Faculty of Medicine

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THE ROLE OF МR SPECTROSCOPY AND CONTRAST ENHANCED MRI IN PROSTATE CANCER DIAGNOSIS
(Macedonian Association of Anatomists and Morphologists, 2025-11-25)
Kostova, Masha
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Bozhinovska, Biljana
In patients with increased prostate-specific antigen, the next diagnostics tool is transrectal ultrasound-guided biopsy. The biopsy can cause pain, bleeding and infection. Multiparametric magnetic resonance imaging (mp MRI) as non-invasive diagnostics tool is used as a triage test to avoid biopsy, as well as to improve the diagnostics. The aim of this study was to examine the value of MR spectroscopy and dynamic post-contrast series in the diagnosis of prostate cancer. This cohort prospective study included 100 patients from CGH “September 8th” with increased levels of PSA. The MRI equipment used was Siemens Essenza 1,5T with body coil. The results obtained by MR spectroscopy analysis were correlated with the post-contrast series, whereby by mapping suspicious areas, patients underwent biopsy according to the PIRADS (prostate imaging and reporting data system) classification. Of the 100 patients, 96 were biopsied according to the PIRADS (prostate imaging and reporting data system) classification. The MRI results and pathohistological findings were then compared. On MR postcontrast series, a malignant lesion was detected in 52% of patients, in 33% of patients the lesion was suspicious for malignancy. On MR spectroscopy, a choline+creatinine/citrate ratio of 0.8 to 2 indicating a possible malignant lesion was confirmed in 33% of patients, this ratio was greater than 2 in 33% of patients, indicating a lesion highly suspicious for malignancy. MR spectroscopy combined with contrast enhanced MRI is a powerful tool for non-invasive differentiation of benign prostatic hyperplastic nodule and prostatitis from a malignant nodule.
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Effectiveness of single lumbar periradicular infiltration in patients with sciatica
(Macedonian Association of Radiologists, 2023-11-09)
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Kostova, Masha
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Jovanoska, Ivona
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MINIMALLY INVASIVE APPROACH IN PATIENT WITH EXTRAFORAMINAL DISC HERNIATION
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Kostova, Masha
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Jovanoska, Ivona
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Nancheva, Andrea
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Dungevski, Gjorgi
Objective: The aim of our study was to evaluate the history, treatment and clinical outcome of a patient with low back pain and radiculopathy caused by extraforaminar disck herniation, after a minimally invasive procedure (PRT) periradicular therapy and physical therapy in order for educational purposes. Clinical features: A 48-year-old patient without comorbidities was presented with 3-week history of lumbar pain with irradiation to the left lower extremity. The patient had difficulty sitting and standing with antalgic movement without being able to assume an upright position.. The pain was intensified by lateral movements dominant left and positioning backwards with propagation to the left side and hip. Dominant symptom was radicular pain with paresis and hypesthesia of the affected dermatoma of lower limb. The diagnosis was confirmed by magnetic resonance imaging with showed exoforaminar disc herniation on the level L4-L5. Intervention and outcome: Advantages of PRT are: minimal invasive procedure, CT guided intervention for exact and precise delivery of the medications, low risk in damage of important local anatomical structures, short recovery time, easy approach and low cost for patient and for the medical institution, respectively. In our study, CT Siemens 16 slice was used for the intervention. The patient was treated with lumbar epidural corticosteroid application and physical therapy. Physical therapy included self-traction and strengthening exercises. Functional status was measured using a Modified Oswestry Questionnaire and numerical pain assessment scale VAS scale. Initially, before intervention, functional status was assessed at 68%, with pain 8/10. After treatment, functional status was 4% and pain was assessed as 1/10. Conclusion: Multidisciplinary approach is needed in patients with extraforaminal disc herniation for better results. In our case study, PRT demonstrated a significant role in treating our patient. As a result of the treatment significant reduction of pain and improvement of functional status was observed. The patient returned to normal life habits and activities in a very short time, which was primary goal.
