The role of MR diffusion in differentiation of malignant and benign hepatic focal lesions

AbstractAimTo determine if focal liver masses could be differentiated as benign or malignant by DWI and ADC maps.Methods and materialsSixty focal liver lesions were scanned using 1.5T MRI. DWI was performed with b 0, b 500 and b 1000 gradients with ADC measurements. Comparison of mean ADC values between each benign and malignant lesion was done. Reference standard of diagnosis was obtained by correlating DWI with histopathologic findings and imaging follow-up. The accuracies of DWI and ADC values were assessed with the Student’s t test, and cut-off values were determined with receiver operating characteristic curve analysis.ResultsWhen ADC value of 1.0×10−3mm2/s was used as a threshold value for differentiation of malignant tumors from benign lesions, sensitivity was 90.3%, specificity 78.57% and accuracy 86.7%. The best result was obtained with the use of ADC cut off value (at b 500) of 1.5×10−3mm2/s and ADC cut off value (at b 1000) of 1.0×10−3mm2/s, with 90.3% sensitivity, 92.86% specificity, 91.1% accuracy, 96.6% positive predictive value and 81.3% negative predictive value.ConclusionDWI and ADC map is a useful tool in differential diagnosis of malignant from benign liver lesions

Transvaginal Bilateral Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas: An Effective Modality in Low Resource Settings

Objective: To study the effectiveness and safety of bilateral uterine artery occlusion through the vaginal approach as an alternative treatment modality for symptomatic uterine myomas.Methods: Sixty-nine premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy underwent bilateral vaginal uterine arteries occlusion. The primary outcome measures were patient satisfaction as regards menstrual blood loss compared with pre treatment loss and operative duration. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures.Results: Sixty-three women were completed follow up till 24 months after the procedure. The primary outcomes were encouraging as regards patient satisfaction for post treatment blood loss (90.7 %) and mean operative duration ( 35 ±9.5 minutes). After 6 months of follow-up, 6 patients resumed heavy periods and interventions needs secondary.Conclusion: Trans-vaginal occlusion of uterine arteries improved clinical symptoms in the majority of patients

Associations of symptomatic or asymptomatic peripheral arterial disease with all-cause mortality and cardiovascular mortality

AbstractBackgroundTo investigate the rate of all cause and cardiovascular mortality in patients with symptomatic or asymptomatic peripheral arterial disease (PAD) compared to those without PAD.Methods and resultsAll the subjects were inpatients at high risk of atherosclerosis and enrolled from February to November, 2006. A total of 320 were followed up until an end-point (death) was reached or until February 2010. The mean follow-up time was 37.7±1.5months. Compared with non-PAD, PAD patients had significantly higher rates of hypertension, diabetes mellitus, and smoking (P<0.01). Those with symptomatic and asymptomatic PAD had a much higher all cause (37.5% and 23.0% vs. 12.1%) and cardiovascular mortality (18.8% and 13.8% vs. 6.7%) compared to those without PAD (P<0.001). The symptomatic PAD patients were 1.831 times (95% CI: 1.222–2.741) as likely to die as those without PAD, and 1.646 times (95% CI: 1.301–2.083) in asymptomatic PAD patients after adjusting for other factors. Those with symptomatic or asymptomatic PAD were more than twice as likely to die of CVD as those without PAD (RR: 2.248, 95% CI: 1.366–3.698 and RR: 2.105, 95% CI: 1.566–2.831, respectively).ConclusionsPAD was associated with a higher all cause and cardiovascular mortality whether or not PAD is symptomatic

Sonographic evaluation of tendon abnormalities: Added value of elastography

Background: This study aims to evaluate the value of adding elastography (strain elastography) to US in the evaluation of tendon abnormalities with comparison to conventional MRI. Methodology: After institutional review board approval and informed consent taken from all the patients, supraspinatus and tendoachillis tendon sonoelastography performed on 46 patients with shoulder or ankle pain and limitation of movement. Statistical analysis of this research was assessed by Chi-square test, Fisher’s exact test and Independent-Samples t-test. Results: This study included 46 patients with shoulder or ankle pain and limitation of movement, 23 male and 23 female patients. Their mean age (years) ± SD was 51.30 ± 12.4 years. We found that US had perfect agreement with MRI for detection of complete tear (k=1), strong agreement in diagnosis of partial tendon tear (k=0.810), while moderate agreement in detection of tendinopathy (k=0.645). Also we found that elastography increased US sensitivity and accuracy in diagnosis of partial tendon tear from (73.3% and 93.9% to 86.7% and 97% respectively) while it didn’t add any effect to US in diagnosis of complete tendon tear. Conclusion: Elastography plays an important role if added to US in evaluation of tendon abnormalities, especially if MRI is contraindicated for any reason

