Evaluation of Magnetic Resonance Imaging of the Chest at a Cancer Center

Objective: In the present article, we will describe the indications for chest MRI in patients diagnosed with malignancy and its relevant role in distinguishing benign from malignant lesions and in detecting metastases. Materials and methods: Single-center, retrospective, analytical imaging and chart-review study of all patients with a diagnosis of cancer who underwent chest MRI at the Imaging Department of A.C. Camargo Cancer Center from January 2014 through December 2016. Information was collected through an electronic questionnaire and exported to a Microsoft Excel spreadsheet. Data were then processed in Action Stat 3 software. Descriptive analysis was conducted with conventional measures of central tendency (mean, median, mode) and dispersion (range, variance, standard deviation, and coefficient of variation), as well as calculation of absolute and relative frequencies. Results: The leading indication for chest MRI was post-treatment follow-up. Chest MRI was most often requested by the Departments of Thoracic Surgery and Clinical Oncology. In most cases, the results of chest MRI led to maintenance of the current treatment plan rather than a change in management. Conclusion: Magnetic resonance imaging has several applications in evaluation of the chest, and can be used by various specialties and subspecialties. In the present study, post-treatment follow-up and maintenance of current therapy were the most common indication and management, respectively.

The brainstem in multiple sclerosis: MR identification of tracts and nuclei damage

Objective To evaluate the 3D Fast Gray Acquisition T1 Inversion Recovery (FGATIR) sequence for MRI identification of brainstem tracts and nuclei damage in multiple sclerosis (MS) patients. Methods From april to december 2020, 10 healthy volunteers and 50 patients with remitted-relapsing MS (58% female, mean age 36) underwent MR imaging in the Neuro-imaging department of the C.H.N.O. des Quinze-Vingts, Paris, France. MRI was achieved on a 3 T system (MAGNETOM Skyra) using a 64-channel coil. 3D FGATIR sequence was first performed on healthy volunteers to classify macroscopically identifiable brainstem structures. Then, FGATIR was assessed in MS patients to locate brainstem lesions detected with Proton Density/T2w (PD/T2w) sequence. Results In healthy volunteers, FGATIR allowed a precise visualization of tracts and nuclei according to their myelin density. Including FGATIR in MR follow-up of MS patients helped to identify structures frequently involved in the inflammatory process. Most damaged tracts were the superior cerebellar peduncle and the transverse fibers of the pons. Most frequently affected nuclei were the vestibular nuclei, the trigeminal tract, the facial nerve and the solitary tract. Conclusion Combination of FGATIR and PD/T2w sequences opened prospects to define MS elective injury in brainstem tracts and nuclei, with particular lesion features suggesting variations of the inflammatory process within brainstem structures. In a further study, hypersignal quantification and microstructure information should be evaluated using relaxometry and diffusion tractography. Technical improvements would bring novel parameters to train an artificial neural network for accurate automated labeling of MS lesions within the brainstem.

Role of CT Angiography in Diagnosis of Reno-Vascular Abnormalities

Background: Reno-vascular disease is a complex disorder, the most common cause of which is RAS. Multi detector computed tomography angiography (MDCTA) plays an important role in assessment of the renal vasculature. Despite conventional angiography is still considered the gold standard in reno-vascular imaging, MDCTA is increasingly used as it is less invasive, easily applicable and available. Aim of the Study: In our study we aimed to assess the role of CT Angiography in diagnosis of renal vasculature abnormalities. Patients and Methods: This prospective study was carried out at The Radio-diagnosis and Medical Imaging Department in our institute, conducted on 40 Patients who are clinically suspected to have reno-vascular abnormalities in the period from September 2018 to February 2021. Their ages ranged from 33 to 56 years old. Results: Based on CTA findings, out of 40 patients, 6 (15%) patients were confirmed to have accessory renal arteries, 6 (15%) patients had renal artery aneurysm, 6 (15%) patients had nutcracker syndrome, 6 (15%) patients had dual venous drainage of both kidneys, two of them showed retro-aortic left renal vein &10 (25%) patients were confirmed to have renal artery stenosis. Conclusion: CT Angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with reno-vascular lesions involving the proximal renal vessels. MDCT angiography is advantageous being a non-invasive technique that can be done on outpatient basis without pre or post-procedure admission, no special post-procedure care and less cost.

Role of MRI in Cerebral Venous Thrombosis

Background Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases. Aim of the Work The aim of this subject is to illustrate the various aspects of CVT on MRI. Patients and Methods This is a retrospective study included 30 patients (19 females &11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 & September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis. Results In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients. Conclusion Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI & DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension

Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study

Background There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. Methods We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter. Results The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter. Conclusion To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.

