Radiološke tehnologije

Komparacija kvaliteta prikaza moždanog udara između T2 uravnotežene sekvence obrnutog oporavka sa supresijom vode i T2 uravnotežene sekvence

2022-08-01T11:47:00+00:00

Moždani udar ili cerebrovaskularni inzult (CVI) je u današnje vrijeme jedan od glavnih uzroka smrtnosti i invaliditeta u svijetu. Veoma značajnu ulogu u dijagnostici CVI-a zauzima magnetna rezonanca (MR), koja se ogleda u mogućnosti klasifikacije i otkrivanju patofiziologije kako bi se pravovremeno i brzo postupilo sa terapijskim tretmanom ukoliko je došlo do pojave CVI-a.

Ciljevi: Uporediti kvalitet prikaza CVI-a između T2 FLAIR i T2 sekvence, utvrditi utjecaj lokalizacije CVI-a na intenzitet signala, utvrditi utjecaj vremena pojave CVI-a na intenzitet signala. Utvrditi smo kategorije pacijenata kod kojih najčešće nastaje CVI, kao i korelaciju između uputne i definitivne dijagnoze.

Metode istraživanja: Istraživanje je dizajnirano kao retrospektivna deskriptivna studija. Rad je realiziran u Kliničkom centru Univerziteta u Sarajevu, na Klinici za radiologiju. U studiju je uključeno 50 pacijenata kod kojih MR nalaz ukazuje na prisustvo CVI-a. Ispitivanje je obavljeno na MRI jedinicama jačine 1.5 i 3.0 T.

Rezultati: Od ukupnog broja pacijenata 50 (100%), 32 su muškog pola (64%), a 18 (36%) ženskog pola. CVI je najčešće bio prisutan kod pacijenata muškog pola u grupi od 61-70 godine, dok je kod pacijenata ženskog pola najčešće bio prisutan u grupi od 71-80 godine. 52% pacijenata je imalo jedan od faktora rizika za nastanka CVI-a, HTA je bila prisutna kod 28% pacijenata a DM kod 22% pacijenata. T2 FLAIR sekvenca je imala veće vrijednosti intenziteta signala na lateralnom rubu CVI-a, dok je T2 sekvenca imala veće vrijednosti u centru i prednjem rubu CVI-a. T2 FLAIR sekvenca je imala veći intenzitet signala na lokacijama: thalamus, mesencephalon, okcipitalno kortikalno subkortikalno i područje kapsule interne. T2 sekvenca je imala veći intenzitet signala lokacijama: medula oblongata, parieto okcipitalno kortikalno subkortikalno, frontoparietalno paraventrikularno, parietalno kortikalno subkortikalno, frontoparietalno kortikalno subkortikalno, cerebelum i pons. Najčešća uputna dijagnoza je bila CVI.

Zaključak: T2 FLAIR sekvenca je senzitivnija kod prikaza akutnog i subakutnog CVI-a. T2 sekvenca je senzitivnija kod prikaza hroničnog CVI-a, čime radna hipoteza u ovom slučaju nije u potpunosti dokazana.

Comparison of computed tomography in relation to ventilation perfusion scan in the diagnosis of pulmonary embolism

2022-10-10T10:25:04+00:00

Abstract

Introduction: Pulmonary embolism is still a challenge in diagnosis due to its variable and nonspecific symptoms. Computed tomography and ventilation/perfusion scanning are the modalities most commonly used in the diagnosis of pulmonary embolism, and both modalities have their advantages and disadvantages. One of the most important factors in the assessment and localization of pulmonary embolism is the diagnostic accuracy of these modalities, which serves to model different diagnostic strategies in the diagnosis of pulmonary embolism.

Material and methods: The research was conducted as a review of professional literature available in scientific research databases. A selection of 20 professional papers was made, based on which an analysis was conducted and a database was formed. Criteria for inclusion in the research were scientific research papers that report on the sensitivity and specificity of diagnostic modalities of CT and V/P scanning as well as the results of diagnostic tests based on which the comparison of data from two modalities determined a diagnostically more accurate modality.

Results: Sensitivity of 91.89% and specificity of 98.86% and diagnostic accuracy of 94.83% were determined in the case of computed tomography. Sensitivity of 90.58% and specificity of 98.33% and diagnostic accuracy of 96.43% were determined for the ventilation perfusion scanning method. We can conclude that the application of ventilation/perfusion scanning in the diagnosis of pulmonary embolism is a little more accurate compared to computed tomography.

