Morphometric Study of Lumbar Spinal Canal Dimensions in Bosnia and Herzegovina Population.

Background: The lumbar spinal canal consists of 5 interconnected lumbar vertebrae through which the final part of the spinal cord passes and the lumbar and sacral spinal nerves that form the cauda equina. The lumbar canal stenosis can directly affect neurological symptoms and pain in the lumbar region and lower extremities. Due to the frequency of such symptoms, lumbar stenosis has been the subject of research around the world. Objective: The objective of this study was to measure, analyze and compare the mediosagital and interpeduncular diameters of the lumbar spinal canal in the population of Bosnia and Herzegovina to other populations around the world. Methods: We conducted a retrospective descriptive study on patients (n=200) who underwent Multi-slice computer tomography (MSCT) performed on a 40-slice CT scanner (Siemens Somatom Definition AS) for lumbar pain between January 1, 2013 and December 31, 2014. Age, gender, midsagittal (MSG) and interpeduncular (IP) diameters of the lumbar spine were recorded for each patient. Results: Results of our study show that the largest MSG diameter is at L1 level for both sexes, with an average length of 19,06mm, and the smallest at L3 level, with an average length of 16,66mm. Our study shows that the MSG diameter is significantly larger in females than males on all levels from L1 to L5. In both sexes, MSG diameter shows the form of an hourglass with narrowing at L3 level. IPD is largest at L5 level for both sexes, with an average length of 31,94mm, and the smallest average length at L1 level, at 24,78mm. IPD diameter is significantly larger in males than females on all levels from L1 to L5. IPD shows a tendency of growth from L1 to L5 in both sexes. Conclusion: There were significant differences in the dimensions of the lumbar spine canal between female and male patients. We found significant difference in MSG and IP diameters measurements between Bosnian and Herzegovinian population compared to other populations. The dimensions of the lumbar canal provide a baseline of normative data for the evaluation of patients presenting with lower back pain and lumbar canal stenosis in study population.

Neurosarcoidosis - the Role of Magnetic Resonance Imaging in Diagnostics.

Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by presence of granulomas in affected tissues with variety in clinical presentations and presents a differential diagnostic and therapeutic dilemma. Clinical presentation of neurosarcoidosis is very variable. Diagnosis is based on clinical and radiological criteria and histological findings of disseminated non-necrotic granuloma followed by negative cultures for bacteria and fungi. MRI plays a key role in detection of lesions located in the brain parenchyma. Objective: The aim of this article was to present case of a 36-year-old male patient, who came to doctor with symptoms of fever, dry cough with whitish sputum, lymphadenopathy of neck region and neurological disturbances in form of headaches and vision problems. Case presentation: Patient underwent on pulmonary examination and results indicated presence of sarcoidosis. CT examination was performed (SIEMENS Somatom Definition AS, Erlangen, Germany), which confirmed presence of mediastinal and hilar lymphadenopathy. Ultrasound (US) examination of a neck region was also performed showed significantly enlarged and morphology altered lymph nodes. After biopsy of several neck lymph nodes, histopathological was proven diagnosis of sarcoidosis. Due to neurological disturbances in form of headaches and vision problems patient was examined by an ophthalmologist, neurologist and endocrinologist. Hormonal analysis showed an increase of prolactin and that raised suspicion for neurosarcoidosis. In further diagnostic evaluation it was indicated MRI examination of the brain with focus on sellar region. Conclusion: Contrast-enhanced MRI is the modality of choice for investigating suspected neurosarcoidosis. The versatility of MR recording and the amount of diagnostic informations obtained from MRI examination is huge. Comparison of MRI sequences obtained, facilitate interpretation of these findings. Obtained MRI information and available literature, correlating with other diagnostic modalities (ultrasound and CT) facilitate understanding of the specific pathology.

Apparent diffusion coefficient reproducibility in brain tumors measured on 1.5 and 3 T clinical scanners: A pilot study.

