Úvod: Obstrukce žlučových cest je závažným stavem spojeným s vysokou morbiditou a mortalitou, vyžadující přesnou diagnostiku a vhodně indikovanou terapii. Cílem prospektivní studie bylo zhodnotit proveditelnost a senzitivitu perkutánní endobiliární kryobiopsie ve srovnání s klešťovou biopsií u pacientů se stenózou žlučových cest podstupujících perkutánní drenáž žlučových cest. Metodika: Klešťová biopsie i kryobiopsie byly provedeny během jednoho zákroku a jejich pořadí bylo randomizováno. Byl hodnocen technický úspěch, velikost vzorků, jejich kvalita a diagnostická přesnost. Výsledky: Celkem bylo získáno 90 vzorků (n = 47 biopsie kleštěmi, n = 43 kryobiopsie) od sedmi pacientů. Kryobiopsie poskytla signifikantně větší celkovou plochu mikroskopických vzorků (medián: 2,67 mm2 pro kryobiopsii vs. 0,44 mm2 pro kleště; p < 0,01) a signifikantně větší plochu vzorků bez artefaktů (medián: 1,47 mm2 vs. 0 mm2; p < 0,01). Počet nehodnotitelných vzorků kvůli artefaktům byl u kryobiopsie významně nižší (11,63 % vs. 53,19 %; p < 0,01). Medián hmotnosti vzorků z kryobiopsie byl rovněž signifikantně vyšší než u vzorků z biopsie kleštěmi (7,6 mg vs. 3,5 mg; p = 0,015). Při hodnocení histopatologické kvality na Likertově škále dosáhly vzorky z kryobiopsie významně lepších výsledků než vzorky z biopsie kleštěmi (medián 4 vs. 1; p < 0,01), a to i v podílu vzorků hodnocených jako kvalitní (Likert > 2) (74,42 % vs. 29,79 %; p < 0,01). Adenokarcinom byl prokázán u pěti pacientů, benigní etiologie stenózy u dvou pacientů. Kryobiopsie úspěšně diagnostikovala všech pět případů adenokarcinomu (5/5), zatímco biopsie kleštěmi odhalila pouze dva z těchto pěti případů. Závěr: Získané výsledky naznačují, že kryobiopsie představuje efektivní a přesnou metodu pro diagnostiku malignit žlučových cest, s potenciálním přínosem pro včasnou diagnostiku a cílenou terapii.

Introduction: Obstruction of the bile ducts is a serious condition associated with high morbidity and mortality, requiring accurate diagnosis and appropriate therapy. The goal of this prospective study is to assess the feasibility and sensitivity of percutaneous endobiliary cryobiopsy in comparison with forceps biopsy in patients with billiary duct stenosis. Methods: Both forceps biopsy and cryobiopsy were performed during a single proce- dure, the order of sampling was randomized. Technical success, sample size, quality, and diagnostic accuracy were evaluated. Results: A total of 90 samples were collected (n = 47 conventional forceps biopsy, n = 43 cryobiopsy). Cryobiopsy provided a significantly larger total sample area of microscopic specimen (median 2,67 vs. 0,44 mm2 ; p < 0,01), artefact-free sample area (median 1,47 vs. 0 mm2 ; p < 0,01), smaller number of samples non-evaluable for artefacts (11,6 % vs. 53,2 %; p < 0,01). Median weight of cryobiopsy samples was significantly greater than that of forceps biopsy (7,6 vs. 3,5 mg; p = 0,015). In quality assessment cryobiopsy samples achieved significantly better results than the forceps biopsy both in terms of the median Likert scale value (4 vs. 1; p < 0.01) and in terms of the frequency of quality samples rated as Likert > 2 (74,42 vs. 29,79%; p < 0.01). Biopsy proved adenocarcinoma in 5 patients, 5/5 of them in set of cryobiopsy samples, while only 2/5 in forceps biopsy samples. Conclusion: The obtained results suggest that cryobiopsy could represent an effective and accurate method for diagnosing bile duct malignancies, with potential benefits for early diagnosis and targeted therapy.

