Neonatal hemochromatosis (NH) is a rare condition that is characterized by severe neonatal liver disease in association with hepatic and extrahepatic excess iron deposition (siderosis), while sparing the reticuloendothelial system. The most common cause of fetal liver injury leading to the NH phenotype (accounting for over 95% of cases) is gestational alloimmune liver disease. This condition is caused by the transfer of maternal IgG antibodies through the placenta, targeting a fetal hepatocyte antigen. Prenatal diagnosis, particularly the identification of iron overload involving both liver and thyroid, is of significant importance and can have a profound impact on patient care. To our knowledge, no case has been reported on prenatal diagnosis of iron overload involving both liver and thyroid. We present an exceptionally rare case of fetal hemochromatosis in a primigravida, a case that significantly contributes to our understanding of this condition. The diagnosis was made with the presence of hepatic and extrahepatic siderosis involving the thyroid using Ultrasonography (USG) and fetal Magnetic Resonance Imaging (MRI) findings. A 23-year-old primigravida was referred to our center in view of oligohydramnios, Intrauterine Growth Restriction (IUGR) and echogenic bowel at 29 weeks of gestation. USG and fetal MRI showed features of coarse liver echotexture and iron overload involving the liver and thyroid; this is the first case describing iron accumulation in the fetal thyroid gland diagnosed in utero. This case underscores the critical importance of performing MRI in suspected cases of fetal hemochromatosis for early diagnosis and intervention, emphasizing the potential to significantly improve patient outcomes.
{"title":"Fetal hemochromatosis: rare case of hepatic and extrahepatic siderosis involving thyroid on fetal MRI","authors":"Sumathi Natarajan, Ravindar Kashyap, Saira Rajan, Dhivakar Muthusamy","doi":"10.1186/s43055-024-01361-5","DOIUrl":"https://doi.org/10.1186/s43055-024-01361-5","url":null,"abstract":"Neonatal hemochromatosis (NH) is a rare condition that is characterized by severe neonatal liver disease in association with hepatic and extrahepatic excess iron deposition (siderosis), while sparing the reticuloendothelial system. The most common cause of fetal liver injury leading to the NH phenotype (accounting for over 95% of cases) is gestational alloimmune liver disease. This condition is caused by the transfer of maternal IgG antibodies through the placenta, targeting a fetal hepatocyte antigen. Prenatal diagnosis, particularly the identification of iron overload involving both liver and thyroid, is of significant importance and can have a profound impact on patient care. To our knowledge, no case has been reported on prenatal diagnosis of iron overload involving both liver and thyroid. We present an exceptionally rare case of fetal hemochromatosis in a primigravida, a case that significantly contributes to our understanding of this condition. The diagnosis was made with the presence of hepatic and extrahepatic siderosis involving the thyroid using Ultrasonography (USG) and fetal Magnetic Resonance Imaging (MRI) findings. A 23-year-old primigravida was referred to our center in view of oligohydramnios, Intrauterine Growth Restriction (IUGR) and echogenic bowel at 29 weeks of gestation. USG and fetal MRI showed features of coarse liver echotexture and iron overload involving the liver and thyroid; this is the first case describing iron accumulation in the fetal thyroid gland diagnosed in utero. This case underscores the critical importance of performing MRI in suspected cases of fetal hemochromatosis for early diagnosis and intervention, emphasizing the potential to significantly improve patient outcomes.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1186/s43055-024-01360-6
Ebraheem Hassan Abubakr Shaaban, Mohamed Mahmoud El Shafei, Salah El Deen El Desouki, Rehab Elnemr, Omnia Ezz Eldin
Frozen shoulder is an incapacitating disease that causes pain and limitation in the shoulder joint functional capacity. This work aimed to assess the efficacy of ultrasound-guided combined intra-articular corticosteroids (CS) injection and suprascapular nerve block (SSNB) in pain control in patients with frozen shoulders. Our prospective study included 40 patients, equally divided into two groups: group A; managed with combined ultrasound (US) guided intra-articular corticosteroids injection (IACSI) and SSNB, and group B patients managed with US-guided SSNB. The visual analog scale score statistically significantly improved after both injections. This success was maintained and showed mild improvement at 8-week intervals (with increased patient capability to do physiotherapy after pain control). Similarly, improvement in the functional capacity of the shoulder joint was identified and assessed by the Oxford shoulder score (OSS) in both groups. Mean OSS was statistically significantly higher at 4-week intervals than before the nerve block for groups A and B. At 8 weeks interval, this favorable result was sustained (p < .001). US-guided SSNB is an effective, radiation-free method to alleviate frozen shoulder-related pains. However, US-guided combined SSNB and IACSI was more effective than SSNB alone in both pain alleviation and improved shoulder joint function.
