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Malikova H, Nadova K, Reginacova K, Kremenova K, Rob L. Radiation-Related Fractures after Radical Radiotherapy for Cervical and Endometrial Cancers: Are There Any Differences? Diagnostics (Basel) 2024; 14:810. [PMID: 38667456 PMCID: PMC11049002 DOI: 10.3390/diagnostics14080810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
In this study, we reviewed CT/MRI scans and studied the rates of radiation-related fractures in subjects treated for cervical cancer (CC, 63 subjects) by radical radiotherapy (RT) and in subjects treated for endometrial cancer (EC, 64 subjects) by radical surgery and RT. The differences between bone density measured in L1 on pretreatment CT, age and body mass index (BMI) were evaluated. Despite significant differences in RT total dose, age, BMI, etc., between both groups, the rate of radiation-related fractures was similar: 28.6% of CC versus 26.6% of EC subjects. CC subjects with fractures were significantly older (62.4 ± 10.1 vs. 49.0 ± 12.4 years; p < 0.001), and their bone densities were significantly lower (106.3 ± 40.0 vs. 168.2 ± 49.5 HU; p < 0.001); no difference in BMI was found. EC subjects with fractures were without significant difference in age but had significantly lower bone densities (103.8 ± 29.0 vs. 133.8 ± 42.3 HU; p = 0.009) and BMIs (26.1 ± 4.9 vs. 31.8 ± 6.9 kg/m2; p = 0.003). Bone density strongly correlated with age (r = -0.755) only in CC subjects. Subjects with fractures from both groups had similarly low bone densities (106.3 ± 40.0 vs. 103.8 ± 29.0 HU; p = 0.829); however, no correlation between bone density and BMI was found. The rate of radiation-related fractures in both groups was clearly associated only with low pretreatment bone density, reflecting osteoporosis.
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Affiliation(s)
- Hana Malikova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 11000 Prague, Czech Republic
| | - Katarina Nadova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 11000 Prague, Czech Republic
| | - Klaudia Reginacova
- Department of Oncology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic;
| | - Karin Kremenova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (K.N.); (K.K.)
| | - Lukas Rob
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic;
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Laskov V, Rothbauer D, Malikova H. Robustness of radiomic features in 123I-ioflupane-dopamine transporter single-photon emission computer tomography scan. PLoS One 2024; 19:e0301978. [PMID: 38603674 PMCID: PMC11008844 DOI: 10.1371/journal.pone.0301978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Radiomic features are usually used to predict target variables such as the absence or presence of a disease, treatment response, or time to symptom progression. One of the potential clinical applications is in patients with Parkinson's disease. Robust radiomic features for this specific imaging method have not yet been identified, which is necessary for proper feature selection. Thus, we are assessing the robustness of radiomic features in dopamine transporter imaging (DaT). For this study, we made an anthropomorphic head phantom with tissue heterogeneity using a personal 3D printer (polylactide 82% infill); the bone was subsequently reproduced with plaster. A surgical cotton ball with radiotracer (123I-ioflupane) was inserted. Scans were performed on the two-detector hybrid camera with acquisition parameters corresponding to international guidelines for DaT single photon emission tomography (SPECT). Reconstruction of SPECT was performed on a clinical workstation with iterative algorithms. Open-source LifeX software was used to extract 134 radiomic features. Statistical analysis was made in RStudio using the intraclass correlation coefficient (ICC) and coefficient of variation (COV). Overall, radiomic features in different reconstruction parameters showed a moderate reproducibility rate (ICC = 0.636, p <0.01). Assessment of ICC and COV within CT attenuation correction (CTAC) and non-attenuation correction (NAC) groups and within particular feature classes showed an excellent reproducibility rate (ICC > 0.9, p < 0.01), except for an intensity-based NAC group, where radiomic features showed a good repeatability rate (ICC = 0.893, p <0.01). By our results, CTAC becomes the main threat to feature stability. However, many radiomic features were sensitive to the selected reconstruction algorithm irrespectively to the attenuation correction. Radiomic features extracted from DaT-SPECT showed moderate to excellent reproducibility rates. These results make them suitable for clinical practice and human studies, but awareness of feature selection should be held, as some radiomic features are more robust than others.
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Affiliation(s)
- Viktor Laskov
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David Rothbauer
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Girsa D, Kremenova K, Lukavsky J, Sukupova L, Malikova H. Comparison of dose length product and image quality of a biphasic whole-body polytrauma CT protocol with and without the automatic tube voltage selection. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 38445394 DOI: 10.5507/bp.2024.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND AND AIMS A significant source of man-made radiation is now linked to medical devices especially X-ray imaging based ones like CT scans which expose the body to cumulative ionizing radiation and thus attendant cancer risks. The aim of this study was to determine whether using a combination of Automatic Tube Current Modulation (ATCM) and Automatic Tube Voltage Selection (ATVS) during two-phase whole-body CT (2PWBCT) examinations would reduce the radiation dose while preserving the image quality. PATIENTS AND METHODS This was a prospective, observational, single-centre study of 127 adult patients who had undergone the 2PWBCT polytraumatic protocol. All were examined on a Somatom Drive scanner (Siemens). The patients were divided into two groups: ATCM only (42 patients) and ATCM +ATVS (85 patients). Patients' arm positions during examination and the examination dose length product (DLP) values were recorded, as well the standard deviations (SD) of the density in reference areas on CT scans for the image quality assessment. The DLP values and image quality in the groups were compared using ANOVA. RESULTS Mean Total DLP (in mGy*cm): ATCM only: 3337 +/-797, ATCM+ATVS: 3402 +/-830; P=0.674. No effect of arm position (P=0.586). Mean density SD values in reference areas (in HU) in ATCM only: 49 +/-45, 15 +/-6, 9 +/-2, 12 +/-4, 10 +/-3, in ATCM+ATVS: 48 +/-45, 17 +/-6, 11 +/-3, 15 +/-6, 12 +/-4. SD values was higher in ATCM+ATVS group (P<0.001). CONCLUSION Combination of ATVS and ATCM in polytraumatic 2PWBCT leads to no significant radiation load reduction compared with ATCM only but does lead to a slight degradation of image quality. The radiation load is significantly reduced if the patient has their arms behind the head when scanning, regardless of the activation of ATVS.
