No abstract

Background: Peripheral arterial disease (PAD) is one of the most common cardiovascular diseases in developed countries and is an emerging problem in developing countries. Duplex ultrasonography (DUS) has been used as the initial imaging modality in mild symptomatic PAD. Multi-slice helical CT angiography of arteries of the thigh represents a reliable means for the detection of relevant stenoses in patients with peripheral occlusive artery disease. Objective: To assess value of multi-detector computed tomography angiography (MDCTA) and to compare it with DUS to diagnose chronic ischemia of lower limbs. Methods: A prospective comparative study was conducted on 30 patients with chronic lower limbs ischemia of both limbs during the period from September 2015 to September 2016 at the Department of Diagnostic Radiology of Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq. DUS was done for all the patients and then MDCTA was done. Results: Thirty patients (20 males and 10 females) with a mean age of 57.1 ± 8.5 (range: 33 –80) years were included in this study. MDCTA detects 69 lesions (41 occluded segments and 28 stenotic segments) and DUS detects 58 lesions (35 occluded segments and 43 stenotic segments). In MDCTA, 8 patients (26.7%) had lesion in only one arterial segment, 13 patients (43.3%) had two segment lesions, 3 patients (10%) had three segment lesions, 4 patients (13.3%) with four lesions and only two patients (6.7%) had lesions in five arterial segments. Regarding the findings of the DUS one segment lesion was detected in 13 patients (43.3%), two segment lesions in 11 (36.7%), three segment lesions in 2 (6.7%), four segment lesions in 3 (10.0%) and only five segment lesions in only one patient (3.3). Furthermore, the measure of agreement between both MDCTA and DUS in the number of lesions detected revealed a good agreement between both tests, (Kappa = 0.81) with a percent agreement of (86.6%). Conclusion: Multi-detector CT angiography is a fast, accurate, safe and a minimally-invasive imaging modality which may be used in cases of PAD for diagnosis, grading and for preoperative assessment of lower limb arterial disease. Keywords: Multi-detector CT Angiography, chronic ischemia of lower limbs, doppler ultrasound Citation: Kadhim MA, Eisa YA, Mohammed SJ. Value of multi-detector CT angiography in chronic ischemia of lower limbs in comparison with the doppler ultrasound. Iraqi JMS. 2018; 16(2): 144-151. doi: 10.22578/IJMS.16.2.5

Background: Perianal fistula accounts for 0.01% of general population and is frequently managed inadequately resulting in a significant morbidity. Magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of the disease, therefore improving post-operative surgical outcome. Objective: To study the role of MRI in the evaluation of perianal fistula and to show the value of using contrast enhanced MR study in the determination of the precise tract pathway, extensions and other associated pathologies. Methods: A cross sectional analytic study was conducted on a total of 32 patients with perianal fistulas in the MRI Department of Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq during the period from November 2015 to December 2016. Patients underwent MRI examination using axial and coronal T2 weighted images with and without fat suppression and T1 fat suppressed sequences before and after contrast administration. The type of fistula, location of the internal opening, associated abscesses and/or sinus tracts and horseshoe extension were evaluated using different MR sequences. Results: The most common type of fistula encountered was the inter-sphincteric type, which was seen in 21 patients (66%), of those patients 16 fistulas (50%) were grade I and 5 fistulas (16%) were grade II. Trans-sphincteric fistulas were seen in 9 patients (28%), 2 of them (6%) were grade III and 7 fistulas (22%) were grade IV. Two patients (6%) had extra-sphincteric type. T2 weighted TSE, T2 TSE with fat suppression and T1 weighted fat suppressed post contrast sequences all show significant correlation with surgical results (with p-value less than 0.05) and the highest significance was obtained by the post contrast sequence (p-value of 0.00001). The highest accuracy in the diagnosis of fistula in ano was with the use of T1 enhanced fat suppressed sequence (98.8%) followed by 87% for the T2 fat suppression sequence and only 57% for the T2 weighted TSE sequence. Conclusion: MRI is an essential, noninvasive tool in the preoperative assessment of perianal fistulous tracks, with the axial and coronal post contrast fat suppression T1 providing the highest accuracy and clinical significance with surgical data and therefore giving a highly promising decrement in the incidence of post-operative complications. Keywords: MRI, perianal fistula Citation: Jawad AM, kadhim MA, Al-Jobouri ZK, Hussain MAA. The value of magnetic resonance imaging in the evaluation of peri-anal fistula. Iraqi JMS. 2018; 16(2): 166-176. doi: 10.22578/IJMS.16.2.8

