Role of magnetic resonance spectroscopy in grading of primary brain tumors

To assess the usefulness of MR spectroscopy [MRS] in grading of primary brain tumors. MRS was performed in a 22 patients with primary brain tumors. Metabolite ratios of Choline [Cho] / N-acetyle Laspartate [NAA]. Cho/ Creatine [Cr], Cho+Cr/NAA as well as lipids and lactate [LL]/Cr were calculated at short and intermediate echo time [TE]. Additionally, myoinositol [ml]/Cr was calculated at short TE. Tumors were subdivided into low grades and high grade on the basis of histopathology Receiver operating characteristic analysis of metabolite ratios was performed to find the cut off values between high and low grade tumors. The resulting sensitivity, specificity and accuracy were calculated. At intermediate TE, Cho/NAA, Cho+Cr/NAA and Cho/Cr were significantly higher in high grade tumors than in low grade ones. At short TE, Cho/Cr and LL/Cr ratios were significantly higher in high grade tumors than in low grade ones. The diagnostic accuracy of metabolite ratios at intermediate TE was 86% whereas at short TE, the diagnostic accuracy was 75%. Combination of both TEs revealed a diagnostic accuracy of 88%. Cho/NAA, Cho+Cr/Cr/NAA and Cho/Cr are reliable in determining the tumor grade. LL/Cr is highly related to high grade tumors. Combination of both short and intermediate TEs provides better accuracy, in grading of brain neoplasm, compared to that when using each TE separately

Percutaneous translumibal angioplasty and stenting in treatment of lower limb arterial occlusive disease

To evaluate the role and effectivity of percutaneous transluminal angioplasty [PTA] and stenting in treatment of lower limb arterial occlusive diseases, and to clarify the advantages and limitations of this procedures. 37 patients with chronic lower limb ischemia were included in this study, their age ranged from 42 to 76 years, 29 were males and 8 were females. 35 patients had unilateral lesions while 2 patients had bilateral lesions. The total number of lesions were 51 as there were multilevel affection in some limbs. The patients were suffering from intermittent claudication, ischemic rest pain or ulceration and/or gangrene. All patients were subjected to clinical examination, laboratory investigations, duplex scanning, ankle/brachial index [ABI] measurement and diagnostic arteriography before intervention. Percutaneous translurninal angioplasty [PTA] was done for 26 lesions and stent deployment was done for 25 lesions. Follow up was done for 32 patients [with 45 lesions] at 1, 6 and 12 months using colour Doppler and ABI in all cases and arteriography in recurrent cases. The relation between multiple variables and the patency rates were studied. 48 lesions out of 51 lesions were technically successful [94%] while 3 lesions [6%] were failed to respond. The technical success rate for percutaneous transluminal angioplasty [PTA] was 92.3% while that for stent deployment [96%]. The complication rate was 14.1% in the form of dissection in 2 lesions and inguinal hematoma in 4 limbs. The patency rates at 1, 6 and 12 months were 93.3%, 84.4%and 75.6%, respectively. The patency rates increased in single, short lesions hawing good distal run-off in absence of diabetes, smoking and hyperlipidaemia. The results of this study justify the continuing use of PTA and stent implantation as first line in treatment of chronic lower limb ischemia