Purpose: Haemodialysis provides various options for vascular access, including native arterioveno... more Purpose: Haemodialysis provides various options for vascular access, including native arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central intravenous catheters. However, the use of catheters should be avoided due to their association with greater risks when opposed to AVFs or AVGs. AVFs have garnered strong endorsement as the favoured vascular access choice for extended haemodialysis. A total of 200 patients initially diagnosed with AVF/AVG dysfunction were referred to the radiology department across 3 different institutions. The inclusion criteria involved patients who encountered repeated difficulties with access cannulation during dialysis. Conversely, the exclusion criteria comprised cases that had been solely assessed using colour Doppler ultrasound (CDUS), those exclusively evaluated with digital subtraction angiography (DSA), situations where DSA was not feasible, instances requiring immediate intervention due to acute access failure, and cases in which patients refused participation. Inter-observer agreement regarding complications of AVF/AVG was very good for the identification of thrombus (κ = 1.0), seroma (κ = 0.953), aneurysm (κ = 0.851), and pseudoaneurysm (κ = 0.851). It was considered good for the detection of juxta-anastomosis stenosis (κ = 0.751) and feeding artery stenosis (κ = 0.638). However, the agreement was fair for identifying draining vein stenosis (κ = 0.380) and distal arterial steal syndrome (κ = 0.210). The overall diagnostic performance of CDUS exhibited 86% sensitivity in identifying stenosis, with a specificity of 99.1%, a positive predictive value (PPV) of 96.5%, a negative predictive value (NPV) of 97%, and an accuracy of 94.3%. CDUS is a noninvasive diagnostic approach for the prompt picking of AVF complications. It serves as a suitable first-line imaging modality for nonfunctional AVF due to its cost-effectiveness and accessibility. Additionally, we provide evidence of reproducibility, encouraging the diligent use of CDUS in AVF and AVG evaluation for early complication detection and management guidance.
Understanding the consistency of pituitary macroadenomas is crucial for neurosurgeons planning su... more Understanding the consistency of pituitary macroadenomas is crucial for neurosurgeons planning surgery. This retrospective study aimed to evaluate the utility of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) as non-invasive imaging modalities for predicting the consistency of pituitary macroadenomas. This could contribute to appropriate surgical planning and therefore reduce the likelihood of incomplete resections. The study included 45 patients with pathologically confirmed pituitary macroadenomas. Conventional MRI sequences, DWIs, ADC maps, and pre-and post-contrast MRIs were performed. Two neuroradiologists assessed all of the images. Neurosurgeons assessed the consistency of the tumor macroscopically, and histopathologists examined it microscopically. The MRI findings were compared with postoperative data. According to the operative data, macroadenomas were divided into the two following categories based on their consistency: aspirable (n = 27) and non-aspirable tumors (n = 18). A statistically significant difference in DWI findings was found when comparing macroadenomas of different consistencies (p < 0.001). Most aspirable macroadenomas (66.7%) were hyperintense according to DWI and hypointense on ADC maps, whereas most non-aspirable macroadenomas (83.3%) were hypointense for DWI and hyperintense on ADC maps. At a cut-off value of 0.63 × 10 -3 mm 2 /s, the ADC showed a sensitivity of 85.7% and a specificity of 75% for the detection of non-aspirable macroadenomas (AUC, 0.946). The study concluded that DWI should be routinely performed in conjunction with ADC measurements in the preoperative evaluation of pituitary macroadenomas. This approach may aid in surgical planning, ensure that appropriate techniques are utilized, and reduce the risk of incomplete resection.
