Spirov, Vasilcho
Preferred name
Spirov, Vasilcho
Official Name
Spirov, Vasilcho
Main Affiliation
Email
vasilco.spirov@medf.ukim.edu.mk
9 results
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Item type:Publication, Adrenal tumors as incidentalomas: report of our experience(Macedonian Association of Anatomists and Morphologists, 2017); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Interventional procedure in breast lesions- core-biopsy(Macedonian Association of Anatomists and Morphologists, 2017); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 18F-FDG PET/CT IN DIFFERENTIATING EQUIVOCAL CT LESIONS IN PATIENTS WITH COLORECTAL CANCER(Macedonian Association of Anatomists, 2022-05-22); ; ; Imaging is vital in the follow-up strategy of patients with colorectal cancer. Computed tomography is widely accepted as a method of choice, but further work up is required when equivocal findings are present. The objective of this study was to investigate the potential of positron emission tomography (PET)/computed tomography (CT) as a problem-solving tool of dubious CT findings in patients with colorectal cancer (CRC) in the follow-up period. This was a retrospective review of thirty-two patients referred for 18F-fluorodeoxyglucose (FDG) PET/CT imaging due to suspicion of recurrent disease solely based on CT exam. The diagnosis of a malignancy lesion was based on intensity of the lesion, location, shape, size, as well as CT findings. There was a follow-up period of at least six months after the PET/CT examination. The most common site of detected lesions that could not be characterized by CT were the lungs (13/32; 40.5%), followed by liver (8/32, 25%) and lymph nodes (5/32, 15.6%). Additionally, lesions were reported at adrenal gland, spleen, peritoneum, ovary and at surgical site. In almost half of the patients (15/32; 46.8%) lesions were detected by PET/CT and characterized as disease recurrence. Metastases at additional site were detected in five patients (6/15, 40%). In the follow-up period recurrent disease was detected in two patients (2/32, 6.2%) with negative PET/CT findings. Only one person had a false positive finding. The overall positive and negative predictive value of FDG-PET/CT was 93.3% and 84.6% respectively. PET/CT offers a high overall positive and negative predictive value in distinguishing CRC metastasis. Furthermore, it exceeds CT performance in detecting extrahepatic recurrent disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Extracolonic findings on computed tomographic colonography in symptomatic patients: retrospective study.(Macedonian Association of Physiologists and Anthropologists, 2017); Computed tomographic colonography (CTC) represents a minimally invasive, safe and robust tool for evaluating colorectal lesions. CTC is well established in screening settings, and as well as in symptomatic patients as a colonoscopy alternative. The cross-sectional nature of CTC allows examining of colon and rectum and also extra colonic structures like abdominal parenchymal organs, vessels, bones, and soft tissue in the scanning range with low-dose. Thus extra colonic findings (ECFs) are also detected. Benefits are potentially life-saving in small percentage of patients. Most ECFs stay clinically insignificant. Intravenous administration (IV) of contrast medium increases the number of ECFs, but does not ultimately increase the number of clinically significant lesions. A system for categorization of ECFs is established, C-RADS, and most of them are classified as clinically unimportant prior further research. So, the effect of the detection of the ECFs remains controversial. Our aim was to analyze the incidence and the significance of ECFs in symptomatic adults, when colonoscopy is not an option. This retrospective review of the CTC studies is performed at the University Clinic of Radiology in Skopje, Macedonia, from January, 2011 to December, 2015. Patients are referred by gastroenterologist or abdominal surgeon because of change in bowel habit, abdominal pain, rectal bleeding, anemia and/or weight loss. Exclusion criteria include history of malignancy, abdominal surgery or positive findings of previous abdominal CT examination. Study includes 83 consecutive symptomatic patients, 47 women and 36 men, median age of 58.6 years. CTC technique used is standardized with prior bowel preparation using cathartic osmotic cleansing agent. Positive fecal tagging is not included. Intravenous spasmolytic is not administrated. The distension of the colon is achieved by controlled insufflation of room air. Scanning is performed on multidetector computed tomography scanner with 64 rows of detectors (Somaton Definition AS, Siemens) (0.6-mm collimation, 0.7-mm reconstruction interval, tube-current modulation - range, 30–200mA - and 120 kVp). Supine and prone acquisitions are obtained for all patients. Additional prone acquisition is obtained 70 seconds after intravenous application of iodine contrast. ECFs are defined as unsuspected and unrelated to the colon, excluding anatomic anomalies or variations. ECFs are classified into: (1) clinically important findings requiring urgent medical or surgical management, and (2) unimportant findings with little immediate clinical relevance