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Elsaid N, Razek A, Batouty NM, Elmokadem AH, Tawfik AM, Saied A. Combined Conduit Score in Contrast-Enhanced Magnetic Resonance Venography in Patients with Idiopathic Intracranial Hypertension : Neuro-interventionalists' vs. Radiologists' Assessment. Clin Neuroradiol 2023; 33:695-700. [PMID: 36799990 PMCID: PMC10450004 DOI: 10.1007/s00062-023-01263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Based on increased understanding of the idiopathic intracranial hypertension (IIH) pathophysiology, venous sinus stenting (VSS) has emerged as an effective treatment for patients with transverse sinus stenosis (TSS). The presence of a reliable TSS screening tool is warranted. The combined conduit score (CCS) is the most widely used score for evaluation of the cerebral sinovenous stenosis in contrast-enhanced magnetic resonance venography (CE-MRV). PURPOSE OF THE STUDY To evaluate the interobserver agreement between neuro-interventionalists and radiologists with respect to the CCS in evaluation of transverse sinus stenosis in patients with idiopathic intracranial hypertension using CE-MRV. METHODS A retrospective study was conducted on 26 consecutive patients diagnosed with IIH and underwent CE-MRV. The 2 neuro-interventionalists and 2 radiologists separately evaluated the cerebral venous sinuses using the CCS. RESULTS The mean CCS was significantly different between the neuro-interventionalists and radiologists (p < 0.001), higher for the radiologists. The inter-rater reliability was excellent (ICC = 0.954, 95% CI: 0.898-0.979) between the 2 neuro-interventionalists, good between the 2 radiologists (ICC = 0.805, 95% CI: 0.418-0.921), but was not acceptable between the neuro-interventionalists and the radiologists (ICC 0.47 95% CI:-2.2-0.782). CONCLUSION Despite the excellent agreement between the neuro-interventionists and the good agreement between the radiologists, there was no agreement between the neuro-interventionists and the radiologists. Our finding suggests that there is a gap between the 2 specialties but does not favor any of them. Factors related to the observers, the venous sinus system, the MRV or the CCS score may have resulted in this discrepancy. Automatic or semi-automatic feature extractions to produce quantifiable biomarkers for IIH are warranted. The clinical decisions should not depend only on strongly observer-dependent scores with training and/or experience-dependent influences.
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Affiliation(s)
- Nada Elsaid
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Razek
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nihal M Batouty
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Tawfik
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Saied
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Elmokadem AH, Elged BA, Abdel Razek A, El-Serougy LG, Kasem MA, EL-Adalany MA. Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management. World J Radiol 2023; 15:201-215. [PMID: 37424734 PMCID: PMC10324495 DOI: 10.4329/wjr.v15.i6.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/17/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.
AIM To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.
METHODS The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.
RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.
CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | | | - Mohamed Ali Kasem
- Department of Neurosurgery, Mansoura University, Mansoura 35516, Egypt
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Karam R, Elmokadem AH, El-Rakhawy MM, Soliman N, Elnahas W, Abdel-Khalek AM. Clinical utility of abbreviated breast MRI based on diffusion tensor imaging in patients underwent breast conservative therapy. Radiol Med 2023; 128:289-298. [PMID: 36763315 DOI: 10.1007/s11547-023-01600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate the added value of the diffusion tensor imaging (DTI) parameters to abbreviated breast MRI protocol in differentiating recurrent breast cancer from post-operative changes in cases of breast conservative surgery (BCS). METHODS This prospective study was approved by our institutional review board. Written informed consent was obtained in all patients. 47 female patients (mean age, 49 years; range, 32-66 years) that previously underwent breast conservative surgery with a palpable mass were included in this study (62 breast lesions). Two abbreviated MRI protocols were compared using 1.5 Tesla MRI, AB-MRI 1 (axial T1, T2, pre-contrast T1, 1st post-contrast and subtracted images) and AB-MRI 2 (same sequences plus adding DTI). In both protocols, the wash-in rate was calculated. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each protocol. RESULTS The mean total acquisition time was of 6 min for AB-MRI 1 and 10 min for AB-MRI 2 protocols while the mean interpretation time was of 57.5 and 75 s, respectively. Among analyzed DTI parameters, MD (mean diffusivity) showed the highest sensitivity (96.43%) and specificity (91.18%) (P value = < 0.001). FA (fractional anisotropy), AD (axial diffusivity) and RD (radial diffusivity) showed sensitivity = (78.57%, 82.14% and 85.71%), specificity = (88.24, 85.29% and 79.41%), respectively, P value (< 0.001). CONCLUSION DTI may be included in abbreviated MRI protocols without a significant increase in acquisition time and with the advantage of increasing specificity and clinical utility in the characterization of post-conservative breast lesions.
