44 research outputs found
Radiological Diagnostics of the Urogenital System
Uloga radiologa kod dijagnostiÄkih pregleda
urogenitalnog sustava ponajprije je dokazivanje anatomsko-
-morfoloŔkih promjena te detekcija, lokalizacija i karakterizacija
patoloÅ”kog procesa. MoguÄe je i odreÄivanje proÅ”irenosti bolesti
(staging) i planiranje lijeÄenja (biopsije, zraÄenja, odabir protokola
lijeÄenja). Kod pojedinih bolesti nužna je i procjena odgovora
na lijeÄenje ā usporedba ili praÄenje tijeka bolesti te otkrivanje
povrata bolesti. U danaŔnje vrijeme zbog naglog razvoja
tehnoloÅ”kih moguÄnosti radiologije lijeÄnicima neradiolozima
nije viŔe jednostavno odabrati pravu i bolesniku najkorisniju
dijagnostiÄku metodu. Svaka od metoda radioloÅ”ke dijagnostike
ima svoje moguÄnosti i ograniÄenja te ih je potrebno poznavati.
RazliÄita je i kvaliteta radioloÅ”kih ureÄaja unutar iste skupine
poput CT-a ili MR-a, s razliÄitim moguÄnostima primjene. Stoga
je nužna sve bolja suradnja lijeÄnika-ordinarijusa koji traži pregled
i radiologa dijagnostiÄara koji ga primjenjuje i interpretira.
Ako takva suradnja izostane, mogu biti primijenjene pogreŔne
ili suviÅ”ne metode, na krivi naÄin, izgubljeno vrijeme i novac, a
bolesnik izmoren brojnim dijagnostiÄkim postupcima.The role of a radiologist in the diagnostic
examination of the urogenital system is primarily to establish
the presence of anatomico-morphological changes, and to
detect, localize and characterize the pathologic process. It is
also possible to determine the extent of spread of the disease
(staging), and to plan the treatment (biopsy, radiation therapy,
the choice of treatment protocol). In certain conditions it is also
necessary to assess the response to treatment ā to compare
and monitor the course of disease, and detect its recurrence.
Due to rapid development of technological possibilities in
radiology, non-radiology physicians find it increasingly difficult
to choose the most appropriate diagnostic mode, which is at
the same time the most useful for the patient. Each diagnostic
method in radiology has its possibilities and limitations with
which physicians need to be acquainted. The quality of radiological
equipment within the same modality, such as CT or MRI,
and the availability of different applications, also varies. All this
necessitates a close cooperation between the physician ordering
the exam and the radiologist-diagnostician applying and
interpreting it. The lack of such cooperation may result in inadequate
and ineffective diagnostic methods, their misapplication,
waste of time and money, and in patients being exhausted by
numerous diagnostic procedures
Should we use CT or MRI for detection and characterization of benign adrenal lesions?