6 The Value of Ultrasound in Diagnosing Acute Appendicitis

Aim The diagnosis of acute appendicitis relies on a thorough history and examination and can often be challenging. Ultrasound is widely considered to be the most appropriate first line investigation; however non-diagnostic ultrasounds are not uncommon and do lead to delays in diagnosis and/or definitive treatment by creating a need for further clinical assessment. The purpose of this study was to determine the sensitivity and specificity of ultrasound diagnosis of appendicitis in patient treated at Doncaster Royal Infirmary, and to determine the local negative appendicectomy rate. Method This was a retrospective analysis of 99 patients undergoing appendicectomy, with a prior ultrasound abdomen within one week of the procedure being undertaken. Data was collected from review of patient's hospital medical records (discharge summaries, clinic letters, PACs). Results 99 patient aged 8-76 years were studied. Male to female ratios was 3:1. The sensitivity and specificity of ultrasound was 16% (95% CI - 7% to 29%) and 96% (95% CI - 86% to 99%) respectively with PPV of 80% and NPV of 52%. The accuracy of ultrasound diagnosis was found to be 55% (95% CI 44% to 65%). The negative appendicectomy rate was 48%. Conclusions From our study, ultrasound cannot reliably identify nor exclude appendicitis. Less than 16% of patients who had proven appendicitis (positive histology) had scans that indicated. Almost 50% of the normal/indeterminate scans were false negatives. Furthermore, 20% of positive ultrasound reports were false positives. A collaborative quality improvement project with the imaging department is planned to address these findings.

Radiographers’ Knowledge Versus Practice about Methods of Attracting Pediatric Corporation in Medical Imaging Departments

Purpose: The goal of this study was to evaluate radiographers’ knowledge and practice on different methods for attracting pediatrics’ cooperation in medical imaging departments for achieving high-quality images without repetition and minimum absorbed dose. Materials and Methods: For conducting this descriptive-analytical study, a researcher-made questionnaire, including two parts of radiographer knowledge and practical methods, which were applied as a routine in the departments for reduction of pediatrics’ stress, was distributed between radiographers. Results: The results revealed that verbal justification was declared as the most efficient way of informing the parents as compared to the other methods. Establishing verbal communication is the most practical way of engaging the child. Meanwhile, application of immobilization tools, justification of parents by the admission staff, playing music was used, respectively. Conclusion: Considering these findings, there is a need to equip the imaging department with the appropriate facilities, perform continuous training of radiographers to increase the practice of different techniques and tools.

ROLE OF MRI IN GYNECOLOGICAL EMERGENCIES

AIM: The aim of this study was to assess the emerging role of magnetic resonance imaging in the gynaecological emergencies. MATERIALS AND METHODS: Methods: Twenty nine non pregnant female patients with acute pelvic pain or bleeding per vagina who underwent MRI pelvis at our imaging department between November 2019 and August 2020 were reviewed. The final diagnosis was established by surgical findings in 16 cases, & biopsy in 1 respectively. The remaining 11 cases underwent follow-up MRI. Results: MRI was diagnostic in 28 (95.5%) out of 29 patients and non-diagnostic in 1 case. The commonest gynaecological emergency was ovarian cyst with complications. Imaging findings in 16 (55.2%) patients were correlated with surgery . The overall sensitivity and PPV of MRI in acute gynaecological conditions was 95.6% and 98.2%.

Ultrasonographic Assessment of Retroverted Gravid Uterus and First Trimester Pregnancy loss of women in a semi-urban area of Dhaka, Bangladesh

Ultrasonography is a safe and effective method of diagnosing early pregnancy and determining the position of the gravid uterus. In our study, 2080 pregnant women with amenorrhea for three months and a positive pregnancy test were chosen. The study was conducted in the Radiology & Imaging department of Failaria & General Hospital from Jan 2016 to Dec 2019. Descriptive statistics were used to compute percentages and averages. Results were presented in tables and charts and expressed as percentages/proportions, means and average. The objective of our study is to investigate the Sonographic findings of first trimester pregnancies detecting the retroverted gravid uterus, normal, abnormal and complicated pregnancies. In the present study out of 2080 pregnancies, we found uterus retroverted in about 7% of women and only one case of acute retention of urine due to retroverted gravid uterus. Here, the majority of pregnant women were 20-24 years of age, which is 980 (47.12%) and 150 (7.21%) women pregnant at the age of over 35 years. In our study, 190 (9.13%) of the 2080 pregnancies with sonographic diagnosis were fetal losses. The diagnosis of early normal intrauterine pregnancy (IUP) was 1890 (90.87%), Incomplete abortion 95 (4.57%), Missed abortion 35 (1.68%), Blighted ovum 39 (1.88%), ectopic pregnancy 14 (0.67%) and Hydatiform mole 7 (0.34%) cases. If urinary retention due to retroverted gravid uterus, abnormal and complicated pregnancies are diagnosed early and treated properly, it can reduce maternal morbidity and mortality.