Petar Jovan Avramovski
Research interests
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InterestsDoppler Ultrasound, Pulse Wave Analysis, Doppler Ultrasonography, Doppler Effect, abdominal ultrasonography, Carotid Artery Diseases
Other
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LanguagesEnglish, Macedonian, Serbian
Publications
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Pulse Harmonic Inversion Imaging and Contrast Transition Time Value in the Detection of Liver Metastases
Journal of Medicine and Medical Sciences. 01/2012; 3(2)(02).
The aim of this study was to detect of liver metastasis by contrast enhanced Doppler ultrasound with measuring the contrast transitions times. Material and methods: We estimate 60 patients with colorectal carcinoma with or without liver metastasis and 60 healthy subjects. Results: The mean value of ... [more] The aim of this study was to detect of liver metastasis by contrast enhanced Doppler ultrasound with measuring the contrast transitions times. Material and methods: We estimate 60 patients with colorectal carcinoma with or without liver metastasis and 60 healthy subjects. Results: The mean value of HATVTT in control group was 32 ± 1,8sec. The HATVTT results in group with or without liver metastasis were: 25 ± 2,1; 24 ± 1,9; 23 ± 2,0; 21 ± 2,4 and 19 ± 1,8sec versa 32 ± 1,6; 32 ± 1,0; 31 ± 1,4; 29 ± 1,9; and 26 ± 1,5sec respectively. The percents of liver metastasis were: 6,6%, 15%, 20,0%, 28,3% and 36,6% inside in subgroups. There were no cases with normal HATVTT and liver metastasis. Conclusion: We can constitute that the contrast transition time has a significant impact on the detection of metastases, in particular the very small dimensions, which meaning is significantly longer than classical B-mode ultrasonography.
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The value of renal artery resistance index in diagnosis of liver cirrhosis
Macedonian Science Society - Bitola. 01/2010; 7:11-12.
The aim of the study is to measure renal and interlobar artery RI at cirrhotic patients in different stadium. We estimate 60 patients with liver cirrhosis and 60 health subjects. With Doppler were measured the renal artery speed flow, were calculated RI and we were got these results: RImean = 0,70±0... [more] The aim of the study is to measure renal and interlobar artery RI at cirrhotic patients in different stadium. We estimate 60 patients with liver cirrhosis and 60 health subjects. With Doppler were measured the renal artery speed flow, were calculated RI and we were got these results: RImean = 0,70±0,02; RI1=0,75±0,02; RI2=0,82±0,03 and RI3=0,90±0,02 respective for left artery and right artery: RI1=0,75±0,023; RI2=0,85±0,04 and RI3=0,94±0,02. The RI value was increased in cirrhotic patients and it is proportionally raised with advancing of the disease.
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Carotid Artery Wall Changes as a Prognostic Indicator of Coronary Artery Disease
Macedonian Journal of Medical Sciences. 01/2009;
Aim. The aim of this study is to investigate the prevalence of coronary and carotid arteries atherosclerotic abnormalities, and exactly to examine the predictive value of ultrasonography of carotid artery on the basis of intima - media thickness in coronary artery disease (CAD) evaluation. Material ... [more] Aim. The aim of this study is to investigate the prevalence of coronary and carotid arteries atherosclerotic abnormalities, and exactly to examine the predictive value of ultrasonography of carotid artery on the basis of intima - media thickness in coronary artery disease (CAD) evaluation. Material and metods. The study involved sixty patients (aged 40 to 70 years) who had been referred to our clinical hospital for evaluation of chest pain.Results. Fifty one patients had increased intima media thickness (IMT) (>0.8). Involvement of coronary arteries regarding one, two or three vessels was 28, 12, 7 and 4%, respectively for left main stenosis- coronary artery disease (LMS- CAD). A significant correlation (p<0.05) was demonstrated between coronary and carotid arteries atherosclerosis. Conclusion. A great carotid disease sensitivity (85%), acceptable specificity (39%) and positive predictive value (79%) for presence of CAD, make this measurement of IMT and myocardial perfusion imaging (MPI), predictive parameter for CAD presence, useful for noninvasive determination of CAD.
