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1.

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.  相似文献   

2.

Objective

Assessing the role of MSCT compared to TTE in pediatric patients with congenital heart diseases especially the thoracic congenital vascular anomalies.

Methods

54 pediatric patients underwent a 128 detectors computed tomography cardiac angiography with retrospective ECG-gating. Images were reviewed based on segmental approach using the operative data (35/54 patients) or cardiac catheterization (19/54 patients) findings as reference standard. Sensitivity, specificity, positive and negative predictive values and accuracy of TTE and MDCT were evaluated.

Results

MDCT was superior to TTE in evaluating vascular lesions (aortic, conotruncal, coronary artery, major aorto-pulmonary collaterals, patent ductus arteriosus, venous anomalies and postoperative complications) as well as pulmonary lesions; while TTE was superior in intracardiac anomalies with equal performance in (pulmonary artery anomalies, concordance and valvular atresia). MDCT achieved (100%, 96.3% and 87%) accuracies compared to TTE (94.4%, 85.2% & 96.3%) for delineating isolated vascular anomalies, complex vascular anomalies and intracardiac anomalies respectively.

Conclusion

The main added value of cardiac MDCT to TTE is the precise illustration of the extracardiac anatomic structures, without adding significant information on intracardiac abnormalities. Using MDCT with TTE has improved the diagnostic accuracy thus obviating the need for diagnostic cardiac catheterization especially in critically ill patients.  相似文献   

3.

Background

Patients with pulmonary embolism have high mortality and morbidity rate due to right heart failure and circulatory collapse leading to sudden death. Multi-detector computed tomography MDCT can efficiently evaluate the cardiovascular factors related to pulmonary embolism.

Objectives

To evaluate the diagnostic accuracy of multi-detector computed tomography (MDCT) in differentiation of between sever and non-severe pulmonary embolism groups depending on the associated cardiovascular parameters and create a simple reporting system.

Patients & methods

Prospective study contained 145 patients diagnosed clinically pulmonary embolism. All patients were examined by combined electrocardiographically gated computed tomography pulmonary angiography-computed tomography venography (ECG-CTPA-CTV) using certain imaging criteria in a systematic manner.

Results

Our study revealed 95 and 55 non-severe and severe pulmonary embolism groups respectively. Many cardiovascular parameters related to pulmonary embolism shows significant p value and can differentiate between sever and non-severe pulmonary embolism patients include pulmonary artery diameter, intraventricular septum flattening, bowing, superior vena cava and Azygos vein diameters, right and left ventricular diameters.

Conclusion

Multi-detector computed tomography (MDCT) can be valuable to assess the severity of pulmonary embolism using the related cardiovascular parameters and leading the management strategy aim for best outcome.  相似文献   

4.

Aim and objectives

To evaluate the diagnostic accuracy of elastosonographyin prediction of malignancy in solitary thyroid nodule.

Methodology

60 patients (37 females and 23 male) with solitary thyroid nodule were included, their age ranged from 21 to 52?years (mean age 30.6?years), grey scale, color-power Doppler US and elastography were performed for all patient.

Results

Presence of hypoechogenicity, absent halo sign, irregular margins, microcalcifications and predominant intranodular vascularity were the most US patterns predictive of malignancy. Suspicious nodule by elastography (Astria score 3 and 4) were found in 19 nodules (31.7%), 9 of them were benign and 10 of them were malignant with sensitivity 58.82%, specificity 79.07% and accuracy 73.33%, combined suspicious US findings (TIRAD 4&5) and suspicious elastography score (3&4) were most predictive of malignancy which was found in 16 out of 17 nodules with sensitivity 94.12%, specificity 76.74% and accuracy 81.67%.

Conclusion

Combined gray scale, color Doppler US and elastography were more sensitive and accurate than US features alone in prediction of malignancy of solitary thyroid nodules with sensitivity 94.12%, specificity 76.74% and accuracy 81.67%.  相似文献   

5.

Purpose

The goal of the study was to assess and confirm the role of 64-slice multidetector computed tomography (MDCT) with its new applications for diagnosis and its impact on management of small bowel obstruction.

