Introduction: Prior to the 1990s, the most common sources of HCV infections were blood transfusions, unsafe injections and I.V drug use. Screening of blood products for HCV has eradicated transfusion-transmitted hepatitis C in most countries since 1992–in Bosnia and Herzegovina, however, since 1995, due to the war. Aim: To investigate the impact of the source of HCV infection on the therapeutic response in patients treated for chronic HCV infection with dual combined therapy. Methods: We diagnosed chronic HCV infections amongst 246 patients over a period of five years and selected them according to the reported source of infection. Pegylated interferon alfa 2a or alfa 2b with ribavirin was administered during the time that was genotype-dependent. HCV RNA levels in sera were measured by real time PCR. Liver histology was evaluated in accordance with the level of necroinflammation activity and the stadium of fibrosis. Results: Regardless of the genotype of the virus and the source of infection, SVR was achieved in 67% of the patients. Therapeutic response (ETR) was not achieved in 25% of the patients who were infected with an untested blood transfusion and 6% of the patients who had had wartime surgery. Amongst the different sources of infections, patients with a war-surgery source of infection responded better to therapy than those with a blood transfusion source of infection (p = 0.023). A blood transfusion source of infection implies a larger fibrosis stage than in blood donors; (g = 1.177; s2 = 0.577). A blood transfusion source of infection implies a significantly larger necroinflammatory activity than in blood donors; (g = 1.456; s2 = 0.618). Conclusions: An untested blood transfusion was a significant risk factor for more advanced liver diseases in regards to necroinflammatory activity and the fibrosis stage. This source of infection was also a risk factor for low responses to antiviral therapy. At the same time, I.V. drug users had more progressive necroinflammatory activity, but a high therapeutic response to antiviral therapy.

Research goal: The aim of the research is to define the possibilities of TVU and the MRI in the diagnosis of the most common benign ovarian lesions which cause pelvic pain. Patients and methods: In study were included n=74 patients with pelvic pain, who were examined with TVU and then with an MRI of pelvis. Diagnostic results of all patients (n=74) divided into two groups according to the modality that was performed (TVU results n=74 and MRI results n=74 MRI ). We compared the results of TVU and MRI, and with a pathohistological finding after surgery. TVU test sensitivity and MRI test sensitivity has been made for each pathological entity in particular. The overall sensitivity test of TVU was performed for all pathological entities together. The overall sensitivity test of MRI was performed for all pathological entities together. Results: TVU demonstrated sensitivity of 83.3% for ectopic pregnancy, 83.3% for ovarian torsion, 84% for endometriotic cyst, 88.2% for hemorrhagic cysts, 58.3% for tubo-ovarian abscesses, 62.5% for dermoid cysts. Overall sensitivity of TVU for all these pathological entities was 78.4%. MRI showed a sensitivity of 100% for ovarian ectopic pregnancy, 83.3% for ovarian torsion, 100% for endometriotic cyst, 100% of hemorrhagic cysts, 83.3% tubo-ovarian abscess, and 87.5% for dermoid cysts. Overall sensitivity of MRI in all of these pathological entities was 94.6%. The analysis using the chi square test shows that there is a significant difference in the sensitivity between the US and MRI in favor of greater overall MRI sensitivity in diagnosing ovarian pain caused by benign lesions. (χ2 = 14.352, df = 9, p = 0.0021). Conclusion: TVU is the first choice method for ovarian analysis due to the convenience and absence of radiation, and MRI is a very useful modality when TVU’s results are confusing and unspecific.

The aim of this study was to examine the possibilities of measuring ADC/DWI values with the ROI method for precise differentiation of focal liver lesions from normal liver parenchyma. The study included 100 liver lesions sized ≥1 cm, previously detected in patients by ultrasound and computed tomography. It is done by measuring the diffusion coefficient ADC folder (MRI 3T), setting the ROI on the periphery of hepatic lesions, on the liver parenchyma around the focal hepatic lesions and on liver parenchyma that is distant to hepatic lesions. In our study, difference between the average ADC value of focal liver lesions (1.24 x10(-3) mm(2)/s) and normal liver parenchyma around focal liver lesions (1.001x10(-3) mm(2)/s) was statistically confirmed. There was statistically proven difference in the average ADC values between normal liver parenchyma around focal lesions and liver parenchyma located distant from focal lesions of (1.003x10-3 mm2/s). Wilcoxon rank test yielded differences in the average (median) ADC values between total lesions in patients and liver parenchyma directly around focal lesions (p<0.0005). Wilcoxon rank test showed no differences in the average (median) ADC between liver parenchyma directly around focal lesions and distant of focal hepatic lesions (p<0.0005). The results obtained for each focal liver lesion were compared with histopathology findings obtained by puncture or surgery, and for cystic lesions radiological follow up was sufficient. For all liver lesions, the resulting overall DWI/ADC sensitivity was 92% and specificity 77%. Kendall’s tau-b coefficient of concordance showed a statistically significant correlation between our DWI diagnosis and histopathology verification for all liver lesions (p<0.0005). He mangiomas and cysts showed greatest difference in ADC values as compared with healthy liver. ADC values of hepatocellular carcinoma (HCC) and the surrounding normal liver parenchyma were not statistically different, which can be explained by similarities in their cell structure. Related articles conclude that DWI has inadequate sensitivity in detecting HCC, explaining this minimal difference in cellularity of well differentiated HCC and liver parenchyma. DWI/ADC has the potential to differentiate and reliably define the limits of focal lesions of the normal liver parenchyma. ADC delimitation of focal lesions of the liver parenchyma is most reliable for hemangiomas and cysts, while ADC delimitation of HCC can pose diagnostic difficulties.