Background: Characterization of the ovarian masses preoperatively is important to inform the surgeon about the possible management strategies. MRI may be of great help in identifying malignant lesion before surgery. Diffusion Weighted Imaging (DWI) is a sensitive method for changes in proton of water mobility caused by pathological alteration of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity. Objective: to study the diagnostic accuracy of DWI in differentiation between benign and malignant ovarian masses. Type of the study:Cross-sectional study. Methods: this study included  53with complex ovarian mass or masses ,Diffusion Weighted Imaging was obtained to all these patient with correlation to the histopathological results; the Signal Intensity (SI) of the solid and cystic part of the lesions was evaluated on T2 and Diffusion Weighted Imaging  ,with Apparent Diffusion Coefficient (ADC) values were also obtained . Results: 22 masses out of the total 53 were malignant and 31 were benign .On DWI the high SI intensity observed more frequently in the malignant lesions than the benign lesions (p value 0.0293) .There was significant difference between the mean ADC value of the malignant and benign ovarian lesions, with the mean ADC value for the benign lesions solid component =1.05 x10 -3, and the mean ADC value for the malignant lesions solid component =0.91 x10-3. The ROC study reveals that 0.926 x 10 -3  may be the optimal cutoff value  with sensitivity 54.8 %, specificity 59.1%, NPV 48.15 %, PPV 63.39%  , Accuracy 56.6%. With exclusion of the teratoma and endometriomas from statistical analysis the ROC reveals that 0.99 x10 -3  may be the optimal cut off value with sensitivity 76.9 % , specificity 77.3% , PPV 66.67% , NPP 85% and  accuracy 77.14% Conclusions: Combined with conventional pelvic MRI, DWI is a helpful tool in differentiation between benign and malignant ovarian masses, with high signal intensity on DWI more frequently observed in the malignant than benign ovarian lesions.

Background: magnetic resonance imaging (MRI) is becoming an essential tool for assessment of parotid gland pathology. Diffusion weighted imaging (DWI) provides quantitative and qualitative information reflecting the changes in tissue cellularity and integrity of cell membranes. Objective: To evaluate the diagnostic accuracy of diffusion weighted -MRI in the differentiation between benign and malignant solid parotid gland masses using 1.5 Tesla MRI scanner and to obtain the best cutoff value of apparent diffusion coefficient (ADC) to differentiate between benign and malignant masses. Patients and methods: prospective cross-sectional analytic study was conducted in Al Imamein Al Kadhumein Medical City, at the period between January 2019 and January 2020, 50 patients were included in the study. DWI was acquired at following b-values [50, 1000 millimeter (mm) 2/second (sec)], in this study the results were obtained and depending on b-value 1000 mm2/sec. Results: The mean level of ADC value of malignant masses (0.599 ± 0.117 SD x 10-3 mm2/sec), while for benign masses (1.590 ± 0.363 SD x10-3 mm2/sec); According to Receiver operating characteristic (ROC) curve the optimal cutoff point of ADC value was (0.914x10-3 mm2/sec) with sensitivity 100%, specificity 97%. The association between MRI diagnosis and histopathological diagnosis was significant (P value< 0.001). Conclusion: Diffusion weighted-MRI and ADC values are highly sensitive and specific to differentiate between benign and malignant solid parotid gland masses and the best ADC cut off value was (0.914x10-3 mm2/sec).