Abstract Malignant peritoneal mesothelioma is an extremely rare and poorly recognized neoplasm in children. A 5-year-old boy presented with a 1-year history of progressive painless abdominal distension. A CT revealed a 19 × 19 × 11 cm3 cystic mass in the right hemiabdomen, without infiltrating the surrounding structures. The tumor was completely removed by surgery. The microscopic and immunohistochemical analyses confirmed peritoneal mesothelioma. Comprehensive genomic profiling revealed no major driving mutations including BAP1, no fusions, but with amplifications of AURKA, AURKC, HLA-1B, ZNF-217, OR5F1 and MEN1 genes. Imaging follow-up 3 months after surgery revealed metastatic disease. The patient died of pneumonia at another hospital shortly after the last follow-up examination at our institution. Pediatric peritoneal mesothelioma is an extremely rare malignancy with limited targeted options and a poor prognosis. Some of the identified molecular genomic biomarkers require further exploration and validation in this cancer.

Abstract Lipofibromatosis (LF) is a rare benign fibrofatty tumor of infancy and childhood with a predilection for distal extremities, poor margination, and a high local recurrence rate. We report a toddler who presented with an LF involving her right labiocrural fold. Imaging showed a soft tissue mass extending through the right labiocrural fold with possible infiltration into the underlying muscles. The mass was excised entirely, preserving adjacent structures. The histopathologic report revealed the mass to be LF. A 3-year follow-up revealed no disease recurrence. No other cases of LF in this localization have been presented in the literature. Despite its rarity, LF should be considered in diagnosing soft tissue neoplasms in children. Accurate diagnosis and proper surgical management with complete resection are essential to reduce the postoperative recurrence risk.

Introduction: Computed tomography angiography (CTA) represents the gold standard as a method for the diagnosis of carotid artery diseases. The current topic is the use of CTA for the evaluation of carotid arteries with a reduction in the dose of contrast agent and dose of ionizing radiation, which, with adequate preparation, would enable the use of this method in some risk groups. The aim of this study was to evaluate the feasibility and image quality of a new low-dose CTA protocol in comparison with a standard protocol. Methods: Forty patients with recumbent ischemic stroke were included in the study, twenty of whom underwent lowdose CTA, and the remaining twenty underwent a standard CTA protocol of the carotid arteries. Results: No significant difference was found between the mean values of CT number (Hounsfield unit), signal-to-noise ratio, contrast-to-noise ratio, and subjective assessment of image quality in the comparison of the control and experimental groups. CT dose index, volume, and dose length product were significantly lower in patients who underwent lowdose carotid CTA. There was no significant difference in the degree of carotid stenosis between color Doppler and CTA. Conclusion: The use of the low-dose protocol for carotid CTA allows the application of this method in risk groups, in which it was previously not possible to perform, with the same image quality in comparison with the standard protocol.

Aim To determine a prognostic value of cerebral blood flow parameters for the development of neurological sequelae in term neonates with hypoxic ischaemic encephalopathy (HIE). Methods We reviewed medical records of 47 term neonates with HIE who survived until the age of 12 months of life. According to the Sarnat and Sarnat clinical score, neonates were divided into 3 groups: mild HIE, moderate HIE and severe HIE. All included neonates had the colour Doppler brain sonography performed in the first 24 hours of life. The neurological assessment was done at the age of 12 months of life by using the Denver Developmental Screening Test (DDST). Logic regression analysis was performed using the colour doppler brain sonography parameters with the development of neurological impairment as the primary outcome. Results Out of 47 neonates, 19 (40.4%) were with mild, 17 (36.2%) with moderate and 11 (23.4%) with severe HIE. The values of cerebral blood flow parameters and resistance index (RI) significantly correlated with the neurological impairment at the age of 12 months of life (p<0.001). The limit value of RI indicating the poor neurodevelopmental outcome was 0.81, sensitivity 80%, specificity 85.3%, positive predictive value 52.2% and negative predictive value 95.2%. Conclusion The cerebral blood flow parameters measured with colour doppler brain sonography are good indicators of the severity of HIE and later neurodevelopmetal outcome.

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.

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.

NUT-midline carcinoma is a rare and very aggressive tumor, with fast progression and poor prognosis. It should be suspected in poorly differentiated tumors, especially if located in midline structures of the head, neck, and thorax. It is characterized by gene translocation of nuclear protein in testis (NUT) gene from chromosome 15, most frequently to bromodomain containing protein 4 (BDR4) gene on chromosome 19. We present a case of mediastinal NUT-midline carcinoma in 11-year old boy.CT revealed a large mediastinal mass on the right side, with elevated serum alpha-fetoprotein (AFP), neuron-specic enolase (NSE), ferritin and lactate dehydrogenase (LDH). The patient was treated with chemotherapy, but the progression of disease was rapid, and he died within four months after the onset of disease.

Introduction: Diffusion weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within a tissue. The aim of this study was to show the significance of diffusion-weighted imaging (DWI) in differentiating pancreatic cystic formations from normal pancreatic parenchyma using MRI 1.5 T.Methods: A total of 52 patients were included in the study (25 with pancreatic cystic formations and 27 with normal MRI findings of the pancreas). DWI technique was used with b values of 0.500 and 1 000 mm2/s at 1.5 T. The signal intensity was measured, as well as apparent diffusion coefficient (ADC). Visual estimation of the signal intensity of detected cystic lesions was performed and compared to the normal appearance of pancreas.Results: The highest signal intensity of the cystic lesions with hyper-signal was observed with DWI b0 value in the pancreatic head (M 185.1 ± 47.205, p 0.05.Conclusions: Differences in signal intensity and ADC values have an important diagnostic value in differentiating the cystic formations from normal pancreatic parenchyma in MRI examination.