Repeat transcranial Doppler ultrasound imaging in Kuwaiti children with sickle cell disease after a 10-year interval: A prospective, cohort study.

Objectives: Transcranial Doppler imaging (TCDI) of the cerebral arteries is the method of choice to predict patients with sickle cell disease (SCD) at risk for stroke. This study reports TCDI follow-up of cerebral blood flow in a cohort of Kuwaiti children with SCD after a 10-year interval. Methods: Twenty-one pediatric patients with SCD, aged 16.0 ± 1.6 years were initially studied when they were aged 6.5 ± 1.2 years. TCDI scanning was carried out using a phased-array transducer of 1-3 MHz through the trans-temporal window. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged mean of the maximum velocity (TAMMV), resistive index (RI), and pulsatility index (PI) were obtained in the anterior and posterior Circle of Willis vessels. Results: The follow-up indices were mostly lower than in the initial study although they remained within the normal range in all the arteries. TAMMV was less than 170 cm/s, and PSV did not exceed 200 cm/s in all vessels. The initial and follow-up TAMMV (mean ± SD) were: 77.3 ± 20.9 and 71.6 ± 9.9 in the terminal internal carotid artery, 94.3 ± 25.8 and 82 ± 18.2 in the middle cerebral artery, 76.6 ± 25.6 and 70.6 ± 10.7 in the anterior cerebral artery, and 59.1 ± 15.8 and 63.9 ± 8.5 in the posterior cerebral artery, respectively. The mean differences between the old and follow-up data for RI, and PI were statistically significant (p < 0.05). Conclusions: Kuwaiti patients with SCD appear to be largely protected from cerebral artery vasculopathy in childhood.

Comparison of radiation doses between diagnostic full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT): a clinical study.

INTRODUCTION: There are increasing concerns about radiation exposure among women who undergo full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT). The main aim of this study was to compare the entrance surface dose (ESD) and average glandular dose (AGD) from FFDM and DBT for different breast thicknesses. METHODS: The ESD and AGD for FFDM in craniocaudal, mediolateral oblique and DBT in craniocaudal projection were recorded from a GE Senographe Essential FFDM unit. The accuracy of the ESD and AGD from the FFDM unit was verified during regular quality assurance programme. Patients were categorised according to their compressed breast thicknesses. X-ray tube potential and target filter combinations were varied with ESD and AGD recorded directly from the FFDM unit. The non-parametric Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were performed. RESULTS: The median and interquartile range (IQR) age of the patients were 48 and 11 years, respectively. The highest median for ESD and median total AGD for different breast thicknesses were ranged from 3.3 to 9.1 mGy and 3.3 to 6.0 mGy, respectively, for two-view FFDM. However, it ranged from 3.1 to 8.9 mGy and 1.8 to 4.0 mGy, respectively, for single-view DBT. Both ESD and AGD were significantly lower for DBT (P < 0.001) compared with FFDM. There was a significant difference (P = 0.001) in the ESD and AGD values for different breast thicknesses in FFDM and DBT techniques. CONCLUSIONS: The AGD for a single-view DBT was lower than the two-view FFDM technique.

Pattern of Renal Blood Flow and Renovascular Parameters in Adult Patients With Sickle Cell Disease.

OBJECTIVES: To evaluate renal blood flow patterns and renovascular parameters in adult patients with sickle cell disease (SCD) without laboratory evidence of renal impairment. METHODS: Sixty-five steady-state adult patients with SCD (50 hemoglobin SS [HbSS], 12 HbSß0 , and 3 HbSD) and 30 age- and sex-matched healthy controls were studied. The kidney length, echo pattern, peak systolic velocity (PSV), end-diastolic velocity, renal-to-aortic ratio, resistive index (RI), acceleration time (AT), and renal vein velocity were acquired, recorded, and analyzed with a 1-5-MHz curvilinear transducer through the abdomen. RESULTS: The mean age ± SD of the patients with SCD was 32.89 ± 13.89 years. The highest means for the ultrasound-measured renal length and cortical thickness in the SCD and control groups were 11.78 ± 1.30 and 11.27 ± 0.77 cm and 1.86 ± 0.41 and 1.78 ± 0.28 cm, respectively. The figures were significantly higher in the SCD group than the control group (P < .05). Fifty-nine (90.8%) patients had a mild diffuse increase in cortical echogenicity with preserved renal cortical thickness. The highest mean extrarenal PSVs in the SCD and control groups were 138.46 ± 56.32 and 101.75 ± 31.48 cm/s (P < .05). However, the highest intrarenal RI and AT in SCD and control groups were 0.69 ± 0.07 and 0.06 ± 0.02 seconds and 0.63 ± 0.05 and 0.04 ± 0.01 seconds (P < .05). There was no significant correlation between the RI, AT, and PSV among the patients with SCD (P > .05). CONCLUSIONS: Increased renal length and cortical echogenicity with elevated PSV, RI, and AT values can serve as early ultrasound changes in adult patients with SCD without renal impairment.

Comparison of Digital Breast Tomosynthesis and Digital Mammography for Detection of Breast Cancer in Kuwaiti Women.

