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Magnetic resonance imaging (MRI) is not the initial imaging technique in pediatric abdominal neoplasms, but it is an excellent method to assess tumor extension due to superb soft-tissue contrast. The main disadvantage is time-consuming procedure that frequently warrants general anesthesia in children. Novel CT machines provide excellent images of the body (e.g. lung parenchyma) with significantly reduced radiation burden, mostly without general anesthesia. Here we present typical pediatric abdominal tumors where MRI is inevitable part of treatment planning. With neuroblastoma MRI can accurately assess potential invasion of the spinal canal and bone marrow, which is beyond the scope of ultrasound. MRI is optimal modality to evaluate therapeutic response and detect residual or recurrent disease. It reliably reveals tumor necrosis, hemorrhage, and cystic degeneration, but cannot detect calcifications within the tumor tissue (e.g. neuroblastoma). Due to its capacity to comprehensively assess liver parenchyma, vascular and biliary structures, MRI is the method of choice to evaluate resectability of liver neoplasms. MR reliably reveals tumor invasion into the paravertebral soft tissues and neural structures of the spinal canal. Beyond morphology, MRI obtain functional information from the tissue when diffusion weighted imaging (DWI), dynamic contrast-enhanced MRI (DCE-MRI) or MR spectroscopy are applied. For example, high cellular tumor tissue or abscess will cause restriction of water diffusion which can be quantified. Increase of water diffusion corresponds to decrease in cellularity indicating favorable response to chemotherapy. Furthermore, using DWI we can guide biopsy needle to the most cellular part of the tumor to obtain representative sample. [ABSTRACT FROM AUTHOR]

Aim: Patella position has a significant effect on the appearance of clinical symptoms of pain and swelling of the knee joint as well as on the appearance of patellar instability. The aim of this study was to evaluate the reliability of patellar height measurement using the methods of Insall-Salvati, Modified Insall-Salvati, Blackburne-Peel, Caton-Deschamps and the plateau–patella angle. Subjects and methods: The study was conducted on 100 lateral knee radiographs of patients with a mean age of 51.14 years, who were examined at the Clinic for Orthopedics Surgery Lovran, over a period of one year. The average value of knee flexion on the analyzed lateral radiographs of the subjects was 36.57°. The measurements were done by two researchers and were repeated on two occasions at one-month intervals. Statistical methods were performed to analyze the precision and accuracy of the two methods using the Concordance Correlation Coefficient and the modified Pearson Correlation Coefficient. Results: The results showed that in the number of clinically diagnosed patella alta or infera there was no significant difference between the measurements of the two researchers in each of the applied patellar height measurement methods. Comparing the obtained measurement results based on calculations of the Concordance Correlation Coefficient, the Insall-Salvati method demonstrated to be the most reliable due to the highest precision (p1 = 0.8431, p2 = 0.8337) and satisfactory accuracy (Cb1 = 0.9171, Cb2 = 0.9275). The results of other measurement methods demonstrated that very good accuracy is achieved, but lower precision. Conclusion: The Insall-Salvati patellar height measurement method on lateral knee radiographs could be recommended as an optimal tool in daily clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Primary vaginal cancer is rare, comprising about 3% of all gynaecological malignancies. Solitary bone metastases to appendicular skeleton are extremely rare and there are only few published reports. We report the case of isolated metastasis in the tibia as a feature of primary squamous vaginal carcinoma. We present this case because of its rarity and for documentation and discussion purposes. Case report: We present a case of a 44-year old woman diagnosed with squamos vaginal cancer in June 2015. Computed tomography of the thorax, abdomen and pelvis revealed no distant metastases. She was treated with interstitial intracavitary brachytherapy and concomitant chemoradiotherapy. In March 2016 she was admitted to our hospital because of the swelling and the pain in the lower right leg. There was no history of trauma and plain radiographs were normal. Two months later, after further progression of pain, plain radiographs showed intramedullary permeative bone lesion with cortical disruption of tibial dyaphisis and local soft tissue swelling. MRI and core needle biopsy confirmed vaginal cancer metastasis containing tumor cells identical to the primary tumor. The patient was treated with radiotherapy and chemotherapy. Despite the treatment there was further progression of the disease with multiple bone metastases and eventually lung and brain metastases. Conclusion: This case report is another reminder that although extremely rare, solitary metastatic bone lesions of vaginal cancer are possible. Since symptoms mimic various benign conditions, it is important to consider bone metastasis as possible diagnosis in patients with progressive bone pain not responding to analgesic treatment. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To correlate tracheal width as measured by ultrasound with width measured by computed tomography (CT), and to evaluate the possible role of ultrasound in the selection of the proper size of left-sided double-lumen endotracheal tubes (LDLTs). Design: Two independent, prospective, observational clinical studies (Study 1 and Study 2). Setting: University hospital. Patients: Study 1 included 25 patients and Study 2 included 20 adult thoracic surgery patients who required a LDLT during anesthesia. Interventions and Measurements: In Study 1, CT measurements of tracheal width were made at the coronary plane 0.5 cm above the sternoclavicular joint; CT measurements of the left main bronchus diameter were made 1 cm below the carina. Ultrasound measurement of tracheal width was performed just above the sternoclavicular joint in the transversal section. In Study 2, patients'' tracheas were intubated with a LDLT based on ultrasound measurements. The frequencies of incorrect selections of LDLT and unsatisfactory lung collapse were analyzed. Main Results: There was a strong correlation between tracheal width as measured by ultrasound and tracheal width (r = 0.882, P < 0.001) and left main bronchus width (r = 0.832, P < 0.001) as measured by CT. In 5 cases (25%), the incorrect LDLT by ultrasound was selected; and one (5%) was found to have an unsatisfactory lung collapse. Conclusion: Measurement of the outer tracheal width by ultrasound can be a useful method for predicting the diameter of left main bronchus and for selecting a LDLT. [Copyright &y& Elsevier]

