added value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma

Primary CNS lymphoma is difficult to diagnose with conventional imaging modalities. Magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images have been recently investigated as a problem-solving tool for evaluation of primary CNS lymphoma with favorable results. To assess the value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma. Five adult patients with suspected primary CNS lymphoma [as suggested by clinical or conventional imaging techniques] were prospectively studied by magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images aiming to confirm the suspected diagnosis. The examinations were done on 1.5T machines using diffusion weighted, dynamic susceptibility contrast perfusion and chemical shift CSI imaging sequences. Regarding DWI, all patients show low ADC value of 0.63 +/- 0.025[SD] x 10[-3] mm[2]/s, regarding the DSC perfusion. The max rCBV ratios are ranging from 0.23 to 1.52 with a mean ratio of 1.14 +/- 0.54[SD]. Regarding

Role of multi-row detector CT enterography in evaluation of small bowel disorders

Imaging diagnosis of small bowel diseases has long been technically challenging. Imaging techniques included plain radiography, contrast studies, computed tomography [CT], magnetic resonance imaging [MRI], sonography, scintigraphy and angiography. Multi-row detector CT [MDCT] enterography is a new technique that improved depiction and characterization of small bowel pathology. To assess the role of multi row detector computed tomography [CT] enterography in evaluation of small bowel disorders. The study was conducted on 30 patients suffering from known or suspected small intestinal disease and subjected to CT enterography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material. CT showed symmetrical mural and mucosal changes in 12 patients, seven of them associated with comb sign and creeping fat sign proved to be Crohn's disease and five patients without specific features due to Crohn's, ulcerative colitis, typhoid colitis, ileitis sequel to complicated appendicitis and typhlitis with ileitis. CT showed symmetrical thickening, grey attenuation pattern and aneurysmal dilatation proved to be lymphoma in three patients. CT showed vascular occlusion and mural changes in two patients. CT showed hyperattenuating lesion in two patients due to bowel wall hematoma, CT showed asymmetrical thickening in four patients, two of them showed infiltrative mesenteric mass with calcifications and desmoplastic reaction proved to be due to carcinoid tumour. One patient with asymmetrical thickening showed strongly enhancing lesion in the enteric phase in the second part of duodenum proved to be periampullary carcinoma. The fourth patient with asymmetrical thickening showed heterogeneous enhancement in the venous at distal heal loop with mesenteric stranding, lymph adenopathy and liver deposit proved to be due to adenocarcinoma. CT showed dilated bowel loops with transitional zone in two patients proved to be due to intestinal obstruction, There were five patients with unremarkable CT features that were followed up without definite lesion. CT enterography with iso-osmotic mannitol is a simple, non invasive, economic, effective method for assessing small bowel disease and can replace other imaging modalities

Transaxillary abdominal and lower limb arteriography the King Abulaziz University Hospital experience

The authors reviewed their experience with 31 patients with transaxillary abdominal and lower limb arteriography; with particular attention to technical difficulty or any complication related to the procedure. The indication/or transaxillary approach were aortic occlusion or stenosis [20/31] common or external iliac occlusion or stenosis [7/31], abdominal aortic aneurysm [2/31], iatrogenic abdominal aortic dissection [1/31] and bilateral femoral artery aneurysm [1/31]. Technical difficulties are minimal using single pigtail catheter technique. Difficulties in catheterization can be overcome by the use of catheter exchange technique and thin safety J guide wire [0.028, 0.025 inch]. Only one patient out of 31 had minimal insignificant axillary haematoma from the procedure. It was concluded that the use of minicatheters [5F] with minimal catheter exchange and adequate manual compression after catheter withdrawal until complete haemostasis minimize the risk of complications

Takayasu's arteritis: angiographic and duplex finding

To our knowledge, this is the first report of Takayasu's arteritis from Arabia. Seven patients out of ten were Saudis. Seven were females and three were males. Chest radiograph is invaluable in the evaluation of this disease since it allows visualization of the contour of the aorta with calcification of aortic wall. Carotid duplex can initially suggest the diagnosis based on characteristic sonogrphic features of the disease, however, panarteriography helps in evaluation of the extent of the disease and the state of collateralization

Role of computed tomography in diagnosis of cerebral infarction

CT study was done to 78 patients presenting with clinical findings suggestive of brain infarction. The CT appearance of brain infarction was found to be dependent on many parameters, mainly the age and stage of the infarction whether initial, developmental or sequellar stage, the location of infarction whether superficial or deep and the size of infarction area whether small or massive. Hypodensity was the most characteristic and most stable CT abnormality of brain infarct. Diminution or disappearance of hypodensity, the fogging effect, occurred during the second and third weeks after the ictus. This phenomenon lasts for few days and may present a great diagnostic difficulty. Contrast enhancement is of utmost importance in detecting cerebral infarction during this period