Faculty of Medicine

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Incidental Detection of Familial Fahr’s Disease Following a Traffic Accident - A Case Series
(Remedy Publications LLC, 2026-01-08)
Josifovska Mitreska, Angela
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Objective: To present a case series of asymptomatic patients in whom Fahr’s disease was incidentally identified during routine CT imaging after a car accident. Methods: We report three asymptomatic individuals—a 28-year-old mother and her two children (aged 8 and 5)—who presented to the emergency department following a car accident. All underwent non-contrast cranial CT as part of standard trauma protocol. Neurological examinations were non-specific, with no clinical signs of neurological dysfunction. Results: CT imaging revealed symmetrical bilateral calcifications in the basal ganglia in all three patients. In the mother, additional calcifications were present in the caudate nucleus. No evidence of acute traumatic brain injury was found. There was no known family history of neurological disease. Based on the characteristic calcification pattern and familial clustering, a presumptive diagnosis of familial Fahr’s disease was made. Further evaluation, including calcium-phosphorus metabolism testing and genetic screening, was recommended. Conclusion: These cases demonstrate that routine trauma imaging can incidentally reveal undiagnosed familial Fahr’s disease in asymptomatic individuals. Recognition of the typical radiological features allows for early diagnosis, clinical follow-up, and consideration of genetic counseling for affected individuals and their families.
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Neuroimaging, a key role in diagnosis of diffuse axonal injury. CT and MRI patterns every radiologist should know
(EUROPEAN SOCIETY OF RADIOLOGY, 2023-03-01)
Jovanoska, Ivona
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Gjoreski, Aleksandar
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Lombardo, I
Learning objectives - to understand the common mechanisms and pathology of diffuse axonal injury (DAI) - to recognize the radiological appearances on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) - to understand the role and clinical importance of neuroimaging in patients with DAI Read more Background Diffuse axonal injury as the name implies is a traumatic stretch/disruption of axons that occurs with sudden acceleration/deceleration or rotation of the brain. Patients with DAI are most commonly injured in high-velocity vehicle crashes and DAI represents 50% of all primary intraaxial traumatic brain lesions in moderate/severe traumatic brain injury (TBI). It has 80-100% autopsy prevalence in fatal injuries and even occurs in utero if pregnant woman subjected to sufficient force. Typically, patients present with loss of consciousness at the time of accident and often... Read more Findings and procedure details Non enhanced CT is the first-choice neuroimaging tool in all emergency head trauma patients, but MRI is the modality of choice for assessing suspected diffuse axonal injury. It is a potentially difficult diagnosis to make on imaging alone. Some patients with relatively normal CT scans may have significant unexplained neurological deficit, in those cases DAI should be suggestive and confirmed with MRI. On CT the finding can be subtle or absent, but that does not categorically exclude the presence of axonal injury. Contrary to the... Read more Conclusion DAI as a diagnosis should be suggestive in TBI patients with clinical symptoms disproportionate to imaging findings. More than 30% of patients with negative CT have positive MR, so in general it is clinically developed based on clinical manifestations and MRI findings. Neuroimaging plays a significant role, by detecting the location and number of lesions, not only in diagnosis but also in determining the outcome of patients after DAI.
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CT Findings in Progressive Xanthogranulomatous Pyelonephritis
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
Jovanovska, Zlatica
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Petkovikj, Magdalena
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Donevska Efremovska, Kristina
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Kamcheva, Marta
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Resulting from recurrent subacute or chronic urinary infections, a chronic pyelonephritis develops, which can be represented as several entities. Xanthogranulomatous (XGP) pyelonephritis is one of those entities which has characteristic radiographic features. The inflammatory process following the recurrent infections causes destructions to the parenchymal wall of the kidneys and over time it is replaced with a mass of reactive granulomatous tissue, containing lipid-laden macrophages, which surrounds the typical form of calculi – staghorn calculi. These are the pathognomonic radiological signs. CT is the modality of choice in diagnostic imaging for xanthogranulomatous pyelonephritis for two reasons – in the most of cases it demonstrates a highly specific tirade of findings that allow a confident diagnosis and offers accurate follow-up of the disease which is of great importance for the further surgical treatment. We present the CT findings of a clinical case throughout 6 years long follow up of chronic pyelonephritis which advanced to development of XGP and a complication with purulent collection in the left kidney, which resulted in left sided nephrectomy. This article describes the role of diagnostic imaging and correlates the radiologic findings to the underlying disease process. Additionally, we emphasize the diagnostic importance of CT in treatment, follow-up and preoperative planning.
