Gordana Ivanac

Smaller right hippocampus in war veterans with posttraumatic stress disorder

Chronic stress can putatively cause damage in the human hippocampus, but evidence of damage has not been consistently shown in studies on hippocampal morphology in posttraumatic stress disorder (PTSD). We compared hippocampal volumes in PTSD patients and normal subjects. Using a 3D T1-weighted GRE magnetic resonance imaging sequence, we measured hippocampal volumes in 15 war veterans with combat-related chronic PTSD and 15 case-matched normal controls. Although war veterans, our PTSD subjects were not professional soldiers and were mobilized shortly before they were exposed to a very specific combat-related trauma over a 3-day period. In our study, the period between traumatic exposure and imaging was considerably shorter, on average, 9 years, compared with at least two decades in previous studies on subjects with combat-related PTSD. Moreover, our subjects were free of any comorbidity, treatment or medication. The right hippocampus was significantly smaller in PTSD subjects than in healthy controls. The left hippocampus was also smaller in PTSD subjects than in controls, but the difference was not significant. In all PTSD subjects, the right hippocampus was smaller than the left (on average, 7.88%). Our results show smaller volume of the right hippocampus in PTSD patients than in normal subjects.

Ultrasound-guided bipolar radiofrequency ablation of breast cancer in inoperable patients: a pilot study.

PURPOSE Radiofrequency ablation (RFA) is a promising minimal invasive modality to treat small breast cancer (BCA). In most studies cancers were surgically excised shortly after RFA. We present six patients inoperable when diagnosed with BCA, and performed RFA instead of surgery. MATERIALS AND METHODS Ultrasound-guided bipolar RFA was performed under local anesthesia in six women aged 63 - 85 years. They had core-biopsy proven T 1 - 2N0 M0, grade I or II, 1.0 - 2.7 cm sized invasive ductal cancers, with positive estrogen receptor status. Four tumors measured > 2 cm, and three 1.0 - 1.2 cm in diameter. Patients were at high-risk for general anesthesia and surgery because of severely impaired cardiac function, advanced age, or associated diseases (acute myeloid leukaemia (AML), diabetes, hypertension, depression) and/or refused surgery. RESULTS Six tumors in five patients were completely ablated, without recurrence during follow-up (range: 9 - 49 months). One superficially located cancer was partially ablated; the patient died two months later from myocardial infarction. The Patient with AML and BCA had an infection of the treated breast after 4 months and postponed mastectomy to an AML remission status. There were no signs of malignancy in histopathology; the patient finally died of leukemia 42 months after RFA. The remaining four patients are well, without complications. CONCLUSION Ultrasound-guided percutaneous RFA under local anesthesia is an effective alternative to surgery for BCA < 3 cm in patients with a high-risk for surgery.

An unusual case of bronchial rupture—pneumomediastinum appearing 7 days after blunt chest trauma

We present a case of bronchial disruption after blunt chest trauma, which is unusual because the pneumomediastinum on the chest radiograph was detected 7 days after the injury. The first day imaging methods of the thorax showed only the fractures of the first and third left rib without any complications. A computed tomography (CT) scan was done following control chest radiograph and it revealed a rupture of the left main bronchus with pleural effusion, subcutaneous emphysema and pneumomediastinum. This case shows that a finding of pneumomediastinum after blunt chest trauma should always merit further investigation of its cause, even in cases of postponed detection of pneumomediastinum and regardless of the absence of other indicators of tracheobronchial disruption. Although fiber-optic tracheobronchoscopy is considered a diagnostic golden standard, in this case, diagnosis was clearly confirmed by spiral CT scan, due to thin slices and continuous data acquisition.

Shear-wave sonoelastographic features of invasive lobular breast cancers

Aim To evaluate shear-wave elastographic (SWE) and related gray-scale features of pure invasive lobular breast carcinoma (ILC) and compare them with invasive ductal breast cancers (IDC). Methods Quantitative SWE features of mean (El-mean), maximum (El-max), minimum (El-min) elasticity values of the stiffest portion of the mass, and lesion-to-fat elasticity ratio (E-ratio) were measured in 40 patients with pure ILC and compared with 75 patients with IDC. Qualitative gray-scale features of lesion size, echogenicity, orientation, and presence of distal shadowing were determined and compared between the groups. Results ILC were significantly larger than IDC (P = 0.008) and exhibited significantly higher El-max (P = 0.015) and higher El-mean (P = 0.008) than IDC. ILC were significantly more often horizontally oriented, while IDC were significantly more often vertically oriented (P < 0.001); ILC were significantly more often hyperechoic than IDC (P < 0.001). Differences in stiffness between ILC and IDC determined by quantitative SWE parameters were present only in small tumors (≤1.5 cm in size), ie, small ILC had significantly higher El-max (P = 0.030), El-mean (P = 0.014), and El-min (P = 0.045) than small IDC, while tumors larger than 1.5 cm had almost equal stiffness, without significant differences between the groups. Conclusion Specific histopathologic features of ILC are translated into their qualitative sonographic and quantitative sonoelastographic appearance, with higher stiffness of small ILC compared to small IDC. Gray-scale and sonoelastographic features may help in diagnosing ILC.