BACKGROUND AND AIMS: Computed tomography (CT), especially contrast-enhanced CT (CECT), provides important information on the severity and prognosis of acute pancreatitis (AP). Magnetic resonance imaging (MRI) has become a useful tool as an alternative to CT in the assessment of AP. The primary aim of our study was to determine the diagnostic value of nonenhanced MRI (NEMRI) to assess severity and predict outcome in patients with AP from the third to fifth day after admission. We also correlated MRI findings with CT and biochemical parameters. PATIENTS AND METHODS: The study included 101 patients (49 men, 52 women, median age 62 yr, range 20–82) with a diagnosis of AP admitted to our hospital between January 1, 2004 and June 31, 2005. The inclusion criteria consisted of a combination of clinical features, a typical case history, elevation of serum pancreatic enzymes, and diagnosis confirmed by imaging studies. Contrast-enhanced spiral CT exams were performed in all patients from the third to fifth day after admission, and Balthazar grade and CT severity index were calculated. All patients underwent NEMRI, and MR severity index (MRSI) was calculated. We also performed magnetic resonance cholangiopancreatography (MRCP) in all patients to detect bile duct lithiasis. RESULTS: Significant correlation between CECT and NEMRI was found for Balthazar grade ( P < 0.001) and the assessment of pancreatic necrosis ( P < 0.001), as well as between the combined severity indices (ρ= 0.819, P < 0.001). MRSI correlated with Ranson score (ρ= 0.656, P < 0.01), C-reactive protein (CRP) levels 48 h after admission (ρ= 0.502, P < 0.01), appearance of systemic complications (ρ= 0.576, P < 0.01), and length of hospital stay (ρ= 0.484, P < 0.01). Considering the Atlanta criteria as the gold standard and the Ranson score, no difference in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two methods was observed. Comparing the group of patients with presumed acute pancreatic hemorrhage with the group of patients with severe AP, we found a significantly higher APACHE II score on the first day ( P < 0.05), that the development of systemic complications was more frequent ( P < 0.05), and that the hospital stay and ICU management of patients with MRI signs of pancreatic hemorrhage tended to be longer. CONCLUSION: NEMRI is comparable to CECT in the early assessment of the severity of AP, and both methods are equally efficient in predicting local and systemic complications of AP. MRI has a potential advantage over CT in detecting bile duct lithiasis and pancreatic hemorrhage. [ABSTRACT FROM AUTHOR]