Úvod: Zobrazovací metody mají v diagnostice pacientů s Crohnovou chorobou nezastupitelnou úlohu. V současné době existuje několik skórovacích systémů, jejichž cílem je pomocí předem stanovených parametrů objektivizovat hodnocení zánětlivého postižení střeva. Cílem této práce bylo srovnání nálezu zánětlivého střevního postižení na koloskopii a magnetické rezonanci (MR) při použití skórovacího systému MaRIA. Materiály a metody: Pacienti s Crohnovou chorobou podstoupili v rozmezí do 2 měsíců koloskopii a MR enterografii ve Fakultní nemocnici Brno v letech 2020–2022. Aktivita onemocnění na koloskopii byla hodnocena pomocí SES-CD a Rutgeerts score, na MR pomocí MaRIA skóre (zesílení stěny, její sycení, edém a přítomnost ulcerací). Nálezy z obou zobrazovacích metod byly srovnány, koloskopie byla zvolena zlatým standardem. U každého pacienta bylo analyzováno terminální ileum, tlusté střevo (rozdělené anatomicky na čtyři segmenty) a rektum. Výsledky: V této retrospektivní studii bylo analyzováno 203 střevních segmentů u 43 po sobě jdoucích pacientů (42 % mužů). Senzitivita MR enterografie v hodnocení aktivity střevního zánětu byla 62 %, specificita 94 %. Všechny parametry určující aktivitu zánětu na MR byly signifikantně vyšší u pacientů s aktivitou dle koloskopie a celková hodnota MaRIA skóre byla rovněž vyšší v této skupině (12,76 ± 7,48 vs. 5,27 ± 3,45; p < 0,001). Senzitivita se zvýšila na 90 % při izolované analýze tenkého střeva, při analýze tlustého střeva se naopak snížila na 34 %. Závěr: V naší studii jsme prokázali shodu mezi MR s použitím MaRIA skórovacího systému a koloskopií při hodnocení střevního zánětu u pacientů s Crohnovou chorobou.

Introduction: Imaging methods have an irreplaceable role in the diagnosis of Crohn’s disease. Several scoring systems are currently available to objectify the assessment of inflammatory bowel disease using predetermined parameters. The aim of this study was to compare the findings of inflammatory bowel involvement on colonoscopy and MRI using the MaRIA scoring system. Materials and methods: Patients with Crohn’s disease underwent colonoscopy and MR-enterography at the University Hospital Brno within 2 months between 2020 and 2022. Disease activity on colonoscopy was evaluated by SES-CD and Rutgeerts score; and on MRI by MaRIA score (wall thickening, wall enhancement, edema, and presence of ulceration). Findings from both imaging modalities were compared, and colonoscopy was chosen as the gold standard. In each patient, the terminal ileum, colon (divided anatomically into 4 segments), and rectum were analyzed. Results: 203 intestinal segments in 43 consecutive patients (42% male) were analyzed in this retrospective study. The sensitivity of MR enterography in the evaluation of intestinal inflammation activity was 62% and specificity was 94%. All parameters determining the activity of inflammation on MR were significantly higher in patients with activity according to the colonoscopy, and the overall MaRIA score was also higher in this group (12.76 ± 7.48 vs. 5.27 ± 3.45; P < 0.001). Sensitivity increased to 90% in isolated small bowel analysis, but decreased to 34% in colonic analysis. Conclusion: In our study, we demonstrated concordance between MRI using the MaRIA scoring system and colonoscopy in the evaluation of intestinal inflammation in patients with Crohn’s disease.

