Ayman F. Ahmed

Olfactory Bulb Volume Changes in Patients with Sinonasal Polyposis: A Magnetic Resonance Imaging Study

Objectives The olfactory bulb (OB) is thought to be a plastic structure with highly active afferent neurons. The aim of this study was to evaluate the effect of olfactory deprivation caused by sinonasal polyps on OB volume. Study Design Cross-sectional study. Setting Tertiary university hospital, Department of Otolaryngology. Subjects and Methods Twenty-two subjects were included: 11 adult patients with bilateral allergic sinonasal polyposis (patient group) and 11 adult healthy controls (control group). Both study groups were matched for age and sex. OB volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. Results In the patient group, OB volume measurements ranged from 5.2 to 19.5 mm3 (mean ± SD, 10.14 ± 3.8). In the control group, volume measurements ranged from 35 to 75.8 mm3 (mean ± SD, 47.66 ± 10.75). The difference in OB volumes between patient and control groups was statistically significant (P < .001). Conclusion Our study highlights the significant reduction in OB volume in patients with bilateral sinonasal polyposis as compared with its volume in healthy controls. Further studies are required to evaluate the impact of OB volume reduction on olfactory recovery postoperatively.

5 years follow up after transnasal endoscopic surgery of Thornwaldt's cyst with powered instrumentation

OBJECTIVE To assess the long term results of a transnasal endoscopic, power-assisted marsupilization of Thornwaldts cyst (TC). METHODS Patients who were operated and followed up at our institution for the management of symptomatic TC in the period from February 2002 till May 2012 were included in the study. All the patients were operated through a transnasal endoscopic power-assisted marsupilization of the cyst. RESULTS Eleven patients with a diagnosis of TC (by nasaoendoscopy, CT and MRI) were included in this study. They included six males and five females with age ranging from 15 to 55 years. Transnasal endoscopic, power-assisted marsupilization was performed for all cases with no intra- or postoperative complications. Throughout 5 years follow up, no recurrence of the cyst or its related symptoms were reported. CONCLUSION Long term (5 years) follow up showed that transnasal endoscopic marsupilization of Thornwaldts cyst using micodebrider is a safe and effective maneuver with no cyst recurrence, eustachian tube affection or post-operative complications.

Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study

ObjectiveTo compare diagnostic performance and agreement between CT, MRI and combined CT/MRI in reference to LI-RADS classification system to categorize hepatic observations detected in hepatic patients during screening ultrasound.Methods240 patients with 296 liver observations detected during ultrasound surveillance underwent hepatic CT and MRI examinations, histopathology, and clinical and radiological follow-up. Using LI-RADS v2014, six radiologists evaluated the observations independently and assigned a LI-RADS category to each observation using CT, MRI and combined CT/MRI.ResultsCombined CT and MRI in LI-RADS yielded better accuracy (91.29 %), sensitivity (90.71 %) and specificity (92.31 %) for hepatocellular carcinoma (HCC) diagnosis than using MRI or CT alone; accuracy, sensitivity and specificity decreased to 85.37 %, 86.34 %, and 83.65 %, respectively, for MRI and 67.6 %, 54.10 % and 91.35 %, respectively, for CT. The intraclass agreement of the LI-RADS scores between CT, MRI and combined CT/MRI was excellent (κ=0.9624 (95 % CI: 0.9318–0.9806)).ConclusionCT and MRI are complementary to each other. Combined CT/MRI enabled a more precise determination of LI-RADS category of hepatic observations; however, due to the expense and minor increase in accuracy, the combined methodology should only be utilized in cases of suspected HCC.Key Points• Hepatic observation may be categorized differently depending on the imaging modality used.• We compared LI-RADS categorization between CT, MRI and combined CT/MRI.• MRI produces higher accuracy and sensitivity, while CT produces higher specificity.• Combining CT and MRI improves LIRADS categorization reports.• Considering additional cost, combined methodology could be restricted to challenging cases.

Relation of Lower Last Molar Teeth With Mandibular Fractures.

Objectives:The objectives of this study were to study and investigate the relation between the state of the lower last molar teeth eruption and the site of the mandibular fractures. Methods:Adult patients with traumatic mandibular fractures were included in this study. Panorama and computed tomography was performed for all patients. The relation between the state of the lower last molar eruption and criteria of the fracture was analyzed. Results:In 106 patients who had 168 mandibular fractures, impacted lower third molar teeth were found to significantly increase the incidence of mandibular angle fracture while they had nonsignificant effect on incidence of other sites of mandibular fractures. Conclusion:Impacted lower third molar teeth significantly increase the incidence of mandibular angle fracture but did not have the same effect on other sites of mandibular fractures.

