Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP)

Twin reversed arterial perfusion (TRAP) sequence is a rare pregnancy complication occurs in an identical twin pregnancy that share a single placenta. TRAP sequence is a twin's pregnancy includes a normal-developed viable pump fetus and an abnormal usually nonviable acardiac fetus. The nonviable acardiac fetus depends on the pump fetus for his blood supply and put the pump fetus at risk of high cardiac output heart failure and congenital anomalies with high mortality rate. Gray-scale ultrasound and color and pulsed Doppler imaging is a noninvasive accessible imaging modality for the diagnosis of TRAP sequence. Early diagnosis of such conditions is mandatory in order to apply the proper therapeutic measures and to help the normal developed pump fetus to survive. The main goal of management is to interrupt blood supply to the nonviable acardiac fetus to reduce the strain on the heart of the pump fetus thus, increase the chance of survival.

Establishing local diagnostic reference levels for computed tomography examinations using size-specific dose estimates

OBJECTIVES

To establish local DRL (LDRL) for computed tomography (CT) examinations based on size-specific dose estimates (SSDEs), which consider patient size. The concept of diagnostic reference level (DRL) was introduced to limit patient exposure to unnecessary radiation. However, traditional DRL values do not consider patient size.

METHODS

Following institutional committee approval, data were collected from CT examinations of adult patients at Madinah General Hospital, Al Madinah Al Munawwarah, Saudi Arabia from January to March 2023. The SSDE was calculated for each patient using the effective diameter (Deff).

RESULTS

The LDRLs of the brain, cervical spine, chest, thoracic spine and kidneys, ureters, and bladder (KUB) examinations were 118 mGy, 12 mGy, 8 mGy, 17 mGy, and 7 mGy, respectively. A strong correlation was observed between SSDEs and the volume computed tomography dose index (CTDIvol) for all examinations except chest scans (p<0.05). Size-specific dose estimates were higher than the CTDIvol, with a greater difference for patients with smaller Deff (p<0.05).

CONCLUSION

The established LDRL was within the international DRL. The use of SSDE has the potential to provide more accurate and relevant data for radiation safety practices; however, widespread adoption of SSDE in new CT scanners is necessary for promoting consistency and standardization methodologies.

Clinical presentation and angiographic findings of acute myocardial infarction in young adults in Jazan region

BACKGROUND

There is a paucity of information about the clinical features and angiographic findings in young patients with acute myocardial infarction (MI), especially in the Arab Peninsula countries.

OBJECTIVE

The aim of this study was to assess the proposed risk factors, clinical presentation, and angiographic findings of acute myocardial infarction in young adults.

METHODS

This prospective study included young (range, 18 to 45 years) patients who presented with acute MI based on clinical evaluation, laboratory investigation, and electrocardiogram, and they underwent a coronary angiography procedure.

KEY FINDINGS

Data of 109 patients with a diagnosis of acute MI were collected. Patients' mean age was 39.98 ± 7.52 years (range, 31 to 45 years), and 92.7% (101) were male. Smoking was the highest risk factor in 67% of patients, obesity and overweight in 66%, sedentary lifestyle in 64%, dyslipidaemia in 33%, and hypertension in 28%. Smoking was the most common risk factor for acute MI in males (p = 0.009), whereas sedentary lifestyle was the most common risk factor in females (p = 0.028). Chest pain typical of acute MI was the most common presenting symptom in 96% of patients (p < 0.001). On admission, 96% of patients were conscious, and 95% were oriented. On angiography, the left anterior descending artery (LAD) was affected in 57%, the right coronary artery (RCA) was affected in 42%, and the left circumflex artery (LCX) was affected in 32% of patients. The LAD was severely affected in 44%, the RCA was severely affected in 25.7%, and the LCX was severely affected in 19.26% of patients (p < 0.001).

CONCLUSION

Smoking, obesity, sedentary lifestyle, dyslipidaemia, and hypertension were the most common risk factors for acute MI. Smoking was the most common risk factor in males and sedentary lifestyle in females. The LAD was the most commonly affected coronary artery, followed by the RCA and LCX arteries, with the same order for severity of stenosis.

