[Imaging methods in diagnosis and monitoring of multiple myeloma]. / Zobrazovací metody v diagnostice a sledování mnohocetného myelomu.

Imaging methods (IM) are important for both the diagnosis and monitoring of the treatment of multiple myeloma (MM). The report discusses radiological IM as well as methods of nuclear medicine. Hole-body screening using simple X-ray pictures is still used in all newly diagnosed cases of the disease, though its validity is significantly higher in chronic forms and primarily in the diagnostics of vertebral compressions. Computer tomography (CT) ideally scans the destructive changes on the compact bone, but it is not very good in showing bone marrow. It is however, invaluable in targeted biopsy or vertebroplasty. Magnetic resonance imaging (MRI) currently has a decisive role mainly in early diagnostics, thanks to its ability to show early changes in the bone marrow. Of critical importance is also indication for MRI in the imaging of structures of the spinal canal and in evidencing epidural propagation of tumour mass. A disadvantage of the method is its inability to show the effects of the treatment immediately following its administration. Contraindications of MRI are also addressed. Among the methods of nuclear medicine, the most important are hole-body 99mTc-MIBI scintigraphy and full-body FDG-PET/CT examinations. 99mTc-MIBI is a sensitive indicator of the biological activity of the disease. It shows the damage to the skeleton caused by the tumour before anatomic changes appear. It reliably differentiates MM remissions from relapses and can be used to determine the optimal position for biopsy puncture. The method is good for monitoring the course of the disease and forecasting the results of the treatment. Its disadvantage is its limited resolution capacity, therefore focal lesions smaller than 10 mm usually escape scintigraphic detection. Similarly to 99mTc-MIBI scintigraphy, FDG-PET/CT examination shows tumorous affection of the skeleton before structural changes appear. It is a highly effective method especially in detecting skeletal damage and extramedullar exhibitions of the disease. The sensitivity and specificity of FDG-PET/CT examination is increased by simultaneous CT examination which is made possible by new generation hybrid instruments. The method, together with 99mTc-MIBI scintigraphy, is very important in the detection of hypo/non-secretional forms of MM. It provides "real time" information on the response of the tumour to treatment and reliably detects the relapse and the remission. An overview is given of recommended examination algorithms for acute and chronic forms and for the monitoring of the treatment of MM, as well as of the importance of all IM for clinical practice.

Scintigraphy using (99m)Tc-MIBI (sestamibi), a sensitive parameter of activity of multiple myeloma.

Technetium-99m methoxyisobutylisonitrile ((99m)Tc-MIBI) has been shown to be useful in identifying several types of tumors, such as breast, brain, thyroid gland, malignant lymphomas and multiple myeloma. In this study, 102 patients with multiple myeloma (MM) and 32 patients with monoclonal gammopathy of undetermined significance (MGUS) had been evaluated for correlation between (99m)Tc-MIBI and biochemical and hematological markers of activity of the disease. Significant statistical correlation was found between summary score (SS) of (99m)Tc-MIBI scintigrams and beta2-microglobulin (p<0.001), monoclonal immunoglobulin level MIG (p<0.001), serum thymidinekinase - sTK (p<0.001), CRP (p<0.05) and cross-linked carboxyterminal telopeptide of type I collagen - ICTP (p<0.05) bone marrow plasmocytosis-BMPc (p<0.001) and hemoglobin Hb (p<0.001). All 32 patients with MGUS had physiological activity of (99m)Tc-MIBI scintigrams. Technetium-99m methoxyisobutylisonitrile is a useful indicator of activity of MM and helps in differentiating between multiple myeloma and monoclonal gammopathy of undetermined significance.

[Magnetic resonance in examination of the spine in patients with multiple myeloma]. / Význam magnetické rezonance pri vysetrení pátere u nemocných s mnohocetným myelomem.

Multiple myeloma (MM) is a malignant disease of the haematopoietic system characterized by the formation of osteolytic foci of the skeleton with predilection of the thoracolumbar portion of the spine. The submitted investigation evaluates the importance of examination of the spine by magnetic resonance (MR), as compared with results of conventional radiology (CR). The analyzed group of 75 patients with multiple myeloma was assembled in the course of the previous four years. All patients were examined by conventional radiology and magnetic resonance and the assembled results were mutually compared. On examination by MR a pathological finding was recorded in 68/75 (91%) patients, when using CR in 41/75 (55%) patients. Compression of the vertebral bodies was assessed by means of magnetic resonance in 42/75 (56%) patients, when using CR in 37/75 (49%) patients. Secondary stenosis of the spinal canal was detected by MR in 23/75 (30%), extramedullary spread of myelomatous masses was found in 15/75 (20%) patients whereby radiographic examination was negative in these patients. Osteolytic foci in the area of the spine were recorded in 62/75 (83%) patients examined by MR, while by using CR only in 3/75 (4%). From the presented results ensues that nuclear magnetic resonance is for evaluation of spinal lesions in MM much more sensitive than conventional radiography, mainly due to the possibility of direct visualization of soft tissue tumourous masses and evaluation of their relationship to the spinal canal. The contribution of MR examination is invaluable in particular in patients with obscure back pain and a negative finding on radiographic examination of the skeleton where X-ray examination does not explain adequately the patient's complaints, as well as in patients with suspected compression of the spinal cord. In some liminal situations it contributes to more accurate assessment of the clinical stage and thus to selection of adequate treatment.

[Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos)]. / Dysplastický gangliocytom mozecku (Lhermitte-Duclos).

