Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study

Background: Colorectal cancer (CRC) is a diverse disease with various clinical, pathological and molecular features that affect tumor biological behavior, treatment response and prognosis. Objective: The aim of this study was to evaluate the correlation between metabolic 18F-FDG PET/CT parameters (SUVmax, MTV and TLG) and CEA in recurrent and metastatic CRC and to evaluate prognostic value of metabolic 18F-FDG PET/CT parameters in recurrent and metastatic CRC. Methods: A descriptive study of 100 patients with previously detected and surgically treated CRC referred to PET/CT with a suspicion of recurrent or metastatic CRC. CEA was measured within three months from the imaging. A low-dose PET/CT was performed per institutional protocol. For each hypermetabolic lesion, metabolic PET/CT parameters (SUVmax, MTV, TLG) were calculated semiautomatically. Pathohistology or clinical data from the follow-up were used as the gold standard. Sensitivity, specificity, PPV and NPV for 18F-FDG PET/CT and CEA in detection of recurrent or metastatic CRC were calculated. Correlation between CEA and SUVmax, MTV and TLG was calculated, separately. To assess the prognostic values of metabolic parameters in CRC, survival analysis with 18-month progression-free survival (PFS) as an endpoint was performed. Microsoft Excel sheets, ROC and Kaplan-Meier curves were used to present the data. Logrank and Tarone-Ware test and Cox model of proportional hazards were used to compare the groups. Results: Study included 100 patients, 45 males and 55 females, age range 36-81 years, mean age 61,4 years. Cancer site was colon in 56% and rectum in 44%. Sensitivity, specificity, PPV and NPV of 18F-FDG PET/CT in detection of recurrent or metastatic CRC was 95%, 73%, 70% and 95%, respectively. Sensitivity, specificity, PPV and NPV of CEA in detection of recurrent or metastatic CRC was 58%, 96%, 91% and 78%, respectively. SUVmax, MTV and TLG positively correlated with CEA, but only CEA-TLG correlation was considered significant (r=0,67). The regression model analysis revealed: SUVmax (HR=0,63, 95%CI=0,28-1,41, p=0,214), MTV (0,59, 95%CI=0,28-1,22, p=0,111) and TLG (HR=0,45 95%CI=0,21-0,99, p=0,028), and the prognostic role in CRC was proven for TLG only. Conclusion: Metabolic 18F-FDG PET/CT parameters may have the prognostic value in CRC, but further multicentric prospective studies are required for validation.

Introduction: A number of nuclear medicine procedures significantly dropped worldwide during the COVID-19 pandemic. Every nuclear medicine department has faced changed working environment in terms of the type of requested procedures, number of requests and personal protection issues. Also, some specificities emerged that affect standard operating procedures. Aim: The aim here is to present different clinical scenarios related to RT PCR molecular testing and COVID-19-associated pulmonary findings on PET/CT in oncologic patients. Methods: A case series of four patients imaged on oncologic PET/CT is presented. Short clinical history followed by description of significant PET/CT findings and their importance from the perspective of COVID-19 pandemic and interpretation of PET/CT findings is presented. Conclusion: PET/CT imaging remains of paramount importance for oncologic patients during the pandemic. Under the unprecedented circumstances, interpretation of PET/CT findings has become more complex having some specificities that must be kept in mind.

