Moždani udar ili cerebrovaskularni inzult (CVI) je u današnje vrijeme jedan od glavnih uzroka smrtnosti i invaliditeta u svijetu. Veoma značajnu ulogu u dijagnostici CVI-a zauzima magnetna rezonanca (MR), koja se ogleda u mogućnosti klasifikacije i otkrivanju patofiziologije kako bi se pravovremeno i brzo postupilo sa terapijskim tretmanom ukoliko je došlo do pojave CVI-a. Ciljevi: Uporediti kvalitet prikaza CVI-a  između T2 FLAIR i T2 sekvence, utvrditi utjecaj lokalizacije CVI-a na intenzitet signala, utvrditi utjecaj vremena  pojave CVI-a na intenzitet signala. Utvrditi smo kategorije pacijenata kod kojih najčešće nastaje CVI, kao i korelaciju između uputne i definitivne dijagnoze. Metode istraživanja: Istraživanje je dizajnirano kao retrospektivna deskriptivna studija. Rad je realiziran u Kliničkom centru Univerziteta u Sarajevu, na Klinici za radiologiju. U studiju je uključeno 50 pacijenata kod kojih MR nalaz ukazuje na prisustvo CVI-a. Ispitivanje je obavljeno na MRI jedinicama jačine 1.5 i 3.0 T. Rezultati: Od ukupnog broja pacijenata 50 (100%), 32 su muškog pola (64%), a 18 (36%) ženskog pola. CVI je najčešće bio prisutan kod pacijenata muškog pola u grupi od 61-70 godine, dok je kod pacijenata ženskog pola najčešće bio prisutan u grupi od 71-80 godine. 52% pacijenata je imalo jedan od faktora rizika za nastanka CVI-a, HTA je bila prisutna kod 28% pacijenata a DM kod 22% pacijenata. T2 FLAIR sekvenca je imala veće vrijednosti intenziteta signala na lateralnom rubu CVI-a, dok je T2 sekvenca imala veće vrijednosti u centru i prednjem rubu CVI-a.  T2 FLAIR sekvenca je imala veći intenzitet signala na lokacijama: thalamus, mesencephalon, okcipitalno kortikalno subkortikalno i  područje kapsule interne. T2 sekvenca je imala veći intenzitet signala lokacijama: medula oblongata, parieto okcipitalno kortikalno subkortikalno, frontoparietalno paraventrikularno, parietalno kortikalno subkortikalno, frontoparietalno kortikalno subkortikalno, cerebelum i pons. Najčešća uputna  dijagnoza je bila CVI. Zaključak: T2 FLAIR sekvenca je senzitivnija kod prikaza akutnog i subakutnog CVI-a. T2 sekvenca je senzitivnija kod prikaza hroničnog CVI-a, čime radna hipoteza u ovom slučaju nije u potpunosti dokazana.

SUMMARY Background : Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). Subjects and methods : The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall’s tau-b statistics. Results : Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. Conclusion : 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.

BACKGROUND Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). SUBJECTS AND METHODS The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. RESULTS Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. CONCLUSION 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.

Introduction: The most common cause of intracranial bleeding in younger patients and children are vascular anomalies. Digital subtractions angiography presents a gold standard in diagnostics of aneurisms and vascular malformations. Our aim is to present our experience in using computed tomography angiography in diagnosing arteriovenous malformations. Methods: We included 150 patients with acute non-traumatic intracranial hemorrhage diagnosed by non-contrast CT examination, after which they were subjected to CT angiography of the cerebral vessels, and then underwent maximum intense projection and volume rendering reconstruction. Results:  Out of 150 patients with non-traumatic intracranial hemorrhage, in 121 (81%) a diagnosis of  aneurysm was rendered, while in 8 (5%) arteriovenous malformation was found. In 29 (14%) patients cause of bleeding was not identified. Patients with arteriovenous malformations, were age 17-77 years, with mean age 42.75 years. Five (62.5%) of them were female patients and three (37.5%) were male. Conclusion: Spontaneous non-traumatic intracranial hemorrhage is a significant cause of morbidity and mortality. Computed tomography angiography is sufficiently specific and sensitive in diagnosis of arteriovenous malformations in our experience.

