Vertebral artery fenestration is a rare vascular anomaly. It most commonly occurs in extracranial segments of the vertebral artery. This congenital anomaly can occur during the various stages of embryonic development of the vertebral artery. This usually does not have clinical significance, but the possibility of associated anomalies such as saccular aneurysms and arteriovenous malformations should be noted. Awareness of vascular anomalies is key to avoiding iatrogenic injury during endovascular diagnostic and therapeutic interventions. Here, we present incidental findings of vertebral artery fenestration in a 46-year-old woman evidenced by CT angiography of the neck's blood vessells after I .V. contrast medium applications.

OBJECTIVES Although dual-energy X-ray absorptiometry (DXA) is gold standard for osteoporosis diagnosis, several reports have shown discordant T-score values measured by quantitative computed tomography (QCT) and DXA especially in obese subjects, but it is still not clear whether BMD measurement by two modalities is affected by overall obesity or central obesity in postmenopausal females. Therefore, the aims of this study were to compare BMD and T-scores by DXA and QCT and to evaluate whether these two osteoporosis assessment modalities yield different T-score values in postmenopausal females with obesity and central obesity. METHODS This cross-sectional study enrolled 44 postmenopausal females, referred for osteoporosis screening. Anthropometric indices (BMI-body mass index, WC-waist circumference and ICO-index of central obesity) were measured and females underwent assessment of bone mineral density by DXA and QCT. RESULTS Lumbar spine (LS) T-score values were significantly lower by DXA compared to qCT in females with BMI >25 kg/m2, (-1.9±1.5 vs. -2.3±1.2; p=0.039), in females with WC>88 cm(-1.9±1.5 vs. -2.4±1.2; p=0.008) and in females with ICO>0.5(-1.96±1.4 vs. -2.5±1.2; p=0.004). However, in normal weight females and in those without central obesity, LS T-scores by DXA were not different than qCT. DXA at lumbar spine and proximal femur revealed osteoporosis in 47.7% and 11.4% respectively, while QCT detected osteoporosis in 61.4% of females (p<0.001). Measures of central obesity; ICO and WC were not associated with QCT bone mineral density (BMD) (r=0.14 and r=0.21, respectively), but were positively associated both with DXALS BMD (r=0.29 and r=0.31; p<0.05) and DXA proximal femur BMD (r=0.41 and r=0.44; p<0.01). CONCLUSION Our results suggest that obesity is associated with lower T-scores by DXA compared to QCT. Caution is needed when assessing osteoporosis status in obese postmenopausal females. However, further studies with larger sample size are needed to confirm the findings.

The purpose of this study was to compare unenhanced MR angiography with contrast-enhanced MR angiography and visualisation of renal arteries with its segment branches using both techniques. We performed renal MRA on 22 patients using a 1.5T MRI unit. For renal MRA, a three dimensional balanced type steady-state free precession (SSFP) sequence (Time-SLIP, Canon) was used with respiratory gating and conventional CE-MRA sequnce (upisati tačan naziv). For analysis, two radiologists independently evaluated the visual quality of the axial images and axial maximum intensity projection images (MIP) of Time SLIP and CE MRA. Visualisation of aorta and main stem of the renal arteries were satisfactory on both techniques, and there was no statistically significant difference. The score of segmental renal artery appeared superior with Time-SLIP and showed a statistically significant difference (P<0.05). Visualisation of segmental renal arteries, interlobar renal arteries and kidneys parenchyma was significantly superiorwith Time-SLIP technique. We compared visualisation of renal arteries and its branches using unenhanced MRA, Time-SLIP, in comparison with contrast-enhanced MRA. Although it is slightly time-consuming and its clinical utility is necessary to further investigate, unenhanced MRA provides superior visualization of peripheral branches even in this study. Further improvement of the technique would make it even more sensitive in detecting small vessel abnormalities and it is promising for clinical use.

