Lukoševičius, Saulius

Objectives: While longitudinal studies have linked parietal lobe structure and muscle mass, no resistance exercise studies have evaluated whether interventions can have a positive impact on parietal lobe structure. Therefore, we investigated the effects of high-intensity resistance training (HIRT) and blood-flow restriction training (BFRT) on cortical thickness and white matter integrity in the parietal region, as well as in other regions, in an exploratory manner. Methods: A total of 63 older men were assigned to BFRT, HIRT or control groups for 12 weeks of intervention. A total of 48 participants completed brain and thigh magnetic resonance imaging before and after intervention. Cortical thickness was assessed using FreeSurfer, fractional anisotropy (FA) values were calculated using ExploreDTI, thigh muscle anatomical cross-sectional area was measured from MRI. Results: A significant difference in cortical thickness was observed only in HIRT group in the left parietal cortex—inferior parietal, supramarginal and posterior cingulate. Exploratory analyses revealed cortical thickness changes in other left-hemisphere regions, including the temporal (bankssts, inferior temporal), frontal (medial orbitofrontal, precentral, rostral middle frontal), and occipital (lateral occipital) cortices. In contrast, the BFRT group showed significant FA value change in parietal region – in left inferior parietal, left precuneus and right superior parietal. Exploratory analyses showed FA value change in additional regions in the BFRT group, including the left frontal (caudal middle frontal and superior frontal), left temporal (fusiform), right occipital (lateral occipital), and in the HIRT group, in the left frontal region (pars opercularis). Conclusions: HIRT and BFRT were associated with beneficial brain structural changes, although through distinct neurobiological mechanisms, with HIRT primarily influencing cortical thickness and BFRT predominantly affecting white matter microstructure.

Įprastinė transplantuoto inksto būklės stebėsena remiasi inksto funkcijos rodiklių kraujyje ir šlapime tyrimais bei inksto biopsija. Visgi, šie metodai sulaukia kritikos, nes dažnai atspindi jau pažengusius pokyčius ir neleidžia aptikti ankstyvosios patologijos bei laiku užkirsti kelią jos progresavimui. Dėl šios priežasties aktyviai ieškoma papildomų neinvazinių biožymenų. Magnetinio rezonanso tomografija (MRT), gebanti įvertinti ne tik struktūrinius bet ir fiziologinius organų procesus, nefrologijos srityje vis dar naudojama palyginti retai. Šio tyrimo tikslas – įvertinti neinvazinio struktūrinio MRT ir paciento volemijos rodiklių klinikinę bei prognostinę vertę po inksto transplantacijos. Tyrimo rezultatai atskleidė, kad plaučių hipervolemijos būklė prieš transplantaciją, įvertinta ultragarsu, koreliuoja tiek su lėtesniu transplantato funkcijos atsistatymu, tiek su prastesne funkcija po vienų metų. Tuo tarpu MRT tyrime gautos sąsajos tarp ADC bei T1 relaksacijos laikų žemėlapių reikšmių ir aGFG, proteinurijos bei albuminurijos. Taip pat stebėta T1 žievės-šerdies diferenciacijos rodiklio koreliacija su inkstų struktūriniais pokyčiais kartotiniuose tyrimuose ir lėtinės fibrozės progresavimu. MRT pritaikymas, nuosekliai vertinant transplantato struktūrinę būklę, ir šių radinių susiejimas su laboratorinių tyrimų bei protokolinių biopsijų duomenimis gali padėti anksčiau identifikuoti pacientus, kuriems kyla didesnė lėtinio transplantato nepakankamumo rizika.