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Value of Ultrasound Machine Settings Optimization for Better Diagnosis of Focal Liver Lesions
Macedonian Journal of Medical Sciences. 01/2009;
Background. Focal liver lesions and metastasis can be very hard to localize. For best imaging, customizing of several settings of the machine are necessary: brightness, contrast, probe frequency, focusing, dynamic range, time gain compensation, flow area, flow gain, sample volume, angle, peak repeti... [more] Background. Focal liver lesions and metastasis can be very hard to localize. For best imaging, customizing of several settings of the machine are necessary: brightness, contrast, probe frequency, focusing, dynamic range, time gain compensation, flow area, flow gain, sample volume, angle, peak repetitive frequency, filter adjusting and parallelogram of region of interest.Aim. The aim of this study is to examine the influence of adjusted or not adjusted ultrasound scanner in diagnosing of focal liver lesions. Material and methods. The study involves 129 patients from the group of focal liver lesions including a broad spectrum of benign, malignant, and infectious aetiologies. We made ultrasound examination with automatic factory settings of ultrasound machine parameters and after that all off them were examined with manual settings of the scanner. Results. The results obtained from “auto” and “manual” mode settings were compared with CT and MRI imaging as a gold standard. In auto mode false positive results were seen in patients with hiperechoic metastases understood like FNH, patients with hipoechoic metastases treated like haemangioma, patients with anechoic metastases and patients with abscesses treated like cysts. Conclusion. Manual mode ultrasound procedure is more accurate in detection of focal liver parenchymal lesions because of reduced specificity in auto mode compared with higher specificity and small percentage of false positive results within manually adjusted scanner. We show the great value of best performance manual setting of the scanner in liver parenchymal focal lesions detecting.
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PORTAL VEIN PULSATILITY INDEX AS RELEVANT MARKER FOR RIGHT SIDE HEART FAILURE DISEASE
Medicus. 01/2009; XI (1):101-108.
The aim of the study was estimate hemodynamics parameters during right side heart failure by Doppler. We estimate 60 patients, 34 male and 26 female, from 52 to 78 years age, with mean age of 65,5 years, classified in three subgroup because of them heart failure stadium and 35 healthy objects, 16 ma... [more] The aim of the study was estimate hemodynamics parameters during right side heart failure by Doppler. We estimate 60 patients, 34 male and 26 female, from 52 to 78 years age, with mean age of 65,5 years, classified in three subgroup because of them heart failure stadium and 35 healthy objects, 16 male and 19 female, from 25 to 52 years age, with mean age of 39,5 years. We got these results: Vmax=19,3±3,8cm/s; Vmin=11,3±3,7cm/s and PI=0,41±0,09 at control group, but : Vmax1=15±2,1cm/s cm/s; Vmin1=11±1,9cm/s and PI1=0,3±0,09 at first, Vmax2=13±2,4cm/s cm/s; Vmin2=10±1,3cm/s and PI2=0,26±0,07 at second and Vmax3=10±2,2cm/s cm/s; Vmin3=8±1,5cm/s и PI3=0,22±0,05 at third subgroup. We saw continuingly raising on all Doppler vascular parameters during escalating of the disease, especially at pulsatility index. The pulsatility index estimate is a relevant marker for right side disease diagnosing and staging.
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Carotid Artery Wall Changes as a Prognostic Indicator of Coronary Artery Disease
Macedonian Journal of Medical Sciences. 01/2009; 2009 Jun 15:137-140..
Aim. The aim of this study is to investigate the prevalence of coronary and carotid arteries atherosclerotic abnormalities, and exactly to examine the predictive value of ultrasonography of carotid artery on the basis of intima - media thickness in coronary artery disease (CAD) evaluation. Material... [more] Aim. The aim of this study is to investigate the prevalence of coronary and carotid arteries atherosclerotic abnormalities, and exactly to examine the predictive value of ultrasonography of carotid artery on the basis of intima - media thickness in coronary artery disease (CAD) evaluation. Material and metods. The study involved sixty patients (aged 40 to 70 years) who had been referred to our clinical hospital for evaluation of chest pain. Results. Fifty one patients had increased intima media thickness (IMT) (>0.8). Involvement of coronary arteries regarding one, two or three vessels was 28, 12, 7 and 4%, respectively for left main stenosis- coronary artery disease (LMS- CAD). A significant correlation (p<0.05) was demonstrated between coronary and carotid arteries atherosclerosis. Conclusion. A great carotid disease sensitivity (85%), acceptable specificity (39%) and positive predictive value (79%) for presence of CAD, make this measurement of IMT and myocardial perfusion imaging (MPI), predictive parameter for CAD presence, useful for noninvasive determination of CAD.