Utility of Ultrasound Imaging Features in Diagnosis of Breast Cancer

Background Currently, breast cancer (BC) is considered one of the most prevalent cancer worldwide in women and represents a global health challenge. Early diagnosis is the keystone in the management of BC patients. This study aims to assess the utility of ultrasonography (US) features of malignancy in the diagnosis of BC. Methods This retrospective cross-sectional study involved the electronic records of 326 female patients who were diagnosed with BC. A cross-tabulation test was performed to identify the association between the presence of each US feature (yes/no), and the final US diagnosis (benign/malignant). The strength of association of each feature was measured using the odds ratio (OR) which was assumed to be significant when > 1, with a 95% confidence interval (CI). Results The mean age of the female patients involved in this study was 45.36 ±12.16 years old (range, 17-90 years). Cross-tabulation test showed a significant association between the malignancy tumor and the irregular shape of the lesion (p < 0.001, OR=7.162, CI 2.726-18.814), non-circumscribed margins (p < 0.001, OR = 9.031, CI 3.200-25.489), tissue distortion (p < 0.001, OR = 18.095, CI 5.944-55.091), and the lymph node enlargement (p < 0.001, OR = 5.705, CI 2.332-13.960). Conclusion US imaging features of malignancy have a high sensitivity and positive predictive value for detection of the BC. However, the specificity of breast US imaging features is much lower because of the overlapping features in benign and malignant breast lesions. Breast lesions with an irregular shape, not circumscribed irregular or spiculated margins, hypo-echogenicity, tissue distortion, and those with lymphadenopathy have the highest likelihood of malignancy despite the low specificity. US is a highly valuable, safe, and affordable imaging modality with high diagnostic accuracy for BC.

The Neoplasms Mimicker: A Pictorial Review of Hydatid Disease

Hydatid cyst is a common name for the larval stage of a tapeworm species of the genus Echinococcus granulosus, which is transmitted from animals to humans via the fecal–oral route. Hydatid cysts predominantly affect the liver (75%), followed by the lung (15%), and they can affect many organs in the human body. Medical imaging modalities are the keystone for the diagnosis of hydatid cysts with high sensitivity and specificity. Ultrasound imaging with high resolution is the first choice for diagnosis, differential diagnosis, staging, establishing a role in interventional management, and follow-up, and it can differentiate Type I hydatid cysts from simple liver cysts. Unenhanced computed tomography (CT) is indicated where or when an ultrasound is unsatisfactory, such as with chest or brain hydatid cysts, when detecting calcification, and in obese patients. Magnetic resonance imaging (MRI) is superior for demonstrating cyst wall defects, biliary communication, neural involvement, and differentiating hydatid cysts from simple cysts using diffusion-weighted imaging (DWI) sequences. According to the phase of growth, hydatid cysts occur in different sizes and shapes, which may mimic benign or malignant neoplasms and may create diagnostic challenges in some cases. Hydatid cysts can mimic simple cysts, choledochal cysts, Caroli’s disease, or mesenchymal hamartomas of the liver. They can mimic lung cystic lesions, mycetoma, blood clots, Rasmussen aneurysms, and even lung carcinomas. Differential diagnosis can be difficult for arachnoid cysts, porencephalic cysts, pyogenic abscesses, and even cystic tumors of the brain, and can create diagnostic dilemmas in the musculoskeletal system.

Evaluating sonographers' awareness of artifacts in renal ultrasound scans

BACKGROUND

A routine ultrasound scan is used to assess a variety of renal pathological cases. Sonographers face a variety of challenges that may affect their interpretation. Understanding normal organ shapes, human anatomy, physical concepts, and artifacts is required for accurate diagnosis. Sonographers must understand how artifacts appear in ultrasound images in order to reduce errors and improve diagnosis. The purpose of this study is to assess sonographers' awareness and knowledge of artifacts in renal ultrasound scans.

