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- Author or Editor: Pál Maurovich-Horvat x
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Abstract
Coronary computed tomography angiography has an emerging role in the diagnostic workup of coronary artery disease. Due to its high sensitivity and negative predictive value, coronary computed tomography angiography can rule out obstructive coronary artery diseases and substitute invasive coronary angiography in many cases. In addition, coronary computed tomography angiography provides a unique information beyond stenosis grading as it can visualize atherosclerosis and quantify its extent. Qualitative and quantitative plaque assessment provides an incremental value in the prediction of future major adverse cardiac events. Moreover, determining adverse plaque features has a potential to identify advanced atherosclerosis and patients at increased risk of acute coronary syndrome. Nevertheless, challenges may emerge with the process of quantifying coronary plaques due to limited reproducibility, lack of automated, standardized and validated techniques. Therefore, reliable quantified data are scarce due to the various computed tomography scanners and software platforms and investigations with small sample sizes. Radiomics and machine learning-based image processing methods are relatively new in the field of cardiovascular plaque imaging. These techniques hold the promise to improve diagnostic performance, reproducibility and prognostic value of computed tomography based plaque assessment.
Absztrakt:
Bevezetés: A coronaria komputertomográfiás angiográfia az egyetlen nem invazív vizsgálómódszer, amely a plakkok mennyiségéről, helyéről, illetve szerkezetéről ad információt, így alkalmas a koszorúér-betegség, illetve a fokozott rizikójú betegek azonosítására. Nagy esetszámú regiszterek létrehozásának legfőbb nehézségét a vizsgálati eredmények adatbázisba és a kórházi informatikai rendszerbe párhuzamosan történő kettős rögzítése jelenti. Célkitűzés: A coronaria komputertomográfiás vizsgálatok eredményeinek kutatásban való felhasználásához megbízható regiszter kialakítása. Módszer: Klinikai leletezéssel egy időben tudományos igényű adatrögzítést is lehetővé tevő strukturált leletezőeljáráson alapuló regisztert alakítottunk ki. Az adatbevitelt követően automatikusan hozzuk létre a nemzetközi irányelveknek megfelelő leletet. Eredmények: 2014. augusztus 1. és 2015. szeptember 1. között 2866 beteg adatát rögzítettük. A betegek 77,03%-ánál találtunk coronariaplakkot, amelynek 33,18%-a kalcifikált elváltozás. Súlyos fokú szűkülettel 13,71%-uk rendelkezett. Következtetések: A strukturált leletezés használata növeli az adatbevitel sebességét, kiiktatja a kettős adatbevitelt és csökkenti a hibalehetőségek számát. További célunk egy országos rendszer, az Országos Plakk Regiszter és Adatbázis létrehozása. Orv. Hetil., 2017, 158(3), 106–110.
Onkológiai beteg tervezett PET/CT vizsgálata során véletlenszerűen felfedezett COVID–19-betegség.
(A COVID–19-pandémia orvosszakmai kérdései)
Oncologic patient with COVID-19 discovered incidentally by PET/CT examination
Absztrakt:
A koronavírus-betegség 2019 (COVID–19) szakmai irodalma meglehetős gyorsasággal bővül. Adatok jelzik, hogy sokszor nagy az ellentmondás egy-egy beteg esetében a klinikai kép és a radiológiai lelet súlyossága között. Esetismertetésünk egy tünetszegény beteg viszonylag súlyosabb radiológiai leleteit részletezi. Az onkológiai alapbetegségben szenvedő, 75 éves nőbetegnél a tervezett, onkológiai indikációval végzett F18-fluoro-dezoxi-glükóz pozitronemissziós tomográfia/komputertomográfia vizsgálat során a tüdőkben incidentálisan COVID–19-re utaló radiomorfológiai jeleket azonosítottunk. Azonnali izolációt követően a beteget a megfelelő osztályra helyeztük át, ahol a további vizsgálatok megerősítették a COVID–19 kórisméjét. Esetünk arra hívja fel a figyelmet, hogy járványügyi veszélyhelyzet idején az esendő betegek (magas életkorú, onkológiai betegségben szenvedők) tervezett képalkotó vizsgálata során az elkészült mellkas-CT azonnali kiértékelésének nagy a jelentősége, mert így időben azonosíthatunk a COVID–19 esetleges jelenlétére utaló radiomorfológiai eltéréseket, amelyek alapvetően meghatározzák az aktuális további teendőket. Orv Hetil. 2020; 161(23): 971–976.
