Pub Date : 2024-08-27DOI: 10.1186/s43055-024-01332-w
Sarah El-Nakeep, Ehab Nashaat, Fatma Alsherif, Mohamed Magdy Salama
Inflammatory bowel disease is a chronic inflammatory condition of the gut. It has two major subtypes Crohn’s disease and ulcerative colitis. The follow-up consists of radiologic, molecular, endoscopic, and histological assessments. Intestinal ultrasound (IUS) is a noninvasive measure that provides future hope in guiding the management of IBD patients. This study is to assess the effectiveness of IUS in IBD patients’ follow-up in our tertiary center during the pandemic. This is a prospective observational study during the COVID-19 pandemic. We used IUS to assess activity of IBD at baseline and at 6-month follow-up of patients on maintenance biological therapy using the following parameters: bowel haustrations, stratification, bowel wall thickness (BWT), Doppler sign (Limberg classification), presence of lymph nodes, or fibrofatty infiltration, echogenicity of the bowel, and presence of fistulae or abscesses. We compared the IUS with other radiologic parameters, histologic, and endoscopic scores at baseline before therapy, while we compared IUS with clinical scores and laboratory parameters before and after 24 weeks of biological treatment. The cohort included 50 known IBD patients from June 2021 to January 2022. The laboratory studies showed a significant improvement in the hemoglobin indices, CRP, and fecal calprotectin from baseline and after 24 weeks. BWT, lumen diameter, lymph node presence, inflammatory signs, and Doppler activity signs were the most significant parameters in detecting improvement. However, there was no significant correlation between fecal calprotectin levels and ultrasound parameters. There was a positive correlation between MR and CT enterography, endoscopic parameters, and IUS parameters at baseline. IUS is an effective tool for follow-up of IBD patients especially during the pandemic periods.
炎症性肠病是一种慢性肠道炎症。它有两大亚型，即克罗恩病和溃疡性结肠炎。随访包括放射学、分子学、内窥镜和组织学评估。肠道超声（IUS）是一种无创措施，为指导 IBD 患者的治疗带来了希望。本研究旨在评估 IUS 在大流行期间对我们三级中心的 IBD 患者进行随访的有效性。这是一项在 COVID-19 大流行期间进行的前瞻性观察研究。我们使用 IUS 评估了接受维持性生物治疗的患者在基线和 6 个月随访时的 IBD 活动情况，并使用了以下参数：肠造影、分层、肠壁厚度 (BWT)、多普勒征（Limberg 分类）、淋巴结或纤维脂肪浸润的存在、肠道回声、瘘管或脓肿的存在。我们将 IUS 与治疗前基线的其他放射学参数、组织学和内窥镜评分进行了比较，同时将 IUS 与生物治疗 24 周前后的临床评分和实验室参数进行了比较。该队列包括 50 名已知的 IBD 患者，时间为 2021 年 6 月至 2022 年 1 月。实验室研究显示，血红蛋白指数、CRP 和粪便钙蛋白在基线和 24 周后均有明显改善。BWT、管腔直径、淋巴结存在、炎症体征和多普勒活动体征是检测改善情况最重要的参数。然而，粪便钙蛋白水平与超声参数之间没有明显的相关性。基线时的 MR 和 CT 肠造影、内窥镜参数和 IUS 参数之间存在正相关。IUS 是随访 IBD 患者的有效工具，尤其是在大流行时期。
{"title":"Intestinal ultrasound for follow-up after 24 weeks of biological therapy in inflammatory bowel disease patients: an Egyptian center experience during the COVID-19 pandemic","authors":"Sarah El-Nakeep, Ehab Nashaat, Fatma Alsherif, Mohamed Magdy Salama","doi":"10.1186/s43055-024-01332-w","DOIUrl":"https://doi.org/10.1186/s43055-024-01332-w","url":null,"abstract":"Inflammatory bowel disease is a chronic inflammatory condition of the gut. It has two major subtypes Crohn’s disease and ulcerative colitis. The follow-up consists of radiologic, molecular, endoscopic, and histological assessments. Intestinal ultrasound (IUS) is a noninvasive measure that provides future hope in guiding the management of IBD patients. This study is to assess the effectiveness of IUS in IBD patients’ follow-up in our tertiary center during the pandemic. This is a prospective observational study during the COVID-19 pandemic. We used IUS to assess activity of IBD at baseline and at 6-month follow-up of patients on maintenance biological therapy using the following parameters: bowel haustrations, stratification, bowel wall thickness (BWT), Doppler sign (Limberg classification), presence of lymph nodes, or fibrofatty infiltration, echogenicity of the bowel, and presence of fistulae or abscesses. We compared the IUS with other radiologic parameters, histologic, and endoscopic scores at baseline before therapy, while we compared IUS with clinical scores and laboratory parameters before and after 24 weeks of biological treatment. The cohort included 50 known IBD patients from June 2021 to January 2022. The laboratory studies showed a significant improvement in the hemoglobin indices, CRP, and fecal calprotectin from baseline and after 24 weeks. BWT, lumen diameter, lymph node presence, inflammatory signs, and Doppler activity signs were the most significant parameters in detecting improvement. However, there was no significant correlation between fecal calprotectin levels and ultrasound parameters. There was a positive correlation between MR and CT enterography, endoscopic parameters, and IUS parameters at baseline. IUS is an effective tool for follow-up of IBD patients especially during the pandemic periods.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"2 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226047","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 : 2024-08-26DOI: 10.1186/s43055-024-01336-6
Mohamed Salah Ayyad, Mahmoud Fawzy Elbellasy, Amany Hassan, Mona Gad