or no clinical importance. Vascular calcifications, degenerative disease of the spine without significant spinal canal stenosis, enlarged prostate or punctiform parenchymal calcifications are omitted from both groups. Statistical analysis is done using the chi square test and the t test assessing the frequency of important ECFs according to patient age, sex, and colorectal findings. Out of total 83 patients ECFs are identified in 15 patients, (15/83, 18%). The total number of ECFs is 19 (2 patients had more than one). ECFs are detected in 6 males, (6/36, 16.6%) and 9 females, (9/47, 19.1%). There are no significant differences in the mean age and sex. Two patients have significant ECFs (2/83, 2.5%), abdominal aneurism and renal cell carcinoma. The rest of the ECFs are unimportant (17/19, 89.5%). The most common lesion is cortical renal cyst. The IV application of contrast detected ECFs in three patients, 3.6% (3/83), two hemangiomas and renal cell carcinoma. Additional ultrasound examination was required in 4 patients, 4.8% (4/83). There was no need for patient follow up. There were no complications of the CTC or the workup. A total of 12/83 (14.4%) patients had colorectal lesion greater than 6 mm, of whom 5/83 (6%) had a colorectal malignancy. The incidence of ECFs was identical in the subset of patients with or without positive CTC study. Specifically CTC with administration of IV contrast medium could help detect and differentiate more ECFs and as a result extra colic diseases could be detected in earlier phase, or unnecessary diagnostic testing could be reduced as well as nonessential surgery and unnecessary patient anxiety. Cost and risks of administering IV contrast medium is not to be neglected. Effort is to be made for introducing selective contrast administration. As designed, this study with objectively limited number of participants, affirms the findings of other reported studies. CTC ECFs are valuable in various manners and should not be ever neglected. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Imaging findings on chest X-ray in patients with Covid-19(Macedonian Association of Anatomists, 2020); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Virtual colonoscopy - CT colonography our experiences(Здружение на радиолозите на Македонија, 2016); ; ; ; Introduction: Virtual colonoscopy (VC) produces two-dimensional images and a detailed 3-D model of the abdomen and pelvis to view the bowel in a way that simulates travelling through the colon as in a conventional colonoscopy. Furthermore, it has been validated as a colorectal cancer test that provides an additional minimally invasive screening option which is likely to be preferred by some patients. Aim: The aim of this paper is to present our experience from technical and clinical aspect, based on the VC examinations performed at our clinics. Material and method: In all patients a thin tube is inserted into the rectum so that air to be pumped to inflate the colon for better viewing. No sedation is administered. Endoluminal lesions are categorized according to size: A lesion is defined as a mass if its diameter at VC is 20 mm or larger, as a large polyp if its diameter is 10 mm or larger but smaller than 20 mm, and as a medium polyp if its diameter is 6 –9 mm. diminutive lesions are polyps less than 5 mm. Results: VC is usually regarded as “not painful” compared with colonoscopy. Discomfort from air filling of the colon is the major complaint about VC. In VC polyps smaller than between 2 and 10 millimetres in diameter may not show up. Furthermore, it is not recommended for patients with active Crohn's disease, ulcerative colitis, inflammatory bowel disease or diverticulitis, because of increased risk of perforating the colon. Discussion: The American Cancer Society (ACS) recommends that women and men undergo screening for colon cancer or polyps beginning at age 50. Results of a prospective study, held from 2004 to 2008 at two centers shows that the overall detection rate of unsuspected cancer has been approximately one per 200 asymptomatic adults undergoing routine screening VC, including about one invasive CRC per 500 cases and one extracolonic cancer per 300 cases. Detection and treatment at an early presymptomatic stage may have contributed to the favorable outcome. The results of large studies have demonstrated that the diagnostic performance ofVC approaches that of optical colonoscopy for detection of colorectal polyps that are 1 cm or larger. Conclusions: VC is considered less painful and less difficult overall than colonoscopy and is the preferred examination for the patients. Studies suggest that VC is an alternative or complement to current methods in clinical practice. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE VALUE OF PET/CT IN DETECTING COLORECTAL CANCER RECURRENCE IN PATIENTS WITH NEGATIVE CT FINDINGS(2021-07); ; ; ; 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 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, МР ентерографија (МРЕ) - технички и медицински аспекти на овој метод и наши искуства(Здружение на радиолозите на Македонија, 2016); ; ; ; Ilievski, MitkoВовед. МРЕ е релативно нов и безбеден радиолошки метод за неинвазивно, брзо, достапно, точно и прецизно дијагностицирање на болестите на тенкото црево со примена на орално контрастно средство и/или и.