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The Damping Index value to estimate cirrhosis liver portal hypertension
Macedonian Science Society - Bitola. 01/2009; УДК 616.12-008.331.1. .616.36-004(497.774):11-12.
We estimate hepatic waveform and Dаmping Index by Doppler ultrasound. The aim of the study is to estimate value of them to assign portal hypertension degree. Triphasic waveform have 11,25% of objects, biphasic 27,5%, biphasic reduced have 36,25% and flat waveform have 15%. The mean value of damping ... [more] We estimate hepatic waveform and Dаmping Index by Doppler ultrasound. The aim of the study is to estimate value of them to assign portal hypertension degree. Triphasic waveform have 11,25% of objects, biphasic 27,5%, biphasic reduced have 36,25% and flat waveform have 15%. The mean value of damping index was 0,59±0,18, but when it is more then 0,6 there is hard degree of portal hypertension. Reduced phases and high value of damping index have a great value as prognostic sign for advanced cirrhosis with portal hypertension.
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Fatty Liver Index (FLI) and Doppler Perfusion Index (DPI) alteration under L-Ornithinum - L-Asparticum (Hepa-Merz) and Simvastatitn therapy
MEDICUS. 01/2009; 2009;:92-101.
In our study were estimate together 40 patients (24 male et 16 female, from 31 to 65 year age, with mean age of 43, 7) with liver steatosis: that mean 30 patients examined in hospital (Clinical Hospital ―D-r Trifun Panovski‖, Bitola, Department of Internal medicine), and the rest of them were examin... [more] In our study were estimate together 40 patients (24 male et 16 female, from 31 to 65 year age, with mean age of 43, 7) with liver steatosis: that mean 30 patients examined in hospital (Clinical Hospital ―D-r Trifun Panovski‖, Bitola, Department of Internal medicine), and the rest of them were examined ambulatory (Gastroenterological ambulance in Clinical Hospital – Bitola). The aim of the study is to represent decrease of Doppler ultrasound parameters Doppler Perfusion Index (DPI) and laboratories analysis indexes - Fatty Liver Index (FLI) during treatment of liver steatosis by L-ornitin – L- asparticum (Hepa Merz®). We estimate 40 objects with fatty liver continuity treated by L-ornitin–L-asparticum (Hepa Merz®) during two months study. The control group content 40 object too, with fatty changes and increase of triglycerides and increase of amintransferases activity. This group was treated only by simvastatin (Tabl.Cholipam®) a 20 mg. This group who was treated with monotherapy during first month, had decreased of perfusion index from 0, 31(0, 26±0, 12) to 0, 27±0,2. Patients with BMI elevation have more increased DPI (p=0, 03). The patients treated with adjuvant therapy of L-ornitin-L-asparrticum during the same period results with decrease of DPI index to 0, 23±0, 2. The same results we get consecutive with FLI decreased value. After all, the degree of liver steatosis is successfully in quantification by DPI and FLI, as relevant markers for monitoring of homodynamic and biochemical parameters in liver steatosis and monitoring during different types of medical treatment and records the different effects of medical therapy.
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HEPATIC VEIN AND PORTAL VEIN DOPPLER WAVEFORM ALTERATION VALUE IN PATIENT WITH DIFFUSE PARENCHYMAL LIVER DISEASE
Medicus. 01/2009; 11(2);:84-91.