BACKGROUND: Gradient and coil systems, pulse sequence design, and imaging parameters, as well as different scanners, can influence apparent diffusion coefficient (ADC) values. The aim of this study was to evaluate the effect of two different field strengths on the reproducibility of mean absolute ADC measurements in various primary and secondary brain tumors. METHODS: Fifty patients with histologically proven brain tumors were prospectively examined on two MR scanners from the same vendor, with different field strengths-1.5T and 3T-on the same day. Absolute ADC values were compared using the Wilcoxon matched-pairs signed-rank test. Inter-scanner agreement between two different fields in the same tumor was examined using correlation coefficients, and the discrepancy between the highest and the lowest mean absolute ADC values between scanners was tested using a one-way analysis of variance. Statistical significance was set at p < 0.05. RESULTS: There was no statistically significant difference between mean absolute ADC values obtained on 1.5T and 3T scanners for all patients and all brain tumor types. The intratumoral difference in ADC values, averaged from two scanners in the same tumor type, ranged from 1.58 to 4.5% for 1.5T, and from 1.18 to 4.37% for 3T.Inter-scanner agreement was high, and the kappa coefficient ranged from 0.88 to 0.99, with no significant difference between obtained values on different field strengths. CONCLUSION: Based on the results obtained in our study, there is no significant difference between mean absolute ADC values measured in various primary and secondary brain tumors at different field strengths (1.5 and 3.0T MR systems), in the same patient, and in the same tumor, measured on the same day.

Impact of Different Sources of Infection on Therapy Response in Chronic Hepatitis C.

INTRODUCTION: Prior to the 1990s, the most common sources of HCV infections were blood transfusions, unsafe injections and I.V drug use. Screening of blood products for HCV has eradicated transfusion-transmitted hepatitis C in most countries since 1992-in Bosnia and Herzegovina, however, since 1995, due to the war. AIM: To investigate the impact of the source of HCV infection on the therapeutic response in patients treated for chronic HCV infection with dual combined therapy. METHODS: We diagnosed chronic HCV infections amongst 246 patients over a period of five years and selected them according to the reported source of infection. Pegylated interferon alfa 2a or alfa 2b with ribavirin was administered during the time that was genotype-dependent. HCV RNA levels in sera were measured by real time PCR. Liver histology was evaluated in accordance with the level of necroinflammation activity and the stadium of fibrosis. RESULTS: Regardless of the genotype of the virus and the source of infection, SVR was achieved in 67% of the patients. Therapeutic response (ETR) was not achieved in 25% of the patients who were infected with an untested blood transfusion and 6% of the patients who had had wartime surgery. Amongst the different sources of infections, patients with a war-surgery source of infection responded better to therapy than those with a blood transfusion source of infection (p = 0.023). A blood transfusion source of infection implies a larger fibrosis stage than in blood donors; (g = 1.177; s2 = 0.577). A blood transfusion source of infection implies a significantly larger necroinflammatory activity than in blood donors; (g = 1.456; s2 = 0.618). CONCLUSIONS: An untested blood transfusion was a significant risk factor for more advanced liver diseases in regards to necroinflammatory activity and the fibrosis stage. This source of infection was also a risk factor for low responses to antiviral therapy. At the same time, I.V. drug users had more progressive necroinflammatory activity, but a high therapeutic response to antiviral therapy.

Comparison of Conventional Ultrasound and Contrast Enhanced Magnetic Resonance (MR) Enterography in Evaluation Patients with Crohn's Disease.

INTRODUCTION: The small intestine is a challenging organ for clinical and radiological evaluation, and by introducing imaging radiological techniques, not significantly disturbing the comfort and safety of patients, it attempts to obtain adequate diagnosis and valuable information. AIM: The research was conducted with the aim of checking the comparability and potential of diagnostic modality of ultrasound and dynamic contrast enhanced MR Enterography (DCE-MR) in patients with Crohn's disease. METHODS: 55 patients were examined prospectively, and ultrasound examination of the abdomen was performed for all patients before the MR enterography. They were subsequently endoscopically examined or treated surgically, which was taken as a reference. Four parameters characterizing the disease itself were analyzed: bowel wall thickening, presence of abscess, fistula and lymphadenopathy. RESULTS: Comparing the accuracy of the results of ultrasound findings and findings of MR enterography, it was found that there is a significant difference in the results obtained. The study found that the sensitivity for MR enterography for bowel wall thickening was 97.8%, and the specificity was 70%, while the sensitivity for ultrasound for the bowel wall thickening was 51% and the specificity was 100%. In the diagnosis of abscess, there was no significant difference between the results obtained by ultrasound and magnetic resonance imaging (MRI) findings, while in fistula and lymphadenopathy there was a significant difference. CONCLUSION: Conventional ultrasound is a good orientation method in the initial evaluation of patients with Crohn's disease, while contrast enhanced MR enterography provides an excellent assessment for disease activity as well as the complications that accompany it.