The aim of our study was to investigate iodine density (ID) and fat fraction (FF) on dual-energy computed tomography (DECT) in patients with acute pancreatitis (AP). This retrospective study included 72 patients with clinically confirmed AP and 62 control subjects with DECT of the abdomen. Two radiologists assessed necrosis and measured attenuation values, ID, and FF in three pancreatic segments. We used receiver operating characteristic (ROC) analysis to determine the optimal threshold for ID for the differentiation between AP groups. The ID was significantly higher in interstitial edematous AP compared to necrotizing AP and the control group (both p < 0.05). The ROC curve analysis revealed the thresholds of ID for detecting pancreatic necrosis ≤ 2.2, ≤2.3, and ≤2.4 mg/mL (AUC between 0.880 and 0.893, p > 0.05) for the head, body, and tail, respectively. The FF was significantly higher for pancreatitis groups when compared with the control group in the head and body segments (both p < 0.001). In the tail, the difference was significant in necrotizing AP (p = 0.028). The ID values were independent of attenuation values correlated with the FF values in pancreatic tissue. Iodine density values allow for differentiation between morphologic types of AP. [ABSTRACT FROM AUTHOR]

The aim of our study was to establish and compare the diagnostic accuracy and clinical applicability of published chest CT severity scoring systems used for COVID-19 pneumonia assessment and to propose the most efficient CT scoring system with the highest diagnostic performance and the most accurate prediction of disease severity. This retrospective study included 218 patients with PCR-confirmed SARS-CoV-2 infection and chest CT. Two radiologists blindly evaluated CT scans and calculated nine different CT severity scores (CT SSs). The diagnostic validity of CT SSs was tested by ROC analysis. Interobserver agreement was excellent (intraclass correlation coefficient: 0.982–0.995). The predominance of either consolidations or a combination of consolidations and ground-glass opacities (GGOs) was a predictor of more severe disease (both p < 0.005), while GGO prevalence alone was not. Correlation between all CT SSs was high, ranging from 0.848 to 0.971. CT SS 30 had the highest diagnostic accuracy (AUC = 0.805) in discriminating mild from severe COVID-19 disease compared to all the other proposed scoring systems (AUC range 0.755–0.788). In conclusion, CT SS 30 achieved the highest diagnostic accuracy in predicting the severity of COVID-19 disease while maintaining simplicity, reproducibility, and applicability in complex clinical settings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to raise awareness of how cherry pits can cause bowel obstruction in patients with colon cancer. Case report: A 68-year-old male presented to the emergency department with a history of constipation and left paraumbilical pain. A standing abdominal x-ray revealed air-fluid levels in the small and large bowel suggestive of ileus, and the CT scan confirmed the dilation of the small and large bowel with air-fluid levels and a stenosing neoplasm in the descending colon. The narrow, irregular lumen of the tumor was obstructed by a round foreign body. The CT scan showed a hypodense oval center and hyperdense shell consistent with a cherry pit. A surgical opening was made in the abdominal wall and a segment of the bowel was extracted (anus praeter), and the patient was discharged after recovery. Two months later, the patient was readmitted to the surgical department, and a planned surgery was performed after preoperative evaluation. However, peritoneal carcinomatosis was found intraoperatively, and the planned radical procedure was abandoned. He was referred to the Department of Radiotherapy and Oncology where he received chemotherapy cycles. The following year in September, the patient returned for the 12th cycle application. He felt well and was discharged with the recommendation to continue his current therapy. Conclusion: Bowel obstruction caused by a cherry pit is a rare condition but should be included in the differential diagnosis in patients with risk factors such as colon cancer. Colon cancer is a serious disease that requires careful nutrition and bowel management. [ABSTRACT FROM AUTHOR]

Early diagnosis of breast cancer leads to better survival and less aggressive treatment. Imaging techniques such as ultrasound, mammography and magnetic resonance imaging are the basic breast imaging techniques that can be used to detect lesions at a very early, noninvasive stage. Pathohistologic tissue analysis is considered the gold standard in diagnosis, so biopsy of suspicious lesions in the breast is an indispensable part of treatment. In general, image-guided breast biopsy is required for nonpalpable lesions, but it is also recommended for palpable lesions as it improves the accuracy of diagnosis. Ultrasound-, mammographic-, or magnetic resonance-guided breast procedures are reliable methods, and placement of a tissue marker after biopsy is a sign of good practice. Marking lesions after mammography-guided biopsy and lesions smaller than 5 mm is particularly important, as these lesions can be completely removed and preoperative marking is then much more difficult. The same principle applies to neoadjuvant treatment, where the tumor may have already completely regressed, so that marking the tissue enables precise surgical intervention. For marking of pathological lymph nodes, it is advisable to use specially markers that are clearly visible under all imaging modalities and allow precise marking of the lymph node during neoadjuvant treatment. Preoperative localization of nonpalpable lesions is used to optimize surgical excision to obtain negative margins without sacrificing normal tissue. This review also describes minimally invasive techniques such as thermal ablation, cryoablation, and high-frequency focused ultrasound as alternatives to surgical excision to reduce complications, achieve better cosmetic results, and shorten hospital stay. This review describes the spectrum of image-guided procedures performed at the Clinical Hospital Center in Rijeka. [ABSTRACT FROM AUTHOR]

