assiut medical j vol 17 no 2 march 1993 mohsen m abdellatif ibtisam m h elmileegy m s hasanein
To compare the visual, refractive and topographic outcomes of standard and accelerated corneal collagen cross-linking (CXL) in pediatric keratoconus patients.
Prospective, comparative observational study on 68 eyes of 35 pediatric keratoconus patients (<18 years). Patients were classified into two groups, group (I) included 34 eyes and received standard “Epi-Off” CXL (3 mW/cm2, 30 min.) and group (II) included 34 eyes and received accelerated “Epi-Off” CXL (9 mW/cm2, 10 min.). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), simulated keratometry (Sim K-1, Sim K-2, K-max, K-mean), cylindrical (CYL), pachymetry and Q-value were evaluated preoperatively and for 3 years postoperatively.
Postoperative UDVA and CDVA did not significantly change in both groups after 3 years. Postoperative SE was increased significantly in accelerated CXL (p=0.012) with no significant change in the postoperative cylinder in both procedures. Standard CXL had greater “significant” effect in decreasing Sim K-1, K-max and K-mean. The mean reduction in postoperative corneal pachymetry (at thinnest location) was significant in standard CXL (18.4 μm) (p=0.001). No significant change was noticed in postoperative Q-value.
Standard and accelerated CXL protocols are efficient in pediatric keratoconus management with better outcomes in the standard procedure.
Purpose. To provide quantitative measurements for the foveal avascular zone (FAZ) and to describe its morphological characteristics by optical coherence tomography angiography (OCT-A). Design. Cross-sectional observational case series. Methods. Healthy volunteers were recruited and evaluated using Triton-DRI SS-OCT Angiography. A 4.5 × 4.5 mm square was evaluated by OCT-A center around the fovea. Superficial and deep capillary plexus were identified, and different quantitative measurements were conducted along with categorization of the FAZ pattern. Results. Eighty-two eyes (41 volunteers) were evaluated. Mean age was 30.59 ± 7.6 years (23–42 years). Mean subcentral retinal thickness was 200.1 ± 5.66 um (192–210 um). The number of terminal vessels was variable (range, 8–11). Mean maximum terminal vessel-to-vessel intervening distance was 527.8 ± 60.3 um (471–674 um). Mean minimum terminal vessel-to-vessel intervening distance was 296.7 ± 45.8 um (233–373 um). Mean maximum horizontal diameter of FAZ (superficial) was 716.17 ± 124.09 um, while mean maximum vertical diameter of FAZ (superficial) was 667.76 ± 131.28 um. Mean maximum horizontal diameter of FAZ (deep) was 823.19 ± 144.92 um, while mean maximum vertical diameter of FAZ (deep) was 794.03 ± 150.28 um. OCT-A detected different FAZ patterns; horizontally oval configuration in 32 eyes (39%), rounded configuration in 24 eyes (29.3%), pentagon configuration in 14 eyes (17.1%), and vertically oval and nonspecific configuration in 6 eyes each (7.3%). Conclusion. OCT-A could efficiently provide both
Abstract:
Background: Hepatic steatosis has been shown to worsen the course of liver disease in chronic hepatitis C (CHC) patients, it may reduce the efficacy of antiviral therapy and accelerate disease progression. In this cross-sectional study, we aimed to evaluate the role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the quantitative assessment and grading of hepatic steatosis to evaluate the association between hepatic steatosis and fibrosis in Egyptian genotype 4-CHC (G4-CHC) patients.
Results: Histopathological hepatic steatosis was found in 70.3% of patients. No correlation was found between the CT ratio and pathological hepatic steatosis. Proton-density fat fraction, T1-fat fraction and fat percentage correlated with histological steatosis grading (r=0.953, p< 0.001; r=0.380,p=0.027 and r=0.384, p=0.025 respectively).An agreement between steatosis grading by histology and 1H-MRS was found in 74.2% of patients. Compared to other MRI modalities, proton-density fat fraction had the highest area under the receiver operating characteristic curve (AUC), with 0.910,0.931, and 0.975 for mild, moderate, and severe steatosis respectively. The cut-off with the best ability to predict steatosis was>4.95 for a proton-density fat fraction (AUC=0.958) with 95.8% sensitivity, 90% specificity, 78.5% positive predictive value and 96.1% negative predictive value.
Conclusion:1H-MRS had good diagnostic performance in predicting hepatic steatosis in G4-CHC patients and hence it may offer a useful-noninvasive quantitative modality for grading of steatosis with clinical applicability especially in those where a liver biopsy cannot be done.
Abstract:
Background: We Explored the strength and weaknesses of Multi-detector computed tomography (MDCT) and Magnetic resonance imaging (MRI) in preoperative evaluation of cochlear implant candidates.
Methods: A retrospective study including 13 adults and 38 pediatric patients who suffered from bilateral profound sensory neural hearing loss (SNHL) and underwent MDCT and MRI examination as a preoperative assessment for cochlear implant procedure. All patients underwent high-resolution spiral MDCT (128-slice) and 1.5 T MRI examination. Notes of history and physical ear examination, audiometry results, and operative data were collected and compared with imaging findings.
Results: MDCT was superior in demonstration of middle ear disease while MRI was more useful in delineation of the cochlear nerve and cochlear patency and detection of central causes of SNHL . Only 15% of adult patients had a positive clinical concern and showed positive imaging findings. All adult patient that had no clinical concern showed no significant imaging findings. About 36.8% of pediatric patients had a positive clinical concern and showed positive imaging findings. About 33.3% of pediatric patients who had no clinical concern showed positive imaging findings. The surgical plan was changed based on combined imaging findings in 15.4% of adult patients and 39.4% of pediatric patients.
Conclusion: Multi-detector computed tomography and Magnetic resonance imaging are useful in the evaluation of congenital anomalies of inner ear. MRI is superior in the evaluation of cochlear nerve ,early detection of labyrinthine fibrosis and detection of intrauterine causes of SNHL. MDCT is helpful in evaluation of middle ear pathology and enables detailed evaluation of osseous anatomy. Integrative employment of both modalities in preoperative assessment of cochlear implant candidates is recommended.
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
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