Leiomyosarcoma (LMS) of vascular origin is a rare entity of soft tissue sarcomas. Although they arise mostly from retroperitoneal major vascular structures, some encountered cases may arise from the smaller vascular structures of the thigh as the femoral vein. Due to their origin from the vascular structures, they represent a diagnostic challenge as they may be misdiagnosed as deep vein thrombosis (DVT). We present a case of a 45-year-old woman with left femoral and iliac vein LMS that was previously described in the vascular ultrasound (US) report as extensive DVT involving the femoral and external iliac veins. The patient did not improve after receiving the prescribed anticoagulants. Seven months later, the patient underwent computerized tomography (CT) with contrast, revealing a soft tissue mass in the anatomical site of the left common femoral and external iliac veins. The patient underwent both US-guided tru-cut biopsy and incisional biopsy from the iliac lymph nodes which revealed leiomyosarcoma. The patient underwent both vascular ultrasound and magnetic resonance imaging of the pelvis and the left thigh at the time of the first presentation. Seven months later, she underwent contrast-enhanced CT of the abdomen and pelvis. The patient was referred to the oncology department to receive the appropriate chemotherapy protocol as the tumor was inoperable. Although leiomyosarcoma of vascular origin is a rare entity of neoplasms, it is usually underestimated. A high index of suspicion would help the clinician to suspect such a neoplasm and save time for early diagnosis and management. Special caution should be taken for patients with venous thrombosis not improving on anticoagulants. When there is suspicion, other modalities such as computerized tomography and magnetic resonance imaging help confirm the diagnosis.
血管源性雷米肉瘤（LMS）是一种罕见的软组织肉瘤。虽然它们大多来自腹膜后的主要血管结构，但有些病例也可能来自大腿上较小的血管结构，如股静脉。由于其来源于血管结构，可能会被误诊为深静脉血栓（DVT），因此给诊断带来了挑战。我们接诊了一例 45 岁女性患者，她患有左股静脉和髂静脉 LMS，血管超声（US）报告曾将其描述为累及股静脉和髂外静脉的广泛深静脉血栓。患者在接受处方抗凝药物治疗后病情未见好转。七个月后，患者接受了造影剂计算机断层扫描（CT）检查，发现左侧股总静脉和髂外静脉解剖部位有一个软组织肿块。患者接受了 US 引导下的真切活检和髂淋巴结切口活检，结果显示为亮肌肉瘤。患者在首次就诊时接受了盆腔和左大腿血管超声和磁共振成像检查。七个月后，她接受了腹部和盆腔对比增强 CT 检查。由于肿瘤无法手术，患者被转到肿瘤科接受适当的化疗方案。虽然血管源性子宫肌瘤是一种罕见的肿瘤，但通常被低估。高怀疑指数有助于临床医生怀疑此类肿瘤，为早期诊断和治疗节省时间。对于静脉血栓患者，在使用抗凝剂后病情未见好转的情况下应特别小心。当有怀疑时，计算机断层扫描和磁共振成像等其他方式有助于确诊。
{"title":"Leiomyosarcoma of vascular origin: lessons learned from misdiagnosis","authors":"Mohamed Salah Ayyad, Mahmoud Fawzy Elbellasy, Amany Hassan, Mona Gad","doi":"10.1186/s43055-024-01336-6","DOIUrl":"https://doi.org/10.1186/s43055-024-01336-6","url":null,"abstract":"Leiomyosarcoma (LMS) of vascular origin is a rare entity of soft tissue sarcomas. Although they arise mostly from retroperitoneal major vascular structures, some encountered cases may arise from the smaller vascular structures of the thigh as the femoral vein. Due to their origin from the vascular structures, they represent a diagnostic challenge as they may be misdiagnosed as deep vein thrombosis (DVT). We present a case of a 45-year-old woman with left femoral and iliac vein LMS that was previously described in the vascular ultrasound (US) report as extensive DVT involving the femoral and external iliac veins. The patient did not improve after receiving the prescribed anticoagulants. Seven months later, the patient underwent computerized tomography (CT) with contrast, revealing a soft tissue mass in the anatomical site of the left common femoral and external iliac veins. The patient underwent both US-guided tru-cut biopsy and incisional biopsy from the iliac lymph nodes which revealed leiomyosarcoma. The patient underwent both vascular ultrasound and magnetic resonance imaging of the pelvis and the left thigh at the time of the first presentation. Seven months later, she underwent contrast-enhanced CT of the abdomen and pelvis. The patient was referred to the oncology department to receive the appropriate chemotherapy protocol as the tumor was inoperable. Although leiomyosarcoma of vascular origin is a rare entity of neoplasms, it is usually underestimated. A high index of suspicion would help the clinician to suspect such a neoplasm and save time for early diagnosis and management. Special caution should be taken for patients with venous thrombosis not improving on anticoagulants. When there is suspicion, other modalities such as computerized tomography and magnetic resonance imaging help confirm the diagnosis.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"34 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203339","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 : 2024-08-26DOI: 10.1186/s43055-024-01337-5
Umar Hussain Haider, Babar Hussain, Wajeeha Shaheen, Shakeel Ur Rehman
The aim of this study was to find the entrance skin dose (ESD) for diagnostic radiation qualities RQRs, RQAs and RQTs given in IAEA technical report series No. 457 using direct and indirect methods of measurement. Measurements were done for 5 × 5, 10 × 10, 15 × 15, 20 × 20 and 25 × 25 cm2 field sizes and 70, 80, 90 and 100 cm source to surface distance (SSD) using shadow-free diagnostic (SFD) chamber and water phantom having dimension 30 × 30 × 30 cm3. ESD direct measurements were done by placing SFD chamber on the surface of water phantom, while in the case of indirect measurements, air kerma values were obtained. ESD values for different selected radiation qualities RQR2, RQR5, RQR8, RQR10, RQA2, RQA5, RQA8, RQA10, RQT8, RQT9 and RQT10 were found to be in the range of 0.0045–5.11 mGy per examination. Results obtained were found to be comparable with ESD values published in the literature. The obtained results in this research would help in establishing the national diagnostic reference levels (DRLs) which would help in the optimization of diagnostic imaging procedures. It would also help the radiographers to optimize field sizes and SSDs in order to reduce dose to the patients thereby ensuring good radiological practices, and this would reduce the stochastic risk to the patients caused by the ionizing radiations.
