Diagnostic imaging of traumatic pseudoaneurysm of the thoracic aorta Background. The purpose of the study was the presentation of findings and diagnostic imaging in patients with traumatic pseudoaneurysms of the thoracic aorta, as a rare consequence of road traffic accidents. Patients and methods. In 22 years we have found 8 traumatic pseudoaneurysms of the thoracic aorta, out of which 7 (87.5%) in male and 1 (12.5%) in female patients. At the time of accidents the youngest patient was 21 and the oldest was 55 (mean age 33.8 years), and at the moment of diagnosing a pseudoaneurysm they were 26 and 55 years old, respectively (mean age 38.7 years). In all patients chest radiography was performed as well as CT scan, in 6 (75%) patients intra-venous digital subtraction angiography was performed (i.v. DSA) and in 1 (12.5%) MRI. CT was performed with the application of 120 ml, and i.v. DSA with 60 ml of contrast medium, respectively. Results. In 8 (100%) patients, who suffered a road traffic accident, and whose chest radiograph showed the enlargement of the aortic knob and widening of the mediastinum, CT, i.v. DSA and MRI revealed a traumatic pseudoaneurysm of the thoracic aorta. Periods of time between the accidents and the initial diagnosis of the pseudoaneurysm varied from 7 days to 18 years (median 2.0 years). The diameter of the pseudoaneurysm was from 4.5 to 9.2 cm (median 5.5 cm). In 7 (87.5%) isthmus was involved, and in 1 (12.5%) descending thoracic aorta, respectively. The chest radiograph revealed marginal calcifications in 4 (50%), and on the CT in 5 (62.5%) patients. Intraluminal thrombosis was found by CT in 2(25%) traumatized patients. Conclusions. Traumatic pseudoaneurysm should be taken into consideration in blunt chest trauma, where a chest radiograph shows suspicious regions. A multislice CT is a diagnostic method of choice.

Direct coronary stenting in reducing radiation and radiocontrast consumption Introduction. Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. Patients and methods. In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Results. Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. Conslusions. If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation.

CT colonography in detection of colorectal carcinoma Background. Diagnostic methods used in screening and detecting colorectal carcinoma are digitorectal examination, faecal occult blood testing, sigmoidoscopy, DNA stool analysis, barium enema, colonoscopy, and as of recently CT colonography. The aim of this study was to establish diagnostic accuracy and comfort of CT colonography compared to colonoscopy and barium enema. Patients and methods. We included 231 patients in the prospective study. For all patients CT colonography and barium enema followed by colonoscopy were performed. After the procedures a comfort assessment was done in all patients. Diagnostic positive results were verified by the pato-histological examination. Sensitivity, specificity, positive predicative value (PPV) and negative predicative value (NPV) were calculated for each procedure. Results. With CT colonography, barium enema and colonoscopy 95 lesions were found, 56 (59%) of them were tumours and 39 (41%) were polyps. Among polyps pato-histology revealed 34 adenomas, 3 tubulovillous adenomas and 2 lipomas, among tumours there were 55 adenocarcinomas and 1 lymphoma. Results showed CT colonography sensitivity to polyps to be 89.7%, barium enema 48.7%, and colonoscopy 94.9%. Sensitivity to tumours of CT colonography and colonoscopy was 100% and of barium enema 94.6%. Specificities and PPV were 100% in all procedures. The comfort assessment showed CT colonography as the far most comfortable out of three procedures.

Background. Diagnostic methods used in screening and detecting colorectal carcinoma are digitorectal examination, faecal occult blood testing, sigmoidoscopy, DNA stool analysis, barium enema, colonoscopy, and as of recently CT colonography. The aim of this study was to establish diagnostic accuracy and comfort of CT colonography compared to colonoscopy and barium enema. Patients and methods. We included 231 patients in the prospective study. For all patients CT colonography and barium enema followed by colonoscopy were performed. After the procedures a comfort assessment was done in all patients. Diagnostic positive results were verified by the pato-histological examination. Sensitivity, specificity, positive predicative value (PPV) and negative predicative value (NPV) were calculated for each procedure. Results. With CT colonography, barium enema and colonoscopy 95 lesions were found, 56 (59%) of them were tumours and 39 (41%) were polyps. Among polyps pato-histology revealed 34 adenomas, 3 tubulovillous adenomas and 2 lipomas, among tumours there were 55 adenocarcinomas and 1 lymphoma. Results showed CT colonography sensitivity to polyps to be 89.7%, barium enema 48.7%, and colonoscopy 94.9%. Sensitivity to tumours of CT colonography and colonoscopy was 100% and of barium enema 94.6%. Specificities and PPV were 100% in all procedures. The comfort assessment showed CT colonography as the far most comfortable out of three procedures.

