Imaging of ischemic cereberal infarction during the 1[st] week: the role of diffusion and perfusion weighted magnetic resonance study

The purpose of the study to evaluate the role of diffusion and perfusion functional MRI in evaluation of the hyperacute and acute stroke patients and the benefit of each examination and what can add. One hundred thirty patients with clinical suspicion of ischemic brain lesions selected to this study. DWI was performed, Fluid Attenuation Inversion Recovery [FLAIR] WI and T2WI sequences also done for comparison with the DWI; three-dimensional time of flight [3D-TOF] magnetic resonance angiography [done in 86 patients] and perfusion-weighted images were obtained following administration of a bolus of gadolinium [done in 31 patients]. PWI images and color maps [rCBV, TTP, MTT] were generated. Patients were classified according to the onset of the ischemic lesions into: Hyperacute ischemic infarction Time period: Group I [< 6 hours from the onset], group II [patients presented at 6- 24 hours]. and group III [presented from 1[st] to the 7[th] days from the onset] DWI b1000 showed the ischemic lesions as a bright signal in all cases [of the group I], with sensitivity of 100% for detection of the ischemic lesions, while FLAIR sequence showed faint hyperintense signal in 13 cases and no lesions detected in 16 patients with a sensitivity of 44.8% for detection of the ischemic lesions. MRA detect no abnormalities in 13 cases while diffuse atherosclerotic changes were found in 39.2% of patients [51 patients]. Perfusion study was done only in 17 cases of the 1[st], in 7 cases of the 2[nd] group and in 7 cases of the 3[rd] group. We have only one patient with mild affection of the penumbra [TTP delay from the normal state of perfusion was less than 4 seconds while rCBV was normal], this patient received thrombolytic therapy with good response. Six patients with moderate affection of the penumbra [The TTP delay was between 4-6 seconds; one with decreased rCBV and 5 cases with average rCBV] Five of them showed good response after thrombolytic therapy. Comparison of the size of the lesions of the group [I] patients by perfusion and diffusion study revealed: Seven cases with PI and DWI of the same size; two of them were with increased regional cerebral blood volume, one with mild TTP delay, and the other with marked TTP delay. The remaining five cases presented with no change of cerebral blood volume; two of them with mild TTP delay and the remaining three cases with no TTP delay. Two patients presented with small lesion in DWI with no associated PWI defect and patients received only supportive measures and complete recovery occurred within 24 hours and diagnosed as TIA. Information obtained by MRI about an ischemic lesion is so extensive and a single early MRI study is all that most patients presenting with stroke syndrome will need. The ability of DWI to identify areas of cerebral ischemia and infarction within hours of their presentation, with sensitivity reaching 100%. Perfusion-weighted imaging [PWI] provided an answer to a fundamental question prior to initiation of treatment: is the ischemic brain parenchyma already reperfused, insufficiently perfused, or completely avascular. PWI measures the seventy of ischemia and accurately differentiates irreversibly injured core from penumbral, salvageable tissue. Earlier and more accurate diagnosis by MRI methods will reduce costs arising from diagnostic error and treatment delay

Three-dimensional fast field sequence magnetic resonance imaging of the scrotal lesions: is there a role for MRI?

Over the last 2 years, 25 patients with testicular masses detected at clinical examination or US underwent MR imaging, in addition to US. The findings of US and MR were compared. Imaging findings were correlated with the surgical and histopathologic findings. Finally, all MR examinations were retrospectively reviewed after the diagnosis was confirmed. The results showed that four patients were found to have extratesticular lesions and 21 patients intratesticular abnormalities. The extratesticular abnormalities included one case of simple hydrocele, one case of chronic hematocele, one case of infected hematocele with epididymo-orchitis and one case with tumor. The intratesticular abnormalities included malignant tumors [17 patients] and chronic inflammatory disease [4 patients]. Of the 17 patients with malignant tumors, 16 patients were primary and 1 patient with metastasis from Hodgkins disease. Of the 16 primary tumors, 11 patients had seminoma and 5 had non-seminomatous tumors [2 patients with teratoma, 1 patient with embryonal cell carcinoma and 2 patients with mixed germ cell origin]

superadded value of magnetic resonance angiography in evaluation of renal artery stenosis

The aim of this work was to study the optimal techniques, applications, limitations and value of magnetic resonance angiography [MRA] in the diagnosis of renovascular hypertension, using digital subtraction angiography [DSA] as the standard procedure in most of the cases. Fifty-five patients were included in this study; all referred from Nephrology Unit for the clinical suspicion of renovascular hypertension. Ultrasonography [US] including Doppler [CDUS] examination was done to exclude renal parenchymal disease. Breath hold gadolinium enhanced MRA for renal arteries, followed by three dimensional phase contrast angiography [3D PCA] maximum intensity projection [MIP] reformatting images were done in axial and oblique directions. The study concluded that MRA is a sensitive procedure [100%] in the diagnosis of main renal artery stenosis, particularly those with significant stenosis near 50% stenosis. MRA is also a sensitive procedure in the following up patients with previous intravascular procedure and for the vascular assessment of transplanted kidneys

MRI study of the congential uterine anomalies

Twenty-five patients with high clinical suspicion of uterineanomaly shared in this study. Clinical examination and full history taking proceed the ultrasound examination, transabdominal or if possible transvaginal HSG, if possible, and MRI were done for all patients. Uterine malformation has been confirmed in all cases by surgery and considered the gold standard. anti considered the gold standard [laparoscopy, hystroscopy and/or laparotomy to confirm the suspicion cases. The results revealed that 27 selected patients shared group I [primary amenorrhea group, seven patients; transverse vaginal septum and imperforate hymen were seen in four patients, uterine hypoplasia in two cases and cervical agenesis in one patient. Group II included 20 patients; females complaining mainly from primary sterility after exclusion of male factors. HSG can not differentiate septate from bicornuate uterus in four patients out of 13 and can not detect a rudimentary horn in one case of unicornuate uterus. HSG has a sensitivity reaching 82% for differentiating bicornuate from septate uterus and a specificity 67% and positive predictive value reaching 82% and negative predictive value 67%. Bicornuate uterus and septate uterus represent the majority of group II patients [16 patients, 3 of them with arcuate shared uterus]. In all cases, there was complete correlation between surgical findings and MRI findings. Only one case of group I patients diagnosed by MRI and transabdominal ultrasound as imperforate hymen and transverse vaginal septum diagnosed at surgery

Evaluation of erectile function in patients with myocardial infarction

In this study, 120 patients with a history of myocardial infarction [MI] and admission to coronary care unit for their erectile function were prospectively evaluated using the questioner of international index for erectile function after reviewing their medical records. Patients with erectile dysfunction [ED] were seen by psychotherapist and evaluated for this problem using the office injection test, color duplex ultrasound and were offered certain choices for management using oral non-specific medication, i.e. sildenafil citrate, self-injection pharmacotherapy, vacuum constriction device and prosthesis. The patients were followed up for one year. Forty out of the 120 patients had no problem with their erection. For the 80 patients with erectile dysfunction, 5 were feared of doing sex and refuse further evaluation. All patients refused the vacuum device as well as ten patients were not on nitrite therapy and were put on sildenafil oral pills. Sixty patients were put on pharmacotherapy program using self-injection of trimix. Five patients were non-responders to pharmacotherapy using trimix and three of them had prosthesis. During one-year follow up, one patient in the oral therapy group stopped the treatment since he was put on nitrite therapy and eleven patients stopped the injection. No ECG changes could be detected in the pharmacotherapy group