Kosta Petrovic

Current diagnostic trends in radiology

Since the discovery of X-rays by Wilhelm Conrad Röentgen at the end of the 19th century, diagnostic imaging techniques have been continously improved by technological advances, bringing radiological diagnosis into the very center of modern medicine. Nowadays, it is hard to imagine therapy planning without previous radiological examination. Great advances in the field of computer technology have been accompanied by development of radiological techniques, and today they include not only morphological and anatomical, but also dynamic, functional and molecular imaging. This paper is an overview of new and improved radiological techniques and their implementation.

Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

BACKGROUND/AIM Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. METHODS This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. RESULTS Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. CONCLUSION Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

Recurrent longitudinally extensive transversal myelitis in a patient with Sjögren's syndrome.

INTRODUCTION Longitudinally extensive transverse myelitis (LETM) is a transversal myelitis that extends through three or more vertebral segments in length. CASE REPORT A 52-year-old woman was hospitalized due to pain in the lumbar region, difficulty in walking, hypoesthesia of the anogenital area and urinary retention. In the past medical history, two years earlier, the patient had been diagnosed with transversal myelitis confirmed by MRI of the cervical spine and six months earlier, the patient was diagnosed with primary Sjögrens syndrome (SS). During the current hospitalization MRM of the spinal cord revealed extensive inflammatory lesions of almost the whole spinal cord. Lumbar puncture (LP) revealed mild pleocytosis and slightly increased protein level. Isoelectric focusing of cerebrospinal fluid (CSF) and serum proteins was normal. Visual evoked potentials were normal. Serological testing excluded acute viral infections. Corticosteroid therapy was applied with good therapeutic response. Control MRI revealed regression of pathological changes in the spinal cord. CONCLUSION A wide range of disorders can cause LETM, but usually the first line diagnosis is neuromyelitis optica (NMO). Based on the detection of NMO immunoglobulin G in the serum of affected patients, a variety of allied disorders were grouped under the name of NMO spectrum disorders, including recurrent myelitis associated with LETM and myelitis associated with autoimmune disorders such as SS. There have been only a few cases reported in the literature with recurrent LETM associated with non-organ specific autoimmune disorder.

Duplex doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities

INTRODUCTION The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. MATERIAL AND METHODS During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619 (72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro colour doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. RESULTS 185 (21%) patients had DVT, 366 (42.5%) patients had predominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. COCNCLUSIONS: Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy.

Color doppler ultrasonography and multislice computer tomography angiography in carotid plaque detection and characterization

BACKGROUND/AIM Cerebrovascular diseases are the third leading cause of mortality in the world, following malignant and cardiovascular diseases. Therefore, their timely and precise diagnostics is of great importance. The aim of this study was to compare duplex scan Color Doppler ultrasonography (CDU) with multislice computed tomography angiography (MSCTA) in detection of morphological and functional disorders at extracranial level of carotid arteries. METHODS The study included 75 patients with 150 carotid arteries examined in the period from January 2008 to April 2009. The patients were firstly examined by CDU, then MSCTA, followed by the surgery of extracranial segment of carotid arteries. In 10 patients, the obtained material was referred for histopathological (HP) examination. We used both CDU and MSCT in the analysis of: plaque surface, plaque structure, degree of stenosis, and the presence of in-traplaque hemorrhage. RESULTS The results obtained by CDU and MSCTA were first compared between themselves, and then to intraoperative findings. Retrospective analysis showed that MSCTA is more sensitive than CDU in assessment of plaque surface (for smooth plaques CDU 89%: MSCTA 97%; for plaques with irregular surface CDU 75% : MSCTA 87%; for ulcerations CDU 54%: MSCTA 87%). Regarding determination of plaque structure (mixed plaque CDU 66% : MSCTA 70%; correlation with HP findings CDU 94% : MSCTA 96%) and localization (CDU 63%: MSCTA 65%), and in terms of sensitivity and specificity, both methods showed almost the same results. Also, there is no statistical difference between these two methods for the degree of stenosis (CDU 96%: MSCTA 98%). CONCLUSION Atherosclerotic disease of extracranial part of carotid arteries primarily affects population of middle-aged and elderly, showing more associated risk factors. Sensitivity and specificity of CDU and MSCTA regarding plaque composition, the degree of stenosis and plaque localization are almost the same. These results and the fact that there are no adverse effects (high radiation dose) compared to MSCTA indicate that CDU should be the initial method in diagnostic algorythm for carotid arteries.

Renal colic: Radiological approach

Acute flank pain is commonly caused by urolithiasis. This paper discusses advantages and disadvantages of procedures used for evaluation of acute flank pain. In our institution, the diagnostic algorithm includes ultrasonography and plain film radiography, and unenhanced spiral CT in equivocal cases.

Diffusion restriction of posterior uveal melanoma on MR imaging.

A 55-year-old male with clinical and opthalmological signs of retinal ablation was referred for orbital magnetic resonance imaging (MRI). MR scan revealed a small tumor nodule in the posterolateral part of left eye globe as a cause of ablation. Tumor showed high signal on transverse diffusion weighted image (DWI) (Fig. A, arrow), low signal on apparent diffusion coefficient image (Fig. B, arrow), consistent with restricted diffusion. The nodule had intermediate signal on T1 sagittal weighted unenhanced image (Fig. C, arrow). The patient underwent left eye enucleation with histopathologically proved uveal melanoma.

Tuberculous Meningoencephalitis: A Case Report

817 pe of CNS involvement. Tubercles rupturing into the subarachnoid space cause meningitis. The ones deeper in the brain parenchyma cause tuberculomas or abscesses . A thick gelatinous exudate infiltrates the cortical or meningeal blood vessels, causing inflammation, obstruction, or infarction. Basal meningitis produces the frequent dysfunction of cranial nerves III, VI, and VII, eventually leading to obstructive hydrocephalus due to obstruction of basilar cisterns. Subsequent neurological pathology is 3three the result of general processes: adhesion formation, obliterative vasculitis, and encephalitis . Tuberculomas are conglomerate caseous foci within the substance of the brain. Centrally located, active lesions may reach considerable size producing encephalitis . Under conditions of poor host resistance, this process may result in focal areas of cerebritis or frank abscess formation. Papilledema is the most common visual effect of TBM. In children, papilledema may progress to primary optic atrophy and blindness. Cranial nerve VI is affected most frequently by TBM, followed by III, IV, VII and, less Introduction