Plaučių vėžys vis dar tebėra didžiulė grėsmė ne tik pasaulio, Europos Sąjungos, bet ir Lietuvos gyventojams. Siekiant pagerinti pagalbą plaučių vėžiu sergantiems ligoniams, suvienodinti specialistų požiūrį į šios ligos diagnostikos ir gydymo standartus, Lietuvos sveikatos mokslų universiteto ir Lietuvos sveikatos priežiūros specialistų draugijų iniciatyva bei bendru darbu nuo 2007-ųjų kas kelerius metus išleidžiamos „Plaučių vėžio diagnostikos ir gydymo rekomendacijos“. Išlaikydami tradicijas ir tęstinumą pristatome aštuntąsias atnaujintas ir papildytas „Plaučių vėžio diagnostikos ir gydymo rekomendacijas“, kurios yra gausaus autorių, savo srities ekspertų ir pagrindinių Lietuvos sveikatos priežiūros specialistų draugijų atstovų, kolektyvo ilgametės patirties, bendro nuolatinio darbo rezultatas. Plaučių vėžio gydymas išlieka viena dinamiškiausių onkologijos sričių, todėl ankstesnes rekomendacijas buvo būtina atnaujinti apžvelgiant svarbiausias prigijusias naujoves. Plaučių vėžio profilaktika, ankstyva diagnostika ir atrankinė patikra yra viena iš prioritetinių sričių naujame Europos Sąjungos kovos su vėžiu plane. Kai kuriose Europos Sąjungos šalyse jau yra įdiegtos nacionalinės plaučių vėžio patikros programos, kitose, taip pat ir Lietuvoje, vykdomos ar jau atliktos bandomosios programos. Tačiau, kol nėra patvirtinta nacionalinė plaučių vėžio patikros programa Lietuvoje, šiose rekomendacijose paliekame tikslinės plaučių vėžio atrankinės patikros gaires, kurios sėkmingai pritaikytos daugelyje Europos Sąjungos šalių ir yra patvirtintos Lietuvoje Plaučių vėžio metodiniame dokumente. Tikimės, kad netolimoje ateityje galėsime pristatyti ir nacionalinę plaučių vėžio atrankinės patikros programą. [...].

Magnetinio rezonanso tomografijos (toliau - MRT) atlikimas ir saugos principų taikymo metodinės rekomendacijos (toliau - Rekomendacijos) skirtos radiologijos technologams, gydytojams radiologams, kurie ambulatoriniams ir stacionaro pacientams atliks MRT tyrimus, gydytojams specialistams, bendrosios praktikos slaugytojams, siunčiantiems pacientus MRT tyrimui atlikti, rezidentams, studentams ir visiems darbuotojams, kurie, eidami savo pareigas, dalyvaus šio tyrimo atlikimo procese.

INTRODUCTION Mechanical thrombectomy (MTE) is an established treatment for acute ischemic stroke. However, early postprocedural CT interpretation may be challenging, as contrast staining can mimic intracranial hemorrhage on conventional imaging. Dual-energy computed tomography (DECT) allows material differentiation and improves diagnostic confidence in such cases. AIM To demonstrate the usefulness of DECT in distinguishing post-thrombectomy contrast material from intracranial hemorrhage. METHODS & MATERIALS An 80-year-old female presented with acute neurological deficits consistent with cerebral stroke. Non-contrast and contrast-enhanced CT of the brain was performed. Imaging revealed acute ischemic changes in the right middle cerebral artery (MCA) territory involving the caudate head and lentiform nucleus, without evidence of intracranial hemorrhage. CT angiography demonstrated focal occlusion (~2.4 mm) in an M2 branch of the right MCA. Mechanical thrombectomy of two M2 branches was performed with complete reperfusion (TICI 3). Follow-up CT showed new hyperdense areas in the right cerebral hemisphere, raising suspicion of hemorrhage. After 24 hours, DECT was performed with iodine and water reconstructions. DISCUSSION On DECT, hyperdense inclusions persisted in the iodine images and were nearly absent on water images, findings consistent with residual contrast material rather than hemorrhage. This allowed confident exclusion of intracranial bleeding, directly influencing further patient management. DECT proved superior to conventional CT in post-interventional stroke assessment. CONCLUSION DECT is a valuable tool in the differentiation of contrast staining and intracranial hemorrhage following mechanical thrombectomy. Its use improves diagnostic accuracy and supports safer clinical decision-making in acute stroke care.

