Faculty of Medicine

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Accuracy of high-resolution ultrasound in carpal tunnel syndrome
(Georg Thieme Verlag KG, 2016-08-18)
Ivanoski, Slavcho
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Bozhinovska Smicheska, Maja
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Purpose: The aim of this study was to evaluate the diagnostic efficiency of high-resolution ultrasound in diagnosis of carpal tunnel syndrome compared to electromyography exam (EMG). Materials and methods: 36 wrists of 20 patients with EMG diagnosis of carpal tunnel syndrome were prospectively evaluated using high resolution ultrasound. 14 patients were female and 6 male. Control group consisted of 17 asymptomatic volunteers (34 wrists). Ultrasound exam was performed the same day right after the EMG, by a radiologist experienced in MSK ultrasound. High resolution linear transducer was used. The radiologist was blinded to EMG results. Ultrasound diagnostic criterion for carpal tunnel syndrome was cross section area of median nerve of 10 mm2 or more measured at proximal carpal tunnel (at the level of pisiform bone). Sensitivity, specificity and accuracy of the method were evaluated. Results: Majority of the patients, 80% had bilateral carpal tunnel syndrome. Ultrasound showed true positive finding in 31 of 36 cases of carpal tunnel identified by EMG. Sensitivity was 86.1%. Specificity was also high, 88.2%, 30 of 34 cases were correctly recognized as normal by ultrasound. Positive predictive value was 88.6%, and negative predictive value was 85.7%. Accuracy of the method was high, 87.1%. Conclusion: Ultrasound in comparison to EMG shows high sensitivity, specificity and accuracy in diagnosis of carpal tunnel syndrome. Due to its availability, easiness of use and cost of the exam it can be used as a reliable method of choice for quick and accurate evaluation of carpal tunnel syndrome.
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CT Evaluation of Sarcopenia in Patients with and without Malignant Tumor: Psoas Muscle Density as a Biomarker
(Georg Thieme Verlag KG, 2019-06)
Ivanoski, Slavcho
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Purpose: Sarcopenia is related to decreased quality of life, disability, and adverse outcomes, and its diagnosis in patients with malignant disease is important. This study evaluates the prevalence of sarcopenia in patients with a malignant tumor diagnosis compared with patients without known cancer. We also assess the relationship between low muscle density measured by computed tomography (CT) as a biomarker for sarcopenia, and malignancy, age, sex, psoas muscle area, and bone mineral density in both groups. Methods and Materials: A total of 110 consecutive patients who underwent abdominal CT were included in this retrospective study. All patients were 65 years or older (53 men and 57 women). The study group consisted of patients with a diagnosis of an active or previous malignant tumor (N = 54; mean age: 72.3 years). Fifty-six patients without a previous history or CT-proven malignancy (mean age: 72 years; age and sex matched with study group), made up the control group. Psoas muscle density was measured at the L3 vertebral body midlevel for the diagnosis of sarcopenia. Threshold values for sarcopenic low muscle density established by previous researchers were used. Psoas muscle area at the same vertebral body level, as well as bone mineral density of the trabecular bone at the upper half of the L1 vertebral body, were also measured. We used 3-mm-thick axial slices on noncontrast-enhanced series for all measurements plus regression analysis, chi-square, t test, and the Pearson correlation coefficient. Results: Most of the study group had colorectal cancer (33.3%). Thirty-five patients had metastatic malignant disease visible on CT. Twenty-two patients of the study group had sarcopenic psoas muscle density (40.5%), and eight patients of the control group had sarcopenia (14.3%). Differences for the presence of sarcopenia between the study and control group were statistically significant (p < 0.05). Values for psoas muscle density between the groups were also statistically significant (p < 0.05). Regression analysis showed that sarcopenia, defined by low muscle density, was positively correlated with the presence of malignant disease (p = 0.003) and the age of the patient (p = 0.001). Conclusion: Sarcopenia is significantly higher in patients with a malignant tumor diagnosis when compared with a group without malignant tumor disease. Due to the importance of sarcopenia as a prognostic factor in these patients, and the possibility of assessment with routine CT examination, low psoas muscle density should be mentioned routinely in every CT report of patients with a cancer diagnosis.
