Nikolova, Sonja

Preferred name

Nikolova, Sonja

Official Name

Nikolova, Sonja

Main Affiliation

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Colon Screening: Colonoscopy vs Virtual Colonoscopy
(2013-03)
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K. Nikolov
Virtual colonoscopy or appropriately named CT Colonography(CTC) is a new radiologic method of screening the colon for precancerous polyps with an ongoing tendention to supplement the regular endoscopic colonoscopy. We are trying to show how this method with the abbility to reconstruct and render the images can better depict the colon and any suspicious lesion thus avoiding the invasivness of the old method and sedation of the patient. We suggest this method for any patient with: * known familial polyposis * blood in the stool * with known Ulcerative colitis or Crohn's disease.
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Abdominal ultrasound in pediatric pathology
(2016-03)
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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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ИМПЛЕМЕНТАЦИЈА НА ОПТИМИЗАЦИЈАТА НА МЕДИЦИНСКАТА ЕКСПОЗИЦИЈА ВО КЛИНИЧКАТА ПРАКСА НА ИНСТИТУТОТ ЗА РАДИОЛОГИЈА, СКОПЈЕ, МАКЕДОНИЈА
(2019-03-20)
Radioactivity is a natural phenomenon and feature of the environment. Radiation and radioactive substances have many beneficial applications, ranging from power generation, to uses in medicine, industry and agriculture.In recent years, new radiology technologies and devices using ionizing radiation, such as CT and PET-CT, have led to major improvements in the diagnosis and treatment of various diseases. However, inappropriate or unskilled use of such technologies and devices can lead to unnecessary or unintended man-made radiation exposures and potential health hazards to patients and staff.According to the IAEA ( International Atomic Energy Agency), all medical exposures should be guided by the general principles of radiation protection which include-justification, optimization and dose limit. Regulation is essential to control radiation exposure in clinical practice.Optimization of medical exposure means that all exposure should be kept as low as can be rationally achieved, taking economic and social factors into consideration. Optimization is considered from the viewpoints of image quality and exposure reduction which was the main purpose of our project-to possibly reduce the exposure in 100 CT scans and 100 chest x-rays without losing the diagnostic quality of the images that were acquired. We were collecting information about the total doses of exposition prior to, and after the optimization, and image quality estimation, in order to prove the benefit of optimization in medical exposure.Although dose limits for medical exposure have not been established by law, it is necessary to confirm the potential benefit for the patient from medical exposure of radiation, balanced by the potential risks.
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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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Differential Diagnosis of Diffuse Cystic Lung Disease at HRCT - An Overview
(Biomedical & Clinical Research (Biores Scientia), 2024)
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Introduction: The diffuse cystic lung diseases (DCLDs) are a diverse group of lung disorders characterized by the presence of multiple regular or irregular spherical parenchymal lucencies bordered by a thin wall and having a well-defined interface with normal lung. Other lucent lung lesions like centrilobular emphysema, cavity, cystic bronchiectasis, honeycomb cyst, and pneumatoceles are close mimics of a lung cyst on high-resolution computed tomography (HRCT) HRCT is an important modality in the evaluation of interstitial lung disease to include cystic lung disease. This review describes a simple algorithmic approach for DCLDs on HRCT based on cyst’s distribution, size, and shape, as well as background parenchymal changes and it helps also in differentiation of common and uncommon diffuse cystic lung disease. Aim: The aim of the study is to present, describe and make differential diagnosis of this spectrum of diseases associated with air cysts at high-resolution CT. Conclusion: Diffuse cystic lung diseases are a group of complex disorders that often have an overlapping clinical presentation, but different underlying pathological processes. HRCT still remains the imaging of choice for the diagnosis of common diffuse cystic lung diseases.
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Pulmonary manifestation of sarcoidosis detected on high resolution computed tomography
(Macedonian Association of Anatomists, 2023)
