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Background: Schizophrenia is a severe illness whose clinical course is characterized by various numbers of psychotic episodes (PE). The neurotoxic hypothesis (NH) of schizophrenia assumes that psychosis is biologically toxic. The aim of the study was to investigate whether schizophrenia patients (SP) with multiple PE have greater grey matter volume (GMV) reduction compared to SP with fewer PE.Subjects and methods: We enrolled 106 adult SP and 63 healthy controls. Demographic and clinical data were collected and statistically analysed for all included subjects. Magnetic resonance imaging (MRI) of the brain was acquired on a 1.5 T scanner. SP were grouped according to the number of PE into a group with up to 3 PE (SCHG-1) and with 4 or more PE (SCHG-2). SCHG-1 was further subdivided into two groups regarding to disease duration (DD). Voxel based morphometry (VBM) analyses were performed between SP groups as well as between SP groups and the healthy controls group (HCG).Results: No relevant GMV differences were detected between SP groups. Comparison between HCG and SCHG-1 showed only 3 regions with reduced GMV, while multiple regions with reduced GMV were detected when comparing HCG and SCHG-2. Conclusions: GMV reduction in schizophrenia varies depending on the number of PE when compared to HCG, regardless of disease duration (DD), but PE is not the only contributing factor that leads to neurotoxicity.

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.

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.

Background Virtual monoenergetic (VM) dual-energy computed tomography (DE-CT) enables grey-to-white matter contrast-to-noise ratio optimization, potentially increasing ischaemic brain oedema visibility. The aim of this study was to compare the diagnostic accuracy of VM and standard DE-CT reconstructions for early stroke detection. Methods Consecutive patients with non-contrast DE-CT of the brain scanned within 12 h of stroke symptom onset were prospectively included in the study. Patients with other significant brain pathology were excluded. Two radiologists jointly evaluated standard and VM reconstructions (from 40 to 190 keV at increments of 10 keV) for early stroke signs on a four-point Likert scale: (a) stroke definitely present, (b) stroke probably present, (c) probably no stroke, and (d) definitely no stroke. Follow-up imaging and clinical data served as the standard of reference. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. Results Stroke incidence among 184 patients was 76%. In 64 patients follow-up imaging served as the standard of reference: ischemic brain oedema detection was significantly more accurate on VM reconstructions at 80 keV compared with standard DE-CT reconstructions (area under the curve (AUC) = 0.821 vs. AUC = 0.672, p = 0.002). The difference was most prominent within the first 3 h after symptom onset (at 11%, AUC = 0.819 vs. AUC = 0.709, p = 0.17) and in patients with National Institutes of Health Stroke Scale above 16 (at 37.5%, AUC = 1 vs. AUC = 0.625, p = 0.14). Conclusion VM DE-CT reconstructions at 80 keV appear to be the optimal non-contrast CT technique for diagnosing early ischaemic stroke, particularly within the first 3 h after symptom onset and in severely ill patients.

Brain maturation is considered completed around the age of 25, when prefrontal cortex maturation has been achieved. The aim of our study was to investigate the alterations of grey matter (GM) in patients with the onset of schizophrenia before and after the completion of brain maturation.The study group included 100 schizophrenia patients, while the control group comprised 50 healthy individuals. Brain magnetic resonance imaging was acquired on a 1.5 T scanner. Voxel-based morphometry (VBM) analyses were performed between groups.GM of the schizophrenic patients is reduced in many regions (p0.005 FDR corrected). Most widespread reduction is detected in frontal cortex and cerebellum, the other regions being limbic cortex, insula, cuneus, precuneus, superior temporal gyrus and motor cortex. The decrease of grey matter volume (GMV) increases with the increase in number of psychotic episodes and is more pronounced in the patients with earlier onset of the disease.The age of the onset of the disease is important for both total and relative loss of GMV. Earlier onset of schizophrenia, prior to full brain maturation results in significant reduction of GM in comparison with healthy subjects and patients with later, post full brain maturation onset of the disease.