• Klíčová slova
• MaRIA skóre,
• MeSH
• Crohnova nemoc * diagnostické zobrazování   diagnóza   patologie   MeSH
• dospělí MeSH
• kolonoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tlusté střevo diagnostické zobrazování   patologie   MeSH
• vyhodnocení orgánové dysfunkce MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

INTRODUCTION: Muscle magnetic resonance imaging (MRI) is an emerging method in the diagnosis and monitoring of muscular dystrophies. This cross-sectional, comparative study aimed to evaluate quantitative MRI (qMRI) parameters of the lumbar paraspinal muscles (LPM) in myotonic dystrophy type 2 (DM2), to assess their relationship with functional examination, and to evaluate their evolution with aging. METHODS: The study enrolled 37 DM2 patients and 90 healthy volunteers (HV) who were matched based on physiological parameters to create 35 pairs. Utilizing a 6-point Dixon gradient echo sequence MRI, fat fraction (FF), total muscle volume, and functional muscle volume (FMV) of the LPM and psoas muscle (PS) were obtained. Using correlation coefficients and regression models, the relationship between MRI and the maximal isometric lumbar extensor muscle strength (MILEMS) and lumbar extensor muscle endurance (LEME), and their evolution with age, were assessed. RESULTS: LPM showed significantly higher FF in DM2 patients compared to HV (21.3% vs. 11.3%, p-value <0.001). FMV of LPM correlated significantly with MILEMS (ρ = 0.5, p- value = 0.001) and FF with LEME (ρ = -0.49, p- value = 0.002) in DM2. No significant differences in the rate of deterioration in functional and morphological parameters of the LPM with age were observed between the two groups. CONCLUSION: We demonstrated morphological correlates of lumbar extensor muscle dysfunction in DM2 patients. The qMRI parameters of LPM correlated with functional parameters but could not be used either as a reliable biomarker of lumbar extensor muscle impairment or as a biomarker of disease progression.

• Publikační typ
• časopisecké články MeSH

Biliary drainage is then one of the necessary procedures to help patients suffering from icterus to reduce serum bilirubin levels and relieve symptoms. The aim of this study was identifying risk factors for survival in patients with cholangiocarcinoma (CCA) treated with percutaneous transhepatic biliary drainage (PTBD) and to develop a simple scoring system predicting survival from PTBD insertion. This single-centre retrospective study included 175 consecutive patients undergoing PTBD for extrahepatic CCA (perihilar and distal). Prognostic factors affecting survival of patients with CCA treated with PTBD were analysed. A multivariate analysis showed that mass forming tumor with mass larger than 5 cm and presence of metastasis at the time of PTBD served as a negative prognostic factor (p = 0.002), better survival was associated with lower preprocedural bilirubin and lower CRP (p = 0.003). Multivariate analysis identified two significant risk factors for 3-month mortality: mass-forming tumors and bilirubin levels exceeding 185 μmol/L. A simple scoring system was developed to predict 3-month mortality after PTBD in patients with advanced CCA, demonstrating 86.3% negative predictive value and 43.2% positive predictive value.

• MeSH
• bilirubin krev   MeSH
• cholangiokarcinom * mortalita   terapie   patologie   MeSH
• dospělí MeSH
• drenáž * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory žlučových cest * mortalita   terapie   patologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

In contrast to conventional diffusion magnetic resonance imaging (MRI), multi-b-value diffusion MRI methods are able to separate the signal from free water, pseudo-diffusion, and non-Gaussian components of water molecule diffusion. These approaches can then be utilised in so-called intravoxel incoherent motion imaging and diffusion kurtosis imaging. Various parameters provided by these methods can describe additional characteristics of the tissue microstructure and potentially help in the diagnosis and classification of various pathological processes. In this review, we present the basic principles and methods of analysing multi-b-value diffusion imaging data and specifically focus on the known possibilities for its use in the diagnosis of brain lesions. We also suggest possible directions for further research.