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Affiliation(s)
- David Girsa
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady; Second Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Karin Kremenova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Czech Academy of Sciences, 110 00 Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University in Prague, Czech Republic
| | - Lucie Sukupova
- Director's Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady; Second Faculty of Medicine, Charles University in Prague, Czech Republic
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Malikova H, Kremenova K, Lukavsky J, Holesta M, Lauer D, Koznar B, Weichet J. Early and late infarct growth rate in ischemic stroke patients after successful endovascular treatment in early time window: correlation of imaging and clinical factors with clinical outcome. Quant Imaging Med Surg 2023; 13:5770-5782. [PMID: 37711771 PMCID: PMC10498245 DOI: 10.21037/qims-23-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/30/2023] [Indexed: 09/16/2023]
Abstract
Background The prospective study assessed infarct growth rate (IGR) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) after recanalization in early time window. Early IGR (EIGR) and late IGR (LIGR) were correlated with imaging and clinical data; we searched for outcome predictors. Methods We included 71 consecutive patients. Subjects underwent computed tomography perfusion (CTP) for ischemic core volume assessment at 99.0 minutes (median) from stroke onset, recanalization was performed at 78.0 minutes (median) from CTP. Final infarct volume (FIV) was measured on 24±2 hours imaging follow-up. EIGR was calculated as the core volume/time between stroke onset and CTP; LIGR was calculated as FIV/time between CTP and imaging follow-up. Twenty-two subjects were assessed as poor outcome, 49 as good outcome. Group differences were tested by Mann-Whitney test and χ2 test. Bayesian logistic regression models were used to predict clinical outcome, Pearson correlations for the log-transformed predictors. Results Subjects with poor outcome were older, median age 78.0 [interquartile range (IQR): 71.8, 83.8] versus 68.0 (IQR: 57.0, 73.0) years; 95% confidence interval (CI): 6.00 to 16.00; P<0.001. Their stroke severity scale was higher, median 19.0 (IQR: 16.0, 20.0) versus 15.5 (IQR: 10.8, 18.0); 95% CI: 1.00 to 6.00; P<0.001. They had higher EIGR, median 23.9 (IQR: 6.4, 104.0) versus 6.7 (IQR: 1.7, 13.0) mL/h; 95% CI: 3.26 to 53.68; P=0.002; and larger core, median 52.5 (IQR: 13.1, 148.5) versus 10.0 (IQR: 1.4, 20.0) mL; 95% CI: 11.00 to 81.00; P<0.001. In subjects with poor outcome, infarct growth continued after thrombectomy with LIGR 2.0 (IQR: 1.2, 9.7) versus 0.3 (IQR: 0.0, 0.7) mL/h; 95% CI: 1.10 to 6.10; P<0.001; resulting in larger FIV, median 186.5 (IQR: 49.3, 280.8) versus 18.5 (IQR: 8.0, 34.0) mL; 95% CI: 55.30 to 214.00; P<0.001. Strong correlations among predictors were found e.g., core and EIGR (r=0.942), LIGR and FIV (r=0.779), core and FIV (r=0.761). Clinical outcome was best predicted using data from later measurements as FIV and LIGR. Conclusions Data from later measurements were more predictive, there was no major benefit to use growth over volume data.
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Affiliation(s)
- Hana Malikova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
- Institute of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karin Kremenova
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Czech Academy of Sciences, Prague, Czech Republic
| | - Michal Holesta
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David Lauer
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
- Neurology Department, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Boris Koznar
- Cardiology Department, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jiri Weichet
- Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Kroupa J, Buk M, Weichet J, Malikova H, Bartova L, Linkova H, Ionita O, Kozel M, Motovska Z, Kocka V. A pilot randomised trial of catheter-directed thrombolysis or standard anticoagulation for patients with intermediate-high risk acute pulmonary embolism. EUROINTERVENTION 2022; 18:e639-e646. [DOI: 10.4244/eij-d-21-01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kremenova K, Lukavsky J, Holesta M, Peisker T, Lauer D, Weichet J, Malikova H. CT Brain Perfusion in the Prediction of Final Infarct Volume: A Prospective Study of Different Software Settings for Acute Ischemic Core Calculation. Diagnostics (Basel) 2022; 12:diagnostics12102290. [PMID: 36291979 PMCID: PMC9601142 DOI: 10.3390/diagnostics12102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
CT perfusion (CTP) is used for the evaluation of brain tissue viability in patients with acute ischemic stroke (AIS). We studied the accuracy of three different syngo.via software (SW) settings for acute ischemic core estimation in predicting the final infarct volume (FIV). The ischemic core was defined as follows: Setting A: an area with cerebral blood flow (CBF) < 30% compared to the contralateral healthy hemisphere. Setting B: CBF < 20% compared to contralateral hemisphere. Setting C: area of cerebral blood volume (CBV) < 1.2 mL/100 mL. We studied 47 AIS patients (aged 68 ± 11.2 years) with large vessel occlusion in the anterior circulation, treated in the early time window (up to 6 h), who underwent technically successful endovascular thrombectomy (EVT). FIV was measured on MRI performed 24 ± 2 h after EVT. In general, all three settings correlated with each other; however, the absolute agreement between acute ischemic core volume on CTP and FIV on MRI was poor; intraclass correlation for all three settings was between 0.64 and 0.69, root mean square error of the individual observations was between 58.9 and 66.0. Our results suggest that using CTP syngo.via SW for prediction of FIV in AIS patients in the early time window is not appropriate.
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Affiliation(s)
- Karin Kremenova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
- Correspondence:
| | - Jiri Lukavsky
- Institute of Psychology, Czech Academy of Sciences, 110 00 Prague, Czech Republic
| | - Michal Holesta
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Tomas Peisker
- Neurology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - David Lauer
- Neurology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Hana Malikova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
- Institute of Anatomy, Second Faculty of Medicine, Charles University, 150 00 Prague, Czech Republic
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Tichy M, Kojanova M, Velackova B, Dolezal T, Gkalpatiotis S, Cetkovska P, Antal Z, Arenberger P, Bartonova J, Blahova L, Brodska P, Petr B, Buckova H, Cetkovsky M, Diamantova D, Duchkova H, Fialova J, Filipovska O, Gkalpakioti P, Grycova M, Horazdovsky J, Horka E, Hrazdirova K, Hrncir E, Hugo J, Janku J, Kopova R, Kovandova D, Lomicova I, Machackova R, Machovcova A, Malikova H, Matzenauer M, Necas M, Nemcova H, Neumannova R, Michaela N, Osmerova J, Pallova V, Pinkova B, Plzakova Z, Policarova M, Pospisil T, Filip R, Salavec M, Slonkova V, Smetanova A, Strouhalova I, Stuchlik D, Stumpfova A, Sevcik J, Sternbersky J, Stork J, Svarcova K, Tepla K, Tomkova H, Vantuchova Y, Vasku V, Vejrova I, Zampachova I. Efficacy of switches within the class of IL‐17 inhibitors: An analysis of data from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP). Dermatol Ther 2022; 35:e15772. [DOI: 10.1111/dth.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Tichy
- Department of Dermatology and Venereology, Faculty of Medicine and Dentistry Palacky University and University Hospital Olomouc Czech Republic
| | - Martina Kojanova
- Department of Dermatovenereology, First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | | | | | - Spyridon Gkalpatiotis
- Department of Dermatovenereology, Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Faculty of Medicine in Pilsen Charles University Czech Republic
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Malikova H, Weichet J. Diagnosis of Ischemic Stroke: As Simple as Possible. Diagnostics (Basel) 2022; 12:diagnostics12061452. [PMID: 35741262 PMCID: PMC9221735 DOI: 10.3390/diagnostics12061452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.