Background: Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and fourth in terms of cancer deaths. In clinical practice, computed tomography (CT) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-foetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study CT or magnetic resonance imaging (MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is valid to diagnose hepatocellular carcinoma. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma is, therefore, missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of CT may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of CT in people with chronic liver disease, who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. Objectives: Primary: to assess the diagnostic accuracy of multidetector, multiphasic contrast-enhanced CT for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting. Secondary: to assess the diagnostic accuracy of CT for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease. Search methods: We searched the Cochrane Hepato-Biliary Trials Register, Cochrane Hepato-Biliary Diagnostic-Test-Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science until 4 May 2021. We applied no language or document-type restrictions. Selection criteria: Studies assessing the diagnostic accuracy of CT for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. Data collection and analysis: At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. Main results: We included 21 studies, with a total of 3101 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time-interval between the index test and the reference standard was rarely defined. Regarding applicability in the patient selection domain, we judged 14% (3/21) of studies to be at low concern and 86% (18/21) of studies to be at high concern owing to characteristics of the participants who were on waiting lists for orthotopic liver transplantation. CT for hepatocellular carcinoma of any size and stage: sensitivity 77.5% (95% CI 70.9% to 82.9%) and specificity 91.3% (95% CI 86.5% to 94.5%) (21 studies, 3101 participants; low-certainty evidence). CT for resectable hepatocellular carcinoma: sensitivity 71.4% (95% CI 60.3% to 80.4%) and specificity 92.0% (95% CI 86.3% to 95.5%) (10 studies, 1854 participants; low-certainty evidence). In the three studies at low concern for applicability (861 participants), we found sensitivity 76.9% (95% CI 50.8% to 91.5%) and specificity 89.2% (95% CI 57.0% to 98.1%). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. Authors' conclusions: In the clinical pathway for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, CT has roles as a confirmatory test for hepatocellular carcinoma lesions, and for staging assessment. We found that using CT in detecting hepatocellular carcinoma of any size and stage, 22.5% of people with hepatocellular carcinoma would be missed, and 8.7% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 28.6% of people with resectable hepatocellular carcinoma would improperly not be resected, while 8% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results

Cilj: Osnovni cilj našeg istraživanja je usporedba doznih parametara i debljine komprimirane dojke kod mamografskog pregleda koji je izvršen digitalnom tomosintezom (engl. digital breast thomosynthesis; DBT) i standardne, 2D mamografije. Ispitanici i metode: U istraživanje je uključeno 200 ispitanica životne dobi od 40 do 81 godine (median 60,5 ± 10,6). Ispitanice su podijeljene u dvije skupine, ovisno o vrsti mamografskog pregleda. Ova retrospektivna analiza obuhvatila je pretrage koje su vršene na mamografskom uređaju Hologic Selenia Dimensions (Hologic, Bedford, Mass) u razdoblju od 1. veljače 2018. do 30. ožujka 2018. Rezultati: Hi-kvadrat testom isključila se statistički značajna razlika u gustoći parenhima dojki između dviju grupa ispitanica. T-test nije pokazao statistički značajnu razliku u dobi ispitanica, kao niti razlike u debljini komprimiranih dojki između dviju ispitanih skupina. Vrijednost srednje glandularne doze (engl. average glandular dose; AGD) kod DBT-a u odnosu na 2D mamografiju bila je viša 0,53 mGy za lijevu dojku, a 0,37 mGy za desnu dojku (3,83 / -1 mGy, p = 0.001; 3.82 / -0.9 mGy, p = 0.023). Zaključak: Usprkos statistički značajnoj razlici u AGD-u kod DBT-a u odnosu na 2D mamografiju između dviju skupina ispitanica, ona je unutar granica prihvatljivosti propisanih Pravilnikom o uvjetima za primjenu izvora ionizirajućeg zračenja u svrhu medicinskog i nemedicinskog ozračenja (NN 42/2018, 9. 5. 2018.), stoga smatramo da je opravdano uvođenje DBT-a kao standardne radiološke metode pregleda dojki.

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To assess the diagnostic accuracy of magnetic resonance imaging for the diagnosis of hepatocellular carcinoma of any size and at any stage in people with chronic liver disease. SECONDARY OBJECTIVES: To assess the diagnostic accuracy of MRI for the diagnosis of resectable HCC in adults with chronic liver disease. To identify potential sources of heterogeneity, we plan to investigate the effects of the following variables: study date; inclusion of people without cirrhosis; study location (population differences); participant selection; different HCC stages; different reference standards; different liver cirrhosis aetiologies; differences in prior testing; predefinition of magnetic resonance (MR) positivity criteria; and type of contrast media (see Investigations of heterogeneity).

Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Advances in knowledge: This study shows that single-phase DE-CTU is feasible if VNC imaging is simultaneously utilised with post-contrast images.

In clinical analysis, medical radiology is a widely used technique to make a noninvasive medical diagnosis that establishes the presence of an injury or disease without requiring invasive surgery. The purpose of computer-aided diagnosis (CAD) is to assist the clinician in interpreting the acquired data. In recent years, the application of machine learning techniques in this field has greatly increased, leading to increased accuracy or even complete replacement of manually created models. The main reason for the increased use of these techniques in medical image analysis is due to the fact that medical data has become increasingly available, the computational power of computers has increased, and significant advances have been made in machine learning, especially in machine vision applications. This development is a driving force behind major changes in the field of medicine, both in the laboratory and in the clinic. Unlike filtering techniques, machine learning can open up new methods for diagnosing diseases that were previously unthinkable. Moreover, the implementation of personalised medicine in the clinic, i.e. modelling specific conditions closely related to patient characteristics, requires the use of machine learning. In this paper, we give an overview of the field and present a set of guidelines that can be helpful in analysing large collections of medical images using data-driven techniques.

Purpose Weighted average dual-energy computed tomography (DE-CT) reconstructions are considered a proxy of standard CT images of the brain, recommended for routine clinical use and used as a reference standard in DE-CT research. However, their image quality has not been assessed, which was the aim of our study. Methods Images from 81 consecutive patients who underwent both non-contrast single-energy (SE)-CT and DE-CT of the brain on the same scanner were retrospectively evaluated. Attenuation values (HU) and SD of grey matter/white matter (GM/WM) pairs, along with SD in the posterior fossa and subcalvarial region were measured. Four readers evaluated image noise, GM/WM contrast, posterior fossa and subcalvarial artefacts, as well as overall image quality. Results Weighted average DE-CT GM and WM HU were significantly lower and noise higher compared to SE-CT (GM HU 36.46 v. 41.82; WM HU 28.18 v. 29.94; GM SD 2.93 v. 2.49; and WM SD 3.16 v. 2.44, all p Conclusion Weighted average DE-CT images of the brain yield less artefacts at 37% dose reduction and lower noise at SE-CT equivalent dose. Dose-adjusted GM/WM contrast-to-noise ratio of weighted average DE-CT with 0.4 weighting factor remains inferior to SE-CT images.

Colorectal cancer (CRC) is one of the most common malignant tumors in Western countries. The treatment outcomes of this disease have improved significantly in recent years due to the improvement of diagnostic methods (pathohistology, radiology, nuclear medicine), screening and treatment improvements: surgical and oncological (chemotherapy, immunotherapy, radiotherapy). Additional progress has been made in the definition of prognostic and predictive factors of CRC. It is very important to emphasize the multidisciplinary approach to patients with CRC and to make a decision on optimal treatment based on evidence.

Ciste na bubrezima vrlo su čest i najčešće slučajan nalaz kod rutinskih radioloških pretraga, počevši od ultrazvuka do slikovnih metoda, kompjutorizirane tomografije (CT) i magnetske rezonancije (MR). Općenito se dijele na jednostavne i komplicirane. Jednostavne ciste su benigne i ne zahtijevaju daljnje praćenje niti liječenje. Ovoj kategoriji pripada velika većina cista. Kategoriji kompliciranih cista, međutim, pripada širok spektar cističnih promjena bubrega, od potpuno benignih do definitivno malignih. Bosniak klasifikacija korisna je i primjenjiva metoda u procjeni cističnih promjena na bubrezima. Proizašla je iz kliničkog iskustva s ciljem da slikovne morfološke karakteristike cističnih lezija bubrega posluže kao prediktivni faktor za pouzdanu kategorizaciju i razlikovanje „kirurških” od „nekirurških’’ cista. Iako se u dijagnostici i procjeni cista bubrega koriste i drugi modaliteti kao što su ultrazvuk i magnetska rezonancija, CT je slikovna metoda izbora. Standardni protokol čine prekontrastna (nativna) faza i postkontrastna arterijska i/ili parenhimna faza. Procjenjuje se veličina, smještaj unutar bubrega, oblik i gustoća ciste, broj i karakteristike septa ili kalcifikata te prisutnost postkontrastne imbibicije. Ultrazvuk se najčešće koristi kao screening metoda, a prikladna je i kod učestalih, ponavljajućih pregleda dok je magnetska rezonancija metoda izbora za mlađe pacijente, ima ključnu ulogu kod pacijenata s preosjetljivošću na jodno kontrastno sredstvo i one s kroničnom bubrežnom insuficijencijom, a sve češće se koristi i kao metoda izbora kada je nalaz CT pregleda nekonkluzivan., 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.

