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.

Ultrasound device, essentially, consists of a transducer, transmitter pulse generator, compensating amplifiers, the control unit for focusing, digital processors and systems for display. It is used in cases of: abdominal, cardiac, maternity, gynecological, urological and cerebrovascular examination, breast examination, and small pieces of tissue as well as in pediatric and operational review.

Ultrasound devices and methodologies have been continuously evolving and becoming more important as tools in diagnostic medicine. Recently a new ultrasound diagnostic technique has been developed. Named sonoelastography, the technique enables evaluation of tissue elasticity and is based on differences in stiffness (hardness, compressibility, elasticity) of pathological changes and normal adjacent tissue. Sonoelastography (SE) is also known as Real-time tissue elastography (RTE), Real-time sonoelastography (RTSE), Tissue type imaging (TTI) and Ultrasound Strain Imaging Technology. It has been found useful in many medicine � elds and adopted readily by clinicians of different specialties. It gives more information than conventional ultrasound in evaluation of tumors, liver disease, skeletal muscles, rheumatoid nodules and other pathological changes. This review covers the basics of elastography, its applications, instruments, techniques, the scoring system and the indications for elastography. © 2011 University of Sarajevo Faculty of Health Studies

INTRODUCTION Radical retropubic prostatectomy is a therapeutic option for treatment of localized prostate cancer. The goal of radical prostatectomy is to completely remove the tumor while preserving erectile function and urinary continence as well as factors that determine the postoperative quality of life. There are many factors influencing sexual function after radical prostatectomy of localized prostate cancer. All factors can be divided into the preoperative, postoperative and intraoperative. In this paper we examine the significance of individual factors affecting erectile dysfunction following surgical treatment. MATERIAL AND METHODS The study included 36 patients who underwent nerve sparing radical prostatectomy at the Urology Clinic, Clinical Center of Sarajevo University in period from January 2009 until December 2010. RESULTS Out of 84 patients tested, radical retropubic prostatectomy with the reservation of neurovascular bundles was performed in 36 patients (42.8%). Of this number, both of the neurovascular bundles were preserved in 28 patients (77.7%) and one in 8 patients (22.2%). CONCLUSION The positive predictive factor for erectile function after radical retropubic prostatectomy is the preoperative sexual function, younger age, preservation of both neurovascular bundles and early rehabilitation therapy.

Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.

The second half of twentieth century is characterized by development of many digital methods in medical diagnostics, such as ultrasound. Each one of them (US, CT, MRI, DSA, termovision, nuclear medicine) has its advantages and limits, which resulted with their multidependencies. Continuous technical advancements improved diagnostically quality of methods mentioned above. Since 1950th many innovations resulted in diagnostical improvements of ultrasound: B-mode, Doppler and 3D modality, harmonic imagining and contrast. In last couple of years, big improvement was brought by introduction of sonoelastography, which is used for precise identification of character of pathoanatomical changes, as well as their stages.

As is well known, surgical treatment is the most effective therapy for non-small cell lung cancer, although only a small number of patients are suitable for this type of treatment (25%-30%). The outcome of operative treatment and prognosis greatly depends on accurate preoperative diagnostic process using the TNM classification. Until now, different diagnostic methods are used in the preoperative staging of this severe illness, including computer assisted tomography which acquired a leading role. Despite its high value as a method of assessing the operability of lung cancer, there is a smaller percentage of diagnostic oversights where the stage was under or over-estimated and where discrepancy between CT and operative findings was present. Prospective study was conducted on 60 patients with lung cancer in the period from December 2000 to December 2007. Among our respondents there were more males (6.5:1), average age was 56; the youngest patient was 32 and the oldest 70 years old. All patients underwent complete pulmonary and bronchial CT examination and then were subjected to one of the surgeries (28 lobectomies, 15 pneumectomy and 17 exploration thoracotomy) with pathohistological verification of findings. CT and postoperative lung cancer results were compared and statistically processed using the usual statistical methods. The results show that CT as a method in the preoperative clinical evaluation of patients with lung cancer is very useful because of its high diagnostic accuracy in determination of TNM stages of disease (83.33% accuracy, sensitivity 76.40%, specificity 93.00%, PPV 90.90% and 81.25% NPV). CT of thoracic organs still remains irreplaceable method in everyday clinical treatment of patients with lung cancer.

Cat Scratch Disease (CSD) is an infectious illness, caused by the Bartonella henselae bacterium. Besides the common infective symptoms, swelling in the axillary and cervical region is very common and is usually evaluated by Color Doppler US (CDUS) (among other diagnostic methods). The aim of this work is to present ultrasound findings of the Cat Scratch Disease. During 2002 and 2003, we followed four patients (three male and one female) by CDUS, with different manifestations of the disease. The average age of the patients was 12. In all four cases, the local and generalized lymphadenopathy was found, and in two cases we found multiple focal hepatolienal lesions as well. The enlarged lymph nodes were found, with heterogeneous echogenicity of the cortex, and increased number of the hiluses, disturbed vascular structure and non specific hemodynamic. Hepatolienal lesions were hypoechogenic, round, unclear outline, and poorly vascularised. CDUS has proved to be a very sensitive imaging method in detection of pathomorphologic and hemodynamic changes of superficial lymph nodes and focal lesions of visceral organs in CSD. Opposite to the high sensitivity, its specificity is much lower, because of similar findings in lymphoma, TB lymphadenopathy and multiple visceral abscesses. Detailed anamnesis, clinical findings, with laboratory and specific serological tests (IgG, IgM), US characteristics, sometimes percutaneous aspiration biopsy as well, are crucial in determination of etiology of the disease.