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GOSSYPIBOMA - CASE REPORT
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Kostova, Masha
Introduction. The term Gossypiboma is used to describe a retained surgical sponge after surgical procedure. It is an infrequent but serious surgical complication which is seldom reported because of the medicolegal implications. Its diagnosis is usually difficult because the clinical symptoms are nonspecific and the imaging findings are often inconclusive. Case presentation. We report a case of 68-year-old female who presented with acute pain abdomen and severe distention of abdomen. She had history of hernioplasty 1 year ago prior at another hospital. From clinical features the patient had discomfort in epigastrium, upper gastrointestinal symptoms and fever. On computed tomography (CT) and magnetic resonance (MRI) was seen abscess collection in upper abdomen, with visible inhomegenous spongeous mass, that did not exclude presence of foreign body. On exploratory laparotomy there was a lump in abdominal cavity, which confirmed the diagnosis of Gossypiboma. Discussion. Gossypiboma is an important topic, seldom reported because of the medicolegal issues and a significant embarrassment; it is considered by some authors as a severe postoperative iatrogenic complication. The reported estimate of retained surgical items is 1.32 per 10, 000 procedures and 0.3 to 1% of abdominal operationsIts clinicalpresentation is extremely variable. The standard treatment is laparotomy, surgical removal, and in some selected cases, laparoscopic and endoscopic removal can be performed. Conclusion. Gossypibomas are uncommon, mostly asymptomatic, and hard to diagnose. Gossypiboma is an unwanted and preventable complication that should be considered as a differential diagnosis for all mass lesions detected in the postoperative period. It is considered a serious medicolegal problem and, hence, should be prevented at all costs.
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COMBINING PROSTATE HEALTH INDEX AND ampMRI DATA (MRI SPECTROSCOPY) TO MANAGE PI-RADS LESIONS AND REDUCE EXCESSIVE BIOPSY, A SINGLE CENTER STUDY
(Macedonian Association of Anatomists and Morphologists, 2023)
Krstev, Toni
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Stojanoski, Ivica
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Ilievski, Lazar
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Tufekchioski, Nerhim
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To evaluate the values of PHI and PI-RADS findings in the early detection and prediction of prostate cancer, as well as their application in clinical trials, especially when values of PSA are in the „ grey zone„ with negative DRE. The 100 patients, men aged 50 years or older with prostate-specific antigen 4 to 10 ng/ml („gray zone„) and normal digital rectal examinationwith suspected prostate cancer were examined, who had undergone biopsy and were divided in two groups. A group with no evidence of PCa (non PCa) and the group with PCa. The performance of PHI and mpMRI PI-RADS score was compared to predict biopsy results and, specifically, the presence of clinically significant prostate cancer (csPCa) using multiple criteria. Among 100 subjects, 21 (21.0%) were diagnosed with PC, including 13 (61.95%) with csPC (Gleason≥7). By the threshold of PHI≥36, the sensitivity, specificity, PPV, and NPV to predict PCa were 100%, 68.35%, 45.65%, and 100%, respectively. The best cut-off (PHI) was 42.8% with sensitivity 85.7% and specificity 86.1%. The area under the receiver operator characteristic curve (AUC) of combining PHI and mpMRI was greater than that of PHI alone (0.993 vs. 0.954, p=0.002) and mpMRI alone (0.993 vs. 0.976, p=0.025). Comparing the performance in the identification of clinically significant prostate cancer (csPCa), we found that PHI ≥ 73.04 and PI-RADS score ≥ 4 were able to identify csPCa (Gleason score ≥ 7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI≥36.0, 50% of biopsy could be avoided with one csPCa patient being missed. The analyzed correlation between PHI and PI-RADS score was statistically significant (p<0.0001). According to the value of Spearman's coefficient, R=0.748, the correlation is positive, i.e. direct, and they showed that with an increase in the value of the prostatic health index, (PHI) the PI-RADS score increases, and vice versa. The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone.
