Role of quantitative diffusion weighted

Purpose: To evaluate the diagnostic accuracy of diffusion-weighted imaging (DWI) in differentiating benign from malignant breast lesions. Patients and methods: Forty patients with positive diagnoses at mammography or breast ultrasound were included in this study. Patients were imaged with dynamic contrast enhanced MRI and DWI before biopsy of their breast tumors. Apparent diffusion coefficient (ADC) map was utilized to select the region of interest (ROI) for ADC calculation. DWI was performed using three sets of b value (0, 400, and 800 s/mm2). Results: The final analysis comprised 40 breast lesions, 18 of which were malignant and 22 were benign. Significant results were obtained between ADC values of benign and malignant lesions (p < 0.001). The cut-off ADC value for benign and malignant lesions was 1.25 × 10–3 mm2/s. Conclusion: The present study provides consistent evidence to support DWI as a diagnostic tool for breast lesion characterization and as a useful adjunct to standard breast MRI protocols in aiding the diagnosis of breast cancer

Complications of Port A Cath implantation: A single institution experience

Objectives: To determine the complications associated with Port A Cath insertion in cancer patients. Methods: The records 250 patients, who received a subcutaneous port catheter between 2009 and 2013, were analyzed retrospectively with regard to implantation complications and complications in the course of Port A Cath use. Results: The average duration over which the Port A Cath remained in place was 22 months. Postoperative complications occurred in 29 patients (11.6%); of these, 4 (1.6%) were perioperative and 25 (10%) were long-term complications. Perioperative complications were in the form of inadvertent arterial rupture. Long-term complications included the following: infection in 10 patients (4%), mechanical failure in 5 patients (2%), thrombosis in 4 patients (1.6%), suture disruption in 3 patients (1.2%), extravasation in 2 patients (0.8%), and catheter migration in one patient (0.4%). Conclusion: Port A Cath implantation is associated with some risk of serious complications. Care of the catheter and the patient should be maintained to decrease the risk of complications

Chemoembolization follow-up of hepatocellular carcinoma with diffusion-weighted MR imaging

Purpose: To assess the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization with diffusion weighted magnetic resonance (MR) imaging with a 1.5 T system. Materials and methods: Thirty patients with 30 HCC focal lesions were prospectively evaluated for early treatment response after transarterial chemoembolization using dynamic contrast enhanced MRI and diffusion weighted MRI before and after the procedure. Diameter of arterially enhancing portions and apparent diffusion coefficient (ADC) values of lesions were recorded. The significance of differences between ADC values of completely responding and partially responding lesions was calculated. Results: Tumor ADC value increased from 1.2 + 0.1 × 103 mm2/s to 1.49 + 0.3 × 103 mm2/s after treatment (p < 0.001). There was a significant positive correlation between the percent change in the mean ADC and the percent change in the diameter of the enhancing tumor tissue after chemoembolization. The best predictive cutoff value for differentiation between complete and partial response was 24% change in the mean ADC. Conclusion: Responding HCC lesions exhibited decreases in arterial enhancement and increases in ADC values. Percent change in the mean ADC values was predictive of response to chemoembolization

Value of central vein sign in discriminating multiple sclerosis plaques from other white matter lesions

Introduction: Susceptibility weighted (SW) magnetic resonance imaging (MRI) can visualize the vein/s around which multiple sclerosis (MS) plaques are centered. This study's purpose was to assess the ability of the central vein sign (CVS) to differentiate MS plaques from non MS white matter lesions (WMLs). Methods: Out of 18 patients, 9 had MS, 3 had systemic lupus erythematosus, 4 had hypertensive microangiopathy and 2 had Behcet’s disease. 3 T MRI examination was performed to obtain fluid attenuated inversion recovery (FLAIR) and the SW images. Lesions more than 3 mm were identified and analyzed for location and existence of the CVS. Results: Out of 572 MS lesions, 281 lesions were positive for the CVS, while only 66 out of 279 non MS lesions were CVS positive with a statistically significant difference between the two groups (p < 0.001). As regards the percentage of perivenous lesions per patient; using a cutoff value of 30%, MRI accurately segregated all patients with MS and 8/9 non MS patients. Conclusion: Though the CVS is not found solely in MS lesions it is more frequent in MS WMLs as compared to non MS WML and thus is reliable adjunctive tool in differentiation of MS plaques from WMLs of alternative etiologies. Keywords: Central vein sign, Multiple sclerosis, Susceptibility weighted imaging, White matter lesion

The clinical and neuroimaging differences between vascular parkinsonism and Parkinson’s disease: a case-control study

Abstract Background Parkinson’s disease (PD) and vascular parkinsonism (VaP) have highly overlapping phenotypes, and different prognosis. This study comprehensively investigated the clinical, brain MRI and transcranial sonography differences between VaP and PD. Methods Forty-eight patients with PD, 27 patients with VaP, and 29 healthy controls were compared. All patients were assessed using the MDS-UPDRS, Berg Balance Scale (BBS), Ten-Meter Walking Test (10-MWT), Time Up and Go Test, and Non-Motor Symptoms Scale. Beck Depression Inventory, PD questionnaire- 39, international urine incontinence scale, cognitive assessment scales, MRI brain and transcranial colour-coded doppler. The study was registered on clinical-Trial.gov (NCT04308135) on 03/12/2020. Results VaP patients showed significantly older age of onset, shorter disease duration, lower drug doses and levodopa responsiveness, higher On and Off axial scores, On and Off BBS, higher On scores for PIGD, rigidity, bradykinesia and total motor MDS-UPDRS, lower On and Off tremor, lower-half predominance, lower asymmetrical presentation and symmetric index than PD patients. VaP patients had worse non-motor symptoms Scale (NMSS) than controls except for perceptual problems/hallucinations but better symptoms than PD patients except for urinary dysfunction. Quality of life (QoL) was impaired in VaP patients and was correlated with motor function and NMSs. The VaP group had significantly higher white matter lesions and brain atrophy, with lower hyperechogenicity of the substantia nigra and more impaired cerebral vascular resistance and vasoreactivity than the PD group. Conclusions VaP has a characteristic motor and non-motor profile, with impaired QoL, white matter, and transcranial sonography abnormalities that differentiate it from PD. Further studies are warranted to explore the role of vascular lesions in the pathogenesis of VaP. Trial registration The registered identifier NCT04308135 on clinical-Trial.gov. Registered on 03/12/2020