weighted images. The mean cortical and medullary R2* values ( = 1/T2*) were calculated before and after administration of IV furosemide, a low R2* indicating a high tissue oxygenation. We studied 195 subjects (95 CKD, 58 treated AHT, and 42 healthy controls). Mean cortical R2 and medullary R2* were not significantly different between the groups at baseline. In stimulated conditions (furosemide injection), the decrease in R2* was significantly blunted in patients with CKD and AHT. In multivariate linear regression analyses, neither cortical nor medullary R2* were associated with eGFR or blood pressure, but cortical R2* correlated positively with male gender, blood glucose and uric acid levels. In conclusion, our data show that kidney oxygenation is tightly regulated in CKD and hypertensive patients at rest. However, the metabolic response to acute changes in sodium transport is altered in CKD and in AHT, despite preserved renal function in the latter group. This suggests the presence of early renal metabolic alterations in hypertension. The correlations between cortical R2* values, male gender, glycemia and uric acid levels suggest that these factors interfere with the regulation of renal tissue oxygenation.

Animal studies suggest that renal tissue hypoxia plays an important role in the development of renal damage in hypertension and renal diseases, yet human data were scarce due to the lack of noninvasive methods. Over the last decade, blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), detecting deoxyhemoglobin in hypoxic renal tissue, has become a powerful tool to assess kidney oxygenation noninvasively in humans. This paper provides an overview of BOLD-MRI studies performed in patients suffering from essential hypertension or chronic kidney disease (CKD). In line with animal studies, acute changes in cortical and medullary oxygenation have been observed after the administration of medication (furosemide, blockers of the renin-angiotensin system) or alterations in sodium intake in these patient groups, underlining the important role of renal sodium handling in kidney oxygenation. In contrast, no BOLD-MRI studies have convincingly demonstrated that renal oxygenation is chronically reduced in essential hypertension or in CKD or chronically altered after long-term medication intake. More studies are required to clarify this discrepancy and to further unravel the role of renal oxygenation in the development and progression of essential hypertension and CKD in humans.