{"title":"Comparison of directly and indirectly estimated entrance skin dose (ESD) for diagnostic radiation qualities (RQR, RQA and RQT) using water phantom and shadowfree diagnostic chamber (SFD)","authors":"Umar Hussain Haider, Babar Hussain, Wajeeha Shaheen, Shakeel Ur Rehman","doi":"10.1186/s43055-024-01337-5","DOIUrl":"https://doi.org/10.1186/s43055-024-01337-5","url":null,"abstract":"The aim of this study was to find the entrance skin dose (ESD) for diagnostic radiation qualities RQRs, RQAs and RQTs given in IAEA technical report series No. 457 using direct and indirect methods of measurement. Measurements were done for 5 × 5, 10 × 10, 15 × 15, 20 × 20 and 25 × 25 cm2 field sizes and 70, 80, 90 and 100 cm source to surface distance (SSD) using shadow-free diagnostic (SFD) chamber and water phantom having dimension 30 × 30 × 30 cm3. ESD direct measurements were done by placing SFD chamber on the surface of water phantom, while in the case of indirect measurements, air kerma values were obtained. ESD values for different selected radiation qualities RQR2, RQR5, RQR8, RQR10, RQA2, RQA5, RQA8, RQA10, RQT8, RQT9 and RQT10 were found to be in the range of 0.0045–5.11 mGy per examination. Results obtained were found to be comparable with ESD values published in the literature. The obtained results in this research would help in establishing the national diagnostic reference levels (DRLs) which would help in the optimization of diagnostic imaging procedures. It would also help the radiographers to optimize field sizes and SSDs in order to reduce dose to the patients thereby ensuring good radiological practices, and this would reduce the stochastic risk to the patients caused by the ionizing radiations.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"13 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203342","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 : 2024-08-26DOI: 10.1186/s43055-024-01340-w
Mohamed Mohsen, Nehal Aboubakr Elsayed Mohamed, Abdelhalim El-Tantawy Mohamed Bedir, Ahmed Abdel Khalek Abdel Razek, Ahmed Effat Abbas Mohamed Saied
Parkinson’s disease (PD) is the most common movement disorder and the second most common neurodegenerative disease. The aim of our study was to compare gray–white matter changes (GWC) between Parkinson's disease (PD) patients and age-matched healthy control group as well as comparing GWC between different stages of PD (early and complicated). Our study was prospective cross-sectional case–control observational study with analytic component conducted on twenty patients and ten controls without any signs or symptoms of PD or any history of PD in first-degree relatives. All patients and controls were tested for history taking with stress on resting tremors, rigidity, gait abnormalities, postural instability and any symptoms of cognitive impairment, clinical examination including general examination and neurological examination. Also diffusion tensor imaging (DTI) with fiber tracking (tractography) and susceptibility-weighted MR imaging were performed for all cases. As regards DTI and evaluation of fractional anisotropy (FA) and mean diffusivity (MD) values between PD cases and healthy controls, the cases group showed significant decrease in FA values at substantia nigra on both sides and left cingulum as well as significant increase in MD values at substantia nigra on both sides and corpus callosum. Also, there are significant decrease in FA values at substantia nigra on both sides and significant increase in MD values at substantia nigra on both sides and right cingulum in late parkinsonism when compared to early parkinsonism. A cutoff FA value of 0.945 at right substantia nigra and cutoff FA value of 0.585 at left substantia nigra showed significant AUC that could differentiate between cases and controls. Also cutoff MD value of 0.791 at right substantia nigra and cutoff MD value of 0.813 at left substantia nigra showed significant AUC that could differentiate between cases and controls. Diffusion tensor imaging showed valuable role in evaluation of gray–white matter changes in Parkinson's disease. Also, it helps to assess degree of gray–white matter changes when comparing late parkinsonism to early parkinsonism through evaluation of FA and MD values at corpus callosum, substania nigra, and cingulum.
