Triangular fibrocartilage and ligamentous injury of the wrist joint: Does MR arthrography improve diagnosis over standard MRI?

Objective: To detect the added value of magnetic resonance arthrography (MRA) over MRI in different triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament lesions. Patients and methods: MRI and MRA were achieved in 57 patients presented with wrist pain. Another symptompless Ten control individuals with negative MRI and MRA findings were included. Images were assessed for the presence of TFCC, scapholunate ligament (SCL) and lunotriquetral ligament (LTL) lesions. Imaging findings were compared with arthroscopic findings in all cases. Results: Out of fifty-seven patients, 38 males (66.6%) and 19 females (33.3%) (age range 19–61 years (mean = 34.3 years) were included in the study, The sensitivity, specificity and accuracy of MRI and MRA for TFCC peripheral tears were 79.16%, 100%, 85.29% and 91.66%, 100%, and 94.11% respectively, the sensitivity, specificity and accuracy of MRI and MRA for TFCC central tears were 60%, 100%, 80% and 90%, 100%, and 95% respectively. Sensitivity, specificity and accuracy of MRI and MRA for SCL partial tears were 63.15%, 100%, 75.86% and 94.73%, 100% and 96.55%, respectively. For LTL partial tears, the values were 20%, 100%, 73.33% and 80%, 100%, and 93.33% respectively. Conclusion: MR arthrography is highly accurate for the evaluation of TFCC and ligamentous injury of the wrist joint

Subtraction MRI versus diffusion weighted imaging: Which is more accurate in assessment of hepatocellular carcinoma after Trans Arterial Chemoembolization (TACE)?

This study aims to compare the role of both subtraction MRI and Diffusion weighted images in assessment of HCC after trans-arterial chemo embolization (TACE). Patients and methods: 32 patients having 54 HCC lesions underwent TACE. Ages ranged between 59 and 73 years (mean age 59.6); there were 26 males and 6 females. All examinations were performed using Philips 1.5 T MRI (Achieva). Pre contrast: T1, T2W and In phase and out phase gradient echo sequence, dynamic: eTHRIVE technique performed. Subtraction of an unenhanced T1-weighted was from the identical post enhancement sequences in early angiographic and late arterial phases. Diffusion imaging: it was performed using single-shot spin-echo echo-planar imaging with b = 0, 300, 600 mm/s2. DWI was used to create ADC maps. Two readers blinded to each other assessed subtraction of dynamic study and DWI technique to evaluate post treatment response. Results: Reader 1 subtraction dynamic MRI sensitivity = 97%, specificity = 100% PPV = 100% and NPV = 95% compared to 70.59%, 75%, 82.76% and 60% respectively in DWI. Reader 2 subtraction dynamic MRI sensitivity = 97%, specificity = 100% PPV = 100% and NPV = 95% compared to 76.5%, 90%, 92.8% and 69% respectively in DWI. Conclusion: DW-MRI had lower accuracy measures compared to subtraction MRI with increased false negative. DWI may act as a supplementary sequence to compensate for the dynamic MRI in patients who couldn't hold their breath adequately

Contrast enhanced digital mammography: Is it useful in detecting lesions in edematous breast?

Introduction: Breast edema can be caused by a variety of pathologic processes of benign or malignant diseases. Contrast enhanced digital mammogram (CEDM) has been shown to improve the probability of malignancy detection when compared with the conventional mammography alone. Patients and methods: This study was prospectively carried on 34 female patients with breast edema at the female imaging unit of the Radiology Department. The age range was 29–80 years. Bilateral conventional mammography (MX) and contrast-enhanced digital mammographic procedure (CEDM) were performed in approximately 7–10 min and followed by complementary ultrasound (US). Results: As regards enhancement patterns in our study, noncontrast uptake and diffuse parenchymal uptake were considered as benign and intense contrast uptake is considered malignant and ring enhancement in keeping with both benign and malignant lesions. The calculated sensitivity and specificity of dual energy contrast enhanced digital mammography were 95%, and 73% respectively, with a positive predictive value (PPV) of 88% and negative predictive value (NPV) of 88%. Conclusion: Dual-energy contrast-enhanced digital mammography is a useful technique in identification of lesions in mammographically dense edematous breasts and proved to be a useful tool in the follow-up of cases presenting by edema after conservative breast surgery and chemotherapy

Diagnostic accuracy of diffusion weighted MRI in cervical lymphadenopathy cases correlated with pathology results

Introduction: Diffusion weighted magnetic resonance imaging (DW MRI) is an imaging technique showing molecular diffusion. Cell size, density and integrity influence the signal intensity seen on diffusion-weighted images. This technique is a helpful complementary tool to distinguish tumoral from non tumoral tissue. The aim of this prospective study is to define the diagnostic accuracy of DWI to differentiate benign from malignant cervical lymph nodes. Patients and methods: Twenty six patients who presented with 32 nodes were included in this study, 9 males (35.6%) and 17 females (65.4%). Their age ranged from: 6 to 76 years, mean age 45 ± 18.8 years referred to the radiology department of NCI, complaining of neck swelling, ultrasound showed cervical nodes. Results: According to histopathological analysis we divided the examined lymph nodes (n = 32) into 2 categories: malignant lymph nodes 75% (n = 24) benign lymph nodes 25% (n = 8). DWI and ADC (apparent diffusion coefficient) values revealed 27 malignant lesions (84%), 5 benign (16%). The accuracy of the DWMRI was 89%. A significant difference between benign and malignant cervical nodes on DWI and on ADC maps is reported. The results obtained were 24 true positive, 3 false positive, 5 true negative. No false negative cases were identified, yielding a sensitivity of 100%, specificity of 62.5%, NPV = 100% and PPV = 89%. The difference between the mean ADC values between benign and malignant lesions was statistically significant (P < 0.0001). Conclusion: MR diffusion imaging could be an important supportive tool in differentiation between benign and malignant lymph nodes, can to a lesser extent differentiate between the types of malignant lymphadenopathy and can be used as an indicator for improvement and recurrence post chemo and radiotherapy

Role of MRI in the evaluation of postchemotherapy brain changes in childhood leukemia: An Egyptian study

Aim of the study: To evaluate the role of MRI in the detection of the side effects of chemotherapy on the brain in leukemic children presenting with clinical symptoms. Patients and methods: 20 pediatric patients aged between 1 and 16 years receiving or have received chemotherapy for acute leukemia have undergone MR examination of the brain for evaluation of neurological symptoms related to treatment from August to December 2015. Written consent was taken from the patients. Results: This study included 20 children, 15 (75%) were males and 5 (25%) were females. Their ages at the time of the study ranged from 1 to 16 years. 17 patients (85%) were on maintenance chemotherapy, 2 patients (10%) were on induction and 1 patient (5%) had finished treatment. Multiple complications were recorded by MRI and its correlation to the treatment phase of the cases. All cases of Sino-venous thrombosis and hemorrhage occurred within the maintenance phase. Leukoencephalopathy was divided equally between maintenance and induction phases. Brain atrophy was divided equally between induction and maintenance phases. PRES occurred within the maintenance phase. Most of infection cases (sinusitis and otitis media) occurred within maintenance; only one case was seen in a patient who just ended his chemotherapy. Conclusion: Chemotherapy is associated with certain side effects that can be evaluated by utilization of MRI. An elevated degree of suspicion is needed to recognize the radiological features of CNS complications of chemotherapy and familiarity with the imaging findings is essential for proper diagnosis and further treatment of neurological symptoms in pediatric patients with leukemia