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.

Purpose The aim of our prospective randomized study was to assess diagnostic quality and stability of bowel distension in patients with Crohn’s disease (CD) and healthy volunteers subjected to synchronous magnetic resonance enterography and colonography (MREC), as well as to test the role of water enema and intravenous spasmolytics. The influence of gastric content, age, gender, and body mass on bowel distension was also evaluated. Method Study groups included 164 CD patients and 53 healthy volunteers. After bowel preparation, randomized subgroups started ingestion ≥1000 mL of hyperosmolar solution within 30, 45, 60, 75, and 90 min before admission to MRI, respectively. Patients were examined in prone position and water enema was applied. Spasmolytics were administered prior to I.V. gadolinium. Distension of five bowel segments was independently assessed by two experienced radiologists. Results MREC yields diagnostic distension of the jejunum in 81.1 % and 79.2 % patients in the CD group and controls, respectively. For the terminal ileum it was >94 % in both groups. Good and excellent distension was achieved in other bowel segments. Distension was maintained up to 75 min from the start of oral ingestion. Water enema and spasmolytics significantly and independently improved distension of the small bowel. Distension of the cecum after spasmolytics was decreased. Gastric content, age, gender and body mass had no significant influence of bowel distension. Conclusions MREC enables diagnostic distension of the colon and ileum (including terminal segment) in CD patients and healthy volunteers and diagnostically acceptable distension of the jejunum.

Cistične lezije gušterače su raznovrsna grupa lezija s vrlo širokom histološkom diferencijacijom, od benignih tvorevina do invazivnih malignih tumora. Predstavljaju klinički problem budući da je etiologija tih promjena vrlo raznolika, tijek bolesti često asimptomatski, a potencijalno su malignog karaktera. Tijekom godina broj pacijenata s dijagnosticiranim cističnim lezijama gušterače je značajno porastao prvenstveno zbog napretka radioloških tehnika i starenja populacije. Kompjutorizirana tomografija i magnetska rezonancija predstavljaju izvrsne slojevne slikovne metode za otkrivanje i karakterizaciju cističnih lezija te su predvodnice u dijagnostici i temelj odluke o terapijskom pristupu. U radu ćemo ukratko prikazati spektar najčešćih cističnih lezija gušterače i njihovu radiološku prezentaciju., Cystic lesions of the pancreas are histologically diverse group of lesions, from benign to the invasive malignant lesions. Due to diverse etiology, sometimes asymptomatic course of the disease and potentially malignant character they represent significant clinical problem. With the development of radiological techniques and aging of population the number of diagnosed cystic lesion increases. Computed tomography and magnetic resonance imaging are excellent modalities for both initial detection and later characterization of cystic pancreatic lesions and they have leading role both in diagnostic and therapy planning. In this article we will present the spectre of most common cystics lesion of the pancreas and their radiologic presentation.