The aim of the study is to register hepatic vein and portal vein spectral changes at patients with diffuse parenchymal liver disease and at healthy objects. All 240 patients, (145 male and 95 female), from 27 to 65 years old, with mean age of 47,5 years were examined. The hepatic vein and portal vei... [more] The aim of the study is to register hepatic vein and portal vein spectral changes at patients with diffuse parenchymal liver disease and at healthy objects. All 240 patients, (145 male and 95 female), from 27 to 65 years old, with mean age of 47,5 years were examined. The hepatic vein and portal vein spectral analysis was made wit ultrasound machine Toshiba SSA-340A, in Echotomographic cabinet, Clinical Hospital – Bitola. The number of healthy objects with spectral changes is 11 (14%), but number of diseased objects is 68 (86). Normal specter had 67% of objects, but 21 (36,2) objects with portal vein spectral changes were not approved and with approved disease were 37 (63,8). The hepatic vein spectral changes have a grate diagnostic value in diffuse parenchymal liver disease, like screening method.
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DOPPLER FLOW RATIO ALTERATION VALUE IN LIVER METASTASIS DETECTION
Macedonian Medical Examination. 01/2008;
Metastasis deteriorate classic model of liver vascularization. These results with increase of portal flow and decrease of hepatic artery flow. The aim of the study is to estimate value of Doppler Flow Rate. Material and methods. We estimate 60 patients with colorectal disease by color Doppler ultras... [more] Metastasis deteriorate classic model of liver vascularization. These results with increase of portal flow and decrease of hepatic artery flow. The aim of the study is to estimate value of Doppler Flow Rate. Material and methods. We estimate 60 patients with colorectal disease by color Doppler ultrasonography in two group (with or without liver metastasis). All of them were controlled preoperative and postoperative during one year period. Results: We measure increased value of Doppler flow rate in patient with liver metastasis from first to fourth period: 0,34±0,06; 0,38±0,06; 0,42±0,05 i 0,46±0,05 ( ). Discussion. There is increasing of DFR value at patients with liver metastasis with high statistical significant of DFR value because the value of “p” is very small. We find a strong correlation between DFR value in preoperative and postoperative period. Conclusions. DFR is more elevated in all liver metastatic group and decreasing in patients number with metastasis and elevated DFR.
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VALUE OF DOPPLER ULTRASOUND IN PREDICTING ESOPHAGEAL VARIX BLEEDING
Medicus. 01/2008; X(2):140-151.
Bleeding from esophageal varices is the most lifethreatening complication of cirrhosis. The purpose of the study was to elucidate the hemodynamic features of left gastric veins (LGV) and portal vein (PV) during portal hypertension. We want to determine value of Color Doppler Ultrasoung detecting eso... [more] Bleeding from esophageal varices is the most lifethreatening complication of cirrhosis. The purpose of the study was to elucidate the hemodynamic features of left gastric veins (LGV) and portal vein (PV) during portal hypertension. We want to determine value of Color Doppler Ultrasoung detecting esophageal varices (EV) in different grades of those on upper gastrointestinal endoscopy. We used CDUS to measure diameter, flow velocity and flow volume of LGV and PV at 60 patients with diagnosed varices by endoscopy in different stage, because esophageal varices reflect hemodynamics of the LGV and to evaluate whether these Doppler US parameters might predict variceal bleeding in patient with portal hypertension. The flow velocity in the LGV of F0 healthy controls was V=8,27±2,2 cm/s (n = 21), diameter of LGV was d=2,36±0,2mm and mean flow volume was Vflow =21,7mL/min. The mean portal flow volume was PFmean=1600mL/min. The flow velocity in the LGV of F1 stage group was V=8,9±2,7 cm/s (n = 13), diameter of LGV was d=3,4±0,3mm and mean flow volume was Vflow =48,45mL/min. The mean portal flow volume was PFmean=1430mL/min. The flow velocity in the LGV of F2 stage group was V=11,0±2,3 cm/s (n = 15), diameter of LGV was d=4,1±0,4mm and mean flow volume was Vflow =87,09mL/min. The mean portal flow volume was PFmean=1275mL/min, and in F3 stage group the parameters were V=14,1±3,1cm/s (n=18), d=5,4±0,4mm and Vflow =193,6mL/min. PFVmean=975 mL/min. Variceal bleeding was more frequent in F3A stage patients with a hepatofugal flow velocity >15 cm/s. In that stadium we measured: V=16,3±1,1cm/s (n=20), d=6,2±0,3mm and Vflow =295,1mL/min and PFVmean=952mL/min. No correlation was observed between the portal blood flow velocity and EV. There was a relationship between the percentage changes in LGV flow velocity, diameter of LGV and the size of varices (P<0,01). Doppler ultrasonography has great value in the identification of patients with portal hypertension at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding. The ultrasonographic examination is a simple, inexpensive, accurate, and noninvasive technique and it is useful tool for predicting esophageal varix bleeding.
