value of diffusion weighted magnetic resonance imaging in differentiating atypical vertebral haemangiomas from metastatic lesions

Background: Atypical vertebral hemangioma and metastatic spinal lesions share many MRI signal intensity and appearance in common, thats why differentiation between them is crucial. For two decades, diffusion-weighted imaging [DWI] has been applied to the evaluation of intracranial diseases, but DWI technical advancement make it possible to apply for assessment of extra cranial sites, including vertebral column

Objective: The goal of our study is to assess the value of diffusion weighted MRI imaging in differentiating vertebral atypical hemangiomas from metastatic lesions

Patients and Methods: A prospective cross-sectional study was employed at AL-Imammain AL-Khadymain Medical city in Baghdad health directorate, [43] patients with total [65] vertebral lesions grouped into three groups Group [A] 10 patients [23.2%] with total [15] lesions of vertebral typical hemangiomas, Group [B] 13 patients [30.3%] with total [ 13] lesions of vertebral atypical hemangiomas and Group [C] 20 patients [46.5%] with total [ 37] lesions of spinal vertebral metastases. MRI was done for all patients [including T1, T2, T1 fat suppression with IV contrast administration [when needed] and DWI]. Complementary non contrast CT was also done

Results: Total study sample were [43] patients with total [65] lesions, with [29/43] females and [14/43] males with male to female ratio of [1:2], their age range from [28-75 years] and their mean age was [54.2 +/- 10.1 years]. Atypical hemangioma and malignant lesions were generally low signal in T1 and high or intermediate signal in T2 WI. Restricted diffusion and low ADC values were seen in atypical hemangioma compared with metastasis with mean ADC value were [1.426 +/- 0.231.6x10[-3] mm[2]/s and 0.6182 +/- 0.137x10[-3] mm[2]/s respectively]. Complementary CT confirmed the lytic or sclerotic nature of malignant lesions while in haemangiomas, it showed their characteristic striated [polka dot] appearance

Conclusion: Diffusion weighted Magnetic Resonance Imaging is a valuable tool in differentiation of atypical hemangioma and metastasis of spine with high sensitivity and specificity with the aid of ADC values calculated from the maps obtained by DWI

Magnetic resonance urography plus, abdominal radiograph in acute calculus ureteric obstruction

Background: About 2-3% of the population experiences an attack of acute ureteric colic during their lifetime, and 67%-95% caused by ureteric calculi. Magnetic Resonance Imaging [MRI] can rapidly demonstrate both the presence and the level of ureteric obstruction]

Objective: To study the diagnostic accuracy of MRI [alone and in combination with plain abdominal radiograph] in detecting acute ureteric calculus obstruction compared to unenhanced Computed Tomography [CT]

Patients and Methods: A cross sectional comparative study was conducted on a total of 48 patients suspected to have acute ureteric calculus obstruction, at the radiology department in AL-Imamain AL-Kadhemain Medical city, during the period from March to November 2015. Patients underwent MRU then unenhanced abdominal CT, and plain abdominal radiograph. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of MRU findings were obtained in comparison to CT findings regarding ureteric dilatation and its level, stone detection and perirenal fluid and fat stranding

Results: Of the 48 patients imaged with both CT and MRU, 4 of them showed no evidence of obstruction on any imaging modality, and 44 of them had a final diagnosis of acute calculus ureteric obstruction. Regarding the detection of ureteric dilatation in MRU, in comparison to CT, the sensitivity = 100%, specificity = 80%, the positive predictive value [97.72%], the negative predicative value [100%], and overall accuracy [97.9%]. The detection of ureteric stone by MRU [when combined with plain abdominal radiograph] in comparison to CT, the sensitivity = 95.45%, specificity = 100%, the positive predictive value [100%], the negative predicative value [66.66%], and over all accuracy [95.8%]. The detection of peri-renal fluid by MRU in comparison to CT, the sensitivity = 96.66%, specificity = 72.22%, positive predictive value [85.29%], the negative predicative value [92.85%], and overall accuracy [87.5%]

Conclusion: MRI when combined with plain abdominal radiograph was nearly as accurate as unenhanced spiral CT in acute calculus ureteric obstruction. Also the MRI was more sensitive than unenhanced CT in detecting the secondary signs of upper urinary tract obstruction, as perirenal fluid

Peritoneal complications of ventriculo-peritoneal shunt: retrospective review of 23 cases

The management of hydrocephalus most commonly involves placement of ventriculoperitoneal shunts. However, high rates of complications have been reported, ranging from 24-47%, among which abdominal complications account for approximately 25%. The aims were evaluation of symptoms, diagnosis and surgical treatment in abdominal complications following ventriculoperitoneal shunt. Between June 2007 and August 2010 a retrospective review of 23 patients suffering from late complications of ventriculoperitoneal shunt were done at Al-Kadhimyia teaching hospital, Baghdad, Iraq. Patient presenting symptoms, time between the insetion of ventriculoperitoneal shunt, onset of abdominal complications and the operative time were recorded. Methods of diagnosis were also recorded. There were 4 male and 19 females, F:M ratio 4-75:1 and mean age of 11.5 years. Methods of diagnosis were as follows: abdominal CT in 10 patients, abdominal Ultrasound in 8 patients and x-ray in remaining 5 patients. Clinical presentations: fever in 26.1%, abdominal distension in 26.1%, abdominal pain in 21.7%, nusea and vomiting in 13% and headache in 13%. Abdominal complications include: infections [abscesses and peritonitis] in 26.1%, shunt disconnection with intraperitoneal distal catheter migration 21.7%, coiled catheters in the subcutaneous tissue in 21.7%, pseudocysts 17.4%, CSF ascites 8.7%, and excessive length of intraperitoenal tube 4.3%. Surgical treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the intraperitoneal tube in excessive length. The operative time ranged from 45-150 minutes. Shunts replacement or revision was ultimately successful in all patients. Infection is the most common abdominal complication after ventriculoperitoneal shunt. Infected shunt should be removed and replaced when all signs of infection subside. Reimplantation is successful in patients with CSF pseudocyst and ascitis