帕金森病（PD）是最常见的运动障碍，也是第二大神经退行性疾病。我们的研究旨在比较帕金森病（PD）患者与年龄匹配的健康对照组之间的灰白质变化（GWC），并比较帕金森病不同阶段（早期和复杂期）的灰白质变化。我们的研究是一项前瞻性横断面病例对照观察研究，其中包括分析部分，研究对象是 20 名患者和 10 名对照组，他们没有任何帕金森病的症状或体征，一级亲属中也没有任何帕金森病病史。所有患者和对照组均接受了病史采集，重点是静止性震颤、僵直、步态异常、姿势不稳和任何认知障碍症状，以及包括全身检查和神经系统检查在内的临床检查。此外，还对所有病例进行了纤维追踪弥散张量成像（DTI）和感度加权磁共振成像。在 DTI 和分数各向异性（FA）及平均扩散率（MD）值评估方面，PD 病例与健康对照组相比，病例组两侧黑质和左侧脑室的 FA 值显著降低，两侧黑质和胼胝体的 MD 值显著升高。此外，与早期帕金森病相比，晚期帕金森病患者两侧黑质的 FA 值明显下降，两侧黑质和右侧胼胝体的 MD 值明显上升。右侧黑质的FA临界值为0.945，左侧黑质的FA临界值为0.585，显示出显著的AUC，可以区分病例和对照组。此外，右侧黑质的MD临界值为0.791，左侧黑质的MD临界值为0.813，显示出显著的AUC，可区分病例和对照组。弥散张量成像在评估帕金森病患者灰白质变化方面具有重要作用。此外，在比较晚期帕金森病和早期帕金森病时，通过评估胼胝体、黑质和齿状体的 FA 值和 MD 值，有助于评估灰白质变化的程度。
{"title":"Advanced MRI-based evaluation of gray and white matter changes in Parkinson’s disease","authors":"Mohamed Mohsen, Nehal Aboubakr Elsayed Mohamed, Abdelhalim El-Tantawy Mohamed Bedir, Ahmed Abdel Khalek Abdel Razek, Ahmed Effat Abbas Mohamed Saied","doi":"10.1186/s43055-024-01340-w","DOIUrl":"https://doi.org/10.1186/s43055-024-01340-w","url":null,"abstract":"Parkinson’s disease (PD) is the most common movement disorder and the second most common neurodegenerative disease. The aim of our study was to compare gray–white matter changes (GWC) between Parkinson's disease (PD) patients and age-matched healthy control group as well as comparing GWC between different stages of PD (early and complicated). Our study was prospective cross-sectional case–control observational study with analytic component conducted on twenty patients and ten controls without any signs or symptoms of PD or any history of PD in first-degree relatives. All patients and controls were tested for history taking with stress on resting tremors, rigidity, gait abnormalities, postural instability and any symptoms of cognitive impairment, clinical examination including general examination and neurological examination. Also diffusion tensor imaging (DTI) with fiber tracking (tractography) and susceptibility-weighted MR imaging were performed for all cases. As regards DTI and evaluation of fractional anisotropy (FA) and mean diffusivity (MD) values between PD cases and healthy controls, the cases group showed significant decrease in FA values at substantia nigra on both sides and left cingulum as well as significant increase in MD values at substantia nigra on both sides and corpus callosum. Also, there are significant decrease in FA values at substantia nigra on both sides and significant increase in MD values at substantia nigra on both sides and right cingulum in late parkinsonism when compared to early parkinsonism. A cutoff FA value of 0.945 at right substantia nigra and cutoff FA value of 0.585 at left substantia nigra showed significant AUC that could differentiate between cases and controls. Also cutoff MD value of 0.791 at right substantia nigra and cutoff MD value of 0.813 at left substantia nigra showed significant AUC that could differentiate between cases and controls. Diffusion tensor imaging showed valuable role in evaluation of gray–white matter changes in Parkinson's disease. Also, it helps to assess degree of gray–white matter changes when comparing late parkinsonism to early parkinsonism through evaluation of FA and MD values at corpus callosum, substania nigra, and cingulum.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"55 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203341","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}
Rosai–Dorfman disease (RDD)/sinus lymphohistiocytosis is a rare benign lymphoproliferative disorder. Only 25% show extra-nodal manifestation, only 5% are seen involving the CNS, with intraventricular manifestation rarely reported. Our aim was to highlight important imaging features which would be useful in considering this entity as one of the differentials while encountering this rare entity. We present a case of a 34-year-old female with complaints of headache, altered behavior and visual disturbances. MRI brain showed T2 hypointense lesion arising from the left choroid plexus with dense homogenous enhancement, with multiple additional extra-axial dural-based lesions and a small lesion involving right choroid plexus. Left parietal craniotomy was done, and the lesion was excised. Histopathology showed large foamy macrophages in eosinophilic background, with lymphophagocytosis (emperipolesis), confirming the diagnosis of Rosai–Dorfman disease. Intraventricular Rosai–Dorfman disease is a rare entity. Imaging features of T2 hypointense homogenously enhancing lesion with blooming on GRE, without features of calcification or hemorrhage, may be helpful in prompting adequate histopathologic evaluation.
