Contrast enhanced MRI and Diffusion Weighted Imaging (DWI) in the evaluation of renal cell carcinoma and differentiation of its subtypes

Objective: The prognosis of different histologic subtypes of RCC varies and affects management. Patients with chromophobe or papillary RCC have better prognosis than those with clear cell RCC. The aim of our work was to study the utility of DCE and DWI in the preoperative prediction of renal cell carcinoma subtypes, using histopathology as a gold standard method of diagnosis. Patients and methods: Thirty five patients with 38 renal masses were included in the study. All had DCE MRI studies with DWI sequences, CER and ADC values calculation for normal and diseased renal tissues. Results: The Mean ADC value of normal renal parenchyma was significantly higher than RCC. The CER and ADC values for Clear cell RCC were higher than Papillary and Chromophobe RCC. No statistically significant difference was found between the CER & ADC values for Papillary and Chromophobe RCC. CER & ADC values of clear RCC were higher than non clear RCC. Conclusions: DCE MRI in addition to DWI & ADC appears as a very helpful imaging tool in the differentiation between clear cell and non-clear cell RCCs

Assessment of vascular invasion in pancreatic carcinoma by MDCT

Background: Pancreatic cancer is one of the aggressive cancers with poor resectability and survival rates. The relationship to adjacent vessels must be assessed before deciding the choice of treatment. Aim: Assessment of the MDCT signs of arterial and venous invasion in pancreatic carcinoma. Subjects and methods: Total of 179 of the major peripancreatic vessels (CA; CHA; SMA; PV; SMV) in 47 patients who underwent surgery for pancreatic cancer after MDCT were assessed at surgery and compared with CT findings. Statistical analysis of the findings was done using Chi square test. Results: 115 vessels were not invaded at surgery, while the remaining 64 vessels were invaded (22 arteries and 42 veins). There was over all statistically significant difference between arterial and venous invasion regarding stenosis, occlusion, infiltration and circumferential involvement of the vessel wall. Conclusion: Assessment of vascular invasion is crucial in the evaluation of resectability for pancreatic cancer. MDCT is an accurate diagnostic tool for peripancreatic vascular invasion in cancer pancreas

Relationship of lumbosacral spine morphometrics and lumber disc degenerative disease in young adults using magnetic resonance imaging

Objectives: To evaluate the relationship between lumbosacral morphological parameters and intervertebral disc degenerative disease. Material and methods: A retrospective study of MRI lumbosacral studies of low backache patients included 152 patients (92 females and 60 males). Patients were evaluated for the presence of disc herniation or degeneration. Angles of lumbar lordosis, sacral table, and sacral kyphosis were measured. Results: Normal population included 51 patients (30 males and 21 females) and showed no statistically significant difference between male and female. 101 patients had degenerated disc and/or disc herniation. There was no statistically significant difference between normal population and patients with disc pathology as regards lumber lordosis angle (p > 0.05) while a statistically significant difference was observed as regards both sacral kyphosis angle and sacral table angle. Patients with disc pathology showed; moderate negative correlation between lumber lordosis angle and sacral table angle (p = 0.001), strong negative correlation between lumber lordosis angle and sacral kyphosis angle (p = 0.000) and no correlation between sacral table angle and sacral kyphosis angle (p > 0.05). Conclusion: The risk of developing disc degeneration and herniation increases with increasing sacral table angles and decreasing sacral kyphosis angle

Ischiofemoral impingement syndrome: Spectrum of MRI findings in comparison to normal subjects

AbstractObjectiveTo evaluate the MRI findings of patients with ischiofemoral impingement in comparison to healthy subjects.Materials and methodsThe study included 34 subjects; 14 patients clinically suspected to have ischiofemoral impingement and twenty volunteer subjects used as a control group. The MRI images were evaluated for both hip joints for two measurable parameters; the ischiofemoral space (IFS) and the quadratus femoris space (QFS). The quadratus femoris muscles were evaluated for; muscle edema, tear, or muscle atrophy. Statistical analysis was performed with the (Minitab Ver.16). The Paired t-test and ANOVA test were used to analyze differences of the distance measurements in each side of the patient group as well as both sides in the control group. Receiver operating characteristic (ROC) curves were used to determine optimal threshold values of IFS and QFS using (MedCalc software, version 12.7.8.0.).ResultsThere were statistical differences between affected hip and healthy hip regarding IFS and QFS (P=0.000) associated with QF muscle changes ranged from focal edema to partial tear in the affected joints.ConclusionIschiofemoral impingement is an uncommon cause of hip pain. Our study illustrates the MR spectrum of IFS, QFS and quadratus femoris muscle abnormalities

Evaluation of sonoelastography in Achilles tendon of healthy volunteers and patients with symptomatic Achilles tendon

Aim and objectives: To assess the role of SEL in evaluation of Achilles tendon. Methodology: This study included 40 healthy volunteers and 40 patients with symptomatic Achilles tendon. All patients were examined by conventional B-mode ultrasound, sonoelastography and MRI. Results: Achilles tendons of the volunteers were characterized by hard texture with higher strain ratios than those of the patients with Achilles tendinopathy. No significant differences could be detected between SR of male and female volunteers yet significant differences could be detected in the volunteer group above and below forty being lower with softer tendon properties in the group above forty with a cut-off value of ≤1.84 between healthy and diseased group. Sonoelastography had the sensitivity of 89.1% and specificity of 96.1% for diagnosis of tendinopathy with results superior to those of conventional B-mode ultrasonography. Conclusion: SEL is a reliable tool in the evaluation of Achilles tendinopathy with sensitivity and specificity superior to B-mode US. Strain ratio provides excellent non-invasive diagnostic data adds strongly in more objective evaluation of Achilles tendon properties. Keywords: Tendinopathy, Sonoelastography, Strain rati

“Facial vascular anomalies; MRI and TRICKS-MR angiography diagnostic approach”

Purpose: Evaluate role of MRI and TRICKS-MR angiography in diagnosis of facial vascular anomalies. Material and methods: This study included 22 patients (mean age 9 years) with proved facial vascular anomalies on basis of interventional/surgical procedures (n = 19) or clinical follow up (n = 3). They underwent MRI examination with TRICKS-MRA. Images were evaluated for lesion location, size, feeding arteries and draining veins. Results: AVM was diagnosed in 15 patients (68.2%), hemangioma (5) patients (27.7%) and low flow venous malformation (2) patients (9.1%). TRICKS-MRA was accurate in diagnosis of 25 feeding arteries out of total 27 included in the study with 92.6% positive predictive value, 100% negative predictive value and 93.1% accuracy. AVMs were treated with sclerotherapy (26.7%), embolization (40%) and combined embolization and surgery (33.3%). Surgery was done in 2 hemangiomas (40%) while the other three patients (60%) underwent clinical follow up for 2 years with stationary course. The 2 patients with venous malformation underwent successful sclerotherapy. Conclusion: MRI & TRICKS-MRA provide excellent diagnostic data for assessment of facial vascular anomalies. TRICKS -MRA adds precise delineation of the vascular mapping, regarding feeding arteries and draining veins which helps in planning of therapeutic approach and reduces needing for invasive DSA