Gordana Ivanac's research while affiliated with Klinička bolnica Dubrava and other places

Current research in breast cancer Magnetic Resonance Imaging (MRI), especially with Artificial Intelligence (AI), faces challenges due to the lack of expert segmentations. To address this, we introduce the MAMA-MIA dataset, comprising 1506 multi-center dynamic contrast-enhanced MRI cases with expert segmentations of primary tumors and non-mass enhancement areas. These cases were sourced from four publicly available collections in The Cancer Imaging Archive (TCIA). Initially, we trained a deep learning model to automatically segment the cases, generating preliminary segmentations that significantly reduced expert segmentation time. Sixteen experts, averaging 9 years of experience in breast cancer, then corrected these segmentations, resulting in the final expert segmentations. Additionally, two radiologists conducted a visual inspection of the automatic segmentations to support future quality control studies. Alongside the expert segmentations, we provide 49 harmonized demographic and clinical variables and the pretrained weights of the well-known nnUNet architecture trained using the DCE-MRI full-images and expert segmentations. This dataset aims to accelerate the development and benchmarking of deep learning models and foster innovation in breast cancer diagnostics and treatment planning.

Aim: Renal artery disease is the most common cause of secondary hypertension worldwide. B-mode and Doppler ultrasound are considered the modalities of choice for the imaging of the renal arteries. However, an adequate examination can be plagued by difficulties in patients with unfavorable anatomy. UltraFastTM ultrasound is faster, performed with higher frame rates, and enables prospective and ret- rospective data analysis with quantification of flow data in the obtained image, so it may be able to resolve some of the difficulties encountered during conventional ultrasound examinations in patients with suspected renal artery disease. Material and methods: Comparison of the duration of conven- tional and UltraFastTM Doppler examinations of segmental renal arteries was performed on 52 young, healthy volunteers. Duration times were summarized using the median and interquartile range, and comparisons between the two methods were performed using the Wilcoxon test for paired samples. Results: The duration of UltraFastTM ultrasound examinations was significantly shorter in comparison to conventional ultrasound for both kidneys and in total (p <0.001, median difference in duration 65 s, median 64% shorter duration of analysis), while both conventional and UltraFastTM ultrasound examina- tions demonstrated consistent velocity measurements with very high correlation (Rho = 0.94, p <0.001). Conclusions: The study provides evidence that UltraFastTM ultrasound is faster than conventional Dop- pler ultrasonography for the assessment of renal artery disease in healthy adults without a history of renal disease. The findings have important implications for clinical practice, as they suggest that Ultra- FastTM imaging could offer a more efficient and time-saving approach to vascular imaging in patients with suspected renal artery disease.

Reaching equity in the distribution of opportunity between men and women is in the agenda of premier international agencies worldwide, and in the last decades a significant improvement in women’s access to care and education as well as in terms of equality in the labor market has been achieved. In the medical field and, in particular, in radiology, the number of women progressively increased but still much has to be done to guarantee equal opportunities. Aiming to provide an overview of the European musculoskeletal imaging community regarding gender equity, we developed a 39-item survey addressed to the 2481 members of the European Society of Musculoskeletal Imaging (ESSR). The responses of the 74 participants (3%) demonstrated that for most of the addressed clinical, academic, and ESSR-related questions, no statistically significant differences gender-related occurred except for instance for the experienced gender discrimination, which affected women more often (55% of women vs 21.9% of men; p = 0.017). Despite the low participation rate, our results suggest that there is hope of ‘suffrage’ with leadership and steering roles in the Executive Committee and Subcommittees and a real-time reduction in the gender gap.

Among available papers published on the given subject over the last century, various terms have been used as synonyms for one, now generally accepted—osteoarthritis, in some countries called “wear and tear” or “overload arthritis”. The opsolent terms—hypertrophic arthritis, degenerative arthritis, arthritis deformans and osteoarthrosis—sought to highlight the dominant clinical signs of this ubiquitous, polymorph disease of the whole osteochondral unit, which by incidence and prevalence represents one of the leading chronic conditions that cause long-term pain and incapacity for work. Numerous in vitro and in vivo research resulted in broadened acknowledgments about osteoarthritis pathophysiology and pathology on both histological and cellular levels. However, the cause of osteoarthritis is still unknown and is currently the subject of a hypothesis. In this paper, we provide a review of recent findings on biological phenomena taking place in bone tissue during osteoarthritis to the extent useful for clinical practice. Choosing a proper radiological approach is a conditio sine qua non to the early diagnosis of this entity.

