Role of multidetector CT in evaluation of liver transplantation donors

Several factors have contributed to an increasing demand for liver transplantation including an Increasing incidence of cirrhosis caused by hepatitis C and the early detection of small hepatomas that are potentially curable with transplantation. Living donors can help alleviate the shortage of available livers for transplantation. Multidetector CT is a technologic advance that permits highspeed and high-resolution helical imaging of the entire liver volume during a single breath-hold. Rapid helical data acquisition has resulted in increased body coverage, decreased motion artifact, better use of contrast bolus, and multiphase organ scanning that allows accurate vascular mapping. The combination of fast helical scanning and image processing in three-dimensional [3D] and multiplanar reconstructions has resulted in dramatic improvement of image quality and the ability to depict fine anatomic-vascular detail The study included 50 potential living liver donors to asses the impact of multidetector multiphase CT in facilitating patient selection and surgical planning in potential donors being evaluated for living adult right lobe liver transplantation. Results: the mean age of the donors was 27.4 years including 28 females and 22 males. Calculated total liver volumes mean was 1523 +/- 239 gm, right lobe mean weight with middle hepatic vein was 893 +/- 153 gm and 621 +7-772 gm without middle hepatic vein, intra operative mean graft weight was 1043.46 +7-763.77 gm while that measured intra operatively had a mean weight of 853.14 +7-122.69 with a mean weight difference of 190.32 gm. CT calculated graft recipient weight ratio was 1.34 while actual GRWR was 1.068. meal L/S ratio 1.12. The classic anatomy of right main hepatic artery originating from the caeliac trunk [Michel type I] is seen in 35 cases [70%], while RHA originating from SMA [Michel s' type HI] seen in 8 cases [16%], CHA originating from SMA [Michel s' type IX] in 4 cases [8%], RHA from the aorta [Michel s' type XI] in 2 cases [4%] and two LHAs [Michel s' type VII] in one case [2%]. Variation in portal venous anatomy occurred in 20% of patients and includes:1-trifurcation of the portal vein [type B] in 9 cases [18%] 2-posterior right portal vein from main portal vein [separate branch for posterior inferior segment, segment VII] Type D in lease [2%]. hepatic veins showed early confluence to the right was present in j patients [6%] and accessory inferior right hepatic vein was detected in 2 patients [4%] Multidetector CT is a valuable tool in the evaluation of potential living liver donors that provides complete and comprehensive information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements

Role of multislice CT in diagnosis of parenchymal renal masses

The challenges of renal tumoral imaging include not only reliable differentiation between benign and malignant lesions but also accurate delineation of the extent of the disease to ensure optimal treatment planning. The aim of this study is to evaluate the role of multiphasic multidetector CT in characterization of parenchymal renal masses and identify the role and accuracy of MDCT in detection and surgical planning of renal masses as one single modality, using the state of art of CT. The study included 20 patients out of 120 patients with parenchymal renal masses underwent MDCT with single holus technique and four phases including unenhanced phase, arterial phase, nephrographic phase and excretory phase. According to MDCT findings we can classifyparenchymal renal masses into: 14 malignant renal masses [10 renal cell carcinoma RCC and 4 Wilm's tumor] and 6 benign renal masses [2 angiomylipoma AML, 2 xanthoglumerulonephritis 2 renal abscess,]. MDCT imaging can differentiate between different types of parenchymal renal masses

Dynamic magnetic resonance imaging in evulation of female pelvic organ prolapse

The aim of this study is to evaluate the role of dynamic MRI in diagnosis of pelvic organ prolapse [POP]. Forty-three female patients were included in this prospective observational study with age range from 25 to 70 year. They presented with POP and voiding dysfunction. They were evaluated by dynamic pelvic MRI at our institute. The MRI examination was done using superconducting magnet 1.5 tesla with surface body coil. The patient was positioned supine in the magnet. Then dynamic fast images were obtained using single shot T2 - weighted sequence in the sagittal plane in sequential images during voluntary strain. The images were analyzed by drawing the following lines: Pubo-coccygeal line [PCL]: as a reference line, H line and M line. Extent of POP by MRI was measured by the vertical distance from the PCL to the most inferior portion of the bladder base, cervix or vaginal vault and ano-rectal junction. A total of 43 female patients were included with mean age 42.8 +/- 9.8 years and mean parity of 5[range 0-10]. History of previous pelvic floor repair was reported in 8 patients and vaginal hysterectomy in 2 patients. Stress urinary incontinence was the most presenting symptom [69.8%] followed by constipation [60.5%] and heaviness in the pelvis [53.5%]. MRI depicted cystocele in 40 patients with a mean urinary bladder base descent below PCL by 2.80 +/- 1.9cm. Uterine-cervical descent was detected by MRI in 31 patients with mean descent below PCL 1.99 +/- 1.8cm as well as vaginal vault prolapse in 2 patients with descent of vaginal vault below PCL by 1cm. MRI depicted Excessive ano-rectal descent in 40 patients with mean 4.04 +/- 1.2cm, anterior rectocele in 43 patients and enterocele in 21 patients. All patients have pelvic floor relaxation with mean H line [7.31 +/- 1.03cm] and mean M line [4.42 +/- 1.47cm]. Multi-compartment organ prolapse was found in all patients. MRI is a new non-invasive imaging modality for evaluation of POP with encouraging results especially in those with multi-compartment prolapse

