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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ЕФЕКТИВНОСТА НА ПЕРИРАДИКУЛAРНАТА ТЕРАПИЈА ПОД ВОДСТВО НА КОМПЈУТЕРИЗИРАНА ТОМОГРАФИЈА КАЈ ПАЦИЕНТИ СО ХРОНИЧНА ЛУМБАЛНА БОЛКА И РАДИКУЛОПАТИЈА
(МЕДИЦИНСКИ ФАКУЛТЕТ УНИВЕРЗИТЕТ “СВ. КИРИЛ И МЕТОДИЈ”- СКОПЈЕ, 2022-03-21)
Introduction: Low back pain is one of the most common conditions that every person faces in his life and one of the most common reasons to visit a doctor. The frequency is so high that it is believed that about 80% of the population have at least one episode of low back pain in life of various degrees and forms. Life expectancy of lower back pain is estimated at 13-40% in industrialized countries with a one year prevalence of 15-45%, the incidence in adults is 5% per year, with a peak of 35 to 55 years of age for the most part in the working age population. Chronic lumbar pain and radiculopathy is a clinical lumbar pain syndrome followed by limb pain involving sensory or motor deficits on the affected side for more than 12 weeks. The modern treatment requires a multiplicity of approach that includes physical therapy, minimally invasive techniques, and sometimes a classic surgical approach. Diskal herniations, spinal stenosis, degenerative diseases with or without disc herniation, and postoperative lumbar pain syndrome are the most common conditions responsible for chronic persistent lumbar pain and radiculopathy. Minimally invasive techniques including periradicular therapy are the most commonly used nonvascular interventions to manage chronic lumbar pain and painful radicular syndrome. Many studies show a significant reduction in lumbar pain and radiculopathy shortly or for a long time after epidural application. Main objectives of the study: To evaluate the efficacy of PRT (Periradicular Therapy) in patients with chronic lumbar pain and radiculopathy most commonly caused by disc herniation, disc osteophyte complex or central lumbar stenosis in the lumbar segment with the following objectives: Secondary goals: • To see if there is an association between the duration of pain before the intervention and the degree of its reduction with PRT after 2 weeks, 3 months and 6 months. • Assess whether there is a possible association between age, sex, location of the lesion (pain) and the degree of effectiveness of the intervention (degree of pain reduction). • To determine the group of demographic, radiological and clinical factors that are associated with the effectiveness (success) of the intervention. • Assess the degree of pain reduction and the degree of functionality of the patients depending on the type of hernias (foraminarian, extraformaramin, posterolateral) after PRT. 11 2. To assess the quality of life in patients with lumbar pain and radiculopathy before and after the intervention. Study design: According to the design, the study is non-randomized (patients were included as indicated), prospective, interventional, which includes prospective follow-up of 166 male and female subjects with chronic lumbar or radicular pain, all treated with PRT. Materials and methods: The clinical study was conducted in the PHI CGH " 8 September " of the Department of Diagnostic and Interventional Radiology. The study included prospective follow-up of 166 male and female subjects with chronic lumbar or radicular pain. All patients underwent MRI (magnetic resonance imaging) at least one month before the intervention and central canal stenosis, spondylolisthesis, or disc herniation with or without nerve root compression were demonstrated. Subcutaneous application of Lidocaine 3ml as well as Bupivacaine 2ml and Kenalog 2ml at the level of the lateral epidural space was used for all subjects. Medical application (Bupuvacaine and Kenalog) was monitored by 16-slice CT (computed tomography).The degree of pain intensity was scored according to the VAS scale (visual analog scale) – The National Initiative on Pain Control ™ (NIPC ™) which included mild, moderate, severe and very severe pain.The degree of improvement was presented as excellent (over 75%,) good (50-70%), medium (25-49%), poor (less than 25%). Functional and working status were assessed according to Oswestry Disability index 2.0 (ODI). Follow-up of treated patients was after 2 weeks, 3, 6 months. Results: There was a statistically significant reduction in the average value of VAS and ODI. For VAS good response – (≥ 50%) was observed at 51.81% after 2 weeks, 54.22% after 3 months and 59.04% after 6 months. For ODI higher or equal to 40% in 22.29% after 2 weeks, after the 3rd 13.86%, and after the 6th month 8.43%.The number of patients with a good VAS and ODI response was higher when the pain duration interval was shorter. After 2 weeks in patients with pain duration up to 3 months the improvement was excellent in 32 (58.18), after 3 months 41 (74.55) and after 6 months 41 (74.55), in contrast to patients with pain over 1 year who showed excellent improvement at 2 (5.71) after 2 weeks, 41 (74.55) after 3 months, and 41 (74.55) after 6 months. The mean percentage improvement after 6 months of intervention was highest in patients with localization of pain at level L4-L5 (69.69 ± 29.7), and lowest 51.52 ± 30.1 in patients with localization of pain at level L5-S1.At the end of follow-up patients, the mean ODI values were 27.67 ± 25.2 in patients with L3-L4 level pain, as opposed to patients with L2-L3 level pain with an average ODI value of 46.75 ± 39.02. The mean percentage improvement after 6 months was highest in patients with extraforaminal herniations (65.25 ± 28.8) and lowest in patients with central canal stenosis (45.21 ± 25.7). ODI lower than 40%, 2 weeks after the intervention was registered most often in patients with extraforaminal herniations – 90% (16) and most rarely in patients with central canal stenosis – 58.6% (10). Patients with a lower degree of nerve root compression had a significant improvement. The percentage 12 improvement after 6 months post-intervention was highest in patients without nerve root compression (86.25 ± 19.2), followed by patients with first, second, third, and fourth degree compression (78.1 ± 22.7, 57.2 ± 28.5, 46.4 ± 49.8, and 34.6). ± 33.2, respectively). The ODI index after 6 months of intervention presented the lowest values in patients without nerve root compression (10.5 ± 7.5), followed by patients with first, second, third and fourth degree of compression (14.6 ± 9.4, 25.7 ± 20.2, 40.4 ± 23.8, and 64 ± 33.8 respectively. Conclusion: CT performed PRT in patients with lumbar pain and radiculopathy is a safe, effective therapy and procedure and it is best to do it as soon as the symptoms appear. The benefit is greater in patients with less compression of the nerve radix. In patients treated with PRT there is a reduction in the use of analgesics and anti-inflammatory drugs and a significant improvement in quality of life. Keywords: periraductal therapy, chronic lumbar pain, radiculopathy, corticosteroids, PRT, CT
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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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