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide with the incidence of about 1,8 million newly diagnosed cases in 2018. According to the World Cancer Report 2014, in Bosnia and Herzegovina 6700 people died of cancer in 2014, and CRC was the cause of mortality in 724 patients (10%). Prevention programs including screening, state-of-the-art diagnostic modalities and therapeutic approaches to CRC are being constantly improved. Aim: Our study was designed to address the diagnostic accuracy of 18F-FDG PET/CT in the follow-up of CRC in patients with normal or elevated CEA. Methods: We retrospectively analyzed 50 patients previously diagnosed with CRC who were initially surgically treated. All patients were suspicious of recurrence and were referred to as 18F-FDG PET/CT for restaging between February 2014 and February 2019. Possible recurrence was indicated by rising CEA, equivocal radiological findings or clinical findings. Results: Out of a total of 50 patients for whom the follow-up of at least six months was available, 27 had CRC confirmed with the gold standard, and all 27 patients had 18F-FDG PET/CT positive for recurrence, giving a sensitivity of 18F-FDG PET/CT in detecting the recurrence of CRC of 100.0% (0.0% of false-negative – FN results). Out of 23 patients with no signs of CRC recurrence on the gold standard, 19 were also 18F-FDG PET/CT negative, giving a specificity of 18F-FDG PET/CT in detecting the recurrence of CRC of 82.6%, and 17.4% of false-positive – FP results. Out of 31 patients who were 18F-FDG PET/CT positive, 27 had it confirmed pathophysiologically or clinically, giving positive predictive value (PPV) of 18F-FDG PET/CT in detecting CRC recurrence of 87.1%; negative predictive value (NPV) was 100.0%, meaning all 19 patients showing no signs of CRC recurrence when imaged with 18F-FDG PET/CT were gold standard negative as well. Conclusion: 18F-FDG PET/CT proves to be a valid diagnostic tool in detecting recurrence in patients with CRC.

OBJECTIVE The aim of the study was to evaluate the prognostic value of the maximum standardized uptake value (SUVmax) of 18F-Fluorodeoxyglucose (18F-FDG) PET/CT in patients with metastatic colorectal cancer, and to compare it with classical prognostic markers. MATERIALS AND METHODS The study included 70 patients with metastatic colorectal cancer who had not been treated for the metastatic disease. The patients underwent 18F-FDG PET/CT as part of their routine diagnostic reevaluation. During the analysis, the value of the largest tumor diameter and SUVmax was determined for the lesion with the highest SUVmax observed. The values of CEA and CA 19-9 were recorded 7 days before the PET/CT analysis. RESULTS SUVmax and Carbohydrate antigen (CA)19-9 were found to be independent prognostic markers of disease progression within 12 months. Based on the Receiver Operating Characteristics (ROC) curve analysis, the patients could be divided into two groups: SUVmax≤4.1 vs. SUVmax>4.1. Patients with SUVmax values of 4.1 or less had significantly better progression-free survival within 12 months with an HR (95% CI) of 2.97 (1.4-6.3), relative to patients with SUVmax values above 4.1. CONCLUSION SUVmax may be used as a novel prognostic marker of disease progression among patients with metastatic colorectal cancer. Values of SUVmax can be used to select patients with a more aggressive type of disease and higher risk for progression within 12 months of PET/CT analysis.

Introduction: Consensus hasn’t been yet achieved about optimal dose quantity that could prevent post therapy hypothyroidism, thus dosing approach varies among different centers. I131 doses can be fixed or calculated, although treatment outcomes don’t differ significantly according to recent acknowledgments. Aim: Determination of the incidence of hypothyroidism after radioiodine treatment (I131) in dependence of hyperthyroidism etiology and quantity of applied doses. Materials and methods: The study included 100 patients which have had radioiodine treatment, with a three year post-treatment follow up. The study was conducted at the Nuclear Medicine Department, University Clinical Center of Sarajevo. Data were provided from the patient medical histories. Research is designed as a retrospective, descriptive study. All data were analyzed using Microsoft Excel and the statistical program SPSS 13.0. Results: After the three year follow up, incidence of hypothyroidism within patients with Graves’ disease was 89.5%, with diffuse goiter 50%, with toxic adenoma (TA) 26.8%, and with multinodulare goitre (MNG) 57.1%. Hypothyreoidism in patients with diffuse goiter, Graves’ disease and TA was mostly developed after I131 therapy with a dose quantity of 10.1-15 mCi and in MNG patients after RAI therapy with applied doses of 15.1-20 mCi. Conclusion: The hypothyroidism incidence rate is the highest among patients with Graves’ diseases and the lowest among the TA patients. It’s mostly developed after dose quantity of 10.1-15mCi and it is rare at dose quantity less than 5mCi. 50% of hypothyroidism were developed among patients with diffuse goiter, Graves’disease.

