Abstract:

Background: Coronavirus disease (COVID-19) is a respiratory syndrome with a variable degree of severity. Imaging is a vital component of disease monitoring and follow-up in coronavirus pulmonary syndromes. The study of temporal changes of CT findings of COVID-19 pneumonia can help in better understanding of disease pathogenesis and prediction of disease prognosis. In this study we aim to determine the typical and atypical CT imaging features of COVID-19 and discuss the association of typical CT imaging features with the duration of the presenting complaint and patients’ age.

Results: The lesions showed unilateral distribution in 20% of cases and bilateral distribution in 80% of cases. The lesions involved the lower lung lobes in 30% of cases and showed diffuse involvement in 58.2 % of cases. The lesions showed peripheral distribution in 74.5% of cases. The most common pattern was multifocal ground glass opacity found in 72.7% of cases. Atypical features like cavitation and pleural effusion can occur early in the disease course There was significant association between increased number of the lesions, bilaterality, diffuse pattern of lung involvement and older age group (≥ 50 years old) and increased duration of presented complaint (≥4 days). There was significant association between crazy paving pattern and increased duration of presenting complaint. No significant association could be detected with any CT pattern and increased patient age.

Conclusion: The most common CT feature of COVID-19 was multifocal ground glass opacity. Atypical features like cavitation and pleural effusion can occur early in the course of the disease. Our cases showed more extensive lesions with bilateral and diffuse pattern of distribution in older age group and with increased duration of presenting complaint. There was significant association between crazy paving pattern and increased duration of presenting complaint. No significant association could be detected with any CT pattern and increased patient age.

Abstract:

Background:

High-resolution computed tomography (HRCT) is the most accepted imaging tool for the detection, characterization, and monitoring of interstitial lung diseases (ILDs). The correct interpretation of HRCT findings still often represents a problem for the radiologists since there is wide interobserver variability. Therefore, a quantitativeand non-invasive imaging method able to permit an accurate assessment of ILD is highly desirable. The purpose of this study is to compare the visual method and quantitative CT histogram in the evaluation of ILDs and to identify the best quantitative parameter in the prediction of severity of ILDs.

Results:

There is a correlation between the HRCT score by the qualitative method and CT histogram parameters by the quantitative method in the evaluation of ILDs. Total lung volume inspiratory, mean lung density expiratory, and high attenuation area expiratory showed a significant correlation with the HRCT score.

Conclusion:

The single best predictor of fibrosis severity in interstitial lung disease is HAAs % expiratory.

Abstract:

Background: Asymmetric breast density is a potentially perplexing finding; it may be due to normal hormonal variation of the parenchymal pattern and summation artifact or it may indicate an underlying true pathology. The current study aimed to identify the role of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values in the assessment of breast asymmetries.

Results: Fifty breast lesions were detected corresponding to the mammographic asymmetry. There were 35 (70%) benign lesions and 15 (30%) malignant lesions. The mean ADC value was 1.59 ± 0.4 × 10–3 mm2 /s for benign lesions and 0.82 ± 0.3 × 10–3 mm2 /s for malignant lesions. The ADC cutoff value to differentiate between benign and malignant lesions was 1.10 × 10–3 mm2 /s with sensitivity 80%, specificity 88.6%, positive predictive value 75%, negative predictive value 91%, and accuracy 86%. Best results were achieved by implementation of the combined DCE-MRI and DWI protocol, with sensitivity 93.3%, specificity 94.3%, positive predictive value 87.5%, negative predictive value 97.1%, and accuracy 94%.

Conclusion: Dynamic contrast-enhanced MRI (DCE-MRI) was the most sensitive method for the detection of the underlying malignant pathology of breast asymmetries. However, it provided a limited specificity that may cause improper final BIRADS classification and may increase the unnecessary invasive procedures. DWI was used as an adjunctive method to DCE-MRI that maintained high sensitivity and increased specificity and the overall diagnostic accuracy of breast MRI examination. Best results can be achieved by the combined protocol of DCE-MRI and DWI.