Aim: The main goal of our research is to compare the thickness of the breast and the parameters of DBT and standard 2D mammography. Respondents and methods: The study included 200 respondents with an age range from 40 to 81 years, (median 60,5 ± 10,6). The respondents are divided into 2 groups depending on the type of mammograms they were subjected to. This retrospective analysis included tests performed on the mammography device Hologic Selenia Dimensions (Hologic, Bedford, Mass) in the period from February, 1st till March, 30th 2018. Results: Hi-square test excluded statistically significant difference in breast density. The T-test didn't show any statistically significant difference in breast thickness between two groups. The mean values of the overall glandular dose of the DBT for left and rigt breast were 0.53 mGy and 0,37 mGy, respectively (3.83 / -1mGy, p = 0.001, 3.82 / -0.9 mGy, p = 0.023). The difference was statistically significant and dose was 20% greater in DBT. Conclusion: Despite the statistically significant difference in the absorbed glandular dose between the two groups, it remains within the limits of acceptability according to the guidelines provided by the Ordinance on Conditions for application of sources of ionizing radiation for the purpose of medical and non - medical irradiation (OG 42/2018, 9.5.2018). Digital breast tomosynthesis with S-mammography is an important imaging modality in early detection of pathological breast changes. [ABSTRACT FROM AUTHOR]

Systematic review articles are considered as a part of relevant scientific and professional literature which has become an infallible part of everyday medical practice and a vital part in decision making. This scientific work is based on the systematic and strictly defined methodology of research, selection and analysis of available medical evidence which provides and answer to a specific scientific question. The Cochrane Collaboration is a world non-profit organizaton whose goal is to publish high qualitiy systematic reviews through detailed and rigorous methodology. Through out different scientific groups, authors publish Cochrane systematic reviews of interventions and diagnostic tests which are published in the Cochrane Database of Systematic Reviews. These reviews develope in several steps: question formulation, Cochrane group selection, title registration, writing and publishing a protocol and writing, publishing and updating a systematic review. In this article we wish to present the methodology of Cochrane systematic review development as a general insight into its complexity. [ABSTRACT FROM AUTHOR]

The spinal epidural space is located between the spinal dura mater and the vertebral column and extends from the foramen magnum to the sacral canal at the level of S2/S3. It is divided into anterior and posterior compartment. Due to its excellent soft tissue contrast magnetic resonance imaging is the gold standard for imaging and diagnosis of pathological processes of the spinal epidural space which differ in etiology. Many processes origin in the spinal epidural space or extend from adjacent structures and epidural space is a frequent location for metastatic processes. Due to the possibility of spreadingof the pathological processes along spinal nerves and the spinal cord, they may present with symptoms of radiculopathy or myelopathy. [ABSTRACT FROM AUTHOR]

Background and objectives: A radiologist’s work in detecting various injuries or pathologies from radiological scans can be tiresome, time consuming and prone to errors. The field of computer-aided diagnosis aims to reduce these factors by introducing a level of automation in the process. In this paper, we deal with the problem of detecting the presence of anterior cruciate ligament (ACL) injury in a human knee. We examine the possibility of aiding the diagnosis process by building a decision-support model for detecting the presence of milder ACL injuries (not requiring operative treatment) and complete ACL ruptures (requiring operative treatment) from sagittal plane magnetic resonance (MR) volumes of human knees. Methods: Histogram of oriented gradient (HOG) descriptors and gist descriptors are extracted from manually selected rectangular regions of interest enveloping the wider cruciate ligament area. Performance of two machine-learning models is explored, coupled with both feature extraction methods: support vector machine (SVM) and random forests model. Model generalisation properties were determined by performing multiple iterations of stratified 10-fold cross validation whilst observing the area under the curve (AUC) score. Results: Sagittal plane knee joint MR data was retrospectively gathered at the Clinical Hospital Centre Rijeka, Croatia, from 2007 until 2014. Type of ACL injury was established in a double-blind fashion by comparing the retrospectively set diagnosis against the prospective opinion of another radiologist. After clean up, the resulting dataset consisted of 917 usable labelled exam sequences of left or right knees. Experimental results suggest that a linear-kernel SVM learned from HOG descriptors has the best generalisation properties among the experimental models compared, having an area under the curve of 0.894 for the injury-detection problem and 0.943 for the complete-rupture-detection problem. Conclusions: Although the problem of performing semi-automated ACL-injury diagnosis by observing knee-joint MR volumes alone is a difficult one, experimental results suggest potential clinical application of computer-aided decision making, both for detecting milder injuries and detecting complete ruptures. [ABSTRACT FROM AUTHOR]

