Color Doppler ultrasonography and multislice computer tomography angiography in carotid plaque detection and characterization.

BACKGROUND/AIM: Cerebrovascular diseases are the third leading cause of mortality in the world, following malignant and cardiovascular diseases. Therefore, their timely and precise diagnostics is of great importance. The aim of this study was to compare duplex scan Color Doppler ultrasonography (CDU) with multislice computed tomography angiography (MSCTA) in detection of morphological and functional disorders at extracranial level of carotid arteries. METHODS: The study included 75 patients with 150 carotid arteries examined in the period from January 2008 to April 2009. The patients were firstly examined by CDU, then MSCTA, followed by the surgery of extracranial segment of carotid arteries. In 10 patients, the obtained material was referred for histopathological (HP) examination. We used both CDU and MSCT in the analysis of: plaque surface, plaque structure, degree of stenosis, and the presence of in-traplaque hemorrhage. RESULTS: The results obtained by CDU and MSCTA were first compared between themselves, and then to intraoperative findings. Retrospective analysis showed that MSCTA is more sensitive than CDU in assessment of plaque surface (for smooth plaques CDU 89%: MSCTA 97%; for plaques with irregular surface CDU 75% : MSCTA 87%; for ulcerations CDU 54%: MSCTA 87%). Regarding determination of plaque structure (mixed plaque CDU 66% : MSCTA 70%; correlation with HP findings CDU 94% : MSCTA 96%) and localization (CDU 63%: MSCTA 65%), and in terms of sensitivity and specificity, both methods showed almost the same results. Also, there is no statistical difference between these two methods for the degree of stenosis (CDU 96%: MSCTA 98%). CONCLUSION: Atherosclerotic disease of extracranial part of carotid arteries primarily affects population of middle-aged and elderly, showing more associated risk factors. Sensitivity and specificity of CDU and MSCTA regarding plaque composition, the degree of stenosis and plaque localization are almost the same. These results and the fact that there are no adverse effects (high radiation dose) compared to MSCTA indicate that CDU should be the initial method in diagnostic algorythm for carotid arteries.

Duplex Doppler sonography in portal hypertension.

Conventional echotomography and duplex Doppler ultrasonography are noninvasive imaging techniques in measurement of hepatic blood flow. In the period from February 2002 to March 2004, 29,086 patients underwent ultrasound examination at the Institute of Radiology in Novi Sad, and 17,503 presented with symptoms of gastroenterology diseases and/or hepatobiliary tract diseases. 984 patients underwent duplex Doppler sonography. This prospective study included 50 patients with suspected or confirmed diagnosis of portal hypertension. All patients were examined using Siemens Versa Pro (3.5 MHz convex probe: B-mode, color and pulse Doppler). The following parameters were evaluated: Doppler sonoscore, congestion index and portal vein thrombosis. By analyzing gathered data, the diagnosis of portal hypertension was confirmed in 10% of patients at baseline, and in 6% of patients at last follow-up, six months later. Results of this investigation demonstrate the importance of duplex Doppler ultrasonography as an excellent noninvasive diagnostic method used for visualization of the direction and velocity of blood flow, as well as presence of portal vein thrombosis. This imaging modality is used as an initial diagnostic tool in the evaluation of the portohepatic circulation, especially in portal hypertension syndrome and in suspected portal vein thrombosis.

[Current diagnostic trends in radiology].

Since the discovery of X-rays by Wilhelm Conrad Röentgen at the end of the 19th century, diagnostic imaging techniques have been continously improved by technological advances, bringing radiological diagnosis into the very center of modern medicine. Nowadays, it is hard to imagine therapy planning without previous radiological examination. Great advances in the field of computer technology have been accompanied by development of radiological techniques, and today they include not only morphological and anatomical, but also dynamic, functional and molecular imaging. This paper is an overview of new and improved radiological techniques and their implementation.

[Basic characteristics of duplex sonography in the assessment of lower limb arterial circulation].

