Diagnostic validity and reliability of BT-RADS in the management of recurrent high-grade glioma.

BACKGROUND AND PURPOSE: BT-RADS is a new framework system for reporting the treatment response of brain tumors. The aim of the study was to assess the diagnostic performance and reliability of the BT-RADS in predicting the recurrence of high-grade glioma (HGG). MATERIALS AND METHODS: This prospective single-center study recruited 81 cases with previously operated and pathologically proven HGG. The patients underwent baseline and follow-up contrast-enhanced MRI (CE-MRI). Two neuro-radiologists with ten years-experience in neuroimaging independently analyzed and interpreted the MRI images and assigned a BT-RADS category for each case. To assess the diagnostic accuracy of the BT-RADS for detecting recurrent HGG, the reference standard was the histopathology for BT-RADS categories 3 and 4, while neurological clinical examination and clinical follow up were used as a reference for BT-RADS categories 1 and 2. The inter-reader agreement was assessed using the Cohen's Kappa test. RESULTS: The study included 81 cases of HGG, of which 42 were recurrent and 39 were non-recurrent HGG cases based on the reference test. BT-RADS 3B was the best cutoff for predicting recurrent HGG with a sensitivity of 90.5 % to 92.9 %, specificity of 76.9 % to 84.6 %, and accuracy of 83.9 % to 88.9 %, based on both readers. The BT-RADS showed a substantial inter-reader agreement with a K of 0.710 (P = 0.001). CONCLUSIONS: The BT-RADS is a valid and reliable framework for predicting recurrent HGG. Moreover, BT-RADS can help neuro-oncologists make clinical decisions that can potentially improve the patient's outcome.

Total cholesterol/high-density lipoprotein cholesterol and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol as predictors of coronary artery calcification assessed by multidetector computed tomography coronary angiography.

BACKGROUND: Coronary artery calcification (CAC) is an important marker of total burden of coronary atherosclerosis. Furthermore, it is a measure of subclinical atherosclerotic disease that correlates well with the cardiovascular risk. The aim of our study was to determine the role of the different lipid parameters in prediction of calcification in coronary arteries using multidetector computed tomography (MDCT). METHODS: This study was conducted on 120 patients presenting to the clinic with typical or atypical chest pain or dyspnea on exertion, or equivocal stress test results along with standard cardiac risk factors; they all underwent computed tomography (CT) coronary angiography. A total calcium score was determined by summing individual lesion scores from each of our anatomic sites: left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). The amount of calcium present in the coronary arteries was scored according to Agatston score, and patients were divided into 2 groups based on absence (group I) and presence (group II) of CAC. Clinical characteristics, lipid ratios, and a full blood count were calculated and compared between both groups. RESULTS: Mean and standard deviation (SD) for age of group I was 52.4 ± 8.4 years, while that of group II was 53.7 ± 7.9 (P > 0.005). Patients in group II had a higher total cholesterol (TC), low-density lipoprotein (LDL), TC/high-density lipoprotein cholesterol (HDL-C) and LDL/HDL-C ratio, and lower HDL levels. TC/HDL ratio and LDL/HDL ratio were found to be good predictors of calcium using a regression analysis model. Finally, at a cut-off value of ≥ 3.108, LDL/HDL ratio showed a sensitivity of 58.8% and specificity of 84.6% in prediction of coronary calcium, while TC/HDL ratio ≥ 4.742 showed a sensitivity of 60.3% and specificity of 88.5%. CONCLUSION: Amongst the different lipid parameters, TC/HDL-C and LDL/HDL ratio were found to be good predictors of presence of CAC in coronary arteries.

Ángulo de bifurcación corregido versus ángulo de bifurcación distal para la predicción de la rama lateral. Compromiso después de la bifurcación provisional Intervención Coronaria / Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Provisional bifurcation percutaneous coronary intervention (PCI) is recommended over two stent strategy but with the risk of side branch (SB) compromise. Prediction SB compromise is crucial for optimizing of the procedure outcome. Neglecting the proximal bifurcation angle (BA), the distal BA was presented as a reliable predictor of SB compromise supposing that the main vessel is always a straight vessel. However, its impact on the fate of side branch is debated. This study aims to compare between of the corrected BA, the sum of proximal and distal BAs, and the distal BA in terms of prediction of SB compromise. This prospective cohort study was conducted in Zagazig university hospitals in the duration between March 2019 and March 2020, and involved 185 patients who underwent provisional bifurcation PCI. Patients were divided according to the corrected BA into two groups; straight bifurcation model group which involved 73 patients with corrected BA = 180º, and wide bifurcation model group which involved 112 patients with corrected BA > 180 º. Compared to the wide bifurcation model, the incidence of SB compromise was substantially higher in the straight bifurcation model (52.1% vs. 15.2%; P < 0.001). The corrected BA had a better area under the curve compared to the distal BA with statistically significant difference (0.711 vs. 0.580; P = 0.023). Multivariate analysis demonstrated that the corrected BA was among the independent predictors of SB compromise. The study concluded that the corrected BA could be a novel strong predictor of SB compromise after provisional bifurcation PCI for future verification.

The Predictive Value of Multidetector High Resolution Computed Tomography in Evaluation of Suspected Sputum Smear Negative Active Pulmonary Tuberculosis in Egyptian Zagazig University Hospital Patients.

The aim of this work is to study the usage of multi-detector HRCT chest in diagnosing pulmonary TB cases whose sputum smears are negative and making a correlation between their CT features and their sputum culture results. This study was carried out from December 2014 to December 2016 at Zagazig university hospitals, Radiodiagnosis department. It included 150 patients. Their ages ranged between 10 to 70 years with a mean age 40 years. They were referred from the outpatient respiratory medicine clinic of the hospital. All patients had been presented clinically with suspicion of PTB. Their clinical features and HRCT findings were investigated to predict the risk for PTB. We then designed provisional HRCT diagnostic criteria based on the results to rank the risk of PTB. A positive tuberculin skin test alone among clinical laboratory findings was significantly associated with an increase of risk of PTB. Centrilobular nodules, large nodules, tree-in-bud appearance and the main lesion being located in S1, S2, and S6 lung segments were significantly associated with an increased risk of PTB. At HRCT 40 out of 44 patients with class III ranking showed active pulmonary TB. 12 out of 51 patients presented with class II ranking and 8 out of 40 were ranked as class I. The sensitivity, specificity and positive likelihood ratio of class I ranking HRCT criteria to diagnose active pulmonary TB were 95%, 40% and 1.4, respectively. Class II ranking results were 85%, 72%, 3, respectively. Finally class III ranking results were 45%, 90%, 11.5, respectively. Cases suspected of having active pulmonary TB whose smears are negative can benefit from MD HRCT chest findings to predict those patients of high risk with good reproducibility.