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Affiliation(s)
- Hana Malikova
- Correspondence: ; Tel.: +420-267-162-400; Fax: +420-267-162-409
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Nadova K, Burghardtova M, Fejfarova K, Reginacova K, Malikova H. Late Radiation-Related Toxicities in Patients Treated for Early-Stage Cervical Carcinoma by Surgery and Adjuvant Radiotherapy: A Retrospective Imaging Study. Pathol Oncol Res 2021; 27:1609915. [PMID: 34650341 PMCID: PMC8506932 DOI: 10.3389/pore.2021.1609915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
Surgical treatment is preferred therapy of early-stage cervical carcinoma. In the risk of cancer recurrence surgery is often followed by adjuvant radiotherapy. In our retrospective study we aimed at identifying late (≥6 months) and very late (≥5 years) radiation adverse effects on imaging scans as CT, PET/CT and MRI in patients who underwent successful treatment for cervical carcinoma by radical surgery combined with radiotherapy ± chemotherapy. We correlated imaging results with clinical manifestations. We selected young and middle-aged patients with long life expectancy, as late radiation-related toxicities may significantly affect their quality of life. Patients were selected from those who were primary diagnosed and treated between the years 1987–2011 and regularly visited our Oncology department in years 2011–2012. Following inclusion criteria were applied: age ≤55 years at diagnosis, clinical follow-up ≥5 years and at least one tomography scan ≥3 years after finished treatment. One hundred and three subjects were reviewed: 73 patients met all inclusion criteria, while 30 patients fulfilled the inclusion criteria except for available tomography scan ≥3 years after therapy. The mean imaging follow-up was 11.2 ± 7.6 years and the mean clinical follow-up was 15.0 ± 6.9 years. In 20 (27%) subjects 27 cases grade I radiation-related toxicities were found; 9 (33%) of those 27 cases were clinically silent. In 14 (19%) females only grade I toxicities were observed. Grade III-IV toxicities were found in 5 (6.8%) subjects. No grade V toxicities were observed. We concluded that severe late side effects caused by radiotherapy were exceedingly rare in females successfully treated for early-stage cervical carcinoma, only 1 bilateral osteonecrosis, 2 cases of ileus, and 2 potentially radiation-induced tumors were found. The majority of radiation-related comorbidities found on imaging scans were clinically silent.
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Affiliation(s)
- Katarina Nadova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia.,Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Miroslava Burghardtova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia
| | - Klara Fejfarova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia
| | - Klaudia Reginacova
- Oncology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia
| | - Hana Malikova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia.,Institute of Anatomy, Second Medical Faculty, Charles University, Prague, Czechia
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Osmancik P, Herman D, Kacer P, Rizov V, Vesela J, Rakova R, Karch J, Susankova M, Znojilova L, Fojt R, Prodanov P, Kremenova K, Malikova H, Peisker T, Stros P, Curila K, Javurkova A, Raudenska J, Budera P. The Efficacy and Safety of Hybrid Ablations for Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:1519-1529. [PMID: 34217655 DOI: 10.1016/j.jacep.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.
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Affiliation(s)
- Pavel Osmancik
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Dalibor Herman
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vitalii Rizov
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Vesela
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radka Rakova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Karch
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Susankova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Znojilova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Fojt
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petko Prodanov
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karin Kremenova
- Department of Radiology, University Hospital Kralovske Vinohrady Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, University Hospital Kralovske Vinohrady Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Stros
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karol Curila
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alena Javurkova
- Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Jaroslava Raudenska
- Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Petr Budera
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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11
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Malikova H, Burghardtova M, Fejfarova K, Nadova K, Weichet J. Advanced cervical cancer in young women: imaging study of late and very late radiation-related side effects after successful treatment by combined radiotherapy. Quant Imaging Med Surg 2021; 11:21-31. [PMID: 33392008 DOI: 10.21037/qims-20-553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Radical combined radiotherapy (RT) is a standard treatment for advanced cervical cancer. The aim of our study was to identify morphological late (≥6 months) and very late (≥5 years) radiation-related comorbidities on computed tomography (CT), positron emission tomography/computerized tomography (PET/CT) or magnetic resonance imaging (MRI) scans in young females who survived ≥5 years since RT and were considered as successfully treated. Secondly, we studied a rate of clinically silent radiation-related toxicities apparent on imaging scans that might influenced on future well-being of survived females. Thirdly, we analyzed reasons why patients underwent imaging scans. Methods We included 41 subjects aged under 50 years (mean 41.8±7.2 years, median 41 years), who survived ≥5 years since RT, with at least one available imaging scan ≥3 years since RT. The mean time between RT and the last available scan was 12.3±7.9 years (median 9 years); the mean time of clinical follow-up was 15.4±7.1 years (median 14 years). Results Fourteen (34.1%) females underwent the first imaging scan in emergency situation and 27 (65.9%) patients due to variable chronic complaints. Grade III-V radiation-related comorbidities occurred in 19 (46.3%) females including one case of death due to radiation-induced osteosarcoma. In 14 of 19 patients, comorbidities were multiple. Four (9.8%) females suffered from life-threatening complications (grade IV): one from an uretero-arterial fistula with massive hematuria and 3 from bowel perforations. Eleven (26.8%) subjects suffered from bowel strictures with ileus development, they underwent mean 1.7±0.8 surgery (median 1.5). The mean time since RT to the first surgery for intestinal complications was 5.4±6.0 years (median 3 years), to the second 12.0±9.6 years (median 11.5 years) and to the third surgery 9.0±4.2 years (median 9 years). Late fistulas formations (vesico-recto-vaginal) were seen in 6 (14.6%) patients. Bone complications were diagnosed in 9 (22.0%) of treated females, one case of osteosarcoma included, 4 of 9 bone complications were clinically silent. In 5 (12.2%) subjects, toxicities grade III-IV first time manifested >5 years since RT, majority of them were multiple. The bowel perforation and fistulas formations were the earliest manifested grade III-IV toxicities, with median time 3 years since RT, the bone complications were the latest manifested with median time 16 years since RT. Conclusions Our study is not able to bring information about the incidence of late and very late radiation related comorbidities, according to International Federation of Gynecology and Obstetrics (FIGO) recommendations patients are clinically followed only for 5 years and imaging cross-sectional scans are not recommended. However, our study shows that if females successfully treated for advanced cervical cancer report abdominal/pelvic clinical problems, it is highly probable their imaging scans will reveal late radiation related side-effects that may affect the rest of their life. It puts forward question whether females after radical RT should been regularly followed by cross-sectional imaging methods.
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Affiliation(s)
- Hana Malikova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Institute of Anatomy, Second Medical Faculty, Charles University, Prague, Czech Republic
| | - Miroslava Burghardtova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Klara Fejfarova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Katarina Nadova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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12
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Michna M, Kovarova L, Valerianova A, Malikova H, Weichet J, Malik J. Review of the structural and functional brain changes associated with chronic kidney disease. Physiol Res 2020; 69:1013-1028. [PMID: 33129242 PMCID: PMC8549872 DOI: 10.33549/physiolres.934420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) leads to profound metabolic and hemodynamic changes, which damage other organs, such as heart and brain. The brain abnormalities and cognitive deficit progress with the severity of the CKD and are mostly expressed among hemodialysis patients. They have great socio-economic impact. In this review, we present the current knowledge of involved mechanisms.
