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Vertebral fracture is a common trauma can occur at any age group. Unstable fractures are treated surgically to restore the basic spinal functionality. In most cases, stable fractures are treated conservatively or by minimally invasive techniques. Pain is the most common symptom and can be a limiting factor for an early return to ones daily activities. Among the minimally invasive procedures for pain management are analgesis blockades, oxygenozone therapy, radiofrequency ablation or augmentation. This paper presents the current view of evidence-based medicine (EBM) on individual methods of pain treatment of which basic principles and aspects are discussed. Furthermore, the practical experiences of the author's workplace are presented. Over the past 8 years, more than 8,800 back pain treatments under CT guidance and 253 augmentation procedures have been performed at the authors' workplace. No clinically significant complication was observed. [ABSTRACT FROM AUTHOR]

Percutaneous vertebroplasty is a minimally invasive procedure, in which fractured or otherwise affected vertebra is filled with polymethylmethacrylate (PMMA) cement. The main indications include osteoporotic vertebral fracture, spinal hemangioma, multiple myeloma and selected groups of patients with metastatic spinal injuries. The procedure leads to the stabilization of the affected vertebrae and then to analgesic effect. Our work presents a current view of vertebroplasty in these basic indication groups in light of current knowledge of evidence-based medicine (EBM). We are discussing and comparing the results of the studies concerning the treatment of osteoporotic fractures and other main indications for percutaneous vertebroplasty. [ABSTRACT FROM AUTHOR]

Background: A high multiple sclerosis activity while on alemtuzumab is rather uncommon compared to moderate-efficacy drugs. The purpose of this case report is to present a case of a 37-year-old female patient with bronchial asthma and no other medical history, whose disease activity required switching from dimethyl fumarate to fingolimod, then to alemtuzumab and finally to ocrelizumab.Case Presentation: In our patient, two severe attacks were observed and treated after administration of the first pulse of alemtuzumab. After six months of therapy, patient's immunological profile showed the expected decrease in CD4+ and CD8+ T-cells and, markedly increased values of CD19+ B-cells. Surprisingly memory B-cells, which typically repopulate very slowly following alemtuzumab treatment, were above baseline levels. Regular administration of ocrelizumab based on a standardised scheme, after the alemtuzumab therapy failure, resulted in the stabilisation of the patient's condition both clinically and radiologically.Conclusion: Thus, when the alemtuzumab treatment is unsuccessful, the authors recommend testing T- and B-cell levels and proceeding with an early switch to ocrelizumab if high B-cell counts are found. [ABSTRACT FROM AUTHOR]

Persistent primitive trigeminal artery belongs to the group of rare developmental intracranial vascular anomalies. This structure can be encountered at computed tomography (CT) and magnetic resonance imaging (MRI) or at angiographic studies of brain vessels. We report the case of an 18-year old woman in whom this artery was detected at MRI of the brain. Persistent primitive trigeminal artery is usually asymptomatic. However, it can cause neurologic symptoms, such as tic douloureux, according to literature. There is also reported concomitant occurrence of persistent trigeminal artery together with other vascular anomalies. Persistent trigeminal artery has a vital importance in surgery planning near the region of sella. It could be also considered significant in the case of stroke. [ABSTRACT FROM AUTHOR]

Low back pain belongs to the most common health problems in general population, with increasing prevalence in recent decades. The involvement of the minimally invasive procedures increases in therapeutic approach to the patients suffering from low back pain. Periradicular therapy belongs to the most used method of this kind worldwide. Two novel minimally invasive methods: pulsed radiofrequency modulation and oxygen-ozone therapy are performed at CT department of Radiology Clinic of the University Hospital Hradec Králové for several years. CT helps to achieve higher level of efficacy and to lower the risk of procedural complications. Analgesic effect of these methods lasts approximately weeks to months, in our experience and also according to the literature. There is a possibility to repeat the procedures in time. The most common indication for these procedures is a low back pain with radicular symptomatology, or low back pain caused by facet joint syndrome. These methods can reduce the amount of used analgetics. [ABSTRACT FROM AUTHOR]

MRI is a method of choice for the evaluation of spinal canal (chord), ligament apparate and other soft tissue structures of the spine. MRI provides additional information to the CT and X ray of the spine. Urgent MRI should be performed in the cases expressed by relevant neurologic symptomatology, with supposed follow of early surgery or essential change of therapy. Such examples of clinical indications: trauma with suspected chord injury or spinal instability, sudden onset of nontraumatic myelopathy or rapid impairment of neurologic functions and also suspicion of osteomyelitis. Native MRI is usually diagnostically sufficient in most cases. Nevertheless, diffuse weighted imaging or eventually gadolinium enhanced MRI can provide valuable supplementary information. The disadvantage of MRI compared to CT (not only in acute states) is a relatively long examination time, with limited access to the patient during data acquisition. Utmost of importace is a respect to the contraindications for MRI, especially when there are only limited anamnestic data. For that reason, the indication of acute MRI must be well considered. [ABSTRACT FROM AUTHOR]