AIM To evaluate possibilities of computed tomography (CT) perfusion in differentiation of solitary focal liver lesions based on their characteristic vascularization through perfusion parameters analysis. METHODS Prospective study was conducted on 50 patients in the period 2009-2012. Patients were divided in two groups: benign and malignant lesions. The following CT perfusion parameters were analyzed: blood flow (BF), blood volume (BV), mean transit time (MTT), capillary permeability surface area product (PS), hepatic arterial fraction (HAF), and impulse residual function (IRF). During the study another perfusion parameter was analyzed: hepatic perfusion index (HPI). All patients were examined on Multidetector 64-slice CT machine (GE) with application of perfusion protocol for liver with i.v. administration of contrast agent. RESULTS In both groups an increase of vascularization and arterial blood flow was noticed, but there was no significant statistical difference between any of 6 analyzed parameters. Hepatic perfusion index values were increased in all lesions in comparison with normal liver parenchyma. CONCLUSION Computed tomography perfusion in our study did not allow differentiation of benign and malignant liver lesions based on analysis of functional perfusion parameters. Hepatic perfusion index should be investigated in further studies as a parameter for detection of possible presence of micro-metastases in visually homogeneous liver in cases with no lesions found during standard CT protocol.

Magnetic resonance urography in children - when and why? Background. The aim of the study was to determine the potential of magnetic resonance urography (MRU) in evaluation of paediatric urinary tract pathologies. Patients and methods. Twenty-one paediatric urological patients were evaluated with T1, T2 prior and after and 3D gradient echo sequences after the contrast administration. Results were compared with findings obtained with ultrasound which was performed to all of patients, intravenous urography performed to 14 patients with the diagnosis of hydronephrosis and voiding cystouretrography performed to 6 patients where hydronephrosis was suspected to be caused by vesicoureteral reflux (VUR). Results. MRU not only established the cause of hydronephrosis in all 14 cases (5 ureteropelvic junction (UPJ) stenosis, 1 functional stenosis, 3 residual hydronephrosis, 1 combination of UPJ and vesico-ureteric junction (VUJ) stenosis with hydromegaureter, 2 fetal ureters and 3 insufficient broad ureteral orifices), but gave additional information about existing pathological conditions in all of patients compared to other previously performed examination (1 caliceal lithiasis, 4 UPJ stenosis, 1 VUJ stenosis, 1 neurogenic bladder, 1 hypotonic ureter, 1 urinary infection, 1 duplication of pelvis and ureter, 1 urinary retention and 1 fetal ureter). Other MRU findings were: 3 polycystic kidney disease, 1 caliceal cyst, 2 simple renal cysts, 1 long hypotonic twisted ureters and 1 hypertrophied column of Bertini. Conclusions. Because of the ability to acquire high contrast and spatial resolution images of the whole urinary tract in any orthogonal plane, MRU enables a precise detection and differentiation of pathological urological conditions. We believe that in the future, because of its advantages, MRU will replace traditional methods in the evaluation of urinary tract pathologies.

Cardiologists at the Cardiac Centre of the Clinical Centre of Sarajevo University performed invasive cardiology procedures in one room equipped with a Siemens Coroskop (Siemens Healthcare, Erlangen, Germany) unit with the possibility of digital cine imaging. The number of procedures performed with this unit is 1126 per year. The number of adults performing only diagnostic procedures is 816, therapeutic procedures 62 and both diagnostic and therapeutic 228. Twenty diagnostic examinations but no therapeutic procedure are performed on children per year. The workload is increasing year by year, with an average increase of 26 % per year. The X-ray system does not have a kerma area product (KAP) meter installed; therefore an external KAP meter was mounted on the X-ray tube. Gafchromic dosimetry films (International Specialty Products, Wayne, USA) were placed under the patient to record the skin dose distribution. The peak skin dose (PSD) was calculated from the maximum optical density of the dosimetry films. Dose measurements were performed on 51 patients undergoing therapeutic procedures (percutaneous transluminal coronary angioplasty and stent placement). Two patients received doses (KAP) larger than 100 Gycm(2). The PSD was higher than 1 Gy in 3 out of 16 evaluations, and one of these patients received a skin dose >2 Gy. No deterministic skin effects were recorded. The dosimetry results are similar to results reported in other countries. Invasive cardiac procedures deliver high doses to the skin that could cause deterministic effects (erythema). Physicians performing these procedures should be aware of these risks. More efforts should be put into the training of cardiologists in radiation protection.

