Combined FDG PET/MRI versus Standard-of-Care Imaging in the Evaluation of Cardiac Sarcoidosis.

Purpose: To compare combined cardiac fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/MRI with standard-of-care evaluation using cardiac MRI, 18F-FDG PET/CT, and SPECT perfusion imaging in suspected cardiac sarcoidosis (CS) with respect to radiation dose, imaging duration, and diagnostic test performance. Materials and Methods: Consecutive patients with suspected CS undergoing clinical evaluation with cardiac 18F-FDG PET/CT and gated rest technetium 99m sestamibi SPECT perfusion imaging were prospectively recruited between November 2017 and May 2021 for parallel assessment with combined cardiac 18F-FDG PET/MRI on the same day (ClinicalTrials.gov identifier, NCT03356756). Total effective radiation dose and imaging duration were compared between approaches (combined cardiac PET/MRI vs separate cardiac MRI, PET/CT, and SPECT). MRI findings were initially interpreted without PET data, and then PET and late gadolinium enhancement images were fused and interpreted together. Final diagnosis of CS was established using Japanese Ministry of Health and Welfare guidelines. Results: Forty participants (mean age, 54 years ± 14 [SD]; 26 [65%] male participants) were included, 14 (35%) with a final diagnosis of CS. Compared with separate cardiac MRI, PET/CT, and SPECT perfusion imaging, combined cardiac PET/MRI had 52% lower total radiation dose (8.0 mSv ± 1.2 vs 16.8 mSv ± 1.6, P < .001) and 43% lower total imaging duration (122 minutes ± 15 vs 214 minutes ± 26, P < .001). Combined PET/MRI had the highest area under the curve for diagnosis of CS (0.84) with 96% specificity and 71% sensitivity for colocalized FDG uptake and late gadolinium enhancement in a pattern typical for CS. Conclusion: In the evaluation of suspected CS, combined cardiac 18F-FDG PET/MRI had a lower radiation dose, shorter imaging duration, and higher diagnostic performance compared with standard-of-care imaging.Clinical trial registration no. NCT03356756Keywords: Cardiac Sarcoidosis, 18F-FDG PET/MRI, 18F-FDG PET/CT, SPECT Perfusion Imaging, Cardiac MRI, Standard-of-Care Imaging Supplemental material is available for this article. © RSNA, 2023.

Are Pediatric Residents in Saudi Arabia Equipped to Provide Breastfeeding Care? A Cross-Sectional Study.

Background: There is a progressive reduction in breastfeeding rates in Saudi Arabia. Counseling and support from health-care providers are useful in overcoming barriers to continuing breastfeeding. However, medical education and residency programs often do not adequately provide breastfeeding training. Objective: To determine the knowledge, comfort level, perception, and clinical practices of pediatric residents regarding breastfeeding in Saudi Arabia and to measure the level and type of education received during their residency training. Materials and Methods: This cross-sectional study included pediatric residents from across Saudi Arabia who were registered with the Saudi Commission for Health Sciences and was conducted from February 2021 to January 2022. A validated self-reported questionnaire was used to elicit information from the respondents. Knowledge score was calculated as a percentage of correct answers. Results: A total of 253 residents completed the survey. The mean knowledge score was 58.4% ± 22.7%, which was lower than the cut-off threshold of good knowledge. Almost half of the residents (49.4%) were confident about addressing breastfeeding-related concerns. Although nearly all residents (91.7%) agreed that breastfeeding promotion is part of their role, 35% never or rarely met the mother before birth to discuss breastfeeding. Didactic teaching was the most prevalent educational tool during their training (34.3%); however, most residents preferred learning through interactive workshops (83.7%) and following lactation consultants (82.8%). Conclusion: Despite positive perceptions and confidence in providing breastfeeding care, pediatric residents in Saudi Arabia lack optimal knowledge of breastfeeding. These findings indicate the need for enhancing breastfeeding curricula in pediatric residency programs to improve breastfeeding consultation and management.

The Association of Maternal Height With Mode of Delivery and Fetal Birth Weight at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

STUDY OBJECTIVES: The aim of this study was to find if there is an association between maternal height and mode of delivery, as well as an association between maternal height and baby's weight as a secondary outcome. METHOD:  This retrospective record review was performed at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, including patients admitted between January 2016 to December 2017. All nulligravida with singleton term pregnancies who gave birth were included in this study. Pregnant women with planned elective cesarean section (CS) and incomplete records were excluded. The maternal demographic and clinical data (age, height, weight, hypertension, gestational diabetes (GDM), body mass index (BMI), smoking status, gestational age, regional analgesia during delivery, type of delivery, postpartum hemorrhage (PPH), and episiotomy), neonatal birth weight, and Apgar score were obtained from KAUH computerized records. Our primary outcome was the mode of delivery. The secondary outcome was the classification of neonatal weight into small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA). Maternal height was divided into seven groups. Descriptive statistics using mean and standard deviation were used for continuous variables. Frequencies and percentages were used for categorical variables. Student's t-test and chi-square tests were used to evaluate the differences between continuous and categorical variables. RESULT: A total of 1067 women were included in this study. Most were at 40 weeks of gestation age (14.9%) with a mean height of 156.4±6.2 cm. Of the total, 76.9% were spontaneous vaginal delivery without operative assistance, 15.9% were delivered via CS, and 7.2% delivered vaginally with the assistance of forceps or ventouse. The mean neonatal birth weight was 2994 ± 451 gms with most neonates (87.3%) having a birth weight between 2500 and 4000 gms. Most babies were of average weight for their gestational age at delivery. There was a significant negative association between maternal height with CS (p=0.017). Moreover, there was a correlation between maternal height and the baby's birth weight (p=0.01), and we found that for every 1 cm increase in women's height, the baby's weight increases by 12.8 gms. CONCLUSION: Our study didn't find an association between maternal height and vaginal delivery or operative vaginal delivery. However, there was an impact of maternal height on CS delivery. Therefore, we suggest screening for short maternal height as they have an increased risk of having an emergency CS. In our secondary outcome, we found a positive association between maternal height and baby's birth weight.