Liver biopsy is historically the gold standard for liver fibrosis assessment of chronic hepatitis C patients. However, with the introduction and validation of noninvasive tests (NITs) to evaluate advanced fibrosis, and the direct-acting antiviral agents for treatment of chronic hepatitis C virus (HCV), the role of NITs have become even more complex. There is now need for longitudinal monitoring and elucidation of cutoff values for prediction of liver-related complication after sustained virological response. The aim of this report is to provide a critical overview of the various NITs available for the assessment of liver fibrosis in HCV patients.

Objectives: To develop an intuitive and generally applicable system for the reporting, assessment, and documentation of ADC to complement standard BI-RADS criteria. Methods: This was a multicentric, retrospective analysis of 11 independently conducted institutional review board-approved studies from seven institutions performed between 2007 and 2019. Breast Apparent Diffusion coefficient (ADC-B) categories comprised ADC-B0 (ADC non-diagnostic), ADC-B1 (no enhancing lesion), and ADC-B2-5. The latter was defined by plotting ADC versus cumulative malignancy rates. Statistics comprised ANOVA with post hoc testing and ROC analysis. p values ≤ 0.05 were considered statistically significant. Results: A total of 1625 patients (age: 55.9 years (± 13.8)) with 1736 pathologically verified breast lesions were included. The mean ADC (× 10-3 mm2/s) differed significantly between benign (1.45, SD .40) and malignant lesions (.95, SD .39), and between invasive (.92, SD .22) and in situ carcinomas (1.18, SD .30) (p < .001). The following ADC-B categories were identified: ADC-B0-ADC cannot be assessed; ADC-B1-no contrast-enhancing lesion; ADC-B2-ADC ≥ 1.9 (cumulative malignancy rate < 0.1%); ADC-B3-ADC 1.5 to < 1.9 (0.1-1.7%); ADC-B4-ADC 1.0 to < 1.5 (10-24.5%); and ADC-B5-ADC < 1.0 (> 24.5%). At the latter threshold, a positive predictive value of 95.8% (95% CI 0.94-0.97) for invasive versus non-invasive breast carcinomas was reached. Conclusions: The breast apparent diffusion coefficient system (ADC-B) provides a simple and widely applicable categorization scheme for assessment, documentation, and reporting of apparent diffusion coefficient values in contrast-enhancing breast lesions on MRI. Clinical relevance statement: The ADC-B system, based on diverse MRI examinations, is clinically relevant for stratifying breast cancer risk via apparent diffusion coefficient measurements, and complements BI-RADS for improved clinical decision-making and patient outcomes. Key points: • The breast apparent diffusion coefficient category system (ADC-B) is a simple tool for the assessment, documentation, and reporting of ADC values in contrast-enhancing breast lesions on MRI. • The categories comprise ADC-B0 for non-diagnostic examinations, ADC-B1 for examinations without an enhancing lesion, and ADC-B2-5 for enhancing lesions with an increasing malignancy rate. • The breast apparent diffusion coefficient category system may be used to complement BI-RADS in clinical decision-making.

Ultrasound technology has evolved remarkably over the last decades. High-resolution ultrasound enables the evaluation of breast lesions in great detail and provides excellent guidance modality for aspirations, biopsies, preoperative localization, and clip placements. A novel and promising field of use of breast ultrasound is minimally invasive therapeutic procedures (see Chapter “Minimal Invasive Therapy”). Ultrasound is indicated as a primary imaging modality in young women; it is used as an adjunct to mammography to evaluate mammographically detected lesions, palpable abnormalities, and other breast symptoms, and after breast MRI as a targeted second-look examination. Furthermore, it is also used for the evaluation of the axilla. Grayscale or B-mode imaging is the most important ultrasound modality to evaluate breast lesions, but spatial compound imaging, harmonic imaging, color and power Doppler, 3D ultrasound, as well as sonoelastography and recently automated whole-breast ultrasound are routinely used. In this chapter, the technique of handheld ultrasound examinations of the breast and its normal sonographic morphology are dealt with; sonographic examples of the most common benign and malignant breast lesions are demonstrated.