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Sarcoidosis is a multisystemic disease of unknown etiology that mostly affects the lung parenchyma with interstitial and granulomatous changes of varying intensity and expression depending on the stage of the disease. In addition to the parenchyma and interstitium, the mediastinal lymph nodes are also very often affected. To analyze the distribution and characteristics of interstitial lung lesions and the involvement of mediastinal lymph nodes in pulmonary sarcoidosis by the method of high-resolution computed tomography.15patients diagnosed with pulmonary sarcoidosis were included in the study. Computed tomography with high resolution was made on 128 slice CT scanner PHILIPS INCISIVE, using 1 mm thin-slice thickness and high spatial frequencies algorithm for image reconstruction. Lymph nodes are classified as hilar and mediastinal with a maximum diameter of short axis of more than 10 mm taken as their enlargement. Pulmonary changes are classified as nodules, reticular opacities, fibrous lesions, ground glass opacities and consolidations. The predominant distribution of lesions in the upper and middle zones of the lungs compared to the lower zones was noted. The disease is graded in 5 stages with the Scadding classification. 15cases of patients diagnosed with sarcoidosis were analyzed all of whom are women in the age group of 30-60 years old. Two patients are in stage I and three are in III stage of the disease, 6patients are in stage II of sarcoidosis and 4 are in stage IV of the disease. Dry cough as a symptom predominates in all patients, while dyspnea is graded according to the mMRC scale. Mediastinal lymphadenopathy with and without calcifications was present in 11patients. The type of lung changes as well as their distribution are presented in graphs. HRCT is the method of choice in the evaluation of pathological changes in pulmonary sarcoidosis. It very precisely shows us the characteristic appearance of nodules and lesions, their distribution and atypical changes and helps us in grading the disease and its treatment.
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Correlation between CMR and chest CT in assessment of constrictive pericarditis.
(2023-10-11)
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Ilievski, Mitko
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Description of Clinical Presentation A 35-year-old adult presented to the cardiology department with shortness of breath, coughing, and fatigue. He had a history of recurrent colds with high fever, but their recent cold led to worsening symptoms. Tests revealed atrial fibrillation with a heart rate of 150 bpm, enlarged atria, and reduced systolic function. Laboratory results showed thrombocytopenia, elevated GGT, and high bilirubin, with no elevated Troponin levels. CMR showed systemic volume overload, with passive liver congestion and left pleural effusion, no pericardial effusion, but thickening with dimensions of 4,6mm. SSFP sequences showed left and right ventricle hypokinesia with impaired diastolic filling, severe diastolic septal bounce and abnormal contour of left lateral wall which was akinetic. The T2-STIR sequence showed hypersignal intensity in the basal anterolateral and inferolateral segments, distributed within the subepicardial and mid-wall regions. Additionally, focal pericardial involvement was observed in these segments, along with two central hypo signal lesions that showed identical signal characteristics across all sequences. On delayed enhancement PSIR sequences, there was increased signal intensity in the specific areas on the T2-STIR sequence, suggesting gadolinium accumulation and in the mid and apical inferior and inferolateral segments with subepicardial distribution. There was pericardial enhancement dominantly at the basal ventricular segments, along with focal pericardial enhancement at the left apex also featuring a central hypo signal lesion. The patient underwent a native chest CT examination, revealing circumferential thickening of the pericardium with linear diffuse calcifications. This finding was correlated with the MRI results, indicating a state of subacute to chronic inflammatory/fibrotic constrictive pericarditis with constriction throughout the entire heart with concomitant myocarditis changes dominantly at the left lateral wall. Diagnostic Techniques and Their Most Important Findings Cardiac MRI is a valuable tool for diagnosis of pericardial constriction where the ventricles may appear compressed or have a "square root sign" appearance, reflecting impaired ventricular filling during diastole. T1 and T2 mapping, can provide insights into the tissue characteristics of the pericardium and myocardium. These techniques can help differentiate between pericardial and myocardial involvement and assess the degree of fibrosis. Cardiac MRI can assess respirophasic variation in ventricular filling, which is a hallmark feature of pericardial constriction. During inspiration, there may be an exaggerated increase in ventricular filling due to reduced compliance of the constricted pericardium. Learning Points from this Case Pericardial constriction, characterized by impaired diastolic filling due to thickened, fibrotic, and/or calcified pericardium, can be a diagnostic challenge, often requiring the use of multiple imaging modalities which within this case with the correlation between TTE, CMR and CT scan a noninvasive diagnosis can be made.