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Affiliation(s)
- Rasha Karam
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt.
| | | | - Nermin Soliman
- Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt
| | - Waleed Elnahas
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
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Saleh GA, Elmokadem AH, Razek AA, El-Morsy A, Hamdy O, Eleraky ES, Saleh M. Utility of diffusion tensor imaging in differentiating benign from malignant hepatic focal lesions. Eur Radiol 2023; 33:1400-1411. [PMID: 35982336 DOI: 10.1007/s00330-022-09091-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of diffusion tensor imaging (DTI) in the characterization of hepatic focal lesions (HFLs) and compare it to diffusion-weighted imaging (DWI). METHODS Prospective analysis was done for 49 patients (23 male and 26 female) with 74 HFLs who underwent dynamic MRI, DWI, and DTI. Apparent diffusion coefficient (ADC) values from DWI, fractional anisotropy (FA) values, and mean diffusivity (MD) values from DTI were measured by two independent radiologists. HFLs were classified into benign and malignant HFLs; the latter were subdivided into HCC and non-HCC lesions. Binary logistic regression was performed to analyze the associations between the DTI parameters and the distinction of malignant lesions. RESULTS The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. The mean ADC and MD values of hemangiomas were significantly higher than HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs. The ADC and MD were very good discriminators at cutoff values of > 1.03 × 10-3 mm2/s and > 1.12 × 10-3 mm2/s, respectively. The FA at a cutoff value > 0.38 is an excellent discriminator for HCC versus non-HCC malignant lesions. Only FA value > 0.38 was a statistically significant independent predictor of HCC versus non-HCC lesions among the three parameters. There was an excellent inter-observer agreement with ICC > 0.9. CONCLUSION MD and FA of DTI are non-invasive, very good, and excellent discriminators superior to ADC measured by DWI for the differentiation of HFLs. KEY POINTS • The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. • The mean ADC and MD values of hemangiomas were significantly higher than those of HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs, respectively. • Multivariate regression analysis revealed that only FA value > 0.38 was a statistically significant independent predictor of HCC vs. non-HCC lesions. A lesion with FA > 0.38 has 34 times higher odds of being HCC rather than non-HCC lesions.
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Affiliation(s)
- Gehad A Saleh
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt.
| | - Ahmed Abdel Razek
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ahmed El-Morsy
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Omar Hamdy
- Department of Surgical Oncology, Mansoura University, Mansoura, Egypt
| | | | - Marwa Saleh
- Department of Internal Medicine, Mansoura University, Mansoura, Egypt
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Sakrana AA, Alharbi IH, Elmokadem AH. Diagnostic accuracy of lower-dose cardiac CT in evaluating young infants with non-coronary complex congenital heart disease on a 64-slice multidetector CT scanner. Acta Radiol 2022; 64:2024-2032. [PMID: 36451522 DOI: 10.1177/02841851221139672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Redoable precise and non-invasive diagnostic imaging modality with the least radiation dose is essential for infants with congenital heart disease (CHD) . Purpose To investigate the accuracy and estimate the radiation dose of our cardiac computed tomography (CCT) protocol. Material and Methods A total of 82 infants with CHD underwent non-ECG-gated CCT without contrast timing scanning techniques and were retrospectively studied. The image quality and radiation dose were estimated. The radiation dose was compared statistically to virtual retrospective ECG-gated and prospective ECG-triggering scanning modes. The diagnostic accuracy was assessed assuming the surgical results as the diagnostic gold standard. Results Most exams showed a high quality with low radiation doses compared to previous studies. The mean effective dose (ED) was 0.39 ± 1.2, significantly lower than that of the virtual retrospective ECG-gated and prospective ECG-triggering scanning and lower than in previous studies. Our CCT protocol has achieved a diagnostic accuracy of 99.52% with a sensitivity of 94.83% and specificity of 99.91%. Conclusion Non-ECG-gated CCT without contrast timing techniques can detect the non-coronary cardiovascular defects of CHD in infants with an ultralow radiation dose and a high diagnostic accuracy.