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Affiliation(s)
- M Michna
- Department of Radiology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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13
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Koubska E, Weichet J, Malikova H. Intracranial Hodgkin's Lymphoma. Neurol India 2020; 68:238-239. [PMID: 32129290 DOI: 10.4103/0028-3886.279692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Eva Koubska
- Radiology Department of Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady in Prague; First Medical Faculty, Charles University in Prague, Czech Rep
| | - Jiri Weichet
- Radiology Department of Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady in Prague, Czech Rep
| | - Hana Malikova
- Radiology Department of Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady in Prague, Czech Rep
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14
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Buk M, Rengier F, Mokry T, Riffel J, Giannitsis E, Kihm L, Malikova H, Kauczor HU, von Stackelberg O, Weber TF. Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A retrospective single-center study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:51-56. [PMID: 33087940 DOI: 10.5507/bp.2020.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines. MATERIALS AND METHODS Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS. RESULTS Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification. CONCLUSION There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.
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Affiliation(s)
- Michal Buk
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fabian Rengier
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Lars Kihm
- Department of Endocrinology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hana Malikova
- Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Institute of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | | | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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15
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Kremenova K, Holesta M, Peisker T, Girsa D, Weichet J, Lukavsky J, Malikova H. Is limited-coverage CT perfusion helpful in treatment decision-making in patients with acute ischemic stroke? Quant Imaging Med Surg 2020; 10:1908-1916. [PMID: 33014724 DOI: 10.21037/qims-20-555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The initial core infarct volume predicts treatment outcome in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). According to the literature, CT perfusion (CTP) is able to evaluate cerebral parenchymal viability and assess the initial core in AIS. We prospectively studied whether limited-coverage CTP with automated core calculation correlates with the final infarct volume on follow-up non-enhanced CT (NECT) in patients successfully treated by mechanical thrombectomy. Methods We enrolled 31 stroke patients (20 women aged 74.4±12.9 years and 11 men aged 66±15.4 years; median initial NIHSS score 15.5) with occlusion of the medial cerebral artery and/or the internal carotid artery that were treated by successful mechanical thrombectomy. CTP performed in a 38.6 mm slab at the level of basal ganglia was included in the CT stroke protocol, but was not used to determine indication for mechanical thrombectomy. The infarction core volume based on CTP was automatically calculated using dedicated software with a threshold defined as cerebral blood flow <30% of the value in the contralateral healthy hemisphere. The final infarction volume was measured on 24-hour follow-up NECT in the same slab with respect to CTP. Pearson and Spearman correlation coefficients and robust linear regression were used for comparison of both volumes, P values <0.05 were considered as statistically significant. Results The median time from stroke onset to CT was 77 minutes (range, 31-284 minutes), and the median time from CT to vessel recanalization was 95 minutes (range, 55-215 minutes). The mean CTP-calculated core infarct volume was 24.3±19.2 mL (median 19 mL, range 1-79 mL), while the mean final infarct volume was 21.5±39.5 mL (median 8 mL; range 0-210 mL). Only a weak relationship was found between the CTP-calculated core and final infarct volume [Pr(29) =0.32, P=0.078; rho =0.40, P=0.028]. Regression analysis showed CTP significantly overestimated lower volumes. Conclusions In our prospective study, the infarction core calculated using limited-coverage CTP only weakly correlated with the final infarction volume measured on 24-hour follow-up NECT; moreover, CTP significantly overestimated lower volumes. Our results do not support the use of limited-coverage CTP for guiding treatment recommendations in patients with AIS.
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Affiliation(s)
- Karin Kremenova
- Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep
| | - Michal Holesta
- Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep
| | - Tomas Peisker
- Department of Neurology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep
| | - David Girsa
- Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep
| | - Jiri Weichet
- Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep
| | - Jiří Lukavsky
- Psychology Department, Faculty of Arts, Charles University, Prague, Czech Rep
| | - Hana Malikova
- Department of Radiology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Rep.,Institute of Anatomy, Second Medical Faculty, Charles University, Prague, Czech Rep
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16
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Mociková H, Malikova H, Holesta M, Elturki A, Campr V, Kozak T. Durable Response to Brentuximab Vedotin-Based Chemotherapy in Refractory Hodgkin Lymphoma with Central Nervous System (CNS) Involvement. Am J Case Rep 2020; 21:e921657. [PMID: 32170052 PMCID: PMC7083218 DOI: 10.12659/ajcr.921657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND CNS involvement in Hodgkin lymphoma is rare. Despite various treatment options, median overall survival is only 13 months after diagnosis of CNS involvement in relapsed/refractory HL. CASE REPORT A 29-year-old woman with classical HL (mixed cellularity) in clinical stage IIB was treated with multilineage chemotherapy and radiotherapy without achieving a sustained complete remission. Systemic and CNS progression of HL occurred at the age of 32 years and the patient received 2 cycles of brentuximab vedotin with bendamustine alternating with 2 cycles of high-dose methotrexate-based treatment and achieved partial remission. She then underwent autologous stem cell transplantation followed by brentuximab vedotin consolidation. The disease progressed and the patient died 6 months after the last dose of brentuximab vedotin. CONCLUSIONS We demonstrated a durable response to brentuximab vedotin-based chemotherapy in a patient with refractory Hodgkin lymphoma with CNS involvement. Prognosis of these patients is poor and new treatment options are needed.
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Affiliation(s)
- Heidi Mociková
- Department of Internal Medicine and Hematology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michal Holesta
- Department of Radiology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Abdulfattah Elturki
- Department of Medical Oncology and Hematology, Misurata Cancer Center, Misurata, Libyan Arab Jamahiriya
| | - Vit Campr
- Institute of Pathology and Molecular Medicine, University Hospital Motol, Prague, Czech Republic
| | - Tomas Kozak
- Department of Internal Medicine and Hematology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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17
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Gregušová A, Klézl P, Mašková V, Smíšková D, Pícha D, Malikova H. Acute Urinary Retention in Aseptic Meningitis: Meningitis-retention Syndrome. Neuro Endocrinol Lett 2019; 40:166-168. [PMID: 32087091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
Here we present the case of a 50-year-old woman with acute urinary retention who was treated by the insertion of a permanent catheter. For associated headaches, fever and muscle and joint pain, the patient underwent neurologic examination, including lumbar puncture and magnetic resonance of head and spine. The results confirmed aseptic meningitis. Subsequently, the patient was hospitalized at the infectious disease clinic, where the permanent catheter was extracted after 5 days, with spontaneous micturition recovery and no post-void residual volume. The combination of aseptic meningitis and urinary retention is called meningitis-retention syndrome. This is a rare disease, which has been described only a few times in the literature.
