Caroline Edward Ayad

Characterization of Sphenoid Sinuses for Sudanese Population Using Computed Tomography

The purpose of this study is to determine the anatomical features of the sphenoid sinus using computerized tomography (CT). 100 Sudanese subjects were investigated for CT sinuses; Characterization of the sphenoid sinus and seven horizontal and vertical measurements were evaluated. Onodi cell was found in 13 subjects, 10 of them were sellar and 3 were pre-sellar. Pneumatization was of the sellar type in 85%, presellar was 15%, and no subject was chonchal. The mean length of vertical lines from the center of sphenoid ostium to the roof and bottom were 10.6 ± 3.1 mm, 11.1 ± 3.7 mm respectively. When the sphenoid ostium was located superior to the lowest point of the sella, the line from the center of the sphenoid sinus ostium to the posterior wall of the sinus was 15.2 ± 4.2 mm and when was located inferior, the line was 26.3 ± 5.2 mm on average. The mean length from the lowest point of the sella to the anterior wall of sphenoid sinus was 16.8 ± 3.6 mm. The line from anterior wall to posterior wall of sphenoid sinus lining skull base was 10.9 ± 3.2mm mm. The maximum depth was 25.2 ± 6.9 mm and the maximum width was 18.4 ± 5.9mm. The differences in the sphenoid sinus character take place between males and females. The study provides essential anatomical information for Sudanese subjects and its impact in the clinical surgical practice.

Evaluation of the technical specifications of computerized tomography scanners in Jazan

Introduction : good quality management for computerized Tomography (CT) scanners is essential to safe and efficient CT units, providing quality clinical images, maintaining patient and staff radiation doses as low as reasonably achievable. Aims : to evaluate the technical specifications of (CT) scanners in Jazan region in the period from 2011-2013. Materials and Methods : 13 CT scanners have been evaluated; 2 of them are in private sectors and the rest in public hospitals. The Technical specifications of CT scanners were assessed using template issued by ImPACT (Imaging Performance Assessment of CT scanners). Results : When comparing the 11 public scanners age with guidelines rules of European Coordination Committee of the Radiological and Electro medical Industries (ECCREI); it showed that scanners of Jazan region are within lifecycle guidelines, the total cumulative number of scanners since 1984 to 2013 are 15 scanners, 4 of them were replaced and the rest under use, multi detector CT scanners replaced most of the single detector scanners. for public CT scanners ; results show that all of the scanners are 3 rd generation, gantry bores are arranged between70-80cm, the x-ray tube inventory showed that there is no dual source CT scanner in the region and the anode storage heat capacity ranged from (3-8MHU) except Siemens 64slices and 20slices reached up to (30MHU). All of scanners in the region are built in solid state, image reconstruction time display per second is ranged from 1-40slice/seconds, advance clinical application software are available among the scanners. Jazan region CT scanners have a high capability and their technical specifications are in a rapid pace in developments that impacting on performance which depends on trade-off between image quality and patient dose.

Norms for cerebellum in Sudanese –A morphometric MRI based study

The cerebellum is one of the most important structures in the posterior cranial fossa. The objectives of this study were to characterize the cerebellum and cerebrum by measuring the cerebellum height , vermians AP width in the mid-sagittal plane , the maximum cerebellar hemispheric width in axial plane and the cerebrum length and width, using MRI ,as well as to determine the impact of age and gender on the measurements in healthy Sudanese adults. The data were obtained from MR multi planes images done for 100 healthy Sudanese subjects, their mean age was 42.36±17.87 years old (Min=14.00, Max=80.00 years). Norms for Sudanese cerebellum and cerebrum measurements were established. The cereberum length was affected by age significantly at p=0.004; however no age related differences were noticed in the cerebellum measurements. The degree of the reduction in the cerebellar measurements is mild and unlikely to be significant. Smaller measurements of cerebellum and cerebrum were noticed in females than males, where the cerebellum hemisphere maximum width and cerebrum length were affected significantly by gender, while the cerebellum height and AP vermian width were not significantly correlated with gender. The results of this study provide a valuable addition to the normative database of the cerebellar and cerebrum anatomy for Sudanese .These data are an attempt to support the norms of the cerebellum data measured in axial and saggital images. It should be taken into account in functional imaging studies of aging, when the cerebellum is considered as an appropriate structure for reference and normalization for Sudanese.