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Affiliation(s)
- Amal Abdelsattar Sakrana
- Department of Diagnostic and Interventional radiology, Mansoura University Hospital, Mansoura, Egypt
| | | | - Ali H Elmokadem
- Department of Diagnostic and Interventional radiology, Mansoura University Hospital, Mansoura, Egypt
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Sherif F, Elmokadem AH, Abdel Razek A, Kamal E, Abdou EHE, Salem MA, Ghoneim MM. DTI of the Olfactory Bulb in COVID-19-Related Anosmia: A Pilot Study. AJNR Am J Neuroradiol 2022; 43:1180-1183. [PMID: 36920776 PMCID: PMC9575417 DOI: 10.3174/ajnr.a7590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to assess the utility of DTI in the detection of olfactory bulb dysfunction in COVID-19-related anosmia. It was performed in 62 patients with COVID-19-related anosmia and 23 controls. The mean diffusivity and fractional anisotropy were calculated by 2 readers. The difference between the fractional anisotropy and mean diffusivity values of anosmic and control olfactory bulbs was statistically significant (P = .001). The threshold of fractional anisotropy and mean diffusivity to differentiate a diseased from normal olfactory bulb were 0.22 and 1.5, with sensitivities of 84.4% and 96.8%, respectively, and a specificity of 100%.
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Affiliation(s)
- F Sherif
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - A H Elmokadem
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - A Abdel Razek
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - E Kamal
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - E H E Abdou
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - M A Salem
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - M M Ghoneim
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
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Deif MA, Mounir AM, Abo-Hedibah SA, Abdel Khalek AM, Elmokadem AH. Outcome of percutaneous drainage for septic complications coexisted with COVID-19. World J Radiol 2022; 14:91-103. [PMID: 35646292 PMCID: PMC9124979 DOI: 10.4329/wjr.v14.i4.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/13/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.
AIM To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.
METHODS This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.
RESULTS Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).
CONCLUSION In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.
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Affiliation(s)
- Mohamed A Deif
- Department of Radiology, National Liver Institute, Menoufia University, Shibin Al Kawm 32521, Egypt
| | - Ahmad M Mounir
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
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Elmokadem AH, Bayoumi D, Mansour M, Ghonim M, Saad EA, Khedr D. COVID-19-associated acute invasive fungal sinusitis: Clinical and imaging findings. J Neuroimaging 2022; 32:676-689. [PMID: 35043509 DOI: 10.1111/jon.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal sinusitis (AIFS) and associated comorbidities. METHODS A retrospective study was conducted on 25 patients (12 males and 13 females, mean age of 53.9±9.1 years). All patients had positive polymerase chain reaction test for COVID-19 and histopathological proof of AIFS. Patients underwent computed tomography (CT) and magnetic resonance examinations to assess sinonasal, orbital, and cranial spread. RESULTS The most prevalent comorbidity among the study cohort was diabetes mellitus (DM). Twenty-one patients (84%) were diagnosed in the post-COVID-19 period after hospital discharge, with a mean interval of 19.1±9.2 days. Steroid treatment was given to 19 patients (76%). Orbital manifestations were the presenting symptoms in all patients, followed by facial edema, nasal discharge, and neurological symptoms. Sinonasal involvement ranged from mucosal thickening to complete sinus opacification by a predominant isodensity on CT, low T1, and high T2 signal intensity with variable enhancement patterns. Twenty-four patients had a unilateral orbital extension, and 12 patients showed signs of intracranial extension. Bone involvement was detected in 16 patients (64%). Follow-up scans in 18 patients (72%) showed rapid progression of the disease. Eight patients (32%) died, six from neurological complications and two from severe respiratory failure. CONCLUSION Steroids, DM, and severe COVID-19 are the major risk factors of AIFS in the post-COVID-19 era. Imaging scans in all patients revealed different sinonasal, facial, orbital features, and intracranial involvement with rapid progression of the findings on follow-up scans.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura, Egypt.,Department of Radiology, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Dalia Bayoumi
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Manar Mansour
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Mahitab Ghonim
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Eman A Saad
- Department of Pathology, Mansoura University, Mansoura, Egypt
| | - Doaa Khedr