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Affiliation(s)
- Alexandra Gregušová
- Department of Urology, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Klézl
- Department of Urology, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Věra Mašková
- Department of Urology, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Smíšková
- Department of Infectious Diseases, Na Bulovce University Hospital, Prague, Czech Republic
| | - Dušan Pícha
- Department of Infectious Diseases, Na Bulovce University Hospital, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiodiagnostics, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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18
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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19
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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20
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Ryznarová Z, Keller J, Záleský M, Zachoval R, Čapek V, Malikova H. Comparison of Prostate Imaging Reporting and Data System (PI-RADS) version 1 and version 2 and combination with apparent diffusion coefficient as a predictor of biopsy outcome. Neuro Endocrinol Lett 2019; 40:41-50. [PMID: 31184822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The main aim of the study was to compare the diagnostic performance of Prostate Imaging Reporting and Data System (PI-RADS) versions 1 and 2 for detection of prostate carcinoma (PCa) and clinically significant prostate carcinoma (CSPCa). The second aim was to evaluate the potential benefit of adding the apparent diffusion coefficient (ADC) and prostate specific antigen (PSA) density to the standard evaluation protocol. METHODS A total of 167 consecutive patients with elevated PSA underwent magnetic resonance imaging. The images were evaluated prospectively using both versions of the PI-RADS and the results compared with 12-core template biopsy and magnetic resonance/transrectal ultrasound fusion biopsy. Receiver-operating characteristic (ROC) curves were compared for each scoring system using DeLong\'s test. The area under the curve (AUC) was calculated for ADC and PSA density for lesions scored 4. RESULTS PI-RADS V2 had high discriminative ability for PCa prediction with an AUC of 0.824 (95% CI 0.763 to 0.885), compared to an AUC of 0.724 (95% CI 0.654 to 0.794) for PI-RADS V1 (p = 0.0335). ADC demonstrated a higher discriminative ability with an AUC of 0.702 (95% CI 0.548 to 0.856) in CSPCa prediction. Using the obtained ADC threshold of 828x10^-6 mm^2/s improved specificity to 86.73% with a sensitivity of 60.38%. CONCLUSION PI-RADS version 2 exhibited significantly higher discriminative ability for PCa and CSPCa detection compared to PI-RADS version 1. Using the ADC can improve the tumor predictability of PI-RADS version 2 in lesions scored 4.
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Affiliation(s)
- Zuzana Ryznarová
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Miroslav Záleský
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Václav Čapek
- National Institute of Public Health, Prague, Czech Republic
| | - Hana Malikova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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21
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Malikova H, Holesta M, Fialova A, Arenbergerova M, Weichet J. Hypophysitis and other autoimmune complications related to immune checkpoints inhibitors´ treatment: Spectrum of imaging appearances. Neuro Endocrinol Lett 2018; 39:196-204. [PMID: 30431741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Immune checkpoints inhibitors (ICI) represent a new therapy option for the treatment of several advanced tumors. However, this therapy has been linked to a spectrum of ICI related autoimmune (AI) adverse events. Some may be life threatening and their diagnosis is tricky. The aim of our study was to describe various imaging appearances of ICI related secondary hypophysitis and other coincidental AI diseases. MATERIAL AND METHODS We included 28 patients (19 females, 9 men, mean aged 58±13 years), who were consecutively treated mostly for advanced stage melanoma by different ICI. All their CT/MRI records and clinical data were reviewed. RESULTS We found 5 (18%) cases of endocrinology proven secondary hypophysitis; 2 cases of panhypopituitarism and 3 cases of central hypocortisolism. Four cases were MRI positive, 1 case was MRI negative. Three cases were accompanied by other AI diseases: 1 by hemorrhagic colitis and mesenterial lymphadenitis, 1 by AI pancreatitis and 1 by pneumonitis. On MRI pituitary gland was swollen in 3 cases, twice enhanced non-homogenously, once homogenously; infundibular enlargement was present in 2 cases. Those 3 cases reacted to glucocorticoid therapy by hypophyseal shrinkage. In 1 case of MRI positive hypophysitis, the pituitary gland was not enlarged, slightly nonhomogeneous with peripheral contour enhancement; no reaction to glucocorticoids was mentioned. CONCLUSION Secondary hypophysitis is probably more common ICI related adverse event than reported in the literature. Its MRI appearance is variable. Most of our cases were in coincidence with other AI ICI related events that affected their clinical manifestations.
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Affiliation(s)
- Hana Malikova
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Holesta
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alena Fialova
- Department of Dermatology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Monika Arenbergerova
- Department of Dermatology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Malikova H, Liscak R. A neurosurgeon’s view: Outcome after RF-ablation for mTLE. Epilepsy Res 2018; 142:126-130. [DOI: 10.1016/j.eplepsyres.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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Malikova H, Holesta M, Weichet J, Wagnerova M, Lukavsky J. Gadoxetate disodium, a modern hepatospecific MRI contrast agent: Indirect signs for gadolinium deposition in the brain structures with signal intensity increase after intravenous application. Neurol India 2018; 66:1771-1775. [DOI: 10.4103/0028-3886.246259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Malikova H, Burghardtova M, Koubska E, Mandys V, Kozak T, Weichet J. Secondary central nervous system lymphoma: spectrum of morphological MRI appearances. Neuropsychiatr Dis Treat 2018; 14:733-740. [PMID: 29559780 PMCID: PMC5856045 DOI: 10.2147/ndt.s157959] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) is a rare and aggressive disease, which is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. According to previous reports, SCNSL presents mostly with leptomeningeal spread; however, our experience differs. In the present study, we demonstrate the diversity of magnetic resonance imaging (MRI) patterns in SCNSL. PATIENTS AND METHODS Initial morphological MRI findings in 21 patients (10 women and 11 men with mean age 62.3±16.2 years) with SCNSL were retrospectively evaluated. All patients suffered from neurological symptoms and underwent MRI, and all cases were histologically verified. Twelve patients were treated by corticosteroids at the time of the initial MRI. RESULTS Parenchymal lesions were present in 18 of 21 cases (85.7%), solitary meningeal infiltration was present in 1 patient (4.8%), leptomeningeal infiltration in combination with hypophyseal involvement in 1 patient (4.8%), and solitary involvement of the sixth cranial nerve (CN) was found in 1 patient (4.8%). Multiple lesions were present in 11 of 21 cases (52.4%). Diffusion restriction in all or part of the lesion was detected in 14 of 18 cases (77.8%). All parenchymal lesions had an infiltrative appearance and most enhanced homogenously (11 of 17 cases; 64.7%). A combination of parenchymal and meningeal involvement was found in 10 of 21 cases (47.6%). Infiltration of the CNs, basal ganglia, corpus callosum, and ependyma was present in 8 of 21 cases (38.1%) for each of the abovementioned structures; hypothalamic-hypophyseal axis was affected in 7 of 21 cases (33.3%). CONCLUSION In contrast to previous reports, SCNSL presented as parenchymal disease. MRI is not sufficient for differentiation between primary and secondary CNS lymphoma.