OBJECTIVE: To investigate the sensitivity and specificity of digital mammography (DM) and digital breast tomosynthesis (DBT) for the detection of breast cancer in comparison to histopathology findings. SUBJECTS AND METHODS: We included 65 breast lesions in 58 women, each detected by two diagnostic mammography techniques - DM and DBT using Senographe Essential (GE Healthcare, Buc, France) - and subsequently confirmed by histopathology. The Breast Imaging Reporting and Data System was used for characterizing the lesions. RESULTS: The average age of women was 48.3 years (range 26-81 years). There were 34 malignant and 31 benign breast lesions. The sensitivity of DM and DBT was 73.5 and 100%, respectively, while the specificity was 67.7 and 94%, respectively. Receiver operating characteristic curve analysis showed an overall diagnostic advantage of DBT over DM, with a significant difference between DBT and DM (p < 0.001). By performing Cohen's kappa test, we found that there was a strong level of agreement according to Altman guidelines between DBT and histopathology findings (0.97), but a weak agreement between DM and histopathology findings (0.47). CONCLUSION: DBT improves the clinical accuracy of mammography by increasing both sensitivity and specificity. We believe that this improvement is due to improved image visibility and quality. These results could be of interest to health care institutions as they may impact their decision on whether to upgrade to DBT not only for diagnosis, but also for screening.

Pattern of cerebral blood flow and the interrelationship of vascular parameters of transcranial Doppler imaging in children with sickle cell disease.

PURPOSE: We assessed the pattern of cerebral blood flow and the relationship between the different transcranial Doppler imaging (TCDI) vascular parameters in children with sickle cell disease (SCD). METHODS: Forty-three SCD pediatric patients with a stable condition (21 HbSS, 19 HbSß0 Thal, and 3 HbSD), aged 10.1 ± 3.9 years were studied. A control group of 26 with age and sex-matched, were included for comparison. TCDI scanning was carried out using a phased array transducer of 1-3 MHz through the trans-temporal window. Peak systolic velocity (PSV), end diastolic velocity (EDV), time-averaged mean of the maximum velocity (TAMxV), pulsatility index (PI), and resistive index (RI) were in the anterior circle of Willis vessels and posterior cerebral artery. RESULTS: The highest mean ± SD values for the middle cerebral artery PSV, EDV, TAMxV, PI, and RI were 130.30 + 26.5, 145.0 ± 21.9; 58.60 + 13.70, 67.90 ± 13.3; 84.90 + 14.50, 94.80 ± 17.9; 0.95 + 0.20, 0.80 ± 0.20; 0.58 + 0.09, 0.50 ± 0.10 in the control and SCD groups, respectively. Independent t-test showed significant difference (P < .05) for all vascular parameters in all vessels in each side between both groups. There was a positive significant correlation between TAMxV, PSV, and EDV (P = .001, r = .96), and a negative significant correlation between TAMxV and PI in the SCD group (P = .001, r = -.46) but not in the control group (P > .05, r = -.62). CONCLUSIONS: There was a direct relationship between TAMxV and PSV and EDV, and an inverse relationship between TAMxV and PI in a group of SCD patients with normal TCDI values.

Diastolic versus systolic ankle-brachial pressure index using ultrasound imaging & automated oscillometric measurement in diabetic patients with calcified and non-calcified lower limb arteries.

BACKGROUND: Ankle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and therefore loses its value in this cohort of patients. We aim at investigating the feasibility of using the diastolic (ABI-d) instead of ABI-s to calculate the ABI in diabetic patients with calcified limb arteries. METHODS: A total of 51 patients were chosen from the diabetic foot clinic. Twenty six of these patients had calcified leg arteries by Duplex scan (Group A) and 25 patients did not have calcifications in their leg arteries (Group B). Twenty five healthy volunteers were enrolled in the study for group C and they were matched with other participants from group B and A in age and sex. ABI measurement was performed using "boso ABI-system 100 machine". Systolic ABI (ABI-s) and diastolic ABI (ABI-d) were calculated based on bilateral brachial and ankle oscillometric pressures. ABI is considered normal when it is ≥0.9. Repeated measures ANOVA test was used to test for comparing mean scores for ABI-s and ABI-d across the three groups. Statistical significance is considered when P < .05. RESULTS: The mean age of all participants (±SD) was 64.30 ± 7.1 years (range, 50-82 years). ABI-s mean ± SD was 1.3 ± 0.10 (range, 1.18-1.58) in group A patients, 1.07 ± 0.05 (range, 1-1.16) in group B patients, and 1.06 ± 0.05 (range, 1-1.16) in group C volunteers. While ABI-d mean ± SD was 1.07 ± 0.05 (range, 1.1-1.17) in group A patients, 1.06 ± 0.05 (1-1.14) in group B patients, and 1.05 ± 0.04 (range, 1.01-1.14) in group C volunteers. In group A, repeated measures ANOVA test showed statistical significant difference between ABI-s and ABI-d (P < 0.001) whereas in group B & C was not (P > 0.05). CONCLUSIONS: ABI-d may be helpful and can be used as a complementary measure instead of ABI-s in falsely elevated ABI caused by partial incompressible vessel.