The field of diagnostic radiology continues to evolve, particularly in refinements to crosssectional techniques. Imaging of the urinary tract, as a result, has become more precise, with new digital procedures offering a great selection of options, and new imaging algorithms being implemented. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) provide higher soft-tissue contrast resolution than conventional radiography, as well as multiplanar imaging capability, resulting in significant advances in almost all areas of uroradiology. While such advances have produced new algorithms to approach the diagnostic imaging evaluation, each particular case also depends greatly on the equipment and professional available. In summary, ever changing uroradiology remains indispensable in the diagnosis and treatment of patients with urologic disorders. We discuss the digital imaging techniques used in uroradiology, with summaries of the advantages and disadvantages of the various techniques, and will end with a discussion comparing different Doppler imaging methods.

Infertility is a term with which we define lack of pregnancy among sexual partners within one year of regular intercourses without use of contraceptives. The term primary infertility includes lack of any previous pregnancy, while secondary infertility is a current infertility with previous successful pregnancy. Azoospermia is an inability to produce spermatozoids in testicles or represents normal production of the spermatozoids but the obstacle is somewhere in the ejaculatory paths. Transrectal ultrasonography (TRUS) provides us with the quality and most reliable data about the urinary bladder, prostate gland. Seminiferous tubule and ejaculatory ducts. The goal of this paper is to determine the role of TRUS in patients with azoospermia, in one significant sample of infertile respondents. During 2005 and 2006, among 35 patients with verified azoospermia, and which were involved in determination of infertility cause, also TRUS was performed as a mode of ultrasound diagnostic procedure. Average age of the patients was 35 years. Evaluation is done with use of ultrasound equipment HDI 4000-PHILIPS, with Color Doppler equipped with the transrectal ,biplane" probe of high frequency 9.5 MHz. There was 10 (29%) normal findings (29%), and 25 (71%) pathological. Also there was 8 (23%) dilatated vesicles, 6 (17%) wide ejaculatory ducts, 5 (13%) calcifications in vesicles. Atrophy and hypotrophy of vesicles was present in 3 (9%) cases and 3 (9%) central prostate cysts. TRUS is a useful diagnostic method in evaluation of seminal vesicles, ejaculatory ducts and prostate gland abnormalities. These abnormalities can cause azoospermia as the most important cause of infertility.

INTRODUCTION Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.

Erectile dysfunction (ED)--the consistent or recurrent inability of a man to attain and/or maintain, a penile erection sufficient for sexual performance--is a common health condition among men that is largely untreated. It is estimated that some degree of ED affects more than one half of all men over the age of 40--152 million men worldwide. That is a big problem, that needs appropriate treatment. After diagnostic evaluation of the patient, doctor decides what is the best treatment option for the patient, following his health condition. Choice of treatment options: physio-sexual therapy, oral drug therapy, topical drug therapy, transurethral drug therapy, intracavernosal therapy, hormonal treatment, vacuum devices and surgery. Nowadays the most important contemporary treatments of ED are peroral sildenafil and intracavernosal pharmacotherapy using vasoactive medicines. However, these drugs are not suitable to every patient. More noninvasive methods to treat ED, such as oral medication or locally applicable preparations are needed.

Color Doppler sonography (CDS--spectral, color and power), harmonic imaging techniques (THI, PHI), possibility of 3D analysis of picture, usage of contrast agents, have raised the values of ultrasound as a diagnostic method to a very high level. THI--non-linear gray scale modality, is based on the processing of higher reflected frequencies, that has improved a picture resolution, which is presented with less artifacts and limiting effects of obesity and gases. Ultrasound contrast agents improve analysis of micro and macro circulation of the examined area, and with the assessment of velocity of supply in ROI (wash in), distribution and time of signal weakening (wash out), are significantly increasing diagnostic value of ultrasound. Besides the anatomical and topographic presentation of examined region (color, power), Color Doppler sonography gives us haemodynamic-functional information on vascularisation of that region, as well as on pathologic vascularisation if present. Avascular aspect of a focal pathologic lesion corresponds to a cyst or haematoma, while coloration and positive spectral curve discover that anechogenic lesions actually represents aneurysms, pseudoaneurysms or AVF. In local inflammatory lesion, abscess in an acute phase, CDS shows first increased, and then decreased central perfusion, while in a chronic phase, a pericapsular vascularisation is present. Contribution of CDS in differentiation of hepatic tumors (hemangioma, HCC and metastasis) is very significant. Central color dots along the peripheral blood vessels and the blush phenomenon are characteristics of capillary hemangioma, peritumoral vascular ring "basket" of HCC, and "detour" sign of metastasis. The central artery, RI from 0.45 to 0.60 and radial spreading characterize FNH. Hepatic adenoma is characterized by an intratumoral vein, and rarely by a vascular hallo. Further on, blood velocity in tumor defined by Color Doppler, distinguishes malignant from benign lesion, where 40 cm/s is a rough border value. Values of DPI (Doppler perfusion index) over 0.3 and tumor index over 1.0 characterize primary, and lower values characterize secondary liver malignancies. In differentiation of benign and malign tumors of kidneys, besides the aspect of vascularisation, the maximal frequency altitude in tumor artery (the limit around 2.5 kHz) is very important. However, peripheral and penetrating blood vessels are most usually seen in RCC, less often in AML and bigger oncocytomas. CDS with contrast agent is very useful in making differential diagnosis of the focal lesions with 95% specificity for some lesions.

