Epilepsy cases: fMRI and MR tractography as qualitative and quantitative tools for proper localization and pre-operative planning

Functional MRI is a relatively new noninvasive brain imaging technique that has been used for neuroscience research applications since the early 1990s. This technique relies on the blood oxygenation level dependent [BOLD] effect. Diffusion tensor magnetic resonance imaging [DTI] is a noninvasive technique that can be used to assess the integrity of cerebral tissue. We evaluated 16 patients with unilateral MTLE. We did MRI for language and memory areas for localization and lateralization of the dominating cortical areas concerned with language and memory. Diffusion-weighted images along twelve different directions with a b value of 1000 s/mm2. A 1.5-T scanner was used to acquire those examinations. For DTI we compared the mean diffusivity [MD] and fractional anisotropy [FA] from symmetrical voxels by sampling the basal ganglia, thalamus, hippocampus and parahippocampus regions bilaterally. We compared measurements with the EEG, high-resolution MR imaging, as well as clinical data. For MR tractography, various tracts were traced including the Meyer's loop. Among the study group only 5 patients with partial epilepsy out of 16 are promising candidates for surgery representing only 31.25% among the study population 68.75% of our study population were excluded according to our quantitative and qualitative tools. Combined fMRI with MR tractography are valuable qualitative and quantitative tools for proper localization and lateralization of the eloquent areas including memory, language areas and Meyer's loop in the selection of promising epilepsy surgery candidates and for pre-operative planning

Acute large bowel obstruction: Is it mechanical or functional

The value of urgent contrast large bowel enema in the diagnosis and its impact on management of patients with acute large bowel obstruction has been tested. Twenty two patients were the subject of this study. Urgent contrast enema has been done in 13 patients. Correlation between clinical and radiological diagnosis revealed that differentiation between mechanical obstruction and pseudo obstruction can be difficult depending on clinical picture and plain X ray films. The clinical and plain radiological diagnosis was wrong in 22.5% of patients. On the other hand urgent contrast enema had a 100% accuracy. The importance of this investigation is to avoid unnesecessary operations in pseudo obstruction patients who are generally a high surgical risk

Computed tomography versus magnetic resonance imaging in the management of acute ischaemic stroke

To compare the appearance of acute infarets on CT versus MRI, 18 patients with acute ischaemic strokes were imaged by CT and MRI, both being performed within 3 days of the ictus. MRI and CT findings were equivocal in 4 cases. MRI showed acute infarets not detected on CT in 6 cases. MRI better delineated acute infarets than CT in 8 cases by showing that the cause of the stroke is a relatively large zone of infarct not just a lacune or a small zone in 3 cases, by showing acute infarets in more than one vascular territory when CT showed an infarct in only one vascular territory thus suggesting embolic disease in 2 cases, and by detecting a hemorrhagic component of the acute infarct not shown on CT in 3 cases. Our results confirm earlier reports that MRI better detects, delineates distribuion, extent, and components of acute infarets than CT thus providing information that affects patient's management. The impact of this on actual patient Management as well as future prospectives of MRI are discussed