Introduction Pancreas bifidum, also known as bifid or fish-tail pancreas, is a rare developmental anomaly characterized by duplication of the pancreatic duct. This differs from pancreas divisum, in which the dorsal and ventral ducts fail to fuse. Most cases are asymptomatic and found incidentally on CT, MRI, or MRCP [1]. Unlike pancreas divisum (4-14 % prevalence) [2], pancreas bifidum is extremely rare, with fewer than 30 cases reported [3]. Case Presentation A 63-year-old male presented with jaundice, epigastric pain, nausea, and weakness. Laboratory tests revealed hyperbilirubinemia, elevated inflammatory markers, and renal impairment. The patient was diagnosed with acute cholangitis complicated by sepsis due to obstruction of a previously placed biliary stent. Contrast-enhanced CT showed biliary stent obstruction and duplication of the pancreatic body and tail with homogeneous enhancement; both ducts were dilated (3.0 mm and 5.1 mm). An indeterminate lesion in the pancreatic head was also detected. MRCP confirmed two pancreatic ducts converging normally into the duodenum. Biliary obstruction was treated with endoscopic stent replacement and antibiotics, with clinical improvement. The bifid pancreas was considered an incidental benign finding, while further evaluation was recommended for the pancreatic head lesion. Discussion The anatomical configuration of a bifid pancreas, with two ducts extending through the body and tail and merging near the head, may complicate imaging interpretation and affect diagnosis by mimicking pathology, particularly in the presence of ductal dilatation or atypical lesions [2,4]. Most cases are incidental, although some present with acute pancreatitis [4]. MRCP plays the main role in evaluating congenital pancreatic duct anomalies, while CT helps assess parenchymal changes and exclude neoplastic processes [1,3,4]. These findings highlight the importance of accurate imaging interpretation in distinguishing rare pancreatic duct variants from pathological conditions. Conclusions Recognition of pancreas bifidum on imaging prevents misclassification and unnecessary treatment. Accurate imaging interpretation is essential. Asymptomatic patients can be managed conservatively, whereas ductal dilatation or atypical lesions, particularly in the pancreatic head, require further evaluation.

Juvenile idiopathic arthritis (JIA), although rare, remains one the most frequent chronic rheumatological conditions affecting children, necessitating regular assessment of disease activity and timely therapy adjustment. Early diagnostics and longitudinal monitoring still pose clinical challenges, and discrepancies across clinical disease activity scales emphasize the need for additional biomarkers to support decision-making in JIA management. The aim of this dissertation was to evaluate the persistence of subclinical synovitis detected by musculoskeletal ultrasound (MSUS) in patients with JIA over a 12-month follow-up period, and to explore the diagnostic potential of serum and urine microRNAs in JIA. Moreover, associations were evaluated between microRNA, MSUS findings and clinical disease activity measures during both active disease and remission states. In this prospective cohort of JIA patients, we show that (i) subclinical synovitis in MSUS persists in a substantial proportion of children even after 12 months of follow-up, (ii) correlations between clinical measures and MSUS are the strongest in early stage and wane as clinical remission is achieved, and (iii) selected circulating and urinary microRNAs – particularly serum miR-16 and miR-155, and urinary miR-146a – exhibit diagnostic or monitoring potential. To our knowledge, this is the first JIA study to demonstrate that urine is a viable biofluid for exploring microRNA biomarkers, thereby broadening non-invasive options for paediatric populations.