{"title":"Ultrasound-guided combined intra-articular corticosteroids injection and suprascapular nerve block for pain control in patients with frozen shoulder","authors":"Ebraheem Hassan Abubakr Shaaban, Mohamed Mahmoud El Shafei, Salah El Deen El Desouki, Rehab Elnemr, Omnia Ezz Eldin","doi":"10.1186/s43055-024-01360-6","DOIUrl":"https://doi.org/10.1186/s43055-024-01360-6","url":null,"abstract":"Frozen shoulder is an incapacitating disease that causes pain and limitation in the shoulder joint functional capacity. This work aimed to assess the efficacy of ultrasound-guided combined intra-articular corticosteroids (CS) injection and suprascapular nerve block (SSNB) in pain control in patients with frozen shoulders. Our prospective study included 40 patients, equally divided into two groups: group A; managed with combined ultrasound (US) guided intra-articular corticosteroids injection (IACSI) and SSNB, and group B patients managed with US-guided SSNB. The visual analog scale score statistically significantly improved after both injections. This success was maintained and showed mild improvement at 8-week intervals (with increased patient capability to do physiotherapy after pain control). Similarly, improvement in the functional capacity of the shoulder joint was identified and assessed by the Oxford shoulder score (OSS) in both groups. Mean OSS was statistically significantly higher at 4-week intervals than before the nerve block for groups A and B. At 8 weeks interval, this favorable result was sustained (p < .001). US-guided SSNB is an effective, radiation-free method to alleviate frozen shoulder-related pains. However, US-guided combined SSNB and IACSI was more effective than SSNB alone in both pain alleviation and improved shoulder joint function.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1186/s43055-024-01359-z
Mohamed M. Harraz, Ahmed H. Abouissa, Ahmed Adel El Eshmawy, Wael El Refaey, Ahmed Ibrahim Tawfik
Acute pulmonary embolism is recorded as one of the most common and critical medical conditions, resulting in a notable mortality rate requiring a multidisciplinary management. In this series, we address the management of massive and sub-massive pulmonary embolism utilizing catheter-based intervention, in particular the conjunction of mechanical thrombus disruption and aspiration with pharmacological thrombolysis (pharmacomechanical thrombectomy). 37 patients were diagnosed with massive and sub-massive pulmonary embolism based on the clinical and radiological findings. Pre-procedural vital parameters were obtained, including oxygen saturation, pulse rate, and blood pressure. Under continuous monitoring and conscious sedation, a pulmonary angiography via right common femoral vein access was performed for pre-procedural assessment. Pharmacomechanical thrombectomy was performed using the AngioJet Ultra System (Boston Scientific). Using the power pulse option, a fibrinolytic agent was infused into the thrombus. After 5–10 min, mechanical thrombectomy is performed with a maximum 3 passes through the thrombus. This technique is performed in the main pulmonary artery and lower branch. The procedure is repeated on the other side. The maximum duration of thrombectomy is 2–3 min on each side. Procedure success was based on improvement of vital signs and not related to post-procedure angiographic findings. All patients showed immediate improvement of vital signs (blood pressure, 02 saturation, and pulse rate) with progressive improvement over the following days. There were no procedure-related complications. Pharmacomechanical thrombectomy is a safe and effective technique in the treatment of massive and submassive pulmonary embolism. It can be a first-line treatment even in patients without absolute contraindication to systemic thrombolysis.
{"title":"Pharmacomechanical thrombectomy in management of pulmonary embolism","authors":"Mohamed M. Harraz, Ahmed H. Abouissa, Ahmed Adel El Eshmawy, Wael El Refaey, Ahmed Ibrahim Tawfik","doi":"10.1186/s43055-024-01359-z","DOIUrl":"https://doi.org/10.1186/s43055-024-01359-z","url":null,"abstract":"Acute pulmonary embolism is recorded as one of the most common and critical medical conditions, resulting in a notable mortality rate requiring a multidisciplinary management. In this series, we address the management of massive and sub-massive pulmonary embolism utilizing catheter-based intervention, in particular the conjunction of mechanical thrombus disruption and aspiration with pharmacological thrombolysis (pharmacomechanical thrombectomy). 37 patients were diagnosed with massive and sub-massive pulmonary embolism based on the clinical and radiological findings. Pre-procedural vital parameters were obtained, including oxygen saturation, pulse rate, and blood pressure. Under continuous monitoring and conscious sedation, a pulmonary angiography via right common femoral vein access was performed for pre-procedural assessment. Pharmacomechanical thrombectomy was performed using the AngioJet Ultra System (Boston Scientific). Using the power pulse option, a fibrinolytic agent was infused into the thrombus. After 5–10 min, mechanical thrombectomy is performed with a maximum 3 passes through the thrombus. This technique is performed in the main pulmonary artery and lower branch. The procedure is repeated on the other side. The maximum duration of thrombectomy is 2–3 min on each side. Procedure success was based on improvement of vital signs and not related to post-procedure angiographic findings. All patients showed immediate improvement of vital signs (blood pressure, 02 saturation, and pulse rate) with progressive improvement over the following days. There were no procedure-related complications. Pharmacomechanical thrombectomy is a safe and effective technique in the treatment of massive and submassive pulmonary embolism. It can be a first-line treatment even in patients without absolute contraindication to systemic thrombolysis.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1186/s43055-024-01352-6
