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Background Pre-operative MRI examination is currently considered as an evolving tool for assessment of perianal fistula types, extensions, and complications to achieve proper treatment plan. Proper assessment of fistula activity can also have a major contributing role to the treatment plan, through deciding the type of prescribed medications, proper surgical approach as well as the proper operative intervention timing. Reviewing literature, only few studies have mentioned the importance of diffusion tensor imaging (DTI) sequences in diagnosing perianal fistula activity, yet many studies have discussed the perianal fistula activity assessment using other diffusion weighted imaging (DWI) sequences. In the present study, the main objective was to prove the MRI quantitative DTI sequences’ ability of diagnosing perianal fistulae inflammatory activity. Results This study was a prospective analysis in which fistular activity was confirmed by intra-operative findings (considered as the standard reference). The cases included in the study were divided into two groups, based on their surgical findings, positive inflammatory and negative inflammatory groups. Both groups were pre-operatively assessed using MRI imaging and additionally used diffusion weighted and tensor imaging (DWI and DTI) sequences by special post-processing quantitative assessment of DTI FA and ADC values. There was significant statistical difference between the mean ADC value of the PIA and NIA groups in the track, edema, ipsilateral and contralateral sphincter areas with P values (P = 0.000, 0.000, 0.002 and 0.000 respectively). There was also significant difference between the mean FA value of the PIA and NIA groups in the track, edema, ipsilateral and contralateral sphincter areas with P values (P = 0.000, 0.000, 0.000 and 0.008 respectively). Conclusion This study results revealed that FA are relatively lower in positive inflammatory activity lesions than in negative inflammatory activity lesions while the ADC values were relatively higher in positive inflammatory activity lesions than in negative inflammatory activity lesions and the differences were statistically significant having a fundamental role in the assessment of perianal fistula activity especially at the track area being of highest sensitivity and specificity. Unlike conventional MRI sequences which revealed only high specificity being a good negative modality.

Introduction: Most adrenal gland lesions are detected by CT; however some patients are referred for MRI and PET CT, with percutaneous biopsy as the last resort. Aim of study: To provide the role of various imaging modalities for optimal assessment of adrenal masses. Furthermore we would like to recommend a diagnostic algorithm. Patient & methods: We studied 29 patients with 29 adrenal masses (11 adenomas, 6 metastases, 5 myelolipomas, 4 adrenocortical carcinomas, 2 pheochromocytoma & 1 cyst). CT scan was done with a dedicated adrenal CT protocol. Washout characteristics were then assessed. MRI was done in 19 patients. Qualitative assessment of the chemical shift images was done in 11 patients. Five patients underwent PET and PET CT. Results: In CT: a mean absolute percentage washout of 83% and 41.4% while a mean relative percentage washout of 57.4% and 17.95% were found for adenomas and metastases respectively. In MRI: adenomas showed signal drop on out of phase sequences compared to in phase sequences while metastases did not. In PET CT: mean maximum SUV uptake for adrenal metastases was 7.5 compared to 2.1 in adenoma. Conclusion: Our results confirm the evolving role of CT in detection and characterization of an adrenal mass. Further assessment by MRI & PET CT can be beneficial.

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Background: Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women's quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results: There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion: Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.