Material and methods: The study was of prospective-retrospective character. It was carried out at the AKH in Vienna (Austria), where 100 patients with focal liver lesions were included in the study. All patients underwent the routine MR sequences on appliances 1,5 and 3T (Siemens, Germany): T1, T2, HASTE, VIBE, and a DWI with three b values (b 50, b 300 b 600 s / mm2) and ADC map with ROI (regions of interest). The numerical value of ADC map was calculated, where n = 100 liver lesions, by two independent radiologists. Results: On the basis of matching the PH finding statistically we get DWI accuracy of 96.8% for the assessment of liver lesions. The average numerical value of ADC in benign hepatic lesions (FNH, Hemangiomas) in our study amounted to 1.88 (1.326 to 2.48) x103 mm2 /s, while the value of malignant liver lesions (HCC, CCC, CRCLM) were significantly lower and amounted to 1.15 (1.024 to 1.343) x10-3 mm2 /s (Figure 2). Differences between the mean ADC of benign and malignant lesions showed a statistically significant difference with p <0.0005. In our research, we get cut-off for the ADC value of 1,341x10-3 mm2 /s, which proved to be the optimal parameter for differentiation between benign and malignant lesions. Conclusion: Measuring ADC values with DWI as an additional MRI tool can help in oncological practice by distinguishing normal liver parenchyma from focal lesions, and in differentiating benign from malignant liver lesions, particularly in cases where administration of contrast is not possible.

Goal: The aim of the study is to define the MRI appearance of disorder in the Junctional zone (JZ) in women with adenomyosis compared to those without it, given the importance of the JZ in the regulation of various reproductive events. Materials and methods: This was a prospective, comparative and open study. Patients with adenomyosis have been sorted in target group, n = 82, while the control group consisted of patients without adenomyosis, n = 82. All patients, from both groups have undergone a magnetic resonance imaging of the pelvis. Using a software tool for measurement, the thickness of the JZ was measured in T2w sag sequences in all patients from both groups (target and control) n = 164. Patients in the target group type adenomyosis were assessed and categorized either as: diffuse, focal, or Adenomyoma and the results were compared. The presence of endometriosis and myomas in both groups was evaluated and its coexistence with adenomyosis was analyzed as well. Results: Of the 82 patients in the target group, 81.7% of the patients had diffuse adenomyosis, while 18.3% had focal type with statistically significant difference (p <0.05). The results of the Mann-Whitney U test showed that p <0.05, implying that there is a statistically significant difference in the thickness of the JZ between the control and target group, therefore patients from the target group with adenomyosis had a statistically significantly thicker junctional zone than the patients in the control group. The JZ in the target group was on average M = 14,3mm, SD = 1.3mm, while the thickness of JZ in the control group without adenomyosis was M = 5,6mm, SD = 1,3. Chi-square shows that p <0.05, implying that there is a statistically significant difference in the number of patients with myomas between the two groups, where the myomas significantly over-represented in the target group with 32,9 % vs.6 %). Conclusion: MRI is the method of choice for imaging and evaluation of JZ as an important diagnostic marker in the diagnosis of adenomyosis. It is important to recognize this condition as early as possible and distinguish it from other pathologies in order for timely and appropriate treatment.

Liver injuries caused by high voltage electricity are rare and result in high mortality and morbidity. They are produced by the resistance to the passage of electrical current through the tissue, which creates heat that leads to coagulation necrosis and rupture of the cell membrane. We present a case of an electrical injury to the liver, diagnosed by ultrasound and CT in a 39-year-old man who presented with skin burns on his right hand and right hemiabdomen. Injuries occurred after the contact with 220 kV high voltage electricity.