Cystic echinococcosis in the middle region of the Nile Delta, Egypt: Clinical and radiological characteristics

Background: Cystic echinococcosis (CE) is a parasitic disease characterized by cystic lesions mainly in the liver. The diagnosis relies on clinical, laboratory, and radiological examination. Aim: To explore the clinical, radiological, and biological features of patients with CE in the middle region of the Nile Delta, Egypt. Patients and methods: From March 2012 to February 2014, this study was conducted on 45 patients, aged 20–65 years. Patients were subjected to clinical, laboratory, and radiological assessment using conventional X-ray chest, ultrasound and multi-detector CT of the abdomen and chest. Results: This study identified the epidemiological, clinical, laboratory, and radiological characteristics of patients with CE in the middle Delta region, Egypt. The CT may display the same findings as US in diagnosing and staging of most cases; however, CT is more superior to US in the evaluation of heavily calcified cysts, small inaccessible cysts, and pulmonary hydatid cysts. Conclusion: Biological markers seem neither sensitive nor specific, whereas the serological tests, preferably two different techniques, are useful. Ultrasound showed high accuracy rate, but CT, whenever possible, should be employed as it provides additional diagnostic value

Diagnostic value of multidetector computed tomography in differentiation of benign and malignant omental lesions

Objective: To assess the diagnostic value of multidetector computed tomography (MDCT) in differentiation of benign and malignant omental lesions. Patients and methods: MDCT scan was performed for 37 patients with omental lesions after administration of oral and intravenous contrast. The CT diagnosis was compared with the final histopathological findings. Sensitivity, specificity, and diagnostic accuracy of MDCT were calculated using surgical and histopathological findings as the gold standard. Results: MDCT findings of all cases with omental torsion, cystic lymphangioma, and loculated fluid in the greater omentum correlated with the surgical and histopathological findings with 100% diagnostic accuracy. However, the diagnosis was missed in two patients from seven (2/7) with tuberculous peritonitis and in two patients from 21 (2/21) with peritoneal carcinomatosis with sensitivity, specificity and diagnostic accuracy of 73%, 92%, 85% and 90%, 95%, 93%, respectively. Conclusion: MDCT is an excellent diagnostic tool for evaluating omental lesions, especially those present with nonspecific clinical manifestations

The use of multi-detector computed tomography and ultrasonography for evaluation of pleural lesions

Background and objective: Multidetector CT (MDCT) and ultrasonography (US) are of increasing importance for assessment of many pulmonary disorders. Our aim was to evaluate their role in diagnosis of pleural diseases. Methods: Patients from Tanta University Hospital who were suspected to have pleural lesions (symptoms, signs and/or suggestive chest X-ray) during one year period were enrolled in the study. US and MDCT were done for all of them, then data were reported and analyzed. Results: Seventy-one patients were included, sixty of them had evident pleural lesions. Chest pain was the commonest presenting symptom. Malignancy represented 36.7% of pleural lesions, a percentage similar to lesions due to infection etiology. Free pleural effusions were the most common pleural lesions followed by pleural thickening. US was diagnostic in 72% of pleural lesions detectable by MDCT. Multiplanar reconstruction (MPR) images had an additional value than axial images in 39% of pleural lesions, mostly in cases of pleural thickening, free pleural effusion, pleural masses, encysted pleural effusions and pleural plaques. On the other hand, the MPR images had the same value as axial images in empyema and pneumothorax cases. Conclusion: MDCT is an important noninvasive imaging tool in accurate detection and characterization of pleural lesions with complementary MPR images that solve many diagnostic problems. Ultrasonography is a safer alternative but with less diagnostic value

Brachial artery flow mediated dilatation and carotid intima media thickness measured by high resolution B-mode ultrasound in patients with rheumatoid arthritis