Background: Necrotizing fasciitis (NF) is a rapidly progressive infection of fascia and subcutaneous tissues. Early symptoms often mimic cellulitis, abscesses, or vascular disorders, complicating timely diagnosis. Radiological imaging (CT, MRI) is crucial for differentiating NF and guiding urgent surgical management. Aim: To highlight diagnostic challenges and differential diagnoses in NF of the thigh, emphasizing the role of imaging in early recognition and management. Methods: A literature search was conducted in PubMed, Scopus, and Google Scholar using "necrotizing fasciitis," "differential diagnosis," "radiology," "CT," and "MRI." Inclusion criteria were full-text articles in English published between 2020-2025, covering case reports, series, reviews, and original research. Articles not focusing on imaging-based differential diagnosis or older than five years were excluded. Findings were synthesized to summarize clinical and radiological features distinguishing NF from cellulitis, abscess, and vascular disorders. Additionally, a clinical case of NF diagnosed and managed at Kaunas Clinics is presented. Results: NF is frequently misdiagnosed as cellulitis, abscess, or vascular disease due to overlapping early signs such as pain, swelling, and erythema. Imaging is decisive: CT shows fascial thickening, subcutaneous gas, and fluid tracking, while MRI detects early soft tissue involvement. Laboratory tools like the LRINEC score aid risk assessment, though early values may be inconclusive. The presented case of a 76-year-old male with perforated sigmoid diverticulitis illustrates these challenges. Initial suspicion was femoral artery thrombosis, but CT revealed retroperitoneal gas spreading into the groin and thigh, confirming NF. Surgical exploration, sigmoid resection, repeated debridements, and supportive care led to survival, emphasizing early imaging and multidisciplinary management. Conclusion(s): NF often mimics common conditions, causing diagnostic delays. Early imaging, laboratory risk assessment, and prompt surgery are crucial. This case underscores the need for high clinical suspicion, including atypical presentations from rare intra-abdominal sources.

Biophysics-based, patient-specific modeling remains challenging for clinical translation, particularly for cerebrospinal fluid (CSF) flow where anatomical detail and computational cost are tightly coupled. We present a computational framework for steady net CSF redistribution in an MRI-derived cranial CSF domain reconstructed from T2-weighted imaging, including the ventricular system, cranial subarachnoid space, and periarterial pathways, to the extent resolvable by clinical MRI. Cranial CSF spaces were segmented in 3D Slicer and a steady Darcy formulation with prescribed CSF production/absorption was solved in COMSOL Multiphysics®. Geometrical and flow descriptors were quantified using region-based projection operations. We assessed discretization cost–accuracy trade-offs by comparing first- and second-order finite elements. First-order elements produced a 1.4% difference in transmantle pressure and a <10% difference in element-wise mass-weighted velocity metric for 90% of elements, while reducing computation time by 75% (20 to 5 min) and peak memory usage five-fold (150 to 30 GB). This proof-of-concept framework provides a computationally tractable baseline for studying steady net CSF pathway redistribution and sensitivity to boundary assumptions, and may support future patient-specific investigations in pathological conditions such as subarachnoid hemorrhage, hydrocephalus and brain tumors.

Background: Diffusion-prepared pseudo-continuous arterial spin labelling (DP-pCASL) can quantify the cerebral blood flow (CBF) and the water exchange rate (kw) across the blood–brain barrier (BBB). Little is known about the BBB water exchange in major depressive disorder (MDD). Objective: We aimed to explore the associations between kw, CBF, peripheral inflammation, and MDD. Methods: Using DP-pCASL, we measured the global and selected regional kw and CBF together with blood plasma levels of lipopolysaccharide (LPS) and inflammatory cytokines in 85 patients with MDD and 51 controls. Results: The global CBF was significantly lower in MDD patients compared with controls (means of 51 and 57 mL/100 g/min, respectively; p = 0.006), with similar reductions found in the dorsolateral and ventromedial prefrontal, anterior, and posterior cingulate regions, while no differences were found in the amygdala and the isthmic cingulate. There were no differences in the kw between groups globally (means of 128 min−1; p = 0.958) and in the studied regions. Among MDD patients, the kw was weakly correlated with the MADRS scores (r = 0.231, p = 0.034). There were no associations between kw, CBF, and inflammatory markers (LPS, IL-6, IL-10, TNF-α, IFN-γ). Logistic regression showed that a combination of the regional CBF < 59.22 mL/100 g/min together with LPS > 143.58 pg/mL and/or IL-10 > 0 pg/mL distinguished MDD patients from controls with a moderate accuracy of 83.1% (sensitivity = 94.1%, specificity = 64.7%, AUC = 0.876). Conclusions: DP-pCASL imaging confirmed previous findings of reduced CBF in MDD, which together with LPS and IL-10 concentrations were independent significant predictors of MDD. However, no changes in the BBB water exchange were found, suggesting that it may not be as significant as CBF in MDD pathophysiology.