Evaluation of coronary artery disease among population with fatty liver disease using multi-slice computed tomography

Background: Fatty liver disease [FLD] is a common disorder with an increasing prevalence. It is considered to be an important syndrome associated with several cardiovascular risk factors and to be a component of metabolic syndrome. Several studies found significant association of fatty liver and coronary artery disease [CAD]

Aim of the Work: was to evaluate the presence and the severity of coronary artery disease among FLD population and to evaluate the association of FLD and CAD using Multi-Slice Computed Tomography [MSCT] and the possibility of considering FLD as a predictor for CAD

Patients and Methods: The study was conducted in Radiological Department of Ain-Shams Hospital and other private centers. It focused on evaluating 30 patients, who were referred to perform CT coronary angiography. These patients were examined in the period between 1[st] of Oct. 2017 and 1[st] of Apr. 2018. The target sample was patients with fatty liver who underwent CT coronary angiography for recent chest pain. Fatty liver was diagnosed using non-contrast CT when calculated attenuation value of the liver is less than spleen by 10 UH. The coronary arteries were assessed using CT angiography, significant CAD was defined as a stenosis of more than 50% in at least one major coronary artery

Results: fatty liver developed coronary atherosclerosis were 17 [56.7%] and this was statistically significant P= 0.017. Patients with fatty liver developed significant CAD were 9 [30.0%] and this was statistically insignificant P=0.266

Conclusion: Fatty liver disease may be considered as a predictor for coronary atherosclerosis and based on this, more individuals from the general population with subclinical CAD could be detected at earlier stages when fatty liver is identified. Presence of fatty liver may help in cardiovascular risk stratification and assessment

Recommendations: It will be worthwhile to study whether improving FLD will ultimately prevent the development of CAD

[Comparative study between multi-detector Ct Angiography and digital subtraction Angiography in evaluation of Peripheral Arterial Occlusive Disease]

Objective: Evaluation of peripheral arterial occlusive disease with multidetector or multi-slice CT angiography [MDCTA] and comparison of the results with the results of digital subtraction angiography [DSA], a standard reference

Patients and Method: The written informed consent of the patients and ethics committee approval was obtained. The prospective study group consisted of 10 patients complaining of peripheral arterial disease. Using MDCT-A, the arterial tree of the lower extremity was evaluated for the presence of steno-occlusive lesions that might have led to luminal stenosis. The diagnostic accuracy of MDCTA was calculated and compared with that of DSA

Results: In the segment-based analysis, the sensitivity, specificity, and accuracy of MDCT angiography in determining significant stenoses were 100%, 99.3%, and 99.6.3%, respectively. The compatibility between MDCTA and DSA methods in grading stenosis was calculated as 0.896 [P < 0.007] and it was statistically significant

Conclusion: MDCT angiography is significantly compatible with DSA method in the evaluation of peripheral arterial diseases. It is a non-invasive method and can be an alternative to DSA

Postmenopausal bleeding: reliability of non- surgical investigations

To compare the combined diagnostic accuracy of sonohysterography and endometrial biopsy with hysteroscopy and fractional curettage in the initial evaluation of postmenopausal bleeding. Prospective controlled study. Department: of Obstetrics and Gynecology Ain Shams University Maternity and Women's Hospital, and Department of Radiology, Ain Shams University Hospital. A hundred and ten patients with postmenopausal bleeding. Endometrial biopsy was performed at the time of the initial evaluation. Routine transvaginal ultrasonography was then used to measure the uterus, ovaries, and endometrial stripe thickness, followed immediately by sonohysterography to evaluate the symmetry of endometrial wall thickness and delinate any intramural masses. Definitive histopathologic sampling was obtained by hysteroscopy with fractional curettage. The combination of endometrial biopsy and transvaginal sonohysterography positively correlated with the surgical diagnosis > 95% of the time, with a sensitivity and specificity of 94% and 96%, respectively. No patients with cancer or hyperplasia were misdiagnosed. Non-surgical investigation, combined endometrial biopsy and transvaginal sonohysterography, is a reliable office tool for initial evaluation of postmenopausal bleeding. Patients with no endometrial abnormalities can be considered for medical treatment while those with thickened endometrium or intraluminal masses should be referred for hysteroscopy and fractional curettage

Clinico-radiological differentiation between, sinus aspergillosis and mucormycosis

High index of suspicion is mandatory for early detection, diagnosis and accordingly management of fungal sinus disease. Diagnosis of sinus aspergillosis must be considered in: cases of [sinusitis] not responding to antibiotics,unusual coloration of thick sinonasal mucus [green, brown or black], isolated sinus involvement, unilateral [sinusitis] with no apparent cause for unilaterality and in differential diagnosis of nasal polyposis [especially when unilateral] and sinus neoplasms [especially in situations suggesting inverted papilloma]. Presence of underlying cause for immunosuppression should increase the suspicion but its absence must never exclude it. Mucormycosis must be suspected in an immunocompromised patient presenting with nasal black crusts overlying gangrenous mucosa especially when accompanied by facial, orbital and/or intracranial symptoms and signs. The otolaryngologist should transfer his suspicion of fungal infection to the radiologist, bacteriologist and, histopathologist since diagnosis is sometimes difficult and needs the cooperation between these specialists. Paranasal sinus radiology [CT and MRI] are important for diagnosis of the disease, assessment of local predisposing factors [compromising the osteomeatal complex], elucidation of extent of the disease [intraorbil, intracranial, nasopharyngeal... etc.], surgical planning especially when functional endoscopic sinus surgery [FESS] is planned for [in aspergillosis] or surgical debridement is decided [in mucormycosis] and for postoperative follow up. Radiologically, sinuses infected with aspergillosis show areas which appear hyperdense on CT scan, hypointense on Tl and markedly hypointense on T2 weighted MR sequences. Bony walls are frequently deviated with minimal erosions and occasionally thickened. Intraorbital spread is usually subperiosteal and intracranial spread is usually extradural. Sinuses involved with mucormycosis show isodense homogenous lesion on CT scan which appears isointense on Tl but hyperintense on T2 weighted MR sequences. Bony walls are usually intact with no deviation, erosion or thickening. Intraorbital spread usually affects extraoccular muscles, orbital fat and eye globe. Intracranial spread usually affects brain parenchyma without affecting the meninges. Cavernous sinus thrombosis is also common