{"title":"Intraventricular presentation of Rosai–Dorfman disease: a case report with review of literature","authors":"Saranya Ravi, Diya Bajaj, Nishtha Yadav, Shailendra Ratre, Sonjjay Pande","doi":"10.1186/s43055-024-01329-5","DOIUrl":"https://doi.org/10.1186/s43055-024-01329-5","url":null,"abstract":"Rosai–Dorfman disease (RDD)/sinus lymphohistiocytosis is a rare benign lymphoproliferative disorder. Only 25% show extra-nodal manifestation, only 5% are seen involving the CNS, with intraventricular manifestation rarely reported. Our aim was to highlight important imaging features which would be useful in considering this entity as one of the differentials while encountering this rare entity. We present a case of a 34-year-old female with complaints of headache, altered behavior and visual disturbances. MRI brain showed T2 hypointense lesion arising from the left choroid plexus with dense homogenous enhancement, with multiple additional extra-axial dural-based lesions and a small lesion involving right choroid plexus. Left parietal craniotomy was done, and the lesion was excised. Histopathology showed large foamy macrophages in eosinophilic background, with lymphophagocytosis (emperipolesis), confirming the diagnosis of Rosai–Dorfman disease. Intraventricular Rosai–Dorfman disease is a rare entity. Imaging features of T2 hypointense homogenously enhancing lesion with blooming on GRE, without features of calcification or hemorrhage, may be helpful in prompting adequate histopathologic evaluation.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"3 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203343","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 : 2024-08-22DOI: 10.1186/s43055-024-01333-9
Sara Mahmoud Ragaee, Alyaa Mohamed Ali EL Shamsy, Mohamed Abdel Ghany Shweel, Ahmed Hussein Kasem, Hassan Ali Ahmed Mahmoud
The importance of high-resolution computed tomography (HRCT) in the diagnosis of idiopathic interstitial pneumonia (IIP) is being recognized more and more. Pulmonary arterial hypertension is common in patients with idiopathic pulmonary fibrosis, the presence of PAH is linked to higher mortality rates and might explain why some people who otherwise have normal pulmonary function are displaying symptoms of deterioration. The aim of this work was to find out the potency of integration of high-resolution computed tomography (HRCT) scoring system with pulmonary artery systolic pressure (PASP) for ascertaining the disease severity of patients with idiopathic pulmonary fibrosis and to predict the prognosis for proper management, along with incorporation of the key disparity of different HRCT scoring systems for the ILD. This prospective study included 80 patients, who came with idiopathic pulmonary fibrosis. A strong positive correlation (r = 0.989) was noted between total lung zone HRCT score and PASP, pulmonary artery size, grades of dyspnea and PCO2. Nonetheless, total lung zone HRCT score proved to have good correlation and inversely proportional to (r = − 0.71) 6MWT, PO2, SPO2, FVC and FEV1/FVC. We utilized a ROC curve to identify the optimal cutoff value in HRCT scoring systems, for detecting pulmonary hypertension associated with the IPF. The sensitivity and specificity of Warrick score cutoff value was higher compared to that of the HRCT scoring system-based grading scale. Both HRCT scoring systems attained high correlation coefficient factors with various incorporated parameters in the study. We can safely say that in order to reveal the severity and prognosis of idiopathic pulmonary fibrosis, a high-resolution computed tomography scoring system should be incorporated with echocardiography measurement of pulmonary artery systolic pressure —which proved to be the most potent predictive factor; especially when measured after a specific HRCT score cutoff value—followed by (FEV1/FVC), the 6MWT and the severity of dyspnea. Their integration collectively will aid in precise management and follow-up of IPF cases. Both HRCT scoring systems proved to be potent and perfect for short-term interval follow-up, yet the Warrick score was easier and faster to use and attained relatively increased sensitivity and specificity for the cutoff value of the pulmonary hypertension detection compared to the HRCT scoring system-based grading scale.
{"title":"Momentousness of integration of the high-resolution computed tomography scoring systems with pulmonary artery systolic pressure measurement for inference of idiopathic pulmonary fibrosis severity","authors":"Sara Mahmoud Ragaee, Alyaa Mohamed Ali EL Shamsy, Mohamed Abdel Ghany Shweel, Ahmed Hussein Kasem, Hassan Ali Ahmed Mahmoud","doi":"10.1186/s43055-024-01333-9","DOIUrl":"https://doi.org/10.1186/s43055-024-01333-9","url":null,"abstract":"The importance of high-resolution computed tomography (HRCT) in the diagnosis of idiopathic interstitial pneumonia (IIP) is being recognized more and more. Pulmonary arterial hypertension is common in patients with idiopathic pulmonary fibrosis, the presence of PAH is linked to higher mortality rates and might explain why some people who otherwise have normal pulmonary function are displaying symptoms of deterioration. The aim of this work was to find out the potency of integration of high-resolution computed tomography (HRCT) scoring system with pulmonary artery systolic pressure (PASP) for ascertaining the disease severity of patients with idiopathic pulmonary fibrosis and to predict the prognosis for proper management, along with incorporation of the key disparity of different HRCT scoring systems for the ILD. This prospective study included 80 patients, who came with idiopathic pulmonary fibrosis. A strong positive correlation (r = 0.989) was noted between total lung zone HRCT score and PASP, pulmonary artery size, grades of dyspnea and PCO2. Nonetheless, total lung zone HRCT score proved to have good correlation and inversely proportional to (r = − 0.71) 6MWT, PO2, SPO2, FVC and FEV1/FVC. We utilized a ROC curve to identify the optimal cutoff value in HRCT scoring systems, for detecting pulmonary hypertension associated with the IPF. The sensitivity and specificity of Warrick score cutoff value was higher compared to that of the HRCT scoring system-based