Multi-detector computed tomography (MDCT) findings of chemotherapy induced hepatic chan

Purpose: To evaluate the role of multi-detector computed tomography (MDCT) in detection and characterization of chemotherapy induced hepatic changes. Materials and methods: This retrospective study included 400 patients with confirmed 14 malignancies and treated by standard chemotherapy regimens. The most common malignancy was non-Hodgkin lymphoma and mostly chemotherapy regimen was Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisolone (CHOP). All patients underwent CT scan using 64 MDCT scanner (Brilliance 64, Philips) before chemotherapy and follow-up after 6 months from last session of chemotherapy. Precontrast series and post-contrast triphasic study were done for all patients. All the patients underwent radiological evaluation for hepatic changes after chemotherapy treatment. All CT scans were evaluated for fatty liver, capsular retraction, venoocclusive disease and biliary sclerosis. Four patients with capsular retraction underwent liver biopsy. Results: Forty patients (32 females and 8 males) had hepatic changes due to effect of chemotherapy. The most common CT finding was fatty liver. Hepatic fatty changes were detected in 36/40 patients. These fatty changes were diffuse, focal fatty and diffuse with fatty spare area. Four patients had capsular retraction: 1 patient with HD and 3 patients with metastatic cancer breast. Veno-occlusive disease and biliary sclerosis were not detected

Association between HCV induced mixed cryoglobulinemia and pulmonary affection: The role of TNF-alpha in the pathogenesis of pulmonary changes

Background and aim of the work: Chronic hepatitis C virus (HCV) infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. Subjects and methods: After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests (spirometry), arterial blood gas (ABG) parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients. Results: The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea (51.7%), followed by cough (43.3%). Oxygen saturation (Spo2 and Sao2%), and FEV1 and FVC levels, were significantly decreased in the cryoglobulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV1 level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. Conclusions: The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection

Role of DWI and MRS in diagnosis of Alzheimer’s and pre-Alzheimer’s disease

Background and purpose: Alzheimer’s disease (AD) is a major cause of dementia in elderly affecting about 30% above the age of 85 years, while mild cognitive impairment (MCI) is the impairment in cognitive functions with intact daily life activities which is described as the preclinical phase of AD. Purpose: To evaluate the role of DWI and MRS in prediction of pre-Alzheimer’s patients and differentiating them from those with AD. Patients and methods: This study included 37 patients (24 males and 13 females) with age ranged from 50 to 73 years (mean age = 61.6 years). They were divided into two main groups, the first group pre-Alzheimer’s (MCI) included 24 patients, and the second group (AD) included 13 patients. All patients underwent DWI and MRS using 1.5 T system. Results: In our study, males were more commonly affected by the two diseases, the mean age was 61.6 years and memory dysfunction followed by depression was the most common clinical symptom. Regarding DWI study, there were statistically higher ADC values in AD (0.97 and 0.94) than in MCI (0.90 and 0.79) in the hippocampal and temporal regions respectively. The NAA/Cr ratio was significantly higher in MCI (1.74 and 1.58) than in AD (1.41 and 1.05) in the hippocampal, temporal regions respectively. Regarding mI/Cr ratio, it was significantly higher in AD (1.51 and 1.47) than in MCI (1.10 and 1.11). The Cho/Cr ratio also was significantly higher in AD (1.27 and 1.38) than in MCI (1.02 and 0.99) in the same regions respectively. From the ROC curve analysis the NAA/Cr ratio was the most sensitive and specific in both regions. Conclusions: Mild cognitive impairment is a term used to describe the pre-Alzheimer’s stage. Later, most of MCI patients develop Alzheimer’s dementia. The combination of DWI and MRS is promising tool for the detection of early structural changes occurring in MCI patients before the full manifestation of dementia syndrome starts to appear. Clinical significance: DWI and MRS help in early prediction, follow-up, and treatment of patients with pre-Alzheimer’s disease