Introduction: Fetal Magnetic Resonance Imaging (MRI) is an imaging method for displaying anatomical structures of the fetus without ionizing radiation and it has been in use since the MRI has been used for the analysis of the adult human body. Aim: The aim of our paper is the two-year retrospective analysis of fetal MRI examinations for the purpose of presenting various pathological conditions of the fetuses. Methods: A total of 59 fetal MRI examinations were performed on pregnant women in the time period 2016 to 2018 at the Radiology Clinic at Sarajevo University Clinical Center, on Siemens and Toshiba 1.5 Tesla scanners. All cases were referred by gynecologists who suspected a fetal pathology. The comparison of the fetal age at which the congenital anomalies are usually detected is performed using the univariate analysis of variance and the Student t test, at the 95% level of confidence. Results: Of the total of 59 fetal MRI examinations, 2 fetuses (3,4%) were healthy, while pathology of the head and CNS was found in 26 fetuses (44,2%), thoracic cavity pathology in 5 fetuses (8,5%), abdominal cavity pathology in 18 fetuses (30,6%), pathology of extremities in 2 fetuses (3,4%), spinal cord pathology in one fetus (1,7%), and in 3 fetuses associated anomalies were found (5,1%). The pathology of the uterus and placenta was found in two pregnant women (3,4%). Conclusion: Prenatal MRI provides extremely useful information in cases where the ultrasound examination of the fetus is insufficient due to the size and position of the fetus. MRI is a key tool in deciding whether to continue or stop the further development of the fetus.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system, that causes permanent disabilities. Diagnostics of this disease by magnetic resonance requires the appliance of corresponding protocols with the sequences that emphasize demyelinating plaques. Standard sequences T1 and T2 sometimes cannot clearly show demyelinating plaques, and it is necessary to work on perfecting the sequences that emphasize the changes in the brain formed as demyelinating plaques. The aim of the survey: The aim of the survey was to estimate the value of MR sequence with double inversion recovery (DIR) in discovering demyelinating lesions of the brain in multiple sclerosis (MS). Patients and methods of the survey: 22 patients were included in the survey, they were of both genders and different age. The patients were with diagnosed with multiple sclerosis. The patients underwent the scanning on MR apparatus 1.5 T. Comparison of DIR sequence to FLAIR and T2 W sequences were done. Result: DIR sequence proved significantly more MS lesions compared to T2W or FLAIR sequence, including intracortical, juxtacortical and paraventricular zone of the brain. In the infratentorial zone of brain, T2W sequence proved significantly more plaques compared to DIR and FLAIR. Conclusion: DIR sequence compared to T2W and FLAIR sequences discovered more demyelinating lesions in targeted regions that were examined. DIR sequence is a tool that contributes to easier and faster diagnostics of multiple sclerosis, needs to be included into the routine MR protocol of patients with MS, in order to discover more easily intracortical and juxtacortical MS lesions of the brain.

Background The pathogenesis of renal scarring (RS) after first febrile urinary tract infection (UTI) in children is multifactorial. In addition to well-known risk factors, a role for genetic predisposition has been suggested. Aims To determine whether deoxyribonucleic acid (DNA) polymorphisms at the plasminogen activator inhibitor -1 (PAI-1) gene were associated with evolution to RS following a febrile UTI in infants. Materials and Methods Our research included 100 infants, 84 girls and 16 boys, ages up to 1 year with a first febrile UTI, increased inflammatory parameters and positive urine culture treated at the Pediatric Clinic II of the University Clinical Center Sarajevo (UCCS). The diagnostic was based on the imaging studies: ultrasonography, voiding cystourethrography (VCUG) and initial and control static renal scintigraphy (DMSA renal scan), to assess the renal parenchymal damage (RPD). The polymorphisms of the PAI-1 were determined based on polymerase chain reaction technique. The distribution of PAI-1 genotypes and the allele frequencies were compared between different groups of patients with febrile UTI. Results Results presented that 66 infants had acute pyelonephritis (APN) and 22 had vesicoureteral reflux (VUR). On initial DMSA renal scan examination, we detected no RPD in any patient. After 6 months, the repeat DMSA renal scan revealed the presence of RPD in 18 (27%) out of 66 infants with APN. Distribution of PAI-1 genotypes was not different between various groups of patients with febrile UTI. Conclusions The results of our study have not shown that individual genetic variation in PAI-1 is an independent variable that predispose same of children for RS after first febrile UTI. Maybe that yet unknown gene polymorphisms together with geographical and /or socio-economic differences can influence on the development of RS.