grading scale. Both HRCT scoring systems attained high correlation coefficient factors with various incorporated parameters in the study. We can safely say that in order to reveal the severity and prognosis of idiopathic pulmonary fibrosis, a high-resolution computed tomography scoring system should be incorporated with echocardiography measurement of pulmonary artery systolic pressure —which proved to be the most potent predictive factor; especially when measured after a specific HRCT score cutoff value—followed by (FEV1/FVC), the 6MWT and the severity of dyspnea. Their integration collectively will aid in precise management and follow-up of IPF cases. Both HRCT scoring systems proved to be potent and perfect for short-term interval follow-up, yet the Warrick score was easier and faster to use and attained relatively increased sensitivity and specificity for the cutoff value of the pulmonary hypertension detection compared to the HRCT scoring system-based grading scale.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"49 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203347","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 : 2024-08-19DOI: 10.1186/s43055-024-01314-y
Mostafa Elmansy, Noha Magdi, Mohammed A. Elhawary, Amina Sultan
Whole-body magnetic resonance imaging (WB-MRI) has shown its accuracy in the diagnosis of skeletal metastases in patients with known primary solid cancers. The standard protocol was a combination of T1 and short tau inversion recovery (STIR) sequences. Herein, this study was conducted to elucidate the role of the T2-Dixon sequence as a rapid alternative to the standard protocol with the assessment of its diagnostic accuracy and comparability to the established methodology. This prospective study included 30 patients with primary solid malignancies who underwent WB-MRI. The sequences obtained were T1WI, STIR, and T2-Dixon (fat-only and water-only images). Skeletal metastases were evaluated in each sequence. Results were compared between the T1-STIR combination and T2-Dixon fat and water reconstructions. The sensitivity of fat and water reconstructions from a single T2-Dixon in the detection of lytic skeletal metastases was marginally superior to a combination of T1WI and STIR sequences (0–7%). Detection of mixed lesions demonstrated equally high sensitivity in both protocols. Sclerotic metastases detection in WB-MRI showed low sensitivity in both protocols. However, specificity surpassed 95% for all lesion types in both protocols. Overall image quality was favored (in 87–90% of patients) in T2-Dixon images. The overall estimated acquisition timing using T2-Dixon appeared to be approximately half that of the standard T1-STIR combination. WB-MRI using T2-Dixon fat and water reconstructions showed similar accuracy to T1WI and STIR combination in the evaluation of skeletal metastases in patients with primary solid cancers with significantly shorter acquisition time.
{"title":"Can a fast T2-Dixon sequence surpass the time obstacle of whole-body MRI in the evaluation of skeletal metastases?","authors":"Mostafa Elmansy, Noha Magdi, Mohammed A. Elhawary, Amina Sultan","doi":"10.1186/s43055-024-01314-y","DOIUrl":"https://doi.org/10.1186/s43055-024-01314-y","url":null,"abstract":"Whole-body magnetic resonance imaging (WB-MRI) has shown its accuracy in the diagnosis of skeletal metastases in patients with known primary solid cancers. The standard protocol was a combination of T1 and short tau inversion recovery (STIR) sequences. Herein, this study was conducted to elucidate the role of the T2-Dixon sequence as a rapid alternative to the standard protocol with the assessment of its diagnostic accuracy and comparability to the established methodology. This prospective study included 30 patients with primary solid malignancies who underwent WB-MRI. The sequences obtained were T1WI, STIR, and T2-Dixon (fat-only and water-only images). Skeletal metastases were evaluated in each sequence. Results were compared between the T1-STIR combination and T2-Dixon fat and water reconstructions. The sensitivity of fat and water reconstructions from a single T2-Dixon in the detection of lytic skeletal metastases was marginally superior to a combination of T1WI and STIR sequences (0–7%). Detection of mixed lesions demonstrated equally high sensitivity in both protocols. Sclerotic metastases detection in WB-MRI showed low sensitivity in both protocols. However, specificity surpassed 95% for all lesion types in both protocols. Overall image quality was favored (in 87–90% of patients) in T2-Dixon images. The overall estimated acquisition timing using T2-Dixon appeared to be approximately half that of the standard T1-STIR combination. WB-MRI using T2-Dixon fat and water reconstructions showed similar accuracy to T1WI and STIR combination in the evaluation of skeletal metastases in patients with primary solid cancers with significantly shorter acquisition time.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"402 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203346","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}
The characterization of pathologically enlarged mediastinal lymph nodes is clinically essential for effective disease management and accurate prognosis. Malignancy (metastases and lymphoma) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. Magnetic resonance imaging (MRI) is a good modality to characterize the mediastinal pathologically enlarged lymph nodes based on the excellent soft tissue contrast. It can save high-risk patients from radiation exposure and hazards of intervention such as general anesthesia and biopsy. To estimate the accuracy of different advanced MRI quantitative parameters in the differentiation between benign and malignant mediastinal lymphadenopathy. This would involve the lesion-to-cord signal intensity ratio (SIR) in the T2-WI and diffusion weighted image (DWI), the lesion-to-chest wall muscle SIR in T2-WI and DWI, and the mean apparent diffusion coefficient (ADC) values. These values would be correlated with the prospective pathological data and the results of the positron emission tomography (PET-CT). Prospectively, the study was conducted during the period between June 2022 and