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COLOR DOPPLER VALUE IN DIFERENTIAL DIAGNOSIS OF LIVER FOCAL PARENCHYMATOUS LESION
Medicus. 01/2008; X(2):151-163.
Extensive use of B-mode ultrasonography has led to the detection of a large number of small hepatic focal lesions in general practice. However, differential diagnosis of benign and malignant liver lesions may be difficult, even with clinical, biochemical data, and imaging techniques. Color Doppler f... [more] Extensive use of B-mode ultrasonography has led to the detection of a large number of small hepatic focal lesions in general practice. However, differential diagnosis of benign and malignant liver lesions may be difficult, even with clinical, biochemical data, and imaging techniques. Color Doppler flow imaging can provide information on different blood flow model in liver parenchymatous focal lession. After the morphological characteristics of the lesions were assessed by B mode, Color Doppler ultrasound was used to determine the distribution, intra-and/or peritumoral vessels, and pulsed Doppler was used to point the interested lesions. The aim of our study was to develop standard protocol of color Doppler ultrasound for liver focal parenchymatous lesion and to assess resistance index (RI) and Doppler perfusion index (DPI) in differential diagnosis of liver lesions. From 2002 to 2005, 120 patients with hepatic focal solid lesions were studied (84 males, 36 females) their age ranged from 35-72 years. The lesions included: malignant: primary malignant tumor (14), cholangiocarcinoma (6) and initial metastasis (40); benignant: hemangioma (14), angiomyolipoma (6), hepatic adenoma (16), hepatic lipoma (8), cirrhotic nodules (6), absces (4) and focal nodual hyperplasia (6). All of them were proved with another imaging methods: EMR, KTM and Ultrasound guided biopsy. We used color Doppler ultrasonography with spectral signal analysis to measure resistance index in artery flow in focal lesion and liver Doppler perfusion index (DPI). We measure the RI and DPI at 60 healthy volunteers. Estimating flow parameters we find that mean PvFV=1559,03 85,73mL/min, mean HaFV=296,65 29,66mL/min, I calculate that RI=0,607 0,02 by equation max max min V V V HaRI and DPI=0,1595 0,01158 with next equation: HaFV PvFV HaFV DPI . Intratumoral and peritumoral arterial flow signals were obtained in 90% of the malignant tumors, and in 46,66% of benign lesions (P<0.01). The average value of RI in primary malignant liver tumors was RI=0,746 0,037 and RI=0,723 0,01 in metastatic tumors (the difference between them was not statistically significant) but it was significantly higher than that in benign ones RI=0,547 0, 74. There were significant differences between malignant and benign tumors. There were no significant differences in DPI value between them and reference value of DPI, except the value of DPI during metastases DPI=0,35 0,08 compared with reference value of DPI=0,1595 0,01158. In the conclusion, the type of flow signals (arterial and/or venous) are helpful in differentiating benign from malignant lesions. The presence of intratumoral venous flow is strongly suggestive of benign tumors. When intra-and/or peritumoral arterial blood flow is found, RI<0.6 would strongly suggest a benign tumor. Simultaneous occurrence of both intraand peritumoral arterial flow and RI>0.6 would strongly suggest malignancies. Color Doppler ultrasonography would be more helpful in differential diagnosis of benign and malignant liver tumors, with aid of the value of resistance index RI and spectral analysis like powerful tool.