Characterization of the novel HLA-A*68:277 allele by sequencing-based typing.

A single nucleotide change in exon 1 of HLA-A*68:01:01:02 results in the novel HLA-A*68:277 allele.

The novel HLA-DQB1*06:03:01:06 allele identified in a Saudi individual.

HLA-DQB1*06:03:01:06 differs from HLA-DQB1*06:03:01:01 by a single nucleotide substitution in intron 2.

The novel HLA-DQB1*06:358 allele, identified by Next-Generation Sequencing in a Saudi individual.

HLA-DQB1*06:358 differs from HLA-DQB1*06:09:01:01 by two single nucleotide substitutions: 2949 C>T and 3001 A>T.

Check the chest: review of chest findings on abdominal MRI.

Magnetic resonance imaging (MRI) of the abdomen may include lower chest findings which may be overlooked or misinterpreted due to their location outside the area of main exam focus or lack of familiarity with the image appearance of these findings. This article will review the utility of abdominal MRI sequences to diagnose lower chest pathology while providing a systematic pictorial review of imaging findings in the lungs, pleura, mediastinum and chest wall. We will discuss the MRI appearance of lung nodules and masses, lung infiltrates, pulmonary infarction, pulmonary embolism, empyema, pleural effusions and thickening, mediastinal lesions and lymphadenopathy, cardiac thrombus and masses, and breast lesions. The purpose of this article is to increase awareness to the diagnostic advantages of abdominal MRI sequences for lower chest findings and encourage abdominal MRI readers to meticulous scrutinize the lower chest for concomitant pathology.

Factors Influencing the Choice of Radiology Subspecialty Among Radiology Trainees in Saudi Arabia.

Background Differential choices of radiology subspecialties by radiology trainees can cause shortages in some subspecialties. The objective of the current study was to evaluate the relative preference of different radiology subspecialties and the influencing factors among radiology trainees in Saudi Arabia.  Methods An online questionnaire was developed based on previous publications and was used to collect the data from radiology trainees in Saudi Arabia during August 2018. The relative importance of potential personal and work-related factors was assessed using Likert-scaled responses. Results A total of 105 radiology trainees were included in the current analysis. Approximately 64.8% of the trainees were males. A total of eight subspecialties were reported, with the most frequent being interventional radiology (20%), neuroradiology (19%), abdominal/gastrointestinal (15.2%), and musculoskeletal (14.3%). Personal factors that were reported as extremely or very important included strong personal interest (84.8%), successful/enjoyable rotation during training (84.8%), and intellectual challenge (76.2%). Work-related factors that were reported as extremely or very important included direct impact on patient care (84.8%), advanced or a variety of imaging modalities (81%), direct professional contact (77.1%), and favorable/flexibility of working hours and on-call commitments (77.1%). The subspecialty of interventional radiology was more frequently chosen by male trainees (p = 0.006), while the gynecological/breast subspecialty was exclusively chosen by female trainees (p < 0.001). Conclusion In addition to gender-specific differences, we are reporting several important personal and professional factors that influence the choice of radiology subspecialty. These findings can potentially help the directors of radiology training in making evidence-based modifications to their residency programs to ensure the maintenance of a sufficient radiology workforce.

A novel HLA-B allele, HLA-B*44:03:01:19, identified by next-generation sequencing in a Saudi individual.

HLA-B*44:03:01:19 differs from HLA-B*44:03:01:01 by a single nucleotide substitution (T➔C) at position 3856.

Identification of the novel HLA-DRB5*02:21 allele in a Saudi individual.

HLA-DRB5*02:21 differs from HLA-DRB5*02:02 by a single-nucleotide substitution (A → G) at position 3785.

Identification of the novel HLA-B*35:01:01:16 allele in a Saudi individual.

HLA-B*35:01:01:16 differs from HLA-B*35:01:01:01 by a single nucleotide substitution (C → A) at position 3941.

Identification of the novel HLA-C*04:01:01:31 allele in a Saudi individual.

HLA-C*04:01:01:31 differs from HLA-C*04:01:01:01 by a single nucleotide substitution (G → T) at position 72.

Identification of the novel HLA-A*30:02:01:04 allele in a Saudi individual.

HLA-A*30:02:01:04 differs from HLA-A*30:02:01:01 by a single nucleotide substitution (G ➔ C) at position 3222.

Identification of the novel HLA-B*18:01:01:17 allele in a Saudi individual.

HLA-B*18:01:01:17 differs from HLA-B*18:01:01:01 by a single nucleotide substitution (A➔T) at position 3956.

Identification of the novel HLA-A*23:91N allele in a Saudi individual.

HLA-A*23:91N differs from HLA-A*23:01:01 by a single-nucleotide substitution (G → A) at position 369.