Andrzej Ustymowicz

Middle cerebral artery vasospasm: transcranial color-coded duplex sonography versus conventional nonimaging transcranial Doppler sonography.

Objective:To prospectively compare accuracies of transcranial color-coded duplex sonography (TCCS) and transcranial Doppler sonography (TCD) in the diagnosis of middle cerebral artery (MCA) vasospasm. Design:Prospective blinded head-to-head comparison TCD and TCCS methods using digital subtraction angiography (DSA) as the reference standard. Setting:Department of Radiology in a tertiary university health center in a metropolitan area. Patients:Eighty-one consecutive patients (mean age, 53.9 ± 13.9 years; 48 women). The indication for DSA was subarachnoid hemorrhage in 71 patients (87.6%), stroke or transient ischemic attack in five patients (6.2%), and other reasons in five patients (6.2%). Interventions:The MCA was graded as normal, narrowed <50%, and >50% using DSA. The accuracy of ultrasound methods was estimated by total area (Az) under receiver operator characteristic curve. To compare sensitivities of ultrasound methods, McNemar’s test was used with mean velocity thresholds of 120 cm/sec for the detection of less advanced, and 200 cm/sec for the more advanced MCA narrowing. Measurements and Main Results:Angiographic MCA narrowing ≤50% was found in 21, and >50% in 10 of 135 arteries. Accuracy of TCCS was insignificantly higher than that of TCD in the detection of ≤50% and >50% narrowing, total Az for mean velocity being 0.83 ± 0.05, 0.77 ± 0.05, and 0.95 ± 0.02, 0.86 ± 0.08, respectively. Sensitivity of TCCS at commonly used threshold of 120 cm/sec for less advanced MCA spasm was significantly better than that of TCD at similar specificity, 55% vs. 39%, p = 0.038, whereas at a threshold of 200 cm/sec used for more advanced spasm, sensitivities and specificities of both methods were not different. Conclusion:The accuracy of TCCS and TCD is similar, but TCCS is more sensitive than TCD in the detection of MCA spasm. Sensitivity of both techniques in the detection of mild and more advanced spasm using 120 cm/sec and 200 cm/sec thresholds, respectively, is poor; however, a larger sample is required to increase precision of our sensitivity estimates.

Twinkling artifact in color Doppler imaging of the orbit.

Objective. To show an artifact related to color Doppler flow imaging of the orbit. Methods. Three patients with strongly reflective structures in the orbit were selected from those routinely referred by clinicians for color Doppler ultrasonography of the orbit. Gray scale and color flow images were obtained with a 7.5‐MHz linear array probe for a region with strongly reflective structures. A spectral display was acquired to confirm the presence of blood flow. Results. One patient had a metallic foreign body just behind the bulb; another had calcification within the irregular mass of phthisis bulbi; and the third had hyperechoic drusen in the periphery of the intraocular melanoma. The color mosaic, suggesting the presence of blood flow, was detected beyond all hyperechoic structures. Close vertical bands with no outer wrapping were detected in the spectrum display, obtained by placing the sample volume on the region of color flow. The artificial color flow was recognized as a color Doppler twinkling artifact. Conclusions. The color flow beyond the strongly reflecting structures in the orbit might be mistakenly interpreted as real blood flow if an examiner is not familiar with the artifact. It should prompt further imaging with spectral Doppler ultrasonography.

Vasculitis and stroke due to Lyme neuroborreliosis - a review

Abstract Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicion is required in patients who live or have traveled to areas with high prevalence of tick-borne diseases, and in the case of stroke-like symptoms of unknown cause in patients without cardiovascular risk factors. In this review, we also present four illustrative cases of vasculitis and stroke-like manifestations of LNB.

Comparison of contrast-enhanced ultrasonography with grey-scale ultrasonography and contrast-enhanced computed tomography in diagnosing focal fatty liver infiltrations and focal fatty sparing

PURPOSE Fatty liver infiltrations and fatty sparing impair diagnostic performance of grey-scale ultrasonography in differentiating malignant and benign focal liver lesions. In the study, we present our experience in diagnosing focal fatty liver infiltrations and focal fatty sparing with contrastenhanced ultrasonography (CEUS) in comparison to grey-scale ultrasonography and contrast-enhanced computed tomography (CECT). MATERIAL AND METHOD The retrospective study group (n=82 patients), included 44 (53.7%) men, 38 (46.3%) women (aged 29- 81 years, mean 55.8 years) with 48 focal fatty liver infiltrations and 34 focal fatty sparing. All patients underwent grey-scale ultrasonography (US), CEUS using SonoVue® and CECT executed within the 7 days. RESULTS With US, CEUS and CECT focal fatty liver infiltrations were diagnosed in 22, 46 and 44 cases, respectively. The following values were obtained: sensitivity - 45.8%, 95.8% and 91.7%, specificity - 100% for all, accuracy - 95.2%, 99.6% and 99.3%, respectively. Focal fatty sparing was diagnosed in 16, 31 and 30 cases, respectively. The following values were obtained: sensitivity - 47.1%, 91.2% and 88.2%, specificity - 99.8%, 100% and 100%, accuracy - 95.6%, 99.4% and 99.3%, respectively. No statistically significant differences were found in sensitivity of diagnosing focal fatty liver infiltrations and focal fatty liver sparing between CEUS and CECT. Sensitivity of grey-scale ultrasonography was significantly lower when compared to those of CEUS and CECT (p<0.001). CONCLUSION CEUS is as sensitive as CECT in focal fatty infiltrations and focal fatty sparing diagnosing. However, CEUS provides more information than CECT about the vasculature and enhancement pattern of focal fatty liver infiltrations.