Aim: To report a case of a patient with hepatocellular carcinoma that directly invaded the right atrium, initially manifested with painless jaundice and cardiac insufficiency. Case report: A seventy-seven-year-old patient was admitted to the Department of Gastroenterology due to painless jaundice and cardiac insufficiency. Edema of both lower legs and thighs and hepatomegaly were observed in the physical status. Laboratory analysis revealed elevated serum creatinine, total bilirubin, liver enzymes and prolonged prothrombin time and activated partial thromboplastin time. Radiographic tomography showed no pathological finding. In further procedure, abdominal ultrasound was performed which revealed the enlarged liver with irregular surface, diffusely hyperechoic, inhomogeneous, without visible focal lesions with dilation of the intrahepatic bile ducts The test for hepatitis B and C markers were negative. To clarify the cause of biliary obstruction, abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) were indicated. An infiltrative tumor was detected that extensively affected the bile ducts, invaded the inferior vena cava, and penetrates directly into the right atrium. Hepatocellular carcinoma (HCC) was confirmed by core needle biopsy and histopathological examination. During hospitalization, cardiac therapy, low molecular weight heparin, albumin substitution, and antibiotic therapy for Clostridium difficile infection were prescribed. Despite the efforts and treatment, the patient passed away because of multiple organ failure. Conclusion: The extension of hepatocellular carcinoma per continuitatem into the right atrium is a rare entity. In the case of painless jaundice and negative ultrasound findings, it is necessary to extend the imaging diagnostics to magnetic resonance imaging and MRCP which is superior in the assessment of the biliary tree. Although jaundice is a rare manifestation of hepatocellular carcinoma, this entity should not be ruled out, especially in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

The paradigm of acute ischemic stroke treatment has changed significantly in the last decade. Clinicians switched from the former passive approach to active treatment that includes intravenous thrombolysis and mechanical thrombectomy. Epiphany of mechanical thrombectomy as a preferable treatment method for acute ischemic stroke started with publication of several multicentred randomized studies (MR CLEAN, ESCAPE, SWIFT PRIME, REVASCAT, THRACE, PISTE), which confirmed the benefits of this method in the year 2015. Today, mechanical thrombectomy is proven to be a favorable and desirable method of treatment for patients with acute ischemic stroke. Further development of new diagnostic devices and standardization of imaging protocols enabled objective estimation of brain damage, which resulted with extension of the time frame in which invasive treatment has potential benefit. Consequently, it is now advised to perform mechanical thrombectomy even 24 hours from symptom onset, which was confirmed by DAWN and DEFUSE 3 studies. The development of new endovascular materials, techniques and trained medical staff resulted with treating more distally located vascular structures, such as occlusions of M2 and M3 segments of the middle cerebral artery and proximal occlusions of anterior and posterior cerebral circulation. Meanwhile, neurointerventional team becamethe crucial link in acute ischemic stroke treatment. With recent implementation of mechanical thrombectomy in every Clinical Hospital Center in Croatia, a modern and up to date treatment of acute ischemic stroke became available to every patient in our country. [ABSTRACT FROM AUTHOR]

Contrast enhanced ultrasound (CEUS) is a diagnostic method that is well established in childhood because of its benefits. This diagnostic method excludes the use of ionizing radiation, is safe, and is a highly sensitive and specific diagnostic method in certain clinical situations. The method uses ultrasound technology (contrast-specific software) in combination with commercially available second-generation ultrasound contrast, which can be administrated intravenously or intracavitary. In intravenous (IV) application of ultrasound contrast agent, this method is most often used to characterize focal liver changes, to monitor the response of solid malignant tumors during chemotherapy, and to diagnose blunt trauma of the abdomen. In intracavitary application of ultrasound contrast agent, the most widely known and most commonly performed is contrast-enhanced voiding urosonography (ce- VUS - Contrast enhanced voiding urosonography), now an established and routine diagnostic method for the diagnosis and determination of vesicoureteral reflux (VUR). Although only the use of second-generation ultrasound contrast for the characterization of focal liver changes and the diagnosis of vesicoureteral reflux have been legalized for childhood use since 2016, the so-called off-label use of this method is much broader and will certainly be recognized in other areas as very reliable and a safe diagnostic method that does not use ionizing radiation. [ABSTRACT FROM AUTHOR]