An objective of mammographic screening is an early detection of breast cancer. At this moment there is no any known or published data about doses for women included into mammography screening in Bosnia and Herzegovina. Hence, a potential risk of cancerogenesis caused by radiation in this procedure is increasing. The object of this research was to define a mean glandular dose (MGD) at mediolateral (MLO) and craniocaudal (CC) projection for every individual breast and a total dose for a whole mammographic examination at the Radiology Clinic (of the University of Sarajevo Clinics Centre) for two different age groups (age: 40 – 49 and 50 - 64). Dose estimates were made for 63 patients who were subdued to a routine mammographic examination and they involved corrections in regard to variations of age, breast thickness and applied clinical spectra. A mean MGD for women between 40 and 49 was 1, 64 mGy for a MLO screen and 1, 36 mGy for a CC screen. For a group between 50 and 64 mean MGD was 1, 74 mGy for a MLO screen and 1, 45 mGy for a CC screen. Differences of MGD at MLO and CC examination are caused by a huger thickness of a compressed breast at MLO projection, which is 9 - 11 % huger than on CC projection. According to a performed correlation analysis one defined a remarkable significance between MGD and thickness of a compressed breast for MLO and CC screens ; the first age group (MLO: r=0, 852 , p < 0, 01 ; CC : r = 0, 817, p < 0, 01) and the second age group (MLO : r = 0, 721, p < 0, 01 ; CC : r = 0, 674 , p < 0, 01). MGD for the whole mammographic examination was 3, 11 mGy and it was significantly connected to breast thickness (r= 0, 77 , p < 0, 01).

SUMMARY. In this paper we were investigate possibility of using neural network algorithms in prediction of mean glandular dose (MGD), based on the measurement of the compressed breast thickness (CBT) in patients population between 40 – 65 years. According to the available information’s this is the first time that is someone explored this possibility of using neural networks in prediction of MGD based on the information of CBT. The primary aim of this method is reducing unnecessary overdose of X–ray exposure to patients. The study population consisted of 63 patients (234 screens) from 40 to 64 year during routine mammographic control. The best results were achieved with Levenberg-Marquardt learning algorithm where correlation factor between neural network outputs and targets was R=0.845 (71.4%).

The constantly present dilemmas concerning the existence/non-existence of a relationship between bone density andperiodontal disease gave us the idea to do this research. Ourstudy covered 128 female patients in post menopause whowere, on the basis of their densitometry findings, divided intothree groups (healthy, with osteopenia, with osteoporosis).All the patients under research were clinically examined anddental X-rayed (orthopantomogram). Results were processedstatistically and compared to the relevant reference data. Onthe basis of the obtained results we came to the conclusionthat there is a relationship between periodontal disease andsystemic osteoporosis.

Computed tomography and magnetic resonance colonography Background. Colon cancer is the second leading cause of cancer death in the western world. Adenomatous colorectal polyps, which are found in 30-50% of Americans more than 50 years old, are recognized as important precursors of malignancy. Probably most of the invasive colon carcinomas arise from polyps. For this reason an early detection of these polyps and their complete removal is a recognized strategy for the prevention of colon cancer. So far no single method for an early diagnosis of colon polyps or colon cancer offers high sensitivity and specificity along with low cost and good patient acceptance. Endoscopic colonoscopy allows the accurate detection of very small lesions and has since almost completely replaced fluoroscopy. Cross-sectional imaging techniques, including magnetic resonance imaging (MRI) and computed tomography (CT), are increasingly being considered imaging modalities for the detection of colorectal polyps. Conclusions. CT and MR colonography are new techniques for imaging of the colon. In symptomatic patients, these new techniques show promising results for the detection of polyps equal to or larger than 1 cm in diameter.