Amira R. Mahmoud, Nehad Fouda, Eman Mohamed Helmy, Ali Elsorougy
Renal cell carcinoma is the most fatal form of renal tumors, representing about ninety percent of all renal cancers. There are different variations in prognosis among various histological types of RCC. In recent years, there has been a greater emphasis on differentiating between RCC subtypes. Evaluation of different subtypes of renal cell carcinoma using intravoxel incoherent motion (IVIM) diffusion-weighted MRI is the aim of this study. Clear cell renal cell carcinoma (CCRCCs) showed highest f and D values, followed by chromophobe renal cell carcinoma (ChRCCs), while papillary renal cell carcinoma (PRCCs) had the lowest values. CCRCCs had significantly different D and f values compared to non-clear types (PRCC and ChRCC) (P < 0.05). The D* values of CCRCC were the highest, PCRCC had intermediate values, while ChRCCs had the lowest values (P < 0.05). The D* values of ChRCCs demonstrated significant difference when compared to both CCRCCs and PRCCs (P < 0.05). The cutoff points of D, D* and f parameters for distinguishing CCRCCs from non-clear cell types (ChRCCs and PRCC) were 0.835, 0.0355 and 0.335, respectively, yielding specificities of 97.2%, 83.3% and 76.5% and sensitivities of 100%, 57.5% and 72.7%, respectively. Intravoxel incoherent motion (IVIM) can be utilized to distinguish renal cell carcinoma subtypes.
肾细胞癌是最致命的肾肿瘤，约占所有肾癌的百分之九十。不同组织学类型的肾细胞癌预后各不相同。近年来，人们更加重视区分 RCC 亚型。本研究的目的是利用体细胞内不连贯运动（IVIM）弥散加权磁共振成像评估肾细胞癌的不同亚型。透明细胞肾细胞癌（CCRCCs）的f值和D值最高，其次是嗜铬肾细胞癌（ChRCCs），而乳头状肾细胞癌（PRCCs）的f值和D值最低。与非透明类型（PRCC 和 ChRCC）相比，CCRCC 的 D 值和 f 值明显不同（P < 0.05）。CCRCC的D*值最高，PCRCC的D*值居中，而ChRCC的D*值最低（P < 0.05）。与CCRCC和PCRCC相比，ChRCC的D*值有显著差异（P < 0.05）。区分CCRCC和非透明细胞类型（ChRCC和PRCC）的D、D*和f参数临界点分别为0.835、0.0355和0.335，特异性分别为97.2%、83.3%和76.5%，灵敏度分别为100%、57.5%和72.7%。体外非相干运动（IVIM）可用于区分肾细胞癌亚型。
{"title":"Role of intravoxel incoherent motion diffusion-weighted MRI in differentiation of renal cell carcinoma subtypes","authors":"Amira R. Mahmoud, Nehad Fouda, Eman Mohamed Helmy, Ali Elsorougy","doi":"10.1186/s43055-024-01352-6","DOIUrl":"https://doi.org/10.1186/s43055-024-01352-6","url":null,"abstract":"Renal cell carcinoma is the most fatal form of renal tumors, representing about ninety percent of all renal cancers. There are different variations in prognosis among various histological types of RCC. In recent years, there has been a greater emphasis on differentiating between RCC subtypes. Evaluation of different subtypes of renal cell carcinoma using intravoxel incoherent motion (IVIM) diffusion-weighted MRI is the aim of this study. Clear cell renal cell carcinoma (CCRCCs) showed highest f and D values, followed by chromophobe renal cell carcinoma (ChRCCs), while papillary renal cell carcinoma (PRCCs) had the lowest values. CCRCCs had significantly different D and f values compared to non-clear types (PRCC and ChRCC) (P < 0.05). The D* values of CCRCC were the highest, PCRCC had intermediate values, while ChRCCs had the lowest values (P < 0.05). The D* values of ChRCCs demonstrated significant difference when compared to both CCRCCs and PRCCs (P < 0.05). The cutoff points of D, D* and f parameters for distinguishing CCRCCs from non-clear cell types (ChRCCs and PRCC) were 0.835, 0.0355 and 0.335, respectively, yielding specificities of 97.2%, 83.3% and 76.5% and sensitivities of 100%, 57.5% and 72.7%, respectively. Intravoxel incoherent motion (IVIM) can be utilized to distinguish renal cell carcinoma subtypes.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1186/s43055-024-01356-2
Ahmed Marey, Parisa Arjmand, Ameerh Dana Sabe Alerab, Mohammad Javad Eslami, Abdelrahman M. Saad, Nicole Sanchez, Muhammad Umair
The integration of artificial intelligence (AI) in cardiovascular imaging has revolutionized the field, offering significant advancements in diagnostic accuracy and clinical efficiency. However, the complexity and opacity of AI models, particularly those involving machine learning (ML) and deep learning (DL), raise critical legal and ethical concerns due to their "black box" nature. This manuscript addresses these concerns by providing a comprehensive review of AI technologies in cardiovascular imaging, focusing on the challenges and implications of the black box phenomenon. We begin by outlining the foundational concepts of AI, including ML and DL, and their applications in cardiovascular imaging. The manuscript delves into the "black box" issue, highlighting the difficulty in understanding and explaining AI decision-making processes. This lack of transparency poses significant challenges for clinical acceptance and ethical deployment. The discussion then extends to the legal and ethical implications of AI's opacity. The need for explicable AI systems is underscored, with an emphasis on the ethical principles of beneficence and non-maleficence. The manuscript explores potential solutions such as explainable AI (XAI) techniques, which aim to provide insights into AI decision-making without sacrificing performance. Moreover, the impact of AI explainability on clinical decision-making and patient outcomes is examined. The manuscript argues