Radiology Unit Research Articles

Impact of the COVID-19 pandemic on diagnostic breast biopsies: a retrospective comparative study

Aims: The purpose of this study is to evaluate and compare the quantity and pathological outcomes of diagnostic breast biopsy procedures performed in our interventional radiology unit before, during, and after the COVID-19 pandemic. This study aims to examine the influence of the COVID-19 pandemic on the quantity of biopsies performed and the rates of detecting malignancies during different time periods. Methods: This retrospective study examined 365 patients who underwent diagnostic breast biopsies between January 2019 and January 2023. The study was approved by the hospital's ethics committee. After excluding 19 patients with inconclusive pathology results, a total of 346 patients were analyzed. Biopsies were performed utilizing 14-18 G tru-cut needles with the assistance of ultrasound guidance. Patients were classified into the following periods: pre-pandemic, pandemic, and post-pandemic. The histopathological findings were categorized as either benign or malignant. Statistical comparisons were conducted using the SPSS software, and a significance level of p<0.05 was used. Results: The average age of the patients was 53.7 ± 15.7 years. Out of the total of 346 biopsies, 165 (47.7%) were determined to be malignant, while 177 (51.2%) were found to be benign. The distribution of biopsies was as follows: 76 (22.0%) were conducted before the pandemic, 13 (3.8%) were conducted during the pandemic, and 257 (74.3%) were conducted after the pandemic. There was a substantial decline in the number of biopsies during the pandemic compared to before the pandemic, and a significant rise in the post-pandemic period compared to both the pandemic and pre-pandemic periods (p=0.024 and p=0.041, respectively). The incidence of malignancies during the post-pandemic period was significantly greater compared to both the pre-pandemic period (p=0.045) and the pandemic period (p=0.027). Conclusion: The COVID-19 pandemic caused substantial disruptions in breast cancer diagnostics, as indicated by a decrease in the number of biopsies performed and delays in the detection of malignancies. Following the pandemic, there was a significant rise in the incidence of malignancies, which can be attributed to the delays in diagnosing and treating these conditions during the pandemic. These findings indicate the significance for stronger healthcare strategies to reduce the effects of future crises on cancer management.

Effectiveness of Flow Diverter Stents in the Treatment of Intracranial Aneurysms: Single-Center 10-Year Results.

Purpose This study's objective was to show how effectively flow-diverting stents work when treating cerebral aneurysms. The assessment aimedto determine efficaciousness related to aneurysm type, size, and location as well as early- and late-termresults. Material and method The study included 153 aneurysms from 122 patients treated in interventional radiology unit with flow diverter stents between July 2010 and June 2020. Apart from demographic data, size, type, and location of aneurysms; technical success, peri, post-procedural, and late complications; aneurysm occlusion rates, morbidity and mortality rates were extracted from patient records. Results This study enrolled 90 (73.8%) females and 32 (26.2%) males; average age of the patients was 52.8±12.9. The average follow-up period was 33.4±9.9 months. The most common type of aneurysm was saccular (133; 86.9%), and the most common location was the supraclinoid segment with 67 (43.8%). Complete occlusion was observed in 115 of 140 aneurysms from 110 patients during follow-up. No statistically significant difference was detected between the sizes and types of aneurysms and complete occlusion rates (p=0.096, p=0.583). The total occlusion rate was found to be significantly higher in internal carotid artery (ICA) supraclinoid segment aneurysms compared to other locations (p = 0.006). During the follow-up period, flow diverter stent-related permanent morbidity was observed in four (3.6%) patients and mortality was observed in five (4.5%) patients. Conclusion Flow diverter stents can be successfully applied to many aneurysm types, from small aneurysms to large and giant aneurysms, and have high aneurysm occlusion rates with low morbidity and mortality. By the aspects of the current study the total occlusion rate was found to be significantly higher in ICA supraclinoid segment aneurysms compared to other localizations.