The data stored in a Picture Archiving and Communication System (PACS) of a clinical centre normally consists of medical images recorded from patients using select imaging techniques, and stored metadata information concerning the details on the conducted diagnostic procedures - the latter being commonly stored using the Digital Imaging and Communications in Medicine (DICOM) standard. In this work, we explore the possibility of utilising DICOM tags for automatic annotation of PACS databases, using K-medoids clustering. We gather and analyse DICOM data of medical radiology images available as a part of the RadiologyNet database, which was built in 2017, and originates from the Clinical Hospital Centre Rijeka, Croatia. Following data preprocessing, we used K-medoids clustering for multiple values of K, and we chose the most appropriate number of clusters based on the silhouette score. Next, for evaluating the clustering performance with regard to the visual similarity of images, we trained an autoencoder from a non-overlapping set of images. That way, we estimated the visual similarity of pixel data clustered by DICOM tags. Paired t-test (p < 0.001) suggests a significant difference between the mean distance from cluster centres of images clustered by DICOM tags, and randomly-permuted cluster labels.

Cilj. Cilj istraživanja je procijeniti podudarnost veličine rezidualnog tumora, izmjerene magnetskom rezonancijom (MR) i patohistološkom dijagnostikom (PHD) u pacijentica s karcinomom dojke nakon provedene neoadjuvantne kemoterapije (NAK) te procijeniti mogući utjecaj ypT stadija tumora na nepodudarnost veličina izmjerenih navedenim metodama. Ispitanici i metode: U retrospektivno istraživanje uključeno je 50 pacijentica. Uključni kriterij su pacijentice kod kojih je učinjen operativni zahvat uz prethodno proveden NAK karcinoma dojke, na što je odgovor praćen s najmanje dva MR pregleda. Veličina tumora na MR-u uspoređena je s veličinom na PHD-u (zlatni standard) pomoću regresijske analize Passing-Bablok te je izračunat njihov koeficijent korelacije. Analizirana su sva odstupanja i podudarnosti veličine, kao i eventualni utjecaj ypT stadija tumora na razliku između dviju metoda. Razlika od ± 0,5 cm u veličini tumora procijenjenih slikovnom metodom i u PHD nalazu smatrale su se podudarnima veličinama. Rezultati: Srednja vrijednost veličine rezidualnog tumora na MR-u iznosila je 19,1 ± 17,71 mm, dok je na PHD-u iznosila 16,87 ± 18,19 mm. Izračunati r koeficijent korelacije iznosi 0.64 (p < 0.001). Provedenom analizom potvrđeno je da nema značajne razlike izmjerenih veličina tumora na MR-u i PHD-u (p = 0.552) te se metode mogu smatrati podudarnima. Nije uočena statistički značajna razlika u ovisnosti o ypT stadiju tumora koja bi utjecala na nepodudarnost veličina. Zaključci: Među dvjema metodama nema konstantnog niti proporcionalnog odstupanja u mjerenjima te se metode mogu smatrati podudarnim. MR dojke je dobra metoda za procjenu veličine rezidualnog tumora dojke kod pacijentica koje su podvrgnute neoadjuvantnoj kemoterapiji usporedno s PHD-om (zlatni standard)., Aim: The goal of this study is to evaluate the concordance between residual tumour size measured on magnetic resonance imaging (MRI) and pathohistological findings in patients who underwent neoadjuvant chemotherapy and operative procedure, and if any pathohistological features may affect that agreement. Respondents and methods: Fifty patients with breast cancer were retrospectively evaluated. Patients who underwent neoadjuvant chemotherapy before the operative procedure, and were assessed with at least two MRI examinations, where included in this study. The primary tumour size measured by MRI was compared with pathohistological findings, which was considered as the gold standard. All differences and size correspondence were analyzed as well as the possible influence of ypT stage of tumour between the two methods. Results: The mean value of residual tumour size on MRI was 19,2 ± 17,71 mm, while on pathohistological findings it was 16,87 ± 18,29 mm. A calculated correlation coefficient between the two methods was 0.64 (p < 0.001). There was no statistically significant difference between two methods for measuring residual tumour size (p = 0.552), as well as a statistically significant influence of ypT stage on measuring, so these methods may be considered to be concordant. Conclusions: There is neither a constant nor a proportional deviation in the measurements between the two methods, so these methods can be considered concordant. Breast MRI is a reliable method for estimating residual tumour size in patients undergoing neoadjuvant chemotherapy in comparison to pathology.