Imaging methods are an integral part of acute medicine. In emergent brain imaging, CT is most often used for its benefits. With the increasing availability of MRI devices, MRI is the preferred alternative to CT in the indicated cases. The choice of imaging method must be chosen in collaboration with the clinic and radiologist with respect to the expected benefit and clinical status of the patient. The papere describes some indications and facts where it is preferable in favor of MRI over CT. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a rare pathological entity, in which the neuroimaging, especially MRI, is essential for the diagnosis. The disease is characterized by the typical distribution of cerebral vasogenic edema. Several risk factors are known to be associated with the PRES development. This case report describes PRES in a 46-yearold woman treated in the past for acute myeloid leukemia with numerous concomitant complications. The clinical manifestations of PRES is usually sudden and include a various neurological symptoms. The presence of uncontrolled hypertensive disease is a frequent finding. The treatment of PRES usually focusses on the underlying disease. Although the prognosis of the PRES is generally considered to be favorable, the disease may not be completely reversible and may also be fatal. [ABSTRACT FROM AUTHOR]

Purpose: To assess white matter changes after the first episode of schizophrenia by using fixel-based analysis (FBA). Methods: Diffusion weighted MR images were used to prospectively compare white matter microstructure between subjects after the first episode of schizophrenia (n = 16) and healthy controls (n = 22). The subjects were examined on a 3 Tesla MRI system equipped with a 64-channel head coil. FBA was performed using MRtrix software package (version 3.0.1). Results: A limited area of fibre density decrease was found in the anterior commissure. No fixels of fibre cross-section changes were found. For combined metric of fibre density and cross-section only one statistically significant fixel was found in the right frontal white matter. Conclusion: Using FBA, only a limited area of white matter microstructure corruption was found after the first episode of schizophrenia. Changes were located mainly in the anterior commissure. Compared to other published studies using FBA, the extent of changes is distinctly smaller which can be among other causes subjected to earlier stages of the illness of subjects included in this study. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is one of the diseases of the vascular system which, despite the development of modern medicine, still has high morbidity and mortality. The current primary imaging modality in the diagnosis of suspected mesenteric ischemia is computed tomography. Long-term experience with endovascular therapy has provided evidence of its use and indications and thus influenced the guidelines of mesenteric ischemia treatment. Modern treatment of mesenteric ischemia is based on a hybrid approach and a combination of surgical and endovascular techniques. [ABSTRACT FROM AUTHOR]

Purpose: To asses cerebral cortical thickness and area changes in the earliest stage of schizophrenia. Methods: Magnetic resonance was used to prospectively compare cerebral cortex thickness and surface area between subjects after the first episode of schizophrenia (n = 15) and healthy controls (n = 19). The subjects were examined on a 3 Tesla MRI system equipped with a 64-channel head coil. Surface-based morphometry was performed on 3D T1- and T2-weighted data by using Freesurfer software package (ver. 7.1.0). Results: No statistically significantly different clusters of cerebral cortical surface / thickness were found between both groups of subjects. Conclusion: Contrary to the observations published by other authors including large multicentric studies, no statistically significant differences in cerebral cortical thickness or area were found in the earliest stage of schizophrenia. [ABSTRACT FROM AUTHOR]

Brain abscess caused by Listeria monocytogenes (LM) is a rare, yet serious condition with high mortality if not recognized and treated timely. We present a series of three cases of LM brain abscesses and describe their characteristic radiological appearances which can be considered very typical. LM abscesses frequently present as markedly irregular formations, revealing characteristic worm-like tubular pattern of chaotic curvilinear arrangement. Knowledge of this imaging pattern can be very helpful in early recognition of LM abscesses whose initial differential diagnosis can often be misleading initially. [ABSTRACT FROM AUTHOR]

Purpose: Spinal selective angiography (SSA) is due to its extension one of the most demanding angiographic studies with high radiation dose. The retrospective study analysed single centre experience with the most frequent indication which was the dural arteriovenous fistula (dAVF) location during last 5 years. Methods: There were 50 SSAs performed in our department between 2014 and 2019. The study included 31 patients with suspection on the dAVF of average age 65.7 years ( ranged from 25 to 90 years). All patients had at least one MR imaging of the spine for peripheral paresis, and/or urinary problems. Indication for the SSA was done by a neurologist, neurosurgeon or interventional neuroradiologist. The SSA were performed from femoral approach in local anesthesia using biplane angiographic machine. Selective injections of the intercostal and lumbal arteries were registered during procedure, to prevent repeating or skipping of some levels. Numbers of angiographic runs, positive finding of dAVF, location of radiculomedullary and radiculopial arteries, and radiaton doses were recorded in each examination. Results: There were 31 patients indicated for suspection of the dAVF out of 50 patients indicated for the SSA. The dAVF was confirmed in 26 (83%) patients. The SSA had 22.3 angiographic runs (ranged 6-37 runs). The dAVF feeders were equally distributed on the right and left side with two maximum peaks. The cranial peak was at the level of T6 a T7, caudal one was at L1. The thoracolumbal dAVFs occurred in patients above the age of 48 years and more often in men than in women (69% versus 31%). The radiculomedullary arteries arised more often on the left side than on the right (69% versus 31%). Discussion: The study revealed that keeping strict angiographic protocol, the dAVF feeders can be proved in 83% patients suspected for thoracolumbal dAVF and origin of the radiculomedullary arteries is localised too. Age, gender, craniocaudal location of the dAVF, and extension of the SSA were studied as well. [ABSTRACT FROM AUTHOR]