Morphometric Assessment of the Piriform Aperture and Its Clinical and Forensic Applications

Abstract Background: The piriform aperture (PA) is a midface structure that forms the anterior skeletal boundary of the nose. It is highly variant due to its physiological adaptations to the climate. Its variations are useful in forensic identification and reconstructive surgeries of the face. This study aimed at determining the PA’s dimensions and their accuracy in sex determination. Materials and Methods: The PA’s dimensions were retrospectively examined using 336 (199 males and 137 females) adult cranial computed tomography images in the database of the radiology unit of a university teaching hospital in Delta State, Nigeria, following institutional authorization. The aperture’s index was calculated as a ratio of height to width. The data were analyzed using Statistical Package for the Social Sciences Version 23. The sexual dimorphism in the parameters was assessed using an independent t-test. Association among the continuous variables was analyzed by Pearson’s correlation test. P = 0.05 was considered statistically significant. The percentage accuracy for correct sex prediction was assessed using the discriminant function analysis. Results: A significant relationship between dimensions with sex was observed (P < 0.05). The width of the aperture was the best sex-discriminating parameter (70.2%). The overall accuracy for sex discrimination using the aperture’s dimensions was 75.0%. Conclusion: This study provides the standard ranges for the PA’s width and height, valuable for surgical planning. These dimensions were sexually dimorphic and demonstrated an acceptable overall accuracy of correct sex allocation (75%). Consequently, this aperture may be utilized as a supplementary tool in conjunction with other methods for sex determination within studied population.

The evaluation of fine needle aspiration biopsy results in differentiating between benign and malignant thyroid nodules

Introduction: Thyroid fine-needle aspiration biopsy (FNAB) has begun playing an important role in the evaluation of thyroid nodules, in addition to physical examination and imaging techniques. The purpose of this study was to evaluate the results of patients who underwent thyroid FNAB together with their demographic data, imaging findings, and follow-up compliance. Methods: Patients who underwent thyroid FNAB procedures in our hospital’s interventional radiology unit between January 2022 and May 2024 were evaluated retrospectively. Data were retrieved from patient records. Cytological results were classified as malignant, atypia of undetermined significance, benign, and non-diagnostic material. Results: Two hundred twelve solid nodules were detected in the patients who underwent biopsy, and 59 mixed nodules with a cystic component. Non-diagnostic material was reported in 51 cases at cytological examination, benign cytology in 150, atypia of undetermined significance in 53, and malignant material in 17. The incidence of non-diagnostic results was significantly higher in hypoechoic nodules and low-volume nodules. Conclusions: Thyroid FNAB is a valuable diagnostic tool due to its ease of application and provision of useful information in benign-malignant differentiation. Once it becomes capable of application by primary physicians and local state hospitals in Türkiye it will reduce delayed diagnoses, unnecessary surgical procedures, and economic burdens on social security institutions.

Ultrasound Guided Percutaneous Renal Biopsy Using 18-Gauge versus 16-Gauge Needles in Native Kidneys with Diffuse Renal Disease: Comparison Regarding Sample Adequacy and Complication Rates

Abstract Background Regardless of the advancements made in non-invasive diagnostic tools, Percutaneous Renal Biopsy (PRB) remains the corner stone for reaching a reliable diagnosis for most renal parenchymal diseases. Needle gauge is a key variable in determining the adequacy and therefore success of renal biopsy as it influences the number of glomeruli obtained in the sample. To date, there is still much debate over the appropriate needle size to use when trying to balance between meeting diagnostic requirements; whilst decreasing the incidence of complications. At present, 16G needles or 18G needles are used for percutaneous renal biopsy at our institute on basis of personal preference and experience, but there is still controversy about the effect and safety of 18G and 16G biopsy needles in terms of the two different diameters, with no irrefutable evidence to dictate the superiority of one needle gauge over the other within the present literature. This study was the first in the Middle East to address the effect of using different gauge needles on sample adequacy and complication rates in real-time US guided PRB. Objective To compare sample adequacy and complication rates between US guided PRB acquired using 16- Gauge versus 18- Gauge needles. Patients and Methods This study was a prospective study conducted at the Interventional Radiology (IR) Unit at Ain Shams University Tertiary Hospitals from December 2022 till April 2023, on a series of 60 patients who visited our radiology suite to undergo renal biopsy, with a total of 62 renal biopsies. The patients were randomly allocated into two separate groups based on the biopsy needle gauge that was used to retrieve their renal biopsy sample. Results This study showed that a 16G biopsy needle has no obvious advantage over an 18G needle in terms of the number of glomeruli and the adequate sample rate. Although the frequency of overall complications as well as major complications was higher in 16 G in comparison to 18 G group this difference was statistically non-significant yet held clinical implication. Conclusion The 18G needle appears to be as effective as the 16G for percutaneous renal biopsy regarding sample adequacy, with clinically significant lower rate of major complications.

