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Almalki YE, Basha MAA, Refaat R, Alduraibi SK, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Mahmoud NEM, Alayouty NA, Ali SA, Alnaggar AA, Saber S, El-Maghraby AM, Elsheikh AM, Radwan MHSS, Abdelmegid AGI, Aly SA, Shanab WSA, Obaya AA, Abdelhai SF, Elshorbagy S, Haggag YM, Mokhtar HM, Sabry NM, Altohamy JI, Abouelkheir RT, Omran T, Shalan A, Algazzar YH, Metwally MI. Bosniak classification version 2019: a prospective comparison of CT and MRI. Eur Radiol 2023; 33:1286-1296. [PMID: 35962816 DOI: 10.1007/s00330-022-09044-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy and agreement of CT and MRI in terms of the Bosniak classification version 2019 (BCv2019). MATERIALS AND METHODS A prospective multi-institutional study enrolled 63 patients with 67 complicated cystic renal masses (CRMs) discovered during ultrasound examination. All patients underwent CT and MRI scans and histopathology. Three radiologists independently assessed CRMs using BCv2019 and assigned Bosniak class to each CRM using CT and MRI. The final analysis included 60 histopathologically confirmed CRMs (41 were malignant and 19 were benign). RESULTS Discordance between CT and MRI findings was noticed in 50% (30/60) CRMs when data were analyzed in terms of the Bosniak classes. Of these, 16 (53.3%) were malignant. Based on consensus reviewing, there was no difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT (87.8%; 95% CI = 73.8-95.9% versus 75.6%; 95% CI = 59.7-87.6%; p = 0.09, 84.2%; 95% CI = 60.4-96.6% versus 78.9%; 95% CI = 54.4-93.9%; p = 0.5, and 86.7%; 95% CI = 64.0-86.6% versus 76.7%; 95% CI = 75.4-94.1%; p = 0.1, respectively). The number and thickness of septa and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. The inter-reader agreement (IRA) was substantial for determining the Bosniak class in CT and MRI (k = 0.66; 95% CI = 0.54-0.76, k = 0.62; 95% CI = 0.50-0.73, respectively). The inter-modality agreement of the BCv219 between CT and MRI was moderate (κ = 0.58). CONCLUSION In terms of BCv2019, CT and MRI are comparable in the classification of CRMs with no significant difference in diagnostic accuracy and reliability. KEY POINTS • There is no significant difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT. • The number of septa and their thickness and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. • The inter-reader agreement was substantial for determining the Bosniak class in CT and MRI and the inter-modality agreement of the BCv219 between CT and MRI was moderate.
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Affiliation(s)
- Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | | | - Rania Refaat
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | | | - Hala Y Yousef
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmad Abdullah Alnaggar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Saber
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Amgad M Elsheikh
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Waleed S Abo Shanab
- Department of Diagnostic Radiology, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Ahmed Ali Obaya
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shaimaa Farouk Abdelhai
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shereen Elshorbagy
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser M Haggag
- Department of Urology, Faculty of Human Medicine, Al Azhar University, Cairo, Egypt
| | - Hwaida M Mokhtar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Nesreen M Sabry
- Department of Clinical Oncology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Jehan Ibrahim Altohamy
- Department of Diagnostic Radiology, National Institute of Urology and Nephrology, Cairo, Egypt
| | - Rasha Taha Abouelkheir
- Department of Diagnostic Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tawfik Omran
- Department of Diagnostic Radiology, Faculty of Human Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Shalan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Maha Ibrahim Metwally
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Abdel-Tawab M, Basha MAA, Mohamed IAI, Ibrahim HM, Zaitoun MMA, Elsayed SB, Mahmoud NEM, El Sammak AA, Yousef HY, Aly SA, Khater HM, Mosallam W, Abo Shanab WS, Hendi AM, Hassan S. Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia. Insights Imaging 2021; 12:55. [PMID: 33913066 PMCID: PMC8081002 DOI: 10.1186/s13244-021-00998-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/28/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia. Results A retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781). Conclusion CO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.
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Affiliation(s)
- Mohamed Abdel-Tawab
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | | | - Ibrahim A I Mohamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | - Hamdy M Ibrahim
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El Sammak
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Hamada M Khater
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Walid Mosallam
- Department of Radio-diagnosis, Faculty of Human Medicine, Suiz Canal University, Esmaelia, Egypt
| | - Waleed S Abo Shanab
- Department of Radio-diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Ali M Hendi
- Department of Radiology, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sayed Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, 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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Basha MAA, Eldib DB, Aly SA, Azmy TM, Mahmoud NEM, Ghandour TM, Aly T, Mostafa S, Elaidy AM, Algazzar HY. Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging 2020; 11:107. [DOI: https:/doi.org/10.1186/s13244-020-00914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP.
Methods and results
A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66).
Conclusion
Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.
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Basha MAA, Eldib DB, Aly SA, Azmy TM, Mahmoud NEM, Ghandour TM, Aly T, Mostafa S, Elaidy AM, Algazzar HY. Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging 2020; 11:107. [PMID: 33000350 PMCID: PMC7527384 DOI: 10.1186/s13244-020-00914-2] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. Methods and results A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). Conclusion Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.
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Affiliation(s)
| | - Diaa Bakry Eldib
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Taghreed M Azmy
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Tarek Mohamed Ghandour
- Department of Orthopaedic Surgery, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Aly
- Department of Orthopaedic Surgery, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Shimaa Mostafa
- Department of Rheumatology and Rehabilitation, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Asmaa M Elaidy
- Department of Psychiatry, Faculty of Human Medicine for Girls, Al-Azhar University, Zagazig, Egypt
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El-Haieg DO, Madkour NM, Basha MAA, Ahmad RA, Sadek SM, Al-Molla RM, Tantwy EF, Almassry HN, Altaher KM, Mahmoud NEM, Aly SA. Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study. Ultrasonography 2019; 38:355-364. [PMID: 31466142 PMCID: PMC6769195 DOI: 10.14366/usg.19007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/16/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. Methods This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. Results The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). Conclusion MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
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Affiliation(s)
- Dahlia O El-Haieg
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Nadia M Madkour
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | | | - Reda A Ahmad
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Somayya M Sadek
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Rania M Al-Molla
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
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