Patients and methods

Prospective study included 40 patients, referred for radiological assessment of one or more of symptoms of intestinal obstruction or acute abdomen. Patients with clinical suspicion of high grade SBO (30 patients) underwent MDCT, while those with low grade SBO (10 patients) were offered MDCT enterography and the results were compared to the final clinical and surgical diagnosis as well as the histopathology results.

Results

18 patients were found to have intrinsic cause of SBO. 17 patients found to have extrinsic cause of SBO including adhesions and different types of hernia. 1 patient with an intraluminal cause (gall stone ileus) and 4 patients with variety of causes involving ileus, midgut volvulus and Ladd's band compressing duodenum. Those results were compared to final clinical surgical diagnosis with 100% accuracy, sensitivity and specificity.

Conclusion

64-slice MDCT have a very high sensitivity, specificity and accuracy to diagnose and determine the cause of SBO, allowing for better planning of required surgeries.  相似文献   

6.

Objective

To investigate the therapeutic response of radiofrequency ablation for treatment of hepatocellular carcinoma and the consequence of portal hypertension on the survival final results.

Patients & methods

168 patients with portal hypertension undergo radiofrequency ablation in the act of treatment of HCC (≤5?cm). Therapeutic response and prognostic outcomes were then analyzed. Overall survival was assessed using Kaplan-Meier method and multivariate analysis was achieved using the Cox regression model.

Results

Primary and secondary complete ablation of HCC was obtained in 86.3% & 100% of patients respectively. Complication occurred in 13.6% of patients, and thrombocytopenia and prolonged prothrombin time were independent risk factors of complication. Overall survival after the follow-up period of about 25?months was 74.4%. Two elements based on multivariate analysis had been recognized as prognostic factors for poor survival: Thrombocytopenia (HR?=?1.008, P?=?.004), and left lobe location of the tumor (HR?=?0.392, P?≤?.03).

Conclusion

This current study has shown that most cirrhotic patients with portal hypertension can tolerate RF ablation of HCC. The improved patient selection in terms of simple parameters such as platelet count, and prothrombin concentration, we will improve the outcome of RF ablation.  相似文献   

7.

Objective

We evaluated multidetector computed tomography (MDCT) accuracy for the prediction of the optimal prosthetic aortic valve deployment angle in trans-catheter aortic valve implantation (TAVI) with the different variables.

Methods

Sixty-six patients underwent contrast-enhanced MDCT before TAVI. From the three-dimensional aortic root reconstructions, we get the appropriate perpendicular aortic valve projection at which the bases of the aortic valve cusps were on a straight line. The predicted angles by MDCT were compared to the perpendicular fluoroscopic angles of the prosthetic valve. The degree of MDCT accuracy was defined as accurate, suitable or inaccurate according to the difference between the predicted angles and the perpendicular prosthetic valve projections. The degree of aortic cusp calcification, annular ellipticity, the type of aortic valve (to be tricuspid or bicuspid), were compared in patients with accurate, suitable and inaccurate prediction. The radiation exposure and volume of the used contrast agent were also considered in the comparison.

Results

MDCT prediction was accurate in 84.8% of cases, suitable in 9.1% and inaccurate in 6.1% of cases. There was a significant association between MDCT accuracy and the valve type with higher rates of accurate prediction with tricuspid aortic valves than bicuspid valves (93.1% versus 25%, respectively). The mean number of aortograms and the volume of contrast agent used for TAVI procedure were significantly less in patients with accurate CT prediction (p < 0.001).

Conclusion

MDCT allows accurate prediction of the proper deployment angle for TAVI. Bicuspid aortic valve is significantly associated with fewer rates of accurate prediction.  相似文献   

8.

Purpose

To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaks and skull base defects in correlation to operative findings.

Materials and methods

Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings.

Results

MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity 95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases categorized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformat has the highest diagnostic performance in 75% of cases while the least diagnostic value is encountered with the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) between the MDCT measurements and operative size of bony defect with minimal difference in 10% of patients (P < 0.001).

Conclusion

Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea.  相似文献   

9.