for the development of hybrid models that combine interpretability with the advanced capabilities of black box systems. It also advocates for enhanced education and training programs for healthcare professionals to equip them with the necessary skills to utilize AI effectively. Patient involvement and informed consent are identified as critical components for the ethical deployment of AI in healthcare. Strategies for improving patient understanding and engagement with AI technologies are discussed, emphasizing the importance of transparent communication and education. Finally, the manuscript calls for the establishment of standardized regulatory frameworks and policies to address the unique challenges posed by AI in healthcare. By fostering interdisciplinary collaboration and continuous monitoring, the medical community can ensure the responsible integration of AI into cardiovascular imaging, ultimately enhancing patient care and clinical outcomes.
{"title":"Explainability, transparency and black box challenges of AI in radiology: impact on patient care in cardiovascular radiology","authors":"Ahmed Marey, Parisa Arjmand, Ameerh Dana Sabe Alerab, Mohammad Javad Eslami, Abdelrahman M. Saad, Nicole Sanchez, Muhammad Umair","doi":"10.1186/s43055-024-01356-2","DOIUrl":"https://doi.org/10.1186/s43055-024-01356-2","url":null,"abstract":"The integration of artificial intelligence (AI) in cardiovascular imaging has revolutionized the field, offering significant advancements in diagnostic accuracy and clinical efficiency. However, the complexity and opacity of AI models, particularly those involving machine learning (ML) and deep learning (DL), raise critical legal and ethical concerns due to their \"black box\" nature. This manuscript addresses these concerns by providing a comprehensive review of AI technologies in cardiovascular imaging, focusing on the challenges and implications of the black box phenomenon. We begin by outlining the foundational concepts of AI, including ML and DL, and their applications in cardiovascular imaging. The manuscript delves into the \"black box\" issue, highlighting the difficulty in understanding and explaining AI decision-making processes. This lack of transparency poses significant challenges for clinical acceptance and ethical deployment. The discussion then extends to the legal and ethical implications of AI's opacity. The need for explicable AI systems is underscored, with an emphasis on the ethical principles of beneficence and non-maleficence. The manuscript explores potential solutions such as explainable AI (XAI) techniques, which aim to provide insights into AI decision-making without sacrificing performance. Moreover, the impact of AI explainability on clinical decision-making and patient outcomes is examined. The manuscript argues for the development of hybrid models that combine interpretability with the advanced capabilities of black box systems. It also advocates for enhanced education and training programs for healthcare professionals to equip them with the necessary skills to utilize AI effectively. Patient involvement and informed consent are identified as critical components for the ethical deployment of AI in healthcare. Strategies for improving patient understanding and engagement with AI technologies are discussed, emphasizing the importance of transparent communication and education. Finally, the manuscript calls for the establishment of standardized regulatory frameworks and policies to address the unique challenges posed by AI in healthcare. By fostering interdisciplinary collaboration and continuous monitoring, the medical community can ensure the responsible integration of AI into cardiovascular imaging, ultimately enhancing patient care and clinical outcomes.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1186/s43055-024-01357-1
Joe Vimal Raj, B. Vigneshwaran, Yamini Subbiah, Elamparidhi Padmanaban, Umamageswari Amirthalingam, R. L. Balavaitheeswar
Spindle cell lipoma is a benign adipocytic tumour, commonly occuring in the subcutis of posterior neck, upper back and shoulder, particularly in middle aged males. It is often composed of relatively equal ratio of fat and spindle cells, yet either component may predominate. Because of its variable ratio, a spindle cell lipoma may mimic liposarcoma radiologically. This article aimed to describe the MRI characteristics that assist in diagnosing spindle cell lipoma. Case presentation: A 45-year-old female presented with a gradually progressive neck swelling along the posterior aspect over a period of 2 years. Physical examination revealed a firm, mobile, non-tender mass in the left suboccipital region. Radiographic imaging showed a well-defined heterogeneous, minimally enhancing soft tissue swelling with areas of macroscopic fat and multiple macrocalcifications in the left suboccipital region extending to the left parapharyngeal space, showing loss of fat plane with adjacent muscles. Differential diagnoses of soft tissue neoplasms such as atypical lipoma and low-grade liposarcoma were considered. Surgical excision confirmed a myxoid variant of spindle cell lipoma upon histopathological examination. Spindle cell lipomas, commonly found in the posterior neck, have varied imaging features that are not distinctive. Despite their non-specific nature, radiologists should recognize these features, as the tumor can be treated effectively with simple excision. When encountering a well-defined, complex fatty mass in the subcutaneous tissue of the posterior neck, consider a diagnostic possibility of spindle cell lipoma.