OBJECTIVES:
Computed tomography (CT) and magnetic resonance imaging (MRI) are the main imaging modalities used for analysis of adrenal lesions. We compared the ability of CT and MRI to detect and characterize benign adrenal lesions. -----
PATIENTS AND METHODS:
Unenhanced abdominal CT and MRI were performed in 16 patients (age range 39-77), and reviewed by a radiologist with 6years of experience in abdominal imaging. The presence, number, size and structure of each mass were analyzed and compared between the two modalities. -----
RESULTS:
There were 18 adrenal masses in 11 patients, four patients had adrenal hyperplasia (AH), whereas one patient had left-sided AH and right-sided adenoma. Ten masses wereā„2cm in diameter, and were perfectly depicted using CT and all MRI techniques. There were nine masses with diameter10Hounsfield units could not be characterized using unenhanced CT, but three of them were characterized using MRI. -----
CONCLUSION:
CT has higher sensitivity for detection of small adrenal tumours and adrenal hyperplasia than MRI. MRI is an important tool in characterization of adrenal masses that could not be characterized using unenhanced CT
Vrijednost viŔeslojne kompjutorizirane tomografije u procjeni proŔirenosti karcinoma bubrežnih stanica
The purpose of our paper was to show abilities of multidetector CT (MDCT) in staging of renal cell carcinoma (RCC) for proper preoperative assessment and choosing the therapy modality. MDCT has dramatically improved diagnostic evaluation of renal masses. The best results in detection and characterization of renal masses, as well as precise staging, can be achieved with a scanning protocol that includes a combination of unenhanced CT and contrast-enhanced scanning in the corticomedullary and nephrographic phases. MDCT represents the most effective imaging modality for the diagnosis and staging of RCC. In the majority of patients, MDCT is the only diagnostic imaging required for surgical planning.Cilj ovog rada bio je pokazati moguÄnosti viÅ”eslojnog CT-a (MDCT) u procjeni proÅ”irenosti karcinoma bubrega za potrebe toÄnog planiranja kirurÅ”kog zahvata te za izbor terapijskog modaliteta. MDCT je znatno unaprijedio dijagnostiÄku procjenu tumora bubrega. Najbolji rezultati u otkrivanju i karakterizaciji tumora bubrega, kao i u preciznom odreÄivanju proÅ”irenosti tumora, postižu se protokolom CT snimanja koji ukljuÄuje kombinaciju nativnog CT snimanja i CT snimanja uz uporabu intravenskog kontrastnog sredstva u kortikomedularnoj i nefrografskoj fazi. MDCT predstavlja najuÄinkovitiju slikovnu metodu za dijagnosticiranje i procjenu proÅ”irenosti karcinoma bubrega. U veÄine bolesnika, MDCT je jedina dijagnostiÄka metoda potrebna za planiranje kirurÅ”kog zahvata
Tvorbe u ženskoj zdjelici ā zamke u tumaÄenju snimaka dobivenih viÅ”eslojnom 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 patientsā prior imaging material in order to be able to correctly interpret imaging findings of the pelvic lesions.Simptomi razliÄitih stanja u zdjelici neznatni su pa su prema tome i njihove znaÄajke na snimkama obiÄno nespecifiÄne, Å”to podrazumijeva i veliku moguÄnost pogreÅ”nog tumaÄenja.
Cilj ovoga rada jest upozoriti na moguÄnosti pogreÅ”nog tumaÄenja 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 (Äetiri bolesnice) obavljeno je u 22 bolesnice (dob 23-69) sa sumnjivim tvorbama u zdjelici. Za veÄinu su bolesnica na raspolaganju bili njihovi prethodni relevantni laboratorijski i medicinski podaci. Dvadeset bolesnica bilo je podvrgnuto kirurÅ”kom zahvatu i za 18 bili su dostupni patoloÅ”ki nalazi.
Nakon radioloÅ”kog pregleda predložene su razliÄite dijagnoze s obzirom na snimke i raspoložive kliniÄke podatke: upalna bolest zdjelice (jedan), tumor jajnika (Å”est), tumor maternice (osam), metastatski tumor ili recidiv (Äetiri), limfokela (jedna), te postiradijacijske i postkemoetrapijske promjene (dvije bolesnice). Postoperativni nalazi patoloÅ”ke analize razlikovali su se od radioloÅ”ke dijagnoze u tri od 18 pregledanih materijala: jedan dobroÄudni tumor radiolog je pogreÅ”no opisano kao vjerojatnom zloÄudni, jedan kirurÅ”ki transponirani jajnik opisan je kao tumor, a u jedne su bolesnice postiradijacijske promjene opisane kao recidiv tumora.