Conclusion: Ventilation/perfusion lung scanning will more accurately identify healthy individuals while on the other hand we can conclude that computed tomography is more accurate in diagnosing embolism in sick individuals. . Given that this difference between the two modalities is very small, the question is whether it is statistically significant at all. We can conclude that both diagnostic procedures have a high level of accuracy.

Mamografija u screeningu karcinoma dojke

2022-10-15T13:42:13+00:00

Mamografija u screeningu karcinoma dojke

Autori: Mersiha Mehmedović^1*, Semra Šeper¹

¹Klinički centar univerziteta u Sarajevu

ABSTRAKT

From the early 70s of the last century until today, huge progress has been made in the technological development of imaging methods for breast cancer screening, which includes imaging methods, methods of image analysis and optimization of image quality. The introduction of artificial intelligence has made it possible for devices to offer valuable information that helps with greater precision in diagnostic disciplines and the detection of changes that deserve the attention of medical staff.

Objectives and methodology

In the framework of the work, and in accordance with the analysis of available research, we present the advantages and disadvantages of available imaging modalities in breast cancer screening and prove that digital tomosynthesis provides the best results in breast cancer screening.

By analyzing the available data and consulting the professional literature available on the PubMed service, we try to answer the following question:

Is breast cancer screening with digital breast tomosynthesis (DTD) associated with improved cancer detection rates in all age groups and all breast density groups compared with digital mammography?

Retrospective research was conducted by analyzing research published on PubMed in the last 10 years, with open access to information about the design and method of conducting the research and a description of the key aspects of the research conducted.

Globally, in 2020, 2.3 million women were diagnosed with breast cancer, with 685,000 deaths per year. By the end of 2020, there were 7.8 million living women diagnosed with breast cancer in the last 5 years, making it the most common cancer in the world.

According to the report Health status of the population, which was published by the Institute for Public Health of the Federation of Bosnia and Herzegovina in 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women. Although the Ministry's report emphasized a slight downward trend, other studies show that the age limit of women who develop this disease is decreasing. This emphasizes the importance of timely and early detection of the appearance of malignant neoplasms, at a time when the disease is best treated.

Breast cancer is most often diagnosed in women aged 55 to 64, and the risk increases with age. Early diagnosis increases the patient's chances of achieving a cure and also reduces the morbidity of treatment. Breast cancer therapies continue to improve and have contributed to a reduction in mortality, but early diagnosis through mammographic screening has had a greater overall impact on mortality reduction.

Breast cancer arises in epithelial cells of the ducts (85%) or lobules (15%) in the tissue of the mammary gland. Initially, a cancerous growth is confined to a duct or lobule ("in situ") where it generally causes no symptoms and has minimal potential for spread (metastasis). Over time, these in situ (stage 0) cancers can progress to invade the surrounding breast tissue (invasive breast cancer) and then spread to nearby lymph nodes (regional metastases) or to other organs in the body (distant metastases). If a woman dies from breast cancer, it is because of widespread metastases.

Conclusion

Globally, but also at the level of Bosnia and Herzegovina, breast cancer represents an important public health problem. According to the report of the Institute of Public Health of the Federation of Bosnia and Herzegovina from 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women in the Federation of Bosnia and Herzegovina. Multiple studies have shown improved screening results with digital breast tomosynthesis, including lower recall rates and higher cancer detection rates, ranging from 1.6 cancers/1000 scans to 2.4 cancers/1000 scans. The use of DTD reduced the number of recalls for false positive findings on screening (15%-37%), which contributed to the improvement of specificity in the diagnostic evaluation. Numerous retrospective studies have shown that DTB increased cancer detection by 15-30%, and the radiation dose was higher by up to 20%. Based on the above-mentioned conclusions, we can conclude that we have proven that breast cancer screening by digital breast tomosynthesis is associated with improved cancer detection rates in all age groups and all groups of breast density compared to digital mammography.

