Magnetic resonance imaging in the assessment of acute stroke

Introduction: Stroke is the second leading underlying cause of death globally and the leading cause of disability in adults. Stroke diagnosis should be performed quickly and efficiently to eliminate other potential causes of neurological deficits and to assess the time since the onset of clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential methods of detecting and evaluating stroke type and treatmentoptions. Diffusion and perfusion MR imaging is recommended for early stroke diagnosis, as well as for the selection of patients for recanalization therapy, and is considered effective in assessing treatment outcomes. The objectives of this study were to demonstrate the diagnostic value of diffusion and perfusion imaging in the diagnosis of acute ischemic stroke, analyze the role of magnetic resonance imaging in the selection of patients with acute stroke for recanalization therapy, and assess the effect of acute stroke complicity.Material and methods: The research is designed as a systematic review of the primary scientific research literature, which was published in English in relevant scientific databases (PubMed, Google Scholar, Medline) from 2014 to 2021.Results: 14 scientific research papers were singled out and the general characteristics of the study were analyzed (country, authors, year of publication, title of the study, type of study, study objectives, research methods, results and conclusion). A quality assessment of the included studies with cohort design and randomized controlled studies was performed, and most belong to the category of high-quality studies with a smaller number of medium-quality studies. The overall percentage of detected AIS cases in isolated studies using the DWI and/or PWI sequence was 90.8%. At the same time, the outcome of recanalization therapy was assessed using MRI studies (the number of patients who developed adverse events with functional data outcome 30 or 90 days after the procedure was observed). Comparison of MRI and CT imaging protocols provided data on the total percentage of detected acute stroke cases using CT imaging protocols (68.9%) and MRI imaging protocols (88.5%), which is why MRI is considered a superior method.Conclusion: Although CT is a suitable method for visualizing bleeding and also for early differentiation of hemorrhagic from ischemic stroke, if MRI imaging is available, it is recommended to use DWI, PWI, MRA sequences for a more accurate diagnosis of stroke in the acute phase.

Accuracy of clinical examination and magnetic resonance in assessment of chondral lesion of knee joint by arthroscopy

Introduction: The knee joint has a unique anatomical structure in the human body. The localization between the two longest bones in the human body – femur, and tibia – makes it prone to injuries, trauma, and other pathologies. Clinical examination of the joint is still the primary method in evaluating the condition of the patient's knee. The study aims to determine the diagnostic accuracy of clinical examination and magnetic resonance (MR) in assessing chondral lesions of knee joint using arthroscopy as a reference standard.Patients and methods: The examination was conducted on 94 patients (58 males and 36 females) with knee injuries. Clinical examination indicated a primary chondral lesion of knee cartilage in eight patients (five men and three women), with an average age of 45.75. Besides the clinical examination, the diagnostics were performed using MR imaging by Siemens of 0.5 Tesla, and arthroscopy was performed using Storz arthroscope.Results: Our research has generated the following values of clinical and MR results for chondral lesions: Sensitivity (Se) = 12.5%, Specificity (Sp): could not be calculated, Positive Predictive Value (PPV) = 100%, Negative Predictive Value (NPV) = 0% and Accuracy (ACC) = 12.5%. The accuracy of clinical and intraoperative results for chondral lesion was: Se =100%, Sp: could not be calculated, PPV = 100%, NPV: could not be calculated, and ACC = 100%. MR imaging and arthroscopy findings of chondral lesion showed: Se = 100%, Sp = 0%, PPV = 12.5%, NPV: could not be calculated and ACC = 12.5%. In comparing the clinical sign and MRand intraoperative result, Positive Predictive Value for patients with chondral lesion was maximal (100%), while comparing MR with the intraoperative result, Positive Predictive Value was 12.5%. In comparison between clinical sign and intraoperative results, the accuracy for patients with chondral lesion was 100%, while comparing the clinical sign with MR result and MR with the intraoperative result, the accuracy was 12.5%.Conclusion: Our examinations have shown that MR examination is not currently as valid for diagnosing injury of chondral cartilage of knee as the medical community or patients have anticipated it.