Ipsilateral Reduced Olfactory Bulb Volume in Patients with Unilateral Nasal Obstruction

Objectives To evaluate the effect of unilateral nasal obstruction (by nasal polyps of different histopathology) on olfactory bulb volume using MRI technique. Study Design Cross-sectional study. Setting Tertiary university hospitals, Departments of Otolaryngology and Radiology. Subjects and Methods Eleven patients with a few months of complete unilateral nasal obstruction of different pathological etiologies were selected. MRI assessment of olfactory bulb volume was performed using planimetric manual contouring. The contralateral olfactory bulb was used as a comparative control for the same patient. Eleven healthy controls constituted the control group. Results Mean olfactory bulb volume ±SD of obstructed side = 14.3 ± 3.7 mm3, mean olfactory bulb volume ±SD of nonobstructed side = 43.49 ± 10.7 mm3. The difference between the 2 sides was significant (P = .003). The difference in olfactory bulb volume between normal subjects and nonobstructed nasal side was statistically nonsignificant (t = .9118, P = .3727), while the difference between normal subjects’ olfactory bulb volume and obstructed nasal side olfactory bulb volume in our patients was extremely statistically significant (t = 9.7320, P < .0001). A strong negative correlation was found between duration of obstruction and olfactory bulb volume (R = −0.9761). Conclusion This study shows that unilateral nasal obstruction may be associated with a lateralized ipsilateral difference of olfactory bulb volume.

Diagnostic performance of 18 F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study

AbstractObjectiveTo determine the diagnostic accuracy of WB-MRI and 18F-FDG PET/CT in detecting infiltration pattern, disease activity, and response to treatment in patients with multiple myeloma (MM).Materials and methodsFifty-six patients with confirmed MM were included in the present study for pre-treatment evaluation. Among these individuals, 22 patients were available for the post-treatment evaluation of response to therapy. All patients were imaged with both WB-MRI and 18F-FDG PET/CT. All radiographic findings of infiltration pattern, disease activity, and response to therapy were compared. The diagnostic performance of both modalities was estimated using bone marrow aspirate and biopsy as the reference test.ResultsFor detection of active myelomatous tissue at diagnosis, WB-MRI achieved higher sensitivity (94%) than 18F-FDG PET/CT (75%) (p = 0.0039), whereas both modalities achieved the same specificity (80%). For detection of residual myelomatous tissue after treatment, 18F-FDG PET/CT achieved higher specificity (86%) than WB-MRI (43%) (p = 0.0081), whereas both modalities achieved the same sensitivity (75%).ConclusionWB-MRI is more sensitive than 18F-FDG PET/CT in the diagnosis of MM before treatment; however, 18F-FDG PET/CT is more specific than WB-MRI in detecting residual involvement in treated patients.

Does MR spectroscopy of normal-appearing cervical spinal cord in patients with multiple sclerosis have diagnostic value in assessing disease progression? A prospective comparative analysis

AIM To clarify the role of magnetic resonance spectroscopy (MRS) in examining the normal-appearing cervical spinal cord of patients with multiple sclerosis (MS) to detect metabolite abnormalities in this disease and to assess its progression. MATERIAL AND METHODS Thirty-six patients with MS and 30 healthy controls were enrolled. Each patient was submitted to MRS performed using a 1.5 T magnetic resonance imaging (MRI) scanner. The spectra of total N-acetyl-aspartate (tNAA), choline (Cho), creatine (Cr), and myoinositol (M-Ins), as well as the metabolite ratios of tNAA/Cr, tNAA/Cho, Cho/Cr, and M-Ins/Cr of the two groups were measured and compared. The correlations between the metabolite concentrations, disease duration, and clinical disability (expanded disability status scale, EDSS) were further explored. RESULTS Significantly lower tNAA and higher M-Ins were observed in MS patients than in health controls. The tNAA/Cr and tNAA/Cho ratios were significantly lower in MS patients than in healthy controls. In MS patients, the EDSS was correlated with the tNAA/Cr ratio. The spinal cord cross-sectional area was significantly smaller in MS patients than in healthy controls. CONCLUSION Reduced tNAA and increased M-Ins are important, sensitive indices for differentiating between MS patients and healthy controls. In MS patients, before lesions appear, MRS of the spinal cord may provide crucial information for assessing disease progression.

Normal Nasopharyngeal Measurement by Computed Tomography in Adult

Background: This study aims to investigate the detailed computed tomography (CT) measurement of the nasopharynx (NP) in normal adult detecting mean of its dimension and relation of that measurement to that of the sphenoid sinus. Methodology/Principal: A normal paranasal CT scan and a straight nasal septum of 128 individuals (256 sphenoid sinuses) were included in the study. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Measurement of the width, length, and anteroposterior dimensions of the NP and sphenoid sinuses were taken separately. Results: In 128 studied CT of adult subjects, the mean height of the NP was 19.4619 ± 4.52661 and mean depth was 21.80714 ± 4.62324 while the mean width was 25.31951 ± 3.80521. No significant relations between diameters of NP and sphenoid sinuses were found. Conclusion: The detailed CT measurement of the NP in normal adult is an easy and reliable measurement. This study put the base of CT measurement of NP for further work to describe changes in such measures in patients with nasal and paranasal sinus anomalies.