Triphasic Computed Tomography Hounsfield and Pattern in Differentiation of Focal Liver Lesions

Objective: To evaluate the diagnostic value of triphasic spiral Computerized Tomography (CT) Hounsfield (HU) and pattern in differentiating focal liver lesions. Methods: The study was conducted in Department of Radiology:1) Fedail Hospital, 2)Alfaisal Hospital,3) Alzitona Hospital,3) Alturky Center.The study was obtained during the period spanned from January 2015up to August 2016.By convenient sampling, 99 patients who were found to have focal liver lesions were recruited and their triphasic CT scans findings were evaluated. Results: Among the 99 cases of patients with liver lesions it was found to be: 21 hemangiomas, 13Cyst, 38 Metastases, 24 Hepatocelluler Carcinoma, 2 Ischemia and abscess were found in 3cases. All were diagnosed using the typical enhancement patterns and quantification method (HU) values. Based on the results, it could be judged that triphasic CT scan has a great value in diagnoses and differentiating focal liver lesions and the underlying causes significantly at p≤0.000. Conclusion: Triphasic CT scan is a good non-invasive tool and can be used as first line imaging modality for differentiating focal liver lesions; therefore unnecessary biopsies can be avoided.

The impact of age on pancreas .A CT based study

Ethnicity is an important factor known to impact the biology and outcome of many pancreatic diseases. An important feature distinguishing multidetector computed tomography CT is the increased speed of scanning that permits routine use of very thin collimation. The objectives of this study are to establish a population database for pancreas length and width using (CT) scan from ages of 13 to 80years old, as well as to study the impact of age on pancreatic measurements.We measured pancreas length and width in 50 normal subjects with no history of pancreas disease who had undergone abdominal CT scan between 2015 and 2016. Pancreas measured values were computed from the contour of the pancreas on each CT image. In addition to total pancreas measurements, the density was determined by CT Hounsfield (HU). Results showed that during childhood and adolescence, the pancreas measurements and CT(HU) increased linearly with age and then declines thereafter. We provide enduring population highlighting data for pancreatic parenchymal measurements in Sudanese as well pancreatic CT (HU) .

Findings in CSOM: Our Experience in Sudanese Population-A CT based Study

Chronic suppurative otitis media (CSOM) is one of the leading causes of hearing impairment in developing countries. Objectives: are to highlight the high resolution computerized tomography (HRCT) temporal bone findings in chronic middle ear infections with reference to it ’ s extent and complications, as well, the presented common signs, symptoms and the duration impact on the anatomical structures and pathological changes in each part and for both sides. Materials and Methods: Preliminary clinical assessment was obtained for 114 patients diagnosed with CSOM, and then they were referred for a HRCT of temporal bone which was done using multi-detector CT scanner. Results: Of the 114 patients; 63(55.3%) were males and 51(44.7%) were females: Otorrhoea is the most common symptom, and was found in 113 patients constituting (99.1%) followed by Otolegia 69(60.5%) and headache affected 53(46.5%) of the cases. CSOM is more common in low socio-economic status .In ears affected with CSOM, the maximum CT number (Hounsfield) was found to be changed and was significantly affected with increasing patients’ age. Sclerotic changes and soft tissue density increased as the duration of CSOM increased in right and left middle ears significantly (F=5.802, Sig at 0.000), and (F=23.182, Sig at .015) respectively. Partial and complete erosion were detected in both right and left ossicle in the advanced phase of disease, where the ossicle still intact in the early stage , and the correlation is found to be significant with increasing of CSOM duration (F=16.959, Sig 0.000) and (F= 3.673, Sig =0.036)for right and left ossicles respectively. Changes including total and partial opacification, sclerotic changes, soft tissue density, mucosal thickening were the findings detected in both right and left mastoid in HRCT for temporal bone scanning. Conclusions: HRCT of temporal bone is useful in identifying various findings related to the location and extent of disease.

