Mateusz Patyk

Airway Evaluation with Multidetector Computed Tomography Post-Processing Methods in Asthmatic Patients

Asthma is a chronic inflammatory obstructive airways disease. The disease occurs regardless of age and manifests with cough, attacks of breathlessness, and tightness in the chest. The pathophysiology of asthma is complex and still not fully understood. It is essential to find answers concerning the role of each part of the bronchial tree in asthma, especially the role of small bronchioles. With the development of newer generations of multidetector computed tomography (MDCT) and advanced post-processing methods it is possible to obtain more detailed images and gain insight into further aspects of asthma. MDCT post-processing methods can be divided into two-dimensional (2D) and three-dimensional (3D). In 2D projections, visualized hypodense regions correspond to the airway flow limitations. With the more advanced methods, such as multi planar reconstructions (MPR), images in different planes (axial, coronal, or sagittal) can be created. In the MPR technique only the voxels which are adjacent to each other in the predetermined plane can be extracted from the data set. Using the minimal/maximal intensity projections and shaded surface display, the volume of interest (VOI) can be extracted. High resolution CT scans can be used to create a more advanced imaging tool - the virtual bronchoscopy (VB). Using the VB makes it possible to visualize regions of obturation in the bronchi of up to the 5-8th generation. The MDCT with advanced post-processing methods is likely to assume an important role in the differential diagnosis of asthma, particularly when the diagnosis is dubious or hard to settle due to accompanying other lung diseases.

Lung Function in Patients with Gastro-Esophageal Reflux Disease and Respiratory Symptoms

The aim of this study was to investigate lung function in patients with gastro-esophageal reflux disease (GERD) who present respiratory symptoms suggestive of the possibility of co-morbid asthma. The study encompassed 20 patients (9 women and 11 men; age range from 11 to 68 years) diagnosed with GERD and presenting with chronic cough and other non-specific periodic respiratory complaints. The control group consisted of closely gender and age-matched 20 subjects without any gastrointestinal or respiratory symptoms. All patients and control subjects were tested for lung function, which encompassed spirometric and flow-volume variables. We found that none of the GERD patients had lung function abnormalities characteristic of asthma. There were, however, decreases in forced expired volume in 1 s, forced vital capacity, and in maximal instantaneous forced expiratory flows in the GERD patients compared with the healthy subjects. We conclude that cough accompanying GERD is unlikely to be associated with the presence of co-morbid asthma, but rather suggests a mild airway inflammation developing as a sequel of GERD. The corollary is that chronic cough should prompt physicians attention to consider diagnostic work-up toward the possibility of GERD.

Radiomics – the value of the numbers in present and future radiology

Radiomics is a new concept that has been functioning in medicine for only a few years. This idea, created recently, relies on processing innumerable quantities of metadata acquired from every examination, followed by extraction thereof from relevant imaging examinations, such as computer tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) images, by means of appropriate created algorithms. The extracted results have great potential and broad possibilities of application. Thanks to these we can verify efficiency of treatment, predict locations of metastases of tumours, correlate results with histopathological examinations, or define the type of cancer more precisely. In effect, we obtain more personalised treatment for each patient, which is extremely important and highly recommendable in the tests and applicable treatment therapies conducted nowadays. Radiomics is a non-invasive and high efficiency post-processing method. This article is intended to explain the idea of radiomics, the mechanisms of data acquisition, existing possibilities, and the challenges incurred by radiologists and physicians at the stage of making diagnosis or conducting treatment.

Application of the apparent diffusion coefficient in magnetic resonance imaging in an assessment of the early response to treatment in Hodgkin's and non-Hodgkin's lymphoma : pilot study

Purpose Lymphoproliferative neoplasms are the largest and most frequently diagnosed entities in the group of haematological malignancies. The aim of the study was to assess whether apparent diffusion coefficient (ADC) measured on the first day of the second cycle of chemotherapy could be a predictor of prognosis and of the final treatment’s outcome. Material and methods The study included 27 patients with diagnosed Hodgkin’s and non-Hodgkin’s lymphoma, who had magnetic resonance (MR) performed with diffusion weighted imaging/apparent diffusion coefficient (DWI/ADC) before and on the first day of the second cycle of chemotherapy. Imaging was performed using a 1.5 T MR scanner. ADC was measured in lymphoma infiltration in the area of the lowest signal in the ADC map and the highest signal on β 800 images in post-treatment study. After that, the corresponding area was determined in a pre-treatment study and an ADC value was measured. Results The difference between ADC values in pre-treatment (ADC = 720 mm2/s) and post-treatment (ADC = 1059 mm2/s) studies was statistically significant (p < 0.001). Cutoff values for estimating response to treatment were established at the level of ADC 1080 mm2/s, and ADC to muscle ratio at 0.82 in post-treatment study. Patients with ADC > 752 mm2/s before treatment manifested lower probability of progression than patients with ADC < 752 mm2/s. Conclusions ADC measurement’s before treatment and on the first day of the second cycle of chemotherapy can be used as a prognostic marker in lymphoma therapy. ADC values lower than 1080 mm2/s and an increase of the ratio after the treatment can be considered as a marker of disease progression.

Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor - Case Report.

Summary Background MRCP is the method of choice in diagnosing pathologies of the biliary system. One of them is bile fistulae. They are uncommon but tend to cause many diagnostic problems. The possible way to improve MRCP is using it with intravenous injection of hepatobiliary-specific contrast agents. As it is eliminated via the hepatobiliary system, it can be visualized in the bile ducts and may help to reveal disorders undetected by a standard MRCP. Case Report We report a case of a 36-year-old woman with leakage in the biliary system which led to creation of a subcutaneous bile reservoir. By means of a regular MRCP protocol it was impossible to reveal any disorders of the biliary system and thus a decision to inject Gd-EOB-DTPA was taken. As a result, a fistula with its opening in the fundus of the gall bladder was revealed. Patient was qualified for treatment with somatostatin analogues in order to stop bile secretion. Conclusions The Gd-EOB-DTPA in combination with regular T2-weighted MRCP may be helpful in detecting anomalies of the biliary system. Although a high price of the procedure restricts its accessibility, such advantages as lower risk of complications, lower costs of hospitalization, and less traumatic nature make it a technique that may take precedence over ERCP in ambiguous cases.

The Analysis of the Exhaled Nitric Oxide in a Group of Patients with Asthma, Aged 3-18

Abstract The aim of this study was to analyse the results of exhaled nitric oxide examination in a group of patients with hyper-responsive-ness. The study was performed on a group of 297 children who underwent spirometry, examination of exhaled nitric oxide, skin prick test and stress probe in years 2010-2012 in Pulmonology and Allergy Centre in Karpacz. Mean age of patients was 11.86. Patients were divided into four groups: with diagnosed asthma, with bronchial hyper-responsiveness (BHR), with described asthma without BHR and a group with BHR without diagnosed asthma. The results of the study confirmed the presence of high-er amount of exhaled nitric oxide in patients with asthma and bronchial hyper-responsiveness. The elevation of NO concen-tration correlated with age; there was no significant difference between sexes.