Role of transarterial chemoembolization [tace] in down staging of hepatocellular carcinoma [hcc] before liver transplantation

Background: liver transplantation [LT] has emerged as the optimal treatment for cirrhotic patients with Hepatocellular carcinoma [HCC] because it cures both tumor and underlying cirrhosis. HCC could be downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a curative treatment such as LT

Aim of the Work: it was to evaluate the outcomes of HCC downstaged patients using transarterial hepatic chemoembolization [TACE] therapy to allow eligibility for liver transplantation

Patients and Methods: the study included all the cirrhotic patients who underwent TACE for downstaging of HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation

Results: the etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country. All the cases were not eligible for liver transplantation because they were out of Milan criteria, therefore all the cases underwent TACE for downstaging of the tumor to be within the Milan criteria to become fit for liver transplantation. After undergoing TACE for downstaging, Patients underwent living donor liver transplantation, then they were followed up for detection of recurrence on the transplanted liver. Four of the twenty seven patients had recurrent HCC [14.8 %]

Conclusion: successful down-staging of HCC by TACE can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome

Role of mdct in diagnosis of lower limb peripheral arteries diseases

Background: Lower limb peripheral arterial disease [PAD] is a common disease that affects about two hundred million peoples per year. It is the third leading cause of cardiovascular morbidity. We plan to evaluate the diagnostic performance of 64-section computed tomographic [CT] angiography in the assessment of steno-occlusive disease in patients with PAD, with conventional digital subtraction angiography [DSA] as the reference standard

Aim of study: is to compare the diagnostic accuracy of multidetector computed tomographic [MDCT] angiography in diagnosis of PAD compared to the DSA as pre-operative evaluation of lower limb peripheral arterial diseases

Patients and methods: The study included 20 patients clinically presented with symptomatic PAD from February 2018 to July 2018. The study protocol was approved, and written informed consent was obtained from all patients. The patients underwent CT angiography and subsequent DSA. For stenosis analysis [>/=70% stenosis], the arterial bed was divided into 35 segments and evaluated by three readers. Inter observer agreement was determined with generalized Kappa statistics. Accuracy, sensitivity, specificity, was calculated. Mc Nemar test was used to prove significant differences between CT angiographic and DSA findings

Results: A total of 700 arterial segments were evaluated, with excellent agreement between readers [Kappa >/= . 0.928]. On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% [386 of 400 segments and 290 of 300 segments, respectively], with an accuracy of 98% [686 of 7oo segments].There was no significant difference between CT angiographic and DSA findings [P = .62-.87]

Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD

Sonographic evaluation of synovium of wrist joint in rheumatoid arthritis patients during activity

Background: Rheumatoid arthritis [RA] is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process

Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population, compared with the laboratory investigations

Patients and Methods: This study was carried out in Radiology department of Ain Shams university hospitals. Twenty-five patients known patients with rheumatoid arthritis suspecting activity will underwent assessment by ultrasonography and power Doppler of both wrist and hand joints

Result: US and PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in correlation to laboratory investigations. So, they can be used as non-invasive methods in detection of RA activity changes in wrist and hand joints

Conclusion: Both ultrasonography and power Doppler are good predicators for activity in rheumatoid arthritis patients

Comparison of sensitivity and specificity of DWIBS and contrast enhanced T1Wi sequences in characterization of suspicious mammography lesions

Background: diffusion Weighted Imaging with Back-ground Suppression is a new technique which uses the same concept of diffusion weighted imaging yet has the privilege of back-ground suppression and acquisition at a wider range of b-values hence increasing sensitivity and specificity

Objective: to determine the accuracy of DWIBS MR imaging in comparison to the DEC MR imaging in characterizing suspicious mammography lesions

Patients and Methods: twenty patients were included in the study, all with suspicious breast lesions from Ain-Shams University mammography clinic. A cross-sectional study was held where all the patients under-went MRI breast protocol which included DCE and DWIBS sequences. The MRI of all the patients was read by two expert radiologists blinded to each other's opinion. Biopsy was then done for histo-pathological correlation. The results were statistically analyzed

Results: seventy percent of the patients included in our study had malignant lesions and 30% had benign lesions. Both DWIBS and DCE showed comparable efficacy of 90% and 95% respectively

Conclusion: DWIBS can be used as an adjunct to DCE breast MRI improving its sensitivity and specificity. It can as well be used instead of DCE sequences in cases of renal impairment