• MeSH
• difuzní magnetická rezonance * metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mozek diagnostické zobrazování   MeSH
• nemoci nervového systému * MeSH
• pohyb těles MeSH
• senzitivita a specificita MeSH
• voda MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

MRI is becoming increasingly available and more common. However, it is a long examination, within a limited space, and making strong demands on the patient for proper co-operation. Using survey data collected by prospective questionnaire, this work examines the influence of patient preparation and type of MRI device on patients' subjective perception of the examination. The work analysed 800 patient questionnaires from 7 radiology centres, 12 MRI machines from 3 manufacturers. It was shown that 20% of patients were not informed at all or only insufficiently about the MRI examination by the referring physician, and this had a statistically significant effect on subjective perception as to the length of the examination. In claustrophobic patients, there was no significant difference in the perception of MRI examination between machine types (open vs. closed) or between bore size. This work demonstrated the influence of technical parameters of MRI devices on some other evaluated aspects in terms of patients' perception of MRI examinations (such as noise perception or peripheral nerves irritation) and that the preparation prior to the examination itself plays also an important role. Sufficient explanation from the referring physician, good workplace time management, and sufficient communication with the patient influence the subjective perception of the examination and thus indirectly its diagnostic benefit.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• percepce MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: To evaluate and compare the diagnostic power of [18F]FLT-PET with ceMRI in patients with brain tumours or other focal lesions. METHODS: 121 patients with suspected brain tumour or those after brain tumour surgery were enroled in this retrospective study (61 females, 60 males, mean age 37.3 years, range 1-80 years). All patients underwent [18F]FLT-PET/MRI with gadolinium contrast agent application. In 118 of these patients, a final diagnosis was made, verified by histopathology or by follow-up. Agreement between ceMRI and [18F]FLT-PET of the whole study group was established. Further, sensitivity and specificity of ceMRI and [18F]FLT-PET were calculated for differentiation of high-grade vs. low-grade tumours, high-grade vs. low-grade tumours together with non-tumour lesions and for differentiation of high-grade tumours from all other verified lesions. RESULTS: [18F]FLT-PET and ceMRI findings were concordant in 119 cases (98%). On closer analysis of a subset of 64 patients with verified gliomas, the sensitivity and specificity of both PET and ceMRI were identical (90% and 84%, respectively) for differentiating low-grade from high-grade tumours, if the contrast enhancement and [18F]FLT uptake were considered as hallmarks of high-grade tumour. For differentiation of high-grade tumours from low-grade tumours and lesions of nontumorous aetiology (e.g., inflammatory lesions or post-therapeutic changes) in a subgroup of 93 patients by visual evaluation, the sensitivity of both PET and ceMRI was 90%, whereas the specificity of PET was slightly higher (61%) compared to ceMRI (57%). By receiver operating characteristic analysis, the sensitivity and specificity were 82% and 74%, respectively, when the threshold of SUVmax in the tumour was set to 0.9 g/ml. CONCLUSION: We demonstrated a generally very high correlation of [18F]FLT accumulation with contrast enhancement visible on ceMRI and a comparable diagnostic yield in both modalities for differentiating high-grade tumours from low-grade tumours and lesions of other aetiology.