{"title":"Unveiling spindle cell lipoma: a radiological case report","authors":"Joe Vimal Raj, B. Vigneshwaran, Yamini Subbiah, Elamparidhi Padmanaban, Umamageswari Amirthalingam, R. L. Balavaitheeswar","doi":"10.1186/s43055-024-01357-1","DOIUrl":"https://doi.org/10.1186/s43055-024-01357-1","url":null,"abstract":"Spindle cell lipoma is a benign adipocytic tumour, commonly occuring in the subcutis of posterior neck, upper back and shoulder, particularly in middle aged males. It is often composed of relatively equal ratio of fat and spindle cells, yet either component may predominate. Because of its variable ratio, a spindle cell lipoma may mimic liposarcoma radiologically. This article aimed to describe the MRI characteristics that assist in diagnosing spindle cell lipoma. Case presentation: A 45-year-old female presented with a gradually progressive neck swelling along the posterior aspect over a period of 2 years. Physical examination revealed a firm, mobile, non-tender mass in the left suboccipital region. Radiographic imaging showed a well-defined heterogeneous, minimally enhancing soft tissue swelling with areas of macroscopic fat and multiple macrocalcifications in the left suboccipital region extending to the left parapharyngeal space, showing loss of fat plane with adjacent muscles. Differential diagnoses of soft tissue neoplasms such as atypical lipoma and low-grade liposarcoma were considered. Surgical excision confirmed a myxoid variant of spindle cell lipoma upon histopathological examination. Spindle cell lipomas, commonly found in the posterior neck, have varied imaging features that are not distinctive. Despite their non-specific nature, radiologists should recognize these features, as the tumor can be treated effectively with simple excision. When encountering a well-defined, complex fatty mass in the subcutaneous tissue of the posterior neck, consider a diagnostic possibility of spindle cell lipoma.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1186/s43055-024-01353-5
Sahar Mansour, Enas Sweed, Mohammed Mohammed Mohammed Gomaa, Samar Ahmed Hussein, Engy Abdallah, Yassmin Mohamed Nada, Rasha Kamal, Ghada Mohamed, Sherif Nasser Taha, Amr Farouk Ibrahim Moustafa
Although artificial intelligence (AI) has potential in the field of screening of breast cancer, there are still issues. It is vital to make sure AI does not overlook cancer or cause needless recalls. The aim of this work was to investigate the effectiveness of indulging AI in combination with one radiologist in the routine double reading of mammography for breast cancer screening. The study prospectively analyzed 32,822 screening mammograms. Reading was performed in a blind-paired style by (i) two radiologists and (ii) one radiologist paired with AI. A heatmap and abnormality scoring percentage were provided by AI for abnormalities detected on mammograms. Negative mammograms and benign-looking lesions that were not biopsied were confirmed by a 2-year follow-up. Double reading by the radiologist and AI detected 1324 cancers (6.4%); on the other side, reading by two radiologists revealed 1293 cancers (6.2%) and presented a relative proportion of 1·02 (p < 0·0001). At the recall stage, suspicion and biopsy recommendation were more presented by the AI plus one radiologist combination than by the two radiologists. The interpretation of the mammogram by AI plus only one radiologist showed a sensitivity of 94.03%, a specificity of 99.75%, a positive predictive value of 96.571%, a negative predictive value of 99.567%, and an accuracy of 99.369% (from 99.252 to 99.472%). The positive likelihood ratio was 387.260, negative likelihood ratio was 0.060, and AUC “area under the curve” was 0.969 (0.967–0.971). AI could be used as an initial reader for the evaluation of screening mammography in routine workflow. Implementation of AI enhanced the opportunity to reduce false negative cases and supported the decision to recall or biopsy.