Role of Trans perineal Ultrasound in Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) is a medical terminology for a group of diseases that cause chronic intestinal inflammation. It is categorized into two subtypes: Ulcerative colitis and Crohn’s disease. Fistulae are frequently seen manifestations of perianal IBD, and their clinical course these consists of flare-ups with bouts of active drainage, followed by intervals of clinical remission. Improved prognosis, treatment, and assessments of perianal disease activity may all contribute to a better patient quality of life. Aim of the Work to explore the role of trans perineal ultrasound in assessment of disease activity and/or complications in patients with inflammatory bowel disease. Patients and Methods The Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. For 6 months. We studied the relevance of 23 different ultrasound parameters and 6 indices in conjunction with clinical, endoscopic based scores. Sample size of at least 30 patients with IBD with affection of anal or perianal area were sufficient to achieve study objective. Results Rectal wall thickness and submucosal band thickness could be used as indicators for presence of disease in ulcerative colitis patients. TPUS could be used to assess the internal sphincter thickness, external sphincter integrity in Crohn’s disease. Partial Mayo clinical score showed significant correlation with Mayo endoscopic score; however, it couldn’t predict degree of severity. Internal sphincter thickening increased anal canal vascularity and perianal fistula is more common in Crohn’s disease than ulcerative colitis. Conclusion Trans perineal ultrasound is considered as a good tool that is noninvasive, cost effective and convenient and shows a potential in the assessment of disease activity and complications in inflammatory bowel disease.

Ultrasound-Guided Percutaneous Ethanol Ablation in Cystic and Predominantly Cystic Thyroid Nodules

Abstract Background thyroid cystic and predominantly cystic nodules are frequent among the general population. Some can increase in size with time and cause pressure and cosmetic symptoms. Their standard line of treatment is usually simple aspiration which was found to have high recurrence rate. Recurrent cystic thyroid nodules were considered for surgical removal which had many serious adverse effects. Aim of the Work to evaluate the efficacy, and safety of ultrasound guided percutaneous ethanol injection in cystic and predominantly cystic thyroid nodules in patients referred to Interventional Radiology Unit; Ain Shams University Hospitals. Patients and Methods The study was conducted at the Interventional Radiology Unit; Radiology Department, Ain Shams University Hospitals and conducted 20 patients with cystic thyroid nodules. Results The present study concludes that EA should be considered as the first option for the treatment of pure cysts and predominantly cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects. Conclusion EA should be considered as the first option for the treatment of benign cystic thyroid nodules, especially pure cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects.

The Value of Intra-Voxel Incoherent Motion (IVIM) in Evaluation of Inflammatory Bowel Diseases

Abstract Background Crohn’s disease is a chronic inflammatory segmental bowel disorder characterized by attacks of remission and exacerbation that can significantly affect the patients’ quality of life. Hence monitoring the disease activity is crucial to achieve longer symptom free intervals which may result either from active inflammation and its complications as deep ulceration, fistulae formation and abscesses or sequelae from longstanding inflammatory process as fibrotic scarring and strictures. Aim of the Work to determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in IBD. Patients and Methods The study conducted at the Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. From 6 to 9 months. Convenience sample of 32 patients who met the inclusion and exclusion criteria of the study based on clinical suspicion, biomarkers, endoscopy and histopathological specimens referred for MR enterography Results We studied the correlation between IVIM parameters with the four known parameters used for IBD activity evaluation (Biochemical, clinical, endoscopy, and MRE) and presence of complications. We studied the correlation of the previously mentioned prameters to each other Conclusion IVIM-DWI seems to be a potential noninvasive imaging approach that could provide specific quantitative markers, such as D*, ADC and f values, to objectively assess bowel inflammation with no concern about contrast agent complications.