Optimisation of pelvic imaging radiography protocols in plain radiology: a scoping review

Introduction: The purpose of this work is to explore which studies have been performed in the field of radiation dose reduction in pelvic x-ray imaging and to determine optimization techniques for dose reduction.Materials and methods: A scoping review was performed by using databases Science Direct, PubMed, EBSCO Host and Springer Link. The keywords used were "radiography", "dose reduction", "pelvis" and "pelvic". Exclusion criteria were the keywords "CT" and "MRI".Results: 15 scientific articles that analyse the current dose impacts in selected institutions or regions were reviewed as a starting point to optimise protocols, to establish diagnostic reference levels, or to suggest different measures for dose reduction. Studies suggest the use of digital image receptor, adaptation of exposure parameters; they also point out the use of air gap instead of radiographic grid and investigate the usefulness of the gonad protection. A difference was noticed in developing countries that focus more on the establishment of DRLs and following the guidelines provided by other countries rather than developing new dose optimisation techniques.Conclusion: A pelvic x-ray must be performed with a low radiation dose impact that still doesn't compromise the diagnostic value of the image, which can be achieved by following the ALARA principle and with certain adjustments, suggested by the considered studies, especially with exposure parameters. The establishment of national and local diagnostic reference levels is also required.

Pediatric glioblastoma treated with concurrent radiotherapy and adjuvant Temozolomide: A case study of the treatment of pediatric GBM by the technique of volumetric modulated arc therapy

Introduction: Glioblastoma in children (pGBM) occurs somewhat less frequently than in adults. Pediatric pGBMs have a different molecular profile than GBM for adults. The aim of the presentation of this case is the possibility of the effectiveness of the GBM radiation method and the evaluation of magnetic resonance imaging, and the monitoring of the treatment outcome of the patient.Material and methods: The case study is of the retrospective-prospective type. Medical documentation, magnetic resonance imaging, and chronologically monitored evaluation of the findings from November 2018 to August 2021 were used to present the study. The postoperative course was analyzed, as well as the effect of concurrent chemoradiotherapy, VMAT radiotherapy and adjuvant chemotherapy with Temozolomide in a patient aged 4 years and 6 months, comparing treatment outcome with median and overall survival in glioblastoma.Results: The pediatric patient after being diagnosed with high-grade glioma in 2018 is so far in very good general condition, without signs of physical and psycho-social defects, which compared to the scientifically proven median of survival indicates a good therapeutic effect. Volumetrically modulated arc radiotherapy with the use of modern IGRT verification techniques and with the use of chemotherapy with Temozoloimod, has proven to be a still effective oncological method treatment of GBM. For the final outcome of the disease and the effect of therapeutic modalities, the patient's condition and evaluation of magnetic resonance imaging will be monitored. The result supports further research into this therapeutic regimen.Conclusion: Glioblastoma is a very aggressive tumor, which occurs somewhat less frequently in the pediatric population than in adults, but is a very fatal disease. Surgical resection followed by concurrent chemoradiotherapy, with adjuvant Temozolomide is still the method of choice in the treatment of glioblastoma.

Evaluation of usage of bone scan index in assessment of metastatic prostate cancer

Introduction: Prostate cancer has been the leading type of cancer to affect male population, and as such, it is a subject to efforts to furthermore diagnostic tools already in existence as well as development of new ones which will Aid early diagnostic, treatments as well as a follow up procedures and clinical trials. Bone scan index is a useful and objective biomarker used as a valuable tool for determination as to precise bone involvement in advanced cases, as well as a tool to predict the outcome in prostate cancer patients in clinical trials.Methods: This paper is a non-experimental (qualitative) research, that is, a scientific review of the literature.Results: The results we analyzed in this paper were collected from published academic journals.Conclusion: As a new imaging biomarker, bone scan index has potential to predict therapeutic effects and survival of patients with prostate cancer. Using measurable diagnostic image parameters, the bone scan index is important for determining metastatic bone changes in prostate cancer patients.

Frequency of various forms of spondylodiscitis on spinal column segments

Introduction: The term spinal infections or spinal column infections usually include processes localized in various parts of spinal column, parts of vertebrae as well as in intervertebral disc. There are three main types of spondylodiscitis. Bacterial spondylodiscitis (vertebral osteomyelitis) is inflammatory process usually involving two (neighboring) vertebrae and intervertebral disc causing the space for the disc between the vertebrae to be narrowed down. The aim of this paper is to present the frequency of various forms of spondylodiscitis on spinal column segments following laboratory, microbiological and radiological diagnostic procedures.Patients and methods: Descriptive research method was used in the work, as it was deemed appropriate for this type of research analysis. Diagnostic procedures used include: laboratory tests, microbiological analysis, MRI scans of cervical spine, MRI scans of thoracic spine, MRI scans of L/S spinal column.Results: Out of 307 patients included in the research, in 109 occurrences spondylodiscitis was verified on various parts of spinal column. Brucellosis spondylodiscitis represents the most frequent form (in 86% of patients), and the majority of occurrences was localized at lumbosacral part of spinal column. During the research, quite unusually, there was also one occurrence of spondylodiscitis with paravertebral abscess on cervical part of spinal column. It is also a type of brucellosis spondylodiscitis. The use of magnetic resonance imaging appears to be gold standard in diagnostics of spondylodiscitis, especially following the application of contrast agent and the use of T1 FS (fat saturation) sequences along with standard tomograms in times T1 and T2. The majority, up to 262 (85.3%) of Elisa tests were related to brucellosis. In 245 out of 307 cases, the result was positive, that is in direct relation to the fact that various forms of brucellosis are present in the areas being examined.Conclusion: Research results indicated that spondylodiscitis was diagnosed in all segments of spinal column. The most frequent occurrences are on L/S part of spinal column and the most frequent form of brucellosis is spondylodiscitis.

