Residual breast cancer or post operative changes: Can Diffusion-weighted magnetic resonance imaging solve the case?

AbstractObjectiveTo evaluate the ability of Diffusion weighted MR imaging (DWI), as a non-invasive sequence to differentiate between accepted post operative sequel and residual malignancy in breast cancer patients following different surgical procedures.Patients and methodsDWI in addition to the routine post contrast MRI was performed for follow up of 170 post operative breasts (6–24months). DWI acquired using b values: 0, 850, 1000 and 1500. Analysis considered signal intensity (SI) at b 1000 and the ADC map and the mean ADC values.ResultsPost operative changes were: Edema (n=17, 10%), skin thickening (n=25, 15.9%), seroma (n=17, 10%), hematoma (n=5, 3%), fat necrosis (n=13, 7.6%), fibrosis (n=8, 4.7%), and combined (n=83, 48.8%). Residual malignancy found in 16.5% (n=28) of cases.No significant difference was noted between DWI SI at b 850 versus 1000 and b 1000 versus 1500 (P>0.05). Also no difference (P>0.05) was noted between the mean ADC values of residual malignant masses and post operative sequel of fibrosis and fat necrosis. ADC map showed low SI in 30% of cases. Statistical analysis yielded sensitivity, specificity and accuracy of 92.8%, 75.6% and 78% for contrast MRI and 92.8%, 82.6% and 83.4% for DWI respectively.ConclusionDWI enhanced the diagnostic performance of MRI in differentiating residual malignancy from post operative changes

Temporal changes of left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy

Background: Left ventricular dyssynchrony plays an important role in predicting response to cardiac resynchronization therapy (CRT). Methods: Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Results: Thirty patients received CRT (mean age 58.7 ± 9.0, 24 males). CRT implantation had a favorable prognosis on cardiac functions (LVEF preimplantation: 26.8 ± 4.7% versus 29.1 ± 6.4% post-implantation; P = 0.002). Reverse LV remodeling (⩾15%) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC curve for LV phase analysis showed that a cutoff value of 152° for histogram bandwidth had a sensitivity of 72.7% and specificity of 63.2% for predicting CRT non-response status. Also, a cutoff value of 54° for histogram standard deviation had a sensitivity of 81.8% and specificity of 63.2%. Conclusion: Responders of CRT showed improved LV dyssynchrony profiles. Utilizing Gated SPECT LV analysis could provide predictors for CRT non-response. Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters

Congenital biscuspid aortic valve in pediatric and early adults: Does valvular phenotype affect other parameters?

Aim of the study: Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient. Patients and methods: This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other. Results: Patients age ranged from 40 days up to 20 years with 62 patients being in the pediatric age group (<12 years). They were 78males and 26 females. We found 54 cases (53.8%) of 1-RL morphology, 34 cases (32.7%) of 1-RN morphology, 8 cases (7.7%) of 0-AP and 6 cases (5.8%) of 0-Lateral. Aortic stenosis and regurgitation were found in 80.75% of cases. Aortic stenosis was the most common valvular lesion being more evident in the 1-RN valve type. Aortic regurge was more predominant in the pediatric age group with no predilection for a specific valve phenotype. Left ventricular function was normal in most of our cases with only 10 cases showing impairment due to long standing valvular lesion. Thirty-eight cases (36.5%) had associated aortic dilatation. Twenty-six patients (25%) showed associated aortic coarctation. Intra cardiac shunts (24 patients 23%) were the second most common associated anomaly after coarctation. Most of the associated congenital anomalies were found with the 1-RL valve morphology type. Other associated congenital anomalies were detected in 44 patients (42.3%). Conclusion: Cardiac Magnetic resonance should be performed for patients with bicuspid aortic valve to determine the valve phenotype, function and aortopathy for risk stratification and surgical management. Patients with RL type should be properly imaged to detect associated congenital anomalies

Evaluation of left ventricle diastolic dysfunction in ischemic heart disease by CMR: Correlation with echocardiography and myocardial scarring

Objective: To detect the value of cardiac MR imaging in assessment of left ventricle diastolic function in patients with ischemic heart disease compared to echocardiography and to correlate the degree of dysfunction to the extent of myocardial scarring. Patients and methods: We examined 40 patients with known coronary artery disease. Mean patient’s age was 48 ± 10. All patients were subjected to 2D echocardiography and CMR including transmitral flow and left atrial planimetry. The degree of diastolic dysfunction was detected and correlated with the echocardiographic results and the extent of myocardial scarring. Results: On CMR, 35% of the cases had grade I diastolic dysfunction, 35% showed grade II, 15% had grade III while 15% showed normal diastolic function. CMR showed 94.12% sensitivity, 100% specificity and 95% accuracy. Excellent agreement with echocardiography was detected (Kappa coefficient 0.931). There was a significant correlation between the degree of diastolic dysfunction and the extent of myocardial scarring with Spearman’s correlation coefficient of 0.492 and p = 0.028. Conclusion: CMR has comparative results to echocardiography in assessment of diastolic dysfunction. We found a significant correlation between the degree of diastolic dysfunction and the extent of myocardial scarring