Radiomics and 256-slice-dual-energy CT in the automated diagnosis of mild acute pancreatitis: the innovation of formal methods and high-resolution CT.

Acute pancreatitis (AP) is a common disease, and several scores aim to assess its prognosis. Our study aims to automatically recognize mild AP from computed tomography (CT) images in patients with acute abdominal pain but uncertain diagnosis from clinical and serological data through Radiomic model based on formal methods (FMs). We retrospectively reviewed the CT scans acquired with Dual Source 256-slice CT scanner (Somatom Definition Flash; Siemens Healthineers, Erlangen, Germany) of 80 patients admitted to the radiology unit of Antonio Cardarelli hospital (Naples) with acute abdominal pain. Patients were divided into 2 groups: 40 underwent showed a healthy pancreatic gland, and 40 affected by four different grades (CTSI 0, 1, 2, 3) of mild pancreatitis at CT without clear clinical presentation or biochemical findings. Segmentation was manually performed. Radiologists identified 6 patients with a high expression of diseases (CTSI 3) to formulate a formal property (Rule) to detect AP in the testing set automatically. Once the rule was formulated, and Model Checker classified 70 patients into "healthy" or "unhealthy". The model achieved:accuracy81%, precision 78% and recall81%. Combining FMs results with radiologists agreement, and applying the mode in clinical practice, the global accuracy would have been 100%. Our model was reliable to automatically detect mild AP at primary diagnosis even in uncertain presentation and it will be tested prospectively in clinical practice.

Role of Ultrasound in the Evaluation of Skeletal Muscle Changes in Patients with Type 2 Diabetes Mellitus

Abstract Background Diabetes is a global public health problem, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the diabetic population and it has been consistently reported as one of the strongest correlates of mobility limitation, especially in older people, and a potential risk factor for future mobility disability and loss of independence. Long-term complications and diabetes-related comorbidities only partially explain the excess risk of disability associated with diabetes. Changes in body composition, in particular progressive loss of muscle mass and increase in fat mass, with decline in muscle strength and quality have been proposed as additional potential mediators of the association between diabetes and disability. Aim of the Work to investigate the differences in Skeletal muscle ultrasound features in people with and without type 2 diabetes mellitus. Patients and Methods This was a Case control study conducted at the Ultrasound Radiology Unit, Radiology Department, Ain Shams University Hospitals from July, 2023 to January 2024. The study was performed on simple random sample consists of 36 T2DM patients on regular follow up in the endocrinology clinics in Ain Shams University Hospitals. And 36 Healthy controls came for routine checkup in Ain Shams University Hospitals clinics and meeting the study inclusion criteria. A signed informed consent was obtained from all patients and controls prior to inclusion in the study after explaining the procedure details. The approval of research ethical committee of faculty of Medicine - Ain Shams University was obtained before starting the study. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. Results we measured three ultrasonic parameters. MT, FL and PA. The FL and PA are measured in both relaxed and contracted states. the DPN group had the lowest MT, FL at both rest and contracted states and PA at contracted state as well as the lowest ΔFL and ΔPA. The control group had the highest MT, FL at both rest and contracted states and PA at contracted state as well as the highest ΔFL and ΔPA. The non-DPN group had intermediate values for the same variables. The differences among the groups were statistically significant for all the variables except for the pennation angle at rest. It showed that the ΔFL of the DPN group was significantly lower than that of the non-DPN group (p < 0.001), which was similar to a previous conclusion that the gastrocnemius fascicles undergo the smallest length changes in a DPN group. Conclusion The combination of MT,ΔFL and ΔPA of the MG showed high-diagnostic accuracy (sensitivity >80%; specificity >95%) for predicting DPN, which could be used for rapid screening in the future. Early muscle ultrasound screening should be timely carried out in patients with T2DM, especially those with a long disease course and poor long-term blood glucose levels, and there is no difference between men and women.

ANALYTICAL STUDY ON FACTORS AFFECTING THE ATTITUDE AND PERSPECTIVES OF FEMALE PATIENTS ON THE USE OF ARTIFICIAL INTELLIGENCE IN THE ASSESSMENT OF SCREENING MAMMOGRAMS

Background: Breast cancer is one of the most common cancers among Indian women, with an incidence of 25.8 per 100,000 women according to the Ministry of Health and Family Welfare. Late detection is responsible for poor quality of life (QOL), and it is the leading cause of death. Studies have shown that people are positive towards AI performing assessment tasks in healthcare in general and in mammography screening. Moreover, it is challenging to implement strategies based on self-breast inspection or do mammography in rural regions or low and middle income nations for a variety of reasons. Objective: This study was conducted to assess the perception and attitude of various female patients reporting to the radiology unit of a tertiary care centre regarding the use of Artificial Intelligence in routine mammogram screening. Study Design: A cross sectional questionnaire based study was conducted female patients attending the radiology unit of a tertiary Care Centre in Central Kerala. Methods: After obtaining, informed written consent was taken from the study participants. A predesigned, pretested, validated checklist was used to collect the required data. The Knowledge, attitude and practice was ascertained through Likerts scale and scoring done accordingly. Statistical tests of significance was employed to assess the possible associations between various variables with the knowledge, attitude and perceptions regarding Artifical Intelligence based Mammogram Results: Among the 170 study subjects analysed, 68.6% had a satisfactory knowledge about Artificial intelligence. Among the 170 study subjects analysed, 86% had a good attitude about being screened through AI enabled mammogram techniques. 92% of the total study subjects registered for mammogram had done it based on self choice. The association between age and willingness to get screened was found to be statistically significant. It was also seen that there was a statistically very high significance between Knowledge regarding AI and the independent decision to get screened. There was also a statistically significant association between age and scores >60% regarding knowledge and attitude regarding the vaccination among the study subjects. Conclusions: Majority of the study population was having a satisfactory knowledge regarding AI usage in healthcare.

Prevalence Of Congenital Abnormalities On Routine Antenatal Ultrasonography During Second And Third Trimester Of Pregnancy: A Study In A District Hospital Of North East India

Background Prevalence of congenital anomalies varies greatly from country to country. It is reported about 2.5% in India. In India, congenital anomalies are responsible for 15% of perinatal mortality and for 10% to 15% of neonatal deaths. The main aim of the study is to evaluate the prevalence of the congenital anomalies and malformation patterns in our hospital population. Material & Method This is a cross-sectional study carried out in the ‘Radiology unit’ of ‘District Hospital, Gomati’, Tripura. The study population includes about 910 antenatal mothers in the second and third trimester, who were referred to ‘Radiology unit’ from the outpatient and inpatient departments of ‘Obstetrics and Gynaecology’ of the same hospital between September 2017 to February 2018 were included in the study. Data of Antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomaly in 2nd & 3rd trimester. Results: Total 910 numbers of 2nd and 3rd trimester prenatal ultrasonography (USG) were done. Out of these 18 numbers of congenital anomalies were detected. The antenatal prevalence of congenital anomalies was 1.97%. The mean maternal age and mean gestational age at diagnosis was 22.9 years and 27.7 weeks respectively. Genitourinary system defect was the commonest (27.77%), of which maximum number had pyelactasis i.e. 3 (16.66%) cases. Conclusion: Ultrasonography is a cost-effective, non-invasive and sensitive tool in detecting the congenital anomalies antenatally in the hands of an experienced radiologist. Besides the first-trimester USG, the second trimester scan is mandatory in detecting anomaly in the growing foetus, as the majority of congenital anomalies are detected between 20 and 22 weeks of pregnancy