BACKGROUND Coronary artery anomalies (CAAs) are congenital variations of one or more of the coronary arteries and they are an uncommon but important cause of chest pain and, in some cases, sudden cardiac death. Anomalies of coronary arteries may be found incidentally in 0.3-1% of healthy individuals. The three types of coronary artery anomalies are anomalies of origin, anomalies of course and anomalies of termination. The purpose of our study was to estimate the frequency of CAAs in Canton Sarajevo, B&H, and to deteremine the prevalence of origin, course and termination anomalies of coronary arteries. SUBJECT AND METHODS This was a retrospective analysis of 919 patients who underwent Coronary CT Angiography to determine CAAs in the period from 2013 to 2017. RESULTS In our study, total number of CAAs have been found among the 130 patients (14.12%) out of which anomalies of origin are found at 14 patients (1.52%), anomalies of course at 115 patients (12.5%) and anomaly of termination in 1 patient (0.1%). Out of 14 cases in total anomalies of origin, anomalies of origin of the left coronary artery are observed among 11 patients (1.2%), and anomalies of origin of the right coronary artery among 3 patients (0.3%). From mentioned 14 cases of the anomalous origin of the coronary arteries, anomalies with clinical significance (interarterial, malignant course) of the coronary arteries are found among 6 patients (0.65%) and anomalies without clinical significance are found among 8 patients (0.87%). Coronary artery anomalies of origin with malignant course are devided in two groups: LMA from right sinus of Valsalva with interarterial course observed in 4 patients (0.43%) and RCA from left sinus of Valsalva, also with interarterial course in 2 patients (0.21%). We found 4 patients (0.43%) with separated origin LAD and LCX, without LMA. The preavlence rates of separate origin of RCA and conus artery, anomaly origin of the LCX from right coronary sinus, anomaly origin of the LMA from posterior coronary sinus and LMA from right coronary sinus without interarterial course were seen in 0.1% of patients. Among 115 cases of anomalies of course 111 cases (12.07%) belongs to bridging (37 cases to LAD; 25 cases to D1 and D2 and 49 to ramus intermedius), and 4 cases (0.43%) belongs to intraatrial course of RCA. Anomaly of termination presented with fistula between LCX and coronary sinus was found only in 1 case. CONCLUSION Coronary CT angiography is an excellent tool for diagnosis of CAAs regarding origin, course and termination of the coronary arteries.

Introduction: Accessory renal arteries play a significant role in kidney and abdominal aorta surgery, and renovascular hypertension. In the published literature, the frequency varies considerably, depending on the size of the sample, the method of examination and the ethnic group. Materials and Methods: The aim of this study is to determine the general frequency of accessory renal arteries, their frequency in relation to gender, the origin and the vascularization area, and to determine the differences in left-right and bilateral distribution. Results and Discussion: CT scans of 1357 patients were retrospectively analyzed. Accessory renal arteries were recorded in 35.5% of patients, with a statistically significant difference in male and female incidence (p<0.05) with a ratio of 1.4 : 1. Accessory arteries occur more commonly unilaterally (p<0.05) than bilaterally with a ratio of 4 : 1. Unilateral accessory renal arteries occur at approximately the same frequency at right and left side 1.1 : 1, without statistically significant differences in frequencies (p>0.05). Of the total number of noticed accessory renal arteries 76.7% was originated from abdominal aorta (AA), 23% from renal artery and 0.3% from CIA, with a ratio of 3.3: 1 : 0.0005. Conclusions: The study showed a relatively high frequency of accessory arteries and described their anatomy in detail, which can be of great importance in surgical interventions on abdominal aorta, kidneys, and in case of kidney transplantation.

Aim: The aim of this study is to prove the advantages of combined use of T2 weighted three dimensional (T2 W 3D) and T1 weighted three dimensional contrast medium enhanced (T1 W 3D CE) magnetic resonance (MR) urography in displaying urinary tract in child population. Material and methods: Total of 120 patients were included in the study, 71 (59%) male patients and 49 (41%) female patients. The study was conducted on the Radiology clinic, University of Sarajevo Clinical Center, during the period from February to November 2016. Patients were examined on the 1.5T and 3T MRI, with standard protocol which includes T2 W 3D and T1 W 3D contrast medium enhanced MR urography. In the post procesing quantitative measurement of signal intensity and evaluation of the display quality in the area of renal pelvis, middle of ureter and the mouth of the ureter were done. Measurement was concluded on Syngo software B13. Results: Analyzing the acquired data and statistically processing them we got results which have shown higher signal intensity of measured structures on T1 W 3D contrast medium enhanced MR urography on the level p<0.01 and p<0.05 compared to T2 W 3D MR urography in patients that had normal dynamics of contrast medium secretion. However, in kidneys with decreased function, T2 W 3D MR urography provided higher signal intensity and better display compared to T1 W 3D contrast medium enhanced MR urography on the level p<0.05 and p<0.01. Conclusion: T2 W3D MR urography is useful in imaging nonfunctional kidney as well as in patients prone to allergic reactions, where as T1 W3D CE MR urography is at an advantage over T2 W 3D MR urography in imaging the kidney functionality, kidney dynamics measurement, it provides higher MRI signal intensity required for clear 3D reconstructions.