Image Exchange in the Middle East: a Survey.

Developing an enterprise approach to imaging technology rather than a radiology focus has recently increased. The communicator needs to be aware of this shift.The Middle East countries participated in the survey have confirmed the following major benefits of Medical Image Exchange: ✔ Fast access to both image and report ✔ Enable tele-services for second opinion, consulting and reporting ✔ Improve patient journey, workflow and diagnosis ✔ Allowed more patient engagement to be in place The Middle East countries that participated in this survey have agreed on the following shared challenges regarding Medical Imaging Exchange: ✔ Lack of enterprise imaging governance at the early stage of implementation. It will organize the who, when, and how. In addition, any fees and or payment involved for physicians ✔ Infrastructure availability to handle such large volume of data. Growing from mega-byte to petabyte per year is challenge for infrastructure. Cloud against On Premises-Installation implementation model ✔ Interoperability and integration to connect multi specialties from different systems. In addition, how far existing systems are ready for that. A standard-based framework is mature for image exchange, but what follows for other domains? There is a need to move beyond radiology images so as to include images from pathology, ophthalmology, and dermatology There are other countries in the region requiring guidance, support, and funding to move forward from the compact disc into internet-based interoperable image exchange. This should be considered part of the World Health Organization and the United Nation development to the region in the healthcare sector.

Feasibility of Distal Mechanical Thrombectomy in M3, A3 and P3 Segments via a 0.013-inch Delivery System: Preliminary Experience.

AIM: To assess the safety and efficacy of distal thrombectomy (DT) using a Catch View mini (CVm) device via a microcatheter with a 0.013-inch inner diameter. MATERIAL AND METHODS: Nine of 246 acute ischemic stroke patients who underwent mechanical thrombectomy developed distal emboli and were included in the study. In all nine subjects (mean age, 64.5 ± 11.6; range, 39?77 years), a combination of CVm and a 0.013-inch microcatheter was used in distal mechanical thrombectomy. Modified Thrombolysis in Cerebral Ischemia scores of 2c and 3 were considered to indicate successful recanalization, and patients with a Modified Rankin Score of ? 2 on the 90th day were considered to have good clinical outcomes. RESULTS: Eleven DT maneuvers were performed using the same stent retriever and microcatheter. The mean National Institutes of Health Stroke Scale score was 13 ± 3.4. Thrombectomy was performed from M3 in six patients, A3 in four, and P3 in one. Successful recanalization was achieved in all of the procedures. The rate of good clinical outcome was 55.5%. CONCLUSION: Advances in technology in the endovascular field enable access to more distal vessels in acute ischemic stroke. As the profile of the instruments used during access decreases, the risk of complications may decrease. The CVm stent retriever could become a useful tool in DT based on its compatibility with a 0.013-inch lumen delivery system.

Comparison of Two Different Methods of Fine Needle Aspiration Biopsy and Histopathology for Thyroid Nodules.

OBJECTIVE:  Two different methods for fine needle aspiration biopsy (FNAB) of thyroid nodules (multi-pass conventional smear, MPCS; single-pass liquid-based cytology, SPLBC) were evaluated regarding the magnitude of nondiagnostic/unsatisfactory sampling ratio, and basic demographic and ultrasonographic (USG) factors to predict such outcome. METHODS:  One thousand FNAB patients were retrospectively assessed. Of them, 517 nodules were evaluated with the conventional smear method, and the rest were evaluated with liquid-based cytology method using the Bethesda System for Reporting Thyroid Cytopathology. FNAB technique had certain procedural differences for both pathological methods. For conventional smear, a modified "needle-only" technique with three independent passes was performed, whereas a single pass was used for liquid-based cytology. The reduction of nondiagnostic/unsatisfactory results constituted the basis of this study. Pathological results, therefore, were subgrouped under "nondiagnostic/unsatisfactory" (Category I), "benign" (Category II), and "atypia/neoplasia/malignancy" (Category III-VI). RESULTS:  Both FNAB groups were not statistically different or only slightly different regarding size (P = 0.196), echogenicity (P = 0.014), and the presence of echogenic foci (P = 0.11), therefore considered to have equal USG properties. In MPCS method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 24%. Other cytological results were as follows: Category II (67.1%), Category III-VI (8.8%). In SPLBC method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 14.5%. Other cytological results were as follows: Category II (77.6%), Category III-VI (7.8%). A significant difference was found between two sampling methods regarding pathological results (Independent samples t-test, P < 0.0001). The demographic and USG factors, considered in this study, did not offer a successful prediction of nondiagnostic/unsatisfactory outcomes. CONCLUSION:  SPLBC has significantly lower (14.5% vs 24%) nondiagnostic rate than MPCS, and higher 77.6% vs 67.1%) Category II rate than MPCS. This may point to the possibility that MPCS method undercategorizes many benign (i.e., Category II) nodules under nondiagnostic/unsatisfactory category. The success of the former is due to the elimination of confounding material during the process. Single pass, also, increases patient comfort and compliance, and has additional advantages for the interventionalist, as it obviates the need to smear aspirates. This dramatically decreases the actual duration of the biopsy procedure and is free of interventionalist expertise for smearing.

Increased membrane turnover in the brain in cutaneous anthrax without central nervous system disorder: a magnetic resonance spectroscopy study.