Due to their small size, numerous cellular divisions of the still growing and developing tissues and organs, as well as a longer life expectancy, children are approximately three times more sensitive to the same doses of ionizing radiation than adults. This is especially the case with the computerized tomography (CT) examinations, which despite making only 17 % of the ionizing radiological examinations, account for as much as 49 % of the total patient irradiation. Because of this, the Image Gently campaign in the early 2010s was thinking about abandoning the CT examinations in pediatric radiology and replacing them with the ultrasound or magnetic resonance imaging as the methods of choice. The appearance of Flash CT technology, which simultaneously shortens the recording time and reduces radiation doses, has led to the abandonment of this way of thinking. This is also supported by the fact that, on the one hand, CT examinations are practically irreplaceable in the cases of trauma, while on the other hand, children, as well as members of all the other age groups, are constantly exposed to a smaller or larger amount of the environmental ionizing radiation (Earth, space, airplanes). In this sense, it is increasingly recommended to use the low dose CT (LDCT) techniques individually adapted to each patient, due to their small amount of ionizing radiation. On this track, we have tried to make a review of the latest findings on the mentioned problem based on the scientific papers published over the past three years (2016-2018). They show that the CT examinations are not only abandoned in the pediatric radiology, but that on the contrary, in the cases of numerous indications LDCT examinations make the gold standard. [ABSTRACT FROM AUTHOR]

Aim: To present a case with spontaneous, non-traumatic, perirenal haemorrhage (Wünderlich syndrome) as a first manifestation of renal cell carcinoma. Case report: A 37-year-old female was admitted to the emergency unit with sudden and severe pain in the left lumbar area of abdomen. She had normal voiding, without macrohaematuria or trauma in her medical history. Because of her generally instable state she was referred to emergency multi-slice computed tomography (MSCT) exam of the abdomen and pelvis which reveals inhomogeneous mass in the upper pole of the left kidney. Radiology report indicated perirenal haemorrhage most likely caused by an angiomyolipoma. The patient was operated on by urologist who performed a partial nephrectomy of the left kidney and evacuation of haematoma. Samples were taken for histopathology and cromophobe renal cell carcinoma which caused the perirenal haemorrhage was diagnosed. Our patient is controlled on a regular basis, without signs of tumour recurrence. Conclusion: Wünderlich syndrome as the first manifestation of renal cell carcinoma is a very rare but life-threatening manifestation of renal cancer that warrants urgent surgery. MSCT of the abdomen and pelvis is a method of choice in haemodynamically unstable patients with acute abdominal/lumbar pain. [ABSTRACT FROM AUTHOR]

A case study is presented of a female patient presented with bleeding complications and multiple kidney transplants. Pathological analysis of tissues revealed tuberous sclerosis complex associated lesions; molecular genetic analysis of TSC1 and TSC2 was presented; and analysis of pathogenicity of the tuberous sclerosis complex 2 protein.

Renal cysts are a common, usually incidental finding on routine radiological studies, including ultrasound (US), computed tomography (CT), and magnetic resonance (MR). In general, renal cysts may be classified as simple or complicated. Simple cysts are benign and do not require any follow-up or treatment. Most of the cysts belong to this category. Complicated cysts however include a wide range of cystic kidney lesions, from completely benign to definitely malignant. Bosniak classification is a useful and applicable method for renal cyst evaluation. It was developed from clinical experience with the intent that morphologic features of a cyst could serve as a predictor for reliable categorization and differentiation of “nonsurgical” and “surgical” lesions. Although other imaging modalities like MR and US are used for diagnosing renal cysts, CT is the imaging method of choice. Standard CT protocol includes a noncontrast and postcontrast arterial and/or parenhymal phases. Size, location within the kidney, shape, and density of the cyst, the number and morphology of the septa and/or calcification, and postcontrast opacification are evaluated. US is most commonly used as a “screening” method, appropriate for frequent examinations, while MR is the initial method of choice for young patients, those with renal insufficiency and hypersensitivity to iodinated contrast agents, and is proven helpful when CT findings are equivocal. [ABSTRACT FROM AUTHOR]

