Background: Thalassemia major anemia patients require repeated blood transfusions, which improves their survival and quality of life, however it leads to iron overload and cellular damage.Serum ferritin and liver biopsy were used classically to measure iron overload and to monitor patient response to chelation therapy.Magnetic resonance imaging (MRI T2*) has proven to be a noninvasive, effective technique in detecting and quantifying myocardial and hepatic iron overload and in adjustment of iron chelation therapy. Aim of Work: To assess myocardial siderosis among our patients using MRI T2* technique and to correlate it with hepatic iron load and left ventricular ejection fraction (LVEF). Patients and methods: Our study included 42 cases of regularly transfused patients. Hepatic and myocardial iron overload were measured by multi-breath-hold MRI T2* technique and a cine view sequence was used to assess left ventricular function (EF). Results: Myocardial and hepatic iron overload were intercorrelated to each other and correlated to left ventricular function (LVEF).There was insignificant correlation between cardiac and hepatic T2* value results (k = 0.014, P > 0.05).However, there was a progressive and significant decline in left ventricular ejection fraction (r = 0•61, P < 0•001) in patients with low cardiac T2* values (T2* < 20 ms). Conclusion: MRI T2* technique is a precise, reproducible, and non-invasive technique for measuring tissue iron concentration and sparing the patients from an invasive biopsy technique. It also benefits in early detection of cardiac dysfunction and provides a follow up tool helping in chelation therapy adjustment.
Background: Brain tumors represent the most common solid neoplasm in children and second most common pediatric malignancy overall.The majority of primary childhood brain tumors occurs in the infratentorial compartment and includes: medulloblastoma, juvenile pilocytic astrocytoma (JPA), ependymoma, brainstem/pontine glioma, and atypical teratoid rhabdoid tumor (ATRT) which is an additional rare but important primary brain tumor of early childhood.Objective: This study aims to provide an overview of the imaging features and appearances of the most common primary posterior fossa brain tumors in children and the diagnosis of medulloblastoma.Patients and Methods: The pool of our study was 25 patients (12 males and 13 females) who presented to diagnostic radiology departments at EL Demerdash Teaching Hospital and National Cancer Institute.They had been diagnosed to have posterior fossa lesions.Patients' age ranged from 1 to 17 year with mean age of 4.73 years.Results: statistically significant difference between medulloblastoma and other posterior fossa tumors according to location and diffusion.Medulloblastoma is 4 th ventricular in location and shows restriction in diffusion weighted images.Conclusion: Medulloblastoma is predominately 4 th ventricular in location, Medulloblastoma is restricted in diffusion weighted images.
Background: Thalassemia major anemia patients require repeated blood transfusions, which improves their survival and quality of life, however it leads to iron overload and cellular damage. Serum ferritin and liver biopsy were used classically to measure iron overload and to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI T2*) has proven to be a non-invasive, effective technique in detecting and quantifying iron in the heart and liver and in adjustment of iron chelation therapy. Objective: To assess myocardial siderosis among our patients using MRI T2* technique and correlate it with hepatic iron load and left ventricular ejection fraction (LVEF). Patients and methods: Our study included 42 cases of monthly transfused patients. Hepatic and myocardial iron overload were measured by multi-breath-hold MRI T2* technique and a cine view sequence was used to assess left ventricular function (EF). Results: Myocardial and hepatic iron overload were inter-correlated to each other and correlated to left ventricular function (LVEF). There was insignificant correlation between cardiac and hepatic T2* value results (k = 0.014, P > 0.05). However, there was a progressive and significant decline in left ventricular ejection fraction (r = 0·61, P < 0·001) in patients with low cardiac T2* values (T2* < 20 ms). Conclusion: MRI T2* technique is a precise, reproducible, and non-invasive technique for measuring tissue iron concentration and sparing the patients from an invasive biopsy technique. It also benefits in early detection of cardiac dysfunction and provides a follow up tool helping in chelation therapy adjustment.
