MRI of corpus callosum in patients with autism spectrum disorder in Kuantan

OBjective: To study the integrity of the corpus callosum among autistic children population in Kuantan, Pahang, Malaysia, which is determined by MRI’s diffusion tensor imaging (DTI) parameters, fractional anisotropy (FA) and radial diffusivity (RD). These param- eters represent the direction dependence of water molecules diffusion within the measured tissues. As corpus callosum is saturated with brain white matter tracts, the water molecules diffusion here will be direction dependent. Studies involving foreign populations have shown that there is distortion in the corpus callosum’s DTI parameters in autistic population indicative of microstructural distor- tion. Whether similar findings will be observed in our local autistic population still remains a question. Other gross corpus callosum parameters such as its thickness, length and size are also studied. Materials & Methods: 28 randomly selected autistic children under the International Islamic University Malaysia Medical Centre (IIUMMC), Kuantan follow-up are subjected to MRI scan. Limited MRI sequences including DTI are obtained and analysed. FA, RD, midsagittal thickness at the genu, body and splenium of the corpus callosum as well as its midsagittal length and size are measured. Data are tabulated according to age followed by statistical analysis. Results: A weak negative correlation is found between the age and the FA of the corpus callosum. Other parameters such as the thickness, length and size show weak positive correlation with age. Conclusion: Although the correlation is weak, our study shows that there is evidence of distortion of corpus callosum white matter microstructure in children with autism spectrum disorder in Kuantan, Pahang

Investigating white matter changes in auditory cortex and association fibres related to speech processing in noise-induced hearing loss : A diffusion tensor imaging study

This study explores the impact of noise-induced hearing loss (NIHL) on the microstructural integrity of white matter tracts in the brain, focusing on areas involved in speech processing. While the primary impact of hearing loss occurs in the inner ear, these changes can extend to the central auditory pathways and have broader effects on brain function. Our research aimed to uncover the neural mechanisms underlying hearing loss-related deficits in speech perception and cognition among NIHL patients. Methods: The study included two groups: nine bilateral NIHL patients and nine individuals with normal hearing. Advanced diffusion tensor imaging techniques were employed to assess changes in the white matter tracts. Regions of interest (ROIs), including the auditory cortex, cingulum, arcuate fasciculus, and longitudinal fasciculus, were examined. Fractional anisotropy (FA) values from these ROIs were extracted for analysis. Results: Our findings indicated significant reductions in FA values in NIHL patients, particularly in the left cingulum, right cingulum, and left inferior longitudinal fasciculus. Notably, no significant changes were observed in the auditory cortex, arcuate fasciculus, superior longitudinal fasciculus, middle longitudinal fasciculus, and right inferior longitudinal fasciculus, suggesting differential impacts of NIHL on various white matter tracts. Conclusions: The study's findings highlight the importance of considering association fibres related to speech processing in treating NIHL, as the broader neural network beyond primary auditory structures is significantly impacted. This research contributes to understanding the neurological impact of NIHL and underscores the need for comprehensive approaches in addressing this condition

Central line cathetherization & techniques

Presentation about central line, types, indication, contraindication and techniques for Radiation Protection Workshop 202

Biliary stent migration causing simultaneous duodenal and distal ileal perforation: a rare complication

Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article

Aberration in variation: deception by a CTA occult bleeding variant

Introduction: The coeliac axis and its major branches are known to have various anatomical variations, some are more common than others. The presence of variants may complicate the upper abdominal procedures, such as open surgery or interventional radiology procedures. Result: This is a case of a 65-year-old gentleman with various co-morbidities, who initially presented with pyogenic spondylodiscitis. On day 7 of admission, he developed hypovolaemic shock secondary to upper gastrointestinal bleed, requiring massive transfusion protocol. An oesophago-gastroduodenoscopy (OGDS) revealed a Forrest 1b ulcer. Initially the bleeding stopped with endoclip application, but the haemorrhage subsequently resumed with further massive transfusion required. An abdominal CT angiogram (CTA) was then performed revealing active arterial extravasation at the site of the endoclip. However, the actual bleeding artery was not apparent. An aberrant right hepatic artery was observed on the CTA. A subsequent urgent embolization angiographic run revealed some contrast extravasation from the gastroduodenal artery, which arise from the common hepatic artery. 5 pieces of 0.035” coils were deployed at the bleeder site. No extravasation seen on the final angiographic run. However, the next day, the patient continued to developed massive haemorrhage. Another abdominal CTA demonstrated further similar extravasation of contrast near the endoclips. Another urgent embolization was then performed. Angiogram via the aberrant right hepatic artery revealed the presence of an accessory gastroduodenal artery, which in turn demonstrated sizable contrast extravasation near the endoclips. A microcatheter was used to deliver Histoacryl glue for embolization, which subsequently stemmed the bleeding. Conclusion: This case highlights the difficulty that arises during interventional procedure from the presence of anatomical variant of the coeliac axis. Although CTA is usually an important assessment tool prior to embolization, the accessory gastroduodenal artery was not opacified in the pre-embolization CTA. This underlines the need for an interventional radiologist to expect difficulty when variants are presen