Internal carotid artery anatomy - not always straightforward.

OBJECTIVES: To present a rare variant of internal carotid artery anatomy. METHODS: Case report presenting CT angiography finding of internal carotid anatomy variant. RESULTS: We present the case of an unusual origin of the occipital artery from cervical portion of the internal carotid artery as an incidental finding during CT angiography of the carotid arteries. In discussion, we discuss the possible embryological basis, incidence and prevalence of such finding and its possible clinical implications. CONCLUSION: One of the specific aspects of carotid arteries is their straightforward anatomy - the cervical portion of internal carotid artery, unlike the external carotid, does not give origin to any branches - this aspect is even used as a highlight for orientation, e.g. during ultrasound examination. However, although rare, variants exist, and sometimes can have clinical importance - in the endovascular access or surgical treatment.

DIAGNOSTIC REFERENCE LEVELS IN SCREENING MAMMOGRAPHY CENTERS IN SLOVAKIA.

Optimization in mammography remains the most important tool in practice. In the optimization process, we look for a balanced relationship between image quality and patient dose. For mammographic examinations, the diagnostic reference levels (DRLs) are expressed as the average glandular dose (AGD) based on the thickness of the compressed breast. The aim of this study was to analyse DRL compliance in diagnostic mammography at 16 mammography screening centres using an automated system for tracking patient doses during the period between January 2020 and December 2020 and to subsequently propose new DRLs for the screening mammography centres in Slovakia. The new DRLs were ~20% lower than the existing national DRLs in diagnostic mammography in Slovakia and significantly lower than the achievable AGD levels published in the fourth edition of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis.

Human Remains Identification Using Micro-CT, Chemometric and AI Methods in Forensic Experimental Reconstruction of Dental Patterns after Concentrated Sulphuric Acid Significant Impact.

(1) Teeth, in humans, represent the most resilient tissues. However, exposure to concentrated acids might lead to their dissolving, thus making human identification difficult. Teeth often contain dental restorations from materials that are even more resilient to acid impact. This paper aims to introduce a novel method for the 3D reconstruction of dental patterns as a crucial step for the digital identification of dental records. (2) With a combination of modern methods, including micro-computed tomography, cone-beam computer tomography, and attenuated total reflection, in conjunction with Fourier transform infrared spectroscopy and artificial intelligence convolutional neural network algorithms, this paper presents a method for 3D-dental-pattern reconstruction, and human remains identification. Our research studies the morphology of teeth, bone, and dental materials (amalgam, composite, glass-ionomer cement) under different periods of exposure to 75% sulfuric acid. (3) Our results reveal a significant volume loss in bone, enamel, dentine, as well as glass-ionomer cement. The results also reveal a significant resistance by the composite and amalgam dental materials to the impact of sulfuric acid, thus serving as strong parts in the dental-pattern mosaic. This paper also probably introduces the first successful artificial intelligence application in automated-forensic-CBCT segmentation. (4) Interdisciplinary cooperation, utilizing the mentioned technologies, can solve the problem of human remains identification with a 3D reconstruction of dental patterns and their 2D projections over existing ante-mortem records.

Large Thoracic Lymphadenopathy and Pulmonary Nodules in Young Man.

CASE PRESENTATION: A 33-year-old man with obesity, systemic arterial hypertension, and psoriasis who had been treated previously with little success by a pulmonologist for chronic unproductive irritant cough came to the outpatient pulmonary department because of profuse cough and short syncope (probably cough-induced). Chest radiography revealed widened mediastinum with lobular, polycyclic contours that was suspected to be a large mediastinal lymphadenopathy or mediastinal mass.

Gastroenteropancreatic neuroendocrine neoplasm - a complex presentation in imaging methods.

