Role of MRI diffusion tensor imaging in assessment of normal appearing white matter in cases of multiple sclerosis

Background: Multiple sclerosis [MS] is an inflammatory demyelinating condition of the central nervous system [CNS] that is generally considered to be autoimmune in nature. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord. Several methods have been proposed, mainly using conventional MR modalities like T1, FLAIR or T2 images and enhanced MRI to delineate lesions. Conventional MR techniques cannot give detailed information about the integrity and location of WM tracts. Diffusion MRI is one of the non-conventional MRI techniques used for assessment of multiple sclerosis. The emergence of diffusion tensor imaging [DTI] is of great interest in MS. DTI probe the details of water diffusion within tissues, and could therefore reveal alterations in normal appearing white matter fibers before being visible in conventional MRI. Fractional anisotropy [FA], is the measure of the portion of the diffusion tensor that results from anisotropy [i.e, a measure of the directionality of the molecular motion of water]

Purpose: to evaluate the role of diffusion tensor imaging [DTI] in the examination of the brain white matter that shows normal appearance on conventional MRI sequences in patients with MS, thus assessing its ability to detect early abnormalities at diffusion level

Methods: the study included 50 patients; 38 females and 12 males having MS [between 20 and 40 years of age] referred from Neurologists to Radiodiagnosis Department with 10 ages' matched healthy control volunteers. Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Tensor imaging. Technique was performed using a standard 3 Tesla unit [Acheiva, Philips]

Results: the study showed that DTI can reveal normal appearing white matter affection in MS cases before visible sizable plaques can be detected by conventional MRI

Conclusion: the current application of diffusion MRI to patients with MS shows that it has enhanced our understanding of the disease pathophysiology. The study reviewed here provides evidence that DTI-derived measures are more specific to the disease pathological processes and sensitive to the diffuse microscopic injury in the NAWM

Measurement of uterine leiomyomata volume pre and post uterine artery embolization aided by MRI

Background: uterine fibroid embolization [UFE] is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short and midterm outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures

Aim of the Work: t this study aimed to review and illustrate the role of MR imaging in the pre- and post-procedural assessment for uterine fibroid patients undergoing uterine artery embolization

Patients and Methods: the current study was carried out in Radiodiagnosis Department, Faculty of Medicine, Ain shams University and specialized private radiology centers during the period between April 2017 and December 2017. It included 30 patients that were referred from gynecology clinic with their ultrasonographic reports to Radiodiagnosis Department, body imaging unit with a view to carry-out pelvic MRI with contrast

Results: imaging follow-up via pelvic MRI with contrast was obtained in 30 patients at 3, 6 months after treatment. The mean uterine volume was reduced by 25% [standard deviation was SD 0.03763] 3 months after treatment and was further reduced by a mean of 30% [SD 0.02638] by six months after treatment. Post-procedural subtraction MRI revealed mean myoma enhancement to be 5.6 + 0.5 SI in contrast to 133.4 + 18.3 SI prior to UFE. The mean dominant fibroid volume reduced by 34 % [SD 0.09247] after 3 months, 44 % [SD 0.05994] after 6 months. A cumulative reduction in both uterine and dominant leiomyoma mean volume from baseline to 6 months post - UAE was evident with significant interval changes between 3, 6 months follow up [p 0.000]

Conclusion: the MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities was typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE

Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work

Transverse comparisons between ultrasound and radionuclide parameters in children with pelvi-ureteric junction obstruction

Pelvi-ureteric junction [PUJ] obstruction is one of the causes of an obstructive uropathy which may be congenital or acquired. Ureteropelvic junction [UPJ] obstruction is a blockage at the point where ureters attaches to the bladder. This blocks the flow of urine out of the kidney, Urine can build up and damage the kidney, so radiologic imaging is crucial in diagnosing UPJ obstruction. It seemed therefore interesting to determine if some US parameters could predict the radionuclide parameters and which ultrasound parameter most influencing the kidney function. The initial step was to grade the severity of hydronephrosis, calyceal dilatation and cortical thinning, although it was easy for us to classify the importance of hydronephrosis in three groups according to anteroposterior diameter [APD]. AP diameter of renal pelvis and differential renal function were the most effective parameters for surgical decision. These parameters can be used for appropriate management of antenatal hydronephrosis