September 2023 on 45 patients with indeterminate or suspicious mediastinal lymphadenopathy identified by CT. MRI examination, PET-CT, and biopsy were applied for all patients. The intra-class correlation coefficient ranged between 0.89 and 0.95. (A) The lesion-to-cord SIR in T2-WI in the malignant group (1.49 ± 0.30) was higher than that in the benign group (0.83 ± 0.24) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 90% sensitivity, 100% specificity, with AUC = 0.989. (B) The lesion-to-chest wall muscle SIR in T2-WI in malignant nodes (3.13 ± 0.84) was significantly higher than that in the benign nodes (1.90 ± 0.80) with P < 0.001. The statistically calculated cutoff value (> 2.4) estimated 86.67% sensitivity, 86.67% specificity, with AUC = 0.88. (C) The lesion-to-cord signal SIR in b500-DWI in the malignant node (1.80 ± 0.54) was higher than that in the benign group (0.75 ± 0.29) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. (D) The lesion-to-chest wall SIR in b500-DWI in the malignant node (6.43 ± 1.28) was higher than that in the benign node (2.63 ± 0.94) with P < 0.001. The statistically calculated cutoff value (> 4.1) estimated 96.67% sensitivity, 100% specificity, with AUC = 0.997. € The mean ADC values in the malignant nodes (0.83 ± 0.20 × 10–3 mm2/s) were significantly lower than that in the benign nodes (1.85 ± 0.19 × 10−3 mm2/s) with P < 0.001. The statistically calculated cutoff value (≤ 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. Biopsy remains the main diagnostic modality for the characterization of mediastinal lymphadenopathy despite its hazards and limitations. This study proved that MRI could be accepted as an alternative non-invasive imaging tool that can overco
{"title":"The dilemma of mediastinal lymphadenopathy between invasive and non-invasive procedures: ROC analysis of T2WI and DWI-MRI advanced parameters correlated with PET-CT and biopsy","authors":"Hadeer Elkelawy, Adel Rizk, Abdelaziz Elnekeidy, Ayman Baess, Mohamed Meheissen, Ahmed Samir","doi":"10.1186/s43055-024-01331-x","DOIUrl":"https://doi.org/10.1186/s43055-024-01331-x","url":null,"abstract":"The characterization of pathologically enlarged mediastinal lymph nodes is clinically essential for effective disease management and accurate prognosis. Malignancy (metastases and lymphoma) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. Magnetic resonance imaging (MRI) is a good modality to characterize the mediastinal pathologically enlarged lymph nodes based on the excellent soft tissue contrast. It can save high-risk patients from radiation exposure and hazards of intervention such as general anesthesia and biopsy. To estimate the accuracy of different advanced MRI quantitative parameters in the differentiation between benign and malignant mediastinal lymphadenopathy. This would involve the lesion-to-cord signal intensity ratio (SIR) in the T2-WI and diffusion weighted image (DWI), the lesion-to-chest wall muscle SIR in T2-WI and DWI, and the mean apparent diffusion coefficient (ADC) values. These values would be correlated with the prospective pathological data and the results of the positron emission tomography (PET-CT). Prospectively, the study was conducted during the period between June 2022 and September 2023 on 45 patients with indeterminate or suspicious mediastinal lymphadenopathy identified by CT. MRI examination, PET-CT, and biopsy were applied for all patients. The intra-class correlation coefficient ranged between 0.89 and 0.95. (A) The lesion-to-cord SIR in T2-WI in the malignant group (1.49 ± 0.30) was higher than that in the benign group (0.83 ± 0.24) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 90% sensitivity, 100% specificity, with AUC = 0.989. (B) The lesion-to-chest wall muscle SIR in T2-WI in malignant nodes (3.13 ± 0.84) was significantly higher than that in the benign nodes (1.90 ± 0.80) with P < 0.001. The statistically calculated cutoff value (> 2.4) estimated 86.67% sensitivity, 86.67% specificity, with AUC = 0.88. (C) The lesion-to-cord signal SIR in b500-DWI in the malignant node (1.80 ± 0.54) was higher than that in the benign group (0.75 ± 0.29) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. (D) The lesion-to-chest wall SIR in b500-DWI in the malignant node (6.43 ± 1.28) was higher than that in the benign node (2.63 ± 0.94) with P < 0.001. The statistically calculated cutoff value (> 4.1) estimated 96.67% sensitivity, 100% specificity, with AUC = 0.997. € The mean ADC values in the malignant nodes (0.83 ± 0.20 × 10–3 mm2/s) were significantly lower than that in the benign nodes (1.85 ± 0.19 × 10−3 mm2/s) with P < 0.001. The statistically calculated cutoff value (≤ 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. Biopsy remains the main diagnostic modality for the characterization of mediastinal lymphadenopathy despite its hazards and limitations. This study proved that MRI could be accepted as an alternative non-invasive imaging tool that can overco","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"2 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203378","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 : 2024-08-19DOI: 10.1186/s43055-024-01334-8
Hamza Retal, Soumya EL Graini, Hafsa EL Ouazzani, Nadia Cherradi, Meriem Fikri, Najwa Echcherif El Kettani, Mohamed Jiddane, Firdaous Touarsa
Cauda equina syndrome is a surgical emergency caused by the compression of the lumbosacral nerves. The most frequent cause is discal herniation, while tumoral pathology in this region is rare, and congenital processes are less common. We report the case of a young 37-year-old male patient, admitted to the emergency room with an incomplete cauda equina syndrome. As medical history, a lumbar surgery 15 years ago was reported with no documentation. An MRI was performed, revealing a mass within the filum terminal exhibiting three components suggestive of a dermoid cyst accompanying a split cord malformation, which was confirmed by pathology. Various disorders may be associated to intradural dermoid cyst, such as lipoma, low-lying cord, hydromyelia or thick filum. Surgery is the treatment of choice, and MRI plays a crucial role in detecting associated abnormalities and determining surgery priorities.
