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Hui-Ming Lin, E. Colak, T.J. Richards, F. Kitamura, L. Prevedello, Jason Talbott, Robyn L. Ball, E. Gumeler et al.

This dataset is composed of cervical spine CT images with annotations related to fractures; it is available at https://www.kaggle.com/competitions/rsna-2022-cervical-spine-fracture-detection/.

Background: MRI techniques of the lumbar spine have not provided data on the effect of gravity on the spine and on the relationship of anatomic structures during its action. Because conventional MRI examinations of the spine are usually performed in the supine position these are often exacerbated by standing upright and are not evident in the supine position the loading conditions differ from those known to cause symptoms in patients with lumbar instability. Axial loading imaging may improve diagnostics in the clinical management of LBP and lead to appropriate treatment decisions. Objective: The aim of this study is to determine the significance of alMRI in detecting the morphologic changes of the lumbar spine caused by axial loading and to compare it with conventional MRI images of the lumbar spine without loading. Methods: The study was conducted as a prospective, descriptive clinical trial. Imaging was performed with a MRI 1.5 T in the head-first supine position. Imaging was performed in two acts: without load and under load. Loading for alMRI was performed with the DynaWell L-Spine device. The onset of loading was 10 minutes before the start of alMRI. The loading continued throughout the imaging procedure. The height of the IV, AP and LL diameters of IV, IV disk surface area, DSCA and width of the IV foraminas before and under load was measured. Results: After evaluating the changes in the height and size of the lumbar disks, the size of the DSCA, and the narrowing of the intervertebral foramina significant differences were found between the images before and after axial loading. Conclusion: alMRI provides information on morphological changes of all segments of the lumbar spine. This data represents significant information that can lead to more accurate and effective treatment of LBP.

A. Šehić, Fuad Julardžija, Hadžan Konjo, D. Bulja, H. Sefo, Sandra Zubović

Uvod: Do sad korištene tehnike magnetno rezonantnog oslikavanja lumbalne kičme nisu davale podatke o djelovanju sile gravitacije na kičmu, te o odnosu anatomskih struktura prilikom djelovanja iste. Budući da se konvencionalni MRI pregledi kičme obično izvodi u ležećem položaju, u funkcionalnom mirovanju, stanje opterećenja se razlikuje od stanja za koje se zna da izaziva simptome kod pacijenata pogođenih nestabilnošću lumbalne kičme, to se često pogoršava uspravnim stajanjem i nevidljivo je u ležećem položaj. alMRI može poboljšati kvalitet dijagnosticiranja patologije lumbalne kičme i dovesti do lakšeg odlučivanja o daljem tretmanu. Cilj ovog istraživanja je utvrditi značaj alMRI u otkrivanju morfoloških promjena lumbalnog dijela kičme uzrokovanih aksijalnim opterećenjem i uporediti ga sa konvencionalnim MRI snimcima lumbalne kičme bez opterećenja. Metode: Studija je provedena kao prospektivno, deskriptivno kliničko ispitivanje. Snimanje je izvedeno na MR aparatu 1,5 T u ležećem položaju. Snimanje je izvedeno u dva čina: bez opterećenja i pod opterećenjem. Opterećenje za alMRI obavljeno je DynaWell L-Spine uređajem. Početak opterećenja bio je 10 minuta prije početka snimanja alMRI, a opterećenje se nastavilo tokom čitave procedure snimanja. Izmjerena je visina inetrevtebralnih (IV) prostora, AP i LL prečnik IV diska, površina IV diska, površina duralne vreće i širina IV foramena prije opterećenja i pod opterećenjem. Rezultati: Nakon evaluacije promjena visine i veličine lumbalnih diskova, površine duralne vreće i širine intervertebralnih prostora utvrđene su značajne razlike između slika prije i pod aksijalnim opterećenjem. Zaključak: alMRI daje informacije o morfološkim promjenama svih segmenata lumbalnog dijela kičme. Ovi podaci predstavljaju značajnu informaciju koja može dovesti do preciznijeg i efikasnijeg liječenja LBP.

D. Bulja, Jasna Strika, M. Jusufbegović, M. Bečirčić, A. Šehić, F. Julardžija, A. Beganović, F. Zukić et al.

Introduction: Axial-loaded magnetic resonance imaging (MRI), which can simulate an upright position of the patient may cause a significant reduction of the dural sac cross-sectional area (DCSA) compared with standard MRI, thus providing valuable information in the assessment of the lumbar spinal canal. The purpose of this study was to investigate excessiveness of the change in DCSA and depth of lateral recesses (DLRs) before and after axial-loaded imaging in relation to body mass index (BMI) of the subjects.Methods: Twenty patients were scanned to evaluate DCSA and DLR at three consecutive lumbar spine intervertebral disc levels (L3/4, L4/5, and L5/S1) on conventional-recumbent MRI, and after axial loading were applied.Results: Axial-loaded MRI demonstrates a significant difference of DSCA in comparison to conventional MRI. Furthermore, results show a significant correlation between the DCSA and BMI on level L3/L4, both before and after axial loading MRI. With axial loading, there is a reduction of DSCA of 12.2%, 12.1%, and 2.1% at the levels L3/L4, L4/L5, and L5/S1, respectively. After axial loading has been applied, the depth of the neural foramen has been reduced by an average of 10.1%.Conclusion: Axial-loaded MRI reduces DCSA and DLRs in comparison to standard MRI. Information obtained in this way may be useful to explain the patient’s symptomatology and may provide an additional insight that can influence the treatment decision plan accordingly.