Objectives: Firstly to assess the prevalence of subclinical atherosclerosis and endothelial dysfunction by high resolution ultrasound measurements of carotid intima media thickness (CIMT) and brachial artery flow mediated dilatation percentage (FMD%) in patients with rheumatoid arthritis (RA), secondly to analyze the correlation of CIMT and FMD% with different clinical and laboratory parameters, third aim was to analyze the relationship between CIMT and FMD%. Patients and methods: The prospective case–control study included 50 patients with RA and 50 healthy age and sex matched controls. All participants were subjected to carotid and brachial arteries ultrasound for measuring CIMT and FMD%, in addition to detailed history and physical examination. Results: Patients with RA had significantly higher CIMT and significantly lower FMD% than the controls (P < 0.001). In RA patients a significant correlation was found between CIMT and the patient’s age, disease duration, systolic blood pressure, HAQ, DAS, CRP and HDL-c, however no detectable correlation between the brachial artery FMD% and the clinical and laboratory parameters in RA patients. There was no significant correlation between CIMT and FMD%. Conclusion: FMD% and CIMT are important non-invasive independent imaging methods for early prediction of subclinical atherosclerosis in RA patients

Diagnostic accuracy of computed tomography angiography in detection of post traumatic renal vascular injury

Objectives: To evaluate accuracy of computed tomography angiography (CTA) in evaluation of post traumatic renal vascular injury. Patients and methods: 38 patients were presented with post traumatic intermittent or persistent hematuria. Renal CTA and digital subtraction angiography (DSA) were done for all patients. Results: CTA demonstrated pseudoaneurysm (PA) in 30 patients (78.9%) and no vascular lesions in 8 patient (21.1%). CTA had 86.11% sensitivity and 50% specificity in detection of post traumatic renal pseudoaneurysms, CTA missed diagnosis of renal arteriovenous fistula (RAVF) in 10 patients which discovered later by DSA. Conclusion: CTA with MIP as non invasive technique widely replaced renal DSA in detection of posttraumatic renal pseudoaneurysm. Renal DSA is still best modality in detection of RAVF and also has the upper hand in planning of selective renal artery embolization for the management of persistent or delayed hemorrhage from renal vessels. Keywords: Renal CTA, Renal vascular injur

Multi-detector computed tomography imaging of blunt chest trauma

Background and purpose: Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. The purpose of this study was to evaluate the role of multi-detector computed tomography (MDCT) in the assessment of patients with blunt chest trauma. Patients and methods: A prospective study was conducted on thirty (30) patients with blunt chest trauma (21 males and 9 females, aged from 6 to 62 years) and 29 control patients presented with any trauma other than blunt chest trauma (23 males and 6 females, aged from 10 to 68 years) at the Emergency Department, Tanta University Hospital, from January 2013 to February 2014. Cases were subjected to clinical evaluation and radiological assessment of the chest using conventional chest X-ray (CXR) and multi-detector computed tomography. Results: The most common mode of injury was motor vehicle accidents (56.7%). On MDCT scan, the frequency of chest injuries were; chest wall injuries (86.7%), pleural injuries (80%), parenchymal injuries (56.7%), mediastinal injuries (30%) and finally the dorsal spine injuries (16.7%). MDCT is more sensitive, specific, and accurate than CXR in the assessment of blunt chest trauma and management of patients. Conclusion: MDCT is the modality of choice for rapid assessment of emergency chest trauma patients, when chest X-ray was inconclusive

Value of apparent diffusion coefficient and magnetic resonance spectroscopy in the identification of various pathological subtypes of parotid gland tumors

Background and purpose: Pre-operative imaging has a major role in surgical planning of parotid gland tumors. Aim: To assess the role of the combined techniques of ADC generated from DWI and MR spectroscopy in identification of various pathological subtypes of parotid gland tumors. Patients and methods: Prospective study was conducted on 25 patients with primary parotid tumors (11 males, 14 females, age ranged 22–79 years with mean of 53.4 ± 13.6 years). DWI and MRS were performed for all patients and the results were correlated with histopathological findings. Results: The 18 (72%) benign and 7 (28%) malignant tumors consisted of 11 pleomorphic adenomas, 7 Warthin tumors, and 7 malignant tumors. The mean ADC value for pleomorphic adenomas was 1.89 ± 0.18 × 10−3 mm2/s, for Warthin tumors was 0.92 ± 0.22 × 10−3 mm2/s, and for the malignant tumors was 1.03 ± 0.13 × 10−3 mm2/s, significant difference was seen between benign and malignant tumors (P = 0.037). The mean values of Cho/Cr ratios were 3.37 ± 0.78, 5.9 ± 1.75 and 1.72 ± 0.41, for pleomorphic adenomas, Warthin tumors, and malignant tumors, respectively. Difference was significant between benign and malignant tumors (P = 0.001). Conclusion: DWI and MRS are useful noninvasive diagnostic modalities in identification of various pathological subtypes of parotid tumors

