Assessment of the Local Exposure Level during Adult Chest X-Rays at the Ngaoundere Regional Hospital, CameroonRead the full article
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Prevalence, Spectrum, and Outcomes of Single Coronary Artery Detected on Coronary Computed Tomography Angiography (CCTA)
Background. Single coronary artery (SCA) is a rare congenital anomaly in which there is an isolated coronary artery that arises from a single coronary ostium and provides coronary blood supply to the entire myocardium. SCA is classified into different types based on the origin, branching pattern, and course. Although the majority of patients with SCA are asymptomatic, some patients can present with life-threatening symptoms. Aim. To examine the prevalence, anatomical distribution, and outcome of the single coronary artery anomaly detected on coronary computed tomography angiography (CCTA) in a single center in Oman. Methods. Retrospectively, we reviewed 4,445 patients who underwent coronary computed tomography angiography between September 2012 and August 2018 at the National Heart Center, Muscat, Oman. We identified patients with a single coronary artery, and we evaluated the origin, course, and outcome of SCA. Results. We found 12 patients with single coronary artery among 4,445 patients with a mean age of 56.4 years (age range: 34 to 71 years; male : female ratio: 5 : 7). The most common class was RIII-C seen in 4 patients. Other SCA included RII-C, RII-A, and RII-S, two in each class. One patient had RI and one had LII-P. Two patients had coronary artery bypass graft. No major adverse cardiac events were reported over a mean follow-up of 25.3 months. Conclusion. Single coronary artery (SCA) is a rare congenital anomaly classified into different types. In our study, the prevalence of SCA was 0.27% that is higher than the figures from previous reports.
Accuracy of Pelvic Ultrasound in Diagnosing Adnexal Torsion
Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. Pelvic or intravaginal ultrasound remains the first-line imaging modality used for diagnosis and evaluation of suspected ovarian/adnexal torsion. In this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian torsion. Our study successfully determined the important sonographic markers. Our observation and analysis suggest that ovarian enlargement is the most sensitive marker. Ovarian edema was found to be the most specific marker to identify the ovarian torsion with higher level of accuracy and confidence. This pioneer study will provide valuable information and direction to the medical practitioners and radiologists for better diagnosis. Further studies with large sample size will help in establishing our findings universally.
Hearing Thresholds Changes after MRI 1.5T of Head and Neck
Introduction. Exposure to high intensity noise produced by MRI is a cause for concern. This study was conducted to determine the temporary and permanent effects of exposure to noise created by performing MRI on the hearing threshold of the subjects using conventional and extended high frequency audiometry. Methods. This semiexperimental study was performed on 35 patients referred to Shahid Rahnemoun Hospital for head and neck MRI due to different clinical conditions. The hearing threshold of patients was measured before, immediately after, and 24 hours after performing 1.5 Tesla MRI using conventional and extended high frequency audiometry. SPSS version 18 was used to compare the mean hearing thresholds before and after MRI using paired T test and repeated measures analysis. Results. Comparison of auditory thresholds in conventional and extended high frequencies before and immediately after MRI showed a significant shift at 4 KHz (P = 0.008 and P = 0.08 for right and left ears), 6 KHz (P = 0.03 and P = 0.01 for right and left ears), and 14 KHz (P =0.03 and P = 0.31 for right and left ears). However, there was no significant difference between audiometric thresholds before and 24 hours after MRI. Conclusion. Noise due to 1.5 Tesla MRI can only cause transient threshold shift.
Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography
Background and Purpose. There is a wide variation in the anatomy of the CW in different individuals and population groups. The purpose of this study was to determine the proportion of variant anatomy of the circle of Willis (CW) and associated anomalies in patients with suspected cerebrovascular disease referred for cerebral computed tomography angiography (CTA) in two tertiary hospitals in Kenya. Methodology. This was a cross-sectional descriptive study conducted on 94 patients referred for cerebral CTA at the Kenyatta and Nairobi hospitals from August 2017 to February 2018. MIP and 3D reformatted images were analyzed by two senior radiologists to determine the final configuration of the CW and presence of vascular pathology. Vessels with diameters <0.8 mm were considered to be absent or hypoplastic. Chen et al. classification was used to determine the final configuration of CW. Results. Complete CW was seen in 37.2% (37.7% vs. 36.6% in males and females, respectively, p=0.909). Type A variant was the commonest anterior variant at 78.7%. Type E variant was the dominant posterior variant at 41.5%. Fetal PCA was demonstrated in 25.5%, unilateral > bilateral fetal PCA. Aneurysms were seen in 24.5% of patients. ACoA aneurysms were commonest at 43.6%. AVMs were seen in 8.5% of patients. Azygous ACA, fenestration, and duplication of vessels and persistent TA were not demonstrated. There is no significant association between aneurysms/AVMs and CW configuration. Conclusion. The findings in this study demonstrate slight differences in the CW configuration. A higher proportion of complete anterior CW was seen in female patients. Type A anterior and type E posterior circulation variants were the commonest in both males and females. No significant association was demonstrated between CW configuration and occurrence of aneurysms/AVMs in this study. Various methods of classification of CW configuration have been proposed with no standardized method to date, thus the need for consensus building between neuroanatomists, neurologists, neurosurgeons, and neuroradiologists for ease of comparison between similar future studies on the CW.
The Association between the Pulmonary Arterial Obstruction Index and Atrial Size in Patients with Acute Pulmonary Embolism
Purpose. Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism. The aim of this study is to investigate the association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism. Basic Procedure. The study consisted of 86 patients with clinical symptoms of PE. Out of 86 individuals, 50 patients were diagnosed with PE and considered as the patient group. The others were considered as the control group. All patients were scanned by a multidetector CT scanner. Using the radiology workstation, an expert radiologist calculated the left atrium (LA) and right atrium (RA) areas from planimetric measurements obtained from free-hand delineation of the atrial boarders using an electronic pen. Quantitative volumetric measurements of LA and RA were obtained from original axial images. Main Findings. There were 25 males and 25 females with PE, who had a mean age of 58 years. There was not a significant difference in the positive history of diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary diseases, ischemic heart disease, and smoking between patients and control group. There was a significant negative correlation between almost all LA measurements and the PAOI. RA area and volume had the highest area under the curves for recognizing larger clot burden. Principal Conclusions. A higher clot load is associated with a smaller LA size and increased RA/LA ratios, measured with CTPA. Atrial measurements are correlated with POAI, and they could be used as sensitive parameters in predicting heart failure in patients with PE.
Contribution of Computed Tomography Scan to the Diagnosis of Spinal Tuberculosis in 14 Cases in Assaba, Mauritania
Background. The incidence of tuberculosis has increased in recent years in both developed and developing countries. Objective. This retrospective study aimed to review all cases of spinal tuberculosis diagnosed at the Department of Internal Medicine and Infectious Diseases in Kiffa Regional Hospital and assess the role of computed tomography (CT) scan in establishing definite diagnosis. Patients and Methods. Data were collected from clinical records of patients admitted to the hospital for rachialgia between August 2016 and July 2018. Results. Fourteen (12.2%) adults with spinal tuberculosis were found among 115 patients with all forms of tuberculosis during the study period. The mean (± standard deviation) age of our patients was 47.5 ± 22.0 years old with male:female (8/6) sex ratio of 1.3. The mean duration of evolution of the disease was 15 months. The presenting signs and symptoms included rachialgia in most patients (93%), associated with segmental spinal stiffness (50%) and/or neurological complications (50%). Diagnosis was established on the basis of clinical history, clinical examination, standard vertebral column radiography, and CT scan. Vertebral imaging showed a clear predominance of lumbar lesions (57%), followed by dorsal (36%) and cervical (7%) involvement. The evolution under treatment was favorable, with the exception of two cases of medullary compression. Conclusion. Spinal tuberculosis is the most common form of osteoarticular tuberculosis. It affects predominantly lumbar and dorsal vertebrae. In the absence of histological confirmation, the presence of back pain associated with major radiological signs of spondylosis disc disease seems to justify the use of CT scan to confirm the diagnosis of this pathology.