Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients

Diffusion weighted imaging [DWI] offers molecular information that complements the morphologic information obtained with conventional magnetic resonance imaging [MRI] and can reflect the functions and structures of the body without trauma. To assess the role of DWI as a routine sequence in a MRI study to help in differentiating liver lesions. The study included 50 patients referred to do a MRI study to diagnose and/or to confirm the ultrasonographic or CT findings of focal hepatic lesions. The examination was done on 1.5T superconducting magnet MRI machines; Philips Gyroscan Intera version 12.1.1.2 [Best, The Netherlands] and Siemens Magnetom Avanto [Erlangen, Germany] machine. All studied patients had a focal hepatic lesion either on top of cirrhotic liver or non cirrhotic liver. DWI was found to be helpful with the routine MRI sequences to reach the diagnosis. The final diagnosis was confirmed by histopathological examination or follow up. A cutoff value of ADC for benign lesions was found to be 1.25 x 10[-3] mm[2]/s. DWI should be included as a basic sequence in the routine MRI study of the liver as it helps in diagnosis and so reaching a final diagnosis or at least trying to narrow the list of differential diagnosis

Hand osteoarthritis: clinical and imaging study

To examine the validity of US in assessing hand osteoarthritis [OA] and to study the relationship between ultrasonographic findings and OA symptoms. This study was carried out on thirty patients with primary hand OA, and fifteen healthy subjects serving as a control group. Patients were classified according to ultrasonographic findings of joint involvement into two subgroups: 15 patients with interphalangeal [IP] OA and 15 patients with IP and first carpometacarpal [CMC] joint OA. All hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement [nodes], and deformity. Functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by Visual Analogue Scale [VAS] were carried out. Plain X-rays of both hands were taken and classified according to the Kellgren-Lawrence [K-L] grading scale. High resolution US of the hand joints was performed which focused on examining cartilage thinning, joint space narrowing [JSN], and osteophytes [OST]. There was a positive correlation between the K-L grading and US findings regarding JSN and OST. There was a positive correlation of AUSCAN score with cartilage thinning, OST and JSN. There was a negative correlation of grip strength with cartilage thinning and OST. There was a negative correlation between pinch strength and US findings [cartilage thinning, OST and JSN]. There was a positive correlation between pain and US findings. Heberden's nodes were associated with underlying distal IP cartilage thinning, OST and JSN. On comparing the two subgroups of patients; patients with both IP and first CMC joint involvement experienced significantly higher levels of pain and disability and had weaker pinch strength. Ultrasonographic findings correlated with clinical findings as nodes, functional parameters as grip and pinch strength, and pain. The increased detection of OA structural pathology by US may make this a useful tool for hand OA assessment

role of multislice CT in evaluation of chronic inflammatory bowel disease

Ulcerative colitis [UC] and Crohn's disease [CD] are the two main subtypes of chronic inflammatory bowel diseases [IBD]. Multidetector computed tomography [CT] has been recognized as a promising modality for the evaluation of Crohn's disease and other small-bowel abnormalities. CT enterography differs from routine abdominal CT in that CT enterography uses multidetector CT. [narrow section thickness and reconstruction interval], intravenous contrast material, and large volumes of a neutral oral contrast agent to improve depiction of the small-bowel wall and lumen. In patients with Crohn's disease, CT enterography is increasingly used to detect enteric inflammation in addition to extra-enteric complications. The aim of the work will be directed to identify the role of MSCT in the evaluation of idiopathic inflammatory bowel diseases. The present work included 30 patients suffering from idiopathic inflammatory bowel disease [ulcerative colitis or Crohn's disease. All patients subjected to CT enterography and/or colonography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material and Ileo-colonoscopy and mucosal biopsy. CT findings include abnormal wall thickening [generally 1 cm] with skip areas of colonic stenosis and dilatation. Associated findings include pericolonic fat stranding, fistulas, abscesses, fibro fatty proliferation, and mesenteric adenopathy. Findings such as mural thickening, mural enhancement, increased attenuation of the perienteric fat, and the Comb sign have been reported to indicate active inflammatory Crohn's disease. MSCT is a great diagnostic tool in detecting and assessing early changes of inflammatory bowel disease as well as monitoring the disease progress and evaluating the complication

Role of 64 MSCT in the evaluation of aortic lesions

Multslice CT [MSCT] has proved its importance and applicability in the evaluation of vascular disease including stenosis, occlusion, aneursyms and dissection as well as evaluation of post-traumatic events. The aim of the work will be directed to identify the role of MSCT in the evaluation of aortic lesions. The study will be conducted on patients suspected of having aortic lesions based on clinico- laboratory basis. Each patient will be subjected to thorough history taking, Clinical examination, and MSCT aortography. The advance of cardio-thoracic surgery techniques adds the burden of many questions that need to be answered including the extent, width, and shape of the flap and implication of the coronary arteries and major aortic branches. The presence of leakage is of equal importance in both dissecting and atherosclerotic aneurysms. Evaluation of abdominal aortic aneurysm and leakage by MSCT has proved its usefulness particularly in planning for operative intervention including the length, size of the aneurysm and implication of the major aortic branches. 64 MSCT is an excellent tool for examining the aorta. It gives a great deal of information that, abolishes the need of another diagnostic tool prior to operative intervention. It offers a great mapping of dissecting aortic flap, abdominal aortic aneurysms and coarctation. Time of an essence in dealing with emergency patients and 64 MSCT offers a great portal of diagnosis considering time efficacy and accuracy