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Osler-Weber-Rendu syndrome
(Macedonian Medical Association, 2023-04-08)
Tochko, Aleksandra
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Hereditary hemorrhagic telangiectasia (HHT) was first reported in 1896, when Henri Jules Louis Rendu described the classical picture of HHT as a disease consisting mucocutaneous telangiectasias, epistaxis and familial nature. The following decade offered more accurate case descriptions of the disease by William Osler (1900) and Frederick Parkes Weber (1907), thus the eponym “Rendu-Osler-Weber” was created. The vascular malformations in HHT consist of direct arteriovenous connections through thin walled aneurysms, and range from small telangiectasia (predominantly mucosal, skin, and visceral) to larger visceral arteriovenous malformations (AVM). Although there is a wide array of manifestations ranging from asymptomatic to life-threatening, most of the time, the disease presents with a history of recurrent spontaneous epistaxis, symptomatic anemia (fatigue, palpitations, dizziness, etc.), and in some cases, chronic GI bleeding. “Curacao criteria” are applied to clinically diagnose the patients with HHT and include recurrent spontaneous nosebleeds, mucocutaneous telangiectasia, visceral involvement, and first-degree family history of HHT. If ≥ 3 criteria are met, the diagnosis is definitive, if 2 are met, then HHT is suspected and when less than 2 criteria are present, HHT is labeled unlikely. In suspected cases, diagnosis can be confirmed by genetic mutation testing. Treatment of the disease is multimodal, primarily focusing on limiting the bleeding from various sites and correcting the anemia with iron supplementation and blood transfusion when necessary. Symptomatic therapy helps in preventing bleeding but do not target the actual cause of the disease. However, these systemic therapies may cause adverse effects like thromboembolism, hypertension, peripheral neuropathy, etc. , that is why, first, a cost benefit assessment should be initiated. According to the curacao criteria, the present study describes a typical case of HHT, with fulfilled criteria for definite diagnosis, also confirmed by a genetic test.
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Radiology Case Study - Right-Sided Aortic Arch: An Anomalous Vascular Configuration
(2024-04)
Sulejmani, Haris
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Right-sided aortic arch (RAA) is a rare anatomical variant, often discovered incidentally during imaging studies. We present a comprehensive case study of a 77-year-old male with an asymptomatic RAA, emphasizing the crucial role of multimodal imaging in accurate diagnosis. This report explores the imaging findings, potential clinical implications, and the significance of identifying such anomalies for patient management. Right-sided aortic arch (RAA) is an uncommon congenital anomaly characterized by the aorta's deviation to the right of the trachea. While often asymptomatic, its recognition is vital for understanding associated vascular anomalies and potential clinical implications. This case study delves into the imaging nuances, embryological basis, and clinical considerations associated with RAA with mirror image branching of the arch vessels, contributing valuable insights to the existing medical literature. Multidetector computed tomography (MDCT) revealed a right-sided aortic arch with mirror-image branching of the arch vessels. The arch descended on the right side of the trachea, forming a vascular ring.The anomalous arrangement of the left common carotid artery originating from a left brachiocephalic trunk together with the left subclavian artery.Diagnosis: Right-sided aortic arch with mirror-image branching. The embryological basis of RAA involves intricate processes leading to abnormal arch regression and persistence of the right dorsal aorta. The clinical significance lies in potential complications, including tracheal compression and vascular ring formation. Accurate diagnosis through advanced imaging allows for informed decision-making and appropriate patient management. Right-sided aortic arch is a rare anatomical variant that warrants attention due to its potential clinical implications. Awareness of such anomalies and their associated vascular configurations is essential for providing optimal patient care. This case contributes to the limited literature on RAA, emphasizing the importance of thorough imaging in unraveling complex vascular variations. Key words: Right-sided aortic arch,multidetector computed tomography,diagnosis.

Nikolova, Sonja

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