尽管人工智能（AI）在乳腺癌筛查领域具有潜力，但仍存在一些问题。确保人工智能不会忽略癌症或导致不必要的召回至关重要。这项工作的目的是研究在乳腺癌筛查的乳腺 X 射线照相术常规双读中，人工智能与一名放射科医生结合使用的有效性。研究前瞻性地分析了 32,822 张乳腺 X 光筛查照片。阅片由(i)两名放射科医生和(ii)一名与人工智能配对的放射科医生以盲配方式进行。人工智能为乳房 X 光检查中发现的异常提供热图和异常评分百分比。阴性乳房 X 线照片和未进行活组织检查的良性病变由 2 年随访确认。由放射科医生和人工智能双重读片发现了 1324 个癌症（6.4%）；另一方面，由两名放射科医生读片发现了 1293 个癌症（6.2%），相对比例为 1-02（P < 0-0001）。在复查阶段，人工智能和一名放射科医生的组合比两名放射科医生更容易提出怀疑和活检建议。由人工智能和一名放射科医生对乳房 X 光检查进行解读的敏感性为 94.03%，特异性为 99.75%，阳性预测值为 96.571%，阴性预测值为 99.567%，准确性为 99.369%（从 99.252% 到 99.472%）。阳性似然比为 387.260，阴性似然比为 0.060，AUC "曲线下面积 "为 0.969（0.967-0.971）。在常规工作流程中，人工智能可作为乳腺放射摄影筛查评估的初始读片器。人工智能的应用增加了减少假阴性病例的机会，并有助于做出召回或活检的决定。
{"title":"Artificial intelligence as an initial reader for double reading in breast cancer screening: a prospective initial study of 32,822 mammograms of the Egyptian population","authors":"Sahar Mansour, Enas Sweed, Mohammed Mohammed Mohammed Gomaa, Samar Ahmed Hussein, Engy Abdallah, Yassmin Mohamed Nada, Rasha Kamal, Ghada Mohamed, Sherif Nasser Taha, Amr Farouk Ibrahim Moustafa","doi":"10.1186/s43055-024-01353-5","DOIUrl":"https://doi.org/10.1186/s43055-024-01353-5","url":null,"abstract":"Although artificial intelligence (AI) has potential in the field of screening of breast cancer, there are still issues. It is vital to make sure AI does not overlook cancer or cause needless recalls. The aim of this work was to investigate the effectiveness of indulging AI in combination with one radiologist in the routine double reading of mammography for breast cancer screening. The study prospectively analyzed 32,822 screening mammograms. Reading was performed in a blind-paired style by (i) two radiologists and (ii) one radiologist paired with AI. A heatmap and abnormality scoring percentage were provided by AI for abnormalities detected on mammograms. Negative mammograms and benign-looking lesions that were not biopsied were confirmed by a 2-year follow-up. Double reading by the radiologist and AI detected 1324 cancers (6.4%); on the other side, reading by two radiologists revealed 1293 cancers (6.2%) and presented a relative proportion of 1·02 (p < 0·0001). At the recall stage, suspicion and biopsy recommendation were more presented by the AI plus one radiologist combination than by the two radiologists. The interpretation of the mammogram by AI plus only one radiologist showed a sensitivity of 94.03%, a specificity of 99.75%, a positive predictive value of 96.571%, a negative predictive value of 99.567%, and an accuracy of 99.369% (from 99.252 to 99.472%). The positive likelihood ratio was 387.260, negative likelihood ratio was 0.060, and AUC “area under the curve” was 0.969 (0.967–0.971). AI could be used as an initial reader for the evaluation of screening mammography in routine workflow. Implementation of AI enhanced the opportunity to reduce false negative cases and supported the decision to recall or biopsy.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1186/s43055-024-01358-0
Hamza Retal, Soumya El Graini, Amine Naggar, Alia Yassine Kassab, Asaad El Bakkari, Laila Jroundi, Fatima Zahrae Laamrani
Ingestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings. Our retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores. Employing Standardized CT scoring criteria alongside the Zargar’s endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases. While the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars.