Laparoscopic cholecystectomy for acute cholecystitis an experience of 64 cases

To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis, and to assess the incidence of complications. A prospective study included Sixty four patients with a confirmed diagnosis of acute cholecystitis at Al-Kadhimyia Teaching Hospital, over a period of 18 months from march 2009 to August 2010. Sixty four patients with diagnosis of acute cholecystitis were enrolled in our study. All of cases underwent laparoscopic cholecystectomy during the first 72 hours of their admission. Of the 64 patients there were 48 female and 16 male with a female to male ratio of 3:1. The age of our patients ranged from 19 years to 63 years with mean age of 35.6 years in female and 49.8 years in male. Cholecystectomy was completed successfully in 52 patients [81%], conversion to open conventional surgery was necessary in 12 patients [19%]. The main reasons were obscured anatomy [calot's triangle], excessive bleeding and dense adhesions. Data on presenting symptom, ultrasound findings, operative findings, hospital stay and complications were recorded. In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures, shorter hospital stay and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available

Testicular size and resistive index measured by gray scale and color doppler ultrasound before and after varicocellectomy in adult patients with unilateral idiopathic varicocele

Varicocele represents abnormal dilatation and tortuosity of the veins of the pampiniform plexus within the spermatic cord, caused by incompetent valves in the internal spermatic vein. The small vessels of the pampiniform plexus normally range from 0.5-1.5 mm in diameter. As varicocele cause dilatation of these vessels, their diameters usually exceed 2 mm. To evaluate testicular volume and resistive index [RI] of the intra-testicular artery as an indicator of improved seminal parameters after surgical treatment in adult patients with idiopathic varicocele. This prospective study was done in the ultrasound unit of AL-Kadhimiyia Teaching Hospital from the period of November 2006 to July 2008 including the follow up. Forty one patients with left sided idiopathic varicocele [mean age: 27 years; range: 19-40 years], underwent unilateral varicocelectomy were included in the study. Testicular size, RI and seminal parameters were measured before and one year after surgery. All patients had evidence of reversed flow [venous reflux] and are classified as: 30 patients [73.2%] had grade III and the remaining 11 patients [26.8%] had grade II reflux. In terms of seminal parameters, all the patients had abnormal sperm count. Statistical analysis showed a significant increase of testicular volume after varicocele treatment [pre operative 16.55 +/- 2.22 ml, post-operative 18.46 +/- 2.05 ml] [P < 0.05]. A statistically significant decrease in RI values of intratesticular arteries after varicocelectomy was also shown [pre operative 0.74 +/- 0.08, post-operative 0.59 +/- 0.06] [p < 0.001]. Furthermore, the total number of spermatozoa and fast progressive spermatozoa rates significantly increased after surgery [respectively P <0.05 and P <0.01]. Varicocele repair results in increased testicular volume and improved semen profiles. The intratesticular RI seems to be a reliable indicator for routine clinical use to identify subfertile men. Ultrasound is useful to monitor the presence of varicocele, to assess recurrence of varicocele and to evaluate testicular function

MRI appearances of degenerative disc disease of the lumbosacral spine in a cohort of Iraqi patients presenting with low back pain

Low back pain [LBP] is the most common cause of restricted activity for those under 45 years, and the third after heart disease and arthritis in those 45 to 64 years of age. Degenerative disc disease is the most common cause in patients with LBP. The aim is to study the MRI appearances of degenerative degenerative disc disease of the lumbosacral spine in a cohort of Iraqi patients presenting with low back pain. This random prospective study was conducted on 134 patients [78 males, 56 females] suffering from low back pain and has MRI evidence of degenerative disc disease of the lumbo-sacral spine during the period from May 2006 to January 2007, in the MRI unit of Al-Kadhimyia and Al-Yarmuk teaching hospital. Back pain was more common in males [58.5%] than females [41.5%], and more frequently seen between 40-59 years of age. Acute back pain was seen in 13.5% of patients, 30% had subacute back pain and 56.5% had chronic back pain. The disc showed different patterns of pathology [circumferential bulge in 48%, protrusion in 26%, extrusion in 18%, and sequestration in 8%]. The disc disease in most of the patients was localized to L4/L5 and L5/S1 levels [38% and 31% respectively], and 28% had multiple disc disease. Posterolateral disc disease is far more frequently seen [82%] than posterocentral lesion [18%]. Smoking and obesity are noticed in a good proportion of patients having LBP. Degenerative disc disease is the commonest cause in patients with LBP. Precipitating events may not correlate well with the severity of injury to the back