Radiation Protection and Radiobiology

This study provides a comprehensive overview of the principles of radiation protection and radiobiology. It defines and classifies radiation, distinguishing between ionizing and non-ionizing radiation. The biological effects of radiation, with a particular emphasis on its impact on DNA and cellular structures, are examined in detail. The text specifies radiation-sensitive and radiation-resistant tissues and explains both deterministic and stochastic effects. Additionally, the discussion encompasses radioepidemiological information and the relationship between linear energy transfer and DNA damage. The article delineates the classification of radiation areas as either controlled or supervised. It offers an extensive overview of the safety and protection methods employed in radiation work, including the ALARA (As Low As Reasonably Achievable) principle, the use of personal protective equipment, and dosimeters. Furthermore, it explains the radiation protection methods utilized in radiology units and outlines the precautions that should be taken during pregnancy. The article also presents recommendations for reducing radiation exposure. Overall, this article serves as a valuable resource on radiation safety for radiation workers and the public, containing essential information on protection from the harmful effects of radiation and safe working practices.

Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery

PurposeIn the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.MethodsWe performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.ResultsThe difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (p = 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (p = 0.91; p < 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm3 in the CT group, p < 0.001), it was not correlated with the difference in electrode position measured by both techniques (p = 0.17; p = 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv; p < 0.0001).ConclusionsIntraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.

An initial investigation into the use of virtual reality (VR) glasses on self-reported pain perception during mammography

ObjectivePain is one of the causes of refraining from mammography. This study aimed to investigate the use of virtual reality (VR) glasses for management of pain during mammography. MethodsFifty subjects who were referred to the radiology unit for mammography screening were invited to participate in the study. The study was approved by the hospital's ethics committee and participants provided written and oral informed consent. Craniocaudal (CC) and mediolateral oblique (MLO) views of the right breast were first acquired, followed by left CC and MLO mammographic views with the VR glasses on. After the examination, participants completed a questionnaire including a validated visual analog scale (VAS) scoring system to analyze pain scores. Data were analyzed using Spearman's rho and the Kruskal-Wallis test, as well as the Bland–Altman analysis to examine discrepancy. ResultsThe association of the right breast pain score with the parameters of age, breast density, previous mammography, family history of breast cancer, educational attainment, and employment status was examined using a correlation test. All the parameters showed no significant correlation with the right breast pain score except age (p: 0.016, correlation coefficient: −.340). Apart from that this study demonstrated no significant correlation between the perceived pain experienced during mammography and the utilization of VR technology. ConclusionThe findings indicate an inverse correlation between participant's age and pain perception during mammography examinations. Moreover, the utilization of Virtual Reality (VR) did not demonstrate efficacy in reducing pain perception.

Contrast-Enhanced Mammography in Local Staging of Screen-Detected Breast Cancer.

BreastScreen Australia, the population mammographic screening program for breast cancer, uses two-view digital screening mammography ± ultrasound followed by percutaneous biopsy to detect breast cancer. Secondary breast imaging for further local staging, not performed at BreastScreen, may identify additional clinically significant breast lesions. Staging options include further mammography, bilateral ultrasound, and/or contrast-based imaging (CBI) [magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM)]. CBI for local staging of screen-detected cancer was introduced at an academic hospital breast service in Melbourne, VIC, Australia. We report findings for otherwise occult disease and resulting treatment changes. Patients staged using CEM between November 2018 and April 2022 were identified from hospital records. Data were extracted from radiology, pathology, and breast unit databases. CEM-detected abnormalities were documented as true positive (TP) for invasive cancer or ductal carcinoma in situ (DCIS), or otherwise false positive (FP). The impact on surgical decisions was assessed. Of 202 patients aged 44-84 years, 60 (30%) had 74 additional findings [34 (46%) TP, 40 (54%) FP]. These were malignant in 29/202 (14%) patients (79% invasive cancers, 21% DCIS). CEM resulted in surgical changes in 43/202 (21%) patients: wider resection (24/43), conversion to mastectomy (6/43), contralateral breast surgery (6/43), additional ipsilateral excision (5/43), and bracketing (2/43). Additional findings were more common for patients with larger index lesions and for invasive cancer, but there was no significant variation by age, breast density, or index lesion grade. CEM for local staging of screen-detected breast cancers identified occult malignancy in 14% of patients. CEM improves local staging and may facilitate appropriate management of screen-detected breast cancers.

