Comprehensive imaging of stroke – Looking for the gold standard

Background and purpose Stroke is the third cause of death worldwide. In recent decade there has been a marked progress in treatment and prevention of stroke, which was possible largely due to modern neuroimaging techniques. Early radiological confirmation of the diagnosis allows for introduction of fibrinolytic therapy and evaluation of ischaemic penumbra. Material and methods We have analysed clinical and imaging data of 92 patients with early stages of stroke. The sensitivity, specificity and possible influence on the choice of treatment were assessed for different neuroimaging techniques, including diffusion weighted and perfusion imaging in patients with hyperacute and acute stroke. Results A non-contrast computed tomography (CT) allowed for the detection of early ischaemic changes with an overall sensitivity of 38% and 42% in patients in hyperacute phase. In a perfusion CT study the perfusion abnormalities in the area corresponding to the clinical symptoms were present in 79% of patients. The sensitivity of diffusion weighted imaging (DWI) alone was 95% and in conjunction with perfusion MR reached 100%. Conclusions Our study proves that advanced neuroimaging modalities allow for a substantial increase of sensitivity when detecting changes in patients with acute ischaemic strokes and confirming the clinical diagnosis. We believe that MR in combination with DWI should be the imaging methods of choice in diagnosing acute stroke patients. Perfusion adds significant diagnostic value to structural techniques, particularly in clinically ambiguous cases. In cases with a clear clinical picture the data provided by a non-contrast CT study is sufficient for therapeutic decision making

Shoulder joint tuberculosis

Background: Despite the fact that joint tuberculosis is one of the most common forms of extrapulmonary tuberculosis, it is a disease entity that is very rare in Poland (less than 100 cases a year in the last 10 years). The symptoms are non-specific, and thus the disease is rarely taken into account in preliminary differential diagnosis. Case Report: A 68-year-old female patient was admitted to the Internal Diseases Clinic due to oedema and pain of the right shoulder joint. The pain has been increasing for about 8 months. Physical examination revealed increased circumference and elevated temperature of the right shoulder joint. Limb function was retained. The full range of radiological and laboratory diagnostic examinations was performed, including the biopsy of the affected tissue which revealed the presence of Mycobacterium tuberculosis in the bacterial culture. Clinical improvement was obtained after introduction of TB drugs. Conclusions: Radiological diagnostic methods (X-ray, CT scans, MRI scans) provide high precision monitoring of articular lesions. However, the decisive diagnosis requires additional laboratory tests as well as histopathological and bacteriological assays

Neuroimaging of cerebral venous thrombosis (CVT) : old dilemma and the new diagnostic methods

BACKGROUND: Cerebral venous thrombosis is a relatively uncommon neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. The pathogenesis is multifactorial and the disease may occur at any age. CVT is often associated with nonspecific symptoms. Radiologists play a crucial role in patient care by providing early diagnosis through interpretation of imaging studies. Underdiagnosis or misdiagnosis can increase the risk of severe complications, including hemorrhagic stroke or death. The purpose of this study is to investigate radiological and clinical characteristics of cerebral venous thrombosis (CVT) based on material from 34 patients under care of our hospital. MATERIAL AND METHODS: A total of 34 patients were diagnosed with CVT from August 2009 until March 2015. A clinical and radiological database of patients with final diagnosis of CVT was analyzed. RESULTS: Patient group included 22 women and 12 men at a mean age of 48.7 years (ranging from 27 to 77 years). In the study group 8 patients (23.5%) suffered from hemorrhagic infarction, whereas 16 patients (47%) were diagnosed with venous infarction without hemorrhage. Thirty patients (88%) had transverse sinus thrombosis. CONCLUSIONS: According to our study, CVT was more prevalent in women. Transverse sinus was the most common location. Among all age groups, the highest prevalence was seen in the fifth decade (n=14). Contrast-enhanced CT and MR venography were the most sensitive imaging modalities

Embryonic Environmental Niche Reprograms Somatic Cells to Express Pluripotency Markers and Participate in Adult Chimaeras

The phenomenon of the reprogramming of terminally differentiated cells can be achieved by various means, like somatic cell nuclear transfer, cell fusion with a pluripotent cell, or the introduction of pluripotency genes. Here, we present the evidence that somatic cells can attain the expression of pluripotency markers after their introduction into early embryos. Mouse embryonic fibroblasts introduced between blastomeres of cleaving embryos, within two days of in vitro culture, express transcription factors specific to blastocyst lineages, including pluripotency factors. Analysis of donor tissue marker DNA has revealed that the progeny of introduced cells are found in somatic tissues of foetuses and adult chimaeras, providing evidence for cell reprogramming. Analysis of ploidy has shown that in the chimaeras, the progeny of introduced cells are either diploid or tetraploid, the latter indicating cell fusion. The presence of donor DNA in diploid cells from chimaeric embryos proved that the non-fused progeny of introduced fibroblasts persisted in chimaeras, which is evidence of reprogramming by embryonic niche. When adult somatic (cumulus) cells were introduced into early cleavage embryos, the extent of integration was limited and only cell fusion-mediated reprogramming was observed. These results show that both cell fusion and cell interactions with the embryonic niche reprogrammed somatic cells towards pluripotency