в. контраст без употреба на јонизирачко зрачење и јодни контрастни средства. Оттаму, МРЕ особено се смета за примарен метод на испитување во педијатријата и кај младите адулти со воспалително цревно заболување кое бара повторувани испитувања за оценка на болеста и терапевтско следење. Испитувањето, исто така, бара соодветна техничка и клиничка стручност за да има рутинска примена. Цел. Трудот (1) дава основни информации за МРЕ, нејзината клиничка примена, точност и валидност во споредба со други методи; (2) го објаснува начинот на подготовка за преглед, протоколот и потребните материјали и средства за извршување на прегледот, кој се работи рутински на нашата клиника; (3) ја објаснува целта на самиот преглед: (а) да открие промени на ѕидот на тенкото црево и интралуминално, кај воспаленија, Crohn-ова болест, тумори, полипозни синдроми, невоспалителни ентитети (Целијачна болест), мезентерична лимфаденопатија, тенкоцревна опструкција и сл.; (б) да ги испита околните структури во абдоменот, како морфолошки така и според локацијата на процесот. Материјал и метод. Во трудот се презентирани првите сопствени искуства со новиот протокол на работа на нашата клиника. Години наназад употребата на МР во дијагностиката на болестите на тенкото црево беше проблематична пред сé заради долгото траење на секвенците и појавата на бројни артефакти кои се јавуваа заради перисталтиката и дишењето на пациентот. Употребата на брзи и ултра брзи секвенци во поново време и можноста да се заврши секвенцата со едно задржување на здивот на пациентот (од 15-20 сек.), ја направија МРЕ возможен и доста успешен метод во дијагностицирањето на тенкото црево. Протоколот вклучува и употреба на Duphalac, лактулоза, како орално контрастно средство, кое служи за адекватна цревна дистензија и е со различен механизам на дејство од досега користените препарати. Покрај примената на орални контрастни средства, употребата на и.в. контраст, Гадолиниум, Magnevist, и и.в. спазмолитични средства, Buscopan, за време на прегледот ја направија МРЕ една од најкористените и најпрецизни дијагностички методи кај болестите на тенкото црево. Прегледите се правени на 1,5 Т Siemens Avanto апарат. Резултати. Употребата на МРЕ во радиологијата на гастроинтестиналниот тракт води кон побрза и поточна дијагностика на болестите на тенкото црево. Една од главните идикации за употреба на МРЕ е дијагностицирање и следење на Crohn-овата болест на тенкото црево. Освен промените во морфологијата и утврдување на локализацијата на промените, со овој метод се откриваат и аноректалните компликации на Crohn-овата болест, екстензијата и активноста на болеста. МРЕ е применета и кај други тенкоцревни заболувања со наоди презентирани во трудот. Дискусија. Целокупниот технолошки напредок во врска со МРЕ резултира со скратено време на испитување, зголемено задоволство кај пациентите и медицинскиот персонал и со одобрени податоци во врска со добиените резултати особено при откривањето, евалуацијата и следењето на Crohn-овата болест и нејзината активност. Активностите денес се насочени кон употребата на нови секвенци (DWI) и пософистицирани апарати (3Т) за уточнување на дијагнозата. Заклучок. МРЕ денес претставува значаен предизвик на постоечките методи, како што се тенкоцревната пасажа, ентероклизата и КТ Ентерографијата во процесот на дијагностичка проценка на тенкото црево. МРЕ е важно алтернативно испитување на тенкото црево како најтешко достапен дел за евалуација од целиот гастроинтестинален тракт. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The role of computed tomography in diagnosing an acute abdominal pain in ileocecal area(Balkan Society of Radiology, 2017); ; Purpose: To evaluate the role of computed tomography (CT) in diagnosing acute abdominal pain in ileocecal area. Materials and Methods: Retrospectively 457 CT reports of abdomen and the complementary clinical records of patients over the age of 16 presented between April 2016 and June 2016 were reviewed. Considered inclusive criteria were: acute abdominal pain in ileocecal area and negative or inconclusive physical examination, laboratory tests and abdominal ultrasound. Patients with known abdominal disease or previous surgery were omitted. In all patients the abdomen was scanned with 16-row multidetector CT with 2.5mm collimated slice width from dome of diaphragm to pubis symphysis. Intravenous contrast media was administrated if no signs of appendicitis were found. The surgical or clinical record was used for follow-up. Results: Only 33 patients fulfilled the criteria to be included in the study. Radiological diagnosis was reached in 30 of 33 patients (91%). Most common reported entity was appendicitis (33%), followed by infiltrative lesion of colon (30%) and nonspecific inflammatory disease of terminal ileum and cecum (12%). Diverticulitis, epiploic appendicitis and ectopic pregnancy were reported in 5 cases (15%). Out of 33 patients 3 (9%) had nonspecific radiological findings. Surgery was performed in 23 patients (70%). Operative report matched radiological findings in 22 cases (96%). Conclusion: CT is a method of choice for improving accuracy in diagnosing acute abdominal pain in ileocecal area.