Incidental finding on coronary multislice CT angiography: frequency and diagnostic value

Multislice Coronary CT angiography [MSCTA] has emerged over the past few years as an important diagnostic tool in patients with low-intermediate likelihood of coronary artery disease [CAD] presenting with chest pain. MSCTA images also include parts of the lungs, abdomen, and mediastinum. Reading physicians are obliged to evaluate and report incidental [non cardiac] findings. The purpose of our study was to retrospectively assess the prevalence and clinical diagnostic impact of incidental [non cardiac] findings in low intermediate likelihood patients presenting with chest pain to a specialized imaging center. MSCTA was performed in 600 consecutive patients age of 55.8 +/- 10.0 years, with 3.0 +/- 1.5 risk factors, underwent retrospective ECG-gated examination of the coronary arteries using a 64-MSCT scanner [Aquilion, Toshiba Medical Systems, Tokyo, Japan]. In each examination findings were assessed and reported by a consensus between a cardiologist and a radiologist. Incidental finding is defined as a non cardiac finding not previously known; clinical significance was defined as that requiring further, diagnostic or interventional procedure. The 64 MSCT showed a great window for examining the coronaries allowing the diagnosis of a great variety of findings including calcium scoring, non-obstructive and obstructive plaques. The number, size and exerted degree of stenosis of plaques can be examined and outlined in more or less easy and rapid to perform procedure and acceptable by most patients. A wide multitude of incidental findings were seen in our study. Parts of the lungs [and sometimes the hole lungs] are examined during cardiac imaging. Most of the thoracic esophagus, thoracic aorta, diaphragm and a glance of the upper abdomen and breasts are seen during MSCTA of the heart. The visualized portion of the lungs and mediastinum showed multiple lesions. Lung subcentimeter nodules were seen in 10 cases. Five cases showed lung wedge shaped consolidation with associated pleural thickening. Significant mediastinal adenopathy [more than 1 cm in diameter] were seen in two cases. Lung neoplastic process that was proved to be pulmonary carcinoma was seen in 2 cases. Pulmonary embolism was encountered in almost tenth of our cases and actually was the cause of chest pain. Aortic lesions were seen in 12 patients; most of them were aneurysms and two cases were dissection and were incriminated as the major cause of chest pain in those patients. Hiatal hernia was a more or less common incidental finding seen in 40 cases. Hepatic and breast lesions were so few not seen in more than two cases each. Coronary artery MSCTA can reveal important non-cardiac findings and disease in extracardiac structures; these incidental findings are common, many of which would impact patient management. Cardiologist must be aware of the normal and abnormal findings and the best laid plan is to have an integrated cardiologist-radiologist team to ensure that important findings are not missed and unnecessary follow-up examinations are avoided

Relationship between adiponectin, resistin and visceral obesity in type 2 diabetes mellitus in female Egyptians

The aim of this work was to study the possible physiological role of adiponectin and resistin as mediators linking obesity and insulin resistance in type 2 diabetes mellitus. Seventy-five female Egyptian subjects were enrolled in this study. They were divided into four groups as follows: obese nondiabetics [ONDM], obese diabetic type 2 [0DM], nonobese nondiabetic [NONDM] and nonobese diabetic [NODM]. Anthropometric measurements were taken. Abdominal ultrasound was also done to measure visceral fat [VF], subcutaneous fat [SCF] and visceral fat index [VFI]. Fasting blood samples were taken for analysis of serum insulin, blood glucose, plasma adiponectin and resistin. In the diabetic group adiponectin had an inverse correlation with resistin,VF and VFI [P < 0.01, P < 0.05, P < 0.01]. Resistin had a weak positive correlation only with VF, [P = 0.05] and RAI [resistin /adiponectin index] showed a positive correlation with VFI and SCF. In the nondiabetics adiponectin had no correlation with resistin, but had negative correlation with HOMA, age, VF and VFI, whereas resistin had no correlation with the same variables. RAI had a positive correlation with HOMA and SCF. In conclusion it can be said that resistin has no direct relation to insulin resistance either in diabetics or non diabetics. However, it may have a weak relation to visceral obesity only in diabetics. Hypoadiponectinemia is related to visceral obesity and increased resistin level in diabetics, while in non diabetics it is related to visceral obesity, insulin resistance and age. RAI is more informative than resistin which indicates a possible interaction between resistin and adiponectin especially in diabetics. RAI correlates positively with some anthropometrics but not to insulin resistance in diabetics, while it correlates positively with both variables in non diabetics