METHODS

Participants in this cross-sectional study were asked to complete a survey containing different types of common artifacts in renal system ultrasound scans. An online questionnaire survey was used to collect the data. The questionnaire targeted radiologists, radiologic technologists, and intern students in Madinah hospitals in the ultrasound department.

RESULTS

The total number of participants was 99, with 9.1% being radiologists, 31.3% being radiology technologists, 6.1% being senior specialists, and 53.5% being intern students. There was a significant difference in the participants' knowledge of ultrasound artifacts in the renal system with the total selection of the right artifact in senior specialists at 73% and intern students 45%. There was a direct relationship between age and years of experience in distinguishing artifacts in the renal system scan. A category of participants with the highest age and experience got 92% of the correct selection of artifacts.

CONCLUSION

The study concluded that intern students and radiology technologists have limited knowledge of ultrasound scan artifacts, whereas senior specialists and radiologists have a high level of awareness of the artifacts.

The role of teleradiology during COVID-19 outbreak: Saudi radiologists' perspectives

OBJECTIVES

To evaluate the role of teleradiology during the COVID-19 pandemic from Saudi radiologists' perspectives to improve the radiology quality service.

METHODS

A cross-sectional study was carried out in Saudi Arabia among radiologists working at local hospitals from October to November 2021. It contains 21 questions involved demographic information; general information on teleradiology services; and the impact of teleradiology during COVID-19. One-way ANOVA was used to compare demographic groups. Chi-square test was used to compare demographic groups regarding their distribution of responses. All tests were carried out <0.05 level of significance.

RESULTS

A total of 102 radiologists participated in this study (56% males, 44% females), 58.8% of them were sub-specialized in chest radiology. Regarding the general status of teleradiology, 69.6% of participants believed that teleradiology is a helpful tool for imaging interpretation. However, 44% of them were uncertain on the impact of teleradiology on patients' confidentiality. Approximately 87% of participants agreed that there is a positive contribution of teleradiology during COVID-19, which enables decreasing risk of infection and workload. There was a significant difference between professional degrees and overall participant responses (p<0.05). Academicians agreed that it enhances radiology departments' work (mean=17.78, SD=1.86).

CONCLUSION

Concerns raised on complicated cases that require physical presence of patients, cannot be performed by teleradiology. Additionally, it might provide insufficient communication with other professionals to discuss images.

Identifying cerebral microstructural changes in patients with COVID-19 using MRI: A systematic review

Coronavirus disease 2019 (COVID-19) is an epidemic viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the excessive number of neurological articles that have investigated the effect of COVID-19 on the brain from the neurological point of view, very few studies have investigated the impact of COVID-19 on the cerebral microstructure and function of the brain. The aim of this study was to summarize the results of the existing studies on cerebral microstructural changes in COVID-19 patients, specifically the use of quantitative volumetric analysis, blood oxygen level dependent (BOLD), and diffusion tensor imaging (DTI). We searched PubMed/MEDLINE, ScienceDirect, Semantic Scholar, and Google Scholar from December 2020 to April 2022. A well-constructed search strategy was used to identify the articles for review. Seven research articles have met this study's inclusion and exclusion criteria, which have applied neuroimaging tools such as quantitative volumetric analysis, BOLD, and DTI to investigate cerebral microstructure changes in COVID-19 patients. A significant effect of COVID-19 was found in the brain such as hypoperfusion of cerebral blood flow, increased gray matter (GM) volume, and reduced cortical thickness. The insula and thalamic radiation were the most frequent GM region and white matter tract, respectively, that are involved in SARS-CoV-2. COVID-19 was found to be associated with changes in cerebral microstructures. These abnormalities in brain areas might lead to be associated with behaviors, mental and neurological alterations that need to be considered carefully in future studies.

The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.

