Tvorbe u ženskoj zdjelici – zamke u tumačenju snimaka dobivenih višeslojnom kompjutoriziranom tomografijom (MSCT) i magnetskom rezonancijom (MR)

Different conditions within the pelvis are presented with very few symptoms. Likewise, their imaging characteristics are usually non-specific, implying high chance of misinterpretation. The aim of this paper is to point to the misinterpretation possibilities in computed tomography (CT) and magnetic resonance (MR) studies of the pelvic lesions and to outline their differential diagnosis. CT (11), MR (seven) or both (four patients) were performed in 22 female patients (age 23-69) with suspicious pelvic masses. Relevant laboratory and medical history data were available for most of the patients. Twenty patients underwent subsequent surgery and pathological findings were available in 18 cases. After radiological examinations different diagnoses were proposed in respect to imaging findings and available clinical data: pelvic inflammatory disease (one), ovarian tumor (six), uterine tumor (eight), metastatic or recurrent tumor (four), lymphocele (one), and post-irradiation and post-chemotherapy changes (two) patients. Postoperative results of the pathological analysis differed from radiological diagnosis in three of 18 pathologically examined materials: one benign tumor was falsely characterized as possibly malignant by the radiologist, one surgically transposed ovary was described as tumor, and one case of post-irradiation changes was described as recurrent tumor. Aside from knowing imaging characteristics, it is of great importance for radiologists to be aware of clinical, laboratory, and surgical protocols information as well as to have insight in patients’ prior imaging material in order to be able to correctly interpret imaging findings of the pelvic lesions.Simptomi različitih stanja u zdjelici neznatni su pa su prema tome i njihove značajke na snimkama obično nespecifične, što podrazumijeva i veliku mogućnost pogrešnog tumačenja. Cilj ovoga rada jest upozoriti na mogućnosti pogrešnog tumačenja komjutorizirane tomografije (CT) i magnetske rezonancije (MR) lezija u zdjelici te u glavnim crtama prikazati i razmotriti diferencijalnu dijagnozu. CT (11), MR (sedam) ili oboje (četiri bolesnice) obavljeno je u 22 bolesnice (dob 23-69) sa sumnjivim tvorbama u zdjelici. Za većinu su bolesnica na raspolaganju bili njihovi prethodni relevantni laboratorijski i medicinski podaci. Dvadeset bolesnica bilo je podvrgnuto kirurškom zahvatu i za 18 bili su dostupni patološki nalazi. Nakon radiološkog pregleda predložene su različite dijagnoze s obzirom na snimke i raspoložive kliničke podatke: upalna bolest zdjelice (jedan), tumor jajnika (šest), tumor maternice (osam), metastatski tumor ili recidiv (četiri), limfokela (jedna), te postiradijacijske i postkemoetrapijske promjene (dvije bolesnice). Postoperativni nalazi patološke analize razlikovali su se od radiološke dijagnoze u tri od 18 pregledanih materijala: jedan dobroćudni tumor radiolog je pogrešno opisano kao vjerojatnom zloćudni, jedan kirurški transponirani jajnik opisan je kao tumor, a u jedne su bolesnice postiradijacijske promjene opisane kao recidiv tumora. Osim prepoznavanja značajaka na snimkama, za ispravno tumačenje snimaka lezija u zdjelici radiolozima su vrlo važni i podaci dobiveni kliničkim, laboratorijskim i kirurškim postupcima te uvid u prethodne snimke pacijenata

Biopsije koštanih lezija pod kontrolom ct-a, naša iskustva iz 2018. I 2019.

To present our results from 2018 and 2019 and to present the clinical data of the accuracy and clinical usefulness of computed tomography (CT)-guided biopsy for diagnosing suspicious bone lesion. The retrospective study included 98 consecutive patients who underwent CT-guided bone lesion biopsy from January 2018 to December 2019. The localization of the bone lesions, the adequacy of the sample for histopathological analysis, histopathological results, and the procedure’s complications were analyzed. The specimens collected from 76 patients/lesions (77.6%) were considered appropriate for diagnosis. Histological analysis of bone samples showed 52 (68.4%) metastatic lesions. The most common primary tumor origins were breast carcinoma 28 (53.8%) and lung carcinoma six (11.5%). In three patients (4%), the infection was confirmed. No tumor cells were found in 17 (22.4%) patients. There were no post-procedural complications. CT-guided bone lesion biopsy is a safe and effective method for diagnosing suspicious bone lesions that has a great effect in clinical practice without any significant complications.Cilj rada je predstaviti naše rezultate iz 2018. i 2019. i dodati saznanja kliničkim podatcima o točnosti i kliničkoj korisnosti biopsije vođene kompjuteriziranom tomografijom kod dijagnosticiranja suspektnih koštanih lezija. Retrospektivno istraživanje obuhvatilo je 98 uzastopnih bolesnika koji su podvrgnuti biopsiji koštanih lezija pod kontrolom CT-a od siječnja 2018. do prosinca 2019. Analizirani su lokalizacija koštanih lezija, adekvatnost uzorka za patohistološku analizu, patohistološki rezultati i komplikacije postupka. Uzorci prikupljeni od 76 pacijentata iz 76 lezija (77,6%) smatrani su prikladnima za dijagnozu. Histološka analiza uzoraka kostiju pokazala je 52 (68,4%) presadničke lezije. Najčešći izvor primarnog tumora bio je rak dojke 28 (53,8%), a rak pluća 6 (11,5%). U 3 bolesnika (4%) potvrđena je infekcija. U 17 (22,4%) bolesnika nisu pronađene tumorske stanice. Biopsija koštanih oštećenja pod kontrolom CT-a sigurna je i učinkovita metoda bez ozbiljnijih komplikacija