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Elmokadem AH, Mounir AM, Ramadan ZA, Elsedeiq M, Saleh GA. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol 2022; 32:3501-3512. [PMID: 35031841 PMCID: PMC8760133 DOI: 10.1007/s00330-021-08432-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/27/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the diagnostic performance and inter-observer agreement of five different CT chest severity scoring systems for COVID-19 to find the most precise one with the least interpretation time. METHODS AND MATERIALS This retrospective study included 85 patients (54 male and 31 female) with PCR-confirmed COVID-19. They underwent CT to assess the severity of pulmonary involvement. Three readers were asked to assess the pulmonary abnormalities and score the severity using five different systems, including chest CT severity score (CT-SS), chest CT score, total severity score (TSS), modified total severity score (m-TSS), and 3-level chest CT severity score. Time consumption on reporting of each system was calculated. RESULTS Two hundred fifty-five observations were reported for each system. There was a statistically significant inter-observer agreement in assessing qualitative lung involvement using the m-TSS and the other four quantitative systems. The ROC curves revealed excellent and very good diagnostic accuracy for all systems when cutoff values for detection severe cases were > 22, > 17, > 12, and > 26 for CT-SS, chest CT score, TSS, and 3-level CT severity score. The AUC was very good (0.86), excellent (0.90), very good (0.89), and very good (0.86), respectively. Chest CT score showed the highest specificity (95.2%) in discrimination of severe cases. Time consumption on reporting was significantly different (< 0.001): CT-SS > 3L-CT-SS > chest CT score > TSS. CONCLUSION All chest CT severity scoring systems in this study demonstrated excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. CT-SS and TSS had the highest specificity and least time for interpretation. KEY POINTS • All chest CT severity scoring systems discussed in this study revealed excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. • Chest CT scoring system and TSS had the highest specificity. • Both TSS and m-TSS consumed the least time compared to the other three scoring systems.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura, Egypt.
- Department of Radiology, Farwaniya Hospital, Kuwait City, Kuwait.
| | - Ahmad M Mounir
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | | | - Mahmoud Elsedeiq
- Department of Anesthesia and ICU, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Gehad A Saleh
- Department of Radiology, Mansoura University, Mansoura, Egypt
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10
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Abdel Razek AAK, Elmokadem AH, Soliman M, Mukherji SK. MR Imaging of Vascular Malformations and Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:199-213. [PMID: 34802579 DOI: 10.1016/j.mric.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Soft tissue vascular anomalies show a wide heterogeneity of clinical manifestations and imaging features. MR imaging has an important role in the diagnosis and management of vascular lesions of the head and neck. MR angiography is mandatory in cases of arteriovenous and combined malformations to assess the high-flow nature/component of the lesions and plan therapy. Infantile hemangiomas can be differentiated from congenital hemangiomas by clinical course. Reactive vascular tumors have nonspecific features similar to infantile hemangiomas. Locally malignant and malignant vascular tumors have irregular borders, infiltration of different tissue planes, and lower apparent diffusion coefficient values than benign vascular tumors.
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Affiliation(s)
| | - Ali H Elmokadem
- Department of Diagnostic Radiology, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Mosad Soliman
- Department of Vascular Surgery, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Sobh DM, Batouty NM, Tawfik AM, Gadelhak B, Elmokadem AH, Hammad A, Eid R, Hamdy N. Left Ventricular Strain Analysis by Tissue Tracking- Cardiac Magnetic Resonance for early detection of Cardiac Dysfunction in children with End-Stage Renal Disease. J Magn Reson Imaging 2021; 54:1476-1485. [PMID: 34037288 DOI: 10.1002/jmri.27700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Reduction in left ventricular ejection fraction (LVEF) represents late left ventricle (LV) dysfunction. Cardiac MRI myocardial strain analysis is an alternative method for assessment of LV function. PURPOSE To investigate whether LV strain analysis is more sensitive than LVEF for early detection of systolic dysfunction in children with ESRD. STUDY TYPE Case control. POPULATION Thirty-two children with ESRD (median 14 years, 17 females) and 10 healthy control (median 12.5 years, 7 females). FIELD STRENGTH AND SEQUENCES A 1.5 T /retrospective ECG-gated steady-state free precession (SSFP). ASSESSMENT LVEF, and indexed LV mass (LVMi) and LV end-diastolic volume (LVEDVi) were measured. Using tissue tracking analysis, LV endocardial and epicardial contours were traced in short and long axes at end diastole to calculate global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains. STATISTICAL ANALYSIS Cardiac MRI and strain parameters were compared between patients and control, and between subgroup with preserved LVEF and control by Student t-test/Mann Whitney test. Diagnostic accuracy was assessed by Receiver operating characteristic analysis. Strain as predictor of poor outcome (mortality, pulmonary edema, and/or heart failure) within 1-year follow up was investigated by binary logistic regression. RESULTS Compared to control, cardiac MRI LVEF, LVEDVi, LVMi, GLS, GCS and GRS were significantly impaired in patients. Patients with preserved LVEF had significantly higher LVEDVi, LVMi and significantly impaired GCS and GRS than control. Strain parameters were significantly correlated with LVEF, LVEDVi, and LVMi. GCS and GRS demonstrated greater diagnostic accuracy than GLS (area under curve: 0.89). LVEF, LVMi, GCS, and GRS were correlated with poor outcome. CONCLUSION Cardiac MRI tissue tracking could identify subclinical LV dysfunction in children with ESRD and still preserved LVEF. Furthermore, LV strain parameters (GCS and GRS) were correlated with future cardiovascular events. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Donia M Sobh