Cilj: Prikazati učestalost i raspodjelu kalcificiranosti ilijačnih arterija u pacijenata u kojih je učinjena transplantacija bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni pacijenti u Kliničkom bolničkom centru Rijeka u kojih je između 1. siječnja 2015. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Procjena kalcificiranosti ilijačnih arterija učinjena je uz pomoć kompjutorizirane tomografije (CT). Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 115 transplantacija bubrega, a 92 (80 %) pacijenata imalo je prijeoperacijski CT. Prosječna dob pacijenata bila je 60,3 godina, a 26 % pacijenata je imalo šećernu bolest kao osnovnu bolest. Arterijske kalcifikacije pronađene su u 72 (78 %) pacijenata. Kalcifikacije su najčešće pronađene na desnoj zajedničkoj ilijačnoj arteriji (63 pacijenata – 68,5 %), a najrjeđe na lijevoj vanjskoj ilijačnoj arteriji (23 pacijenta – 25 %). Zaključak: Većina naših pacijenata ima prisutne kalcifikacije na ilijačnim arterijama. Prijeoperacijsko utvrđivanje njihove raspodjele i proširenosti ima važnu ulogu prilikom planiranja transplantacije bubrega., Aim. To evaluate the incidence and distribution of calcifications of iliac arteries in patients with kidney transplantation in our transplant center. Patients and Methods. We retrospectively analyzed patients with kidney transplantation operated at University Hospital Rijeka from January 1st 2015 to December 31st 2018. The assessment of iliac arteries calcifications was made using computed tomography. Results. In observed period 115 kidney transplantations were performed in our transplant center and 92 (80%) of patients had preoperative CT scan. The average age was 60,3 years and 26% of patients had diabetes mellitus as principal disease. Arterial calcifications were found in 72 (78%) patients. The calcifications were most common in the right common iliac artery (63 pts – 68,5%) and rarest in left external iliac artery (23 pts - 25%) Conclusion. Most of our patients have calcifications of iliac arteris. Preoperative assessment of their distribution and extent had a very important role in the planning of kidney transplantation.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of contrast‐enhanced ultrasound (CEUS) for the diagnosis of HCC of any size and at any stage in people with chronic advanced liver disease.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of abdominal ultrasound and alpha‐fetoprotein (AFP), alone or in combination, for the diagnosis of hepatocellular carcinoma (HCC) of any size and at any stage in people with chronic advanced liver disease, either in a surveillance programme or in a clinical setting.

Testicular tumors are the most common solid tumors in men between age 15- 34 years. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant tumors arising in the testes and they are classified as seminoma and nonseminoma. Testicular cancer has high cure rates even in disseminated stage of disease. The chemotherapy mostly contributed to these results, but surgery is an unavoidable part of this success. In significant number of these patients treatment algorithms today have intention to offer the same cure rates with minimally aggressive therapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for diagnosis, treatment, and follow-up of patients with testicular cancer in the Republic of Croatia.

Bladder cancer is the second most common malignancy of urinary system according to data from the Croatian National Cancer Registry for 2015. In 90% of cases the underlying histology is urothelial carcinoma. Difference in survival in patients with muscle-invasive disease (MIBC) compared to the survival of patients with non-muscle invasive disease (NMIBC) is enormous. Management of NMIBC, traditionally, has been focused on the reduction of subsequent bladder recurrence and prevention of disease progression and is primarily based on transurethral resection (TUR) of the tumor, followed by intravesical therapy based on estimated individual risk of recurrence. Conversely, in patients with MIBC radical cystectomy remains the corne stone of the treatment, optimally in conjunction with neoadjuvant platinum-based chemotherapy in cisplatin-eligible patients. At the moment of diagnosis, 4–6% of patients already have distant metastases, and post cystectomy recurrence could be expected in 50% of patients. Treatment options in metastatic disease range from cisplatin-based chemotherapy, immunotherapy, palliative radiotherapy and finally supportive care. Landmark feature of bladder cancer is the high prevalence of somatic mutations which enabled profound change for decades held treatment paradigm for advanced bladder cancer leading to regulatory approval of whole array of novel immunotherapy agents. These emerging therapeutics (programmed death ligand-1 (PD-L1) and programmed cell death protein-1 (PD-1)) belong to the class of inhibitors of checkpoint proteins, which are key targets that regulate T-cell mediated immune response.