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Sonographic assessment of the anatomy and common pathologies of clinically important bursae
(Sciendo, 2019-11)
Ivanoski, Slavcho
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High-resolution ultrasonography has many advantages in the imaging of the musculoskeletal system, when compared to other imaging methods, particularly in superficial, easily accessible parts of the body. It is a perfect diagnostic tool for visualizing the most common pathologies of the musculoskeletal system, including the bursae. Inflammation of bursae is frequent, and it can mimic other diseases of the musculoskeletal system. Therefore, knowledge of normal ultrasound anatomy of the bursae, their exact location in the human body, and the sonographic signs of their most common pathologies is essential for establishing a quick and accurate diagnosis by ultrasound. Common conditions affecting bursae, leading to bursitis, include acute trauma, overuse syndromes, degenerative diseases, inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, gout etc.), infections such as tuberculosis, synovial tumors and tumor-like conditions (pigmented villonodular synovitis, osteochondromatosis), and many more. This review article presents and explains ultrasound examples of the most frequent pathological conditions affecting bursae. Images include normal and pathological conditions of bursae around the shoulder joint, elbow, hip, knee, and ankle joint.
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Future Ultrasound Biomarkers for Sarcopenia: Elastography, Contrast-Enhanced Ultrasound, and Speed of Sound Ultrasound Imaging
(Georg Thieme Verlag KG, 2020-04)
Ivanoski, Slavcho
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Sarcopenia is the advanced and generalized loss of muscle mass and strength among the elderly population and is a cause of adverse outcomes. Methods used for the diagnosis of sarcopenia are either unavailable or expensive in everyday clinical settings. Ultrasound presents an inexpensive, convenient, and available method that offers advantages for the evaluation of skeletal muscle. Muscle quality will probably be the most important factor in defining sarcopenia in the future. Different features of muscle quality, including muscle elasticity, microcirculation and muscle perfusion during rest and physical activity, and the content of intramuscular adipose tissue can be measured using emerging and promising ultrasound techniques such as elastography, contrast-enhanced imaging, and speed of sound ultrasound technology. This article reviews the recent evidence on the use of ultrasound techniques in the assessment of muscle quality and the possibilities for the future evaluation of sarcopenia.
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Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies
(Georg Thieme Verlag KG, 2020-12)
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Ivanoski, Slavcho
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Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.
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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part IV, hip
(Springer Science and Business Media LLC, 2022-01)
Sconfienza, Luca Maria
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Adriaensen, Miraude
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Alcala-Galiano, Andrea
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Allen, Georgina
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Aparisi Gómez, Maria Pilar
Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications.
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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle
(Springer Science and Business Media LLC, 2022-02)
Sconfienza, Luca Maria
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Adriaensen, Miraude
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Albano, Domenico
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Alcala-Galiano, Andrea
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Allen, Georgina
Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region.
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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part V, knee
(Springer Science and Business Media LLC, 2022-03)
Sconfienza, Luca Maria
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Adriaensen, Miraude
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Albano, Domenico
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Alcala-Galiano, Andrea
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Allen, Georgina
Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected.
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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb
(Springer Science and Business Media LLC, 2022-03)
Sconfienza, Luca Maria
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Adriaensen, Miraude
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Albano, Domenico
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Alcala-Galiano, Andrea
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Allen, Georgina
To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications.
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Ultrasound-guided Biopsy of Musculoskeletal Soft-tissue Tumors: Basic Principles, Usefulness and Limitations
(Sciendo, 2022-04)
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Ivanoski, Slavcho
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The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal soft-tissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions.

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