INTRODUCTION The injury of Achilles tendon most frequently occurs as a result of overburdening of the tendon, particularly in sportsmen (runners and jumpers) even though they are not rare in the rest of the population. Biomechanical distrubances on the burdening tendon, or its continuous burdening, result in the degenerative changes in the form of pathological tenosynovial adhesions in and around the tendon that precedes the tendon rupture. In the recent years conservative functional treatment increasingly became the method of choice due to final results of the treatment. Basic principle of this method of treatment is to establish disrupted balance between the synergist and the antagonist of the lower leg, which was caused by rupture. This helps to reduce the kinetics of the ankle and the knee joint, and to avoid long lasting classical immobilisation which has found its substitution in a vario stable shoe, which allows possibility of flexibile arthrodesis of ankle with usage of insole. MATERIALS AND METHODS The conservative functional treatment of the acute Achilles tendon rupture has been carried out on 19 patients during the period 1993-1998, at the University of Sarajevo, Clinical Center. Sex structure was 17 males and 2 female patients. Average age of the patients was 27,1 (working population). The study was shortterm with first results obtained after 12 weeks. Etiologically, in the mechanisms of the injury there were 15 spontaneous ruptures from jumps and 3 from in landing after a jump, and in a direct trauma there was one rupture reported. Two of these were sport injuries. Clinical evaluation has been done according to the Thermann score scale. Ultrasound diagnostics was done immediately after the injury, followed by control examinations in the 4th, the 8th, and the 12th week. If the vario stable boot is missing, the modified program can be applied. RESULTS After 12 weeks, the Thompson, the Simmond and the Matles signs were evaluated and the results were negative. No patient reported suffering pain. The muscular atrophy of the lower leg up to 2 cm was reported in six patients, and up 3 cm in 3 patients, while other patients had tolerable 0.5 to 1 cm atrophy. There were no reports of thromboembolism. The largest number of ruptures was verified on the crossing between the middle and the lower third by ultrasound examination (8). Complete ruptures were reported in 14 examinees, partial in 5. There were no reports of desinsertions and distensions. In the 12th week we followed the ultrasound adaptation, i.e. diastases of tendon ends in neutral position (0(0)) and functional with 20(0) of plantar flexion. There were 16 examinees without functional deficit, one with the reduced plantar flexion od 5(0), 1 with the reduced dorsal flexion od 5(0), and also one patient with 10(0) reduced dorsal flexion. After ten years (2003-2004) we reevaluated six patients according to the Thermann scor scale. Functional examinations each patients have been excellent. CONCLUSIONS All patients returned to their daily working activities. We did not record a single case with complicatoions. With regard to other methods of treatment the functional treatment is apparently without an alternative, but at the same time requires methods that seek full engagement of a surgeon, a physiatrist and the radiologist. In order to avoid compromising and make the treatment successful, it is necessary to keep up with the implementation protocol, to have available adequate corrective shoes or other means, and to possess certain level of clinical experience.

AIMS The EUS is a minimally invasive method, with a most specificness and sensitivity in verification of concrements in choledochus. The aim of this study is to compare the findings of conventional ultrasound with radial EUS in diagnosis of choledocholithiasis. PTS AND METHODS: 2o pts were included in the study, 13 females. All pts were under susceptibility of concrement presence in choledoch. From 32 examinees in 13 by the none methods was confirmed that they have the obstruction of this ethiolology. The rest 19 examinees underwent endoscopy by an experienced endosonographyst, completely independent of eventual findings by conventional US. Comparative method was done by an ultrasonographer, also uninformed of earlier procedures. RESULTS 5/20 pts (25%), were excluded from the study. 5/15 pts (33%) were females. Nine (60%) pts (2 males) examined by EUS, showed a presence of concrements in a choledoch, its size varying from 1 x 1 mm to 16 x 6 mm. US provided a very similar results, with minimal differences in the size of concrements (t = 1,706; p < 0.10). In 3 pts the EUS determined a presence of concrements in choledoch, with sizes varying from 1.5 mm to 4 mm, whilst US showed a susceptible changes with recommendation for further analysis. The EUS findings in 3 patients verified a small concrements in choledoch, while standard US did not show presence of these concrements. It is necessary to underline that last three patients underwent cholechistecthomy. CONCLUSION The radial EUS is a preferred method with excellent performance in verification of choledocholithiasis.