CT urography (CTU) is an imaging method tailored specifically for the evaluation of the upper urothelial tract and urinary bladder. High diagnostic accuracy in detecting primary and recurrent urothelial tumours, their differentiation from benign lesions, anatomic variation and malformation characterization, and evaluation of important pathology in the surrounding tissues, renders CTU a valuable imaging study of the urothelial tract. Haematuria, initial staging and post treatment follow up of upper urinary tract and bladder malignancies are the most important indications for CTU. Triple phase and split bolus techniques are most commonly used CTU protocols that consist of a non-contrast, nephrographic, and excretory phase, obtained by three or two acquisitions. CTU scanning protocols are tailored to achieve adequate image quality with optimal opacification and distension of the urinary tract at the lowest achievable radiation dose within the range of 5-15 mSv, comparable to the doses of intravenous urography. Detailed patient history, clinical examination, and urine analysis are essential for proper patient selection and targeted CTU protocol, which are the most important tools for increasing diagnostic accuracy and lowering patient radiation dose of CT urography. [ABSTRACT FROM AUTHOR]

Background: An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother's autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Case Report: Self-expandable, covered stent (Bard, Fluency®) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX®) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Conclusions: Endovascular management of SMAA proved to be safe and efficient. The “access from above” is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications. [ABSTRACT FROM AUTHOR]

The incidence of adrenal lesions on autopsy significantly overcomes the number of clinically diagnosed adrenal lesions. Due to increasing use of cross-sectional imaging in the past few years, a significantly higher number of adrenal lesions is detected, which require characterisation and endocrinological workup. Although a majority of these lesions are nonfunctional (silent) adenomas, imaging characterisation is required to exclude malignant process and determine further management. In this article we present the review of current litterature on imaging of benign and malignant adrenal lessions, with emphassis on computed tomography (CT) and magnetic resonance imaging (MRI) characteristics, presenting images from our clinical practice. Furthermore, we present the algorithm based on the recommendations of American College of Radiology Incidental Findings Committee on how to select optimal imaging method and further management of adrenal lesions. [ABSTRACT FROM AUTHOR]

Objectives: Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients. Methods: We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed. Results: Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (p = 0.006), patients over 55 years (p < 0.001), and patients on haemodialysis (p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (p = 0.041 and p = 0.039, respectively). Conclusions: The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor. Advances in knowledge: Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Objectives: Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients. Methods: We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed. Results: Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (p = 0.006), patients over 55 years (p < 0.001), and patients on haemodialysis (p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (p = 0.041 and p = 0.039, respectively). Conclusions: The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor. Advances in knowledge: Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of this retrospecti ve study was to determine the diagnosti c value of computerized tomography (CT) in pati ents without prior surgery who presented with clinical signs and symptoms of acute abdomen with the goal of assessment of the need for surgery and the detecti on of causes of acute abdomen. Pati ents and methods: This retrospecti ve study included all adult pati ents without prior surgery who were referred to perform abdominal CT scan with the diagnosis of acute abdomen in the period from October 31st 2014 ti ll October 31st 2015. Pati ents who had laparotomy of laparoscopy performed within 30 days prior to CT examinati on and those who died during hospitalizati on aft er the CT examinati on and without surgery were excluded. Reference standards in this study were surgery report and hospital observati on during 30 days aft er CT exam in pati ents who had no surgery. CT exams were independently analysed by two radiology specialists with more than 5 years of experience in abdominal CT imaging and all disagreements were sett led with consensus. Results: Out of 81 pati ents (age 19-91, median 69 years, male/female rati o 45/36) 51 had emergency surgery. Duodenal/gastric ulcer perforati on, diverti culiti s and appendiciti s with complicati ons, bowel perforati on and complicati ons of acute cholecysti ti s were the most common causes for surgery. Sensiti vity and specifi city of abdominal CT were 94.6% and 84.6%, while positi ve and negati ve predicti ve values were 93.0% and 87.5%, respecti vely. In pati ents with true positi ve results, CT successfully assessed the localizati on of the cause of acute abdomen in 83% of pati ents. Conclusion: Abdominal CT examinati on in pati ents with signs and symptoms of acute abdomen is a reliable diagnosti c method in the assessment of indicati on for surgery and the detecti on of causes of acute abdomen. [ABSTRACT FROM AUTHOR]

