A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance.

BACKGROUND: The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population. MATERIALS AND METHODS: The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes. RESULTS: The average size of both sphenoid sinus ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinus ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm). CONCLUSIONS: Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation.

BACKGROUND: Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, a single sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant. MATERIALS AND METHODS: Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender. RESULTS: In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498). CONCLUSIONS: Both agenesis of the sphenoid sinuses and a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.

Analysis of corpus callosum size depending on age and sex.

BACKGROUND: The aim of the study was to analyse changes in the size of the corpus callosum (CC) depending on age and sex and to establish the reference values of the morphometric indices of the CC in the Polish population. MATERIALS AND METHODS: The results of magnetic resonance studies of 1108 patients performed in the years 2010-2014 were analysed. Two independent radiologists evaluated cerebral images to exclude deviations from normal state. In patients divided according to sex and to 10 age groups, measurements of CC and brain dimensions were made and morphometric indices were calculated. RESULTS: The results of measurements related to the following parameters: lengths of longitudinal cross-section of CC (CD), CC thickness in the narrowest place - isthmus (EF), the largest linear dimension of the brain from the frontal pole to the occipital pole (AB), the longitudinal cross-section area of the CC (A1) and cerebral cross-section area (A2) as well as CD/AB and A1/A2 ratios are summarised in 7 figures and 3 tables. CONCLUSIONS: It was demonstrated, that in all age groups there are statistically significant differences in the values of the analysed parameters and ratios of CC size. It was indicated, that there are no statistically significant differences between men and women in the CD, EF, and A1 parameters related to CC size, and the profiles of variations of these parameters are very similar. It was proved that the- re are statistical differences between women and men in parameters/indicators concerning of the brain size.

Quantification of image contrast of infarcts on computed tomography scans.

Introduction Accurate identification of infarcts in non-contrast computed tomography (NC-CT) scans of the brain is fundamental in the diagnosis and management of patients with stroke. Quantification of image contrast properties at the boundaries of ischemic infarct regions in NC-CT can contribute to a more precise manual or automatic delineation of these regions. Here we explore these properties quantitatively. Methods We retrospectively investigated 519 NC-CT studies of 425 patients with clinically confirmed ischemic strokes. The average and standard deviation (SD) of patients' age was 67.5 ± 12.4 years and the average(median)±SD time from symptoms onset to NC-CT examination was 27.4(12)±35.7 h. For every scan with an ischemic lesion identified by experts, the image contrast of the lesion vs. normal surrounding parenchyma was calculated as a difference of mean Hounsfield Unit (HU) of 1-5 consecutive voxels (the contrast window width) belonging to the lesion and to the parenchyma. This contrast was calculated at each single voxel of ischemic lesion boundaries (previously delineated by the experts) in horizontal and vertical directions in each image. The distributions of obtained horizontal, vertical and both contrasts combined were calculated among all 519 NC-CTs. Results The highest applicative contrast window width was identified as 5 voxels. The ischemic infarcts were found to be characterized by 6.60 HU, 8.28 HU and 7.55 HU mean values for distributions of horizontal, vertical and combined contrasts. Approximately 40-50% of the infarct boundary voxels were found to refer to the image contrast below 5 HU. Conclusion Low image contrast of ischemic lesions prevents accurate delineation of the infarcts in NC-CT.

The influence of the menstrual cycle on the result of brain examination with hydrogen magnetic resonance spectroscopy - a pilot study.

BACKGROUND AND PURPOSE: Hydrogen magnetic resonance spectroscopy (1HMRS) is nowadays one of the basic tools for noninvasive brain metabolism assessment. The study focuses on the important problem of the influence of hormone fluctuation during the menstrual cycle on brain metabolism, assessed by 1HMRS for clinical diagnostics. MATERIAL AND METHODS: In 11 healthy regularly menstruating women, 1HMRS was performed at the start (phase I), in the middle (phase II) and at the end (phase III) of the menstrual cycle. The relative concentration ratios of 12 brain metabolites in every woman in all cycle phases were examined, in 6 different volumes of interest (VOIs). Finally, statistically significant differences in relative metabolite ratios between the phases examined in given locations were sought. RESULTS: Statistically significant relations between menstrual cycle phases and relative ratios of 4 metabolites - Lac/Cr, NAA/Cr, Glx1/Cr and Glx2/Cr - in different brain locations were found. In all locations, mean NAA/Cr ratios were greater in phase I compared to the other phases. A similar relationship was found for Glx1/Cr ratio in one location (left occipital lobe). For Lac/Cr and Glx2/Cr ratios, a higher mean ratio value was obtained in phase II compared to phases I and III in the right occipital lobe and left basal ganglia, respectively. CONCLUSIONS: Menstrual cycle phase should be considered in planning a date and interpretation of 1HMRS examination, performed for the verification of a disease manifesting as brain metabolite disturbances in the 1HMRS spectrum.

