Tuberculous versus pyogenic spondylodiscitis: MR imaging evaluation

Infective spondylitis is a condition that involves one or more of the components of the spinal column. MRI represents a major advance in the examination of the spine because of the direct multiplanar capabilities, increased tissue contrast and improved resolution without the need of iodinated contrast or ionizing radiation. The aim of this study was to evaluate the role of MRI in the diagnosis of Spondylodiscitis and in the differentiation between tuberculous and pyogenic Spondylodiscitis. This study included 23 patients, 10 males and 13 females with age ranging from 19 to 75 years and a mean age of 42.3 years. These patients were subjected to complete clinical and neurological examination, laboratory investigations and MR imaging. T1 WIs and T2 WIs were obtained for all patients and Diffusion study was done in 18 patients. Post contrast [Gd-DTPA] TlWIs in at least two orthogonal planes was also obtained. Patients in this study were divided into pyogenic Spondylodiscitis [16 cases] and tuberculous Spondylodiscitis [7 cases]. MR imaging was an ideal method for evaluating infections of the spine and it is extremely sensitive in detecting and delineating the actual extent of these lesions. Characteristic magnetic resonance findings included destructive lesions involving 2 adjacent vertebrae and the intervening disk, low intensity changes in bone and disc were seen on Tl-weighted images, whereas high intensity changes were seen in those structures on T2-weighted images. Intravenous injection of Gd-DTPA shows enhancement of the involved structures. Paravertebral infection, collections under the posterior longitudinal ligament, and epidural abscesses were also seen in this study. MR imaging is sensitive in diagnosing Spondylodiscitis, demonstrating actual extent of the inflammatory process and in differentiation between pyogenic and tuberculous Spondylodiscitis in most cases

role of MRCP in the diagnosis of malignant biliary obstruction

The clinical value of using MRCP is similar to that of diagnostic direct cholangiopancreaticography and in most instances; MRCP will gradually replace direct cholangiopancreaticography and provide an efficient alternative when diagnostic ERCP or PTC is unsuccessful or inadequate. The aim of this study is to evaluate the role of MRCP as a non invasive technique in the diagnosis of malignant biliary obstruction. This study was conducted on 22 patients, 13 males and 9 females and their age ranged between 22 and 70 years with a mean age of 44.6 years. All patients were subjected to: complete clinical examination, laboratory investigations and radiological investigations including MRCP. MRCP as well as complementary axial and coronal T2 W MR images were performed to make prospective diagnosis in 22 patients with suspected pancreatico-biliary tumors. MRCP was performed using, breath- hold 2D singleslice FSE and non breath- hold multi-slice acquisition followed by 3D MIP reconstruction. Patients in this study included 13 cases of cholangiocarcinoma, 3 cases of hepatocellular carcinoma [HCC] causing biliary obstruction, 3 cases of pancreatic head carcinoma, 2 cases of periampullary carcinoma and one case of portahepatis lymphadenopathy causing biliary obstruction. The accuracy of MRCP as well as axial and coronal T2W MR images in diagnosing patients with pancreaticobiliary tumors was [100%]. MRCP could detect level of biliary obstruction which was intrahepatic, hilar, extrahepatic or periampullary. MRCP could also assess degree of proximal biliary ductal dilatation. MRCP as well as complementary axial and coronal T2 WI could define organ of tumor origin and extent of invasion of the malignant lesion. MRCP as well as complementary axial and coronal T2 W MR images are considered a non invasive accurate method in the diagnosis of pancreaticobiliary tumors and in assessing the level of biliary obstruction, degree of biliary ductal dilatation, organ of tumor origin and the extent of tumor invasion

Prediction of hypoxic-ischemic brain damage in full-term neonates with acute encephalopathy, using two different brain proteins, electroencephalogram and magnetic resonance imaging

The Objective of this study was to evaluate the usefulness of serum levels of two different brain proteins; Neuron specific enolase [NSE] and Creatinine brain specific kinase [CK-BB], electroencephalography [EEC], Conventional MRI imaging and diffusion-weighted MR imaging [DWMRI] for the early diagnosis of ischemic brain injury and prediction of hypoxic brain damage. A total of 30 term newborns were included in this study, 20 with neonatal encephalopathy and 10 normal cases. Clinical evaluation of neonatal condition and neurological outcomes was done. Serum estimation of NSE and CK-BB was done at 0, 12 and 24 hours after admission. Electroencephalography [EEC] was done at a median date of 1.17 days. Magnetic resonance imaging [MRI] both conventional and diffusion weighted were also done. EEC and MRI were done for the study group cases. The Apgar score at 2 minutes has highest specificity with a good negative predictive value of severe brain injury. Arterial blood base deficit have the highest sensitivity and highest negative predictive values. The highest significance was evident at 12 hours values of both NSE and CK-BB. A combination of NSE at 12 h with arterial blood pH [cutoff value, <6.9] or arterial blood base deficit [cutoff value, >17 mM/L] increased the positive predictive value and specificity. Bad outcomes as severe degree or death are usually associated with severe findings of both diffusion weighted MRI and background trace of EEG. The early EEG changes distinguish between those infants with a normal or abnormal outcome. MRI gives more specific information about the type and severity of brain lesion. The 12 hour values of NSE and CK-BB have a good predictive power either alone or combined with other clinical tests or investigations. This early determination is becoming increasingly important with the advent of hypothermia and other potential neuroprotective therapies for the treatment of HI brain injury in the asphyxiated newborn

Appendicitis: diagnostic accuracy and limitations of sonography with technical considerations

Two hundred and thirty patients with clinically suspected appendicitis were evaluated prospectively with ultrasonography. Sonographic results were correlated with the final diagnosis established by surgery and pathological diagnosis in 95 cases and clinical follow up in the remainder of cases. Patients with difficult Sonographic examination due to poor preparation, pregnancy or obesity were rescanned with special technical considerations. Accuracy was 97%, specificity 99% and sensitivity 93%