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Nihal M Batouty
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ahmed M Tawfik
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Basma Gadelhak
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ayman Hammad
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Riham Eid
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Nashwa Hamdy
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
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Zaitoun MMA, Elsayed SB, Zaitoun NA, Soliman RK, Elmokadem AH, Farag AA, Amer M, Hendi AM, Mahmoud NEM, Salah El Deen D, Alsowey AM, Shahin S, Basha MAA. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm. Int J Hyperthermia 2021; 38:248-256. [PMID: 33615957 DOI: 10.1080/02656736.2021.1887941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. METHODS This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. RESULTS Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. CONCLUSIONS Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.
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Affiliation(s)
- Mohamed M A Zaitoun
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Diagnostic Radiology Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saeed B Elsayed
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla A Zaitoun
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa K Soliman
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ali H Elmokadem
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa A Farag
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Amer
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali M Hendi
- Diagnostic Radiology Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Nader E M Mahmoud
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Salah El Deen
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shahenda Shahin
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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13
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Elmokadem AH, Batouty NM, Bayoumi D, Gadelhak BN, Abdel-Wahab RM, Zaky M, Abo-Hedibah SA, Ehab A, El-Morsy A. Mimickers of novel coronavirus disease 2019 (COVID-19) on chest CT: spectrum of CT and clinical features. Insights Imaging 2021; 12:12. [PMID: 33533965 PMCID: PMC7856625 DOI: 10.1186/s13244-020-00956-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19 (coronavirus disease 2019) is a recently emerged pulmonary infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It started in Wuhan, China, in December 2019 and led to a highly contagious disease. Since then COVID-19 continues to spread, causing exponential morbidity and mortality and threatening economies worldwide. While the primary diagnostic test for COVID-19 is the reverse transcriptase-polymerase chain reaction (RT-PCR) assay, chest CT has proven to be a diagnostic tool of high sensitivity. A variety of conditions demonstrates CT features that are difficult to differentiate from COVID-19 rendering CT to be of low specificity. Radiologists and physicians should be aware of imaging patterns of these conditions to prevent an erroneous diagnosis that could adversely influence management and patients' outcome. Our purpose is to provide a practical review of the conditions that mimic COVID-19. A brief description of the forementioned clinical conditions with their CT features will be included.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt.
- Department of Radiology, Farwaniya Hospital, Al Farwaniyah , Kuwait.
| | - Nihal M Batouty
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Dalia Bayoumi
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Basma N Gadelhak
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Rihame M Abdel-Wahab
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Mona Zaky
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Sherif A Abo-Hedibah
- Department of Radiology, Farwaniya Hospital, Al Farwaniyah , Kuwait
- Department of Radiology, Cairo University, Giza, Egypt
| | - Ahmed Ehab
- Pulmonary Medicine Department, Mansoura University, Mansoura, Egypt
- Pulmonary Medicine Department, Loewenstein Lung Center, Löwenstein, Germany
| | - Ahmed El-Morsy
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
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14
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Saleh GA, Alghandour R, Rashad EY, Tawfik AM, Elmokadem AH. The adjunctive value of diffusion weighted imaging in diagnosis and follow up of uterovaginal diffuse B-cell lymphoma: A case report and literature review. Curr Med Imaging 2021; 17:1159-1166. [PMID: 33494680 DOI: 10.2174/1573405617666210120094711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed non surgically unlike other non-lymphomatous malignant tumors raising the importance to differentiate between both entities. CASE REPORT We describe the magnetic resonance imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases including our patient were reviewed with age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse large B-cell lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%) while uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map. CONCLUSION MRI shows unique features that help to differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.