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Affiliation(s)
- Hana Malikova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Institute of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslava Burghardtova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Eva Koubska
- Radiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Vaclav Mandys
- Pathology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Tomas Kozak
- Hematooncology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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Malikova H, Koubska E, Weichet J, Klener J, Rulseh A, Liscak R, Vojtech Z. Can morphological MRI differentiate between primary central nervous system lymphoma and glioblastoma? Cancer Imaging 2016; 16:40. [PMID: 27894359 PMCID: PMC5126849 DOI: 10.1186/s40644-016-0098-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/12/2016] [Indexed: 12/18/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare, aggressive brain neoplasm that accounts for roughly 2-6% of primary brain tumors. In contrast, glioblastoma (GBM) is the most frequent and severe glioma subtype, accounting for approximately 50% of diffuse gliomas. The aim of the present study was to evaluate morphological MRI characteristics in histologically-proven PCNSL and GBM at the time of their initial presentation. Methods We retrospectively evaluated standard diagnostic MRI examinations in 54 immunocompetent patients (26 female, 28 male; age 62.6 ± 11.5 years) with histologically-proven PCNSL and 54 GBM subjects (21 female, 33 male; age 59 ± 14 years). Results Several significant differences between both infiltrative brain tumors were found. PCNSL lesions enhanced homogenously in 64.8% of cases, while nonhomogeneous enhancement was observed in 98.1% of GBM cases. Necrosis was present in 88.9% of GBM lesions and only 5.6% of PCNSL lesions. PCNSL presented as multiple lesions in 51.9% cases and in 35.2% of GBM cases; however, diffuse infiltrative type of brain involvement was observed only in PCNSL (24.1%). Optic pathways were infiltrated more commonly in PCNSL than in GBM (42.6% vs. 5.6%, respectively, p <0.001). Other cranial nerves were affected in 5.6% of PCNSL, and in none of GBM. Signs of bleeding were rare in PCNSL (5.6%) and common in GBM (44.4%); p < 0.001. Both supratentorial and infratentorial localization was present only in PCNSL (27.7%). Involvement of the basal ganglia was more common in PCNSL (55.6%) than in GBM (18.5%); (p < 0.001). Cerebral cortex was affected significantly more often in GBM (83.3%) than in PCNSL (51.9%); mostly by both enhancing and non-enhancing infiltration. Conclusion Routine morphological MRI is capable of differentiating between GBM and PCNSL lesions in many cases at time of initial presentation. A solitary infiltrative supratentorial lesion with nonhomogeneous enhancement and necrosis was typical for GBM. PCNSL presented with multiple lesions that enhanced homogenously or as diffuse infiltrative type of brain involvement, often with basal ganglia and optic pathways affection.
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Affiliation(s)
- H Malikova
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic. .,Department of Radiology, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Ruska 87, Prague, 10000, Czech Republic.
| | - E Koubska
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic
| | - J Weichet
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic.,Department of Radiology, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Ruska 87, Prague, 10000, Czech Republic
| | - J Klener
- Department of Neurosurgery, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic
| | - A Rulseh
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic.,Department of Radiology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - R Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic
| | - Z Vojtech
- Department of Neurology, Na Homolce Hospital, Roentgenova 2, Prague, 15000, Czech Republic.,Department of Neurology, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, 10000, Czech Republic
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Koubska E, Weichet J, Malikova H. Central nervous system lymphoma: a morphological MRI study. Neuro Endocrinol Lett 2016; 37:318-324. [PMID: 27857050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate morphological MRI findings in histologically-proven central nervous system lymphoma (CNSL) at time of their first appearance, and to describe dynamic changes on repeat MRI before the diagnosis was histologically proven. METHODS We retrospectively evaluated the MRI examinations of 74 patients with histologically-proven CNSL (10 secondary CNSL, 64 primary PCNSL; 10 immunocompromised, 54 immunocompetent). In 43 patients, we evaluated the evolution of CNSL on MRI before the diagnosis was proven. RESULTS Primary CNSL was typically localized supratentorially (63%), with multiple (59%) or infiltrative (36%) lesions showing diffusion restriction (98%), often (87%) reaching the brain surface. In approximately 50% of patients, meningeal, ependymal or cranial nerve involvement was found. We detected significant differences in enhancement patterns between immunocompromised and immunocompetent patients; non-homogenous enhancement present in 50% of immunocompromised patients. We did not find any significant differences in MRI appearance between primary and secondary CNSL. Regression was evident after corticosteroid treatment in 52% of patients; however, in 16% of cases overall progression was observed. CONCLUSION CNSL generally presents as an infiltrative lesion or multiple homogenously-enhancing lesions of the brain in contact with the brain surface. Involvement of the corpus callosum, cranial nerves, ependyma or meninges is common. No significant differences between primary and secondary CNSL were detected, however differences in enhancement type between immunocompromised and immunocompetent primary CNSL patients were found. We stress the variability of MRI findings in the course of the disease and also the variable response to corticotherapy.
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Affiliation(s)
- Eva Koubska
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Weichet
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Koubska E, Vojtech Z, Weichet J, Syrucek M, Sroubek J, Rulseh A, Liscak R. Late morphological changes after radiosurgery of brain arteriovenous malformations: an MRI study. Acta Neurochir (Wien) 2016; 158:1683-90. [PMID: 27368701 PMCID: PMC4980423 DOI: 10.1007/s00701-016-2876-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiosurgery by Gamma Knife (GK) is an effective treatment for brain arteriovenous malformations (AVM). The aim of the present study was to evaluate late, radiation-induced changes detectable by MRI after AVM radiosurgery in patients treated minimally 10 years prior, with AVM obliteration proven by angiography. METHODS Thirty-five patients with 37 AVMs were included. AVMs were irradiated 16.6 ± 3.5 years prior with AVM obliteration proven 13 ± 4 years prior. All patients underwent recent MRI examinations, including application of gadolinium-based contrast. RESULTS In one case, post-irradiative cystic formation with mass effect and signs of hemorrhage requiring surgery was found. Post-gadolinium enhancement at the site of obliterated nidi was apparent in 28 of 37 cases (76 %). In all cases except one, the mean volume of enhancement at the time of review was clearly lower than the volume of the originally irradiated AVM (88 ± 20 %; median 92 %); in one case the extent was 142 % greater than the irradiated AVM. When we compared enhancing and non-enhancing nidi, we found that enhancing nidi were significantly larger than non-enhancing nidi at the time of radiosurgery (4.39 ± 3.35 cc vs. 0.89 ± 0.79 cc, p = 0.004). Enhancement was not influenced by total radiation dose, patient age at the time of irradiation, duration since radiosurgery, or the number of irradiations. Wallerian degeneration was found in nine of 37 cases (24 %); in six cases the optical tracts were affected and visual field defects were proven. In five of nine cases (55.6 %) with Wallerian degeneration previous hemorrhage was present. Dual vascular pathology was found in eight of 35 patients (23 %). CONCLUSIONS GK radiosurgery for AVM is a safe treatment method although delayed complications may occur. Post-gadolinium enhancement of obliterated nidi may indicate an active post-irradiative process.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
- Institute of Anatomy, Second Medical Faculty, Charles University in Prague, U Nemocnice 3, 120 00, Prague, Czech Republic.
| | - Eva Koubska
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
- Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Ruska 87, 10000, Prague, Czech Republic
| | - Jiri Weichet
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Martin Syrucek
- Department of Pathology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
| | - Aaron Rulseh
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic
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Jerie M, Vojtech Z, Malikova H, Prochazkova S, Vackova Z, Rolfs A. Allgrove syndrome with prominent neurological symptoms. Case Report. Neuro Endocrinol Lett 2016; 37:184-188. [PMID: 27618595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/27/2016] [Indexed: 06/06/2023]
Abstract
We report a young woman with the clinical picture of Allgrove syndrome in whom neurological symptoms are prominent. It usually presents in the first decade of life with a deficiency of tears, recurrent vomiting and dysphagia due to achalasia, severe hypoglycemic seizures and shock due to adrenal insufficiency. Neurological symptoms such as hyperreflexia, dysarthria, hypernasal speech, ataxia, sensory impairment, muscle weakness, and mental retardation are extremely slow to develop and manifest at a later age. Diagnosis was based on clinical presentation and laboratory findings. She is the first patient from the Czech Republic with genetic confirmation of Allgrove syndrome. This patient is one of about 100 cases described in the literature and one of the few patients with all the main typical clinical features.
