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    MRI SIGNS IN METHOTREXATE-RELATED LEUKOENCEPHALOPATHY IN CHILDREN WITH BURKITT LYMPHOMA-ABDOMINAL MANIFESTATION
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-01)
    Mihajlovska Michevska, Tamara
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    Gjorgjioska, Stefani
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    Jukikj, Edis
    Burkitt lymphoma, classified as a subtype of non-Hodgkin lymphoma, primarily targets children. It frequently presents with extranodal involvement, often manifesting as an abdominal or pelvic mass upon initial presentation. Treatment regimen commonly incorporates chemotherapy, wherein the prognosis, particularly in pediatric cases, is notably favorable, with survival rates exceeding 90%. However, the utilization of methotrexate, a chemotherapy agent employed in hematological malignancies and other neoplasms, warrants careful consideration due to its propensity for neurotoxicity. Methotrexate-induced neurotoxicity may be presented across a spectrum of acute and chronic leukoencephalopathies. One significant manifestation is toxic encephalopathy, characterized by its predominant affliction of subcortical white matter. Additionally, notable findings include confluent hyperintensities observable on T2 and FLAIR imaging, particularly evident in the centrum semiovale region. Magnetic resonance imaging (MRI) stands as the preferred diagnostic modality. This non-invasive and sophisticated imaging technique holds immense clinical and research utility. Leveraging MRI enables early detection of neurological conditions, facilitates ongoing monitoring of treatment outcomes, and supports timely interventions, thereby offering significant benefits in patient’s care. We report the case of a 4-years-old patient diagnosed with Burkitt lymphoma, who underwent an MRI scan following symptoms of blindness and convulsions. Initial CT scans showed no discernible pathology. Subsequent MRI findings revealed signal abnormalities, typical of methotrexate-related leukoencephalopathy. Notably, convulsions ensued shortly after initiating methotrexate treatment. These MRI findings are characteristic of toxic encephalopathy, highlighting the importance of vigilant monitoring in patients undergoing methotrexate therapy.
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    Comparative analysis of clinical and arthroscopic findings in ACL injury of the knee
    (2014-01)
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    Background: This study was conducted to compare accuracy of MRI findings taking arthroscopy as standard in knee injuries. Methods: All patients attending our hospital with knee injury underwent clinical examination. Out of them 100 patients with knee injury were subjected to clinical examination, MRI and then Arthroscopy. The results were compared and analyzed using various statistical tests. The accuracy, sensitivity and specificity were calculated based on these arthroscopic and MRI findings. Results: The accuracy of clinical diagnosis in our study was 88% for ACL tears and 85% for meniscal tears. Our study proved high sensitivity and specificity and almost high accuracy for ACL injuries of knee joint in comparison to arthroscopy. MRI is an excellent screening tool for therapeutic arthroscopy. We can avoid diagnostic arthroscopy in patients with knee injuries having equivocal clinical and MRI examination and go on for therapeutic modality. Conclusions: For the assessment of ligamentous and meniscal injuries magnetic resonance imaging (MRI) is accurate and noninvasive modality. It can be used as a first line investigation but arthroscopy still remains gold standard in diagnosing ACL and meniscal injuries.
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    Accuracy of Magnetic Resonance Imaging in comparison with Arthroscopic findings for lateral and medial meniscal tears
    (Macedonian Pharmaceutical Association, Ss. Cyril and Methodius University in Skopje, Faculty of Pharmacy, 2024-11)
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    Vejseli, Valentin
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    Merdjanovski, Igor
    This study was conducted to analyze the reliability of clinical diagnosis in meniscal tear injuries. From one hundred and three patients with knee problems, arthroscopically in 40 were diagnosed LM (lateral meniscus) tears and in 45 patients MM (medial meniscus) tears. MRI of the knee joint was done before the admission and some of them before the clinical examination. In this study meniscal tears were clinically diagnosed by positive McMurray and Apley test. At all these patients the clinical diagnosis was confirmed during underwent therapeutic arthroscopic knee surgery. The accuracy, sensitivity and specificity were calculated based on MRI and arthroscopic findings. The accuracy of clinical diagnosis in our study was 70% for LM tears and 63.1% for MM tears. Our study revealed high sensitivity and specificity and good accuracy for meniscal injuries of knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. Magnetic resonance imaging is accurate and non-invasive modality for the assessment of meniscal injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee.