{"title":"Utility of computed tomography in assessing caustic ingestion damage to the esogastric tract","authors":"Hamza Retal, Soumya El Graini, Amine Naggar, Alia Yassine Kassab, Asaad El Bakkari, Laila Jroundi, Fatima Zahrae Laamrani","doi":"10.1186/s43055-024-01358-0","DOIUrl":"https://doi.org/10.1186/s43055-024-01358-0","url":null,"abstract":"Ingestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings. Our retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores. Employing Standardized CT scoring criteria alongside the Zargar’s endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases. While the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1186/s43055-024-01351-7
Momena Essam Ibrahim Elsadawy, Yehia Omar, Noha M. Taha
Prostate cancer is well known as the commonest cancer in men and the second leading cause of cancer-related death. CT, MRI and bone scintigraphy are considered the commonly widely used imaging diagnostic tools for detection, staging and follow-up of prostate cancer. Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein, that can be concentrated in prostate cancer cells up to 100 times higher than in normal cells. PSMA-targeted imaging modalities have now proven their efficacy in diagnosis, staging and follow-up of prostate cancer. The use of 68Ga PSMA PET-CT has efficiently improved the detection of loco-regional and metastatic disease. 68Ga PSMA PET-CT also has an effective role in the primary diagnosis, staging, and detecting biochemical recurrence after curative treatment and in metastasis-targeted therapy. This work aims to review the role of 68Ga PSMA PET-CT in anatomical staging of prostate cancer in correlation with histopathological staging. Zonal correlation between 68Ga PSMA findings and biopsy results showed sensitivity ranging between 76.9 and 90.6% and specificity ranging from 85.7 to 100%. There was high significant correlation between the SUVmax uptake and the biopsy results, between the SUVmax uptake and the local staging as well as between the Gleason score and 68Ga PSMA PET/CT findings. 68Ga PSMA PET/CT is a highly promising imaging modality with an effective role in detection of prostate cancer showing high sensitivity and specificity in prediction of zonal histopathological results and loco-regional Gleason score staging with significant positive correlation between the SUV uptake results, Gleason score and the PSA levels.
{"title":"The added value of 68Ga-PSMA PET/CT in anatomical staging of prostatic carcinoma in correlation with the histopathological zonal staging","authors":"Momena Essam Ibrahim Elsadawy, Yehia Omar, Noha M. Taha","doi":"10.1186/s43055-024-01351-7","DOIUrl":"https://doi.org/10.1186/s43055-024-01351-7","url":null,"abstract":"Prostate cancer is well known as the commonest cancer in men and the second leading cause of cancer-related death. CT, MRI and bone scintigraphy are considered the commonly widely used imaging diagnostic tools for detection, staging and follow-up of prostate cancer. Prostate-specific membrane antigen (PSMA) is a membrane glycoprotein, that can be concentrated in prostate cancer cells up to 100 times higher than in normal cells. PSMA-targeted imaging modalities have now proven their efficacy in diagnosis, staging and follow-up of prostate cancer. The use of 68Ga PSMA PET-CT has efficiently improved the detection of loco-regional and metastatic disease. 68Ga PSMA PET-CT also has an effective role in the primary diagnosis, staging, and detecting biochemical recurrence after curative treatment and in metastasis-targeted therapy. This work aims to review the role of 68Ga PSMA PET-CT in anatomical staging of prostate cancer in correlation with histopathological staging. Zonal correlation between 68Ga PSMA findings and biopsy results showed sensitivity ranging between 76.9 and 90.6% and specificity ranging from 85.7 to 100%. There was high significant correlation between the SUVmax uptake and the biopsy results, between the SUVmax uptake and the local staging as well as between the Gleason score and 68Ga PSMA PET/CT findings. 68Ga PSMA PET/CT is a highly promising imaging modality with an effective role in detection of prostate cancer showing high sensitivity and specificity in prediction of zonal histopathological results and loco-regional Gleason score staging with significant positive correlation between the SUV uptake results, Gleason score and the PSA levels.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1186/s43055-024-01348-2
Amine Naggar, Ibtissam El Ouali, Saadia Aidi, Adyl Melhaoui, Najwa Ech-cherif el Kettani, Meriem Fikri, Mohamed Jiddane, Firdaous Touarsa
Spinal arachnoid web (AW) is a very rare entity, with a limited number of cases documented in the literature. Our manuscript represented a comprehensive general review, encompassing various aspects of the subject matter without focusing on any single element. The objective of this systematic review was to describe and analyze reported cases of surgically proven spinal arachnoid webs (AWs) to elucidate their imaging and clinical features, pathophysiology, and optimal management strategies, and to determine the total number of documented cases in the literature. Patterns and commonalities across reported cases were identified to provide a clearer framework for diagnosing and treating this elusive condition. A search of Web of Science, PubMed, and Scopus, respecting PRISMA guidelines, was conducted to include reported cases of surgically proven spinal AW. Our surgically proven case was included as well. The search yielded 196 cases of surgically confirmed spinal AWs in the literature. Adding our case, the total is 197. They are seen commonly in middle-aged patients, slightly more prevalent in males, and often without an evident cause. Sensation disturbances were the most frequently found clinical signs, followed by gait difficulties, weakness, and pain. Symptoms were predominantly located in the lower limbs and trunk. On imaging, an indentation to the rear aspect of the spinal cord was most frequently found at the mid-thorax followed by the upper thorax, often associated with a syrinx or a hyperintense T2 cord signal, usually extending rostrally. Excision was the most efficient treatment. The assessment found that AW cases are rare in the literature, indicating the disease's scarcity. It manifests insidiously, with the shortest latency reported being 2 weeks. Upper limb symptoms occur in a quarter of cases regardless of the AW's thoracic location, likely due to rostral syrinx and cerebrospinal fluid flow disturbances. Most pathology results revealed fibrous connective tissue, similar to findings in arachnoid cysts, suggesting that AW may result from a ruptured arachnoid cyst or its precursor. Using 3D SPACE STIR and CISS MRI sequences is recommended to visualize the arachnoid band directly.