Mummified remains from the Archaeological museum in Zagreb, Croatia - reviewing peculiarities and limitations of human and non-human radiological identification and analysis in mummified remains

Forensic protocols and medico-legal techniques are increasingly being employed in investigations of museological material. The final findings of such investigations may reveal interesting facts on historical figures, customs and habits, as well as provide meaningful data for forensic use. Herein we present a case review where forensic experts were requested to identify taxonomic affinities, stage of preservation and provide skeletal analysis of mummified non-human archaeological remains, and verify whether two mummified hands are human or not. The manuscript offers a short review on the process and particularities of radiological species identification, the impact of post-mortem changes in the analysis and imaging of mummified remains as well as the macroscopical interpretation of trauma, pathology and authenticity in mummified remains, which can all turn useful when dealing with forensic cases.

Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis

Aim To evaluate the role of gray-scale and color duplex-Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. Methods Ulnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). Results Clinical indicators changed significantly after treatment: ESR from 38.1 ± 22.4 mm/h to 27.8 ± 20.9 mm/h (P = 0.013), DAS 28 from 5.47 ± 1.56 to 3.87 ± 1.65 (P < 0.001), and HAQ from 1.26 ± 0.66 to 0.92 ± 0.74 (P = 0.030), indicating therapeutic effectiveness. In all MCP and UC joints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol. Conclusion Gray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy.

Evaluation of Breast Cancer Morphology Using Diffusion-Weighted and Dynamic Contrast-Enhanced MRI: Intermethod and Interobserver Agreement: Breast Cancer Morphology: DWI vs. DCE MRI

The capability of diffusion‐weighted imaging (DWI) for morphological analysis of breast lesions is underexplored.

Association of Wnt Inhibitors, Bone Mineral Density and Lifestyle Parameters in Women with Breast Cancer Treated with Anastrozole Therapy

Aim: To determine the levels of Wnt inhibitors in patients treated with aromatase inhibitors (AIs) prior to therapy and to investigate their association with bone mineral density (BMD) and lifestyle parameters. Methods: 137 breast cancer patients were divided into a group treated with 1 mg of anastrozole and a group w/o anastrozole therapy. Serum concentrations of sclerostin and dickkopf1 (DKK1) were measured by ELISA. BMD was measured by dual-energy X-ray absorptiometry (DXA). Lifestyle factors were investigated by a self-reported questionnaire. Results: Sclerostin was significantly higher in the AI-treated group (31.8 pmol/L vs. 24.1 pmol/L; p < 0.001), whereas DKK1 was significantly lower in the AI-treated group (24.3 pmol/L vs. 26.02 pmol/L; p < 0.001). Total hip and femoral neck BMD were significantly lower in the AI-treated group. Conclusion: AI treatment was associated with increased levels of sclerostin and decreased levels of DKK1.

Quantification of coronary atherosclerotic burden with coronary computed tomography angiography: adapted Leaman score in Croatian patients

The aim of the study was to quantify the total coronary atherosclerotic burden in patients with suspected coronary artery disease (CAD) defined by coronary computed tomography adapted Leaman score (CT-LeSc) and to estimate its cut-off level for high coronary atherosclerotic burden. We enrolled 434 consecutive patients referred to coronary computed tomography angiography, of which 261 patients fulfilled the study inclusion criteria. Demographic and clinical characteristics, as well as CAD risk factors were obtained. CAD pre-test probabilities were estimated by the Diamond-Forrester model and Morise score. The coronary atherosclerotic burden was estimated using CT-LeSc. As a cut-off for a high coronary atherosclerotic burden, we used 3rd tercile (Tc3) (CT-LeSc ≥ 5.52). We evaluated the association of clinical characteristics and risk factors with Tc3 in univariate and multivariate analysis. There were 60.9% males and 39.1% females, 81% of patients had above-normal weight, 68.2% hypertension, 54.0% dyslipidemia, 15.3% diabetes mellitus, 12.3% positive smoking history and 11.9% had a family history of CAD. According to the Diamond-Forrester model and Morise score the majority of patients had intermediate risk, 59.7 and 52.8%, followed by the high-risk group, 36.0 and 34.4%, respectively. Age, dyslipidemia, hypertension and pre-test risk scores in the univariate analysis significantly predicted Tc3. In the multivariate analysis, male sex (p = 0.004), dyslipidemia (p = 0.002) and coronary calcium score (< 0.001) were identified as predictors of Tc3. CT-LeSc quantified the total coronary atherosclerotic burden and showed an association of risk factors and pre-test probabilities with Tc3.

US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications

PURPOSE The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. METHODS Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. RESULTS The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. CONCLUSION In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications.