Diagnostic Imaging Techniques Research Articles

Superior vena cava syndrome in chronic intestinal failure patients: When the going gets tough

Catheter-related venous thrombosis is a severe complication of home parenteral nutrition (HPN) with potentially devastating consequences such as superior vena cava syndrome (SVCS). Early recognition and awareness of factors leading to its development are of paramount importance. However, studies are lacking in HPN patients focusing on this topic. In this study, we aimed to determine the incidence of SVCS in HPN patients and describe SVCS-related outcomes. This retrospective cohort study comprised all adult HPN patients who developed SVCS between 2000 and 2022 at our national HPN referral center. Primary outcome was the incidence of SVCS. Secondary outcomes include SVCS-related symptoms, tip location of central venous access device (CVAD) post-insertion and at time of SVCS, diagnostics and treatment. SVCS was diagnosed in 38 of 616 patients (6%), with an annual cumulative incidence rate ranging between 0 and 4.2%. Most common presenting symptoms were facial edema (82%) and arm edema (50%). Post-insertion, 17% (6/36) of patients had a correct position of the CVAD tip and 11% (4/36) during SVCS diagnosis. Computed tomography was the most used diagnostic imaging technique (66%). Sixty-three percent of patients started, 11% switched, and 21% continued anticoagulant treatment. The incidence of SVCS is relatively high in our vulnerable HPN population. It is key to recognize whenever such patients present with vascular obstruction-related symptoms and treat them in an early stage by a multidisciplinary team.

Multipartite patella: A review of diagnostic techniques and management of the symptomatic patient.

Multipartite patella is an anatomical variant classified by the fragmentation of the main patellar body. The cause of this variant is due to failure in fusion of the patellar ossification centers. It is commonly misdiagnosed as a fracture of the patella in clinical practice, leading to unnecessary treatment measures. The aim of this review is to provide an overview of the development and classification of this variation, diagnostic imaging techniques, and assess the optimal management technique for the symptomatic patient. Multiple radiographic methods are used to identify this variant, with recent studies highlighting high sensitivity rates for nonradiative methods (ultrasound). In terms of symptomatic management, accessory fragment excision and vastus lateralis release provide the greatest alleviation of symptoms, with screw fixation being less favorable.

Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58

Ultrasound biomicroscopy in the quantification of brain perfusion parameters of a rat stroke model: Analysis of contrast agent bolus kinetic dynamics

BackgroundIschemic stroke represents a significant global health concern, necessitating thorough investigations and the utilization of stroke animal models to explore novel treatment modalities and diagnostic imaging techniques. New methodUltrasound biomicroscopy (BMU), operating at a center frequency of 21 MHz, along with ultrasound contrast agents (UCAs), was used to quantify microcirculation cerebral blood flow in a rat model of ischemic stroke. The microcirculation parameters were derived from time intensity curve (TIC) plots obtained based on UCA-bolus kinetics. ResultsSemiquantitative perfusion-related parameters were assessed. The TIC curves showed differences in amplitude when compared intra-animal between the left and right sides, and three situations were observed: normal perfusion, hypoperfusion, and nonperfusion. ROC analysis of delays between the left and right time intensity peak (TIP) for regions of interest (ROIs) in the control and stroke-hypoperfusion groups revealed an optimal cutpoint of 0.39 s to indicate when hypoperfusion is occurring in rats, with a sensitivity of 93.33 % and a specificity of 80 %. Comparison with existing method(s)Ultrasound perfusion imaging through the temporal bone window has been clinically applied to stroke patients using a UCA bolus for TIC analysis. TIC parameters were correlated with MRI- and CT-based measurements. ConclusionsThis investigation quantified cerebral blood flow in a rat model of ischemic stroke by measuring microcirculation parameters. The study demonstrated the efficacy of this approach as a valuable tool for conducting preclinical studies.

Where Artificial Intelligence Can Take Us in the Management and Understanding of Cancerization Fields.

Squamous cell carcinoma and its precursor lesion actinic keratosis are often found together in areas of skin chronically exposed to sun, otherwise called cancerisation fields. The clinical assessment of cancerisation fields and the correct diagnosis of lesions within these fields is usually challenging for dermatologists. The recent adoption of skin cancer diagnostic imaging techniques, particularly LC-OCT, helps clinicians in guiding treatment decisions of cancerization fields in a non-invasive way. The combination of artificial intelligence and non-invasive skin imaging opens up many possibilities as AI can perform tasks impossible for humans in a reasonable amount of time. In this text we review past examples of the application of AI to dermatological images for actinic keratosis/squamous cell carcinoma diagnosis, and we discuss about the prospects of the application of AI for the characterization and management of cancerization fields.

Case Series: Multiple Soft Tissue Lesions Demonstrated by Sonography and MRI Correlation

Varied diagnostic imaging techniques may often be used in tandem, to enhance and complement each other, when an initial imaging diagnosis appears equivocal. Diagnostic medical sonography and magnetic resonance imaging (MRI) are imaging techniques that often complement each another. Sonography is an excellent diagnostic technique to determine the consistency of a soft tissue mass (e.g., solid vs cystic), and its relationship to adjacent structures, size, and shape. Sonography is especially useful for evaluating palpable lumps and allows sonographers to perform targeted examinations around the area of interest. In addition, color and pulsed-wave Doppler enable further characterization of a lesion’s presence or lack of vascularity. Sonography can also guide core-needle biopsy of superficial lesions. However, sonography is less reliable for deep masses in large anatomical regions. The American College of Radiology recommends MRI for deeper lesions of this type. Magnetic resonance imaging is also recommended for soft tissue masses suspected to be localized to the peripheral nervous system.

Bone Tumour Sterilization Using Pasteurization for Autologous Bone Reconstruction

Primary bone malignancies have incidence of 0.2% among all malignant tumours and 15% in all primary tumours. The commonest primary bone malignancy is osteosarcoma which the frequency had increased by 0.3% yearly over the last decade. Improvement in treatment of bone sarcoma by multidisplinary protocols involving diagnostic imaging, chemotherapy and surgical technique has improved the survival rate from 20% to 80%, hence paradigm of treatment shifted from amputation to limb preserving surgery. Bone reconstruction techniques varies from prosthetic replacement, allograft and bone autograft method. Bone autograft method needed sterilizing technique to devitalised tumour cells and pasteurization is a good option in maintaining its biomorphogenic properties when heated to 60°C -70°C for 30-40 minutes. This article will be discussing on histopathology findings, biomechanical outcome and clinical outcome of bone reconstruction using pasteurized autograft bone method. The advantages of pasteurization include less risk of disease transmission, no risk of allogenic immunogenicity, readily available, simple, less expensive and satisfactory bone remodelling. However, in certain cases it also shows deteriorating outcome in long term follow up due to issues with graft fracture, infection and resorption.

Contrast Agent-Free 3D Renal Ultrafast Doppler Imaging Reveals Vascular Dysfunction in Acute and Diabetic Kidney Diseases.

To combat the irreversible decline in renal function associated with kidney disease, it is essential to establish non-invasive biomarkers for assessing renal microcirculation. However, the limited resolution and/or vascular sensitivity of existing diagnostic imaging techniques hinders the visualization of complex cortical vessels. Here, a 3D renal ultrafast Doppler (UFD) imaging system that uses a high ultrasound frequency (18MHz) and ultrahigh frame rate (1KHz per slice) to scan the entire volume of a rat's kidney in vivo is demonstrated. The system, which can visualize the full 3D renal vascular branching pyramid at a resolution of 167µm without any contrast agent, is used to chronically and noninvasively monitor kidneys with acute kidney injury (AKI, 3 days) and diabetic kidney disease (DKD, 8 weeks). Multiparametric UFD analyses (e.g., vessel volume occupancy (VVO), fractional moving blood volume (FMBV), vessel number density (VND), and vessel tortuosity (VT)) describe rapid vascular rarefaction from AKI and long-term vascular degeneration from DKD, while the renal pathogeneses are validated by in vitro blood serum testing and stained histopathology. This work demonstrates the potential of 3D renal UFD to offer valuable insights into assessing kidney perfusion levels for future research in diabetes and kidney transplantation.

Los estudiantes de medicina en los Servicios de Radiología: ¿problema u oportunidad?

University Radiology training has been carried out for years out of the Radiology Departments, where radiologists play their professional role. However, the educational needs and the leadership of the Scientific Societies make the Radiology Departments to be involved more and more in that training, though it has to be done in overloaded professional environments where medical students can be seen as a drawback. Nevertheless, radiologists must play an important role in the Radiology training of the future doctors for optimising the use of diagnostic imaging techniques and enhance the future of the specialty by bringing to our departments those medical students who had demonstrated the most adequate personal profiles. The Radiology Department is that place to succeed by increasing the healthcare outcomes, the research results and the visibility of Radiology through a fruitful interaction between radiologists and medical students.

Spinal tuberculosis in Afghanistan: A 2019‐2020 study of patients in Kabul hospitals

AbstractBackgroundTuberculosis (TB) is endemic in many low‐income countries, which can affect the spine in 1%–5% of those with an active infection. This study reports the clinical characteristics of patients admitted for spinal TB in Kabul, Afghanistan, a country with very limited resources.MethodsThis was a descriptive study among 26 patients treated for spinal TB in three major referral hospitals in Kabul, Afghanistan, between March 2019 and April 2020. The sociodemographic and clinical details, gender, age, site of infection, presenting complaints, signs, and symptoms of the patients were retrieved from their medical records. Summary statistics were analyzed using SPSS version 20. Ethics approval was obtained from the ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran.ResultsData were available for 26 patients with spinal TB admitted consecutively. The mean age of the sample was 38.2 years (SD 17.5), and there were 16 males and 10 females. Median time from symptom onset to hospital admission was 60 days. The most common diagnostic imaging technique used was magnetic resonance imaging (92.3%), followed by computed tomography (7.7%). The majority of the lesions involved the lumbar spine (61.4%), followed by the thoracolumbar spine (30.8%). Back pain was the most common manifestation in 21 patients (80.8%), and varying degrees of neurological impairment were found in 16 (61.5%) patients. There were no deaths among the patients up to the discharge date.ConclusionsThis study describes the clinical characteristics of spinal TB among patients in Kabul, Afghanistan. It is essential to strengthen preventive strategies and to improve health awareness about clinical features of spinal TB in patients with chronic back pain even in the absence of signs of TB.

Teknik Pemeriksaan MRI Genu Dengan Penambahan Sequence Axial 3D Spoiled Gradient Recalled Echo

Magnetic Resonance Imaging (MRI) is a medical diagnostic imaging technique that works on the principle of nuclear magnetic resonance. MRI aircraft can produce diagnostic images of the inside of the human body in both sagittal, coronal, and transverse cuts, Magnetic resonance imaging (MRI) is a widely accepted non-invasive technique for the evaluation of cartilage lesions. The femur, tibia, fibula, and patella are united into one complex group by ligaments. According to Moeller, Genu Examination uses STIR Sequence, Sagital T2 Weighted Fat saturated, Sagittal 3D GRE, Proton Density weighted fat saturated T1 Coronal. The author's purpose in conducting this study is because Genu Examination at one of the Jakarta Hospital in the Case of Soft Tissue Tumor, Meniscus Tear and Oesteoarthritis added the Axial 3D SPGR sequence. The research method used is descriptive research with an observational approach. Data collection was carried out on June 5 to August 31 using Mri GE aircraft with a power of 1.5 Tesla. The patient samples used in this study were three patients with clinical Soft Tissue Tumor, Meniscus Tear, and Osteoarthritis. Data collection was carried out through observation, interviews and Genu Examination Documentation with the addition of Axial 3D SPGR. The examination is carried out using Quad Knee Coil, the patient's position is supine, feet first. The sequences used in the examination at one of the Jakarta hospitals are Axial Proton Density Fat saturated, Sagital Proton Density Fat saturated, Sagital T2, Coronal Proton Density Fat saturated, Coronal STIR. The role of the Axial 3D SPGR sequence is to evaluate articular cartilage due to its clear depiction of cartilage morphology and high signal to noise ratio (SNR) images.

Self-Induced Pneumoparotid as a Result of Covering Mouth While Coughing: A Case Report

Introduction Pneumoparotid is a rare condition characterized by the presence of air in the parotid gland, usually caused by the retrograde flow of air through the parotid duct. This report presents a rare occurrence of self-induced pneumoparotid. Case presentation A-41-year-old female presented with a recurrent painless right-sided parotid gland swelling for one month. She reported covering her mouth with her hands while coughing. Clinical examination revealed a right parotid swelling inferior to her right ear. The mass was non-tender and compressible. The neck and skull base computed tomography with contrast revealed a large thin wall cystic space with small air bubbles in the course of Stenson's duct. The patient underwent conservative management with good outcome. Conclusion Pneumoparotid is an extremely uncommon condition characterized by the presence of air in the parotid gland. Diagnostic imaging techniques such as ultrasound, sialography, or CT scans are valuable in confirming the diagnosis.

Assessment of Microvascular Disease in Heart and Brain by MRI: Application in Heart Failure with Preserved Ejection Fraction and Cerebral Small Vessel Disease.

The objective of this review is to investigate the commonalities of microvascular (small vessel) disease in heart failure with preserved ejection fraction (HFpEF) and cerebral small vessel disease (CSVD). Furthermore, the review aims to evaluate the current magnetic resonance imaging (MRI) diagnostic techniques for both conditions. By comparing the two conditions, this review seeks to identify potential opportunities to improve the understanding of both HFpEF and CSVD.

The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint

BackgroundAcute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury.MethodsFrom May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described.ResultsEither an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)).ConclusionsHigh frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

Thermographic Examination of the Horse

Abstract Thermography is a noninvasive diagnostic imaging technique that detects regions of the body surface with increased (or decreased) temperature by measuring infrared radiation. It reveals physiological and pathophysiological changes primarily related to blood flow and metabolic rate in the examined body regions, as well as altered heat production. These include physical stress, various physical injuries, medical conditions, and environmental factors. In equine medicine, thermography can be used for early detection of tissue temperature changes, allowing intervention at an early stage of a medical deterioration. Thermographic examination can be used to detect tissue abnormalities in all regions of the body. It is particularly useful for the detection of musculoskeletal disorders. Inflammatory processes are present in many diseases and injuries, which can be successfully detected with thermography. Thermography makes it possible to monitor the success of treatment. Often, thermographically visible disease changes are detected before clinical signs or other imaging techniques become visible in the animal. In physical therapy, it helps locate regions of the body in need of treatment and plays an important role in detecting illegal procedures (such as local analgesics) to improve competitive performance in horses. Thermography serves as a complementary diagnostic tool. However, in practice, it has some limitations. The method is not specific and cannot determine the etiology of pathological changes. Therefore, it is usually used together with other diagnostic methods (such as X-ray, ultrasound, computed tomography and magnetic resonance imaging) and can not replace them.

Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging.

Advanced chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Due to its unique uremia-derived pathophysiology of atherosclerosis and the limitations of using potentially harmful contrast agents, the best non-invasive approach to assess CAD in these patients remains unclear. We sought to investigate the accuracy, safety, and prognosis of patients with severe CKD undergoing dobutamine stress cardiac magnetic resonance imaging (CMR). In this retrospective, single-center study, patients on dialysis or with a glomerular filtration rate of <15 ml/min/1.73 m2 who underwent dobutamine stress CMR were included. A rest and stress wall motion analysis was performed using dobutamine/atropine as stressor. The target heart rate was 85% of the maximum heart rate. Periprocedural adverse events and 1-year follow-up data were obtained. A total of 176 patients (127 men, 49 women) with a mean age of 60.9 ± 14.7 years were included, of which 156 patients were on permanent dialysis. Short-term symptoms such as angina or shortness of breath during stress CMR were frequent (22.1%), but major complications were rare (one patient with myocardial infarction, 0.6%). The 1-year event rate was high (16.4%) with a significant independent correlation to reduced ejection fraction at rest (p = 0.037) and failure to achieve the target heart rate (p = 0.029). The overall accuracy for predicting significant CAD was good (sensitivity of 71.4%, specificity of 98.4%) and excellent if the target heart rate was achieved (83.3%, 97.9%). A negative stress CMR was highly predictive for the absence of major adverse cardiac event or any coronary revascularization during the 1-year follow-up (negative predictive value of 95.0%). Dobutamine stress CMR is a safe and accurate diagnostic imaging technique in patients at advanced stages of chronic kidney disease. A reduced ejection fraction and the inability to reach the target heart rate are independent predictors of a poor outcome.

Role of Neural Plasticity of Motor Cortex in Gliomas Evaluated by Brain Imaging and Mapping Techniques in Pre- and Postoperative Period: A Systematic Review.

Resection of infiltrative neuroepithelial primary brain tumors, such as low-grade gliomas (LGGs) remains a neurosurgical challenge. Usual lack of clinical deficit despite LGGs growing in eloquent brain areas may be explained by reshaping and reorganization of functional networks. The development of modern diagnostic imaging techniques could disclose better understanding of the rearrangement of the brain cortex; however, mechanisms underlying such compensation and how it occurs in the motor cortex remain unclear. This systematic review aims to analyze the neuroplasticity of motor cortex in patients with LGGs, as determined by neuroimaging and functional techniques. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, medical subject headings (MeSH) and the following terms related to neuroimaging, LGGs and neuroplasticity were used with the Boolean operators AND and OR to synonymous terms in the PubMed database. Among the 118 results, 19 studies were included in the systematic review. Motor function in patients with LGG was characterized by a compensation in the contralateral and supplementary motor areas and premotor functional networks. Furthermore, ipsilateral activation in these types of gliomas was rarely described. Moreover, some studies did not reveal statistical significance in association between functional reorganization and the postoperative period, which can be explained by the low number of patients. Our findings suggest a high pattern of reorganization per different eloquent motor areas and gliomas diagnosis. Understanding this process is useful to guide safe surgical resection and to develop protocols that assess the plasticity, even though functional network rearrangement needs to be better characterized by more studies.

The imaging techniques and diagnostic performance of ultrasound, CT, and MRI in detecting liver steatosis and fat quantification: A systematic review

The most prevalent liver disorder is hepatic steatosis. The gold standard for the assessment of liver fat is biopsy. However, several less invasive diagnostic imaging techniques can be used for more detailed information about hepatic tissue or even replace biopsy. In this review study, we have presented the impact of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) to detect or even quantify the fat content of the liver. US is a relatively cheap, widely available and ionizing radiation-free technique. However, it cannot provide images of the entire liver. New developments increase its diagnostic accuracy even for mild and moderate liver steatosis. CT is a fast and available imaging method; however, it uses ionizing radiation. The diagnostic accuracy of this technique can not exceed the US and MRI, but its information will be useful for further computerized analysis. Despite the disadvantages of MRI including higher cost and time, its diagnostic performance in steatosis grading is greater than US and CT. The MRI methods for liver fat measurements can be considered an alternative reference standard for liver biopsy. In this systematic study, we explained their techniques, diagnostic accuracy, advantages, limitations, and future applications.

Diagnostic Imaging of Diseases Affecting the Guttural Pouch.

The most common diseases of the guttural pouch are empyema, tympany, mycosis and temporohyoid osteoarthropathy. The challenge in diagnosis of guttural pouch diseases lies in the complex anatomy of the guttural pouch and adjacent associated structures. Diagnostic imaging is a good complement to endoscopy for the diagnosis of some guttural pouch diseases, especially to make a full assessment of the lesions involving the pouch and surrounding structures. This review article describes the value of each diagnostic imaging technique in the diagnosis of guttural pouch disease and the corresponding imaging findings. Radiography is generally used as the first line to complement endoscopic findings, and can give useful additional information although it is limited by superimposition. Ultrasonographic examination of the guttural pouch is of limited value due to the presence of gas in the guttural pouch but can eventually be used to detect fluid within the pouch or can help to evaluate the soft tissues located lateral and ventral to the guttural pouch. Cross-sectional imaging, especially CT, is increasingly available and appears to be the best technique to fully assess the surrounding soft tissues and to precisely identify lesions of the temporohyoid apparatus, temporal bone and skull base that are associated with guttural pouch disease.

Multiparameter interferometric polarization-enhanced imaging differentiates carcinoma in situ from inflammation of the bladder: an ex vivo study.

Successful differentiation of carcinoma in situ (CIS) from inflammation in the bladder is key to preventing unnecessary biopsies and enabling accurate therapeutic decisions. Current standard-of-care diagnostic imaging techniques lack the specificity needed to differentiate these states, leading to false positives. We introduce multiparameter interferometric polarization-enhanced (MultiPIPE) imaging as a promising technology to improve the specificity of detection for better biopsy guidance and clinical outcomes. In this ex vivo study, we extract tissue attenuation-coefficient-based and birefringence-based parameters from MultiPIPE imaging data, collected with a bench-top system, to develop a classifier for the differentiation of benign and CIS tissues. We also analyze morphological features from second harmonic generation imaging and histology slides and perform imaging-to-morphology correlation analysis. MultiPIPE enhances specificity to differentiate CIS from benign tissues by nearly 20% and reduces the false-positive rate by more than four-fold over clinical standards. We also show that the MultiPIPE measurements correlate well with changes in morphological features in histological assessments. The results of our study show the promise of MultiPIPE imaging to be used for better differentiation of bladder inflammation from flat tumors, leading to a fewer number of unnecessary procedures and shorter operating room (OR) time.