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Affiliation(s)
- Gehad A Saleh
- Diagnostic radiology Department, Mansoura University. Egypt
| | | | | | - Ahmed M Tawfik
- Diagnostic radiology Department, Mansoura University. Egypt
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15
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Elmokadem AH, Bayoumi D, Abo-Hedibah SA, El-Morsy A. Diagnostic performance of chest CT in differentiating COVID-19 from other causes of ground-glass opacities. Egypt J Radiol Nucl Med 2021. [PMCID: PMC7783705 DOI: 10.1186/s43055-020-00398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background To evaluate the diagnostic performance of chest CT in differentiating coronavirus disease 2019 (COVID-19) and non-COVID-19 causes of ground-glass opacities (GGO). Results A total of 80 patients (49 males and 31 females, 46.48 ± 16.09 years) confirmed with COVID-19 by RT-PCR and who underwent chest CT scan within 2 weeks of symptoms, and 100 patients (55 males and 45 females, 48.94 ± 18.97 years) presented with GGO on chest CT were enrolled in the study. Three radiologists reviewed all CT chest exams after removal of all identifying data from the images. They expressed the result as positive or negative for COVID-19 and recorded the other pulmonary CT features with mention of laterality, lobar affection, and distribution pattern. The clinical data and laboratory findings were recorded. Chest CT offered diagnostic accuracy ranging from 59 to 77.2% in differentiating COVID-19- from non-COVID-19-associated GGO with sensitivity from 76.25 to 90% and specificity from 45 to 67%. The specificity was lower when differentiating COVID-19 from non-COVID-19 viral pneumonias (30.5–61.1%) and higher (53.1–70.3%) after exclusion of viral pneumonia from the non-COVID-19 group. Patients with COVID-19 were more likely to have lesions in lower lobes (p = 0.005), peripheral distribution (p < 0.001), isolated ground-glass opacity (p = 0.043), subpleural bands (p = 0.048), reverse halo sign (p = 0.005), and vascular thickening (p = 0.013) but less likely to have pulmonary nodules (p < 0.001), traction bronchiectasis (p = 0.005), pleural effusion (p < 0.001), and lymphadenopathy (p < 0.001). Conclusions Chest CT offered reasonable sensitivity when differentiating COVID-19- from non-COVID-19-associated GGO with low specificity when differentiating COVID-19 from other viral pneumonias and moderate specificity when differentiating COVID-19 from other causes of GGO.
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Elmokadem AH, Elsalam HA, Elmosry A, Elsabbagh A. Transarterial Embolization of Malignant Tumor-Related Gastrointestinal Bleeding: Technical and Clinical Efficacy. PAIRS Annual Meeting 2020. [DOI: 10.1055/s-0041-1729050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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17
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Zaky MM, Hafez A, Zaky MM, Shoma A, Soliman NY, Elmokadem AH. MRI for assessment of pathologic nipple discharge: is it mandatory? Egypt J Radiol Nucl Med 2019. [DOI: 10.1186/s43055-019-0105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology.
Results
Histopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%.
Conclusion
Magnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.
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18
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Elmokadem AH, Abdel-Wahab RM, El-Zayadi AA, Elrakhawy MM. Uterine Artery Embolization and Methotrexate Infusion as Sole Management for Caesarean Scar and Cervical Ectopic Pregnancies: A Single-Center Experience and Literature Review. Can Assoc Radiol J 2019; 70:307-316. [DOI: 10.1016/j.carj.2018.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/12/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The incidence of caesarean scar pregnancy (CSP) and cervical pregnancy (CP) has increased significantly in recent years. The related hemorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. Methods A retrospective study was conducted for 11 patients (age range from 25–40 years, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mIU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6-24 months included weekly sonography and b-hCG level assessment. A literature review was performed using standard online search tools. Results In 10 patients, UAE controlled active vaginal bleeding and reduced post-procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved, and the uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. Conclusion UAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.