Vesicoureteral refl ux is commonly identifi ed in children and can be associated with refl ux nephropathy. Some patients with refl ux nephropathy develop chronic kidney disease, hypertension, and a small number of patients progress to end-stage renal disease. Identifi cation of patients with these clinical characteristics should be the goal of clinical, biochemical, and radiological evaluation of patients presenting with prenatal hydronephrosis or febrile urinary tract infection. The goals of imaging procedure in general are to confi rm the diagnosis suspected with a high degree of sensitivity and specifi city, to aid treatment and allow prognosis. The diagnosis of vesicoureteral refl ux is a relatively straightforward and well-established procedure. There is increasing awareness of the risks of radiation exposure and invasiveness of vesicoureteral refl ux investigation, which can be unpleasant experience for both the child and the parents. Therefore, it is an imperative for pediatric radiologist together with pediatric urologist and nephrologist to reevaluate the indications and goals for imaging for vesicoureteral refl ux, and to redefi ne the modalities used for diagnosis and follow up. This article reviews the available imaging modalities for evaluating vesicoureteral refl ux, their characteristics, advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Studies show insufficient sensitivity of virtual non-contrast (VNC) reconstructions for stone detection in dual-energy CT urography (DE-CTU). The aim of this study was to investigate if side-by-side-evaluation of both VNC and post-contrast images could increase the sensitivity of single-phase split bolus DE-CTU. Consecutive patients with haematuria who underwent split bolus DE-CTU on the same dual-source DE-CT scanner were retrospectively enrolled in the study. Intravenous furosemide and oral hydration were employed. Two readers, independently and then jointly in two separate sessions, recorded the location and the longest axial stone diameter on three randomised sets of images: separate VNC and post-contrast images, and side-by-side-reconstructions. True non-contrast (TNC) images served as the standard of reference. A total of 83 urinary stones were detected on TNC images. Independent reader side-by-side-evaluation of VNC and post-contrast images yielded higher stone detection sensitivity (76 and 84%, respectively) compared to evaluation of only VNC (71 and 81%, respectively) or post-contrast images (64 and 80%, respectively). The sensitivity of joint reader evaluation of side-by-side-images reached almost 86% and was not significantly different from TNC images (p = 0.77). All stones larger than 3 mm were correctly detected by side-by-side-evaluation. Dose reduction of 55% could be achieved by omitting TNC scans. Side-by-side-VNC and post-contrast image evaluation enable detection of clinically significant urolithiasis on single-phase split bolus DE-CTU with significant dose reduction. This study shows that single-phase DE-CTU is feasible if VNC imaging is simultaneously utilised with post-contrast images. [ABSTRACT FROM AUTHOR]

Narrative texts in electronic health records can be efficiently utilized for building decision support systems in the clinic, only if they are correctly interpreted automatically in accordance with a specified standard. This paper tackles the problem of developing an automated method of labeling free-form radiology reports, as a precursor for building query-capable report databases in hospitals. The analyzed dataset consists of 1295 radiology reports concerning the condition of a knee, retrospectively gathered at the Clinical Hospital Centre Rijeka, Croatia. Reports were manually labeled with one or more labels from a set of 10 most commonly occurring clinical conditions. After primary preprocessing of the texts, two sets of text classification methods were compared: (1) traditional classification models—Naive Bayes (NB), Logistic Regression (LR), Support Vector Machine (SVM), and Random Forests (RF)—coupled with Bag-of-Words (BoW) features (i.e., symbolic text representation) and (2) Convolutional Neural Network (CNN) coupled with dense word vectors (i.e., word embeddings as a semantic text representation) as input features. We resorted to nested 10-fold cross-validation to evaluate the performance of competing methods using accuracy, precision, recall, and F 1 score. The CNN with semantic word representations as input yielded the overall best performance, having a micro-averaged F 1 score of 86.7 % . The CNN classifier yielded particularly encouraging results for the most represented conditions: degenerative disease ( 95.9 % ), arthrosis ( 93.3 % ), and injury ( 89.2 % ). As a data-hungry deep learning model, the CNN, however, performed notably worse than the competing models on underrepresented classes with fewer training instances such as multicausal disease or metabolic disease. LR, RF, and SVM performed comparably well, with the obtained micro-averaged F 1 scores of 84.6 % , 82.2 % , and 82.1 % , respectively. [ABSTRACT FROM AUTHOR]