In a surgical specimen from a 33-year old woman with features of expansive cerebellar symptomatology, dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos) was diagnosed by histology. The lesion was characterized by typical proliferation of dysplastic neuronal elements in the cortical granular and Purkinje cell layers. Immunohistology showed focal positivity of synaptophysin in some cells, thus confirming their neuronal origin. In electron microscopy, peculiar features of ER in some of dysplastic cells was also noted. Genetic examination proved familiar incidence of Cowden's disease in several members. Chromosomal examination of the patient (karyotype 46, XX) was without abnormalities.

[Value of computed tomography in the differential diagnosis of postoperative lumbar disc herniation recurrence and fibrotic changes]. / Die wertigkeit der Computertomographie in der Differentialdiagnostik von postoperativen lumbalen Diskushernienrezidiven und Fibrösen veränderungen.

Plain computed tomography scans and after intravenous contrast enhancement were used to investigate a group of 26 patients after an operation for lumbar disc herniation with signs of failed back surgery syndrome. The diagnosis of relapsing disc herniation was established in 12 patients. It was confirmed by surgery in 10, while massive epidural fibrosis was discovered in two. Own experience with the above method, which is considered by the authors the most reliable, is presented.

[Radiological findings in pseudohypoparathyroidism]. / Radiologische Befunde beim Pseudohypoparathyreoidismus.

Clinical and radiodiagnostic changes in pseudohypoparathyroidism are described in three members of one family. Radiodiagnostic changes consist of symmetric calcifications in basal ganglia, perivascular calcifications in soft tissues, and of alterations on the skeleton--Albright's osteodystrophy. Bone changes include a combination of osteoproductive and osteomalacic alterations. All these changes were observed in both brothers, their mother had only calcifications localised in upper and lower extremities.

[Computed tomography in the diagnosis of recurrent herniated disks following prior lumbar intervertebral disk operations]. / Die Computertomographie in der Diagnostik von Diskushernienrezidiven nach vorangegangener lumbaler Bandscheibenoperation.

20 patients with recurrent symptoms following operations for disc prolapse and resistant to treatment were studied by CT, using plain and enhanced images. The results have been analysed. In 10 patients a recurrence of disc prolapse was diagnosed, and this was confirmed surgically in 8 cases. In 2 patients there was epidural scarring. The findings indicate that differential diagnosis between scarring and recurring prolapse can be accurately made by this technique.

[Late findings on computer tomography after cerebral abscess surgery]. / Pozdní nálezy po operacích abscesu mozku v obraze výpocetní tomografie.

The authors subjected 10 patients CT examination after recovery from surgery of cerebral abscesses. The shortest interval after operation was one year, the longest 20 years. In all instances a hypodense focus of varying extent was revealed, in four patients it gave the impression of a pseudocyst. In one patient the author observed a pseudocyst with an expansive effect on the lateral ventricle. Puncture produced clear, colourless fluid without signs of inflammatory changes. Extensive pathological lesions were found in particular in patients where recovery was complicated by a relapse. It was surprising that quite extensive pathological changes were found also in patients who were treated by so-called minimal surgical intervention (puncture with drainage). The authors emphasize the importance of regular postoperative check-ups by CT which make it possible to detect in time possible relapses and leads to optimal therapy before further cerebral tissue is affected.

[Ossification of the posterior longitudinal ligament in the cervical spine]. / Osifikace ligamentum longitudinale posterius v krcní páteri.

Ossification of the ligamentum longitudinale posterius is a rare disease found in particular in Japan and southeastern Asia. In the literature it is described as the so-called Japanese disease or OPLL syndrome. The disease takes a slow, frequently asymptomatic, course but may cause severe stenosis of the spinal canal with neurological disorders, OPLL occurs frequently concurrently with ankylosing spondylitis, hypertrophic spondylosis, diffuse idiopathic hyperostosis of the skeleton. Own observation: a 68-year-old man with a long history of cervicalgia, subsequently paraesthesias of the upper extremities, without a spastic atactic symptomatology of the lower extremities. An X-ray extremities, of the skeleton was made, tomograms and CT of the cervical spine. In the Cl-6 area major ossifications of the posterior longitudinal ligament were found which caused stenosis of the spinal canal of an extent of up to two thirds.

[Carotid-vertebrobasilar anastomosis]. / Karotido-vertebrobazilární anastomózy.

Anastomoses between carotid and vertebrobasilar vascular bed in extracranial region are less usual compensatory anastomoses of the brain vascular bed. They are either langer compensatory arteries--a. hypoglossica primitiva or a. proatlantica or smaller anastomoses between a. carotis externa and a. vertebralis. A precise differential diagnosis is difficult, as it requires selective catheterization of a. carotis externa, interna, a. vertebralis, or arcography. The paper demonstrates two cases. In a 75 years old man with symptoms of vertebrobasilar insufficiency there was a substantial filling of the whole vertebrobasilar vascular bed in puncture of a. carotis communis. In a 14 years old girl with coarctation of the aorta, acute hemiplegia and occlusion of a. carotis interna in supraclinoideal area there was a conspicuous abnormal filling of large veins in dorsal part of the neck and filling of the atlas loop of a. vertebralis. Selective catheterization could not be performed. The author is of the opinion that the case was an anastomosis between a. occipitalis and a. vertebralis.

Importance of spectral analysis indices for assessment of the grade of stenosis of the arteria carotis interna.

The authors evaluated the indices of Doppler power frequency spectrum analysis in 106 patients with suspected extracranial carotid occlusive disease. Blackshear, Norrving and Knox indices appeared to be most sensitive for identification of the grade of stenosis of the arteria carotis interna. Sensitivity of ultrasound examination was correlated with angiography. The highest sensitivity (90%), specificity (100%), and overal accuracy (97%) were recorded in the group of hemodynamic significances disturbances of ACI, i.e. high stenoses with occlusions. Calculation of indices of spectral analysis has been performed routinely in all non-invasive ultrasound examinations of carotid arteries by means of Echoflow method.