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Affiliation(s)
- Ali H. Elmokadem
- Diagnostic and Interventional Radiology Department, Mansoura University, Mansoura, Egypt
| | - Rihame M. Abdel-Wahab
- Diagnostic and Interventional Radiology Department, Mansoura University, Mansoura, Egypt
| | - Ahmed A. El-Zayadi
- Gynecology and Obstetrics Department, Mansoura University, Dakahlia, Egypt
| | - Mohamed M. Elrakhawy
- Diagnostic and Interventional Radiology Department, Mansoura University, Mansoura, Egypt
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Abdelsalam H, Elmokadem AH. Endovascular Management of External Iliac Blowout Syndrome Secondary to Recurrent Sigmoid Cancer. Vasc Endovascular Surg 2019; 53:512-514. [DOI: 10.1177/1538574419858821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Blowout syndrome caused by vascular invasion is a dreadful complication of late stage malignancies that carry high morbidity and poor overall prognosis in a compromised population. Endovascular management can offer minimally invasive and life-saving alternative for such acute conditions. We describe the case of a 62-year-old man with massive fresh bleeding per rectum and shock resulting from rupture of the left external iliac artery secondary to nearby infiltrative recurrent sigmoid cancer. This complication is rare, presents dramatically, and is frequently fatal. The patient was successfully treated with a stent graft deployment in order to achieve hemostasis and reinstituting the arterial integrity.
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Affiliation(s)
- Hassan Abdelsalam
- Department of Diagnostic & Interventional Radiology, Alexandria University, Alexandria, Governorate, Egypt
| | - Ali H. Elmokadem
- Department of Diagnostic & Interventional Radiology, Mansoura University, Mansoura, Dakahlia, Egypt
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20
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Al-Smadi AS, Abdalla RN, Elmokadem AH, Shaibani A, Hurley MC, Potts MB, Jahromi BS, Carroll TJ, Ansari SA. Diagnostic Accuracy of High-Resolution Black-Blood MRI in the Evaluation of Intracranial Large-Vessel Arterial Occlusions. AJNR Am J Neuroradiol 2019; 40:954-959. [PMID: 31072969 PMCID: PMC6711667 DOI: 10.3174/ajnr.a6065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE 3D high-resolution black-blood MRI or MR vessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ = 0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in >80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial large-vessel arterial occlusions with near-equivalency to DSA and CTA.
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Affiliation(s)
- A S Al-Smadi
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
| | - R N Abdalla
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - A H Elmokadem
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Department of Radiology (A.H.E.), Mansoura University, Mansoura, Egypt
| | - A Shaibani
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M C Hurley
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - T J Carroll
- Department of Radiology (T.J.C.), University of Chicago, Chicago, Illinois
| | - S A Ansari
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurology (S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Elmokadem AH, Abdel Khalek AM, Abdel Wahab RM, Tharwat N, Gaballa GM, Elata MA, Amer T. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging for Differentiation Between Parotid Neoplasms. Can Assoc Radiol J 2019; 70:264-272. [PMID: 30922790 DOI: 10.1016/j.carj.2018.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/25/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study was designed to evaluate the role of multiparametric magnetic resonance imaging (MRI) for differentiation of parotid gland neoplasms. METHODS Prospective study was conducted upon 52 consecutive patients (30 men, 22 women; aged 24-78 years; mean, 51 years) with parotid tumours that underwent multiparametric MRI using combined static MRI, dynamic contrast enhanced (DCE) MRI, and diffusion-weighted imaging (DWI). The static MRI parameter, time signal intensity curves (TIC) derived from DCE-MRI, and apparent diffusion coefficient (ADC) values of parotid tumours were correlated with histopathological findings. RESULTS Static MRI revealed a significant difference between both benign and malignant lesions in regards to margin definition (P < .001) and T2 hypointensity (P < .013), with a diagnostic accuracy 95% and 78.33% respectively. Study of the TIC type on DCE-MRI revealed statistically significant difference between benign and malignant lesions (P < .001) and diagnostic accuracy 96.55%. There was no statistically significant difference (P = .181) between the ADC values of benign and malignant lesions. ROC curve analysis revealed that by using ADC cut-off value of 1 × 10-3 mm2/s had accuracy of 84.62% respectively for differentiating Warthin from malignant tumours that could be modified to higher value (94.28%) by excluding lymphoma from malignant lesions. By using cutoff value of 1.3 × 10-3 mm2/s to differentiate pleomorphic adenoma from malignancy, ROC curve analysis had high accuracy of 97.06%. CONCLUSION Multiparametric MRI can be used for differentiation of malignant from benign parotid tumours and characterization of some benign parotid tumours.