Cutaneous anthrax, caused by Bacillus anthracis contacting the skin, is the most common form of human anthrax. Recent studies implicate the presence of additional, possibly toxin-related subtle changes, even in patients without neurological or radiological findings. In this study, the presence of subtle changes in cutaneous anthrax was investigated at the metabolite level using magnetic resonance spectroscopy. Study subjects were consisted of 10 patients with cutaneous anthrax without co-morbid disease and/or neurological findings, and 13 healthy controls. There were no statistical differences in age and gender between two groups. The diagnosis of cutaneous anthrax was based on medical history, presence of a typical cutaneous lesion, large gram positive bacilli on gram staining and/or positive culture for B. anthracis from cutaneous samples. Brain magnetic resonance imaging examination consisted of conventional imaging and single-voxel magnetic resonance spectroscopy. Magnetic resonance spectroscopy was performed by using point-resolved spectroscopy sequence (TR: 2000ms, TE: 136ms, 128 averages). Voxels of 20mm×20mm×20mm were placed in normal-appearing parietal white matter to detect metabolite levels. Cerebral metabolite peaks were measured in normal appearing parietal white matter. N-acetyl aspartate/creatine and choline/creatine ratios were calculated using standard analytical procedures. Patients and controls were not statistically different regarding parietal white matter N-acetyl aspartate/creatine ratios (p=0.902), a finding that implicates the conservation of neuronal and axonal integrity and neuronal functions. However, choline/creatine ratios were significantly higher in patient groups (p=0.001), a finding implicating an increased membrane turnover. In conclusion, these two findings point to a possibly anthrax toxins-related subtle inflammatory reaction of the central nervous system at the cellular level.

Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus.

The aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM). Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated. Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2-DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (A1C>10%). A1C levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios. T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with A1C levels and, in some, extend with insulin resistance.

1H magnetic resonance spectroscopy of the normal testis: preliminary findings.

PURPOSE: The purpose of this study was to determine the pre- and postpubertal 1H magnetic resonance spectroscopic characteristics of the normal testis to establish baseline values for further clinical studies. MATERIALS AND METHODS: The subjects consisted of male volunteers, of whom 19 were prepubertal with ages between 7 and 13 years and 24 were postpubertal with ages between 19 and 39 years. Their testes were evaluated at 1.5 T with magnetic resonance spectroscopy; in addition, testis volumes were measured. Major metabolite peaks were identified and their ratios were calculated. Metabolite differences of testis between pre- and postpubertal age were analyzed. RESULTS: Major constituents of spectra were 3.21 ppm choline and 0.9-1.3 ppm lipid peaks. At the echo time (TE) spectrum of 31 ms, choline/lipid ratios ranged from 0.35 to 8.30 (mean=1.87) in postpubertal males and from 0.06 to 5.45 (mean=0.88) in prepubertal males (P<.013). At the TE spectrum of 136 ms, choline/lipid ratios ranged from 0.66 to 15.42 (mean=4.09) in postpubertal males and from 0.05 to 4.91 (mean=0.9) in prepubertal males (P<.016). CONCLUSIONS: Choline/lipid ratio was higher in the postpubertal period. The existence of higher choline peak in that age group should be due to the initiation of spermatogenesis. The decrease in the lipid peak may represent the effect of testosterone on testicular tissue or may be due to histochemical changes initiated by puberty. The significant decrease in choline/lipid ratio noted after puberty could represent the presence of spermatogenesis. This hypothesis should be evaluated by further studies on postpubertal subjects with impaired spermatogenesis.

Spontaneous intracranial hypotension with pituitary adenoma.

Spontaneous intracranial hypotension (SIH) is an unusual syndrome that is characterised by positional headache, neck rigidity, nausea and vomiting. The characteristic magnetic resonance imaging (MRI) findings are diffuse smooth pachymeningeal thickening and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. An unusual case of SIH with pituitary macro-adenoma and subsequent subdural haemorrhage is presented, and its clinical picture, MRI findings and possible pathophysiological mechanism are discussed.

Evaluation of tumor angiogenesis with contrast-enhanced dynamic magnetic resonance mammography.

The goal of this research was to correlate dynamic magnetic resonance (MR) mammographic contrast enhancement and microvessel densities in breast masses. Forty-six female patients with breast masses detected by mammography and/or ultrasonography were included in the study. MR contrast enhancements of the lesions were investigated dynamically using axial three-dimensional fast low-angle shot sequences. After excisional biopsy or mastectomy, immunohistochemical staining with factor VIII-RA was performed, followed by microvessel density measurements. Contrast enhancement patterns in dynamic MR mammography were compared with microvessel density measurements using Student's t-test, Pearson's moment correlation coefficients, and one-way analysis of variance (ANOVA). Malignant lesions exhibited three different enhancement patterns: 1) a peak enhancement within 120 seconds (early phase), followed by a decrease in the delayed phase (25 cases); 2) an increase in the early phase, followed by a plateau in the delayed phase (9 cases); and 3) an increase throughout the examination without any peak (5 cases). In benign lesions, signal intensity did not exhibited a peak in five cases, whereas in two cases enhancement was increased in the early phase and made a plateau in the delayed phase. A significant correlation was found between microvessel density and the percentage of maximal signal increase following paramagnetic contrast administration (r=0.322, p<0.05). Dynamic enhancement patterns and rates of maximal signal increase predict microvessel density in breast malignancies and may possibly be used as prognostic indicators.