ABSTRACT
PURPOSE: To estimate the role of patient preparation using castor oil on the ADC value of focal liver lesion. PATIENTS AND METHODS: Retrospective case-control study over more than two years. Magnetic resonance imaging (MRI) scan, including diffusion-weighted imaging (DWI) of the upper abdomen performed for 87 cases and 71 controls in patients with focal hepatic hemangiomas. Cases were prepared using castor oil prior to the scan without identifiable unwanted effect, while controls did not receive any special preparation. Since liver hemangioma is a common lesion, it was selected and used as a sample. Apparent Diffusion Coefficient (ADC) values of focal liver lesion were calculated in cases and controls. RESULTS: The mean ADC value of liver hemangioma was lower in cases compared to controls; the mean ADC value was (2.21±0.39x10-3mm2/s) in cases and (2.51±0.49x10-3mm2/s) in controls. Left lobes were more affected by lesions; the mean ADC value of the left lobe lesions was (2.26±0.37 x10-3mm2/s) and (2.86±0.43 x10-3mm2/s) in cases and controls, respectively. The ADC value of lesions in the right lobe was (2.19±0.39x10-3mm2/s) in cases and (2.39± 0.45x10-3mm2/s) in controls. There was a significant segmental ADC variation; lesions at segments II, III, IVb, and V demonstrated illusive ADC elevation in controls. CONCLUSION: There is erroneous elevation of lobar and segmental ADC value of liver hemangiomas in non prepared patients. This Potential source of error (peristalsis, partial volume, and paramagnetic gas effect of gastrointestinal tract) on hepatic lesions' ADC value can be avoided by proper preparation using castor oil prior to MRI scanning.
ABSTRACT
BACKGROUND: Management of the ischemic diabetic foot (DF) due to infrapopliteal arterial disease is challenging and controversial. Observation, bypass surgery, and endovascular intervention are the 3 available options. Outcome of percutaneous transluminal angioplasty (PTA) versus conservative therapy is evaluated in this prospective study from Sulaymaniyah, Iraq. METHODS: Over 2 years starting at January 2018, 40 patients with ischemic DF underwent PTA and compared with a control group (n = 78) of ischemic DF managed conservatively. Besides clinical assessment, all patients underwent Doppler ultrasonography and computed tomography angiography while conventional angiography was reserved for PTA group. Patients who fulfilled the standard angiographic findings underwent standard PTA, and their outcome was compared with the control group. RESULTS: Mean age was 64 years; 70% (n = 28) were men with a male: female ratio of 2.3: 1. Renal function was impaired in (n = 11, 27.5%), and 7 (17.5%) patients were smokers. The commonest clinical presentation was nonhealing ulcers (n = 39, 97.5%), and most patients (n = 39, 97.5%) had Fontaine IV and Rutherford V-VI grades. Most lesions were anatomically complex; Trans-Atlantic Inter-Society Consensus C and D types, Graziani class ≥4 (75%), long segment (n = 28, 70%), and chronic total occlusion (n = 26, 65%). Success rate was (n = 38, 95%), and no patient died. Ulcer healing was higher (67.5% vs. 34.6%), and ulcer recurrence was lower (20% vs. 47.4%) in PTA group but amputation rate was not significantly different (12.5% vs. 12.8%) (P < 0.05). CONCLUSIONS: Although amputation and death rates were not significantly different, endovascular intervention achieved better ulcer healing in ischemic DF compared with the conservative approach.