MR rectum imaging with ultra sound gel as instrumental contrast media in tubulovillous adenoma Bacground. Colorectal polyps are frequent and can be found in 10% of adults, most common in elderly with prevalence of 20% in age group of 60. Over 90% cases of cancer are being developed from benign adenomas. Colorectal cancer (CRC) is a significantly large cause of death right after bronchial cancer in males, and breast cancer in women. Therefore, a standpoint was adopted that the removal of polyps as precursor will prevent the development of colorectal area cancer. Polyps can occur as peduncular or sessile. Adenomas are grouped in three subtypes based on histological criteria: tubular, tubulovillous and villous. Villous adenomas are larger than others and show a higher level of dysplasia. The prevalence of adenomas increases with the patient's age. Having in mind that the risk of malign adenoma transformation is 10 years average, and that small lesions have no clinical potential to turn into cancer, their removal would lead to unnecessary complications and additional costs. CRC risk grows both with the size and the number of adenomas. In patients who refuse polypectomy, we can expect cancer development in average of 5 years 4% and in 10 years 14%. Case report. We present a patient with a years long history of rectal polyp. She has refused any treatment of polyp removal up so far. Due to stool problems, mostly constipation, occasional bleeding and falling out feeling, she has decided to remove the polyp. The polyp has been detected through colonoscopy and described as very risky for polypectomy due to its suspected malign appearance. We did rectum MR on 1.5T Siemens, so that the patient came with clean lumen into which we applied ultra sound gel with huge 60 ml syringe (no needle) simply and pain free with three fillings (total 180 ml of gel). We have concluded that the polyp was of uneven outline and stretched partially along the inner rectum wall without extra rectal infiltration into mesorectal area. After that, we performed endoscopic polypectomy according to peace meal method resection up to real muscular layer after adrenalin undermining. Pathohistological finding which was done in HE technique showed tubulovillous adenoma. Conclusions. Rectal MR is a new, very reliable method of contemporary radiological imaging that gives better characterization of polyp tissue and of other tumours. It is currently the best imaging modality enabling very accurate evaluation and topographic ratio of tumour growth within the rectum wall and outside the wall, especially compared to mesorectal fascia. In addition, it is a very comfortable procedure without radiation. The application of ultra sound gel as intra luminal rectal contrast agent can distend the lumen and make an excellent contrast of lumen against the rectum wall and thus can better show polyps and tumours.

Background. The goal is to present the possibilities of radiological procedures and the early detection of gastrointestinal perforation as a common cause of acute abdomen. Methods. During one year period, in emergency conditions, we evaluated 20 patients with gastrointestinal perforation. Native x-ray, ultrasound and CT of abdomen were performed on all patients, and on some of them with per os administration of 250 ml contrast, ultrasound was performed with 3, 5 MHz probe on a Siemens machine. CT scans were done on the multi row detector computed tomography (MTDC) »Volume Zoom«, Siemens with four rows of detectors and 2.5 mm width. All patients were admitted with clinical symptoms of acute abdomen. Results. A group of 20 evaluated patients consisted of 8 (40%) women and 12 (60%) men of 41 as average age. The youngest patient was 14, and the eldest 67 years old. 7 (35%) had stomach perforation and 10 (50%) duodenum perforation. There was also a traumatic colon transversal perforation in one case, in the second was stitches rupture after the stomach operation and the third was the sigma perforation caused by the malign process. Out of all above mentioned cases, in 18 (90%) cases perforation occurred spontaneously and in 2 (10%) cases artificialy. Native x-ray of abdomen showed free air in the abdominal cavity in 16 (80%) cases. Ultrasound gave positive results on free liquid in 18 (90%) and CT scan revealed both free liquid and air in 20 (100%) cases. Conclusions. The significance of an early and reliable discovery of gastrointestinal perforation is very important, because it usually requires the surgical intervention. Along with anamnesis, native x-ray of abdomen was and is traditionally the first procedure, especially in the detection of free air. With the development of digital techniques such as ultrasound and CT, we have a new diagnostic procedure at our disposal, especially in detecting free liquid and air as early signs of digestive perforation. According to our researches, ultrasound proves to be very useful in examining free liquid, while CT was more sensitive to the combination of liquid and minimal amount of free air, which was undetectable to ultrasound and x-ray.