UČESTALOST POJAVE AKUTNOG BUBREŽNOG OŠTEČENJA NAKON KORONAROGRAFIJE KOD PACIJENATA SA I BEZ ŠEĆERNE BOLESTI

2022-10-10T10:33:43+00:00

ABSTRAKT

Akutna bubrežna insuficijencija nakon kontrastnih procedura ili contrast indukovana nefropatija (CIN-Contrast-induced nephropaty) se definiše kao povečanje vrijednosti serum kreatinina najmanje 0,5 % mg/dl ili 25% do 50 % u odnosu na predproceduralne vrijednosti u toku 48 do 72 sata nakon apliciranja kontrasta, u odsustvu drugih objašnjenja za nastanak oštećenja bubrežne funkcije. Ona je odgovorna za pojavu akutne bubrežne insuficijencije u 11 do 14,5 % slućajeva.

CILJ STUDIJE: Cilj ove studije je određivanje rizićnih grupa pacijenata i faktora kao I profilaktičkih mjera za kontrastnu nefropatiju nakon koronarografije. U studiju je ukljućeno 200 pacijenata (dijabetičari i nedijabetičari) koji su uradili koronarografiju zbog indikacije na koronarnu bolest.

ZAKLJUČAK: Rizićni faktori za nastanak kontrastne nefropatije kod ovih pacijenata su, šećerna bolest, starija životna dob, aplicirana veća kolićina kontrasta, prethodne bolesti bubrega i srćana slabost.

Procjena terapijske tačnosti radioterapije karcinoma glave i vrata vođene kompjuterizovanom tomografijom konusnog snopa

2022-10-30T10:55:29+00:00

ABSTRACT

Uvod: Karcinom glave i vrata čini 3-5 % svih malignih oboljenja, koji je većinom zastupljen kod muškaraca. Napretkom radioterapije omogućen je optimalniji pristup u liječenju karcinoma glave i vrata, sa poboljšanim ishodom liječenja. Primjena savremenih imidžing tehnika u verifikaciji preciznosti tretmana znatno je promijenila tok radioterapije u liječenju malignih bolesti u smislu eskalacije doze na ciljni volumen uz veću poštedu zdravih struktura. Svrha rada je dokazati značaj i ulogu slikovne verifikacije CBCT imidžing metodom u preciznosti liječenja i kontroli tumora tokom tretmana.

Materijal i metode: Istraživanje je provedeno prospektivno u trajanju od 6 mjeseci, na Klinici za onkologiju, Kliničkog centra Univerziteta u Sarajevu. U studiju je uključeno 30 pacijenata sa karcinomom glave i vrata, kod kojih je primjenom slikovne verifikacije CBCT-om uočen gubitak tjelesne težine ili promjena ciljnog volumena. Pacijenti su zračeni VMAT tehnikom na linearnom akceleratoru TrueBeam.

Rezultati: Rezultati istraživanja su pokazali da je većina pacijenata bila muškog spola (19), starije životne dobi, sa karcinom larinksa koji je bio prisutan u čak 11 ispitanika. Jači nusefekti bili su prisutni samo kod 3,33% pacijenata, a najzastupljenije neželjene reakcije bile su blaga promuklost, suhoća usta, zamor, otežano gutanje. Od ukupnog broja pacijenata, kod 16 pacijenata uočeno je smanjenje volumena targeta koji je inicijalno prosječno iznosio 80,16 cm3, dok je nakon prosječno 18 frakcija zračenja iznosio 77,58 cm3, što je sigifikanto statistički dokazano (p= 0,007). Utvrđeno je smanjenje volumena lijeve parotidne žlijezde nakon reskeniranja u odnosu na inicijalnu vrijednost (17.37±7.55/16.93±7.06 cm3). Kod svih pacijenata na CBCT volumetrijskim slikama uočen je gubitak tjelesne težine.

Zaključak: Radioterapija karcinoma glave i vrata jedan je od učinkovitih modaliteta liječenja, koji moće biti praćen određenim neželjenim reakcijama. Primjena IGRT-a na osnovu kompjuterizirane tomografije konusnog snopa (CBCT), uveliko doprinosi peciznoj isporuci propisane doze zračenja, uz smanjenu toksičnost tretmana. Volumetrijski prikaz anatomskih struktura CBCT metodom, omogućio je da se promijeni tok kursa radioterapije u smislu prilagođavanja PTV margina u toku tretmana, odnosno primjenu adaptivne radioterapije.