Individually Fitted Hearing Aid Device Manufactured Using Rapid Prototyping Based on Ear CT. A Case Report.

Rapid prototyping is the technology of automatic freeform fabrication of physical objects from virtual CAD (computer aided design) models. For medical objects the models may be created using data from CT, MR or rotational angiography. We descriobe the case of a 83-year-old woman with essential bilateral hearing impairment as the effect of chronic otitis media. An individually fitted hearing aid was produced for the patient using stereolithography technology and vacuum casting based on data obtained during ear CT. Rapid prototyping may help in manufacturing individually adjusted biomedical prostheses, reducing the time of device production and improving its fitting.

MR CSF Flow Examination as a Non-Invasive Method of Determining Shunt-Independent Hydrocephalus in Children with Implanted Ventriculoperitoneal Shunt. Preliminary Results.

UNLABELLED: The study discusses the value of MR examination of CSF flow through the cranial part of the ventriculoperitoneal shunt in the evaluation of shunt-dependent hydrocephalus. Sixteen patients aged eight to 18 years were examined in the course of many years of treatment using the ventriculoperitoneal shunt. No clinical manifestations of shunt obstruction had been observed in any of the patients prior to MR examination. A Signa Horizon 1.5T (GEMS) unit was used. Axial and sagittal T1- and T2-weighted images were performed to find the ventriculoperitoneal shunt canal. A 2D CINE/GR/PC sequence was performed in the plane perpendicular to the shunt canal. CSF-flow was calculated by the Flow Analysis program. Patients were divided into two groups: 1) no CSF-flow was noted in five children indicating shunt-independent hydrocephalus; 2) CSF-flow was present (average flow volume from 0.1 to 1.9 ml/min) in 11 children, distinguishing the group with shunt-dependent hydrocephalus. CONCLUSIONS: 1) MR CSF flow examination will establish the absence or presence of CSF flow and determine its direction and velocity. 2) With no clinical manifestations of shunt impatency the absence of flow in the shunt canal found in MR CSF flow examination may indicate shunt-independent hydrocephalus. 3) When the CSF flow in the shunt is found in MR shunt-dependent hydrocephalus is diagnosed.

MR Diffusion Anisotropy Imaging of Spinal Cord Mechanical Compression and Injury on the Rat Model. In Vivo.

The aim of this study was the application of magnetic resonance diffusion anisotropy imaging (MR DAI) for assessment of spinal cord compression (SCC) and injury (SCI) in rats depending on the time course from the moment of injury. Twenty rats were used, divided into three groups (five with no surgical operation, five with laminectomy only and ten with SCI produced using a dynamic weight - drop model). MR DAI was performed four times (1, 24, 48 and 168 hours after surgery) at 4.7 T with diffusion gradients applied parallel and perpendicular to the spine. Diffusion parameters (lADC, tADC and AI) were calculated for defined regions of white and gray matter. Epidural hematoma which appeared after laminectomy compressed spinal cord and caused a decrease of apparent diffusion coefficient (ADC) values in GM and WM. SCI in WM produced a decrease of lADC and increase in tADC. In GM an increase in both lADC and tADC values after SCI was observed. MR DAI will disclose dynamic changes in water diffusion during the first days after spinal cord contusion.

The unique case of adrenocortical malignant and functioning oncocytic tumour.

