Prediction of postnatal outcome in foetuses at risk for chronic lung disease

In this two-part thesis we assessed the value of prenatal ultrasound predictors for postnatal outcome in foetuses with a congenital anomaly associated with pulmonary hypoplasia and an increased risk of postnatal development of pulmonary hypertension and/or chronic lung disease

Minimally Invasive Urological Procedures and Related Technological Developments

The landscape of minimally invasive urological intervention is changing. A lot of new innovations and technological developments have happened over the last 3 decades. Laparoscopy and robotic surgery have revolutionised kidney and prostate cancer treatment, with more minimally invasive procedures now being carried out than ever before. At the same time, technological advancements and the use of laser have changed the face of endourology. Several new innovative treatments are now commonplace for benign prostate enlargement (BPE). Management of prostate cancer now involves procedures such as robotic prostatectomy, brachytherapy, radiotherapy, cryotherapy and HIFU. Robotic partial nephrectomy and cryotherapy have changed the face of renal cancer. En-bloc resection of bladder cancer is challenging the traditional management of non-muscle invasive bladder cancer and becoming commonplace, while robotic cystectomy is also gaining popularity for muscle invasive bladder cancer. Newer surgical intervention related to BPE includes laser (holmium, thulium and green light), water-based treatment (Rezum, Aquablation) and other minimally invasive procedures such as prostate artery embolisation (PAE) and Urolift. Endourological procedures have incorporated newer laser types and settings such as moses technology, disposable ureteroscopes (URS) and minimisation of percutaneous nephrolithotomy (PCNL) instruments. All these technological innovations and improvements have led to shorter hospital stay, reduced cost, potential reduction in complications and improvement in the quality of life (QoL)

Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Novel Applications and Refinements of Ultrasound Techniques in Perinatal and Infant Death Investigation

The decline in parental consent for perinatal autopsies has led to the development of less invasive autopsy techniques, primarily using imaging and in some cases acquiring tissue samples through laparoscopic techniques via small incisions. Whilst post-mortem MRI (PMMR) has been extensively tested, and shown to be a suitable modality for determining the cause of death/demise in the perinatal cohort, it is not widely available. This thesis explores the utility of a poorly explored, yet more accessible, cheaper, dynamic imaging modality widely used in ‘live’ paediatric imaging for the purposes of a less invasive autopsy – the perinatal post-mortem ultrasound (PMUS). I present a systematic review of the limited literature of PMUS diagnostic accuracy for perinatal death investigation encompassing 4 publications with 455 cases in total. This reveals an overall pooled whole body sensitivity rate of 73.3% [95% CI 59.9, 83.5] and specificity rate of 96.6% [95% CI 92.6, 98.4] . A comprehensive imaging protocol for whole body PMUS is also presented based on my own experience in scanning 272 perinatal deaths. An analysis in 130 of these cases with autopsy as a reference standard, showed that brain and abdominal diagnoses yielded the highest sensitivity rates (90.9% and 92.3% respectively), with spinal, cardiac and thoracic diagnoses yielding the lowest sensitivity rates (50%, 50% and 57.1% respectively). Imaging of the brain and heart however were the least likely to be of diagnostic quality (76.8% and 78.3% diagnostic cases respectively), particularly in macerated fetuses. In a subset of cases where PMUS and 1.5T PMMR were performed, there was no significant difference in whole body diagnostic accuracy rates (concordance rates for PMUS versus PMMR of 86.4% [95%CI 77.7, 92.0] versus 88.6% [95% CI 80.3, 93.7]), although PMMR yielded fewer non-diagnostic brain and cardiac examinations (2.9% and 2.9% non-diagnostic brain and cardiac PMMR cases versus 22.8% and 14.7% non-diagnostic PMUS cases). In the second part of my thesis, I describe the development of an ‘incisionless’ ultrasound guided biopsy method using a single entry site for the biopsy needle – the umbilical vein. This ‘INTACT’ biopsy method allowed for a ‘non-invasive’ autopsy with tissue sampling, with a biopsy success rate of 76.1% overall for all organs, with highest individual organ success rates >90% for heart and lungs. I conclude by discussing how best to incorporate PMUS into clinical practice and suggest areas for future researc