Background: A highly helpful diagnostic technique for determining the cause of shoulder pain is m... more Background: A highly helpful diagnostic technique for determining the cause of shoulder pain is magnetic resonance imaging (MRI). Objective: To study the role of MRI in the diagnosis of chronic non-traumatic shoulder pain. Subjects and methods: In this cross-sectional observational research, 60 patients (32 males and 28 females) presented with chronic shoulder pain and limitation of movement. All cases were recruited from the Orthopedic Surgery and Radiodiagnosis Departments at Zagazig University Hospitals. All cases were assessed by Magnetic Resonance Imaging. Results: Fifty-three cases had rotator cuff pathologies, thirty-seven cases had acromioclavicular osteoarthritis, twentynine cases had bursitis, fifteen cases had biceps pathologies and nine cases had miscellaneous conditions. A study; 16 (35%) Sub coracoid, 10(16.7%) in Sub-acromial sub deltoid and (5%) Subscapular. Among the current study, 9 (15%) of cases were miscellaneous. Four cases were suffering from interosseous cystic lesions (6.7%) of all cases. Lipoma was seen in 3(5%) of cases. Ganglion cyst was seen in 2(3.3%) of cases. Conclusion: MRI of the shoulders aided in understanding different underlying pathology of chronic shoulder pain and revealed that dependence on only clinical findings and diagnosis could delay their management as well as chronicity development.
Objective.To compare the diagnostic value of MDCT and single lateral Xray foot in the differentia... more Objective.To compare the diagnostic value of MDCT and single lateral Xray foot in the differentiation of calcaneal fractures. Surgical data was used as reference standard. Material and methods. 100 participants with suspected unilateral calcaneal fracture studied with lateral X-ray and MDCT. MPR obtained by the machine software in coronal and sagittal planes. The Axial and post processing scans analyzed. Results.100 patients examined by the two tools. Our work included 80 males and 20 females, their median age (33 years). The sensitivity, specificity and diagnostic accuracy of single lateral radiography were 100, 76.92 and 88%, respectively. The values for MDCT were 97.92, 96.15 and 97%, respectively. Conclusion. We settled that MDCT imaging tool with MPR was better than the conventional lateral X-ray in differentiating and categorizing calcaneal fractures. However, the values of the lateral X-ray were not far from MDCT plus the low economic burden, low ionization exposure and easy availability , made it a first imaging tool in differentiating extra/intra-articular fractures. So, one study with a large population sample required to confirm the most accurate first imaging tool. Abbreviations: MDCT" multidetector CT", MPR"multiplanar reformat" Keywords Multi-detector computed tomography (MDCT), conventional lateral X-ray foot and calcaneal fractures.
ACR TI-RADS predicts malignant thyroid nodules with high diagnostic validity Combined TR4/TR5... more ACR TI-RADS predicts malignant thyroid nodules with high diagnostic validity Combined TR4/TR5 increases sensitivity of ACR TI-RADS for malignant thyroid nodules The referring clinicians accept ACR TI-RADS as a valuable reporting system
Background: This study aims to evaluate the importance of diffusionweighted MRI imaging (DWI) as ... more Background: This study aims to evaluate the importance of diffusionweighted MRI imaging (DWI) as a truthful marker for detection of rectal cancer tumor aggressiveness, by studying the relation between apparent diffusion coefficient (ADC) values of the tumors, MRI findings and pathological factors for prognosis. Methods: Between October 2017 and May 2019, the study included 80 patients have been proved to have carcinoma of the rectum by colonoscopic biopsy and histopathological assessment. All patients were assessed prior to surgery and neo-adjuvant therapy with standard MRI and diffusion weight images. Results: The mean ADC values are lower with poor prognostic factors for tumors with high CEA levels more than 5 ng/ml (P = 0.004), positive nodal disease (P = 0.0001), positive LVI invasion (P = 0.0001), with increasing T stage (P = 0.0001) and significantly lower among poorly differentiated tumors (P = 0.0341). There is also a significant positive correlation (r = 0.487; P = 0.0001) between ADC values and the distance from the tumor to the MRF. Conclusion: Our study suggests that quantitative measurement of ADC values can be used in preoperative assessment of degree of rectal cancer progression. ADC is capable of becoming a realistic imaging biomarker of tumor profile aggressiveness.
Uploads
Papers by Mona Refaat