Neuroimaging of Spinal Tumors.

Intradural tumors are relatively rare neoplasms; however, when unrecognized in a timely manner, they can result in serious deficits and disability. These tumors lack obvious clinical symptoms until compression of the cord or neurologic deficits occur. The most common intramedullary lesions are ependymomas, astrocytomas, and hemangioblastomas. Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) comprise most intradural-extramedullary tumors. Less common tumors are hemangiopericytoma, paraganglioma, melanocytoma, melanoma, metastases, and lymphoma. MR imaging is the imaging method of choice, helpful for localization and characterization of these lesions before treatment and for follow-up after treatment.

Posterior reversible encephalopathy syndrome (PRES).

Posterior reversible encephalopathy syndrome (PRES) is described neurological condition identifiable by clinical and radiological presentation. It occurs due to elevated blood pressure which exceeds auto-regulatory capacity of brain vasculature. PRES is characterized by headache, confusion, seizures, and altered mental function. In this report we describe a case of eleven-year-old boy who was hospitalized, because of nausea, vomiting, intermittent fever, headache, confusion and distress. Because of suspicion of encephalitis CT and MRI examinations were performed immediately where was established diagnose of PRES syndrome.

Congenital malformations of the central nervous system: clinical approach.

Central nervous system (CNS) malformations represent important factor of morbidity and mortality in children. The aim of the study was to determine the incidence, type and clinical features of CNS malformations in children who were admitted at the Neonatal and Child Neurology Department, Neonatal Intensive Care Unit and Paediatric Intensive Care Unit of Paediatric Clinic, University of Sarajevo Clinics Centre, from January 1st, 2002 to December 31st, 2006. There were total of 16520 admissions at the Paediatric Clinic over the studied period. CNS malformations, solitary or multiple, have been diagnosed in 100 patients (0,61%). The total number of various CNS malformations was 127. Lethal outcome was established in 9/100 cases (9%). The most frequent CNS malformations were neural tube defects 49/127 (38,6%). Hydrocephalus was seen in 34/127 (26,8%), microcephaly in 24/127 (18,9%), agenesis of corpus callosum in 10/127 (7,9%), Dandy Walker malformation in 6/127 (4,7%) and other CNS malformations in 4/127 (3,1%). In 20/100 of patients neural tube defect was associated with hydrocephalus (20%). CNS malformations were prenatally diagnosed in 13/100 of patients (13%). Primary prevention of CNS malformations can be improved in our country by better implementation of preconceptional folic acid therapy for all women of childbearing age. Secondary prevention by prenatal diagnosis requires advanced technical equipment and adequate education of physicians in the field of foetal ultrasonography. In our circumstances, prenatal diagnostics of CNS malformations is still not developed enough.

[Magnetic resonance as the method of choice in diagnosis of cerebellopontine angle tumors]. / Magnetna rezonanca kao metoda izbora u dijagnozi tumora pontocerebelarnog ugla.

UNLABELLED: The aim of this study is to access magnetic resonance as the imaging modality of choice in differentiation of cerebellopontine angle tumors. MATERIAL AND METHODS: In period of five years in 53 patients were diagnosed CPA tumors. 31 were women, 22 men, range age 14 to 72 years. All patients were examined on 1.0 Tesla magnetic resonance unit, using T1, PD, T2 WI sequences, and after paramagnetic contrast administration T1 W1 in three ortogonal planes. REZULTS: In 44 (83%) patients were diagnosed acoustic schwannoma (NVIII), and 8 patients of these had Neurifibromatosis Type 2. In 2 (4%) patients were diagnosed trigeminal schwannoma (NV), in 2 (4%) hypogossal schwannoma. By 5 (9%) patients were diagnosed meningiomas. All diagnoses were by histology confirm. CONCLUSION: Thanks to its multiplanar and multi-parameters capabilities Magnetic resonance allowed precise location and characterization of CPA tumors. MR is the imaging modality of choice for preoperative work-up of cerebellopontine angle tumors.