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease lacking a definite etiology, characterized by the nonspecific symptoms of dyspnea and dry cough. Due to its poor prognosis, imaging techniques play an essential role in diagnosing and managing IPF. High resolution computed tomography (HRCT) has been shown to be the most sensitive modality for the diagnosis of pulmonary fibrosis. It is the primary imaging modality used for the assessment and follow-up of patients with IPF. Other not commonly used imaging methods are under research, such as ultrasound, magnetic resonance imaging and positron emission tomography-computed tomography are alternative imaging techniques. This literature review aims to provide a brief overview of the imaging of IPF-related alterations.
Abstract
In recent years, coronary computed tomography angiography (CCTA) has emerged as an accurate and safe non-invasive imaging modality in terms of detecting and excluding coronary artery disease (CAD). In the latest European Society of Cardiology Guidelines CCTA received Class I recommendation for the evaluation of patients with stable chest pain with low to intermediate clinical likelihood of CAD. Despite its high negative predictive value, the diagnostic performance of CCTA is limited by the relatively low specificity, especially in patients with heavily calcified lesions. The discrepancy between the degree of stenosis and ischemia is well established based on both invasive and non-invasive tests. The rapid evolution of computational flow dynamics has allowed the simulation of CCTA derived fractional flow reserve (FFR-CT), which improves specificity by combining anatomic and functional information regarding coronary atherosclerosis. FFR-CT has been extensively validated against invasively measured FFR as the reference standard. Due to recent technological advancements FFR-CT values can also be calculated locally, without offsite processing. Wall shear stress (WSS) and axial plaque stress (APS) are additional key hemodynamic elements of atherosclerotic plaque characteristics, which can also be measured using CCTA images. Current evidence suggests that WSS and APS are important hemodynamic features of adverse coronary plaques. CCTA based hemodynamic calculations could therefore improve prognostication and the management of patients with stable CAD.
Abstract
Gastroparesis, a form of gastrointestinal dysfunction and the increased risk for aspiration pneumonia are well known complications in patients with Parkinson’s disease. In our case report we demonstrate the case of an 83-year-old, bedridden male patient with Parkinson’s disease, who had a slowly progressing stomach dilation, gradually pushing the otherwise normal liver to a highly unusual craniodorsally rotated position.
Abstract
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary vascular disorder inherited in an autosomal dominant manner. MRI plays a crucial role in the diagnosis and follow-up of patients. Characteristic MRI lesions include symmetric and bilateral white matter periventricular hyperintensities, lacunar infarcts and cerebral microbleeds. In our case report, we demonstrate a male patient with genetically confirmed CADASIL syndrome and the progression of symptoms with corresponding imaging findings throughout the years.
A spontán intracranialis hypotensio diagnosztikája mágneses rezonanciás képalkotással
Evaluation and diagnosis of spontaneous intracranial hypotension with magnetic resonance imaging
Összefoglaló. A klasszikus esetben ortosztatikus fejfájást okozó, spontán intracranialis hypotensiót az esetek túlnyomó többségében a gerinccsatornában, annak nyaki-háti átmenetében, illetve a háti szakaszán található liquorszivárgás okozza. Meglévő kötőszöveti betegség, degeneratív gerincbetegségek, illetve kisebb traumák szerepet játszhatnak a szivárgás kialakulásában. Az ortosztatikus fejfájás létrejöttében szerepet játszhat a meningealis szerkezetek, érzőidegek és hídvénák vongálódása. A klasszikus pozicionális, ortosztatikus fejfájásban szenvedő betegek körében gondolni kell a spontán intracranialis hypotensio lehetőségére, és az agykoponya, illetve a gerinc kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt. A kontrasztanyaggal végzett koponya-MRI-vel klasszikus esetben diffúz, nem nodularis, intenzív, vaskos pachymeningealis kontrasztanyag-halmozás, kitágult vénássinus-rendszer, subduralis effusiók és az agytörzs caudalis diszlokációja („slumping”) látható. Fontos azonban szem előtt tartani, hogy az esetek 20%-ában ezen eltérések nem detektálhatók. Jó minőségű, randomizált, kontrollált vizsgálatok nem történtek, a kezelés hagyományokon alapul. Kezdetben általában konzervatív terápiát alkalmaznak (ágynyugalom, koffein- és folyadékbevitel), ennek hatástalansága esetén epiduralis sajátvér-injekció, epiduralis fibrinragasztó-injektálás, illetve sebészi terápia jöhet szóba. Orv Hetil. 2021; 162(7): 246–251.
