Diagnostic value of MRI for predicting axillary lymph nodes metastasis in newly diagnosed breast cancer patients: Diffusion-weighted MRI

AbstractObjectiveNon-invasive preoperative detection of axillary nodal metastasis is beneficial for the outcome of breast cancer patients. We aimed to determine the value of DW MRI, ADC and their combination with MRI morphological criteria in detecting axillary metastasis.MethodsWe included recently diagnosed forty breast cancer patients. MRI morphological criteria, signal intensity on DWI, and ADC value were assessed and compared between metastatic and non-metastatic LNs using histopathological findings as reference standard. Sensitivity, specificity, PPV, NPV and accuracy for each variable and cutoff value of ADC were evaluated.ResultsNo statistically significant difference between metastatic and non-metastatic LNs in short axis diameter or L/S ratio (p value: 0.87 and 0.82 respectively); however, loss of fatty hilum, high signal intensity on DWI and low ADC value were significant with increasing sensitivity on their combination. The mean ADC was 0.96±0.9×10−3mm2/s for metastatic and 1.53±0.6×10−3mm2/s for benign LNs with cutoff value 1.09×10−3mm2/s and sensitivity (94.5%), specificity (93.6%), PPV (96%), NPV (94.7%) and accuracy (95.6%).ConclusionDW-MRI and ADC per se or in combination with loss of the fatty hila is a promising and supportive tool for detection of axillary LNs metastasis

Early Cerebrovascular Silent Changes in Long-Standing End-Stage Renal Disease Patients on Hemodialysis Value of Adding Advanced Unenhanced MRI Sequences to Imaging Protocols

Background: End-Stage Renal Disease (ESRD) patients on hemodialysis suffered from many central and peripheral neurological insults. Aim of the work:This study aimed to assess the value of using MRA, MRV, and SWAN sequences in early visualization of the silent cerebrovascular complications in those patients. Patients and Methods: Our study was conducted on forty-five patients with well-documented ESRD on regular hemodialysis for more than 5 years with no neurological manifestation, all undergone unenhanced MRI, DWI with ADC and measuring the ADC value, SWAN, MRA, and MRV. Results: we found that 11% of cases have acute infarction at the basal ganglia region. 36.7% of patients are diagnosed with intracerebral hemorrhage, only 26.7% of them are seen by the conventional MRI, and 16.7% of cases showed microbleeds on SWAN with normal conventional MRI. The sensitivity and specificity of SWAN with ADC value to detect brain hemorrhage are 100% and 88.8% respectively. Conclusion: Visualization of cerebrovascular complications such as infarction, hemorrhage, atherosclerosis, and arterial and venous occlusion using DWI with ADC, MRA, MRV, and SWAN and is very useful in early management and better prognosis of ESRD patients even with silent complications that don’t give up symptoms with high sensitivity and specificity of SWAN in early detection of hemorrhage and microbleeds

Auricular Graft vs. Chemoterapy in the Managment of Craniomandibular Joint Ankylosis

ABSTRACT A variety of techniques for the management of craniomandibular ankylosis have been described. However, no single technique has proved entirely satisfactory. These techniques pose a significant challenge due to a high incidence of recurrence. Aim: The aim of this study was to evaluate and compare between the interpositional auricular graft and local application of chemotherapy procedures. Patients/methods : The study has been used on 31 patients with true TMJ ankylosis (18 had unilateral and13 had bilateral ankylosis with average age ranged between 12 and 41). Two procedures for the management of TMJ ankylosis were done. Group (1) included 16 patients were subjected to small gap arthroplasty and topical application chemotherapeutic agent having antiproliferative property to suppress fibrous proliferation and vascular ingrowth between the osteotomy sites. Group (11) included 15 patients were subjected to interpositional arthroplasty using auricular graft of the ipsilateral side. All patients were examined and followed clinically and radiologically using panoramic view, CT and MRI, after the operation for a period extended to 4 years to confirm absence of recurrence. All patients had no recurrence after surgery. Results : Considerable improvement in maximal incisal opening (33 mm) was noted in all patients during the follow up period. Conclusion : The study concluded that both techniques provided satisfactory results. However, chemical application of chemotherapeutic agent was found to be superior in some aspects; no mandibular shifting during the movement, elimination of grafting problems and saving surgical time

Diagnostic performance of multidetector computed tomography in the evaluation of esoph