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VALUE OF CHANGES IN HEPATIC ARTERY FLOW VOLUME AND HEPATIC PERFUSION INDEX IN DETECTION OF LIVER METASTASES
Master work, Medical Faculty, Skopje, 2008: 1-133 (Мак) (Clinic for Gastroenterohepatology, Medical Faculty, University “St.Kiril and Metodij”, Skopje, Republic of Macedonia. 01/2008;
Malignant tumors cells are disseminated from primary focus are disseminated to secondary organs by sanguineous or lymfogenous way producing metastasis. The presence of metastasis in liver is important factor in survival prognosis. Vascular rich networks formed by metastases, disorganize classical li... [more] Malignant tumors cells are disseminated from primary focus are disseminated to secondary organs by sanguineous or lymfogenous way producing metastasis. The presence of metastasis in liver is important factor in survival prognosis. Vascular rich networks formed by metastases, disorganize classical liver hemodynamics model. Metastases blood supply is provide by portal vein in the beginning. When metastases will increase, the blood supply is performed by hepatic artery. The difference between normal or infiltrated liver blood flow, because of neovasular inducing are important factor for metastases detecting: - reduced portal blood flow because of increased vascular resistance due tumor volume compression. - increased blood flow through the hepatic artery results of decreased vascular resistance because of new created vascular grid. The aim of the study is to estimate value of color Doppler duplex ultrasound in early detection of liver metastases, measuring hepatic artery flow volume and portal flow volume, calculating Doppler perfusion index at patients with colorectal carcinoma with or without metastases, before or post opperation. I estimated 60 patients with colorectal carcinoma with different sex (37 male and 27 female) and different age group (43 – 82 year) and 60 healthy volunteers. In the research I used color Doppler ultrasound with spectral analysis of flow signal with ultrasound scanner Toshiba SSA 340A. As additional methods I used thin needle biopsy with hystopathological diagnosis of material, electromagnetic resonance and computerized tomography. I measure average results for HaFV, PvFV and DPI for patients from control group and the same results of patients from preoperative period, first, second, third and fourth period: (KG) 296,65mL, 1559,03mL and 0,1595; (POP) 396,26mL/min, 1277,33mL/min and 0,244; (I) 414,63mL, 1198,55mL and 0,261; (II) 444,26mL, 1172,23mL/min and 0,285; (III) 462,7mL/min, 1089,93mL/min and 0,304; (IV) 493,58mL/min, 1056,716mL/min and 0,3279; There is calculated statistical very significant differences between vascular parameters value: HaFV (p, p, p, p, p); 171094,2−⋅≤201058,9−⋅≤291066,7−⋅≤341092,1−⋅≤461015,1−⋅≤ PvFV (p, p, p, p, p); 171078,2−⋅≤231087,1−⋅≤26109,2−⋅≤371046,1−⋅≤381011,2−⋅≤ DPI (p, p, p, p, p) from preoperative inspection to every next inspection. 191021,3−⋅≤241009,2−⋅≤311031,9−⋅≤401061,6−⋅≤481038,4−⋅≤ The coefficient of regression between DPI value from preoperative inspection to every next inspection amount 0,910655. The results for F- variable are: for HaFV (98,60269 - 561,163), for PvFV (98,8031 - 374,2895) and for DPI (3,28518 - 78,51212); (5,609627 - 46,75867) and (3,1983 - 17,67155). The percent of patients without metastases with increased DPI had amount: 15%, 32,72%, 52%, 57,14% and 65%. The percent of patients with liver metastases with increased DPI had amount: 0%, 60%, 80%, 100% and 95%. Normal value of DPI in POP and initial metastases have 5,8%, 11,76%, 11,76% and 25,49% of patients. At patients with increased value of DPI in POP and liver metastases the percent are: 22,22%, 44,44%, 55,55% and 77,78%. Bearing in overlooking the fact that the growing number of patients with metastasis when DPI is increased, like appearance of metastases in a shorter period when patients with CRC which had increased DPI, I bring the conclusion that the perfusion index is relevant vascular parameter in the close association and correlation with appearance and growth of metastases with surgical treated CRC. This confirms the great importance for use of color Doppler ultrasound to detect metastases of liver.