Diagnostic features of tuberous sclerosis complex: case report and literature review

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic syndrome that is caused by mutations in the tumour suppressor genes TSC1 or TSC2 which causes multiorgan growths. TSC presents at any age as a wide range of clinical and phenotypic manifestations with varying severity. The main goal of this article was to state two cases of TSC and review the most commonly reported major and minor diagnostic clinical features and the most common features that led to an investigation of possible TSC diagnosis. Herein, we report two cases of TSC, which both presented with seizures during the first 6 months of life. Case 1 presented with multiple types of seizures from 6 months of age and was diagnosed by multiple calcified subependymal nodules (SENs) detected by computed tomography and magnetic resonance imaging (MRI). Case 2 presented with seizures from 3 months of age and was diagnosed prenatally when a tumour was seen in her heart during antenatal ultrasonography. In conclusion, the literature review revealed that neurological manifestations (mainly seizures) were the main feature that led to investigation and diagnosis of TSC followed by abdominal manifestations (mainly renal features) and antenatal follow-up imaging. Other manifestations in skin, chest, eyes, teeth and heart rarely led to TSC diagnosis. In some cases, TSC was incidentally discovered by medical imaging. The cortical tubers, SENs, and subependymal giant cell astrocytomas brain lesions were the most commonly reported major features. Skin features including angiofibromas, ungual fibromas and shagreen patch were the second most common major features reported in the literature. However, skin manifestations were not a common led to investigation and diagnosis of TSC. Renal features, mainly angiomyolipomas (AMLs), were the third most common major feature reported. Medical imaging plays an essential role in diagnosis of TSC, and clinical features are important clues that lead to investigation for the disease.

A rare phenotype of breast hydatid cyst causing misdiagnosis and unnecessary intervention: a case report

Hydatid cyst (cystic echinococcosis) is a chronic parasitic infection by the larval stage of the cestode that is called Echinococcus granulosus (E. granulosus) resulting in the development of cystic lesions in animals and humans. In this report, we describe a rare phenotype of hydatid cyst in the breast of a 23-year-old female presented with breast mass in the left upper outer quadrant for 3 months with palpable left axillary lymph nodes. Both US and mammography provided a picture of complex suspicious cystosolid lesion with amorphous micro-calcification (BIRAD-4A). Surgical consultation was performed and Tru-Cut biopsy was recommended. Histopathology results revealed multiple viable protoscolices of E. granulosus and suggested the final diagnosis of breast hydatid cyst. The patient returned with ruptured and infected hydatid cyst of the breast and started treatment with Albendazole 400 mg twice daily in addition to antibiotics. Following-up after two months of Albendazole treatment showed a dramatic shrinkage in the size of the cystic lesion. In conclusion, hydatid cyst should be considered as a differential diagnosis of any cystic or cystosolid lesion in the breast and any organ in the body from head to toe apart from the hair and nails. Radiologists should be aware to the benign lesions that may mimic breast cancer to avoid misdiagnosis and unnecessary invasive procedures and consequent complications.

Autoamputated pharyngeal hairy polyp presented with aero-digestive obstruction: A case report

A pharyngeal hairy polyp (HP) is a rare benign mass that can be surgical detached with few complications. In this report, we describe a hairy polyp in a 7-day-old neonate presented with intermittent respiratory distress and feeding difficulties since birth. Neck computed tomography was performed, and demonstrated a well-defined pedunculated heterogeneous mass arising from the right lateral wall of the nasopharynx extending downward and nearly completely obstructing of the nasopharynx and oropharynx. The central part of the mass was found relatively dense surrounded by low attenuation fatty components with enhancement of the outer wall of the mass. The provisional diagnosis was pharyngeal HP. After autoamputation at the seventh day old, HP was analyzed via histopathology examination that showed a mixture of various ectodermal and mesodermal tissues including skin, cartilage, adipose and fibrous tissue. The patient fully recovered with no residual clinical features. We report this case to elucidate the possibility of this strange behavior of pharyngeal HP.

