Veljanovski, Dimitar

Preferred name

Official Name

Veljanovski, Dimitar

Main Affiliation

dimitar.veljanovski@medf.ukim.edu.mk

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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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VERTIGO AS AN INITIAL MANIFESTATION OF CHRONIC CEREBELLAR ABSCESS- CASE REPORT
(Macedonian Association of Anatomists and Morphologists, 2022)
Ristik-Stomnaroska, Daniela
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Aleksovska, Angela
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Chronic cerebellar abscess is a rare clinical condition, considering the protective function of the blood-brain barrier. The prevalence of brain abscess is increasing with the increase in the number of people living with HIV, especially abscesses caused by a fungal infection. We present the case of a 67 year old male patient with acute onset of dizziness, associated with nausea, vomiting and unstable gait. Initial neurological examination revealed dysarthric speech, with discrete central paresis of the facial nerve, latent left-sided ataxic hemiparesis. In order to clarify the etiology of the expansive change in the left cerebellum, a series of examinations were performed. MRI of the brain was performed with IV contrast, which showed an oval intraaxial lesion with a maximum diameter of 20 x16 mm, on the left cerebellar side. Routine biochemical analyzes was normal, Immunoassay analysis of serum detected a multiple increase in the serum concentration of Immunglobulin E. In consultation with an infectologist, several samples of cerebrospinal fluid were sent for microbiological, parasitological (antibodies to toxoplasmosis, echinococcus and cysticercosis) and serological analysis. The patient was referred to a hematologist again, when a PET scan was performed which showed the presence of metabolically inactive lymph nodes, the same with benign characteristics. A craniotomy and surgical extirpation of the lesion were performed in consultation with a neurosurgeon. The treatment of brain abscesses is multidisciplinary and includes: a neurologist, infectologist, radiologist, neurosurgeon and an internal medicine specialist.
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Sampling technique for Fourier convolution theorem based k‐space filtering
(Wiley, 2023-03-06)
Ciulla, Carlo
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Xhaferri, Ilva
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Deek, Fadi P.
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Muzhaqi, Endri
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This research presents a sampling technique for Fourier convolution theorem (FCT) based k‐space filtering. One polynomial function and three transfer functions were selected: (1) Gaussian, (2) Bessel, (3) Butterworth, and (4) Chebyshev. The functions were sampled on the image grid, and they are called filtering functions. Each filtering function was multiplied by the Sinc function to obtain the “<jats:italic>Sinc‐shaped convolving function</jats:italic>.” The k‐space of the Sinc‐shaped convolving function is calculated by direct Fourier transform (FT) and it is featured by a central region. This central region of the k‐space is rectangular in its shape because it is consequential to the direct FT of the product between the filtering function and the Sinc function. Low‐pass and high‐pass filtering is obtained by inverse FT of the pointwise multiplication between the k‐space of the departing image and the k‐space of the Sinc‐shaped convolving function. A variety of cut‐off frequencies, bandwidth, sampling rates, and numbers of poles of the filters were verified as effective to filter the images. Filtering strength can be modified by fine‐tuning the size of the central rectangular k‐space region of the Sinc‐shaped convolving functions. K‐space analysis of departing images and filtered images provide additional evidence of effective filtering. Moreover, k‐space filtering was compared to Z‐space filtering using the extension of the FCT to Z‐space. The novelty of this research is the sampling technique used to determine the Sinc‐shaped convolving function. The sampling technique uses fine‐tuning of bandwidth and sampling rate to determine the strength of the k‐space filter.
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MAGNETIC RESONANCE IMAGING IN SPORT MEDICINE
(University Ss. Cyril and Methodius in Skopje, 2022)
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The use of appropriate imaging methods in sport medicine is very important in order to diagnose and evaluate the sport injuries. The aim of the study was to present the most frequent sport injuries, for the last 6 month period, using diagnostic modality as MRI, for better patient’s outcome. A number of 45 patients with sport injuries were diagnosed, regarding knee injury (n=28), shoulder injury (n=10), ankle injury (n=5) and hip injury (n=2). Out of all patients, 39 were male, and 6 were female. Regarding sport type, ball sports (n=40), bodybuilding (n=2), skiing (3) were included. In the study, the imaging device Magnetom Essenca 1.5T by Siemens, Erlangen, Germany was used. Most of the sport injuries were related to knee joint (62%), mostly involving the meniscus, common for ball sports, skiing, and gymnastics. The other injuries were related to the following body parts: shoulder joint (22%), ankle joint (11%) and hip (5%). MRI was found to be sensitive in diagnosis of soft tissue injuries, providing a good visualization in the musculoskeletal system, and may be clarified as a golden standard to diagnose and evaluate sport injuries.
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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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COVID -19 INDUCED AORTIC THROMBUS AND CRITICAL LIMBISHAEMIA
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2023-04-07)
Nancheva Bogoevska, Andrea