Zusammenfassung Ziel Es soll untersucht werden, ob der Second-Look-US mittels Scherwellen-Elastografie (SWE) nützlich ist, um zwischen benignen und malignen Veränderungen in der postoperativen Brust nach der operativen Therapie des Mammakarzinoms zu differenzieren. Material und Methoden SWE und die damit verbundenen sonografischen Merkmale wurden bei 90 Patientinnen mit Anamnese einer operativen Therapie des Mammakarzinoms und einer bei der MRT-Nachuntersuchung entdeckten verdächtigen Läsion überprüft. Ein einziger erfahrener Radiologe führte alle Second-Look-US-Untersuchungen mit SWE-Messungen durch, indem er eine kreisförmige Region of Interest von 2 mm Durchmesser über dem steifsten Teil der Läsion legte. Gewebeproben für die histopathologische Untersuchung wurden dabei durch Stanzbiopsie entnommen. Ergebnisse Von 90 Läsionen erwiesen sich 39 als maligne in der histopathologischen Untersuchung. Von den malignen Läsionen zeigten 50 % Elmax-Werte im Bereich von 128 bis 199 kPa, und 50 % der benignen Läsionen hatten Elmax-Werte von 65 bis 169 kPa. Ein Cut-off-Wert von 171,2 kPa für Elmax zeigt eine Sensitivität von 59 % und eine Spezifität von 78,4 % für das Karzinomrezidiv und eine AUC von 0,706 (95 %-KI 0,6–0,81; p = 0,001). In univariaten logistischen Modellen erwiesen sich eingeschränkte Diffusion und Steifigkeit bei SWE, Elmax > 171,2 kPa, als signifikante Rezidiv-Prädiktoren. Im multivariaten Modell bleibt die eingeschränkte Diffusion ein signifikanter unabhängiger Rezidiv-Prädiktor. Bei einer Rezidiv-Prävalenz von 43 % liegt die Testsensitivität bei 95 % (95 %-KI 81–99 %) und die Spezifität bei 75 % (95 %-KI 60–85 %). Schlussfolgerung Steifere Läsionen in der postoperativen Brust sollten im Second-Look-Ultraschall als suspekt angesehen werden. SWE kann eine hilfreiche Methode zur Identifizierung maligner Läsionen sein, insbesondere im Zusammenhang mit einer eingeschränkten Diffusion in der MRTUntersuchung. Die Steifigkeit der Läsion sollte jedoch nicht als unabhängiger Prädiktor für die Läsionsmalignität in der postoperativen Brust angesehen werden, da in der SWE benigne Veränderungen steif, Karzinomrezidive hingegen weich erscheinen können.

Carotid artery disease is one of the main global causes of disability and premature mortality in the spectrum of cardiovascular diseases. One of its main consequences, stroke, is the second biggest global contributor to disability and burden via Disability Adjusted Life Years after ischemic heart disease. In the last decades, B-mode and Doppler-based ultrasound imaging techniques have become an indispensable part of modern medical imaging of carotid artery disease. However, they have limited abilities in carotid artery plaque and wall characterization and are unable to provide simultaneous quantitative and qualitative flow information while the images are burdened by low framerates. UltraFast™ ultrasound is able to overcome these obstacles by providing simultaneous quantitative and qualitative flow analysis information in high frame rates via UltraFast™ Doppler. Another newly developed ultrasound technique, shear wave elastography, is based on the visualization of induced shear waves and the measurement of the shear wave propagation speed in the examined tissues which enables real-time carotid plaque and wall analysis. These newly developed ultrasound modalities have potential to significantly improve workflow efficiency and are able to provide a plethora of additional imaging information of carotid artery disease in comparison to conventional ultrasound techniques.

High incidence of venous thromboembolic (VTE) events in coronavirus disease 2019 (COVID-19) patients has been reported despite pharmacologic thromboprophylaxis. We performed prospective bilateral lower extremity ultrasound evaluation of prolonged hospitalized COVID-19 ward patients from our institution without clinical suspicion of deep vein thrombosis (DVT).A total of 102 patient were included in the study. All patients were receiving pharmacologic thromboprophylaxis, the majority in intermediate or therapeutic doses. Asymptomatic DVT was detected in 26/102 (25.5%) patients: 22 had distal and four had proximal DVT, six had bilateral leg involvement. Pulmonary embolism was highly prevalent (17/70, 24.3%) but similarly grouped among patients with and without asymptomatic DVT. In total 37.2% of patients included in the study were recognized as having VTE.Asymptomatic DVT events were more common in intensive care unit (ICU) survivors (60% in postmechanically ventilated ICU survivors, 21.2% in ward patients, 22% in high-flow oxygen treated patients; P = 0.031), in patients with higher modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE risk-score (median 3 vs. 2 points with and without DVT; P = 0.021) and higher body temperature on admission (median 38.7 °C vs. 37.7 °C with and without DVT; P = 0.001). No clear associations with Padua VTE risk score, demographic and other clinical characteristics, intensity of thromboprophylaxis, severity of other COVID-19 symptoms, degree of systemic inflammation or D‑dimers on admission were found (P > 0.05 for all analyses).Systematic ultrasound assessment in prolonged hospitalized severe COVID-19 patients prior to hospital discharge is needed, especially in ICU survivors, to timely recognize and appropriately treat patients with asymptomatic DVT.