Frequent clinical and radiological manifestations of the Novel SARS-CoV-2: A review article

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the novel “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2) and is rapidly spreading worldwide. This review is designed to highlight the most common clinical features and computed tomography (CT) signs of patients with COVID-19 and to elaborate the most significant signs indicative of COVID-19 diagnosis. This review involved five original articles with both clinical and radiological features of COVID-19 published during Jan and Mar 2020. In this review, the most frequent symptoms of COVID-19 were fever and cough. Myalgia, fatigue, sore throat, headache, diarrhea, and dyspnea were less common manifestations. Nausea and vomiting were rare. Ground-glass opacity (GGO) was the most common radiological finding on CT, and mixed GGO with consolidation was reported in some cases. In addition, elevated C-reactive protein and lymphopenia are the pertinent laboratory findings of COVID-19. CT is an effective and important imaging tool for both diagnosis and follow-up COVID-19 patients with varied features, duration, and course of the disease. Bilateral GGOs, especially in the periphery of the lungs with or without consolidation, are the hallmark of COVID-19.

Comparative Study of Hemodialysis in Arteriovenous Fistulas in Low Versus High Blood Flow Rate

BACKGROUND AND OBJECTIVE

Arteriovenous Fistula (AVF) is an essential requirement in Hemodialysis (HD) to remove toxins and excess fluid from the blood of patients with Chronic Renal Failure (CRF). The Blood Flow Rate (BFR) in AVF is an important factor in the success of HD. Due to a lack of studies of low BFR during HD, this study was conducted. The objective of this study was to compare the success rate of HD in patients with a BFR = 400-500 mL min-1 (group-2), in comparison to those of higher BFR (group-1).

MATERIALS AND METHODS

This prospective cohort study was conducted at the ultrasound Doppler (USD) unit in King Fahad Hospital in Almadinah from July to December, 2019. In this study, 44 patients underwent AVF for HD and were assessed by USD for 2 consecutive visits at 3 months intervals. The success rate of HD was measured in patients with a BFR = 400-500 mL min-1 and in those with BFR>500 mL min-1. A comparison of the success rate in the 2 groups was done.

RESULTS

Among the 44 patients, 59% were males and 41% were females. The age of participants ranged from 20-80 years (mean: 46.75±13.67 years). The patients underwent HD 3 or 2 session's week-1 for 3 or 4 hrs (mean 3.84±0.36 h) per session. In the first assessment, the success rate was 100% in both groups but it was 88.24% in group-1 and 70% in group-2 in the second assessment.

CONCLUSION

The success rate of hemodialysis in patients with BFR 400-500 mL min-1 in AVF was acceptable in comparison to that in patients with BFR>500 mL min-1.

Evaluation of optimised 3D turbo spin echo and gradient echo MR pulse sequences of the knee at 3T and 1.5T

INTRODUCTION

To investigate the impact of parameter optimisation for novel three-dimensional 3D sequences at 1.5T and 3T on resultant image quality.

METHODS

Following institutional review board approval and acquisition of informed consent, MR phantom and knee joint imaging on healthy volunteers (n = 16) was performed with 1.5 and 3T MRI scanners, respectively incorporating 8- and 15-channel phased array knee radiofrequency coils. The MR phantom and healthy volunteers were prospectively scanned over a six-week period. Acquired sequences included standard two-dimensional (2D) turbo spin echo (TSE) and novel three-dimensional (3D) TSE PDW (SPACE) both with and without fat-suppression, and T2∗W gradient echo (TrueFISP) sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for knee anatomical structures. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings were investigated for differences using Friedman tests. Inter- and intra-observer agreements were determined with κ statistics.

RESULTS

Phantom and healthy volunteer images revealed higher SNR for sequences acquired at 3T (p-value <0.05). Generally, the qualitative findings ranked images acquired at 3T higher than corresponding images acquired at 1.5T (p < 0.05). 3D image data sets demonstrated less sensitivity to partial volume averaging artefact (PVA) compared to 2D sequences. Inter- and intra-observer agreements for evaluation across all sequences ranged from 0.61 to 0.79 and 0.71 to 0.92, respectively.