UNLABELLED: Adrenocortical oncocytoma is extremely rarely found. Only a little more than thirty cases of adrenal oncocytoma, mainly nonfunctioning and benign, have been reported in the literature. Adrenal mass 150 x 160 x 172 mm in size and enlarged periarterial lymph nodes were found in CT examination performed in 51-year-old male. Main complaints: weight loss, general asthenia and abdominal pain. PHYSICAL EXAMINATION: elevated blood pressure (180/120 mmHg), no features typical of Cushing's syndrome. Abnormal laboratory findings: oral glucose tolerance test revealed diabetes, elevated serum dehydroepiandrosterone-sulfate (1101.9 microg/dl; normal, 59-452), elevated serum cortisol following overnight 1 mg dexamethasone test (5.1 microg/dl; normal, <1.8), increased urinary excretion of 17- hydroxycorticosteroids (18.1 mg/24 h; normal, 2.0-7.0) with pathological response to high-dose dexamethason test (16.6 mg/24). On laparotomy, the lesion was considered unresectable because of evident - confirmed by intraoperative ultrasound - tumour infiltration of the inferior caval vein. The large biopsy specimen was obtained for histological examination in which tumour fulfilled criteria proposed by Bisceglia et al. for adrenocortical oncocytic borderline tumour. On immunohistochemistry, the lesion showed cytoplasmic reaction for cytokeratin, vimentin and synaptophysin. The presented case appears to be the first malignant and functioning adrenocortical oncocytic tumour reported and confirms the complexity of its biology.

MRI disturbances caused by dental materials.

Dental materials are common sources of artifacts during brain MRI studies. The aim of the present study was to estimate the degree of image disturbance caused by dental materials during an MRI examination, and the risk of ferromagnetic materials being dislocated in the magnetic field. MR sequences where dental materials containing metals produced the smallest artifacts was also calculated. Thirty-five dental material samples containing metals were examined using the 1.5 T MR system. They consisted of the most commonly used dental restorations and root-canal instruments left in the oral cavity for iatrogenic reasons. Additionally, cubes (10×5×5 mm) and balls (10 mm diameter) were cast from commonly used dental alloys. No dislocation of the examined samples in the gelatin medium was observed. All the materials were found to produce artifacts characterised by similar images. The study showed that the presence of distant artifacts, besides those located in the area immediately surrounding the object, depends on the shape of the given material. The size of artifacts generated by the most commonly used fixed restorations was graded. The sequences in which artifacts were least pronounced were selected. No dislocation of samples in the 1.5 T field was observed during the examination. However they produced artifacts; the typical image of an artifact - a signal void zone surrounded by a hyperintensive rim. Alloys consisting of Ag-Pd, dental gold and amalgam distorted the MR image to the least degree. In the case of a routine spin echo (SE) sequence examination the smallest artifacts were generated in the FSE T2 and PD sequences.

The value of modern ultrasonographic techniques and computed tomography in detecting and staging of pancreatic carcinoma.

OBJECTIVE: to assess the clinical value of ultrasonographic methods and computed tomography in diagnosing and staging pancreatic carcinoma. METHODS: prospective clinical trial of 140 patients (64 women and 77 men; mean age 59,6) operated on for pancreatic carcinoma between 2000 and 2004. In each case helical CT, routine-, color- and power Doppler and 3-D USG were performed to detect and stage cancer. Analyses of accuracy, sensitivity, specificity, PPV and NPV of ultrasonographic methods and CT were made. RESULTS: 3-D USG showed the best accuracy of local staging (T): 95.6%. CT was the most accurate in lymph node assessment: 91.3%. The accuracy of CT, 3-D USG and power-Doppler at detecting vascular infiltration was 93.1%. CONCLUSIONS: diagnostic accuracy of modern ultrasound techniques is comparable to helical CT in detecting and staging pancreatic carcinoma. USG is recommended due to the relatively low cost, non-invasiveness and availability of the procedure.

History of Polish gastrointestinal radiology.

As early as several days after the publication of the information concerning Roentgen's discovery the first radiological examinations were performed in Poland. The new method was immediately introduced into medical practice, including gastroenterology. In that pioneer period the most important works were those by Walery Jaworski who was the first man in the world to perform an X-ray of gall stones as well as the stomach with the use of a contrast medium. In its more-than-a-hundred-year history Polish gastrointestinal radiology has attempted not only to catch up with the world science, but it also has made a considerable contribution to its development.

[Severe carbon monoxide poisoning: different clinical course--the same source of exposure]. / Ciezkie zatrucie tlenkiem wegla: rózny przebieg kliniczny--to samo zródlo narazenia.

The different course of acute carbon monoxide poisoning in two young people exposed to the same Carbon monoxide source are reported in the study. The pulmonary edema was diagnosed in the man, but not in the woman. The brain morphological changes revealed by MRI were significantly marked in the women compared to the intoxicated man. MRI detected the brain changes invisible in CT scans and seems be more useful for evaluation CNS abnormalities. The neuropsychological examination, of the brain functional changes is also necessary for proper evaluation of the CNS damage.