Summary. Spontaneous intracranial hypotension, the classic feature of which is orthostatic headache, is most commonly caused by a cerebrospinal fluid leakage at the level of the spinal canal, in most cases at the thoracic level or cervicothoracic junction. Underlying connective tissue disorders, minor trauma, degenerative spinal diseases may play a role in the development of cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal structures, particularly sensory nerves and bridging veins, may play a role in the development of orthostatic headache. In the case of patients with classic orthostatic headache, the possibility of spontaneous intracranial hypotension should be considered, and if suspected, brain magnetic resonance imaging (MRI) with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular, intense, thick dural enhancement, subdural effusions, engorgement of cerebral venous sinuses, sagging of the brain are typical features on brain MRI, which, however, remain normal in up to 20 percent of patients with spontaneous intracranial hypotension. Unfortunately, no randomized clinical trials have evaluated the effectiveness of the various treatment strategies and no definitive treatment protocols have been established. In clinical practice, the first-line treatment of spontaneous intracranial hypotension is conservative (bed rest, caffeine and fluid intake). If conservative therapy is not effective, epidural blood patch, epidural fibrin glue, or surgical repair should be considered. Orv Hetil. 2021; 162(7): 246–251.
Abstract
Background and aim
To assess the prevalence of incidental extracardiac findings in patients who underwent cardiac CT for the evaluation of left atrial (LA) anatomy before atrial fibrillation (AF) catheter ablation. We also aimed to determine the independent predictors of relevant extracardiac alterations.
Patients and methods
We studied consecutive patients who underwent cardiac CT with a 256-slice scanner for the visualization of LA anatomy before AF ablation. Prevalence of clinically significant and not significant extracardiac findings were recorded. Moreover, we determined the variables associated with relevant extracardiac alterations with uni- and multivariate logistic regression analyses.
Results
In total, 1,952 consecutive patients who underwent cardiac CT examination between 2010 and 2020 were included in our study (mean age 61.2 ± 10.6 years; 66.2% male). Incidental extracardiac findings were detected in 820 (42.0%; 95%CI = 0.40–0.44%) patients, while clinically significant alterations were reported in 416 (21.3%; 95%CI = 20.0–23.2%) patients. When analyzing the predictors of clinically relevant alterations, age (OR = 1.04; 95%CI = 1.03–1.05), male sex (OR = 1.39; 95%CI = 1.12–1.73), chest pain (OR = 1.46; 95%CI = 1.09–1.93), hypertension (OR = 1.42; 95%CI = 1.12–1.81), heart failure (OR = 1.68; 95%CI = 1.09–2.53), obstructive CAD (OR = 1.56; 95%CI = 1.16–2.09) and prior stroke/TIA (OR = 1.56; 95%CI = 1.04–2.30) showed association with clinically significant incidental findings in the univariate analysis (all P < 0.05). In the multivariate analysis, age (OR = 1.04; 95%CI = 1.02–1.06; P < 0.001) proved to be the only significant predictor of clinically relevant extracardiac finding.
Conclusion
Cardiac CT performed before AF ablation is not only helpful in understanding LA anatomy, but might also identify clinically significant pathologies. These incidental findings might have further diagnostic or therapeutic consequences.
Abstract
Background and aims
Non-alcoholic fatty liver disease (NAFLD) increases cardiovascular morbidity and mortality, and carries poor long-term hepatic prognosis. Data about the role of genetic and environmental factors in the hepatic lipid accumulation are limited. The aim of the study was to evaluate the genetic and environmental impact on the hepatic lipid accumulation within a cohort of adult twin pairs.
Patients and methods
We investigated 182 twin subjects [monozygotic (MZ, n = 114) and dizygotic (DZ, n = 68) same-gender twins (age 56.0 ± 9.6 years; BMI 27.5 ± 5.0 kg/m2; females 65.9%)] who underwent computed tomography (CT) with a 256-slice scanner. Using non-enhanced CT-images, we calculated the average value of hepatic attenuation [expressed in Hounsfield unit (HU)] suggesting hepatic lipid content. Crude data were adjusted to age, sex, BMI and HbA1c values. Intra-pair correlations were established, and structural equation models were used for quantifying the contribution of additive genetic (A), common environmental (C) and unique environmental (E) components to the investigated phenotype.
Results
The study cohort represented a moderately overweight, middle-aged Caucasian population. There was no significant difference between MZ and DZ twin subjects regarding hepatic CT-attenuation (57.9 ± 12.6 HU and 59.3 ± 11.7 HU, respectively; p = 0.747). Age, sex, BMI and HbA1c adjusted co-twin correlations between the siblings showed that MZ twins have stronger correlations of HU values than DZ twins (rMZ = 0.592, p < 0.001; rDZ = 0.047, p = 0.690, respectively). Using the structural equation model, a moderate additive genetic dependence (A: 38%, 95% CI 15–58%) and a greater unique environmental influence (E: 62%, 95% CI 42–85%) was found. Common environmental influence was not identified (C: 0%).
Conclusion
The results of our classical CT-based twin study revealed moderate genetic and greater environmental influences on the phenotypic appearance of hepatic steatosis, commonly referred to as NAFLD. Favorable changes of modifiable environmental factors are of great importance in preventing or treating NAFLD.