Imaging findings of primary lung tumors in children

Pediatric lung tumors are primarily discussed in the surgical literature. However, limited research has been reported on their imaging findings, and only a few tumor types have been documented. Therefore, the aim of this article is to describe the imaging features of primary lung tumors in children. The archives of the pediatric radiology unit were reviewed for primary lung tumors documented between 2007 and 2023. In total, 24 patients (9 girls and 15 boys; aged 5 months to 16 years) were included in the study. Their demographic characteristics, clinical presentation, and histopathologic results were obtained. All imaging studies were reviewed by two radiologists for various findings (e.g., lymphadenopathy, atelectasis, pleural effusion, calcification, multiplicity, pneumothorax, axial and lobar location, laterality, tumor margin, mediastinal shift, contrast enhancement pattern, signal intensity on T1- and T2-weighted images, and diffusion pattern), and a final decision was made by consensus. The mean tumor size was compared between the benign and malignant groups using a t-test. There were 15 (62.5%) benign tumors, as follows: inflammatory myofibroblastic tumor (IMT; n = 10, 41%), hemangioma (n = 2, 8%), pneumocytoma (n = 2, 8%), and mature cystic teratoma (n = 1, 4%). Moreover, there were 9 (37.5%) malignant tumors, as follows: pleuropulmonary blastoma (PPB; n = 6, 25%), adenocarcinoma (n = 2, 8%), and lymphoepithelioma-like carcinoma (LELC) (n = 1, 4%). The most frequently reported symptoms were cough, fever, dyspnea, chest pain, and recurrent infection; six patients reported no clinical symptoms. Fifteen tumors (62%) were located in the right lung. The mean tumor diameter at the time of diagnosis was 6.4 ± 3 cm (benign group: 6.7 ± 3.4 cm; malignant group: 6 ± 2.3 cm, P > 0.050). Calcification was present in 80% of the patients with IMT. At the time of diagnosis, two (8.3%) patients were found to have metastasis: one was diagnosed with adenocarcinoma and the other with LELC. Tumors were located peripherally in 18 (75%) patients. The symptoms associated with lung masses are non-specific. There is no correlation between tumor size and malignancy. The most common tumors observed in this study were IMT and PPB, respectively. IMT is highly associated with calcification. Primary lung tumors are rarely seen in children, and they have different histopathological types. Calcification might be an important radiological clue for the diagnosis of IMT, which is the most common lung tumor in children.

