1. ADC values as a biomarker of fetal brain maturationLucija Kobal, Katarina Šurlan Popović, Jernej Avsenik, Tina Vipotnik-Vesnaver, 2023, original scientific article Abstract: Background. During the period of fetal development, myelination plays a key role and follows specific time and spa-tial sequences. The water content in the brain is inversely proportional to myelination – the more myelinated the brain, the lower the water content in it. The diffusion of water molecules can be quantitatively assessed using the apparent diffusion coefficient (ADC). We were interested in whether, by determining the ADC values, we could quantitatively evaluate the development of the fetal brain. Patients and methods. The study included 42 fetuses with gestational age 25 to 35 weeks. We manually selected 13 regions on diffusion-weighted images. Statistically significant differences between ADC values were checked using one-way analysis of variance and Tukey’s post hoc test. The relationship between the ADC values and the gestational age of the fetuses was then assessed using linear regression. Results. The average gestational age of the fetuses was 29.8 ± 2.4 weeks. ADC values in the thalami, pons and cerebellum differed significantly among each other and from the ADC values in other brain regions. In the thalami, pons and cerebellum, linear regression showed a significant decrease in ADC values with increasing gestational age. Conclusions. ADC values change with the increasing gestational age of the fetus and differ among different brain regions. In the pons, cerebellum and thalami, the ADC coefficient could be used as a biomarker of fetal brain matura-tion since ADC values decrease linearly with increasing gestational age. Keywords: myelination, fetal brain maturation, ADC, biomarker, diffusion-weighted imaging, diffusion Published in DiRROS: 25.07.2024; Views: 124; Downloads: 133
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2. Early isolated subarachnoid hemorrhage versus hemorrhagic infarction in cerebral venous thrombosisJan Kobal, Ksenija Cankar, Kristijan Ivanušič, Borna Vudrag, Katarina Šurlan Popović, 2022, original scientific article Abstract: Background: Cerebral venous thrombosis (CVT) is a rare cerebral vascular disease, the presentation of which is highly variable clinically and radiologically. A recent study demonstrated that isolated subarachnoid hemorrhage (iSAH) in CVT is not as rare as thought previously and may have a good prognostic significance. Hemorrhagic venous infarction, however, is an indicator of an unfavorable outcome. We therefore hypothesized that patients who initially suffered iSAH would have a better clinical outcome than those who suffered hemorrhagic cerebral infarction. Patients and methods: We selected patients hospitalized due to CVT, who presented either with isolated SAH or cerebral hemorrhagic infarction at admission or during the following 24 hours: 23 (10 men) aged 22-73 years. The data were extracted from hospital admission records, our computer data system, and the hospital radiological database. Results: The iSAH group consisted of 8 (6 men) aged 49.3 ± 16.2 and the hemorrhagic infarction group included 15 (4 men) aged 47.9 ± 16.8. Despite having a significantly greater number of thrombosed venous sinuses/deep veins (Mann-Whitney Rank Sum Test, p = 0.002), the isolated SAH group had a significantly better outcome on its modified Rankin Score (mRs) than the hemorrhagic infarction group (Mann-Whitney Rank Sum Test, p = 0.026). Additional variables of significant impact were edema formation (p = 0.004) and sulcal obliteration (p = 0.014). Conclusions: The patients who suffer iSAH initially had a significantly better outcome prognosis than the hemorrhagic infarction patients, despite the greater number of thrombosed sinuses/veins in the iSAH group. A possible explanation might include patent superficial cerebral communicating veins. Keywords: cerebral venous thrombosis, hemorrhagic brain infarction, subarachnoid hemorrhage Published in DiRROS: 25.07.2024; Views: 127; Downloads: 78
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3. Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial traumaČrt Langel, Dimitrij Lovrič, Urša Boneš, Tomislav Mirković, Primož Gradišek, Anita Mrvar Brečko, Katarina Šurlan Popović, 2020, review article Abstract: Background. Severe bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methods. PubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusions. Based on a review of 205 cases, the efficacy of TAE was 79.4-100%, while the rate of major complications was about 2-4%. Successful TAE haemostasis, Glasgow Coma Scale score >- 8 at presentation, injury severity score <- 32, shock index <- 1.1 before TAE and <- 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses. Keywords: maxillofacial trauma, external carotid artery injury, intractable bleeding Published in DiRROS: 12.07.2024; Views: 135; Downloads: 84