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Affiliation(s)
- Martin Jerie
- Department of Neurology, Hospital Na Homolce, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Hospital Na Homolce, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Sylva Prochazkova
- Department of Ophtalmology, Na Homolce Hospital, Prague, Czech Republic
| | - Zuzana Vackova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Czech Republic
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Rulseh AM, Keller J, Rusz J, Syka M, Brozova H, Rusina R, Havrankova P, Zarubova K, Malikova H, Jech R, Vymazal J. Diffusion tensor imaging in the characterization of multiple system atrophy. Neuropsychiatr Dis Treat 2016; 12:2181-7. [PMID: 27616888 PMCID: PMC5008640 DOI: 10.2147/ndt.s109094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Multiple system atrophy (MSA) is a rare neurodegenerative disease that remains poorly understood, and the diagnosis of MSA continues to be challenging. We endeavored to improve the diagnostic process and understanding of in vivo characteristics of MSA by diffusion tensor imaging (DTI). MATERIALS AND METHODS Twenty MSA subjects, ten parkinsonian dominant (MSA-P), ten cerebellar dominant (MSA-C), and 20 healthy volunteer subjects were recruited. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps were processed using tract-based spatial statistics. Diffusion data were additionally evaluated in the basal ganglia. A support vector machine was used to assess diagnostic utility, leave-one-out cross-validation in the evaluation of classification schemes, and receiver operating characteristic analyses to determine cutoff values. RESULTS We detected widespread changes in the brain white matter of MSA subjects; however, no group-wise differences were found between MSA-C and MSA-P subgroups. Altered DTI metrics in the putamen and middle cerebellar peduncles were associated with a positive parkinsonian and cerebellar phenotype, respectively. Concerning clinical applicability, we achieved high classification performance on mean diffusivity data in the combined bilateral putamen and middle cerebellar peduncle (accuracy 90.3%±9%, sensitivity 86.5%±11%, and specificity 99.3%±4%). CONCLUSION DTI in the middle cerebellar peduncle and putamen may be used in the diagnosis of MSA with a high degree of accuracy.
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Affiliation(s)
- Aaron Michael Rulseh
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; Department of Radiology, 1st Faculty of Medicine, General University Hospital, Charles University in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Jiri Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic; Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michael Syka
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Hana Brozova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Thomayer Hospital, Prague, Czech Republic
| | - Petra Havrankova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Katerina Zarubova
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Liscak R, Vojtěch Z. Letter to the Editor: Minimally invasive technique for epilepsy surgery. J Neurosurg 2015; 122:1513-4. [PMID: 25859813 DOI: 10.3171/2014.12.jns142834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hana Malikova
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
| | - Zdeněk Vojtěch
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Kramska L, Vojtech Z, Sroubek J, Lukavsky J, Liscak R. Relationship between remnant hippocampus and amygdala and memory outcomes after stereotactic surgery for mesial temporal lobe epilepsy. Neuropsychiatr Dis Treat 2015; 11:2927-33. [PMID: 26640379 PMCID: PMC4657808 DOI: 10.2147/ndt.s95497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Mesial temporal structures play an important role in human memory. In mesial temporal lobe epilepsy (MTLE), seizure activity is generated from the same structures. Surgery is the definitive treatment for medically intractable MTLE. In addition to standard temporal lobe microsurgical resection, stereotactic radiofrequency amygdalohippocampectomy (SAHE) is used as an alternative MTLE treatment. While memory impairments after standard epilepsy surgery are well known, it has been shown that memory decline is not a feature of SAHE. The aim of the present study was to correlate the volume of the remnant hippocampus and amygdala in patients treated by SAHE with changes in memory parameters. MATERIALS AND METHODS Thirty-seven MTLE patients treated by SAHE (ten right, 27 left) were included. Patients underwent magnetic resonance imaging examinations including hippocampal and amygdalar volumetry and neuropsychological evaluation preoperatively and 1 year after surgery. RESULTS Using Spearman correlation analyses, larger left-sided hippocampal reductions were associated with lower verbal memory performance (ρ=-0.46; P=0.02). On the contrary, improvement of global memory quotient (MQ) was positively correlated with larger right-sided hippocampal reduction (ρ=0.66; P=0.04). Similarly, positive correlations between the extent of right amygdalar reduction and verbal MQ (ρ=0.74; P=0.02) and global MQ change (ρ=0.69; P=0.03) were found. Thus, larger right hippocampal and amygdalar reduction was associated with higher global and verbal MQ change after SAHE. CONCLUSION Larger left-sided hippocampal reductions were associated with lower verbal memory performance. This finding is in accordance with the material-specific model of human memory, which states that the dominant hemisphere is specialized for the learning and recall of verbal information. We hypothesize that larger right-sided ablations enable the left temporal lobe to support memory more effectively, perhaps as a consequence of epileptiform discharges spreading from remnants of right mesiotemporal structures to the left.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic ; Institute of Anatomy, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Lenka Kramska
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic ; Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Abstract
Whipple disease (WD) is a rare systemic disorder caused by the bacteria Tropheryma whipplei. In its classic form, it manifests with gastrointestinal problems including diarrhea, abdominal pain, and weight loss. However, various other systems can be affected, including the central nervous system (CNS). Even more rarely, the CNS is primarily affected without gastrointestinal symptoms and with a negative small bowel biopsy. The incidence of primary CNS WD is unknown. We report the case of a young female with the primary CNS form of WD. In this report, we highlight the main clinical features and diagnostic procedures that lead to the diagnosis and comment on the treatment and clinical response. We stress the importance of neuroimaging and brain biopsy. A unique feature of this case is that the patient has been followed up for 12 years. At the time of diagnosis, no neurological manifestations were detected, although a tumor-like lesion in the right temporal lobe and hypothalamic infiltration were present on magnetic resonance imaging (MRI). The first neurological manifestations developed 2 years later despite recommended antibiotic treatment, with cognitive impairment developing more than 10 years later. According to the MRI findings and clinical course, the disease was active for several years when multiple lesions on MRI appeared despite antibiotic therapy. In the discussion, we compare the present case with similar cases previously reported and we elaborate on the similarities and discrepancies in clinical features, diagnostic procedures, results, and treatment options.