Objective

The aim of this work is to assess the role of MRI in the diagnosis of ACL graft failure and detection of complications that may follow ACL reconstruction.

Patients and methods

This study included 55 patients (50 male & 5 female) with age ranged from 18 to 60?years with a mean age of 32y. All patients underwent MRI using sagittal T1WI, T2WI, proton density WI, and axial T2 and coronal STIR images. MRI images were assessed by two radiologists who were blinded to each other. Arthroscopic knee examination was considered as a gold standard of reference.

Results

Observer one found that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MRI in the detection of ACL graft failure were 97.8%, 80%, 95.6%, 88.9 and 94.5% respectively. Observer two found that MRI has a sensitivity of 95.6%, specificity of 70%, PPV of 93.5%, NPV of 77.8% and accuracy of 90.9%.

Conclusion

MRI is considered as a reliable method for assessment of ACL graft failure and detection of complications following ACL reconstruction.  相似文献   

10.

Objective

The aim of this study was to assess the ability of CT to predict the pathological nature of pancreatic cystic lesions if it is benign, malignant or premalignant.

Methods

This is a retrospective study from the database of our hospital EMR (electronic medical records) for pancreatic lesions from patients who proven to be of pathological cystic nature. The diagnosis and characterization of pancreatic cysts were done by multislice 32 CT examination. We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. We compared between operative and pathological data and findings of MDCT using chi square test.

Results

We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. The study was done on 66 patients. Our results showed that CT features for benign cystic lesions are lobulated shape and a thin wall (≤1?mm) while the round or oval shape or a complex cystic shape with tubular cyst and a thick wall (>1?mm) are more frequently seen in pancreatic premalignant and malignant macrocytic lesions.

Conclusion

CT with thin section images allows adequate morphological characterization of macrocytic pancreatic masses that could predict its pathological nature if benign or malignant.  相似文献   

11.

Objectives

To assess the clinical utility of PET-CT in assessment of thoracic involvement in lymphoma patients prior to, during and after finishing treatment and comparing it to contrast enhanced CT (CECT).

Patients and methods

PET-CT was performed for 30 patients with lymphoma. Thoracic nodal and extranodal involvement was assessed and compared to contrast enhanced CT.

Results

Comparison of CECT and PET-CT in staging and assessment of treatment response reveals significant statistical difference (P?=?.0001 & .04 respectively). CECT shows sensitivity?=?83.3% and specificity?=?75% in evaluation of patients after finishing chemotherapy.

Conclusion

PET-CT plays an important role in staging, detection of response to treatment and restaging of lymphoma after finishing chemotherapy.  相似文献   

12.

Purpose

To assess the role of dynamic contrast- enhanced and diffusion-weighted (DWI) MRI in the evaluation of the response of hepatocellular carcinoma (HCC) after chemoembolization.

Patient & method

30 patients having 40 HCC lesions underwent transcatheter arterial chemoembolization (TACE). Ages ranged between 41 and 76?years. All examinations were performed using Philips 1.5 Tesla MRI (Achieva). Precontrast T1, T2, Dynamic contrast enhanced and respiratory triggered DWI MR images with (b?=?50, 400, 800?mm/s). DWI MRI images and Contrast-enhanced MRI images after TACE are assessed to evaluate post treatment response. DWI was used to create ADC maps and ADC values were calculated looking for a cut off value using the ROC curve.

Results

Dynamic MRI had a sensitivity of 94.1%, a specificity of 95.6%, PPV value of 94.1%, NPV of 95.6% and an overall agreement of 95% compared to 82%, 73.9%, 70%, 85% and 77.5% respectively of DWI MRI. The difference between the malignant residual and well ablated groups' ADC variables was statistically significant P value 0.009.

Conclusion

Dynamic and diffusion MRI complete each other in assessment of HCC response to therapy, especially in those who cannot properly hold their breath that cause degradation of the dynamic MR quality.  相似文献   

13.

Purpose

To evaluate the role of DTI & MRS complemented by rotatory chair technique in vestibular cortex assessment in vestibulopathy patients with normal brain MRI.