PET/CT in initial staging and therapy response assessment of early mediastinal lymphoma

Objective: To detect accuracy of PET/CT in the initial staging, response after the first line and end of treatment in early mediastinal lymphoma patients compared to contrast CT. Materials and methods: We studied 50 patients with pathologically proven lymphoma with a mean age = 27.5. All patients were at early stage. All patients performed CT and PET/CT for initial staging, after the first course of chemotherapy (after 4–6 weeks) and at the end of treatment (after 2–4 months). Results: PET/CT upstaged 5 cases. At first line of treatment, PET/CT and CECT were agreeable in 32% of cases. PET/CT showed 100% sensitivity, 96.7% specificity, 95% positive predictive value and 100% negative predictive value. At the end of treatment both methods showed a 46% agreement. PET/CT was statistically significant in the follow up of hilar and axillary lymph nodes. PET/CT showed 100% sensitivity and specificity; compared to 62.5% sensitivity and 97.6% specificity for CECT in detection of extra-nodal disease sites. Conclusion: PET/CT proved higher sensitivity and specificity over CECT. The major strength of PET/CT over CECT was its higher ability for detection of extra-nodal sites of lymphoma and excluding active disease in residual nodal mass lesions on follow up

Diagnostic value of fetal MRI in evaluating fetal urinary anomalies

Purpose: To detect the accuracy of fetal MRI in diagnosing urinary tract anomalies in comparison with ultrasonographic findings and fetal outcome. Methods: We examined 30 fetuses with sonographically suspected congenital urinary tract anomalies by 2D/3D ultrasound and MRI. The gestational age range was 18–36 weeks. 43% of the women were in the second trimester. The diagnosis was confirmed by postnatal ultrasound, cystogram and biopsy in born babies and autopsy in still born or abortus fetuses. Results: We found different urinary tract anomalies including: bilateral autosomal recessive polycystic kidney disease (n = 8), unilateral autosomal recessive polycystic kidney disease (n = 1), dilated collecting system (n = 8), renal agenesis (n = 3), bilateral enlarged multicystic dysplastic kidneys (n = 5), unilateral enlarged multicystic dysplastic kidney (n = 4) and renal dysplasia (n = 1). MRI changed the US diagnosis in 6 cases and added information in 4 cases. MRI changed the patient’s management in 3 cases. MRI confirmed US diagnosis in 20 fetuses. Ultrasound was superior to MRI in one case of renal failure. Associated extrarenal anomalies were detected in 9 cases (30%). MRI showed 96% accuracy in diagnosis. Mortality rate reached 56%. Conclusion: Fetal MR imaging may be used as a complementary modality to US in diagnosing inconclusive or equivocal fetal urinary abnormality

Nephroprotective effects of Acacia senegal against aflatoxicosis via targeting inflammatory and apoptotic signaling pathways

Aflatoxin B1 (AFB1) is a common environmental pollutant that poses a major hazard to both humans and animals. Acacia senegal (Gum) is well-known for having antioxidant and anti-inflammatory bioactive compounds. Our study aimed to scout the nephroprotective effects of Acacia gum (Gum) against AFB1-induced renal damage. Four groups of rats were designed: Control, Gum (7.5 mg/kg), AFB1 (200 µg/kg b.w) and AFB1-Gum, rats were co-treated with both Gum and AFB1. Gas chromatography-mass spectrometry (GC/MS) analysis was done to determine the phytochemical constituents in Gum. AFB1 triggered profound alterations in kidney function parameters (urea, creatinine, uric acid, and alkaline phosphatase) and renal histological architecture. Additionally, AFB1 exposure evoked up-regulation of mRNA expression levels of inflammatory cytokines, including interleukin-6 (IL-6), tumor necrosis factor α (TNFα), inducible nitric oxide synthase (iNOS), and nuclear factor kB p65 (NF-κB/P65) in renal tissue. The oxidative distress and apoptotic cascade are also instigated by AFB1 intoxication as depicted in down-regulated protein expression of the nuclear factor erythroid 2–related factor 2 (Nrf2) and superoxide dismutase type 1 (SOD1) along with upregulation of cytochrome c (Cyto c), and cleaved Caspase3 (Casp3–17 and 19) in renal tissue. In conclusion, current study obviously confirms the alleviating effects of Gum supplementation against AFB1-induced renal dysfunction, oxidative harm, inflammation, and cell death. These mitigating effects are suggested to be attributed to Gum's antioxidant and anti-inflammatory activities. Our results recommend Gum supplementation as add-on agents to food that might aid in protection from AFB1-induced nephrotoxicity

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy

The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4