• MeSH
• dideoxynukleosidy MeSH
• dítě MeSH
• dospělí MeSH
• gadolinium * farmakokinetika   MeSH
• kojenec MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• multimodální zobrazování metody   MeSH
• nádory mozku * diagnostické zobrazování   patologie   metabolismus   MeSH
• pozitronová emisní tomografie * metody   MeSH
• předškolní dítě MeSH
• radiofarmaka MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Lumbar paraspinal muscles (LPM) are a part of the deep spinal stabilisation system and play an important role in stabilising the lumbar spine and trunk. Inadequate function of these muscles is thought to be an essential aetiological factor in low back pain, and several neuromuscular diseases are characterised by dysfunction of LPM. The main aims of our study were to develop a methodology for LPM assessment using advanced magnetic resonance imaging (MRI) methods, including a manual segmentation process, to confirm the measurement reliability, to evaluate the LPM morphological parameters [fat fraction (FF), total muscle volume (TMV) and functional muscle volume (FMV)] in a healthy population, to study the influence of physiological factors on muscle morphology, and to build equations to predict LPM morphological parameters in a healthy population. METHODS: This prospective cross-sectional observational comparative single-centre study was conducted at the University Hospital in Brno, enrolling healthy volunteers from April 2021 to March 2023. MRI of the lumbar spine and LPM (erector spinae muscle and multifidus muscle) were performed using a 6-point Dixon gradient echo sequence. The segmentation of the LPM and the control muscle (psoas muscle) was done manually to obtain FF and TMV in a range from Th12/L1 to L5/S1. Intra-rater and inter-rater reliability were evaluated. Linear regression models were constructed to assess the effect of physiological factors on muscle FF, TMV and FMV. RESULTS: We enrolled 90 healthy volunteers (median age 38 years, 45 men). The creation of segmentation masks and the assessment of FF and TMV proved reliable (Dice coefficient 84% to 99%, intraclass correlation coefficient ≥0.97). The univariable models showed that FF of LPM was influenced the most by age (39.6% to 44.8% of variability, P<0.001); TMV and FMV by subject weight (34.9% to 67.6% of variability, P<0.001) and sex (24.7% to 64.1% of variability, P<0.001). Multivariable linear regression models for FF of LPM included age, body mass index and sex, with R-squared values ranging from 45.4% to 51.1%. Models for volumes of LPM included weight, age and sex, with R-squared values ranged from 37.4% to 76.8%. Equations were developed to calculate predicted FF, TMV and FMV for each muscle. CONCLUSIONS: A reliable methodology has been developed to assess the morphological parameters (biomarkers) of the LPM. The morphological parameters of the LPM are significantly influenced by physiological factors. Equations were constructed to calculate the predicted FF, TMV and FMV of individual muscles in relation to anthropometric parameters, age, and sex. This study, which presented LPM assessment methodology and predicted values of LPM morphological parameters in a healthy population, could improve our understanding of diseases involving LPM (low back pain and some neuromuscular diseases).

• Publikační typ
• časopisecké články MeSH

PURPOSE: To demonstrate advantages of spectral dual-layer computed tomography (CT) in diagnosing pulmonary embolism (PE). To compare D-dimer values in patients with PE and concomitant COVID-19 pneumonia to those in patients without PE and COVID-19 pneumonia. To compare D-dimer values in cases of minor versus extensive PE. METHODS: A monocentric retrospective study of 1500 CT pulmonary angiographies (CTPAs). Three groups of 500 consecutive examinations: 1) using conventional multidetector CT (CTC), 2) using spectral dual-layer CT (CTS), and 3) of COVID-19 pneumonia patients using spectral dual-layer CT (COV). Only patients with known D-dimer levels were enrolled in the study. RESULTS: Prevalence of inconclusive PE findings differed significantly between CTS and CTC (0.8 % vs. 5.4 %, p < 0.001). In all groups, D-dimer levels were significantly higher in PE positive patients than in patients without PE (CTC, 8.04 vs. 3.05 mg/L; CTS, 6.92 vs. 2.57 mg/L; COV, 10.26 vs. 2.72 mg/L, p < 0.001). There were also statistically significant differences in D-dimer values between minor and extensive PE in the groups negative for COVID-19 (CTC, 5.16 vs. 8.98 mg/L; CTS 3.52 vs. 9.27 mg/L, p < 0.001). The lowest recorded D-dimer value for proven PE in patients with COVID-19 pneumonia was 1.19 mg/L. CONCLUSION: CTPAs using spectral dual-layer CT reduce the number of inconclusive PE findings. Plasma D-dimer concentration increases with extent of PE. Cut-off value of D-dimer with 100 % sensitivity for patients with COVID-19 pneumonia could be doubled to 1.0 mg/L. This threshold would have saved 110 (22 %) examinations in our cohort.

• Publikační typ
• časopisecké články MeSH