Vertebrobasilar system variations; Analysis with multi-detector CT angiography

Objective: The vertebrobasilar system provides vascular nutrition to the posterior part of the brain, medulla spinalis, medulla oblongata, and cerebellum. Anatomical variations in these vascular structures increase the incidence of thrombus and aneurysms in patients. This study examines the presence of anatomical anomalies in the vertebrobasilar system. Material and Methods: Retrospective CT angiogram images of 93 adult cases over 18 years of age who were examined for any reason in KSU, Training and Research Hospital Radiology Unit. Results: Vertebral artery hypoplasia was observed in 15% of the cases. Left dominance was observed in 64.2% of the cases, right dominance in 28.6%, and co-dominance in 7.2%. Vertebral artery duplication was not observed. Vertebral artery fenestration was observed in 2.1% of cases. Vertebral artery of flexible origin was detected in 7.5%. In 57% of cases with a variable origin, the vertebral artery originated as the second branch of the subclavian artery. The right vertebral artery originating from the brachiocephalic artery was seen in 14.2%, the left vertebral artery originating from the arcus aorta was seen in 14.2%, and the left aberrant vertebral artery was seen in 14.2%. Fenestration of the basilar artery was observed in 2.1%, and hypoplasia of the basilar artery in 1.1%. Fetal type PCA variation was observed in 35.4% of cases, bilateral fetal PCA in 3.2%, right fetal PCA in 17.2%, and left fetal PCA in 15%. PCA duplication was observed in 3.2%, SCA duplication in 16.1%, unpaired single SCA in 2.1%, and SCA fenestration in 1.1%. An unpaired single AICA was observed in 15%, duplication of AICA in 2.1%, hypoplastic AICA in 6.4%, and AICA originating from SCA in 1.1%. An unpaired single PICA was observed in 12.9%, hypoplastic PICA in 2.1%, basilar artery originating PICA in 9.6%, AICA originating PICA in 4.3%, and PICA duplication in 1.1%. Conclusion: This study provides a detailed analysis of anatomical variations in the vertebrobasilar system using multi-detector CT angiography. The findings highlight the prevalence and diversity of these variations, such as vertebral artery hypoplasia, dominance patterns, fenestrations, and origin variations. These variations have significant clinical implications, particularly in the context of interventional and surgical procedures, as well as in the diagnosis and management of cerebrovascular diseases. Recognizing and understanding these anatomical differences can aid clinicians in planning more effective treatment strategies, potentially reducing the risk of complications associated with thrombus and aneurysm formation. Further research with larger and more diverse populations is recommended to validate these findings and to explore the impact of these variations on clinical outcomes. Ultimately, this study contributes to the existing body of knowledge and underscores the importance of personalized approaches in the management of vertebrobasilar system anomalies.

Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function?

PurposeMicrowave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described.Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function.Materials and methodsAll 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated.ResultsA total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate.ConclusionMWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.

The Value of Magnetic Resonance Enterography Activity Indices in Evaluation of Crohn’s Disease Clinical Activity

Abstract Background Crohn’s disease is a chronic inflammatory segmental bowel disorder characterized by attacks of remission and exacerbation that can significantly affect the patients’ quality of life. Hence monitoring the disease activity is crucial to achieve longer symptom free intervals which may result either from active inflammation and its complications as deep ulceration, fistulae formation and abscesses or sequelae from longstanding inflammatory process as fibrotic scarring and strictures. Aim of the Work to compare the performance of the currently available scoring systems Maria, Clermont, CDMI and MEGS to the clinical disease activity index and endoscopic indices Patients and Methods the study was conducted at the Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. Over a period of 9 months. Convenience sample of proven cases of Crohn’s disease based on clinical suspicion, biomarkers, endoscopy and histopathological specimens who were referred for MRE enterography at our institution. Results We studied the relevance of 18 different single MR parameters and 5 indices in conjunction with clinical and endoscopic based scores. Our aim was to identify if any of the MR parameters can be used solely or in combination with others (indices) as predictors of disease activity. In our study, we identified that the presence of ulcers reflected the clinical rather than the endoscopic severity. Other individual MR parameters couldn’t predict either the clinical or endoscopic severity. The MaRIA score showed significant correlation with the clinical but not endoscopic score. The simplified MaRIA score reflected both the endoscopic and clinical severity scores regarding their absolute values and severity grade. Neither Diffusion- MaRIA/Clermont nor the CDMI scores could predict the degree of clinical and endoscopic disease severity. MEGS score was the most reliable score in determining the endoscopic activity despite being a consuming score with relative subjectivity in comparison to the forementioned scores. Conclusion MR indices provide an adjunct tool for evaluation of disease activity and identifying the severe disease evidenced by MaRIA, simplified MaRIA and MEGS scores. However, the use of a single MR parameter doesn’t provide a true reflection of the ongoing disease process, even the presence of ulcers and haustral loss may be associated with chronic disease.