Contents
01.12.2019.
Professional paper
Anatomical variants of circle of Willis
Introduction: The circle of Willis is the major source of collateral blood flow between the carotid and vertebrobasilar system. Its potential depends on the presence and size of arteries that vary greatly among normal individuals and therefore their adequate observation by a radiologist is necessary. Aim: Determine the type of the circle of Willis and their frequency. Determine the type, frequency and localization of anatomical variants of arteries, as well as their average diameter. Compare these variables according to the age and gender of the examinees. Material and methods: A retrospective study was performed at the Center for Radiology of the Clinical Center Nis during 2017. All subjects underwent CT or MR angiography according to a standard endocranial protocol. The anterior and posterior parts of the circle were specially observed, with an emphasis on the presence or absence of anatomical variants of the arteries, with the measurement of their diameter. The obtained data were classified into variants of the front or rear part of the ring as well as the type of ring according to integrity. The frequency of these variables and their comparison by sex and age were measured. Results: The research included 92 examinees. According to the configuration of the Willis arterial ring, the adult type was the most often represented (71.7%). The most common type in terms of integrity was partially complete. The most common anatomical variants obtained in our work was aplasia of AcoA (27.2%) and aplasia of one or both PCoA (21%). PcoA hypoplasia was occured in women with a frequency of 13.5% while in men it was not present. Conclusion: Adequate understanding of the morphology of the circle of Willis by radiological methods is a good guide for neurosurgical and radiological intervention procedures. In this way, potentially significant neurological complications and the risk of morbidity and mortality could be reduced.
Aleksandra Milenković, Slađana Petrović, Simon Nikolić, Branislava Radović, Aleksandra Ilić, Miloš Gašić, Bojan Tomić
01.12.2019.
Professional paper
The role of computerized tomographic angiography in the diagnosis of pathologically modified renal arteries
Introduction: The most common causes of renal artery disease are stenosis, as a consequence of atherosclerosis and fibromuscular dysplasia. Computed tomographic (CT) angiography is a non-invasive method, which enables visualization of vascular structures and walls of blood vessels, as well as morphology of the renal parenchyma. Objective: To determine the importance of CT angiography in detecting the cause and degree of renal arterial disease. Methods: A total of 45 patients were included in the cross-sectional study conducted from March 2017 to March 2019 in the KBC DR Dragiša Mišović-Dedinje, Belgrade, Serbia. Criteria for inclusion were suspicion of secondary arterial hypertension, patients in preparation for kidney transplantation and in the follow-up period after transplantation, as well as patients with suspected traumatic lesions. We analyzed the causes of the disease, the morphology of the blood vessel wall, the percentage of stenosis, and the renal parenchyma. Results: The most common causes of renal arterial disease are atherosclerosis, which was found in 33 (73%) patients, renal artery aneurysm was found in 5 (11%) subjects, fibromuscular dysplasia in 4 (8.9%) and trauma in 1 (2) , 3%) of the patient. There were 10 (22.2%) patients with a significant (average 80 ± 14.5%) degree of stenosis. The sensitivity of CT angiography in the detection of atherosclerotic changes in the renal arteries was 87.9%, while the sensitivity of CT angiography in the detection of fibromuscular dysplasia was 75%. A statistically significant correlation was found between atherosclerotic stenosis of the renal arteries and a positive CTA finding (p = 0.0002). Conclusion: CT angiography is an important method of visualization and quantification of pathological changes in the renal arteries.
Miloš Gašić, Sava Stajić, Ivan Bogosavljević, Milena Šaranović, Aleksandra Milenković, Sanja Gašić
01.12.2019.