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6. Dynamic susceptibility contrast enhanced (DSC) MRI perfusion and plasma cytokine levels in patients after tonic-clonic seizuresTatjana Filipovič, Katarina Šurlan Popović, Alojz Ihan, David B. Vodušek, 2017, original scientific article Abstract: Background Inflammatory events in brain parenchyma and glial tissue are involved in epileptogenesis. Blood concentration of cytokines is shown to be elevated after tonic-clonic seizures. As a result of inflammation, blood-brain barrier leakage occurs. This can be documented by imaging techniques, such is dynamic susceptibility contrast enhanced (DSC) MRI perfusion. Our aim was to check for postictal brain inflammation by studying DSC MRI perfusion and plasma level of cytokines. We looked for correlations between number and type of introducing seizures, postictal plasma level of cytokines and parameters of DSC MRI perfusion. Furthermore, we looked for correlation of those parameters and course of the disease over one year follow up. Patients and methods We prospectively enrolled 30 patients, 8%24 hours after single or repeated tonic-clonic seizures. Results 25 of them had normal perfusion parameters, while 5 had hyperperfusion. Patients with hyperperfusion were tested again, 3 months later. Two of 5 had hyperperfusion also on control measurements. Number of index seizures negatively correlated with concentration of proinflammatory cytokines IL-10, IFN-[gamma] and TNF-[alpha] in a whole cohort. In patients with hyperperfusion, there were significantly lower concentrations of antiinflammatory cytokine IL-4 and higher concentrations of proinflammatory TNF-[alpha]. Conclusions Long lasting blood- brain barrier disruption may be crucial for epileptogenesis in selected patients. Keywords: cytokines, blood-brain barrier, tonic-clonic seizures Published in DiRROS: 03.06.2024; Views: 245; Downloads: 171
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7. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosisJernej Avsenik, Janja Pretnar-Oblak, Katarina Šurlan Popović, 2016, original scientific article Abstract: Due to the diversity of underlying factors and the absence of a uniform treatment approach, diagnosis and management of patients with cerebral venous sinus thrombosis (CVST) remain a challenging task.1 CVST represents 0.5% to 1% of all strokes and affects approximately 5 patients per million every year, but has a higher frequency among younger patients. Typical acquired risk factors include recent surgery, trauma, pregnancy, postpartum state, antiphospholipid syndrome, cancer and use of oral contraceptives. Cases of inherited thrombophilia include Antithrombin III, Protein C and Protein S deficiency, factor V Leiden positivity, prothrombin gene mutation and hyperhomocisteinemia. Infection of parameningeal spaces (ears, paranasal sinuses, oral cavity, face and neck) is common cause of CVST in pediatric population but rare in adults. The symptoms of CVST are not specific. The most common complaint is headache which occurs in up to 90% of patients. Additionally, abnormal vision, any of the symptoms of stroke and seizures have been described. In the past D-dimer levels appeared to be of value as an initial screening test. A study in 2004 evaluated the sensitivity of D-dimer to be 97.1% and specificity 99.1%.8 However, later studies showed that up to 10% of patients with CVST have a normal D-dimer. As it is fast, affordable and widely available, non-contrast computed tomography (NCCT) is the most frequently performed imaging study for evaluation of patients with new headache, focal neurological abnormalities, seizure, or change in mental status. A typical imaging finding in patients with CVST is direct visualization of a hyperattenuating thrombus in the occluded sinus (dense sinus sign). Occasionally, NCCT may only show indirect signs of thrombosis, including diffuse brain edema and parenchymal hemorrhage. Sensitivity of NCCT in the diagnosis of CVST was previously considered rather poor. However, using modern multidetector row CT scanners, recent studies report higher sensitivity and specificity values. In addition, Buyck et al. suggest measurement of the venous sinus attenuation to increase the diagnostic yield of the examination. Therefore, the goal of the present study was to evaluate the diagnostic accuracy of NCCT in the diagnosis of CVST in the emergency setting Keywords: cerebral venous sinus thrombosis, computed tomography, stroke, radiologija, računalniška tomografija, diagnostika, možganski venski sinusi Published in DiRROS: 09.05.2024; Views: 209; Downloads: 184
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10. Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysmsSnezana Lukic, Slobodan Janković, Katarina Šurlan Popović, Dušan Dragič Banković, Peter Popović, Milan Mijailović, 2015, original scientific article Keywords: intracranial aneurysms, enovascular embolization, perianeurysmal oedema, hypertension Published in DiRROS: 16.04.2024; Views: 281; Downloads: 102
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