Rak testisa najčešći je solidni tumor u muškaraca u dobi od 15. do 34. godine. Incidencija raka testisa u svijetu udvostručena je u posljednjih 40 godina. Tumori zametnih stanica čine 95% svih tumora testisa, a podijeljeni su u dva osnovna histološka tipa: seminomi i neseminomi. Osobito značenje daje im velik postotak izlječivosti i u diseminiranoj fazi bolesti. Tom je uspjehu najviše pridonijela kemoterapija, ali kirurgija je i dalje neizostavan dio uspješnog liječenja. U znatnog dijela bolesnika danas se nastoji odrediti terapijski minimum kojim se izbjegava niz nuspojava, a dovodi do jednakog uspjeha kao i donedavno agresivniji terapijski pristup. U tekstu koji slijedi iznesene su kliničke upute radi standardizacije dijagnostike, liječenja i praćenja bolesnika s tumorima zametnih stanica testisa u Republici Hrvatskoj., Testicular tumors are the most common solid tumors in men between age 15- 34 years. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant tumors arising in the testes and they are classified as seminoma and nonseminoma. Testicular cancer has high cure rates even in disseminated stage of disease. The chemotherapy mostly contributed to these results, but surgery is an unavoidable part of this success. In significant number of these patients treatment algorithms today have intention to offer the same cure rates with minimally aggressive therapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for diagnosis, treatment, and follow-up of patients with testicular cancer in the Republic of Croatia.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of multidetector, multiphasic contrast‐enhanced computed tomography (CT) for the diagnosis of hepatocellular carcinoma (HCC) of any size and at any stage in people with chronic advanced liver disease.

Cilj: Prikazati spontano, netraumatsko perirenalno krvarenje (Wünderlich sindrom) kao prvu manifestaciju karcinoma bubrega te dijagnostički i terapijski postupak kod takvog bolesnika. Prikaz slučaja: Bolesnica stara 37 godina je došla na hitni medicinski trakt s intenzivnim, naglo nastalim bolovima u lijevom lumbalnom predjelu abdomena; uredno mokri, negira traumu i nema makrohematuriju. Zbog općeg lošeg stanja bolesnica je poslana na hitnu višeslojnu kompjuteriziranu tomografiju (Multi-slice computed tomography, MSCT) abdomena i zdjelice na kojoj je utvrđena inhomogena formacija u gornjem polu lijevog bubrega uz zaključak radiologa da se radi o perirenalnom krvarenju, najvjerojatnije uzrokovanog angiomiolipomom. Urolog se odlučio za hitni operacijski zahvat koji uključuje djelomičnu nefrektomiju lijevog bubrega te evakuaciju hematoma. Patohistološki pregled uputio je na karcinom bubrega kromofobnog tipa koji je uzrokovao krvarenje. Bolesnica se redovito kontrolira, nema znakova recidiva. Zaključak: Wünderlich sindrom je rijetka, potencijalno životno ugrožavajuća manifestacija karcinoma bubrega koja zahtijeva hitni operacijski zahvat. MSCT abdomena i zdjelice je radiološka metoda izbora za akutnu abdominalnu/lumbalnu bol u hemodinamski nestabilnog bolesnika., 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 has 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 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.

A case of 16-year-old female with second-ary psoas abscess as the complication of the Crohn’s disease was analysed. Her pre-hos-pital, long lasting, non-specific symptoms led to ultrasound (US) and radiologic im-aging confirming the diagnosis. The anti-biotic treatment was insufficient and wors-ening of the patient’s condition required surgical treatment including descendent colectomy, abscess drainage and negative pressure wound therapy (NPWT). In spite of numerous complications the condition of the child gradually improved and she was discharged from the hospital on the 71st postoperative day. Two years after the colectomy, the occlusion of her colostomy was performed.

