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Computed tomography (CT) is a diagnostic imaging process that uses ionising radiation to obtain information about the interior anatomic structure of the human body. Considering that the medical use of ionising radiation implies exposing patients to radiation that may lead to unwanted stochastic effects and that those effects are less probable at lower doses, optimising imaging protocols is of great importance. In this paper, we used an assembled 3D-printed infant head phantom and matched its image quality parameters with those obtained for a commercially available adult head phantom using the imaging protocol dedicated for adult patients. In accordance with the results, an optimised scanning protocol was designed which resulted in dose reductions for paediatric patients while keeping image quality at an adequate level.

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For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection.

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Circulation of the Omicron variant with the reemergence of the N501Y mutation along with many others in the spike protein has once again stirred the academic community. Interestingly, tracing the genetic diversity of SARS-CoV-2 shed light on a less frequent N501Y + Delta variant which has been in the global circulation for some time before the Omicron appearance. This paper aims to present the molecular characteristics of the SARS-CoV-2 Spike_N501Y + Delta variant detected in Bosnia and Herzegovina. The study was conducted during November and December 2021. All patients were tested using real-time RT-PCR for detection of SARS-CoV-2. A representative number of SARS-CoV-2 positive samples was pre-screened using VirSNiP SARS-CoV-2 Spike N501Y kit. The characterization of the viruses was carried out with Illumina RNA Prep with enrichment and the Respiratory Virus Oligo Panel kit. Among the analyzed sequences, we found two isolates of the Delta variant that differ from their most related clade- GK AY.4.3 in additional mutations N501Y and L54F. In this study, we described the presence of a rare form of Delta variant with Spike_N501Y mutation in the shadow of the Omicron emergence. Despite the set of mutations in the Spike protein, this form of Delta variant does not indicate the large-scale consequences for the general population. Further functional studies of this form could provide more information about its antigenicity and infectivity.

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A fetus with suspicion for holoprosencephaly and various brain malformations were seen on ultrasound and send for magnetic resonance imaging (MRI). Immediately after the birth of the female patient ultrasound and MRI was made which confirmed lobar holoprosencephaly. Fetal MRI stands out as a powerful diagnostic tool for detecting anomalies and other disorders. By developing new sequences and raising image quality will enable visualization of small details.

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OBJECTIVE: The aim of the study was to evaluate the prognostic value of the maximum standardized uptake value (SUVmax) of 18F-Fluorodeoxyglucose (18F-FDG) PET/CT in patients with metastatic colorectal cancer, and to compare it with classical prognostic markers. MATERIALS AND METHODS: The study included 70 patients with metastatic colorectal cancer who had not been treated for the metastatic disease. The patients underwent 18F-FDG PET/CT as part of their routine diagnostic reevaluation. During the analysis, the value of the largest tumor diameter and SUVmax was determined for the lesion with the highest SUVmax observed. The values of CEA and CA 19-9 were recorded 7 days before the PET/CT analysis. RESULTS: SUVmax and Carbohydrate antigen (CA)19-9 were found to be independent prognostic markers of disease progression within 12 months. Based on the Receiver Operating Characteristics (ROC) curve analysis, the patients could be divided into two groups: SUVmax≤4.1 vs. SUVmax>4.1. Patients with SUVmax values of 4.1 or less had significantly better progression-free survival within 12 months with an HR (95% CI) of 2.97 (1.4-6.3), relative to patients with SUVmax values above 4.1. CONCLUSION: SUVmax may be used as a novel prognostic marker of disease progression among patients with metastatic colorectal cancer. Values of SUVmax can be used to select patients with a more aggressive type of disease and higher risk for progression within 12 months of PET/CT analysis.

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Aim To evaluate vertebral bone marrow adiposity (BMA) using magnetic resonance spectroscopy (MRS) in postmenopausal women and to determine an association of bone density with bone marrow fat content. Methods This cross-sectional study included 120 postmenopausal women referred for osteoporosis screening. All women underwent assessment of bone mineral density by dual X-ray absorptiometry (DXA), who were divided based on T scores into osteoporosis (OST; n=60) and control group (CG; n=60). MRS was used to measure fat fraction (FF), lipid/water ratio (LWR) and fat content (FC) at vertebral spine (L1-L4). Results Mean age, menopause or reproductive period duration was not significantly different between women in OST and control group. Median LWR in OST group was significantly higher compared to CG, 31.5 (22.9-38.8) vs. 28.7 (13.7-37.3) (p=0.039). Median FC was significantly higher in OST compared to the control group, 47.0 (46.3-78.8) and 46.4 (44.3-48.6), respectively (p=0.011). FC was significantly negatively associated with BMD at lumbar spine (Rho=-0.042; p<0.001) and with BMD at hip (Rho=-0.64; p<0.001). In logistic regression model, FC remained independently associated with osteoporosis after controlling for confounders (age, menopause duration, reproductive period duration and body mass index) (OR=1.3; 95% CI 1.1-1.6). Conclusion Bone marrow adiposity is an independent predictor of low bone mass in postmenopausal women suggesting its role as a therapeutic target in postmenopausal osteoporosis management.

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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 ICOindex of central obesity) were measured and females underwent an assessment of bone mineral density by DXA and QCT. RESULTS: Lumbar Spine (LS) T-score values were observed to be 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 with both 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.

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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.

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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.