Osim prepoznavanja znaÄajaka na snimkama, za ispravno tumaÄenje snimaka lezija u zdjelici radiolozima su vrlo važni i podaci dobiveni kliniÄkim, laboratorijskim i kirurÅ”kim postupcima te uvid u prethodne snimke pacijenata
Erdheim-Chester Disease and Concomitant Tuberculosis Successfully Treated with Chemotherapy and Long-Term Steroids
Erdheim-Chester disease (ECD) is a rare histiocytosis usually affecting the skeletal system, but visceral organs and
central nervous system involvement are common as well. Probability exists that immunomodulatory therapies and disorders
can play a role in clinical course of the disease. Because of rarity of the disorder, it is hard to classify it and standardize
the treatment options, but, according to published material and our experience, cytotoxic chemotherapy and
long-term steroids have therapeutic benefit. Although this approach can probably be accepted as standard of care management,
novel therapeutic modalities should be explored, and pathogenesis and disorder classification should be cleared
out as well. The case of ECD affecting skeletal system and lungs and concomitant laryngeal tuberculosis successfully
treated with chemotherapy and long-term steroid therapy is presented
DIFFUSE INFANTILE HEPATIC HEMANGIOENDOTHELIOMA: A CASE REPORT
Vaskularni tumori najÄeÅ”Äi su benigni tumori jetre, a meÄu njima najÄeÅ”Äi je infantilni hepatalni hemangioendoteliom (IHHE), koji dobro reagira na terapiju i ima nisku stopu mortaliteta. U rijetkim sluÄajevima IHHE mogu biti rezistentni na terapiju te svojom veliÄinom i volumenom krvnog protoka mogu dovesti do kardiorespiratorne dekompenzacije i smrti. U ovom radu prikazuje se tromjeseÄno muÅ”ko dojenÄe koje je kliniÄki obraÄeno zbog uÄestalih respiracijskih infekcija, bronhoopstrukcija i tumorske tvorbe u trbuhu. Slikovnim prikazima (CT, MR i DSA) prikazao se morfoloÅ”ki tipiÄan difuzni IHHE koji je bio dokazan patohistoloÅ”kom biopsijom. Tumor je bio rezistentan na standardnu medikamentnu terapiju, svojom je veliÄinom uzrokovao kardiorespiratornu dekompenzaciju i arest sa smrtnim ishodom u dobi od 13 mjeseci. U rijetkim sluÄajevima tumora rezistentnih na lijekove trebalo bi uÄiniti transplantaciju jetre Å”to ranije, prije razvoja kardiorespiratornih komplikacija.Infantile hepatic hemangioendothelioma (IHHE) is the most common benign hepatic tumor in children (12% of hepatic tumors), that usually responds well to therapy and has low mortality rates. In extremely rare cases of diffuse tumors resistant to therapy, size and blood flow can lead to cardiorespiratory failure and death. A 3-month-old male infant presented with respiratory infections and an abdominal mass, with frequent broncho-obstructive attacks. The CT, MRI and DSA exams showed typical morphology of hemangiendothelioma that was proven on histopathological biopsy. The tumor was resistant to standard medical therapy, and its volume led to cardiopulmonary arrest and death at 13 months of age. In rare cases of diffuse therapy-resistant IHHE a liver transplantation should be considered as an earlier treatment
Double, Ectopic Blind-end Ureter: A Case Report
We report a case of a complete, ectopic blind-ending ureteral duplication in a 26-year-old man who presented with the symptoms of an acute urinary tract infection for the first time. Since anamnestic data and clinical examination indicated a complicated urinary infection he was referred for further examination. On the left side, the imaging studies revealed a normal ureter draining the lower pole of the kidney and a blind-ending ureter with ectopia in the seminal vesicle. The patient recovered completely following surgical removal of the blind-ending ureter
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 radioloÅ”ka metoda za analizu sakroilijakalnih zglobova i kralježnice u bolesnika sa seronegativnim spondiloartritisima. MR-om se mogu prikazati akutne upalne i morfoloÅ”ke promjene u tijeku bolesti, bez izlaganja ionizirajuÄem zraÄenju. MR-om vidljive promjene karakteristiÄne za akutnu upalu su edem medularne kosti i nakupljanje kontrastnog sredstva u paraartikularnim dijelovima zgloba. KroniÄne promjene u seronegativnim spondiloartritisima su erozije, zone skleroze, periartikularno nakupljanje masti, rubne apozicije i ankiloza. MR ima veÄu osjetljivost u usporedbi s drugim radioloÅ”kim 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