The usefulness of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences visual assessment in the early diagnosis of axial spondyloarthritis.

The aim of the study was to compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). The study group consisted of 49 patients who had undergone multiparametric magnetic resonance imaging of the sacroiliac joints (SIJs) due to clinical suspicion of axSpA. Two independent observers retrospectively assessed four quadrants of the SIJs for the presence of subchondral bone marrow oedema/osteitis with the use of modified SPARCC score in sequences: STIR, DWI (with ADC map) and DCE. Diagnostic efficiency parameters were calculated for DWI and DCE sequence separately, using STIR sequence as a reference. Inter-observer agreement was evaluated with the use of κ coefficient. Patients' clinical symptoms were analysed to identify the group fulfilling the imaging arm of the ASAS criteria for axSpA. Overall, 46.9% (n = 23) of patients fulfilled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specificity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specificity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (κ = 0.888), slightly lower for DCE sequence (κ = 0.773) and the lowest for DWI with ADC (κ = 0.674). Visual assessment of the DWI and DCE sequences has high accuracy and sensitivity of bone marrow oedema/osteitis detection, but the specificity and inter-observer agreement are poor, especially for the DWI sequence with ADC maps.

Cerebral Aneurysms: Are They Associated with Anatomic Variations of Carotid and Main Cerebral Arteries?

OBJECTIVE: Vascular anatomic variations are very common in the population, but their coexistence with life-threating vascular malformations remains unclear. The objective of the study was to assess the correlation between the presence of anatomic variants of both carotid and main cerebral arteries and the occurrence of cerebral aneurysms. METHODS: We analyzed examinations of 194 patients who underwent computed tomography angiography of the head and neck between September of 2016 and November of 2017. The assessed parameters were: the variation of the common carotid arteries origin, hypoplasia or duplication of any of the main cerebral arteries, carotid artery kinking, and the presence of cerebral aneurysms. RESULTS: We found 5.7% of patients had a cerebral aneurysm. Hypoplasia of at least 1 main cerebral artery occurred in 34.5% of patients, with the most frequent being the vertebral artery (21.6%). Duplication of at least 1 main cerebral artery was detected in 2.6%. Cerebral aneurysms occurred more often together with hypoplasia (P = 0.041; OR = 3.175) or duplication (P < 0.001; OR = 18.500) of at least 1 main cerebral artery. In 7.2% of cases, the origin of common carotid arteries created a true bovine arch, and in 4.1% the so-called bovine arch. Patients with alternative variants of aortic arch branching were more likely to have cerebral aneurysms (P = 0.002; OR = 5.903). We found 27.3% of patients had internal carotid arteries affected by kinking. Carotid kinking did not predispose the patient to the formation of a cerebral aneurysm (P = 0.378). CONCLUSIONS: There is an evident correspondence between the presence of vascular anatomic variants (abnormal origin of the carotid arteries, hypoplasia, or duplication of the main cerebral artery) and the occurrence of cerebral aneurysms.

Spleen enlargement assessment using computed tomography: which coefficient correlates the strongest with the real volume of the spleen?

PURPOSE: The aim of the study was to find which linear measurements, field and volume coefficients correlate the best with real volume of the spleen and can be further used for identification of splenomegaly. METHODS: Abdominal computed tomography (CT) examinations of 264 patients were retrospectively analyzed in terms of maximal length, maximal thickness, hilum thickness, maximal height, vertical height and estimated height. Spleen volume was manually measured in Vitrea software. Two- and three-dimensional coefficients were calculated through proper mathematical formulas from linear measurements. Splenomegaly cut-off: 314.5 cm3. Data were analyzed with use of Pearson correlation and χ2 test with statistical significance at p < 0.05. RESULTS: For single measurements, the correlation with real spleen volume was the strongest for maximal height (r = 0.804; p < 0.05). Among two-dimensional indexes, multiplication product of maximal length and vertical height reached the highest level of correlation with spleen volume (r = 0.923; p < 0.05) and had the highest sensitivity and specificity (94.3% and 93.0%, respectively) for splenomegaly detection (threshold 115 cm2). In case of three-dimensional ones, the coefficient calculated from maximal length, vertical height and hilum thickness established the strongest link with spleen volume (r = 0.956; p < 0.05). CONCLUSIONS: Coefficient calculated from maximal length, vertical height and hilum thickness correlates the strongest with spleen volume and can be utilized for monitoring of spleen volume instead of obsolete splenic index. The most suitable for quick splenomegaly screening is two-dimensional coefficient (maximal length × vertical height), with the cut-off 115 cm2.

Nasal Septal Deviation and Concha Bullosa - Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

BACKGROUND: The aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them. MATERIAL/METHODS: We retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18-97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum. RESULTS: Mean volume of the right maxillary sinus was 17.794 cm3, while for the left one it was 17.713 cm3. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients' examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048). CONCLUSIONS: Nasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.