Functional disability of occupational-related lumbar disc degeneration: Evaluation by magnetic resonance imaging with surgical correlation

Objectives: The objectives of our work were to determine disability and study MRI findings of occupational-related lumbar disc degeneration and also to show the relationship between MRI grading of nerve root compromise with surgical grading. Participants and methods: The study included 103 workers with lumbar disc prolapse. Nerve roots were assessed on MRI and during surgery for the degree of compromise. Oswestry Disability Index and Visual Analogue Scale were used for assessment of disability and pain intensity pre- and post-operative respectively. Results: The majority of workers was less than 40 years and suffered from moderate to severe disability. 73.8% had grade IV disc degeneration mostly at the level of L4/L5. Nerve root compromise was found in 86.4% of workers. 48% of nerve roots were deviated and 32% were compressed, with significant correlation between MR grading of nerve root compromise and surgical grading (r = 0.89, P < 0.0001). Conclusion: Disability of occupational-related lumbar disc degeneration is a grave health problem between construction workers. MR imaging is a reliable tool for grading nerve root compromise in disc degeneration. Nerve root compromise is a significant factor to explain pain than the morphologic extension of disc material outside the intervertebral space

Evaluation of benign and malignant vertebral lesions with diffusion weighted magnetic resonance imaging and apparent diffusion coefficient measurements

Aim of the work: The aim of this study was to assess the utility of apparent diffusion coefficient obtained in diffusion-weighted MR imaging for the differentiation between benign and malignant vertebral lesions, and to determine the sensitivity and the specificity in differentiating benign and malignant vertebral lesions according to the optimal cutoff ADC value. Patients and methods: In 50 patients, 96 vertebral lesions were included and underwent DW MR Imaging. The mean ADC values of normal and abnormal vertebrae were calculated. The optimal cutoff ADC value was determined for the differentiation of benign and malignant lesions. The results were correlated with histopathological and surgical findings. Results: The mean ADC value of benign lesions was significantly higher than that of malignant ones (P < 0.05). There was an overlap between the mean ADC values of malignant and tuberculous lesions. According to the optimal cutoff value of 1.21 × 10−3 mm2/s, determined for the differentiation of benign and malignant vertebral lesions, sensitivity was 95.12%, specificity 92.73%, positive predictive value 90.70%, and negative predictive value 96.23%. Conclusion: Vertebral lesions were differentiated as benign or malignant with high sensitivity and specificity with the aid of ADC values calculated from maps obtained by DWI

Brain volumetrics, regional cortical thickness and radiographic findings in children with cyanotic congenital heart disease using quantitative magnetic resonance imaging

Background: Hypoxia in children with cyanotic congenital heart disease may cause structural brain changes. Objectives: 1. To assess brain volumetrics and ischemic brain lesions in children with cyanotic congenital heart disease using quantitative MRI. 2. To study the correlation between MRI findings, oxygen saturations and some laboratory measures. Participants and methods: Fifty children with CCHD and a mean oxygen saturation of 83 ± 2.2% were investigated using quantitative MRI. Brain volumetric results were compared with 20 controls. Results: Dilated Ventricles were found in 14 cases (28%). 23 cases (46%) had PWM hyper-intensity. The common sites for DWML were sub-cortical that was detected in 17 cases (34%). Sub-cortical lacunar infarcts in GM were found in 8 cases (16%). Significant WM and GM volume loss was found in cyanosed subjects. The volumes of the thalamus (P = 0.01), putamen (P = 0.003), and caudate (P = 0.042) were significantly reduced in the cyanotic group. Local regions of decreased cortical thickness were detected in frontal, parietal and temporal lobes. Conclusions: Children with CCHD show MRI evidence of micro- and macro vascular injury, reduced brain volume and cortical thickness. Brain volume loss correlated with hsCRP, oxygen saturation and packed cell volume