Role of endorectal ultrasonography in staging of rectal cancer

This study included 50 patients of cancer rectum were admitted in the department of surgery, Assiute University Hospital in the period from February 2002 to June 2003. Their ages ranged from 15 to 80 and they were 56% males and 44% females the main symptoms were increasing alternation in bowel habits 30 patients [60%] and bleeding per rectum 20 patients [40%]. Adenocarcinoma was found to be the common histopathological type 48 cases [96%] while liposarcoma was found in 2 cases [4%]. Polypodial masses constituted about 56% of cases [28 patients] annular types were [24%] while ulcers were 20% of cases. In 84% of cases [42 patients] the lesions were within the lower thirds of the rectum. Concerning the depth of rectal wall invasion 36 of 50 cases were staged correctly by TRUS [72%], 8 cases were over staged [16%] and 6 cases were under staged [12%]. - The accuracy rate for each histological T stage PT[2] was 50% [7/14], PT[3] was 834.33% [20/24] and PT[4] was 75% [9/12]. - The accuracy for detecting lymph node involvement by TRUS was 68% and a sensitivity 60%.TRUS is inexpensive and easy to perform technique, Awareness of technical and anatomical factors that produce over or under-estimation allows more accurate tumour staging and thus facilitates management

Comparative study between magnetic resonance cholangiopancreatography MRCP and surgical results in evaluation of obstructive jaundice

Thirty patients with obstructive jaundice suspected clinically, 14 males and 16 females were admitted in the surgery department, Assiut University Hospital, in the period between September 1999 to September 2000. Their ages ranging from 5 to 70 years. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and MRCP. Twenty-three patients were operated upon. ERCP was done in three patients [as diagnostic, therapeutic and palliative], PTC and PTD [as diagnostic and palliative] was done in one patient. The last three patients were diagnosed by US and MRCP to have primary sclerosing cholangitis. MRCP images revealed surgical biliary obstruction in 27 cases with good quality images. It demonstrated the level of obstruction in all patients [27 cases were extrahepatic and 3 patients were intrahepatic] and diagnosed the causes of obstruction in 27 patients [13 cases were malignant, 7 were calcular, 3 primary sclerosing cholangitis, one benign stricture of common hepatic duct [CHD], one case benign stricture of common bile duct [CBD], one case stenosis of doudenal papilla and one case chronic pancreatitis]. In three patients there was distal obstruction of undetermined origin by MRCP. One patient had calcular obstructive jaundice by ERCP [false -ve] and in two patients no cause was found by surgical exploration. In this study, MRCP was found to be a helpful technique in children and also in malignant obstruction, where it enable to diagnose four early resectable cases [three with pancreatic head cancer and one patient with ampullary carcinoma]. The specificity of MRCP in this study was found to be 100%, the sensitivity 96%, the accuracy 96.5% and the success rate in diagnosis of biliary obstruction was 100%. It was concluded that, MRCP is evolving as a rapid, easy, accurate and noninvasive tool for evaluation of the pancreaticobiliary system in patients with various obstructing biliary conditions

Assessment of gastrointestinal lymphoma by abdominal computed tomography

To clear up the role of abdominal computed tomography [CT] as a non invasive technique in evaluation of the extent of intra abdominal disease in lymphoma patients and to determine its role in staging of gastrointestinal lymphoma. Eighty patients, already having lymphoma were selected in our study and referred from oncology, surgery and internal medicine department to radiology department from the period of June 1999 to June 2001. All patients underwent full clinical examination, laboratory investigation, routine chest X-ray, abdominal sonography and abdominal computed tomographic examination. Twenty patients [25 percent] were HD and the other sixty patients [75 percent] were NHL. Fourty eight were males [60 percent] and thirty-two were females [40 percent]. The patients age ranged from 5 years to 60 years in HD group and between 2 years to 60 years in NHL. From our study we found that CT is well tolerated, non invasive technique to detect the hidden lymph nodes, that are not routinely visualized by other modalities for example, retrocrural lymph nodes [40 percent in HD and 20 percent in NHD L] mesenteric L.Ns, splenic, renal and hepatic hilum lymph nodes as well as infiltration of the intestinal wall and adjacent structures. From our study we clarified that abdominal CT is a simple non invasive investigation, should be used routinely for staging, planning of therapy and follow up of lymphoma patients

Role of ct and mri examination for assessment of the paranasal sinuses malignant tumours

This study included 24 patients with pathologically proved malignant lesions involving the paranasal sinuses. All the 24 cases were examined by CT and 8 of them were examined by MRI. The maxillary sinuses were the commonest to be involved by malignant lesions, followed by the ethmoid sinuses. The most prevalent CT findings were soft tissue mass, sinus opacification and direct extension to the surrounding structures with bone destruction and/or erosion. Most of these lesions [15/24] showed homogenous enhancement after contrast media injection. MRI study showed hypo to isointensities in T1 and iso to hyperintensities in T2 weighted images in all the lesions and showed enhancement after gadolinium injection. The relative efficacy of MRI and CT in assessing the eight cases with malignant lesions revealed that MRI was superior in mapping tumor margins and CT was superior in demonstrating bony changes and calcifications. These information are important in determining treatment policy for such patients

Comparative study of computed tomography and water soluble myelography in lumbar disc lesions

The advent of computed tomography has revolutionized the radiological work-up of lumbar spine disorders. It is a simple non-invasive technique which is able to display the bony and soft tissue constituents of the lumbar spine. In this work, twenty patients with various disc lesions were selected. Each case was examined separately by CT and myelography. The results of both techniques were discussed and compared. CT was proved to be as accurate or slightly more higher, ideal and reliable method for demonstration and evaluation of intervertebral disc lesions, as myelography. Axial CT accuracy exceeds that of water soluble myelography in assessing disc herniation at L [5]-S [1] disc level, lateral disc herniation and study of levels distal to complete block to myelographic contrast column. Myelography is superior to CT in showing nerve root sleeves amputation