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

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

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

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

Late presenting diaphragmatic hernia: clinical and diagnostic aspects.

BACKGROUND: The congenital diaphragm hernia presents most frequently in the neonatal period. In a small group of children his defect can be diagnosed beyond the newborn age, during late infancy or early childhood. The late presenting congenital diaphragm hernia is characterized by a variable clinical picture and represents a considerable diagnostic challenge. The aim of this study was to evaluate the usefulness of imaging methods in diagnosis, monitoring and management of late presenting diaphragmatic hernias. MATERIAL/METHODS: The retrospective analysis of 58 children with congenital diaphragm hernia, aged from 1 day to 7.5 years (the average: 2.6 years) treated between 1990-2006 in the Department of Pediatric Surgery and Urology of the Medical University of Wroclaw was carried out. 19 (39%) children in whom the malformation was recognized beyond the newborn period were numbered to this group. The detailed analysis comprised the type of clinical manifestation, as well as the therapeutic and diagnostic algorithm. RESULTS: The postero-lateral variant of the defect was recognized in 15 children, the Morgagni type in 2 and the hiatal type in 2. Right-sided hernia was found in 4 children, whereas left-sided in 15. 8 infants with left hernia presented with dominant symptoms from the respiratory system; 3 infants - from the GI tract with delayed somatic growth. Among children over 1 year of age, 6 presented symptoms of respiratory origin and only 2 of gastrointestinal nature. Only one child showed associated congenital malformations. In all children the diagnosis was made on the basis of imaging modalities. The GI contrast study was decisive imaging method in 14 children, ultrasonography in 15, CT in 4. CONCLUSIONS: The lack of typical clinical presentation in cases of late presenting CDH leads to delayed diagnosis of the defect. This clinical entity should be however taken into account in the differential diagnosis of children with respiratory distress and GI disturbances. The imaging studies are essentials in every case.

[The usefulness of contrast-enhanced sonography in the differential diagnostic of adrenal tumors]. / Przydatnosc ultrasonograficznego srodka kontrastujacego Levovist w diagnostyce róznicowej guzów nadnerczy.

INTRODUCTION: The occurrence of gland tumors causes significant clinical problem. Non hormone-secreting tumors provide the most complicated diagnostic difficulties. The application of contrast-enhanced sonography could improve the vessels visualization and point out characteristic features of benign and malignant changes. The authors believe that this new method make possible the differential adrenal tumor diagnostic process more precise and increase the specificity of ultrasonography in the recognition of benign and malignant tumors. The aim of this study was to define the usefulness of contrasting agent Levovist in differential diagnostics of adrenal tumors and its influence on sensitivity and specificity of ultrasound examination and to establish patients qualification criteria for surgical procedures. MATERIAL AND METHODS: Ultrasound examinations were made with the use of digital devise by GE Voluson 740, probe 4-6 mHz with Doppler options and volumetric probe 3D according to the following protocol: 26 patients with recognized adrenal tumor were qualified for the examination. Patients in the first stage of tumor vascularization had Doppler examination with color (CD) and power Doppler (PD). Three-dimensional ultrasonography was used to improve visualization of vascularization. In the final phase of the examination the patients were administrated of Levovist in the recommended by the producer dose: 2.5 g in the concentration of 400 mg/l. RESULTS: 26 cases of adrenal gland tumours were subjected to analysis. In standard ultrasonographic examination focal changes in 25 patients were hipoechogenic focuses and in one case the focus was hyperechogenic. Heterogeneity of focuses was observed in 16 cases. In Doppler examination with color (CD) and power Doppler (PD) vascular blood flow was revealed within 12. After using contrasting agent Levovist vascular blood flow was achieved in 4 additional cases, which constituted 61%. CONCLUSIONS: 1. 3D ultrasound could be useful in cases of big adrenal tumors--over 3 cm diameter after application of ultrasound contrast agents. 2. The use of Levovist in Doppler examination improves the visualization of tumor vascularization. However, it is impossible to differentiate benign from malignant tumors unequivocally.

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

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

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

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