Katarzyna Karmelita-Katulska

Anti-leukemic treatment-induced neurotoxicity in long-term survivors of childhood acute lymphoblastic leukemia: impact of reduced central nervous system radiotherapy and intermediate- to high-dose methotrexate

Abstract The aim of the study was to evaluate the long-term neurodevelopmental consequences of currently applied acute lymphoblastic leukemia (ALL) therapy containing chemotherapy alone or combined with 12 Gy radiotherapy. Seventy-nine children aged 6.3–21.7 years diagnosed with ALL and treated according to ALL IC-BFM 2002 have been studied. The control group consisted of 23 children newly diagnosed with ALL. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between three therapeutic schemes and patients prior to treatment. Irradiated patients had smaller selected subcortical volumes than those treated with chemotherapy alone and than the controls, while the chemotherapy group had similar volumes as the control one. In neurocognitive assessment, irradiated children performed worse in major domains than the control group. There were no significant results for patients after high dose chemotherapy without radiotherapy. There was a significant relationship between full scale IQ together with verbal learning and volumes of hippocampus, amygdala, and pallidum. In all children treated for ALL, both decreased volume of selected subcortical structures and cognitive impairment were observed, especially in children who were irradiated.

The Usefulness of Magnetic Resonance Imaging of the Cardiovascular System in the Diagnostic Work-Up of Patients With Turner Syndrome

Cardiovascular defects occur in 50% of patients with Turner syndrome (TS). The aim of the study was to estimate the usefulness of cardiac magnetic resonance imaging (CMR) and magnetic resonance angiography (angio-MR) as diagnostics in children and adolescents with TS. Forty-one females with TS, aged 13.9 ± 2.2 years, were studied. CMR was performed in 39 patients and angio-MR in 36. Echocardiography was performed in all patients. The most frequent anomalies diagnosed on CMR and angio-MR were as follows: elongation of the ascending aorta (AA) and aortic arch, present in 16 patients (45.7%), a bicuspid aortic valve (BAV), present in 16 patients (41.0%), and partial anomalous pulmonary venous return (PAPVR), present in six patients (17.1%). Aortic dilatation (Z-score > 2) was mostly seen at the sinotubular junction (STJ) (15 patients; 42.8%), the AA (15 patients; 42.8%), the thoracoabdominal aorta at the level of a diaphragm (15 patients; 42.8%), and the transverse segment (14 patients; 40.0%). An aortic size index (ASI) above 2.0 cm/m2 was present in six patients (17.1%) and above 2.5 cm/m2 in three patients (8.6%). The left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) were diminished (Z-score < −2) in 10 (25.6%), 9 (23.1%), and 8 patients (20.5%), respectively. A webbed neck was correlated with the presence of vascular anomalies (p = 0.006). The age and body mass index (BMI) were correlated with the diameter of the aorta. Patients with BAV had a greater aortic diameter at the ascending aorta (AA) segment (p = 0.026) than other patients. ASI was correlated with aortic diameter and descending aortic diameter (AD/DD) ratio (p = 0.002; r = 0.49). There was a significant correlation between the right ventricular (p = 0.002, r = 0.46) and aortic diameters at the STJ segment (p = 0.0047, r = 0.48), as measured by echocardiography and CMR. Magnetic resonance can identify cardiovascular anomalies, dilatation of the aorta, pericardial fluid, and functional impairment of the ventricles not detected by echocardiography. BMI, age, BAV, and elongation of the AA influence aortic dilatation. The ASI and AD/DD ratio are important markers of aortic dilatation. The performed diagnostics did not indicate a negative influence of GH treatment on the cardiovascular system.

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

The abdominal aortic aneurysm is tenth most common cause of death in Western countries. Since maximal transverse diameter as indication for surgical interventions is often criticized, biomechanics of the aneurysm has been studied to develop new criteria for a treatment. The Finite Element Method is being utilized to predict vessel stability. Computer simulations are proven to have high accuracy of rupture risk assessment, although the impact of all incorporated factors is still not fully known. The objective of this paper is to review the most commonly used biomechanical components of computer analysis, including geometry of the vessel, mechanical properties of the wall, thrombus and calcification, their impact on rupture risk, and methods of modelling blood pressure. Comprehension and precise assessment of biomechanics of aneurysm in terms of Finite Element Analysis have high potential in clinical management of abdominal aortic aneurysm.