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer]. / Wideorentgenokinematograficzna ocena zaburzen fazy gardlowej aktu polykania u chorych po operacjach czesciowego usuniecia krtani z powodu raka o lokalizacji nadglosniowej.

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

[The efficacy of non-pharmacological intervention in obese patients with newly diagnosed diabetes mellitus type II]. / Skutecznosc interwencji niefarmakologicznej u chorych z nowo rozpoznana cukrzyca typu 2 i towarzyszaca otyloscia.

In Poland like in other countries we observe an increasing number of diabetes mellitus cases with about half of the patients in whom the disease remains undiagnosed. Therefore it seems necessary to improve early diagnoses and prevention of the disease. The aim of the study was to assess the efficiency of a 3-month non-pharmacological intervention based on diet and increased physical activity in patients with newly diagnosed diabetes type 2 (diagnosis based on oral glucose tolerance test (OGTT), WHO 1999). We investigated 37 newly diagnosed diabetic type 2 patients, 16 men (aged 52.4 +/- 5.4) and 21 women (aged 51.0 +/- 5.7). Anthropometric and biochemical measurements were performed before and after intervention. Two-kilometres Walking Test with an intermediate estimation of VO2max and fitness index (FI) was performed before and after intervention. Total abdominal fat volume (measured from diaphragm to pubis): visceral fat volume (VFV) and subcutaneous fat volume (SFV) (mm3) were assessed according to the standard protocol of NMR abdominal examination. Patients completed 12 weeks of supervised intervention focused on weight reduction, increase of physical activity, changes of nutritional habits. Students t-test, Mann-Whitney test and Spearman's correlation were used for statistical analysis. In women the average weight reduction was 4.7 kg (5.8% of initial body weight), whereas in men 5.9 kg (5.9% of initial body weight). In women VO2 max increased from 23.7 +/- 6.4 to 24.9 +/- 4.8 (ns), and fitness index increased from 78.7 +/- 11.7 to 83 +/- 14.7 (ns). In men VO2 max increased from 22.5 +/- 6.7 to 26.6 +/- 8.6 (ns) and fitness index increased from 55.1 +/- 12.5 to 64.8 +/- 13.7 (p < 0.05). In women the level of fasting glycaemia decreased from 6.47 +/- 1.2 to 4.84 mmol/l +/- 0.6 (p < 0.01) and the level of glycaemia at 120 minutes of OGTT decreased from 13.2 +/- 2.5 to 6.76 +/- 2.7 mmol/l (p < 0.01). The decrease of plasma glucose was accompanied by the decrease of fasting insulin from 19.2 +/- 15.5 to 8.53 +/- 93.2 uj/ml (p < 0.01) and in 120 minutes of OGTT from 148.8 +/- 86.2 to 58.4 +/- 41.0 uj/ml (p < 0.01). In men the level of fasting glycaemia decreased from 8.63 +/- 2.0 to 7.07 mmol/l +/- 2.4 (p < 0.05) and the level of glycaemia at 120 minutes of OGTT decreased from 15.76 +/- 3.2 do 9.3 +/- 5.7 mmol/l (p < 0.01). The decrease of plasma glucose was accompanied by the decrease of fasting insulin from 21.99 +/- 12.6 to 10.1 (3.8 uj/ml (p < 0.05) and at 120 minutes of DGTT from 81.5 +/- 52.7 do 41.6 +/- 21.0 uj/ml (p < 0.05). After the intervention 45% of the patients (57% of women and 31% of men) were non-diabetic (correct OGTT). In men visceral fat volume (VFV) was greater than in women (7642.6 +/- 1774.6 and 4789.9 +/- 1242.0 mm3 respectively (p < 0.01). Subcutaneous fat volume (SFV) was smaller in men than in women (7116.5 +/- 2048.5), in men and 10533.9 +/- 3478.3 respectively (p < 0.01). In women and men a strong (p < 0.01) correlation between waist circumference and visceral fat volume (VFV) (r = 0.573 (p < 0.01) and r = 0.833 (p < 0.01) respectively) and subcutaneous fat volume (SFV) (r = 0.900 (p < 0.01) and r = 0.790 (p < 0.01) respectively) was found. The results of the study confirm that in newly diagnosed diabetic type 2 patients body weight reduction and increased physical activity result in the improvement of biochemical indices. In about one half of patients the early phase of the disease might be reversible due to weight reduction and increased physical activity. The non-pharmacological intervention should be the first intervention undertaken in newly diagnosed diabetic type 2 patients.