INTRODUCTION: Dulpex and color duplex ultrasonography of lower limb arteries are valuable non-invasive diagnostic methods in the pathology of vascular diseases and a major step in diagnostics and in follow-up of hemodynamic and morphologic characteristics. COLOR DUPLEX SONOGRAPHY: The method consists of image analysis and analysis of Doppler information. Real-time-B mode is used to visualize the anatomy of blood vessels and other pathological lesions. Doppler information based on the Doppler effect determine the pulse wave i.e. the shape of flow velocity--hemodynamic characteristics. Spectral analysis is the most important element of Doppler examination of the lower limb peripheral arteries. Based on the spectral analysis, there are four stages of lower limb arterial disease: normal findings--1% - 19% diameter reduction; medium stenosis--artery diameter reduction of 20% - 49%; high level stenosis--artery diameter reduction of 50% - 100%; occlusion--no flow detected within the imaged arterial segment. In the first place, both iliac arteries are examined, which is followed with femoral, popliteal and crural arteries. The examination of iliac arteries is carried out with a 3.5 MHz transducer, and other peripheral arteries of the lower limbs are examined with a 7, 5 or 5 MHz transducer. CONCLUSION: Color Doppler is an extremely valuable diagnostic method in detecting pathology of the lower limb arteries. With high reliability level arterial insufficiency and pathological arterial segments are diagnosed by a duplex-Doppler.

Renal colic--radiological approach.

Acute flank pain is commonly caused by urolithiasis. This paper discusses advantages and disadvantages of procedures used for evaluation of acute flank pain. In our institution, the diagnostic algorithm includes ultrasonography and plain film radiography, and unenhanced spiral CT in equivocal cases.

[The place and role of computed tomography and magnetic resonance imaging in diagnosis of gynecological diseases].

INTRODUCTION: In everyday gynecological clinical practice imaging modalities are becoming more and more important. Depending on the site of pathology itself, CT and MR have certain advantages and disadvantages, which are important to know in order to choose adequate diagnostic procedure. DIAGNOSIS OF GYNECOLOGICAL DISEASES: Benign conditions such as myomas, inflammatory processes and genital tract abnormalities are major indications for MR imaging. In oncology, it is necessary to perform staging of the disease by imaging modalities. Tumors of the vagina and vulva are diagnosed by clinical examination and imaging modalities are used for staging. In cervical carcinoma it is very important to define stages of the desease and invasion of the surrounding structures which is better seen on MR, but invasion of parametria can be visualized by CT as well. For endometrial cancer MR imaging is a modality of choice. For ovarian cancer both modalities are in use, CT is less expensive and gives enough information. New possibilities with MR imaging using an endovaginal coil in diagnosis of stress incontinence are also discussed.

[Ultrasound artifacts as differential diagnostic problems in ultrasound of the upper abdomen].

INTRODUCTION: The word artifact stands for any visible result of imaging procedures which is caused by the procedure itself and not the entity being analyzed. Recognition of artifacts in everyday work is of great significance for final diagnosis, since their wrong interpretation not only compromises the value of ultrasound finding, but may also lead to a wrong therapeutic approach. ULTRASOUND ARTIFACTS: Artifacts appear as the result of physical properties of an ultrasound beam, technical aspects of ultrasound apparatus and immobility in creation of ultrasound image. Artifacts in the form of acoustic shadows, acoustic enhancements and reverberation most commonly appear and lead to changed appearance of certain structures. That is why great experience and knowledge of radiologists-ultrasonographists is necessary, since diagnostic accuracy of the method itself is under their immediate control. Incorrect interpretation of artifacts and failure to recognize them reduces the value of ultrasound imaging which has, during the past 25 years, confirmed its exceptional diagnostic value.

[Diagnosis of ureteral calculi using ultrasonography, intravenous urography and unenhanced helical computed tomography].

INTRODUCTION: The pain in the loins is usually the consequence of renal colic caused by small ureteral calculi. ULTRASONOGRAPHY: Ultrasonography is an efficient tool in the detection of calculi in the pyelocalyx system, but it may not be sufficient for the area of renal pelvis and ureter, as wll as for the ureter and the ureterovesical junction. INTRAVENOUS UROGRAPHY: Radiolucent stones, dilatation of the ureter and of the pyelocalyx system were identified on the urogram, which are common signs of ureter calculosis. Defects in the contrast can be caused by blood clots and papillary or malignant tumors of the ureter, thus causing a differential diagnosis problem. UNENHANCED HELICAL COMPUTED TOMOGRAPHY: Noncontrast spiral CT is useful for detection fo calculi as small as 3mm. It can identify their localization and size without enlargements. The primary and secondary CT signs also confirm the established diagnosis. CONCLUSION: The noncontrast spiral CT is a highly precise method for assessment of kidney pain. It is a realiable and rapid diagnostic modality for the detection of urinary stones which differentiates them from blood clots, tumors, air and other factors which create a differential diagnosis problem.

