Radiological Diagnostics of the Urogenital System

Uloga radiologa kod dijagnostičkih pregleda urogenitalnog sustava ponajprije je dokazivanje anatomsko- -morfoloških promjena te detekcija, lokalizacija i karakterizacija patološkog procesa. Moguće je i određivanje proširenosti bolesti (staging) i planiranje liječenja (biopsije, zračenja, odabir protokola liječenja). Kod pojedinih bolesti nužna je i procjena odgovora na liječenje – usporedba ili praćenje tijeka bolesti te otkrivanje povrata bolesti. U današnje vrijeme zbog naglog razvoja tehnoloških mogućnosti radiologije liječnicima neradiolozima nije više jednostavno odabrati pravu i bolesniku najkorisniju dijagnostičku metodu. Svaka od metoda radiološke dijagnostike ima svoje mogućnosti i ograničenja te ih je potrebno poznavati. Različita je i kvaliteta radioloških uređaja unutar iste skupine poput CT-a ili MR-a, s različitim mogućnostima primjene. Stoga je nužna sve bolja suradnja liječnika-ordinarijusa koji traži pregled i radiologa dijagnostičara koji ga primjenjuje i interpretira. Ako takva suradnja izostane, mogu biti primijenjene pogrešne ili suvišne metode, na krivi način, izgubljeno vrijeme i novac, a bolesnik izmoren brojnim dijagnostičkim 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 – 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 were≥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 višeslojne kompjutorizirane tomografije u procjeni proširenosti 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 mogućnosti višeslojnog CT-a (MDCT) u procjeni proširenosti karcinoma bubrega za potrebe točnog planiranja kirurškog zahvata te za izbor terapijskog modaliteta. MDCT je znatno unaprijedio dijagnostičku procjenu tumora bubrega. Najbolji rezultati u otkrivanju i karakterizaciji tumora bubrega, kao i u preciznom određivanju proširenosti tumora, postižu se protokolom CT snimanja koji uključuje kombinaciju nativnog CT snimanja i CT snimanja uz uporabu intravenskog kontrastnog sredstva u kortikomedularnoj i nefrografskoj fazi. MDCT predstavlja najučinkovitiju slikovnu metodu za dijagnosticiranje i procjenu proširenosti karcinoma bubrega. U većine bolesnika, MDCT je jedina dijagnostička metoda potrebna za planiranje kirurškog zahvata

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

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

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 najčešći su benigni tumori jetre, a među njima najčešći je infantilni hepatalni hemangioendoteliom (IHHE), koji dobro reagira na terapiju i ima nisku stopu mortaliteta. U rijetkim slučajevima IHHE mogu biti rezistentni na terapiju te svojom veličinom i volumenom krvnog protoka mogu dovesti do kardiorespiratorne dekompenzacije i smrti. U ovom radu prikazuje se tromjesečno muško dojenče koje je klinički obrađeno zbog učestalih respiracijskih infekcija, bronhoopstrukcija i tumorske tvorbe u trbuhu. Slikovnim prikazima (CT, MR i DSA) prikazao se morfološki tipičan difuzni IHHE koji je bio dokazan patohistološkom biopsijom. Tumor je bio rezistentan na standardnu medikamentnu terapiju, svojom je veličinom uzrokovao kardiorespiratornu dekompenzaciju i arest sa smrtnim ishodom u dobi od 13 mjeseci. U rijetkim slučajevima tumora rezistentnih na lijekove trebalo bi učiniti transplantaciju jetre što 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 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