Background: Renal resistive index (RRI) was suggested as an indicator of renal atherosclerotic changes in hypertensive patients with possible prognostic role in treatment.Objectives: This study aimed to assess RRI in hypertensive subjects, its relation to other predictors of target organ damage and prognostic usefulness in management, specifically, with different antihypertensive drugs. Patients and methods:The study included 100 newly diagnosed hypertensive adult subjects, who underwent abdominal ultrasound with Doppler to assess RRI, which was correlated with their clinical parameters including estimated glomerular filtration rate (eGFR) and other subclinical atherosclerosis markers as carotid intima-media thickness (IMT) and aortic knob width (AKW) calculated from chest radiograph.Another 50 non hypertensive subjects were assessed for their RRI as a control group.In addition, some of hypertensive patients were followed up one year after starting treatment was done and effects of different antihypertensive agents on their RRI were compared. Results:The mean baseline RRI in hypertensive patients (0.71 ± 0.04) was significantly higher compared to control group (0.60 ± 0.02) and was positively significantly correlated with their clinical parameters (age, systolic, diastolic, pulse pressure and eGFR) and with their atherosclerotic parameters (IMT and AKW).In addition, ACE/ARBs treatment was associated with significant decrease of RRI compared to other drugs [beta blocker (BB) and calcium channel blocker (CCB)], indicating their more renal protective effect.Conclusion: Assessment of RRI in patients with primary hypertension not only reflecting intrarenal perfusion changes, but it indicates systemic atherosclerotic changes, so it can be useful as prognostic parameter in addition to its possible therapeutic implications.
Abstract Background Breast cancer (BC)is the most commonly occurring cancer in women and the second most common cancer overall.An increase in the rate of breast preservation has come to be expected because of tumor reduction using neo-adjuvant chemotherapy (NAC) for locally advanced cancer and it is important to accurately determine the effects of NAC. Patients and Methods This study was conducted on 30 female patients with histopathologically confirmed breast cancer referred for a PET/CT scan aiming to demonstrate the role of 18F-FDG PET/CT in detecting the pathological response to NAC in BC patients. Results No statistically significant differences were found between the baseline number of lesions and that after three cycles of chemotherapy. Also, no statistically significant differences were found between the mean values of baseline and after three cycles of chemotherapy of both liver activity and size of right breast lesions. Meanwhile, the mean values of SUV of right and left breast lesions as well as the size of left breast lesions were significantly lower after three cycles of chemotherapy when compared to their baseline values. And no statistically significant differences were found between complete and partial therapeutic response in the right breast lesions as well as between complete and no therapeutic response in the left breast lesions as regards baseline SUV and SUV after 3 cycles of chemotherapy. Conclusion It can be concluded that FDG-PET/CT is useful for evaluation of neo-adjuvant chemotherapy for breast cancer. However, more studies are needed to validate the results of the current study.
Food Bolus Obstruction (FBO) often presents as an emergency, with an estimated incidence of 13 per 100 000 population (Longstreth et al. Gastrointest Endosc 2001;53:193–8). Endoscopic management is required in many cases, but carries a risk of complications. Our aim was to audit the management and outcomes for patients with FBO admitted to our institution.
Methods
We reviewed all cases presenting with FBO to the Emergency Department and/or admitted to the hospital between October 2014 and October 2017. Data was retrieved from the hospital electronic patient records for demographics, duration of stay, performance of endoscopy as well as the endoscopic findings, FBO removal technique and any complications.
Results
A total of 160 patients presenting with FBO were identified; 103 (64%) males and 57 (36%) Females, average age of 65 years. Of these, 55 (34%) patients passed the food bolus spontaneously without a referral for endoscopy. Of the 105 (66%) patients who had an endoscopy, data on the time of admission and the time of endoscopy was available for 62 (59%) patients. 11 (18%) patients had endoscopy within 4 hours and 51 (82%) within 24 hours. At endoscopy, an addition 32 (30%) patients were found to have passed the food bolus spontaneously, whilst 72 (70%) needed endoscopic intervention; the push technique was most often employed (33% of cases). Endoscopic therapy was effective in 66 (91.2%) patients. Of the 6 patients in whom initial endoscopic therapy was unsuccessful, 2 patients were intolerant of the procedure (one required an endoscopy under general anaesthetic, and the other patient underwent a repeat procedure the following day successfully); 2 patients had FBO at a high level requiring ENT referral; 2 patients sustained an oesophageal perforation). The underlying pathology was documented as benign stricture/web/Schatzki ring in 20 (19%) of cases, oesophagitis in 12 (11%), oesophageal malignancy in 9 (8%), hiatus hernia in 3 (3%), eosinophilic oesophagitis 1 (1%), oesophageal spasm 1 (1%), Barrett's oesophagus 1 (1%) and candidiasis in 1 (1%); 57 (55%) of patents had no underlying oesophageal abnormality. Endoscopic complications were seen in 4 (4%) patients – mucosal tear in 2 cases and perforation in 2 cases. The duration of hospital stay was 1 day in 136 (85%), 2 days in 16 (10%) and 3 or more days in 8 (4%) of cases.
Conclusion
FBO resolves spontaneously in around half of cases. Endoscopic therapy has a high success rate for the remaining patients, but is associated with a small risk of complications.
The diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) map and the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) constitute the functional MRI technique with many oncological applications as it can define tissue microstructure and characterize the post-treatment changes from a recurrent tumor in treated head and neck squamous cell carcinoma (HNSCC).