Summary Background Internal carotid artery agenesis is a rare anomaly that can be clinically asymptomatic. Klippel-Feil syndrome is a skeletal malformation characterized by vertebral fusion. Presence of postaxial polydactyly is suggestive of an underlying syndrome. Case Report We report a rare case of a 44-year-old patient with non-specific symptoms and an association between these three rare abnormalities. Vascular anomalies were found using intracranial MR angiography and multi-detector CT angiography of the supraaortic arteries. Conclusions Presence of a single aforementioned anomaly requires cautious imaging assessment in order to detect possible associated anomalies and avoid diagnostic pitfalls. A possible common genetic background could explain the coexistence of these three anomalies.

Sustavni pregledni radovi se danas smatraju dijelom relevantne znanstvene i stručne literature koja postaje neizostavni dio svakodnevne medicinske prakse i važan element u donošenju odluka. Radi se o znanstvenom istraživanju koje temeljem sustavne i strogo definirane metodologije pretrage, odabira i analize dostupnih znanstvenih dokaza daje odgovor na točno definirano znanstveno pitanje. Cochrane kolaboracija je svjetska neprofitna organizacija čiji je cilj stvaranje kvalitetnih sustavnih preglednih radova kroz detaljnu, razrađenu i rigoroznu metodologiju. Kroz različite znanstvene grupe, autori publiciraju Cochrane sustavne preglede intervencija i dijagnostičkih testova koji se objavljuju u Cochrane bazi sustavnih preglednih članaka. Cochrane sustavni pregledni rad se razvija u nekoliko koraka: formulacija pitanja, odabir Cochrane skupine, registracija naslova, izrada i objava protokola, te izrada, objava i održavanje sustavnog preglednog rada. Ovim radom želimo prikazati metodologiju razvoja sustavnog pregleda u sklopu Cochrane kolaboracije kao općeniti uvid u kompleksnost njegove izrade., Systematic review articles are considered today as part of relevant scientific and professional literature which is becoming an infallible part of everyday medical practice and a vital part in decision making. This scientific work is based on systematic and strictly defined methodology of search, 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 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 are developed through 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.

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.

We presented an extremely severe case of tuberous sclerosis complex (TSC) in a female patient with recurring, life-threatening bleeding complications related to renal angi-omyolipomas. Massive intratumoral hemorrhage required surgical removal of both angiomyolipomatous kidneys and kidney transplantation. During the follow-up period, the patient developed severe metrorrhagia that eventually led to hysterectomy and salpingo-oophorectomy. Bleeding from the operative sites caused the loss of the first kid- ney transplant received from the mother, and immediate hemorrhagic shock led to the loss of the second, cadaveric kidney allograft. The third kidney transplant had a successful outcome. Pathological analysis of all tissue specimens showed TSC-associated lesions and deformed blood vessels in the surgically removed organs. Molecular genetic analysis of TSC1 and TSC2 in the DNA of peripheral leukocytes identified a novel TSC2 c.3599G>C (p.R1200P) variant. Functional assessment confirmed the likely pathogenicity of the TSC2 c.3599G>C (p.R1200P) variant. To the best of our knowledge, this is the first report of the c.3599G>C (p.R1200P) variant in exon 29 of the TSC2 gene related to a severe clinical course and multiple kidney transplants in a patient with TSC

Od ranije je poznato kako učestalost ekspanzivnih lezija nadbubrežnih žlijezda na obdukcijama značajno nadilazi broj klinički potvrđenih adrenalnih lezija. Zbog sve učestalijeg korištenja slojevnih tehnika snimanja posljednjih godina otkriva se značajno veći broj suprarenalnih tvorbi koje zahtijevaju karakterizaciju i endokrinološku obradu. Većina tih lezija su nefunkcionalni (silentni) adenomi, tzv. incidentalomi, no potrebna je slikovna karakterizacija lezija kako bi se isključio maligni tumor i odredili daljnji terapijski postupci. U radu prikazujemo pregled literature o slikovnoj dijagnostici najčešćih benignih i malignih lezija nadbubrežnih žlijezda, s fokusom na kompjutoriziranu tomografiju i magnetsku rezonanciju s prikazom primjera iz vlastite kliničke prakse. U nastavku prikazujemo algoritam temeljen na preporukama ACR-a (American College of Radiology) i algoritmu koji je sastavio Incidental Findings Committee o optimalnom odabiru slikovne metode i daljnjim postupcima s novootkrivenim lezijama nadbubrežnih žlijezda., 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.

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.