Patient & method

The study was carried on 40 persons, 15 control group and 25 study group. Their age ranging from (50–75) years, they all subjected to Conventional MRI, Diffusion tensor imaging and MRS of the right operculum.

Results

5 cases gave very low gain with immeasurable phase and symmetry. They show abnormal MRI finding and were excluded from our study, 20 cases showed low gain with measurable levels of phase & symmetry. 15 cases show high level of asymmetry with DTI results as follow decreased FA in cerebellar peduncle (3 cases) right operculum (7 cases) denoting central affection, 5 cases showed normal DTI making it most probably peripheral vestibular affection variable level of asymmetry were seen in 5 patients, combined decreased FA in cerebellar peduncles & right operculum with thinning of the CST (2 cases), combined decreased FA in cerebellar peduncles & right operculum without thinning of the CST (1 cases), right operculum affection associated with thinning of the CST (2 case). Decreased NAA & NAA/Cr was seen in 5 patients.

Conclusion

Combined radiological & audiological examinations are advised for evaluation of the problematic vestibulopathy to differentiate whether the cause is central and/or peripheral injury.  相似文献   

14.

Purpose

The study aims to compare the accuracy of washout and perfusion CT techniques in diagnosis of adrenal tumors.

Patients and methods

A prospective study included 38 patients with incidentally detected adrenal masses on conventional abdominal CT studies performed for unrelated reasons were subjected to full medical history, physical examinations, serum creatinine assessment, dynamic perfusion CT using 64 MDCT scanner with Absolute washout (APW), Relative washout (RPW) assessment and CT perfusion parameters calculation [perfusion, Peak enhancement intensity (PEI), Time to peak (TTP) & Blood volume (BV)]. Time density curves (TDCs) for all adrenal masses were done. The gold standard was either follow up or histopathological examination after fine needle biopsy or surgical resection.

Results

Washout CT differentiated between adenomas and non-adenomas using APW (≥55%) with sensitivity 73.3%, specificity 90% and accuracy 82.8%, and using RPW (≥36%) with sensitivity 53.3%, specificity 85% and accuracy 81.8%. Perfusion CT differentiated between adenomas and nonadenomas using BV (≥15 ml/100 g) with sensitivity 80%, specificity 75% and accuracy 77.1%. TDC curves of adenomas show slow-rise platform pattern.

Conclusion

Perfusion CT can distinguish between adrenal adenomas and non-adenomas using the BV, however washout CT was more accurate than perfusion CT in characterization of adrenal masses using the APW and RPW.  相似文献   

15.

Objective

The aim of this study was to monitor the incidence of complicated inferior vena cava (IVC) anomalies and evaluate the role of Multidetector Computed Tomographic Venography (MDCTV) in diagnosis and assessment of associated venous collaterals, lower limb deep venous thrombosis (DVT) or varicose veins (VV).

Patients and methods

During two years duration 100 patients with clinical history and complains suggesting of DVT or VV were prospectively evaluated after performance of MDCTV examination. The images obtained were interpreted and reconstructed using dedicated software and work stations. Results were correlated with Color Doppler Ultrasound (CDUS) findings.

Results

Out of 100 cases, 9 cases (9%) were diagnosed to have complicated IVC anomalies while 91 cases (91%) had either well developed IVC or common anatomical variations. 6 cases (66.7%) had complicated IVC anomalies and 3 cases (33.3%) had associated complicated common iliac veins (CIV) anomalies. 8 cases (88.9%) had associated DVT and all cases (100%) had bilateral VV. 2 cases (22.2%) had associated varicocele and 1 case (11.1%) had associated KILT syndrome.

Conclusion

MDCT venography examination has a major role in diagnosis of complicated IVC anomalies and detection of associated venous collaterals, lower limb DVT or VV.  相似文献   

16.

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.  相似文献   

17.

Purpose

The aim of this study was to highlight the different computed tomography (CT) features of groove pancreatitis (GP) in order to make this entity more familiar to radiologist.

Patients & method

This study enrolled 15 patients who had histopathologically confirmed GP. Their CT scans were retrospectively reviewed for the encountered manifestations.