CT arthrography prior to CT guided bone lesion biopsy, a case report

Background: Suspicious bone lesions are very common and often need a pathohistological verification. Surgical (open) and percutaneous image guided biopsies can be used to get a sample for pathology analysis. As the barriers of lesion compartment shouldn’t be crossed due to risk of dissemination, transarticular approach is not advised. Case study: We present a case of 57-year-old female patient with lung cancer history and left knee pain. Lytic lesion in lateral femoral epycondile with fluorodeoxyglucose (FDG) uptake was confirmed by positron emission tomography with computed tomography (PET/CT). Surgical biopsy was performed and pathohistological analysis showed no tumor cells. A month later a computed tomography (CT)-guided percutaneous bone biopsy with CT arthrography was performed and pathohistological analysis confirmed metastatic lesion. Conclusion: CT-guided percutaneous bone biopsy is a safe, effective and minimally invasive procedure. CT arthrography can add some additional information for anatomical positioning in order to avoid transarticular approach in reaching the targeted lesion

Radiologic imaging of crystalline arthritides

Giht je skupina bolesti karakterizirana artritisom, a nastaje zbog promjene u metabolizmu urata te dolazi do odlaganja mononatrijskih kristala urične kiseline u zglobove i meka tkiva. Klinički nalazimo akutni i kronični artritis, nakupine tofa, intersticijsku renalnu bolest i nefrolitijazu kristalima urične kiseline. Definitivna dijagnoza postavlja se dokazom kristala urične kiseline u zglobu ili tjelesnim tekućinama.Gout is a group of diseases characterized by arthritis and is a result of urate metabolism disturbance with the deposition of monosodium urate crystals in the joint and soft tissues. Clinical manifestations include acute and chronic arthritis, tophaceous deposits, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joint or body fluids

RARE LOCALIZATION OF OSTEOID OSTEOMA – DISTAL PHALANX OF THE RING FINGER

Ovim kliničkim zapažanjem želimo upozoriti na osteoid osteom kao mogući uzrok tegoba u području distalne falange prstiju šake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za prepoznavanje i zbog atipične prezentacije. Dvadesetogodišnji bolesnik se pet godina žalio na bol u području jagodice IV. prsta desne šake koja je bila praćena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u području baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, što je potvrđeno kompjuteriziranom tomografi jom. Nakon kirurškog liječenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je već tri mjeseca nakon zahvata pao sa 54,5 na 0 što je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praćena bolovima koji se smanjuju korištenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti načinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog blizine neurovaskularnih struktura i tetiva najboljim oblikom liječenja osteoid osteoma u području distalne falange prstiju šake smatra se kirurška ekscizija ili ekskohleacija.With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fi ngers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fi ngertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fi ngertip of his right ring finger persisting for fi ve years. Swelling and redness of the fi ngertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confi rmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring fi nger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring fi nger was immobilized in a plaster splint for a three-week period. After removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confi rmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical fi ndings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the fi nger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be diffi cult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling and redness of the fi nger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fi ngers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the fi nger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger

The role of magnetic resonance imaging in seronegative spondyloarthritides

Seronegativni spondiloartritisi su skupina upalnih reumatskih bolesti dominantno obilježenih upalom sakroilijakalnih zglobova i/ili kralježnice, enteza i perifernih zglobova. Prema ASAS klasifikacijskim kriterijima, magnetska rezonancija (MR) je radiološka metoda za analizu sakroilijakalnih zglobova i kralježnice u bolesnika sa seronegativnim spondiloartritisima. MR-om se mogu prikazati akutne upalne i morfološke promjene u tijeku bolesti, bez izlaganja ionizirajućem zračenju. MR-om vidljive promjene karakteristične za akutnu upalu su edem medularne kosti i nakupljanje kontrastnog sredstva u paraartikularnim dijelovima zgloba. Kronične promjene u seronegativnim spondiloartritisima su erozije, zone skleroze, periartikularno nakupljanje masti, rubne apozicije i ankiloza. MR ima veću osjetljivost u usporedbi s drugim radiološkim metodama i najvažnija je slikovna metoda za postavljanje pravovremene dijagnoze te procjenu aktivnost bolesti.Seronegative spondyloarthritides (SpA) is a group of inflammatory rheumatic diseases characterized by inflammation of the sacroiliac joints and/or the spine, enthesitis and peripheral arthritis. MRI is the imaging method of choice for visualization of the sacroiliac joint and spine according to the new ASAS classification criteria for axial SpA. It can visualize both active inflammation and structural damage and is not associated with radiation exposure. MRI findings characteristic for active disease include bone marrow edema and contrast enhancement of the bone marrow and the joint space, while chronic changes include bone erosions, sclerosis, periarticular fatty tissue accumulation, bone spurs and ankylosis. MRI has higher sensitivity comparing to other radiological modalities. MRI is the most important diagnostic imaging method in early SpA. It is sensitive and reliable for objective monitoring of the disease process and it is essential in the management of patients with SpA