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Large Ovarian Cyst Presenting as Weight Gain in an Adolescent Girl: A Case Report
(SHMSHM - AAMD, 2022)
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Jovanovska, Zlatica
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Kamcheva, Marta
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Dukovska, Marija
Ovarian cysts are a common finding in female adolescents presenting with macrocysts that occupy the entire pelvis or abdomen. Ovarian cysts can be asymptomatic and found accidentally or be manifested as a painful syndrome in which one of the first clinical signs is the feeling of abdominal fullness or progressive enlargement of the abdomen. The frequency of which ovarian cyst are present in adolescent young females has raised and is in the range from 3,8% to 30,9%. Peak ovarian cyst frequency was at age of 15 years with a rate of 31.3%.1 We report an unusual case of a large ovarian cyst in a 12-year-old girl without previous medical information of illness. The cyst was asymptomatic until it became large enough and manifested as weight gain and progressive abdominal distension over the course of a few months and was an accidental finding on an abdominal CT. Because of the progressive pain and discomfort of the patient, CT and MR imaging were performed. The radiographic features of the cyst together with the further management and treatment are discussed below.
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CT and MRI, importance of preoperative radiological assessment in pediatric cochlear implantation
(Europrean Federation of Audiology Societies, 2023-05)
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INTRODUCTION: Cochlear implantation (CI), in the past more than 30 years, has become a standard of care for children with profound sensorineural hearing loss. As it became a routine intervention, requests for pre-op images have increased in the work-up for candidates. The optimal protocol for radiodiagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. The presence of a functional cochlear nerve is a key issue in pediatric CI. Cochlear nerve aplasia is the only absolute contraindication for CI and MRI is a gold standard for cochlear nerve (CN) detection. Recently, some authors have reported the relationship between bony cochlear nerve canal (BCNC) stenosis on CT and cochlear nerve deficiency (CND). OBJECTIVES: The aim of this study was to consider the importance of CT in the preoperative assessment of prelingualy deaf children and to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND. MATERIALS AND METHODS: A total of 11 children with confirmed diagnosis of prelingual, severe sensorineural hearing loss will be included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. CND is diagnosed if the cochlear nerve is absent (aplasia) or very thin i.e. smaller than the adjunct facial nerve in the internal auditory canal on MRI (hypoplasia). Two factors were reviewed retrospectively: presence of inner ear anomalies and the relationship between BCNC stenosis on CT and the existence of CND on MRI. RESULTS From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR. CONCLUSION: Radiological evaluation is integral in surgery planning. The optimal protocol for radio-diagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. Children with BCNC stenosis on CT have a high incidence of CND on MRI. A narrowed BCNC on CT can be an indicator for the selection of children who are candidates for CI and need to be additionally referred for MRI. So, when its feasible use both imaging methods, but when not narrow BCNC on CT it’s a reliable indicator for mandatory MRI. KEYWORDS: CT, MRI, bony cochlear nerve canal, cochlear nerve, pediatric cochlear implantation.
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ZINNER SYNDROME
(Macedonian Association of Anatomists, 2021)
Nacko Stavreski
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Aleksandar Petrovski
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Mitko Ilievski
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Developmental malformations of the urogenital tract are rare, and most of them are cystic anomalies. In the embryogenesis, exactly during the first trimester of gestation developmental arrest affecting mesonephric (Wolffian) duct results in unilateral renal agenesis. Ipsilateral seminal vesicle cyst also affecting the caudal end of Mullerian duct produces ipsilateral ejaculatory duct obstruction. Most of the patients with this malformation are asymptomatic until the 2nd or 3rddecade of life. Initially, majority of patients have nonspecific symptoms such as perineal discomfort, urinary urgency, prostatism, painful ejaculation and dysuria. We report an uncommon case of a 24-year-old patient presented with symptoms of lower urinary tract irritation. Radiologic imaging modalities as ultrasonography, contrast-enhanced computed tomography and magnetic resonance imaging are all helpful in diagnosis of this extremely rare developmental anomaly.