Majda Handanović, F. Julardžija, A. Šehić, A. Sofić, M. Jusufbegović, D. Bulja

Introduction: Stroke is the second leading underlying cause of death globally and the leading cause of disability in adults. Stroke diagnosis should be performed quickly and efficiently to eliminate other potential causes of neurological deficits and to assess the time since the onset of clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential methods of detecting and evaluating stroke type and treatmentoptions. Diffusion and perfusion MR imaging is recommended for early stroke diagnosis, as well as for the selection of patients for recanalization therapy, and is considered effective in assessing treatment outcomes. The objectives of this study were to demonstrate the diagnostic value of diffusion and perfusion imaging in the diagnosis of acute ischemic stroke, analyze the role of magnetic resonance imaging in the selection of patients with acute stroke for recanalization therapy, and assess the effect of acute stroke complicity.Material and methods: The research is designed as a systematic review of the primary scientific research literature, which was published in English in relevant scientific databases (PubMed, Google Scholar, Medline) from 2014 to 2021.Results: 14 scientific research papers were singled out and the general characteristics of the study were analyzed (country, authors, year of publication, title of the study, type of study, study objectives, research methods, results and conclusion). A quality assessment of the included studies with cohort design and randomized controlled studies was performed, and most belong to the category of high-quality studies with a smaller number of medium-quality studies. The overall percentage of detected AIS cases in isolated studies using the DWI and/or PWI sequence was 90.8%. At the same time, the outcome of recanalization therapy was assessed using MRI studies (the number of patients who developed adverse events with functional data outcome 30 or 90 days after the procedure was observed). Comparison of MRI and CT imaging protocols provided data on the total percentage of detected acute stroke cases using CT imaging protocols (68.9%) and MRI imaging protocols (88.5%), which is why MRI is considered a superior method.Conclusion: Although CT is a suitable method for visualizing bleeding and also for early differentiation of hemorrhagic from ischemic stroke, if MRI imaging is available, it is recommended to use DWI, PWI, MRA sequences for a more accurate diagnosis of stroke in the acute phase.

Mirela Lisičić-Konaković, Aida Lokvančić-Bekto, Amela Kulašević, D. Bulja

OBJECTIVE To present a rare disease, and to point out that clinical manifestations treated for a long period of time without an adequate response to therapy may be a manifestation of a rare disease. CASE REPORT We present the case of a 3-year-old girl who had been drinking a large amount of water for the previous ten days with frequent urination, and who experienced the worsening of symptoms of scalp dermatitis that had been treated for a year without success. Physical examination revealed a maculopapular rash on the scalp, neck and both ear shells, and exophthalmos of the right eye with periorbital edema. Magnetic resonance imaging of the orbits showed extensive lesions of the skull bones. Further diagnostic evaluation revealed similar lesions in other bone structures. Biopsy of the affected region, microscopic and immunohistochemical analysis led to diagnosis of Langerhans cell histiocytosis. CONCLUSION Langerhans cell histiocytosis mostly occurs in the first three years of life. The incidence is 4-5 patients per million children under 15 years of life. The clinical presentation is highly variable, and can range from isolated, self-healing skin and bone lesions to life-threatening multisystem diseases. Due to the diverse clinical picture, that is often unrecognized, these patients are often referred to other specialists, resulting in the treatment of individual symptoms rather than the underlying disease.

K. Zeleňák, A. Krajina, L. Meyer, J. Fiehler, Esmint Artificial Intelligence And Robotics Ad Hoc, D. Behme, D. Bulja, J. Caroff et al.

Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.

D. Bulja, O. Abud, M. Jusufbegović, S. Zubović

Experience in managing thromboembolic complications of distal blood vessels during coil embolization in the case of subarachnoid hemorrhage (SAH) is still limited. This is the presentation of the case of a 23-year-old man with a ruptured small aneurysm who experienced thromboembolic occlusion during coil embolization. Mechanical thrombectomy resulted in complete recanalization of the occluded branches without ischemic complications. This case should be used for the use of mechanical thrombectomies as an effective rescue strategy and treatment of distal arteries occlusions of the brain.

Poster: "ECR 2020 / C-11002 / A spectrum of imaging findings in the hydatid disease in the pediatric population: A pictorial essay " by: " M. Becircic 1, I. Sefic-Pasic1, D. Bulja1, O. Ali Abud2, S. Vegar-Zubovic1; 1Sarajevo/BA, 2Sarajevo, sarajevo/BA"

D. Bulja, Jasmin Havić, S. Vegar-Zubović, M. Jusufbegović, A. Šehić, F. Julardžija

Vertebral artery (VA) fenestration is a rare vascular anomaly. It most commonly occurs in extracranial segments of the VA. This congenital anomaly can occur during the various stages of embryonic development of the VA. 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 a key to avoid iatrogenic injury during endovascular diagnostic and therapeutic interventions. Here, we present incidental findings of VA fenestration in a 46-year-old woman evidenced by computed tomography angiography of the neck’s blood vessels after I.V. contrast medium applications.

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