Knowledge, attitudes and practice in the field of the radiation protection of medical radiology engineers in radiotherapy

Introduction: The engineers of the medical radiology in radiotherapy are key professional group directly responsible for reliable delivery of radiation therapy treatment and the implementation of radiation protection measures in practice. Therefore, their knowledge and skills in this area need to be adequate and up to date. The aim of this research is the assessment of knowledge, attitudes and practice in the field of radiation protection among the engineers of medical radiology employed in radiotherapy centers within the public healthcare system in Bosnia and Herzegovina.Material and methods: The research was conducted on a sample of 30 engineers of medical radiology using a structured questionnaire which contains demographic data and sets of 10 questions related to radiotherapy devices, radiation protection in radiotherapy, risks and incidents related to use of ionizing radiation and the role of medical radiology engineers in radiation protection system.Results: The results of the research show optimal level of knowledge in the field of radiation protection (74.66%) and optimal level of awareness of the risks associated with the use of ionizing radiation (72%). The level of knowledge and awareness is significantly higher among respondents with longer working experience and those who have completed master’s degree and postgraduate education in the field of radiation protection. The application of ionizing radiation protection measures in practice has been assessed as satisfactory (2,3). Respondents are not sufficiently involved in the work of regulatory bodies (26.7%), decisionmaking (23.3%), development of procedures (23.3%) and education of other employees in the field of radiation protection (2.7%).Conclusion: Engineers of medical radiology are not fully involved in the radiation protection system as educated and trained professionals. One of the most important professional interests of engineers of medical radiology is adequate influence on the processes in the field of radiation protection.

Adaptive radiotherapy for head and neck cancer

Introduction: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

The significance of mammography and ultrasound examination in the diagnosis of breast cancer

Introduction: Mammography represents a very accessible diagnostic method that has been accepted as the initial method of examining women over the age of 40 worldwide. It is a method with a high percentage of accuracy (80-90%) in the detection of breast cancer in patients without symptoms. However, there may be a significant overlap of mammographic presentation of benign and malignant changes in the structural tissue of the breast. The ultrasound method of breast examination is invaluable in breaking down between solid and cystic changes, as well as for clarifying palpable lumps in the breast. In almost 98% of cases, ultrasound examination can distinguish whether it is a benign or malignant change. The aim of this study is to prove the correlation between mammography and ultrasound methods of breast examination.Material and methods: The examination was performed as a retrospective - prospective descriptive study in the Department for radiological and ultrasound diagnostics of the Derventa Health Center. The study included 80 female respondents who consented to the recording. Based on the performed ultrasound and mammography images, a qualitative analysis was made. A comparison of the sensitivity of the breast imaging between mammography and ultrasound imaging was performed.Results: Comparing mammography and ultrasound examination according to BI-RADS classification, based on Pearson's correlation coefficient, we concluded that there is a strong correlation between these two tests (r = 0.743), which is statistically significant (p <0.005). The correlation, in addition to having a strong connection, moves in a positive direction, that is, by increasing the value of BI-RADS of one diagnostic procedure, there is an increase in another.Conclusion: By analyzing the obtained results, we can conclude that mammography and ultrasound methods of breast examination are complementary methods, which complement each other, and which are not perfect. However, these two methods certainly have their place in breast cancer screening.

Influence of F-18 FDG radiotracer application on image quality and SUV values when performing PET / CT study

18F-FDG PET/CT is the most widely used diagnostic modality for detection of malignant disease. Beside the visual insight of FDG pathways into the human body, PET/CT can give valuable information based on the SUV values. The SUV is a quantitative parameter of metabolic activity. FDG application has 2 major impacts on PET/CT: qualitative aspect (visual insight of FDG in the body) and quantitative aspect (degradation of the SUV values). Based on the literature, FDG extravasation incidence is 31% for all PET/CT studies and in 8% of all cases extravasation has been visually confirmed since the application place has been in the field of view. By constantly developing the technique, work methodology and increasing the quality control of the staff in the PET/CT department, the incidence of extravasation can be significantly reduced based on the results from the literature. In the case when paravenous injection is present on PET/CT images we can use certain software procedures to improve image quality and SUV quanitification.