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Our experiences with Virtual CT pneumocystography and the detection of bladder cancer.
(2014-03)
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Nikolov, Kiril
Our goal was to evaluate the prospect of future use, sensitivity and specificity of CT volume- rendering techniques in the evaluation of bladder wall changes, without the need of conventional endoscopic procedures which is limited by its invasiveness and the difficulty to explore the bladder in full potential. This study investigates the sensitivity range of virtual CT and 3D reconstruction techniques in assessing lesions of the bladder wall to compare it with that of conventional endoscopy, and outlines the indications, advantages and disadvantages of virtual CT-pneumocystography.
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Importance of CT imaging in pediatric cochlear implantation: Emphasis the significance of the BCNC width.
(2022-07-27)
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Introduction: Cochlear Implantation (CI), in the past more than 30 years, has become a standard of care for children with profound sensorineural hearing loss. As it became a routine intervention, requests for pre-op images have increased in the work-up for candidates. The optimal protocol for radio-diagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. An absent cochlear nerve (CN) is the only absolute contraindication to cochlear implantation and MRI is a gold standard for CN detection. Some authors have reported the relationship between cochlear bony nerve canal (BCNC) stenosis and CN hypoplasia and aplasia. Objectives: The aim of this study was to stress out the importance of CT by evaluating the width of the bony cochlear nerve canal (BCNC) in children with congenital sensorineural hearing loss (SNHL) and “normal" findings on thin section temporal bone CT. Materials and methods: The width of the BCNC was retrospectively evaluated in two groups of patients. The study group included 11 children with congenital, bilateral SNHL who underwent cochlear implantation from July to December 2019. Eleven children aged 3-10 years, with no sensorineural hearing loss were taken as controls. Axial sections of their CT scans were used to measure the width of the BCNC. Results: From the obtained results, the width of the BCNC in children with bilateral, profound sensorineural hearing impairment range from 1.0 to 2.3 mm with mean value of 1.5 ± 0.3 mm and is significantly smaller than in the control group.
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POLYOSTOTIC FIBROUS DYSPLASIA
(Journal of Morphological Sciences, 2022-08-31)
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Antuleska Belcheska,Gordana
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Petrovski, Aleksandar
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Paneva, Elena
Fibrous dysplasia is a benign skeletal disorder in which the normal bone tissue is replaced by immature fibrous tissue. Polyostotic means that abnormal areas may occur in many bones; often they are confined to one side of the body. Replacement of bone by fibrous tissue may lead to pathologic fractures, uneven growth, and deformity. CT and MRI findings in combination with histopathological results are crucial for the diagnosis of this condition. We present a specific case of a patient with polyostotic fibrous dysplasia and the imaging findings that lead to the final diagnosis.
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THE VALUE OF PET/CT IN DETECTING COLORECTAL CANCER RECURRENCE IN PATIENTS WITH NEGATIVE CT FINDINGS
(2021-07)
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Computed tomography (CT) is widely accepted imaging modality used to detect recurrent colorectal cancer (CRC) in the routine follow up, though further imaging may be required. The objective of this research is to investigate the value of PET/CT in detecting colorectal cancer recurrence despite negative CT findings. A retrospective review of colorectal cancer patients referred for 18F-FDG PET/CT imaging to the University institute of positron emission tomography in Skopje, between July 2018 and January 2020. All of the patients had a stage III disease and were clinically suspicious of recurrence (elevated CEA or presence of symptoms) despite recent negative CT findings. Twenty one patients (10 women and 11 men, mean age 56.95) met the above criteria. In 6 patients (28%) cancer recurrence was detected. Negative PET/CT findings were reported in eleven patients and in only one patient (1/11, 9%) recurrence was detected within one year of PET/CT. Equivocal PET/CT finding were reported in three patients, further work-up proved metastasis. In eight (8/9, 88%) patients with abnormal level of CEA, PET/CT detected or initiated further work-up that led to malignancy detection. Patients with stage III CRC had the most positive PET/CT findings 4/7 (57%) compared to others. PET/CT could detect disease recurrence in patients when clinically suspicion persists in spite of negative CT findings. Elevated CEA and the primary tumor stage were dominant features of the patients with recurrent disease. Negative predictive value of PET/CT is high enough to reassure clinicians and reduce patient anxiety

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