The Role of Computed Tomography in Monitoring Patients with Cystic Fibrosis.

Summary Cystic fibrosis is the most common lethal autosomal recessive disorder in the Caucasian population. Although the survival rate in patients constantly improves, lung damage is still the major cause of morbidity and mortality in patients with cystic fibrosis. In clinical practice, evaluation of patients’ pulmonary state is made by combination of monitoring of lung function and more directly by assessing the lung structure in imaging studies. Studies showed that computed tomography findings are more sensitive as compared to the pulmonary function tests. Computed tomography can identify a wide range of morphological abnormalities in patients with cystic fibrosis, such as bronchiectasis (which is progressive, irreversible and probably the most relevant structural change in cystic fibrosis) peribronchial thickening, mucous plugging and many other disorders that occur in the course of the disease. Computed tomography has a crucial role in the assessment of pulmonary damage over time, detecting complications and monitoring treatment effects in patients with cystic fibrosis.

Distinguishing high-flow from low-flow vascular malformations using maximum intensity projection images in dynamic magnetic resonance angiography – comparison to other MR-based techniques

Background In addition to ultrasound, magnetic resonance imaging (MRI) is considered a suitable, non-invasive technique to assess the type and extent of vascular malformations. The distinction between low- and high-flow lesions is crucial because it determines appropriate patient treatment. Purpose To distinguish high-flow from low-flow lesions on the basis of the enhancement pattern on MIP images acquired from dynamic time-resolved MR angiography (MRA) and compare it with previously described MR-based methods. Material and Methods We examined 25 consecutive patients with previously diagnosed vascular malformations. Next, each malformation was classified as “high-flow” or “low-flow” using the following criteria: (i) findings on T1-weighted (T1W) and T2-weighted (T2W) imaging (signal voids, signal intensity); (ii) the time interval between the start of arterial enhancement and the onset of lesion enhancement (artery–lesion time); (iii) the time of maximum lesion enhancement; and (iv) analysis of the slope of the enhancement curve. Results Of the 25 patients, seven had high-flow and 18 had low-flow malformations. Signal voids on spin-echo T1W images were observed only in four of seven high-flow malformations and in two of 18 low-flow malformations. Analysis of signal intensity on T2W images showed increased signal intensity in 17 of 18 low-flow malformations, and in two of seven high-flow lesions. Calculation of the artery–lesion time, maximum enhancement time, and slope revealed significant differences between the high- and low-flow groups. Conclusion In conclusion, the slope of the enhancement curve appears to be useful in distinguishing between high- and low-flow vascular malformations. Standardization of MR image evaluation criteria is essential.

Detection of myocardial edema with diffusion weighted imaging in patients with acute myocarditis

Methods We have analyzed 26 consecutive patients: 22 male, average age: 27 years (range 13-43) with clinical diagnosis of acute myocarditis. The CMR examinations were performed on a 1,5 T scanner using an eight-channel phasedarray coil combined with 4-6 elements of spinal coil. All patients underwent assessment of myocardial oedema: T2weighted triple inversion recovery (STIR), T1-weighted turbo spin echo pre and post contrast, function (cine Steady State Free Precession) and scar (Late Gadolinium Enhancement). Additionally DWI EPI sequence with b = 50 sec/mm was acquired before contrast administration. The sequence parameters were as follows: slice thickness 10 mm, repetition time (depending on patient breath cycle) 3-4 s, echo time 78 ms, bandwidth 1,736 Hz/Px. The DWI sequence was ECG-gated and synchronized to the respiratory cycle using PACE technique. For all patients T1 and T2 ratio were calculated and presence of LGE areas were reported. For STIR and DWI contrast between healthy myocardium and edema was calculated as a difference between edematous and normal myocardial muscle divided by standard deviation of image noise. Results We managed to acquired good quality DWI images in all 26 patients, average acquisition time was 120s per slice, distortion artifacts occurred in 5 patients but did not impaired diagnostic value of analyzed images. Increased signal intensity in DWI images occurred in all patients in the area of LGE enhancement and were consistent with areas of increased signal in STIR. All patients met at least two out of three criteria for inflammatory activity and injury. T2 ratio was increased (≥ 2) in 24 patients, T1 ratio (≥ 4) in 23 cases, all patients had focal non ischemic enhancement in LGE. CNR was higher in DWI than in STIR: 23,8 vs. 17,6 respectively.