Shahizon Azura Mohamed Mukari

Retroperitoneal hemorrhage associated with bone marrow trephine biopsy

Patient: Male, 19 Final Diagnosis: Hyperleukocytosis • thrombocytosis Symptoms: Hyperleukocytosis • retroperitoneal hemorrhage • thrombocytosis Medication: — Clinical Procedure: Bone marrow trephine biopsy Specialty: Hematology • Radiology Objective: Diagnostic/therapeutic accidents Background: Bone marrow (BM) trephine biopsy is generally a safe procedure, but adverse events such as retroperitoneal hemorrhage (RPH) may occur. We report 3 cases of this complication. Case Report: A 19-year-old male with thrombocytopenia and coagulopathy underwent BM trephine biopsy to confirm relapse of acute lymphoblastic leukemia. Two hours later, he developed severe hypotension and a CT scan revealed a massive RPH, and was treated conservatively. The RPH recurred 2 weeks after chemotherapy and was successfully treated with gel foam embolization. A 55-year-old male with coagulopathy underwent BM trephine biopsy for hyperleukocytosis and thrombocytosis. He developed a large RPH preceded by left lumbar dermatome sensory neuropathy. He was treated conservatively. A 56-year-old overweight woman on aspirin underwent BM trephine biopsy for polycythemia. Twelve hours later she developed severe abdominal pain with hypotension. A CT scan showed a massive RPH and secondary hemothorax. She was treated conservatively and the RPH resolved after several months. Conclusions: We and others showed that myeloproliferative neoplasm, quantitative or qualitative platelet abnormalities, aspirin, coagulopathy, and obesity are associated with development of RPH following BM trephine biopsy. Early diagnosis and intervention are crucial. Correction of coagulopathy and cessation of anti-platelet treatment prior to biopsy can prevent this serious complication.PATIENT Male, 19 FINAL DIAGNOSIS: Hyperleukocytosis • thrombocytosis SYMPTOMS Hyperleukocytosis • retroperitoneal hemorrhage • thrombocytosis MEDICATION - Clinical Procedure: Bone marrow trephine biopsy Specialty: Hematology • Radiology. OBJECTIVE Diagnostic/therapeutic accidents. BACKGROUND Bone marrow (BM) trephine biopsy is generally a safe procedure, but adverse events such as retroperitoneal hemorrhage (RPH) may occur. We report 3 cases of this complication. CASE REPORT A 19-year-old male with thrombocytopenia and coagulopathy underwent BM trephine biopsy to confirm relapse of acute lymphoblastic leukemia. Two hours later, he developed severe hypotension and a CT scan revealed a massive RPH, and was treated conservatively. The RPH recurred 2 weeks after chemotherapy and was successfully treated with gel foam embolization. A 55-year-old male with coagulopathy underwent BM trephine biopsy for hyperleukocytosis and thrombocytosis. He developed a large RPH preceded by left lumbar dermatome sensory neuropathy. He was treated conservatively. A 56-year-old overweight woman on aspirin underwent BM trephine biopsy for polycythemia. Twelve hours later she developed severe abdominal pain with hypotension. A CT scan showed a massive RPH and secondary hemothorax. She was treated conservatively and the RPH resolved after several months. CONCLUSIONS We and others showed that myeloproliferative neoplasm, quantitative or qualitative platelet abnormalities, aspirin, coagulopathy, and obesity are associated with development of RPH following BM trephine biopsy. Early diagnosis and intervention are crucial. Correction of coagulopathy and cessation of anti-platelet treatment prior to biopsy can prevent this serious complication.

MR image enhancement for ICH classification

Intracerebral hemorrhage (ICH) and cerebral amyloid angiopathy (CAA) are two common causes of hemorrhagic stroke. Distinguishing CAA from ICH is challenging due to similarities in clinical presentation and imaging. Magnetic Resonance Imaging (MRI) is one imaging modality that can be used in the early detection of ICH. The objective of this paper is to identify the best enhancement techniques in MR images for ICH classification. 5 samples of MR images with a final diagnosis of primary ICH (pICH) were selected from UKM Medical Centre (UKMMC). The MR images which were in Digital Imaging and Communications in Medicine (DICOM) format were later processed using the Matrix Laboratory (MATLAB) software. In this study 5 MR images from 5 different patients were processed using 4 image enhancement techniques; power law transformation histogram equalization image sharpening and median filter. All the 5 processed images were compared to obtain the best enhanced images based on their Absolute Mean Brightness Error (AMBE) and entropy values. Median filter is the best image enhancement technique with average values of AMBE and entropy of 0.0885 and 5.1472.

Comparison of stroke infarction between CT perfusion and diffusion weighted imaging: preliminary results

In this paper we present preliminary results of comparison of automatic segmentations of the infarct core, between that obtained from CT perfusion (based on time to peak parameter) and diffusion weighted imaging (DWI). For each patient, the two imaging volumes were automatically co-registered to a common frame of reference based on an acquired CT angiography image. The accuracy of image registration is measured by the overlap of the segmented brain from both images (CT perfusion and DWI), measured within their common field of view. Due to the limitations of the study, DWI was acquired as a follow up scan up to a week after initial CT based imaging. However, we found significant overlap of the segmented brain (Jaccard indices of approximately 0.8) and the percentage of infarcted brain tissue from the two modalities were still fairly highly correlated (correlation coefficient of approximately 0.9). The results are promising with more data needed in future for clinical inference.

Simultaneous tilt correction and registration of CT angiography and dynamic CT brain images

In this paper we present a pre-processing stage for an automated volumetric CT stroke image diagnosis system. It concerns the automatic intensity-based 3D image registration of dynamic CT (used for CT perfusion imaging) to CT angiography (CTA) images. The dynamic CT images were acquired with a gantry tilt and hence the correct geometry is found. The tilt correction is performed implicitly and combined with intensity based registration to the CTA image. The accuracy of image registration is measured by the overlap of the segmented skull from both images. The results are promising with more efficient implementation in future for clinical feasibility.

Automatic volumetric registration of NCCT and CTA brain images using intensity based image registration

In this paper we present a pre-processing stage for an automated volumetric CT stroke image diagnosis system. It concerns the automatic intensity-based 3D image registration of non-contrast CT (NCCT) to CT angiography (CTA) images. The NCCT were acquired with a gantry tilt and hence they are first tilt corrected. After the tilt correction process, the NCCT images are then registered to the CTA image. The accuracy of image registration is measured by the overlap of the segmented skull from both images. The limitation of the current implementation is computing time which should be improved for a clinical application of the method.