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Affiliation(s)
- Jan Peregrin
- Department of Neurology, Charles University, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Na Homolce Hospital, Charles University, Prague, Czech Republic ; Second Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic
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Malikova H, Kramska L, Vojtech Z, Liscak R, Sroubek J, Lukavsky J, Druga R. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg 2014; 92:372-80. [PMID: 25359168 DOI: 10.1159/000366003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. OBJECTIVES We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. MATERIAL AND METHODS 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). RESULTS SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. CONCLUSION Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Liscak R, Latnerova I, Guseynova K, Syrucek M, Pytlik R. Complications of MRI-guided stereotactic biopsy of brain lymphoma. Neuro Endocrinol Lett 2014; 35:613-618. [PMID: 25617885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/30/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Stereotactic biopsy is a suitable method for sampling intrinsic brain lesions. Although this method is considered to be a safe procedure, some risk of complications still exists. The aim of the study was to retrospectively assess the morbidity and mortality of MRI-guided stereotactic biopsy of lesions which were histologically proven to be brain lymphoma. METHODS We retrospectively studied all accessible medical records for patients who had undergone MRI-guided stereotactic biopsy of brain lesions with histologically proven brain lymphoma from January 2007 to December 2012. Our cohort included 45 patients, 27 males and 18 females, aged 23-84 (63±14) years. RESULTS Forty-nine biopsies were carried out on 45 patients; the average number of tissue specimens was 3±1. The diagnostic yield of the stereotactic biopsy was 92%. Overall major morbidity directly related to stereotactic biopsy of brain lymphoma was 6.1% (3 cases) including 4.1% mortality (2 cases). Both deaths after the stereotactic procedure were due to intracranial hemorrhage and subsequent complications and both these patients had a history of treatment of systemic lymphomas. In one patient the stereotactic biopsy was complicated by a brain abscess which was successfully treated. CONCLUSION Stereotactic biopsy is still a mandatory diagnostic procedure for primary brain lymphomas, with an acceptable risk of complications. However, according to our results, the risk of complications can be higher in patients who have previously been treated for secondary lymphomas.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Iva Latnerova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Khumar Guseynova
- Department of Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Martin Syrucek
- Department of Pathology, Na Homolce Hospital, Prague, Czech Republic
| | - Robert Pytlik
- 1st Faculty of Internal Medicine, 1st Medical Faculty, Charles University, Prague, Czech Republic
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Malikova H, Kramska L, Liscak R, Vojtech Z, Prochazka T, Mareckova I, Lukavsky J, Druga R. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: Do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epilepsy Res 2012; 102:34-44. [DOI: 10.1016/j.eplepsyres.2012.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/28/2012] [Accepted: 04/21/2012] [Indexed: 11/26/2022]
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Malikova H, Liscak R, Vojtech Z, Prochazka T, Vymazal J, Vladyka V, Druga R. Stereotactic radiofrequency amygdalohippocampectomy: Does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome? Epilepsia 2011; 52:932-40. [DOI: 10.1111/j.1528-1167.2011.03048.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liscak R, Malikova H, Kalina M, Vojtech Z, Prochazka T, Marusic P, Vladyka V. Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir (Wien) 2010; 152:1291-8. [PMID: 20361215 DOI: 10.1007/s00701-010-0637-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/12/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Minimally invasive percutaneous single trajectory stereotactic radiofrequency amygdalohippocampectomy was used to treat mesial temporal lobe epilepsy (MTLE). The aim of the study was to evaluate complications and effectiveness of this procedure. MATERIALS AND METHODS A group of 51 patients with MTLE was treated using stereotactic thermo-lesion of amygdalohippocampal complex under local anaesthesia. The target was reached through the occipital approach with a single trajectory using MRI stereotactic localisation. Thermocoagulation of the amygdalohippocampal complex was planned according to the individual anatomy of each patient. Amygdalohippocampectomy was performed using a string electrode with a 10-mm active tip, and 16-38 lesions (median = 25) were performed in all patients along the 30- to 45-mm trajectory (median = 35) in the amygdalohippocampal complex. RESULTS The procedure was well tolerated by all patients with no severe permanent morbidity; meningitis was recorded in two patients (4%), hematoma was detected in four patients, clinically insignificant in three of them, and one patient required temporary ventricular drainage (2%). Thirty-two patients were followed up over at least 2 years, and the clinical outcomes were evaluated by Engel's classification; 25 of them (78%) were Engel I, five (16%) were Engel II, and two (6%) were Engel IV. CONCLUSIONS Stereotactic amygdalohippocampectomy is a minimally invasive procedure with low morbidity and good results that can be the method of choice in selected patients with MTLE.
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Affiliation(s)
- Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Hospital Na Homolce, Roentgenova 2, Prague, Czech Republic.
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Malikova H, Vojtech Z, Liscak R, Prochazka T, Vymazal J, Mareckova I, Kalina M, Dbaly V, Keller J, Vladyka V. Microsurgical and Stereotactic Radiofrequency Amygdalohippocampectomy for the Treatment of Mesial Temporal Lobe Epilepsy: Different Volume Reduction, Similar Clinical Seizure Control. Stereotact Funct Neurosurg 2010; 88:42-50. [DOI: 10.1159/000268741] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 10/13/2009] [Indexed: 11/19/2022]
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Belohlavek O, Votrubova J, Malikova H, Weichet J. Image fusion in cardiology. Nucl Med Rev Cent East Eur 2005; 8:87-9. [PMID: 16437391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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Malik J, Slavikova M, Malikova H, Maskova J. Many clinically silent access stenoses can be identified by ultrasonography. J Nephrol 2002; 15:661-5. [PMID: 12495280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2002] [Revised: 07/19/2002] [Accepted: 10/10/2002] [Indexed: 02/28/2023]
Abstract
BACKGROUND Stenoses of vascular accesses are leading factors limiting access survival. Besides physical examination, screening of access stenoses is based mainly on the "dysfunction hypothesis", which states that progressive stenosis causes graft dysfunction, such as decreased flow. We tested whether Doppler ultrasonography could detect a number of clinically hidden access stenoses in otherwise well-managed patients. Indications from clinical evaluation regarding the presence of stenosis were compared with ultrasound findings. METHODS We made 258 examinations in 193 patients. Whole-length morphological ultrasound examinations of vascular access were done with a 7.5 MHz linear array transducer. The combination of > 50% stenosis in B-mode and at least doubling of peak systolic velocity was the criterion for significant stenosis. We compared the specificity and sensitivity of clinical diagnosis or ultrasound. RESULTS The sensitivity and specificity of the clinical diagnosis of stenosis were 35.8% and 92.8%, respectively. CONCLUSIONS A considerable number of otherwise appropriately managed hemodialysis patients suffer from significant access stenosis. Wider use of Doppler ultrasonography would increase the proportion of clinically hidden stenoses diagnosed in time and thus might prolong access patency. Clinical suspicion of access stenosis is highly specific and such patients should be examined directly by angiography.
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Affiliation(s)
- Jan Malik
- Third Department of Internal Medicine, General University Hospital, First Medical School of Charles University, Prague, Czech Republic.
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