Neuroendocrine neoplasms comprise an ever greater ratio of primary gastrointestinal tract tumors, thanks to the improving diagnostics. The clinical presentation can be quite diverse depending on the type of the tumor. Imaging methods - both the spectrum of radiological methods and methods of nuclear medicine - are an integral part of the diagnostics. This article presents a case report of a 65-year old female patient, whose routine abdominal US scan performed as part of a preventive check-up revealed a suspicious liver incidentaloma. The case report presents the image of the pathology in various imaging modalities, radiologic and molecular/hybrid methods used in the differential diagnostic process of the lesion, as well as findings in follow-up examinations after histological verification of the lesion and an outline of further approach and treatment.

Stage I testicular seminoma risk-adapted therapeutic management.

Following orchiectomy, patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (S) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, especially second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as an adjuvant therapy option for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches - S versus adjuvant chemotherapy (ACT) on the survival of patients with CSI testicular seminoma. This cross-sectional study analyzed a total of 139 patients collected at a single center between 10/2011-5/2020, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches. In the S group (low-risk - without rete testis invasion - RTI, primary tumor size <4 cm), consisting of 77 patients, who underwent S, relapse occurred in 10 (13.0%) patients after a mean follow-up of 14.3 months. In the ACT group (high-risk - RTI and/or primary tumor size >4 cm), consisting of 62 patients, who were treated with ACT, relapse occurred in 5 (8.1%) patients after a mean follow-up of 11.6 months. Overall survival of patients in both groups was 100% with a mean follow-up of 43.9 months. A statistically significant difference in progression-free survival (PFS) between these two groups was not found. Based on our findings, ACT seems to be an adequate treatment for patients with a high risk of relapse, as well as S for those with a low risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

Agreement between prenatal ultrasound and 3.0T magnetic resonance imaging in the assessment of anomalies of the central nervous system: A single-center experience in Slovakia.

OBJECTIVE: To assess the concordance of in-utero magnetic resonance imaging (MRI) findings at 3.0T in fetuses with suspect abnormalities of the central nervous system (CNS) on ultrasonography. METHODS: A retrospective study was done on 222 pregnant women indicated for fetal MRI, with the examination performed within 2 weeks from indication. The inclusion criteria for patients were age 18 years or older with the fetus at 18 weeks of gestation or more. Fetal CNS pathologies were divided into six categories: ventriculomegaly; supratentorial midline abnormalities (ACC); supratentorial space-occupying lesions; abnormalities of the posterior fossa; destructive cerebral lesions; and cortical formation abnormalities (CFA). Chance-adjusted agreement was assessed using unweighted Cohen's kappa (κ). RESULTS: The best agreement between ultrasound and MRI was observed in ventriculomegaly (κ=0.817; 95% confidence interval [CI] 0.76-0.88). There was only a moderate agreement in ACC (κ=0.483; 95% CI 0.35-0.61). CFA pathologies had a poor agreement between the modalities (κ=0.140; 95% CI -0.03 to 0.31). CONCLUSION: Ultrasonography has good overall agreement with MRI in diagnosing fetal CNS anomalies. CFA had the most disagreement between ultrasound and MRI. The prognostic implication of these findings can be used for parental neuro-counseling but should be investigated further.

Neurointerventionalist and Patient Radiation Doses in Endovascular Treatment of Acute Ischemic Stroke.