Results

Pure & segmental forms were identified retrospectively in 6 & 9 patients. The most frequent findings noted in patients' scans were the following, in descending order: medial duodenal wall thickening & cysts, duodenal luminal narrowing, regional lymphadenopathies, pancreatic involvement, isolated groove affection, pancreatic calcifications, distal CBD narrowing, pancreatic duct abnormalities, and retro-peritoneal stranding.

Conclusion

Although the CT features of GP mimic other peripancreatic tumors, yet the constantly associated findings in the proven cases of GP in our study were: duodenal wall thickening, cysts formation, and luminal narrowing. So the presence of these features in alcoholic middle aged male patient with groove or pancreatic lesion, have to trigger radiologist's dubiety of GP entity and so to be addressed in his opinion. Nevertheless, GP diagnosis is still challenging & should be considered based on clinical & radiological data in conjunction with the laboratory and pathological results.  相似文献   

18.

Objective

To evaluate the use of diffusion tensor imaging (DTI) and fractional anisotropy (FA) as prognostic tools in anticipating the recovery of stroke patients.

Patients and methods

40 patients were included in our study after exclusion of 23 patients. All patients admitted in Neurology Department with stroke. The patients subjected to National Institute of Health Stroke Scale (NIHSS) followed by MRI with DTI and FA calculation. Follow up after three months was done based on the Modified Rankin Score (MRS). The results were compared and statistically analyzed.

Results

There was a statistical significant between the NIHSS and DTI pattern at the time of admission (p value?<?0.05) reflecting the severity of the stroke with 22 patients showed disrupted fibers (55%), of which 16 patients were categorized as moderate NIHSS and 19 patients showed poor outcome. Relative FA equal 0.8 was found to be the cut off value in predicting the poor or good prognosis using MRS as a reference with 94.4% sensitivity, 90.9% specificity and 0.833 area under curve.

Conclusion

DTI is a prognostic tool in anticipating the recovery of the stroke patients. Moreover, the relative FA score works as more additive value in evaluation of the patient improvement.  相似文献   

19.

Background

The knee menisci are compound anatomical structures with important purposes within the knee. In the long term, meniscal losing results in high risk of developing degenerative osteoarthritis. MRI is an accurate and non-invasive diagnostic method for the knee injuries providing satisfactory guide for conservative treatment and guarding the patients from uncritical arthroscopy.

Objective

This study aimed to detect the MRI accuracy in diagnosis of meniscal lesions compared to arthroscopy.

Patients & methods

This study included 13 females and 17 males presented by pain, swelling, limitation of movement, in the duration from April 2015 to June 2016. All patients were subjected to MRI followed by arthroscopy.

Results

The study revealed that specificity, sensitivity, NPV, PPV and accuracy, in MRI diagnosis of medial meniscal abnormal signals were 50%, 95.8%, 88.4%, 86.6%, and 90% respectively, whereas those for lateral meniscus signals were 84.6% 88.2%, 84.6%, 88.2% and 86.7% respectively.

Conclusion

MRI of the knee will give the orthopedic surgeons ability to select suitable treatment and arthroscopic interference for their patients. MRI has high accuracy in meniscal tears diagnosis allowing accurate grading of them.  相似文献   

20.

Objective

To compare the accuracy of 2D and 3D CT measurements of femoral anteversion angle, in pediatric patients with developmental hip dysplasia.

Materials and methods

Twenty patients (20 hips) with unilateral non syndromic DDH were studies. CT scans were performed using a 16 slice CT scanner to measure the femoral anteversion angle (FAVA) using 2D & 3D techniques. Findings were correlated with the intra operative measurements.

Results

There was a significant difference between 2D & 3D methods. Results of clinical assessment were comparable to results of 3D CT assessment which range from 30 to 50° with a mean of 37.5°. Mean percent difference between 3D and intra operative measurement of FAVA was significantly lower than the corresponding value between 2D and intraoperative measurement of FAVA.

Conclusion

3D is more accurate than 2D in measuring the degree of FAVA in DDH patients. It is easily applied and rapid and doesn't require sophisticated software.  相似文献   

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