{"title":"Unusual cause of incomplete cauda equina syndrome: dermoid cyst with a split cord malformation case report","authors":"Hamza Retal, Soumya EL Graini, Hafsa EL Ouazzani, Nadia Cherradi, Meriem Fikri, Najwa Echcherif El Kettani, Mohamed Jiddane, Firdaous Touarsa","doi":"10.1186/s43055-024-01334-8","DOIUrl":"https://doi.org/10.1186/s43055-024-01334-8","url":null,"abstract":"Cauda equina syndrome is a surgical emergency caused by the compression of the lumbosacral nerves. The most frequent cause is discal herniation, while tumoral pathology in this region is rare, and congenital processes are less common. We report the case of a young 37-year-old male patient, admitted to the emergency room with an incomplete cauda equina syndrome. As medical history, a lumbar surgery 15 years ago was reported with no documentation. An MRI was performed, revealing a mass within the filum terminal exhibiting three components suggestive of a dermoid cyst accompanying a split cord malformation, which was confirmed by pathology. Various disorders may be associated to intradural dermoid cyst, such as lipoma, low-lying cord, hydromyelia or thick filum. Surgery is the treatment of choice, and MRI plays a crucial role in detecting associated abnormalities and determining surgery priorities.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203344","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 : 2024-08-13DOI: 10.1186/s43055-024-01325-9
Anusha Rudrakshi, Praveenkumar Ramdurg, S. Naveen
A tongue abscess is a rare but serious condition marked by a localized accumulation of pus within the tongue’s tissues. Despite the tongue’s frequent exposure to trauma, bites, and foreign objects, it typically resists infections. However, an acute lingual abscess can be life-threatening due to the risk of airway obstruction from tongue swelling. Common symptoms include increasing pain, fever, swelling, immobility, edema, and redness of the tongue. The case report aimed to highlight the unusual clinical presentation and location of a deep-seated abscess in the anterior third of the tongue, as well as the radiographic approach to diagnosing the lesion. A 30-year-old female patient presented with sudden onset tongue pain and swelling persisting for 4–5 days. Clinical examination revealed a solitary diffuse swelling in the anterior two-thirds of the tongue, approximately 3 × 2 cm in size. Diagnostic imaging, including a plain radiograph, ultrasound (USG), and MRI, was conducted. The patient was hospitalized for incision and drainage of the abscess, followed by a 5-day course of intravenous antibiotics. A tongue abscess, though rare, is a serious condition indicated by tongue swelling, pain, fever, dysphagia, and dyspnea. Diagnosis involves physical examinations and imaging studies like ultrasound or MRI. Immediate treatment includes maintaining airway patency, draining the abscess, and administering broad-spectrum antibiotics. Prompt recognition and treatment are essential to prevent severe complications such as airway obstruction and sepsis. Regular follow-up ensures complete resolution and prevents recurrence.
{"title":"Swollen speech: a case study of tongue abscess detected via imaging technology","authors":"Anusha Rudrakshi, Praveenkumar Ramdurg, S. Naveen","doi":"10.1186/s43055-024-01325-9","DOIUrl":"https://doi.org/10.1186/s43055-024-01325-9","url":null,"abstract":"A tongue abscess is a rare but serious condition marked by a localized accumulation of pus within the tongue’s tissues. Despite the tongue’s frequent exposure to trauma, bites, and foreign objects, it typically resists infections. However, an acute lingual abscess can be life-threatening due to the risk of airway obstruction from tongue swelling. Common symptoms include increasing pain, fever, swelling, immobility, edema, and redness of the tongue. The case report aimed to highlight the unusual clinical presentation and location of a deep-seated abscess in the anterior third of the tongue, as well as the radiographic approach to diagnosing the lesion. A 30-year-old female patient presented with sudden onset tongue pain and swelling persisting for 4–5 days. Clinical examination revealed a solitary diffuse swelling in the anterior two-thirds of the tongue, approximately 3 × 2 cm in size. Diagnostic imaging, including a plain radiograph, ultrasound (USG), and MRI, was conducted. The patient was hospitalized for incision and drainage of the abscess, followed by a 5-day course of intravenous antibiotics. A tongue abscess, though rare, is a serious condition indicated by tongue swelling, pain, fever, dysphagia, and dyspnea. Diagnosis involves physical examinations and imaging studies like ultrasound or MRI. Immediate treatment includes maintaining airway patency, draining the abscess, and administering broad-spectrum antibiotics. Prompt recognition and treatment are essential to prevent severe complications such as airway obstruction and sepsis. Regular follow-up ensures complete resolution and prevents recurrence.","PeriodicalId":11540,"journal":{"name":"Egyptian Journal of Radiology and Nuclear Medicine","volume":"464 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226078","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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