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    Diagnostic assessment in anterior cruciate ligament (ACL) tears
    (Macedonian Academy of Sciences and Arts, 2014)
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    Arsovski, Oliver
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    Nikolov, Vladimir
    The aim of this study was to compare findings from clinical examinations, MRI scans and arthroscopy in ACL injury of the knee in order to assess the diagnostic significance of both examination findings. This study was conducted to manage the reliability of clinical diagnosis in ACL tear injuries. All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. Of 103 patients with knee problems arthroscopy ACL tears was diagnosed in 73. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was evaluated and confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The MRI accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Accuracy for two of three clinical examination tests of clinical diagnosis in our study was 96% and 94% for ACL tears. According to our obtained correlation between clinical examinations, MRI scan and arthroscopy for ACL injuries, we concluded that carefully performed clinical examination can give equal or better diagnosis of ACL injuries in comparison with MRI scan. Our study revealed MRI scan high sensitivity and specificity and not so high accuracy for ACL injuries of the knee joint in comparison with arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. According to our findings we can conclude that a positive anterior drawer test and a positive Lachman clinical examination test is more accurate for predicting, i.e. diagnosis of ACL tear. On the ither hand, MRI scan findings showed less accuracy for predicting, i.e. diagnosis of ACL tear. According to many studies of clinical examination tests compared (correlated) with arthroscopy, the accuracy of predicting ACL tears depends on the level of the skilled orthopaedic or trauma surgeon's hands. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology.
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    Reliability Assessment of Arthroscopic Findings Versus MRI in ACL Injuries of the Knee
    (ScopeMed, 2014-04)
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    Introduction: This study was conducted to analyze the reliability of clinical diagnosis in ACL tear injuries. Material and methods: All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. From one hundred and three patients with knee problems in 73 were arhroscopicaly diagnosed ACL tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. Results: The accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Our study revealed high sensitivity and specificity and almost high accuracy for ACL injuries of knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. Conclusion: Magnetic resonance imaging is accurate and non invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee.
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    MRI diagnosis of Baker cyst and significance of associated medial compartment knee osteoarthritis
    (Walter de Gruyter GmbH, 2008-01-01)
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    Szeimies, Urlike
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    Staebler, Axel
    Background. The purpose was to evaluate the enlargement of the Baker cyst and the significance of medial compartment knee osteoarthritis. Patients and methods. In a period of two years we evaluated 66 patients with MRI signs of the Baker cyst and medial compartment knee osteoarthritis (median age 56 years, age range 34-84 years, 23 males and 43 females). One group was with MRI signs of the large Baker cyst and the other one with the small Baker cyst. Following graded criteria for medial compartment were used: cartilage thickness, meniscus degeneration, bone marrow oedema, effusion. Lateral compartment was normal. Results. In the group with the large Baker cyst, 26/31 cases (84%) had medial compartment cartilage loss. Eighteen from them had associated 3dh degree meniscal degeneration. Five/31 (16%) cases had only medial meniscus involvement. In the second group, 17/35 (48%) cases had cartilage loss, with 3dh degree meniscal degeneration was 14 (82%). In 18/35 (52%) cases only meniscus degeneration was present, 67% had 1st degree of meniscus degeneration. There was a statistically significant difference in the group with the distended Baker cyst between different degrees of medial meniscus degeneration. Conclusion. The size of the Baker cyst, as a soft tissue tumour, is strongly correlated with degenerative changes of the cartilage and with the degree of meniscus degeneration on the medial compartment of the knee joint.
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    Value of ultrasound and MR imaging in diagnosis of tubular ectasia of rete testis.
    (Faculty of Medicine, University of Nis Galaksijanis Nis, 2023-09-21)
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    Rendevska Mihajlovska, Ana
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    Introduction: Tubular ectasia of the rete testis is a rare, cystic lesion of the testis which is a pathologically benign process, usually found bilaterally and incidentally, more common in men over the age of 55 years. The process is bilateral in approximately one-third of cases. Because only 5% of intratesticular tumours are benign, the main significance of this condition is that it must be differentiated from testicular neoplasm. Material and methods: We report a case of tubular ectasia of the rete testis in a 57-year-old man with right epididymal pain. Results: Serum tumour markers for testicular malignancy were not elevated. A scrotal ultrasound scan revealed both testes of normal dimensions. But, we found appearance of indeterminate intratesticular hypoechoic lesion without definite cystic spaces in the confluence of the mediastinum testis, without of mass effect and lack of internal vascularity, billateraly, with a loculated right hydrocoele posterior to the right testis. We made a MR imaging. On T2- weighted images this manifests as a hyperintense zone owing to the presence of fluid in the dilated small mediastinal tubules, but nointernal enhancement was seen after administration of gadolinium contrast. The patient was managed conservatively and repeat scrotal ultrasound scans at 1 and 6 months demonstrated no change in pathology. Conclusion: The use of ultrasonography and colour Doppler imaging is vital in identification of tubular ectasia of the rete testis and, therefore, may avoid unnecessary orchidectomy. When the sonographic findings are equivocal, MR imaging is warranted to confirm the diagnosis.
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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.