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THE ROLE OF T2W PULSE SEQUENCE AND DIFFUSION WITH ITS NUMERICAL ADC MAP IN PROSTATE CANCER DIAGNOSIS
(Macedonian Association of Anatomists and Morphologists, 2023)
Kostova, Masha
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In patients with increased PSA (prostate-specific antigen), the next diagnostics tool is transrectal ultrasound-guided biopsy-TRUS. Multiparametric magnetic resonance imaging (mp MRI) as non invasive diagnostic tool is used as a triage test to avoid biopsy, as well as to improve the diagnostics. In our study we want to prove the clinical meaning of T2W pulse sequence and diffusion as a part of mp MRI in prostate malignant lesions detection and their distinction from the benign lesions. This cohort prospective study included 100 patients with increased levels of PSA from 4 ng/ml to 76 ng/ml. The MRI equipment used was Siemens Essenza1,5T with body coil. The results from the T2W pulse sequence and diffusion are correlated with the values of diffusion and ADC map, in which the suspected zones are marked on a template. Patients undergo biopsy depending on the PIRADS (prostate-imaging and reporting data system) classification. The MRI results and the pathohistological findings are then compared. Clinically significant cancer is considered to be a cancer with a Gleason score 6, diameter > 6mm. The values of diffusion with its numerical ADC map are considerably lower for malignant nodules compared to benign ones. Hyposignal of T2W pulse sequence is characterized with score 2 and 3 in benign changes, and 4 and 5 in malignant changes using the PI RADS score system for differentiation. T2W pulse sequence combined with diffusion is a powerful tool for non-invasive differentiation of benign prostatic hyperplastic nodule and prostatitis from a malignant nodule.
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Clinical Effectiveness of Single Lumbar Periradicular Infiltration in Patients with Sciatica
(Walter de Gruyter GmbH, 2023-07-01)
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Kostova, Masha
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Ristikj-Stomnaroska, Daniela
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Stoshevska, Tatjana Deleva
Periradicular therapy (PRT) is a minimally invasive radiological procedurein patients with chronic lumbar pain.The aim of the study is to identify clinical and radiological predictive factors for treatment success after a single PRT treatment in patients with sciatica.The study includes a prospective follow-up of 166 patients treated with PRT. The pain intensity is determined according to the VAS scale and the degree of improvement is presented as excellent (over 75%), good (50-70%), moderate (25-49%), and weak (less than 25%). The follow up of the treated patients was done at 2 weeks, 3 and 6 months. In patients with pain duration up to 3 months, the improvement was excellent in n=32 (58.18%) after 2 weeks, after 3 months n=41 (74.55%) and after 6 months n=41 (74.55%). This stands in contrast to patients with pain over 1 year. The percentage of improvement after 6 months, post-intervention, was highest in patients without nerve root compression (86.25±19.2),and the highest improvement after 6 months was in patients with localization of pain at the L4-L5 level (69.69±29.7), the greatest improvement after six months was in patients with extraforaminal hernia (62.82±34.3), and the lowest in patients with central stenosis (40.21±30.7).Our study results suggest that the shorter a pain duration, low-grade root compression, injection level and type of herniation area predictor the more favourable response patients have to transforaminal epidural steroid injection in patients with sciatica.
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Evaluation of the therapeutic efficacy of computed tomography - guided periradicular therapy in patients with extraforaminal disc herniations.
(Macedonian Association of Anatomists, 2020-12-30)
Veljanovski, Dimitar
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Kostova, Masha
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Periradiculartherapy (PRT) is a minimally invasive radiological technique for treatment ofchronic lumbar pain.The aim of this study was to investigate the efficacy of PRT in patients with chronic lumbar pain and radiculopathy due to extraforaminal disc herniation.The study included a prospective follow-up of 30 patients with chronic lumbar pain and radiculopathy. All patients underwentmagnetic resonance imaging (MRI) and extraforaminal neuro-radicular conflict was detected. The degree of pain intensity was scored according to the VAS scale. The degree of improvement was presented as excellent (over 75%), good (50 -70%), intermediate (25-49%) and poor (less than 25%). Functional and working status was rated according to Oswestry Disability index2.0 (ODI). Follow-up of treated patients was at 2 weeks and 3 months.After 2 weeks the improvement was excellent in14 patients (47%), good in 7 patients (23%), moderate in 7 patients (23%) and mild in 2 patients (7%). Improvement after 3 months was excellent in 15 patients (50%), good in 7 patients (23%), moderate in 3 patients (10%) and poor in 5 patients (17%). The improvement of the functional status according to the ODI score was at least 40% in 73.3% of patients after 2 weeks and 86.5% of patients after the third month.CTcontrolled PRT in patients with lumbar radiculopathy is a safe and effective procedure leading to a significant pain reduction and a better quality of life after the procedure

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