A local reference value for the mental foramen in adult Sudanese: A 3D computerized tomography based study

The mental foramen (MF) is located on the anterior surface of the mandible. It permits passage of the mental nerve and vessels. Studying the morphological variation of (MF) helps to localize the mental nerve to prevent complications during surgery. (MF) character varied considerably among ethnic groups, although, determination the norms is essential, however no study was conducted in Sudanese. The aims of this study are to establish local reference for (MF) width for Sudanese as well as to study the age and gender related difference and to compare the measurements with other populations. The present study was carried out in the Radiology department-Military Hospital, Khartoum -Sudan on 160 adult Sudanese with mean age is 35.26years old. Three dimensional computerized tomography was obtained for the facial bone .The Mandibles were observed for the right and left of (MF) width. In our study we observed that the (MF) mean width were 4.28 and 3.53 mm for right and left sides. The (MF) differs between the two genders significantly at p≤ 0.035 and 0.010 for right and left sides in respectively .A significant changes in (MF) width were detected in different age groups for both right and left sides. New equations were established to identify the (MF) width as local reference for Sudanese population of known age. The present analysis revealed variations in width of MF of Sudanese from other populations. The (MF) width differs according to age and gender.

A Study of Maternal Ophthalmic Artery Doppler Indices in Diabetics and Smokers

The aims of this study are to characterize the ophthalmic artery (OA) perfusion in smoker pregnant ladies, diabetic pregnant ladies and smoker diabetic pregnant ladies using Doppler indices and to compare with normal healthy pregnancy. The sample was divided into 4 groups: group 1 were normal healthy pregnant ladies (N=57) , group 2 were smokers pregnant ladies (N=44) ,group 3 were diabetic pregnant ladies (N=64),and group 4 were diabetic smoke pregnant ladies (N=71) ladies. All groups were examined and assessed during the pregnancy period for OA Doppler indices of both right and left eyes. The resistive index (RI), pulsatility index (PI), and mean velocity (MV) were determined. Comparisons were performed between the norms and the other three groups. Result showed significant increasing in RI,PI in the right and left eyes in all groups at p≤0.000 except in smoker pregnant ladies p≤ 0.069 , the PI decreased in the third trimester,as well the MV decreased significantly with advancing GA. A significant differences were detected between norms and the three groups at p≤0.000 In conclusion, Doppler velocimetry is an acknowledged technique for evaluation of the RI, PI, and MV in the OA. Regarding the results smoking provokes perfusion changes in ophthalmic artery in smoker pregnant ladies. Thus, there are signs of an OA vasoconstriction and hypoperfusion . OA blood flow velocity was decreased in diabetic pregnant ladies.

Normative Morphometry of Adult Sudanese Mandible: A 3D Computerized Tomography Based Study

Mandible being largest and strongest bone of skull, having various morphological features may show changes with reference to age, gender and race. The aims of this study were to characterize the mandible and to find out if there is age /gender related differences as well as to establish a local reference for the Sudanese mandible measurements. In this descriptive study, the facial computerized tomography scans were obtained from 160 subjects (92males and 68 females) .The population of the study was categorized in six ages (15to24, 25to34, 35to44, 45to54, 55to64 and ages˃65 years old). Volume rendering three-dimensional reconstruction technique was used. Specific parts of the mandible were measured and the data were analyzed using SPSS program version 16. Results showed that the Bicondylar breadth, Bigonial breadth, Mandibular body length and Mandibular symphysis height, differ significantly between the two genders at p≤0.000. Correlation coefficient showed a significant relation between the patient’s age and Bi condylar breadth (R 2 =0.360). A new established equation and a local reference for Sudanese Bicondylar breadth measurement were established. This study presents a new morphologic indicator of age in the human mandible for Sudanese.

Evaluation of calcium oxalate stones size using kidney, ureters and bladder, fluoroscopy and post lithotripsy procedures

Objectives: This study aimed to measure renal stone using different modality (kidney, ureters and bladder [K.U.B], fluoroscopy and intravenous urography [I.V.U]), to compare these three methods of measurements and to detect the variation of stones size after each lithotripsy shock for the same type of stones. Materials and Methods: A total of 26 patients males (19) and females (7) their age ranged between 18 and 70 years with renal stones, I.V.U, K.U.B were done for all cases. In Al Nelain Medical Centre, The size of renal stone was measured in K.U.B and I.V.U by using the Ruler exposure. Staghorn stones which were >4 cm needed >4 times of exposure to. Results: The findings were found to be that stone <1 cm can be measured but does not disintegrated by lithotripsy and most of the stones that were >1 cm were properly measured when using the fluoroscopy and were treated effectively after 2 nd time of the shock waves. Conclusion: This study concluded that the surface area, site, number of stones after extracorporeal shock wave lithotripsy (ESWL) could be detected using K.U.B, I.V.U and fluoroscopy, and could help in prospective selection of patients who will respond well to ESWL.