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Affiliation(s)
- Ali H Elmokadem
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt.
| | - Ahmed M Abdel Khalek
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Rihame M Abdel Wahab
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Nehal Tharwat
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Ghada M Gaballa
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Mohamed Abo Elata
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Talal Amer
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
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22
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Vakil P, Elmokadem AH, Syed FH, Cantrell CG, Dehkordi FH, Carroll TJ, Ansari SA. Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study. AJNR Am J Neuroradiol 2016; 38:243-249. [PMID: 27856437 DOI: 10.3174/ajnr.a4998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic disease plaque hyperintensity and/or gadolinium contrast enhancement have been studied as imaging biomarkers of acutely symptomatic ischemic presentations using single static MR imaging measurements. However, the value in modeling the dynamics of intracranial plaque permeability has yet to be evaluated. The purpose of this study was to use dynamic contrast-enhanced MR imaging to quantify the contrast permeability of intracranial atherosclerotic disease plaques in symptomatic patients and to compare these parameters against existing markers of plaque volatility using black-blood MR imaging pulse sequences. MATERIALS AND METHODS We performed a prospective study of contrast uptake dynamics in the major intracranial vessels proximal and immediately distal to the circle of Willis using dynamic contrast-enhanced MR imaging, specifically in patients with symptomatic intracranial atherosclerotic disease. Using the Modified Tofts model, we extracted the volume transfer constant (Ktrans) and fractional plasma volume (Vp) parameters from plaque-enhancement curves. Using regression analyses, we compared these parameters against time from symptom onset as well as intraplaque hyperintensity and postcontrast enhancement derived from T1 SPACE, a black-blood MR vessel wall imaging sequence. RESULTS We completed analysis in 10 patients presenting with symptomatic intracranial atherosclerotic disease. Ktrans and Vp measurements were higher in plaques versus healthy white matter and similar or less than values in the choroid plexus. Only Ktrans correlated significantly with time from symptom onset (P = .02). Dynamic contrast-enhanced MR imaging parameters were not found to correlate significantly with intraplaque enhancement or intraplaque hyperintensity (P = .4 and P = .17, respectively). CONCLUSIONS Elevated Ktrans and Vp values found in intracranial atherosclerotic disease plaques versus healthy white matter suggest that dynamic contrast-enhanced MR imaging is a feasible technique for studying vessel wall and plaque characteristics in the proximal intracranial vasculature. Significant correlations between Ktrans and symptom onset, which were not observed on T1 SPACE-derived metrics, suggest that Ktrans may be an independent imaging biomarker of acute and symptom-associated pathologic changes in intracranial atherosclerotic disease plaques.
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Affiliation(s)
- P Vakil
- From the College of Medicine (P.V.), University of Illinois, Chicago, Illinois.,Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - A H Elmokadem
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - F H Syed
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - C G Cantrell
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - F H Dehkordi
- Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois
| | - T J Carroll
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - S A Ansari
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.) .,Neurology and Neurological Surgery (S.A.A.), Northwestern University, Chicago, Illinois
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23
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Daruwalla VJ, Syed FH, Elmokadem AH, Hurley MC, Shaibani A, Ansari SA. Large basilar perforator pseudoaneurysm: A case report. Interv Neuroradiol 2016; 22:662-665. [PMID: 27485048 DOI: 10.1177/1591019916659261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/22/2016] [Indexed: 11/16/2022] Open
Abstract
Basilar perforator aneurysms are rare and a communication between a basilar perforator and a separate pseudoaneurysm cavity is extremely rare. We describe a case presenting with high grade subarachnoid hemorrhage which on further investigation delineated a 2-3 mm dissecting basilar perforator aneurysm communicating superiorly into a contained 6 mm pseudoaneurysm cavity. This case illustrates an unusual neurovascular pathology with low potential for successful endovascular treatment such as coil embolization or intracranial flow diverter stenting. Conservative medical management remains the main stay of treatment for such poor surgical candidates.
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Affiliation(s)
- Vistasp J Daruwalla
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Furqan H Syed
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ali H Elmokadem
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Radiology and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Ali Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Radiology and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sameer A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA .,Departments of Radiology and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Elmokadem AH, Ansari SA, Sangha R, Prabhakaran S, Shaibani A, Hurley MC. Neurointerventional management of carotid webs associated with recurrent and acute cerebral ischemic syndromes. Interv Neuroradiol 2016; 22:432-7. [PMID: 26922976 DOI: 10.1177/1591019916633245] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology. CASE REPORT We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment. CONCLUSIONS Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.
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Affiliation(s)
- A H Elmokadem
- Department of Radiology, Mansoura University, Egypt Department of Radiology, Northwestern University Feinberg School of Medicine, USA
| | - S A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - R Sangha
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - S Prabhakaran
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - A Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - M C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
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