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Risteski, Filip
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Gjoreski, Aleksandar
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Jovanoska, Ivona
50 years old male presented with livid redness on both feet, predominantly left, accompanied with severe pain and coldness. Two weeks before, he admitted to hospital due to COVID-19 bronchopneumonia. Urgent abdominal and lower extremities contrast enhanced CT was performed, which showed mural thrombus of the abdominal aorta (AA) extending from below the left renal artery to the iliac bifurcation and total occlusion of the left and partial occlusion of the right crural arteries. Interventional procedures are the first choice for initial emergency management, leaving surgery as a second and anticoagulant therapy as third option for treatment. Endovascular treatment is based on stent grafting. Covered stent graft was used to repair the AA and kissing stenting technique was used in the aortoilical part. The result was complete patency of AA and both iliacal arteries, with improved clinical status. Mural thrombi are likely to occur in large vessels as the heart and descending aorta, and less commonly in the aortic arch or the AA, causing flow reduction. Their occurrence is a rare in the absence of hypercoagulative state or inflammatory, infectious, or familial aortic ailments. In our case, Covid -19 is associate occurrence of thrombus in the AA, which throws out smaller thrombi in the peripheral circulation that causes critical limb ischemia (CLI).CT is the best modality for early diagnosis and endovascular treatment the least invasive treatment. Mural aortic thrombus accompanied by CLI is an urgent medical condition which, if not diagnosed and treated on time, can result in limb amputation or death. Endovascular stenting is first choice of treatment in patients without previous vascular disease.
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ASSOCIATION OF RENAL AGENESIS AND IPSILATERAL SEMINAL VESICLE CYST – ARARE CASE OF ZINNER SYNDROME
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
Chalcheska, Slavica
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Jovanoska, Ivona
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Nancheva Bogoevska, Andrea
Introduction We report a case of Zinner syndrome, a congenital malformation characterized by association of renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Case presentation A 44 years old patient, previously diagnosed with benign prostatic hyperplasia and chronic prostatitis was admitted at our department for puncture of pelvic cyst. Transrectal ultrasound (US) guided puncture and aspiration of the cyst was performed. Few days later, patient presented with septic symptoms and computed tomography (CT) scan was done, which showed large cyst with air inclusions, measuring 13x14cm in diameter in right seminal vesicles and right renal agenesis compatible with Zinner syndrome. An urgent surgical drainage of the cyst was done, followed by improvement of patient’s clinical condition. Discussion Zinner syndrome is one of the rarest congenital anomalies of urogenital tract and is usually discovered and diagnosed after3rd -4th decade of life. Patients are often asymptomatic but they can present with dysuria, recurrent prostatitis or epdidymitis. Radiological modalities have a significant role into detecting and evaluating Zinner syndrome including US, CT and MRI. When symptomatic, most commonly due to its size, surgical excision or transrectal aspirations of the cyst are options of treatment. Conclusion Combination of clinical history and radiological imaging are essential for making the diagnosis and proper management of this rare entity.
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OSMOTIC DEMYELINATION SYNDROME
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Risteski, Filip
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Chalcheska, Slavica
Abstract. Osmotic demyelination syndrome (ODS) may be observed as a result of a rapid change in serum osmolarity, such as that induced by an overly rapid correction of serum sodium levels in hyponatraemic patients. Case presentation. We report a case of a 40-year-old male, first hospitalization through Emergency center (glucose 6.4 mmol/l. ECG: sinus rhythm, normal axis with SF 70/min.). Patient has electrolyte imbalance ,elevated liver enzymes, high enzyme activity predominantly of CK (6664) in relation to transaminase activity (AST 288, ALT 127), elevated CK, hyponatremia, hypokalemia and extremely low sodium = 95.Main complaints were muscle pain, muscle weakness, slurred speech, weakness, walk inability. Diagnostic findings. The diagnosis was confirmed by MRI 1,5T Simens Magnetom Essenca (brain) that showed large tipical inhomogeneous hypersignal lesion in the central pontine region on T2 weighted and FLER images with restriction of DWI. There is signal intensity of the basal ganglia nucleus lentiformis and and caudate cerebral nuclei on axial T2 weighted images and FLAIR images which were suggestive of CPM. Teaching points. Central pontine myelinolysis is an acute non-inflammatory demyelinating disorder.It is precipitated by the rapid correction of severe chronic hyponatraemia.Electrolyte abnormalities other than sodium should be investigated and rectified.An in-depth neurological examination is mandated to assess the severity and progression of ODS.MRI is the radiological modality of choice for earlier detection of ODS lesions.
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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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Sarcoidosis of the nervous system MRI - findings
(2013-10)
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Risteski, Filip
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Gjoreski, Aleksandar
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Veljanovski, Dimitar

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