Abstract:

Background: To investigate the role of dynamic Magnetic Resonance Imaging (MRI) in diagnosing and assessing the severity of Acute Pancreatitis (AP) patients and role out pancreatic necrosis. Aim of Study: The aim of the study was to determine the effectiveness of dynamic MRI in the diagnosis of AP and assessing the severity of AP by detection and delineation of extension of pancreatic necrosis in comparison to clinical scoring systems. Material and Methods: Thirty four patients with clinical diagnosis of acute pancreatitis underwent magnetic resonance imaging using 1.5T machine include T1, T2 weighted imaging, SPAIR and dynamic contrast. Magnetic Resonance Severity Index (MRSI) was used to assess the severity and correlated with clinical scoring based on revised Atlanta classification and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Results: T2-SPAIR is the best sequence to diagnose AP. The MRSI significantly correlates with both revised Atlanta and APACHE II scores in differentiating mild cases of AP from moderate edematous and severe necrotizing cases. Conclusion: Dynamic MRI help to diagnose mild forms of AP and differentiate it from other causes of abdominal pain. MRI can be used in combination with clinical scoring for diagnosis of AP and accurate assessment of disease severity.

Abstract:  Objectives :

To determine the value of quantitative parameters of gadoxetate-enhanced magnetic resonance imaging (MRI) in predicting prognosis in patients with cirrhosis.

Methods : A cohort of 63 cirrhotic patients who had gadoxetate MRI and 2-year clinical follow-up was enrolled. Enhancement ratio (ER), contrast enhancement index (CEI) and contrast enhancement spleen index (CES) were calculated. The usefulness of these parameters and clinical scores, such as Child-Pugh score (CPS) and model for end stage liver disease (MELD), in predicting adverse outcomes, such as variceal bleeding (VB), hepatic encephalopathy (HE) and mortality at 2 years were evaluated.

Results : Fifteen, 31 and 27 patients, respectively, had VB, HE and mortality within 2 years. The ER at 15 min (ER 15) and CES at 20 min (CES 20) were found to be the best MRI predictors. Areas under the receiver operating characteristic curve (AUC) for predicting VB were 0.785, 0.729, 0.673, 0.714, respectively, for ER 15, CES 20, CPS and MELD scores. ER 15 of less than 48 had sensitivity of 96% and specificity of 84% for predicting onset of HE within 2 years.

Conclusions In patients with cirrhosis, ER 15 or CES 20 were equivalent or better predictors of major morbidity and mortality compared with commonly used clinical scores.

Keywords: Liver cirrhosis . Patient outcome assessment . Magnetic resonance imaging Gadolinium . Hepatic encephalopathy

Objective: To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease.

Methods: Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1–2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (D_fast), true diffusion coefficient (D_slow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey–Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard.

Results: The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/ 49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for D_fast and D_slow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between D_fast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between D_fast and fibrosis. On ROC curve analysis, D_fast< 23.4 9 10-3 mm2 /s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis.

Conclusion: D_fast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.

Key words: MRI—Hepatic fibrosis—Hepatic steatosis—Hepatitis—IVIM

m s abdel raheem  m s hasnein   s  m a omar  m g abdelraheem  s r helal  egyp  j  anaesthesia    january  3 th   2004

m s hasanein  golnar m fathy  moh m abdel latif  j e s m p vol 21 no 2  october  2003      95   101

Objectives

Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm via left thoracotomy when proximal crossclamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center.

Methods

Between January 2008 and May 2018, 84 patients with DTAA or Crawford extent I thoracoabdominal aortic aneurysm underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I thoracoabdominal aortic aneurysm. Patients who underwent DHCA had more chronic dissections than those in the non …

Objective

Valve‐sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type‐A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD.

Methods

We retrospectively reviewed 24 consecutive patients (2002–2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow‐up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise.

Results

Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7 …