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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.

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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.

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Aim The aim of this study is to investigate the possibilities of non-invasive diagnostic imaging methods, positron emission tomography/computed tomography (PET/CT) and CT, in clinical N staging of non-small cell lung cancer (NSCLC). Methods Retrospective clinical study included 50 patients with diagnosed NSCLC who have undergone PET/CT for the purpose of disease staging. The International association for the study of lung cancer (IASLC) nodal mapping system was used for analysis of nodal disease. Data regarding CT N-staging and PET/CT Nstaging were recorded. Two methods were compared using χ2 test and Spearman rank correlation coefficient. Results Statistical analysis showed that although there were some differences in determining the N stage between CT and PET/CT, these methods were in significant correlation. CT and PET/CT findings established the same N stage in 74% of the patients. In five patients based on PET/CT findings the staging was changed from operable to inoperable, while in four patients staging was changed from inoperable to operable. Conclusion PET/CT and CT are noninvasive methods that can be reliably used for N staging of NSCLC.

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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.

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Aim To investigate a correlation between calculated creatinine clearance as a measure of kidney's functional abilities and ultrasonographically determined kidney volume, which represents actual size of the kidney, in fact residual renal mass in chronic kidney disease, in order to determine possibilities of ultrasound as a diagnostic method in diagnosing and follow up of chronic renal disease. Methods Prospective study included 150 patients with registered demographic and anthropometric data, and also with relevant laboratory tests of renal function. Longitudinal diameter, thickness and width of the kidney and renal volume calculated according to the Dinkel's formula were measured by ultrasound. A correlation between the measured volume of the kidneys and calculated creatinine clearance was done by the Spearman method, with statistical significance of p<0.05. Results Statistically significant correlation between the estimated creatinine clearance values and the average of the calculated values of kidney volume was found (p<0.01). Average value of the kidneys' volume showed a linear decrease with the progression of chronic kidney disease: the kidney volume in the control healthy group was 171.7 ± 32.6 mL (95.22- 229.59 mL), and in the subjects classified in stage IV it was 74.7 ± 24.6 mL (43.22-165.65 mL). Conclusion Calculated volume of kidney well correlated with creatinine clearance as a measure of functional ability of the kidneys and with the stage of chronic renal disease. It can be used in clinical practice for monitoring of chronic kidney disease in conjunction with other clinical and laboratory parameters.

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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.

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AIM: To analyze the usefulness of five ultrasound parameters (ureteral dilatation, renal pelvis dilatation, renal parenchyma width reduction, calyceal dilatation, and urothelial reaction) in detecting vesicoureteral reflux (VUR). METHODS: The study included 101 patients with diagnosed and therapeutically treated urinary infection. The ultrasound examination and voiding urosonography (VUS) were carried out according to a standard protocol. In the group of patients with proven VUR the presence of the indirect ecomorphological signs of VUR was evaluated. RESULTS: The referral diagnosis urinary tract infection was present at the admission in 53 patients, while the remaining 48 patients were admitted with the diagnosis of infectio tractus urinarii recidivans. Pathological VUS was found in 53 patients. The ultrasound parameter with the highest sensitivity, specificity, and negative predictive value (77.4%, 79.2%, and 76.0%, respectively) in detection of VUR was urethral dilatation, while the parameter with the highest positive predictive value (62.5%) in detection of VUR was urothelial reaction. CONCLUSION: In case of ultrasound verification of ureteral dilatation or urothelial reaction, especially in if the urinary infection has proved, it is necessary to exclude the existence of VUR.

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Lobus v. azygos (lobe of the azygos vein, azygos lobe) is an accessory lobe of the right upper lobe of the lung that corresponds to the anatomical variety. The presence of expansive lesions in it represents unusual radiographic findings. This paper presents the case of a patient with an extensive expansion process in azygos lobe, radiologically diagnosed by standard radiography (X-ray) and Multislice Computed Tomography Scan (MSCT). The process was subsequently treated surgically and confirmed histologically as a non-small-cell lung adenocarcinoma.

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This article discusses the possibilities of diagnosing abdominal imaging in patients with rectal cancer, detecting lesions and assessing the stage of the lesions, in order to select the appropriate therapy. Before the introduction of imaging technologies, the diagnosis of colorectal pathology was based on conventional methods of inspecting intestines with a barium enema, with either a single or double contrast barium enema. Following the development of endoscopic methods and the wide use of colonoscopy, colonoscopy became the method of choice for diagnosing colorectal diseases. The improvement of Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI), gave us new possibilities for diagnosing colorectal cancer. For rectal cancer, trans-rectal US (TRUS) or endo-anal US (EAUS) have a significant role. For staging rectal cancer, the Multi Slice Computed Tomography (MSCT) is not the method of choice, but Magnetic Resonance Imaging (MRI) is preferred when it comes to monitoring the rectum. The role of the MRI in the T staging of rectal cancer is crucial in preoperative assessment of: thickness - the width of the tumor, the extramural invasion, the circumference of resection margin (CRM), and the assessment of the inclusion of mesorectal fascia. For successful execution of surgical techniques, good diagnostic imaging of the cancer is necessary in order to have a low level of recurrence. According to medical studies, the sensitivity of FDG-PET in diagnosing metastatic nodals is low, but for now it is not recommended in routine diagnosis of metastatic colorectal carcinoma.

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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.