INTRODUCTION In advanced stage of renal carcinoma especially in right kidney because of proximity of inferior vena cava in most centers preoperative embolization of kidney is performed in purpose of facilitating surgery and reducing pre- and postoperative complications. In certain number of patients with indication for inoperability, complete embolization is performed in order.to prevent complications like bleeding. After intervention, surgical nephrectomy can be performed. In patients with the absolute contraindication for the surgical treatment, embolization represents the treatment of choice. MATERIAL AND METHODS Material for period of 7 years in Elbeck-Schoen Klinik and CCUS is presented in this paper. There were 72 patients, age range 3 to 92 years old, treated with 77 performed embolizations. Embolization was performed with PVA particles in order of achieving capillary embolization, while the principal trunk of renal artery was occluded with one or more coils until complete occlusion occurred. RESULTS Patients were divided in two groups: group A consisted of patients with preoperatively performed embolization, and to patients in group B embolization was performed as form of palliative care. In all patients in group A procedure was a success, and in one patient from group B procedure was needed to be repeated several times. DISCUSSION AND CONCLUSION As it is known from medical history first embolization was performed by Almgard in 1973 with purpose in providing safer surgical treatment to patient. Nowadays, this procedure got its widespread use in interventional radiology. Our experiences indicate successfulness of this procedure in most cases in preoperative management as well as in palliative treatment of patient. Postembolization syndrome occurred in all patients after intervention has been performed, and was successfully treated with symptomatic therapy. More severe complications were sporadic. In conclusion it might be said that embolization of inoperative tumors may increase both survival rate and quality of patients life.

Background. Acute appendicitis is a leading cause of the abdominal pain in children that need an urgent surgical treatment. Neither of individually clinical variables doesn’t have a real discriminational nor predictive strength to be used as the only diagnostic test. A goal of this study is to define ultrasound criteria of the acute appendicitis by appointing of ultrasound parameters for this pathological condition, determine the relation between ultrasound signs and pathohistological finding, determine the connection of several ultrasound signs with a degree of the inflammation of the acute appendicitis. Methods. In the prospective study with an ultrasound method we examine 50 patients with clinical signs of the acute abdomen. In these patients, the sonographic diagnosis is confirmed by the surgical finding, in fact with a pathohistological diagnosis. A basic, positive sonograph finding of the acute appendicitis was the identification of tubular, noncompresive, aperistaltic bowel which demonstrates a connection with coecum and blind terminal. In our work we analysed the lasting of the symptoms until the hospital intervention in patients stratified according to the pathohistological finding. We used ultrasound equipment- Toshiba Sonolayer with convex 3.75 MHz and linear 8 MHz probes. Results. From 8 ultrasound signs of the acute appendicitis, only an anterior-posterior (AP) diameter of appendices, FAT (width of periappendicular fat tissue) and a peristaltic absence are positive ultrasound signs of the acute appendicitis. Appendicitis phlegmonosa is the most common pathohistological finding in our study (44%). Perforate gangrenous appendicitis and gangrenous appendicitis are represented in more than half of patients (30% + 22%), which suggests a long period of persisting symptoms until a hospital treatment. A statistic analysis shows a great possibility for using values of AP diameter, width of periapendicular fat tissue, just like the values of mural thickness in the evaluation of the appendix inflammation level. Conclusions. Ultrasound is an absolute method of choice in the eventual doubt of the existing state of acute appendicitis, with 8 ultrasound signs that defined this pathological condition. AP appendix diameter, mural thickness and width of periapendicular fat tissue represents highly significant ultrasound criteria in the evaluation of the appendix inflammation level.