Tuberculous versus pyogenic spondylodiscitis: MR imaging evaluation

Infective spondylitis is a condition that involves one or more of the components of the spinal column. MRI represents a major advance in the examination of the spine because of the direct multiplanar capabilities, increased tissue contrast and improved resolution without the need of iodinated contrast or ionizing radiation. The aim of this study was to evaluate the role of MRI in the diagnosis of Spondylodiscitis and in the differentiation between tuberculous and pyogenic Spondylodiscitis. This study included 23 patients, 10 males and 13 females with age ranging from 19 to 75 years and a mean age of 42.3 years. These patients were subjected to complete clinical and neurological examination, laboratory investigations and MR imaging. T1 WIs and T2 WIs were obtained for all patients and Diffusion study was done in 18 patients. Post contrast [Gd-DTPA] TlWIs in at least two orthogonal planes was also obtained. Patients in this study were divided into pyogenic Spondylodiscitis [16 cases] and tuberculous Spondylodiscitis [7 cases]. MR imaging was an ideal method for evaluating infections of the spine and it is extremely sensitive in detecting and delineating the actual extent of these lesions. Characteristic magnetic resonance findings included destructive lesions involving 2 adjacent vertebrae and the intervening disk, low intensity changes in bone and disc were seen on Tl-weighted images, whereas high intensity changes were seen in those structures on T2-weighted images. Intravenous injection of Gd-DTPA shows enhancement of the involved structures. Paravertebral infection, collections under the posterior longitudinal ligament, and epidural abscesses were also seen in this study. MR imaging is sensitive in diagnosing Spondylodiscitis, demonstrating actual extent of the inflammatory process and in differentiation between pyogenic and tuberculous Spondylodiscitis in most cases

role of MRCP in the diagnosis of malignant biliary obstruction

The clinical value of using MRCP is similar to that of diagnostic direct cholangiopancreaticography and in most instances; MRCP will gradually replace direct cholangiopancreaticography and provide an efficient alternative when diagnostic ERCP or PTC is unsuccessful or inadequate. The aim of this study is to evaluate the role of MRCP as a non invasive technique in the diagnosis of malignant biliary obstruction. This study was conducted on 22 patients, 13 males and 9 females and their age ranged between 22 and 70 years with a mean age of 44.6 years. All patients were subjected to: complete clinical examination, laboratory investigations and radiological investigations including MRCP. MRCP as well as complementary axial and coronal T2 W MR images were performed to make prospective diagnosis in 22 patients with suspected pancreatico-biliary tumors. MRCP was performed using, breath- hold 2D singleslice FSE and non breath- hold multi-slice acquisition followed by 3D MIP reconstruction. Patients in this study included 13 cases of cholangiocarcinoma, 3 cases of hepatocellular carcinoma [HCC] causing biliary obstruction, 3 cases of pancreatic head carcinoma, 2 cases of periampullary carcinoma and one case of portahepatis lymphadenopathy causing biliary obstruction. The accuracy of MRCP as well as axial and coronal T2W MR images in diagnosing patients with pancreaticobiliary tumors was [100%]. MRCP could detect level of biliary obstruction which was intrahepatic, hilar, extrahepatic or periampullary. MRCP could also assess degree of proximal biliary ductal dilatation. MRCP as well as complementary axial and coronal T2 WI could define organ of tumor origin and extent of invasion of the malignant lesion. MRCP as well as complementary axial and coronal T2 W MR images are considered a non invasive accurate method in the diagnosis of pancreaticobiliary tumors and in assessing the level of biliary obstruction, degree of biliary ductal dilatation, organ of tumor origin and the extent of tumor invasion

Echo-Doppler study in children with rheumatic mitral stenosis [prediction of severity]

The diagnosis of mitral stenosis is well settled with the advantage of echocardiogram. However, assessment of the severity of the disease is still unimproved. The purpose of this study is to evaluate the specific role of echo-Doppler. ECG, and X-ray findings in predicting the severity of rheumatic mitral stenosis. Ten children with isolated rheumatic mitral stenosis, proved clinically and by investigations were studied with echo-Doppler. ECG, and X-ray. The mitral valve areas determined by planimetery correlated closely with Doppler derived areas. [r = 0.981]. Severe mitral stenosis was defined by a valve area <1 cm2. Two-dimensional echocardiographic analysis of the pliability, thickening and doming of anterior mitral leaflet was valuable in assessing the severity of mitral stenois. Absence of pericardial effusion and calcification of mitral valve was recorded in all our patients. Also, correlation between mitral valve areas and m-mode findings [left atrium/aortic ratio, end-diastolic dimensions, and shortening fraction] was good as the X-ray findings [heart volume]. In contrast ECG findings [width of P wave and R/S in V1] correlated poorly with the severity of mitral stenosis. Therefore, the most useful predictor of severity of mitral stenosis is echo-Doppler study and X-ray with ECG are considered as complementary methods

Computed tomography versus plain radiography in diagnosis of bone tumours

25 patients suspected to have bone tumours on clinical examination, were subjected to laboratory and radiological examination including plain X-ray and computed tomography [CT]. Pathological examination after biopsy was done to confirm the final diagnosis. 16 [64%] out of 25 cases were diagnosed by plain x-ray, 15 [60%] of them showed intramedullary extension, while CT was useful in establishing the primary diagnosis in 22 [88%] patients with intramedullary extension in all of them. CT is an effective method in the diagnosis of bone tumours providing excellent data about the exact anatomical locations and intra and extra-osseous extensions of bone tumours