Professional paper
Errors and artifacts on radiographs
Introduction: The process of recording a patient includes a procedure with several separate segments during work that together provide the imaging to be obtained for adequate radiological analysis. Throughout the process, it is possible to experience errors that create artifacts on X-rays which ultimately results in an inadequate recording that is not for valid analysis. Aim: Determine the total number of radiological films that are not for valid analysis. Sort out and analyze errors in radiographs according to the work process. Provide recommendations for improving the quality in the process of recording the patient. Material and methods: A prospective study was conducted at the Radiology Clinic of the Clinical Hospital Center Pristina-Gracanica, for two calendar years. All films that are not for valid analysis were considered. The radiological procedure of patient imaging was broken down into logical segments so that possible errors could be observed. We have summarized the causes of the artifacts in five appropriate groups (errors made by the recording technique, during the acquisition of the image, caused by the object of recording, during the processing of films in an automated machine and improper handling of films). Results: The total amount of used X-ray films is 32600 pieces, of which 242 (0.74%) were errors and artifacts. The most common format of a film with an error or artifact was 30x40 cm. A frequency of errors according to the cause of the occurrence is classified into appropriate groups. The largest number was in a group 1 - 155 (64.04%), in a group 2 - 3 (1.24%), in a group 3 - 13 (5.37%), in a group 4 - 67 (27.69%), and in a group 5 - 4 (1.66%). Conclusion: In the proper systematization of all observed errors and artifacts of X-ray film, it allows us to realise the place of error during the whole process of recording and processing of the film. We hereby wish to propose their elimination and improve the quality of the radiology department.
Simon Nikolić, Aleksandra Milenković, Bojan Tomić, Branislava Radović, Miloš Gašić
01.12.2019.
Original scientific paper
THE INFLUENCE OF PHACOEMULSIFICATION ON CORNEAL OEDEMA IN PATIENTS WITH GLAUCOMA
Introduction: Glaucoma diagnosis is based on consideration of several factors, such as increased intraocular pressure (IOP), damage to the optical disc, and associated visual field loss. Evaluation of the integrity of the corneal endothelium and monitoring of the corneal thickness is indispensable during the preoperative preparation for phacoemulsification. These data are of great importance for later treatment and monitoring of early and late postoperative complications.
Objective: The aim of this study was to determine the central corneal thickness immediately before and after cataract surgery in patients with primary glaucoma (open and closed angle), comparing them with patients who do not have diagnosed glaucoma. Materials and methods: A prospective study covered a total of 159 subjects who performed cataract surgery by the method of phacoemulsification with the implantation of the intraocular lens in the posterior chamber at the Clinic for Eye Diseases at the Clinical Center of Serbia in Belgrade in 2017 and 2018. Pre-operative patients are classified into two groups. The first group with a primary glaucoma consisted of 71 respondents, with an open angle 41 with glaucoma, and a closed angle glaucoma 30. The second group consisted of people who did not have a diagnosed glaucoma, 88 of them. The central corneal thickness was measured using an ultrasound pachymeter. The measurements were made before the operation, 24 hours, 10 and 30 days after the operation, trying to get all done at the same time of day.
Results: Between patients without glaucoma (BG), primary open-angle glaucoma (POAG) and primary glaucoma of closed angle (PACG), there is a statistically significant difference in median age (χ2 = 10.102; DF = 2; p = 0, 006). Among the observed groups there were statistically significant differences in the values measured preoperatively (χ2 = 10.265; DF = 2; p = 0.006). Among the observed groups, there was no statistically significant difference in the values measured in the first postoperative day (χ2 = 4.364; DF = 2; p = 0.099), nor in the 10th postoperative day (χ2 = 3.250; DF = 2; p = 0.197); 30 days after surgery (χ2 = 1.427; DF = 2; p = 0.490). In each of the groups individually, the appearance of oedema or a very statistically significant difference in the first and tenth postoperative day. Statistically significant difference was present 30 days after surgery, but far less compared to early postoperative period.
Conclusion: Based on the values obtained in this prospective study, we estimate that monitoring of corneal thickness has a mandatory place in the observation of patients after cataract surgery. We found that there is no difference in preoperative measurement only between groups without glaucoma and open angle glaucoma. Measurements performed in the first, tenth, thirtieth day do not differ in groups, but edema restitutin in the 30-th day was observed in all observed groups.
Ivan Bogosavljević, Ivan Marjanović, Miloš Gašić, Marija Božić, Vesna Marić, Jana Mirković, Mona Varga, Milena Šaranović, Miroslav Jeremić