脊髓蛛网膜（AW）是一种非常罕见的疾病，文献中记载的病例数量有限。我们的手稿是一篇全面的综述，涵盖了这一主题的各个方面，并没有侧重于任何单一因素。本系统性综述旨在描述和分析经手术证实的脊髓蛛网膜（AW）病例报告，以阐明其影像学和临床特征、病理生理学和最佳治疗策略，并确定文献中记录的病例总数。研究还确定了所报道病例的模式和共性，以便为诊断和治疗这种难以捉摸的疾病提供更清晰的框架。在遵守PRISMA指南的前提下，我们对Web of Science、PubMed和Scopus进行了检索，以纳入经手术证实的脊柱AW病例报告。我们经手术证实的病例也包括在内。搜索结果显示，文献中经手术证实的脊柱AW病例有196例。加上我们的病例，总数为 197 例。脊髓AW常见于中年患者，男性稍多，通常没有明显的病因。感觉障碍是最常见的临床症状，其次是步态困难、虚弱和疼痛。症状主要出现在下肢和躯干。在影像学检查中，脊髓后方的凹陷最常出现在中胸，其次是上胸，通常伴有鞘膜积液或高强度的T2脊髓信号，通常向喙突延伸。切除是最有效的治疗方法。评估发现，AW 病例在文献中十分罕见，这表明该病十分罕见。该病表现隐匿，最短的潜伏期为两周。四分之一的病例会出现上肢症状，与AW的胸腔位置无关，这可能是由于喙突和脑脊液流动障碍所致。大多数病理结果显示为纤维结缔组织，与蛛网膜囊肿的结果类似，这表明AW可能是蛛网膜囊肿或其前体破裂所致。建议使用 3D SPACE STIR 和 CISS MRI 序列直接观察蛛网膜带。
{"title":"Spinal arachnoid web: a systematic review of a rare entity, with two illustrative case reports","authors":"Amine Naggar, Ibtissam El Ouali, Saadia Aidi, Adyl Melhaoui, Najwa Ech-cherif el Kettani, Meriem Fikri, Mohamed Jiddane, Firdaous Touarsa","doi":"10.1186/s43055-024-01348-2","DOIUrl":"https://doi.org/10.1186/s43055-024-01348-2","url":null,"abstract":"Spinal arachnoid web (AW) is a very rare entity, with a limited number of cases documented in the literature. Our manuscript represented a comprehensive general review, encompassing various aspects of the subject matter without focusing on any single element. The objective of this systematic review was to describe and analyze reported cases of surgically proven spinal arachnoid webs (AWs) to elucidate their imaging and clinical features, pathophysiology, and optimal management strategies, and to determine the total number of documented cases in the literature. Patterns and commonalities across reported cases were identified to provide a clearer framework for diagnosing and treating this elusive condition. A search of Web of Science, PubMed, and Scopus, respecting PRISMA guidelines, was conducted to include reported cases of surgically proven spinal AW. Our surgically proven case was included as well. The search yielded 196 cases of surgically confirmed spinal AWs in the literature. Adding our case, the total is 197. They are seen commonly in middle-aged patients, slightly more prevalent in males, and often without an evident cause. Sensation disturbances were the most frequently found clinical signs, followed by gait difficulties, weakness, and pain. Symptoms were predominantly located in the lower limbs and trunk. On imaging, an indentation to the rear aspect of the spinal cord was most frequently found at the mid-thorax followed by the upper thorax, often associated with a syrinx or a hyperintense T2 cord signal, usually extending rostrally. Excision was the most efficient treatment. The assessment found that AW cases are rare in the literature, indicating the disease's scarcity. It manifests insidiously, with the shortest latency reported being 2 weeks. Upper limb symptoms occur in a quarter of cases regardless of the AW's thoracic location, likely due to rostral syrinx and cerebrospinal fluid flow disturbances. Most pathology results revealed fibrous connective tissue, similar to findings in arachnoid cysts, suggesting that AW may result from a ruptured arachnoid cyst or its precursor. Using 3D SPACE STIR and CISS MRI sequences is recommended to visualize the arachnoid band directly.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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