Ultrasound assessment of the jugular and vertebral veins in healthy individuals: selected physiological aspects and morphological parameters.

Aim Ultrasound assessment of morphological parameters of the internal jugular veins and vertebral veins in healthy individuals as well as their dependence on the patients position. Material The examinations were conducted in 185 healthy individuals (101 females and 84 males) aged 18–89. Ultrasound examinations were conducted with the use of a linear probe with the frequency of 5–9 MHz in the supine (0°) and sitting position (90°). Results In 154 cases (83.2%) on the left side and in 150 cases (81.1%) on the right side, the jugular veins were completely closed in the sitting position. In 31 cases (16.8%) on the left side and in 35 cases (18.9%) on the right side, they were merely narrowed. By contrast with the jugular veins, the cross-sectional area (CSA) of the vertebral veins was greater in the sitting position than in the supine position in a statistically significant way. The CSA values of the jugular veins in the supine position ranged from 0 cm2 to 4.3 cm2. There were no statistically significant differences in the CSA between men and women. The cross-sectional area of the right jugular vein in the supine position was greater in a statistically significant way than that of the left jugular vein. In this study population, the ratio of the cross-sectional areas of the jugular veins on both sides amounted to 8.5:1. Conclusions The width of the jugular and vertebral veins significantly varies depending on the patients position. The range of the CSA values for the jugular veins is broad, which should be taken into account when interpreting imaging findings. The internal jugular veins can show considerable asymmetry.

Infectious spondylodiscitis – A case series analysis

PURPOSE We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis. MATERIALS/METHODS We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy. RESULTS There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed. CONCLUSIONS Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.

Cross-sectional area of the femoral vein varies with leg position and distance from the inguinal ligament

Purpose The risk of complications associated with femoral venous catheterization could be potentially reduced if the procedure was performed at the location where the cross-sectional area (CSA) of the vessel is the largest. The diameter of the femoral vein depends on leg position as well as the distance from the inguinal ligament. We determined the CSA of the right femoral vein in three different leg positions at two distances from the inguinal ligament. Subjects and methods Informed consent was given by 205 healthy volunteers aged 19–39 years, mean: 23±3 years (108 women, 97 men). Ultrasonographic examinations were performed using a linear 14-MHz transducer with CSA measurements in three leg positions: abduction, abduction+external rotation, abduction+external rotation+90° knee flexion/frog-leg position; at levels 20 mm caudally to the inguinal ligament, and 20 mm caudally to the inguinal crease. Results We found significant differences in mean values of CSA in three leg positions regardless of the measurement level. The largest mean CSA (114 mm2±35 mm2) was found at the proximal level in the frog-leg position. There was a significant association of the CSA with sex and height. The CSA in males was greater than in females in all leg positions at the level of 20 mm caudally to the inguinal crease, while 20 mm caudally to the inguinal ligament the CSA was larger in females. The CSA of 25% of the femoral vein was smaller than 45.0 mm2 at the proximal level, and 31.5 mm2 at the distal level, which refers to diameters of 5.3 mm, and 4.5 mm, respectively. Conclusions The cross-sectional area of the femoral vein is the largest in the frog-leg position, and depends on gender.

Computerized tomography of the transverse pericardial sinus: Normal or pathologic?

The transverse pericardial sinus is a uniquely located structure subdivided into many parts. However, discrepancies still exist on the nomenclature and divisions. As noninvasive diagnostic technology such as CT and MR imaging improve, the transverse pericardial sinus and constituent recesses are visualized with more clarity, increasing the risk for misinterpretation. In this review, we will explore the anatomy of the transverse pericardial sinus and associated recesses with the goal of heightening awareness regarding the differential diagnosis between normal and pathological states as seen on CT. In addition, the inconsistencies of the right lateral superior aortic recess are also addressed. Last, we describe the clinical and surgical significance of the transverse pericardial sinus. Clin. Anat. 30:61–70, 2017.

Ultrasound assessment of the caliber of the arteries in the lower extremities in healthy persons – the dependency on age, sex and morphological parameters of the subjects

Aim The aim of this paper was to evaluate the caliber of the following arteries in the lower extremities: the common femoral artery, superficial femoral artery, popliteal artery, posterior tibial artery and dorsalis pedis artery and to determine the relation of the calibers to age, sex and morphological parameters of the body such as weight, height and BMI of the subject. Material Two hundred and twenty-eight healthy persons aged 18–81 were examined (average ±SD; 43.1±16.71): 134 women aged 19–74 (43.2±15.63) and 94 men aged 18–81 (43±18.22). Methods The study was conducted with the use of a linear probe of 7.5 MHz frequency. The vascular caliber was assessed after the color map (color Doppler) was placed on a B-mode image. Results The average and standard deviation values for the calibers of examined vessels were determined. The calibers of all vessels examined in the group of men were statistically significantly larger than those in the group of women. No statistically significant differences between the calibers of the right and left sides were determined. The statistically significant correlations were specified between the age and the caliber of the examined vessels; positive for large femoral arteries and negative for the arteries of the crus and foot. Positive, statistically significant correlations between the caliber and the height, weight and BMI were also reported. Conclusions The reported calibers of the arteries in the lower extremities and their relation to age, sex and morphological parameters of the subjects enable the differentiation of the physiological remodeling of the vessels from the pathological processes in e.g. atherosclerosis or hypertension.