Abstract Background The transcatheter arterial chemoembolization (TACE) is one of the treatment lines for patients with hepatocellular carcinoma (HCC), this study was conducted to assess the role of functional imaging including the DWI, ADC and 18 F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) for detection of residual HCC after TACE as compared to the structural liver imaging reporting and data system (LI-RADS). Results The optimal cut off value of standardized uptake value ratio (SUV max /liver SUV mean ratio) for detection of residual viable HCC after TACE was 1.09 with 88.9%, 87.5% and 88.6% sensitivity, specificity, and accuracy respectively, a lower diagnostic value was noted in the qualitative visual FDG PET/CT assessment with sensitivity, specificity, and accuracy of 81.5%, 75% and 80% respectively. The sensitivity, specificity, and accuracy of DWI for identification of post-TACE viable HCC were 77.8%, 75%, and 77.1% respectively. The optimal cut off value of ADC for the diagnosis of variable HCC was 1.32 × 10 −3 mm 2 /s with sensitivity, specificity, and accuracy of 81.5%, 75%, and 80% respectively. Conclusions DWI, ADC and FDG PET/CT are effective functional imaging modalities for the evaluation of viable residual HCC post-TACE with comparable findings for the dynamic cross-section imaging.
Background: Obesity is a medical condition that have an adverse effect on health. Bariatric surgery is considered nowadays as one of the most effective treatment for obesity. CT is one of the best modalities that is performed after a bariatric procedure to assess for complications. Purpose: The aim of this work was to highlight CT radiological features of postoperative surgical complications after laparoscopic sleeve gastrectomy (LSG) using abdominal multi-slice computed tomography (MSCT), and 3D volumetric rendering if needed. Patients and Methods: 182 patients with post sleeve gastrectomy suspected complications were subjected to CT of the abdomen and pelvis. Post-processing was performed with multi-planner reformation generating coronal and sagittal images together with the raw axial images for assessment of the integrity of the sleeved stomach and detection of any encountered complication with 3D reconstruction if needed to asses gastric pouch volume. Results: CT detected complications in 43 patients (23.6%) out of the 182 patients who underwent laparoscopic sleeve gastrectomy. The complications reported in our study were hematoma occurred in 13 patients (7.1%), leakage occurred in 10 patients (5.5%), abscess formation occurred in 6 cases (3.3%), splenic infarction occurred in 5 patients (2.7%), solid organ injury occurred in 2 patient (1%), Porto-mesenteric thrombosis occurred in 7 patients (3.8%), intestinal obstruction occurred in 2 cases (1%), port site ventral hernia occurred in 3 cases (1.6%), abdominal wall hematoma occurred in 3 cases (1.6%), enlarged gastric pouch occurred in 4 cases (2.2%), hiatus hernia occurred in 2 cases (1%). Conclusion: It could be concluded that sleeve gastrectomy became an increasingly popular surgery for obesity, so the radiologists must recognize and identify the normal postoperative anatomy as well as the possible complications of this procedure. MSCT with the 3D volumetric study is an important imaging tool to diagnose accurately the complications of sleeve gastrectomy.
Background: Obesity is a medical condition, which may lead to serious related diseases, ultimately, resulting in many morbidities and early mortality.Its management involves many approaches of which bariatric surgery is considered nowadays as one of the most effective treatment for it.However, follow up of postoperative complications of this surgery by effective radiological method as computed tomography (CT) is important for assessment of its success.Objective: The aim of this study was to illuminate the radiological signs and features of postoperative complications after non sleeve bariatric procedures and stressing the importance of using multi-slice CT (MSCT), and fluoroscopic study for detection of these complications.Patients and methods: An observational cohort study for 275 patients with suspected complications after non sleeve gastrectomy bariatric procedures, including 195 patients after Roux-en-Y gastric bypass (RYGB), 76 patients after laparoscopic adjustable gastric banding (LAGB) and 4 patients after intragastric balloon placement was done.These patients were subjected to either multi-slice CT and or fluoroscopy.Results: We detected complications in 21 patients out of the 195 patients who underwent RYGB: leakage, abscess, intestinal obstruction, internal hernia, port site ventral hernia, intussusception, fistula between the gastric pouch and the excluded stomach and hiatus hernia.On the other hand, 8 out of 76 patients operated by LAGB developed complications: band slippage, band erosion, pouch dilatation and tubal disconnection.Lastly two out of the 4 patients who placed intragastric balloon encountered other complications: gastric outlet obstruction, spontaneous balloon deflation and distal migration with intestinal obstruction.Conclusion: It could be concluded that bariatric procedures may be followed by many complications and accurate diagnosis of these problems by proper radiological procedures as MSCT is imperative.
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