PURPOSE: To evaluate the patient and the neurointerventionalist radiation dose levels during endovascular treatment of acute ischemic stroke, and to analyze factors affecting doses. MATERIALS AND METHODS: From October 2017 to January 2019, we prospectively collected patient radiation data and neurointerventionalist data from real-time dosimetry from all consecutive thrombectomies. Multivariate analysis was performed to analyze patient total dose area product (DAP) and neurointerventionalist dose variability in terms of clinical characteristics and the technical parameters of thrombectomies. Local dose reference levels (RL) were derived as the 75th percentile of the patient dose distributions. RESULTS: A total of 179 patients were treated during the study period and included in this study. Local dose RL for thrombectomy was derived for total DAP to 34 Gy cm2, cumulative air kerma of 242 mGy and fluoroscopy time of 12 min. The mean neurointerventionalist dose for thrombectomy was 7.7 ± 7.4 µSv. Height (P = 0.018), weight (P = 0.004), body mass index (P = 0.015), puncture to recanalisation (P < 0.001), fluoro time (P < 0.001), number of passes (P < 0.001), thrombolysis in cerebral infarction 2b/3 recanalisation (P = 0.034) and aspiration thrombectomy (P < 0.001) were independent factors affecting patient total DAP, whereas baseline National Institutes of Health Stroke Scale (P = 0.043), puncture to recanalisation (P = 0.003), fluoroscopy time (P = 0.009) and number of passes (P = 0.009) were factors affecting the neurointerventionalist dose. CONCLUSION: New reference patient doses lower than those in previously published studies were defined. However, the operator's doses were higher than those in the only available study reporting on operator's dose during cerebral interventions.

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study.

OBJECTIVES: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. METHODS: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). RESULTS: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). CONCLUSION: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

Fibrocartilaginous Embolization - a Rare Cause of Spinal Cord Infarction: Case Report.

A case of fibrocartilaginous embolization in 24-year-old female as a rare cause of spinal cord infarction is presented. It manifests as infarction syndrome with rapid progression of clinical signs - acute onset of quadriparesis and respiratory insufficiency. Among imaging studies MRI is the most accurate as it readily capable of detection of myelopathy and acute intervertebral disc lesion. Other laboratory tests and imaging modalities are usually normal. The final diagnosis is made by exclusion.

Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Tumors: A 25-year Single-center Experience.

BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.

Controversies in the management of clinical stage I testicular seminoma.

INTRODUCTION: Following orchiectomy patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (AS) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, mainly second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as adjuvant therapy for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches - AS versus adjuvant chemotherapy (ACT) on survival in patients with CSI testicular seminoma. MATERIAL AND METHODS: The cross-sectional study analyzed a total of 106 patients collected at a single centre between 4/2008-8/2015, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches. RESULTS: In group A (low-risk), consisting of 84 patients, who underwent AS, relapse occurred in 10 (11.9%) patients after a mean follow-up of 13.8 months. In group B (high-risk), consisting of 22 patients, who were treated with ACT, relapse occurred in two (9.1%) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100% with a mean follow-up of 25.3 months. The statistically significant difference in progression-free survival (PFS) between these two groups was not found. CONCLUSIONS: ACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy.

PURPOSE: To find the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted transrectal ultrasound (TRUS)-guided biopsy using visual coregistration (TB) in patients with elevated prostate-specific antigen (PSA), normal digital rectal examination, and no previous biopsy. MATERIALS AND METHODS: Fifty-five patients at two institutions underwent mpMRI, consisting of anatomical T2 -weighted imaging (T2 W), diffusion-weighted imaging (DWI), proton magnetic resonance spectroscopy ((1) H-MRS), and dynamic contrast-enhanced MRI (DCE-MRI), followed by TB in addition to 12 core systematic TRUS-guided biopsy (SB). Histopathological scorings of biopsy (n = 38) and prostatectomy (n = 17) specimens were used as the reference standard for calculation of diagnostic accuracy values. Clinically significant prostate cancer (SPCa) was defined as 3 mm core length of Gleason score 3+3 or any Gleason grade 4. RESULTS: The sensitivity, specificity, accuracy, and area under the curve (AUC) values for the detection of SPCa on the sextant level for T2 W+DWI+(1) H-MRS+DCE-MRI were 72%, 89%, 85%, and 0.81, respectively. The corresponding values for T2 wi+DWI were 61%, 96%, 87%, and 0.79, respectively. The overall PCa detection rate per core in 53 patients was 21% (138 of 648 cores) for SB and 43% (33 of 77 cores) for TB (P < 0.001). CONCLUSION: Prebiopsy mpMRI is an accurate tool for PCa detection and biopsy targeting in patients with elevated PSA.