Objective: This study objective was to evaluate interobserver agreement between individual pairs of three nuclear medicine physicians in interpretation of renal cortical scintigraphy in children with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right). Materials and Methods: Thirty children were imaged in planar and SPECT mode per protocol upon the injection of Tc-99m DMSA dose adjusted to their body weight. Patients were classified according to diagnoses into four groups. Three nuclear medicine physicians interpreted the findings blindly and independently. Renal defects were interpreted as focal and diffuse, per three renal segments. For the raters we calculated simple percentage agreement, the Cohen kappa statistic with 95% confidence intervals, and the overall kappa defining the levels of reliability as almost perfect or perfect, substantial, moderate, fair and slight agreement. Results: Interobserver agreement in planar interpretation was 77,2% (kappa=0.59; 95% confidence interval, 0.41 to 0.75) and SPECT 72,9% (kappa= 0,57; 95% confidence interval, 0,41 to 0,72). In planar interpretation, all individual pairs had moderate agreements except one that had a substantial agreement. In SPECT, all the pairs had moderate agreements except one that had an almost perfect agreement. Overall agreement per kidney site was on planar 73,4% for the left (kappa=0,54, moderate agreement), and 81,1% for the right kidney (kappa 0,63, substantial agreement). On SPECT, there was 72,2% agreement for the left (kappa=0,59, mode rate agreement), and 73,7% for the right kidney (kappa=0,54, moderate agreement). Overall agreement per diagnoses ranged from 70-88,9% on planar (kappa= -0,04 to 0,79), and 50-100% on SPECT (kappa=-0,02-1,000) indicating agreements from slight to substantial. Discussion: Our results suggest acceptable levels of interobserver agreement in all individual pairs of raters with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right). For the mode of acquisition, we would recommend hybrid imaging SPECT/CT method to be used whenever possible in the detection of renal cortical defects on Tc-99m-DMSA scintigraphy.

Goal: The goal of this study was the determination of the effects in treatment of early stage (<IIB) and locally advanced stages (≥IIB) of uterine cervical carcinoma by using MRI. Material and Methods: The study was a prospective, comparative, analytical, and observational and included 74 patients with cervical cancer (PH confirmed). All 74 patients have initially gone through the pre-therapeutic MRI to determine the tumour FIGO stage. At a renewal of the initial MRI findings, patients were divided into two study groups: group A and group B. Group A consisted from 39 patients with early-stage cervical carcinoma (<IIB) and group B comprised from 35 patients with locally advanced stage (≥IIB). Postterapeutic MRI control, were perfomed in both group (A and B). Further MRI examinations were set for the patients from both groups. Results: An analysis of treatment outcomes in group A showed that most patients had no local recurrence or residuum disease in 89.7%, while local recurrence was observed in only 10.3% cases. An analysis of treatment outcomes in group B showed that most patients had complete regression after local chemoradiotherapy in 68.8%, while 25.7% of patients had local progression of the disease, while the 5.7% cases recorded partial local tumour regression(p<0.05). It has been shown that a complete local regression was more frequent in the case of squamous cell carcinoma in 74.2% vs 25% in adenocarcinoma cases. Also local and partial regression was observed more frequently in the case of squamous cell carcinoma in 6.5% compared to 0% in adenocarcinoma, while progression was more common in adenocarcinoma at 75% compared to 19.4% for squamous cell (p<0.05). MRI results showed positive outcome of treatment group A and B in our study, showed a statistically significant difference in favour of group A (89.7%) compared to group B 68.8% (p<0.05). Conclusion: The results obtained from our studies show that early stage cervical cancer (<IIB) shows a better outcome in treatment of advanced stages (≥IIB). In the treatment of advanced stages (≥IIB), concomitant radio chemotherapy shows significant results in terms of complete tumour regression, especially in squamous cell type of cervical cancer.