Purpose: Embolisation of the splenic artery has become routine part of conservative therapy of patients with injury of the spleen and spontaneous splenic rupture. The goal of our study was assessment of our series of patients. Methods: Our study is a retrospecitve analysis of results of embolisation therapy in patients with injured spleen who were not primarily indicated for surgical therapy in 2016 and 2017. Results: There were 10 patients included in the study. Three of them had polytrauma, six had isolated laceration of the spleen due to blunt abdominal trauma, and one woman suffered from spontaneous rupture of the spleen having underlying myeloproliferative syndrome. All patients had contrast enhanced CT scan of the abdominal cavity and angiography. Embolisation was performed in eight patiens. There was no recurrent bleeding in all embolised patiens, and in 7 of them the spleen was preserved. One patient underwent splenectomy for high risk of subphrenic abscess development in immunocompromised setting the other day. On contrary one nonembolised patient had delayed rupture of the spleen which neccessitated splenectomy. All ten patients fully recovered in follow up of 3-24 months. Conclusions: Embolisation in nonopKonflikt zájmů: žádný. erative management of splenic hemorrhage saved spleen in 7 out of 8 (87.5%) embolised patients. Embolisation of the splenic artery is a significant part of protocol of conservative therapy of patients with injury of the spleen. [ABSTRACT FROM AUTHOR]

Aim: To assess differences in the evaluation of degenerative changes of the lumbar spine MRI among experienced radiologists, radiology residents and other specialists. Method: Nine evaluators from three groups: experienced radiologists (ER), radiology residents (RR) and non-radiologists (NR) independently assessed MRI examinations of the lumbar spine of 55 patients. All segments of the lumbar spine were evaluated for presence and degree of severity of changes in seven parameters: disc height, disc protrusion or herniation, vertebral body signal changes, spondylolisthesis, dorsal osteophytes, arthritic changes on the intervertebral joints and thickness of ligamenta flava. Statistical evaluation of the degree of agreement among multiple observers was made in individual segments of the lumbar spine by Fleiss kappa; the degree of severity of MRI findings was assessed by Friedman test and pairwise multiple comparisons by Nemenyi post hoc test. Results: Degree of agreement in the overall MRI comparison in individual segments of the lumbar spine ranged from 0.32 to 0.80 kappa values, most frequently from 0.5 to 0.7 - it was moderate or substantial. Testing of the degree of severity of MRI findings showed a statistically significant differences (p < 0.0001) among individual evaluators. In each group of evaluators (ER, RR, NR) was always one evaluator who differed significantly from the other two. These differences were smallest among experienced radiologists. Conclusion: We found statistically significant differences in the assessment of MRI findings among individual evaluators and also within groups of evaluators. These differences were smallest in the group of experienced radiologists. [ABSTRACT FROM AUTHOR]

Background: To review single centre experience of endovascular treatment of descending thoracic aorta. Methods: Between May 1999 and September 2012, 72 patients were treated overall (53 men, 19 women, mean age 60.1 years) for degenerative aneurysms (n = 5), ruptured aneurysms (n = 4), aortic ulcers (n = 8), infected aneurysms (n = 4), type B aortic dissections (n = 23), and traumatic aortic injuries (n = 28). Results: The technical success rate was 98.6%, 30-day mortality was 8.3%, 1-year mortality was 13.8%, and overall mortality was 22.2%. Mortality caused by the treatment of aortic diseases was 6.9%. Permanent stroke occurred in 1 patient, and paraplegia developed in 1 patient. In a group of 23 patients whose left subclavian artery (LSA) was covered, claudication of the left upper extremity developed in 2 cases. Conclusions: Endovascular therapy offers a very effective and less invasive alternative to the surgical approach for a wide range of the thoracic aortic disease. The main advantage of using TEVAR seems to be in acute conditions when a stent graft stabilizes the aorta and prevents further bleeding and organ ischemia. Regular follow-up is mandatory for early recognition of specific TEVAR complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation to lesion size. Methods: Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also "blood pool" ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage-within 5 min from application. Results: In lesions larger than 3 cm (n=20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm (n=10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all (n=1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% (n=19) of cases. In lesions larger than 3 cm, it was present in 85.0% (n=17), in lesions smaller than 3 cm in 20% (n=2). Conclusion: Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings. [ABSTRACT FROM AUTHOR]