Objective: Our purpose was to evaluate the role of multidetector computed tomography (MDCT) in evaluation of esophageal varices (EV). Patients and methods: 112 patients with liver cirrhosis were included, EV was evaluated for grades, presence of collateral, palisade vein dilatation and also patient acceptability. Results: The sensitivity of MDCT for radiologist A was 94.8%, specificity 98.5%, Accuracy 97.8%, PPV 94.8%, NPV 98.5% and for radiologist B, 99.4%, 99.6%, 99.6%, 99.3% and 99.7% respectively. MDCT detected para esophageal varices in 38 cases, gastric fundus varices in 47 cases and splenorenal collaterals were seen in 14 cases, palisade vein dilatation was +ve in 58 cases, −ve in 47 cases and (±) in 7 cases. 3 cases of HCC and 1 liver cyst were incidentally found during examination. There was a highly significant correlation between degree of palisade vein dilatation, increasing grade of esophageal varices and Red color sign with p value <0.01. MDCT was more accepted than endoscopy in 83%. The preference of CT was statistically significant p < 0.01. Conclusion: MDCT is a fast, well tolerable, non-invasive procedure and accepted from most of the examined patients for evaluation and grading of EV, detection of other portosystemic collaterals and hepatobiliary pathologies

Diffusion weighted MRI and transient elastography assessment of liver fibrosis in hepatitis C patients: Validity of non invasive imaging techniques

Objective: Treatment for hepatitis C infection and monitoring of progression were based on degree of fibrosis, which were traditionally diagnosed by liver biopsy but it has many limitations. We aim to evaluate noninvasive imaging methods, so-called diffusion-weighted MRI (DW MRI) and transient elastography [(TE), fibroscan] in diagnosing liver fibrosis in hepatitis C (HCV) patients. Patients: The Study included 102 hepatitis C patients (62 male) with mean age of 38 ± 5. For all patients liver biopsy was done followed by DW MRI and TE. METAVIR classification system was used for staging liver fibrosis. Data obtained were collected and results of DW MRI and TE were compared with those of histopathology. The diagnostic performance of ADC and TE was determined using areas under receiver operating characteristic (AUROC) curves for significant fibrosis ⩾F3. Results: Measuring ADC at different b-values had a significant negative correlation with stage of fibrosis P = 0.001, the best negative correlation at b-value of 700 mm2/s. TE had a significant positive correlation with stage of fibrosis P = 0.005. Both examination showed a significant difference between fibrosis stage <F3 and stages ⩾F3 with P < 0.00 for ADC measure at each b-value and TE respectively. Conclusion: This study suggests that DW MRI and TE had favorable comparable results with liver biopsy for the diagnosis of significant liver fibrosis

MDCT signs predicting internal hernia and strangulation in patients presented to emergency department with acute small bowel obstruction

Objective: We prospectively evaluate multidetector computed tomography (MDCT) criteria of internal hernia, and related complication as intestinal strangulation. Methods: 27 patients presented to emergency department with acute small bowel obstruction (ASBO) and diagnosed with MDCT as IH were included. Validity of different MDCT criteria in diagnosing IH was compared with surgical diagnosis. Results: Surgical diagnosis was 22 patients with IH (14 paraduodenal and 8 transmesenteric hernia) and 5 false positive cases. There was excellent agreement between MDCT and surgery in diagnosing paraduodenal hernia (k = 1), and good agreement in diagnosing transmesenteric hernia (k = 0.624). Significant MDCT criteria include the following: cluster of small-bowel (p < 0.0001); mass effect to surrounding (p = 0.009); crowding of mesenteric vessels (Swirl's sign) (p = 0.01). Sensitivity, specificity, PPV, NPV and accuracy of MDCT in diagnosing strangulation were 83%, 100%, 100%, 95%, and 96% respectively. MDCT signs for detecting strangulation were statistically significant and varied from highly significant for bowel-wall thickening and mesenteric vessel engorgement (p < 0.001) to significant for abnormal bowel-wall enhancement, mesenteric infiltrate and mesenteric fluid with p value = 0.001. Conclusion: MDCT helps in early diagnosis of IH and strangulation, which accounts for appropriate management of such emergent cases

Evaluation of diabetic foot osteomyelitis using probe to bone test and magnetic resonance imaging and their impact on surgical intervention

Objectives: To evaluate the role of probe to bone test (PTB) and magnetic resonance imaging (MRI) in assessing the surgical intervention in diabetic foot. Study design: 102 diabetic patients were included; 42 males and 60 females, mean age was 52 ± 6, all patients were subjected to PTB test followed by MRI, the presence of osteomyelitis was assessed in relation to histopathological examination. Results: We had 80 (75.5%) feet of osteomyelitis, PTB test was true positive in 66 (82.5%), false negative in eight and false positive in 6 feet. MRI was true positive in 78, false positive in three and false negative in two feet. Other MRI finding include abscess in 37, tenosynovitis in 69, neuropathic changes in 20 feet, and all cases had cellulites. Sensitivity, specificity, PPV and NPV were 82.5%, 76.9%, 91.7%, and 58.8% for PTB test and 97.5%, 88.5%, 96.3% and 92% for MRI respectively. Conclusion: PTB test is a simple, minimally invasive, low cost test and can be done at outpatient clinic. Its sensitivity and specificity are good when compared to those of MRI, but when we need to diagnose associated soft tissue infection and planning the surgical management MRI was the image of choice