CONCLUSION

Both 2D and 3D images demonstrated higher image quality at 3T than at 1.5T. Optimised 3D sequences performed better than the standard 2D PDW TSE sequence for contrast resolution between cartilage and joint fluid, with reduced PVA artefact.

IMPLICATIONS FOR PRACTICE

With rapid advances in MRI scanner technology, including hardware and software, the optimisation of 3D MR pulse sequences to reduce scan time while maintaining image quality, will improve diagnostic accuracy and patient management in musculoskeletal MRI.

White-matter integrity and hearing acuity decline in healthy subjects: Magnetic resonance tractography

AIM

The association between hearing acuity and white-matter (WM) microstructure integrity was evaluated in a normal healthy population with a variety of hearing acuity using an automated tractography technique known as TRACULA (TRActs Constrained by UnderLying Anatomy) in order to investigate whether hearing acuity decline is correlated with brain structural connectivity.

METHODS

Forty healthy controls were recruited to this study, which used a Siemens 3T Trio with a standard eight-channel head coil. Hearing acuity was assessed using pure-tone air conduction audiometry (Amplivox 2160, with Audiocups to eliminate noise and allow accurate pure-tone audiometry). Handedness and anxiety and depression were assessed for all participants in this study using the Edinburgh Handedness Inventory and the Hospital Anxiety and Depression Scale, respectively.

RESULTS

This study showed a significant reduction in WM volume of the left cingulum angular bundle (CAB; t = 2.32, p = 0.02) in the mild to moderate hearing-loss group (238 ± 223 mm²) compared to the group with normal hearing (105  ± 121 mm²). The WM integrity of the left CAB was found to be significantly different (t = 2.06, p = 0.04) in the mild to moderate hearing-loss group (0.18 ± 0.06 mm²/s) compared to the group with normal hearing (0.22 ± 0.05 mm²/s). The WM integrity of the left anterior thalamic radiation (ATR) was found to be significantly different (t = 2.58, p = 0.014) in the mild to moderate hearing-loss group (0.33 ± 0.05 mm²/s) compared to the group with normal hearing (0.37 ± 0.03 mm²/s). A significant negative correlation was found between age and the WM integrity of the right ATR (r = -0.33, p = 0.038), and between hearing acuity and the WM integrity of the right ATR (r = -0.38, p = 0.013) and left CAB (r = -0.36, p = 0.019). Discussion and conclusion: An important finding in this study is that brain structural connectivity changes in the left hemisphere seem to be associated with age-related hearing loss found mainly in the ATR and CAB tracts.

The effect of the MR pulse sequence on the regional corpus callosum morphometry

Background and purposes

Brain morphometry is an important assessment technique to assess certain morphological brain features of various brain regions, which can be quantified in vivo by using high-resolution structural magnetic resonance (MR) imaging. This study aims to investigate the effect of different types of pulse sequence on regional corpus callosum (CC) morphometry analysis.

Materials and methods

Twenty-one healthy volunteers were scanned twice on the same 3T MRI scanner (Magnetom Trio, Siemens, Erlangen, Germany) equipped with an 8-channel head coil. Two different MR pulse sequences were applied to acquire high-resolution 3D T1-weighted images: magnetization-prepared rapid gradient-echo (MP-RAGE) and modified driven equilibrium Fourier transform (MDEFT) pulse sequence. Image quality measurements such as SNR, contrast-to-noise ratio, and relative contrast were calculated for each pulse sequence images independently. The values of corpus callosum volume were calculated based on the vertex of reconstructed surfaces. The paired dependent t test was applied to compare the means of two matched groups.

Results

Three sub-regional CC, namely anterior, mid-anterior, and posterior, resulted in an estimated volume difference between MDEFT and MP-RAGE pulse sequences. Central and mid-posterior sub-regional CC volume resulted in not significant difference between the two named pulse sequences.

Conclusion

The findings of this study demonstrate that combining data from different pulse sequences in a multisite study could make some variations in the results.