[Comparison of the clinical usefulness of magnetic resonance (MR), computer tomography )CT) and radiculography (R) in diagnosing lumbar discopathy]. / Porównanie uzytecznosci klinicznej rezonansu magnetycznego (RM), tomografii komputerowej (TK) i radikulografii (R) w rozpoznawaniu dyskopatii ledzwiowej.

The aim of the study was an assessment of the usefulness of magnetic resonance imaging (MRI), computed tomography (CT), and radiculography (R) in the diagnosis of lumbar discopathy. The accuracy of MRI, CT, and R for the diagnosis of lumbar herniated nucleus pulposus ws compared prospectively in 120 patients, undergoing surgical exploration. MRI was the most accurate test (100%) compared with CT (95%) and R (92.5%). The false positive rate was lowest for MRI (0%), followed by CT (5%) and R (7.5%). MRI proves very favorable compared with other currently available imaging modalities for diagnosis of lumbar herniated nucleus pulposus which allows to differentiate hernia and protrusion. MRI is noninvasive, has no known side effects and no radiation exposure. It is the procedure of choice for the radio-diagnosis of lumbar disc herniations.

[Prognostic significance of early CT changes in ischemic stroke patients]. / Prognostyczne znaczenie wczesnych zmian w tomografii komputerowej glowy u chorych z udarem niedokrwiennym mózgu.

The aim of the study was to establish the prognostic value of early CT findings in predicting the 30-day mortality after stroke, to assess the prevalence of these findings in acute stroke patients, and to examine the correlation between these findings and the clinical status. 134 patients (mean age 67.5 +/- 12.1) with supratentorial ischaemic stroke and CT performed within 12 hours from onset of the symptoms were included into the study. The neurological deficit and consciousness disturbances were assessed by means of Scandinavian Stroke Scale. The 30-day mortality was registered. CT findings were found in 84 (63.7%) patients, including hypodense lesions in 74 (55.5%), mass effect in 55 (41.0%) and hyperdense middle cerebral artery sign in 5 (3.7%) cases. Patients with mass effect had greater neurological deficit on admission (p < 0.0001), more frequently developed disorders consciousness (p = 0.001) and had greater 30-day mortality (p < 0.0001). Patients with hypodense lesions of at least two types presented with greater neurological deficit observed on the second day of hospitalization (p < 0.05) and had also greater 30-day mortality (p = 0.01). On multivariate analysis mass effect seen in early CT, as well as older age and greater neurological deficit appeared to be independent predictors of 30-day mortality.

[Optimizing computed tomography diagnosis in retrobulbar orbit tumors]. / Optymalizacja diagnostyki tomografia komputerowa pozagalkowych guzów oczodolu.

CT is still one of the most commonly applied diagnostic procedure in cases of suspected neoplastic lesions in the retrobulbar region. Orbit tumors are rare, however due to their localisation close to the organ of sight, they make a serious clinical problem. The authors analysed retrospectively 127 tumors (interview, ophthalmological examination, CT, surgical procedure, histopathologic findings) with the aim of improving CT diagnostics.

[Computed tomography images of selected retrobulbar orbit tumors]. / Obrazy tomografii komputerowej wybranych, pierwotnych guzów pozagalkowych oczodolu.

Accurate evaluation of the retrobulbar orbit tumors and obtaining similar radiologic and histopathologic diagnosis are the most important for the therapeutic management. The authors analysed a group of 124 patients undergoing orbital CT exams and subsequently surgical procedure. They differentiated and described typical CT images of cavernous angioma, malignant lymphoma, optic glioma and dermoid cyst of orbit in correlation with the clinical data.

[Videorentgenocinematographic analysis of pharyngeal phase in the act of swallowing]. / Badania wideorentgenokinematograficzne fazy gardlowej aktu polykania.

The course of the pharyngeal phase was analysed in physiological conditions. The mobility of anatomical structures taking part in the phase was evaluated, taking into consideration the time sequence in which the elements of the phase followed. To objectify the evaluation of the analysed phenomena, authors of this paper proposed and used linear and time parameters also used by other authors involved with these issues.