[Native and contrast radiographic examination of the urinary tract].

INTRODUCTION: Plain x-rays and contrast urography are important for diagnosing urinary tract diseases. The first plain film of the urinary tract was made in 1896, and the first tests using contrasts started in 1904. Excretory urography has been used since 1930. PLAIN FILM OF THE URINARY TRACT: Plain films of the urinary tract are used in the kidney area, the area of the ureter and urinary bladder. They also show structures (lumbar and sacral spine and pelvis), muscles (m. iliopsoas) as well as calculi. EXCRETORY UROGRAPHY: X-ray visualization of the urinary tract with contrast substances is intravenous urography. It is used for diagnosing diseases of the upper urinary system with symptoms such as: pain, colic, hydronephrosis, as well as acute cortical infections, urinary bladder tumors, etc. RETROGRADE UROGRAPHY: Retrograde urography is a procedure recommended when either the pyelocalyx system or the ureter are not seen unilaterally or bilaterally. CYSTOGRAPHY AND URETHROCYSTOGRAPHY: Cystography is used to visualize the bladder. It is recommended in case of intravesical obstruction. Urethrocystography is a technique for investigation of the anterior and prostatic urethra as well as the neck of the urinary bladder.

[The value of ultrasound in diagnosis of male infertility]. / Doprinos ultrazvuka u dijagnostici muskog steriliteta.

INTRODUCTION: The number of male patients with clinical presentation of infertility, especially secondary infertility after infections, is increasing every day. Contemporary urological standards in defining male infertility include ultrasound examination. Ultrasound examination of the scrotum using color doppler is of great importance. DIAGNOSIS OF MALE INFERTILITY: Testicular atrophy, microlithiasis and varicocele are the most common causes of male infertility. Microlithiasis and classical testicular microlithiasis are not directly associated with infertility. Gray scale sonography is used in evaluation of the dilatation of the testicular veins, but color Doppler made a real contribution in revealing subclinical varicocele. Transrectal ultrasound is used in a number of pathological conditions of prostate, seminal vesicles and ducts. In cases of obstructive azoospermia it is important to find out the cause, such as focal prostatitis, cysts, ejaculatory ducts obstruction or absence of vas deferens. CONCLUSION: Ulltrasound is a noninvasive method easy to perform, which provides information without postexamination consequences such as strictures or obstructions, which are possible after invasive deferentography. Ultrasound guided biopsy, provides a new minimally invasive diagnostic tool in current urology.

[Diagnostic significance of ultrasonography in focal splenic lesions]. / Dijagnosticki znacaj ultrazvuka u fokalnim promenama slezine.

INTRODUCTION: The spleen is situated in the upper left abdominal cavity and spleen parenchyma has a homogenous appearance. For that reason changes in parenchymal echogenicity should be understood as pathological, since many splenic focal lesions appear as different changes in echostructure of spleen parenchyma. FOCAL SPLENICE LESIONS: Focal lesions are not rare and are found in every day work. Great advantages of ultrasound diagnostics in relation to other complementary methods put this method into the leading position in diagnostics, not only in spleen disorders, but the whole abdomen. Advantages include: diagnostic accuracy, possibility of repetition, low price of the examination, and no irradiation. SPLENIC ULTRASONOGRAPHY: Splenic ultrasonography is efficient and provides findings which represent a significant contribution in reaching the final diagnosis and selecting the appropriate therapeutic approach. Due to various ultrasonographic images of numerous splenic focal lesions (metastasis, hemangioma, cysts, infarction, hematoma etc) great knowledge and experience is required in order to come to accurate diagnosis. This will bring application of other diagnostic procedures, such as CT and MR, mostly available in large radiological institutes, to a minimum.