Background: Idiopathic normal pressure hydrocephalus (iNPH) is considered a treatable cause of dementia. MRI-CSF flow study is a non-invasive investigation for qualitative and quantitative CSF flow analysis to be used for the diagnosis of normal pressure hydrocephalus (NPH). The degree of clinical improvement of NPH symptoms post CSF diversion and shunting; was better in patients with higher pre-operative CSF stroke volume; allowing MR-CSF flowmetry to be a promising prognostic tool. Aim of Study:To evaluate the prognostic value of MRI-CSF flowmetry for shunt responsiveness in patients with idiopathic normal pressure hydrocephalus and its usefulness as a predictor of post CSF diversion favorable outcome.Patients and Methods: Our study is prospective. 38 patients with clinical diagnosis of iNPH, ventriculomegaly and hyper dynamic CSF flow on PC MRI were included in our study. We used two protocols of PC MRI-CSF flowmetry examination; one assessing CSF flow dynamics qualitatively using a sagittal plane and one quantitatively using an axial plane perpendicular to the aqueduct. All patients underwent ventriculo-peitoneal shunt (VPS). Patients were followed up after shunting surgery for average 10 months at neurology and neurosurgery outpatient clinics for improvement of clinical symptoms & categorized into well responsive to shunt or not.Results: We found that aqueductal CSF stroke volume (>42 microL) shows sensitivity of about (93.4%) & specificity of about (75.1%) with total accuracy of about (89.6%) in predicting shunt responsiveness and favorable outcome in iNPH patients.Conclusion: MRI-CSF flowmetry is a promising noninvasive prognostic tool for iNPH. It had a high predictive value for shunt responsiveness. Our study enhances the utility of PC MRI-CSF flowmetry in selection of iNPH patients who are likely to benefit from VPS (shunt responsive); thus reducing the rate of unnecessary previously used invasive procedures as external lumbar drainage.
Background: Breast cancer is considered the most common cancer worldwide. Finding a non-invasive method that could increase the accuracy of characterization of breast lesions and consequently decrease the unnecessary biopsies of benign lesions is pivotal. Sonoelastography could help in characterization of the indeterminate cases of ultrasound BI-RADS 3 and 4 breast lesions by upgrading or downgrading them. Aim of Study:To evaluate the usefulness of sonoelastography (using 5-point scoring method and strain ratio) in improving the diagnostic performance of conventional ultrasound in indeterminate cases of US BI-RADS 3 & 4 breast lesions; to guide the diagnostic workup towards biopsy or follow-up.Patients and Methods: Our study is prospective. 90 female patients were included in our study; who presented with breast lumps and examined by ultrasound and sonoelastography (strain elastography) in the radiology department of our hospital. Initially; conventional breast ultrasonography was performed for the patients and classified according to the ultrasound 'breast imaging, report and data systems' (BI-RADS) categories. Only the patients with ultrasound BI-RADS 3 & 4 category were included in our study. Then strain sonoelastography was performed. Lesions were categorized based on Tsukuba strain scoring system (Elasticity score). Strain ratio (SR) was then calculated for all lesions. We used true cut biopsy, aspiration cytology or excision biopsy for histopathological analysis which was the standard reference.Results: We found that when a cutoff value of 3.6 was used for the strain ratio: The sensitivity, specificity, PPV, NPV, and accuracy rates were determined as 91.7%,77.8%, 73.3%, 93.3% and 83.3%, respectively. When the cutoff value of 4 for the elasticity score used; the sensitivity, specificity, PPV, NPV, and accuracy rates were determined as 91.7%, 88.9%, 84.6%, 94.1% and 90% respectively. Conclusion:Breast strain elastography using 5-point scoring method and strain ratio was found to be of high sensitivity, specificity and diagnostic accuracy in differentiating benign from malignant breast lesions initially categorized as US BI-RADS 3 & 4. It provides additional information on
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