Keywords : MRI

Assessment of Articular Cartilage of Knee Joint by Magnetic Resonance Imaging in Comparison with Arthroscopy of the Knee

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 2, Pages 86-96

The use of new and faster MRI techniques with higher resolution, contrast and greater diagnostic
accuracy, make the MRI as an excellent method for evaluating articular cartilage disorders.
To evaluate the sensitivity and specificity of different sequences of MRI in diagnosing and grading
damage of articular cartilage of the knee joint.
From March 2017 to Feb. 2018 ,40 Patients (50 knees) with age ranging from (34-67 years) MRI
evaluation of the knee articular cartilage was performed using a 1.5T MRI scanner . Arthroscopic
surgery was done for them after a maximum delay of 2 months from the MRI study, Employing
the outer bridge grading system, the MRI grade 0, I, II, III and IV lesions were compared to
the arthroscopic results. The sensitivity, specificity and accuracy were evaluated for each sequence.
Of the 40 patients, 22 (55%) were females and 18 (45%) were males. Of 300 joint surfaces
135(45%) grade 0 ,16(5.3%) grade I , 36(12%) grade II , 85(28%) grade III and 28(9.3%) grade IV
by arthroscopy, when comparing to MRI findings, there was good and very good Kappa values
(0.759-0.818). Chondral lesions were undergraded by MRI in (13%) and overgraded in (6.6%),
the sensitivity of MRI was ranging between (60-92%), the specificity ranging (68.7-88.8%) and
the accuracy (70-86%) .Results demonstrated poor sensitivity of MRI in detecting grade I(33.3%) &
grade II(35.8%) and better sensitivity in detecting grade III(85.5%) & grade IV(76.4%). IW-FS-FSE
sequence showed the highest sensitivity (88%) & accuracy (97%), followed by FS-PD with
a sensitivity of (85%) and accuracy (95%).
MRI is an adequately sensitive and specific diagnostic tool for identifying the presence of articular
damage, but still not reliably described as Arthroscopy. Among the 2D and 3D GRE images the best
diagnostic evaluation of cartilage disorders was obtained by the IW-FS-FSE sequence . The PD
sequence can be used to evaluate knee cartilage, the dynamic range and the findings of subchondral
bone disorders are increased by fat suppression during imaging techniques so that it is important in
cartilage disorders interpretation.

Correlation of Optic Nerve Sheath Diameter and Optic Sheath to Optic Nerve Diameter Ratio with Lumbar puncture opening Pressure in Pseudotumor Cerebri Syndrome

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 133-140

In cases of Pseudotumor Cerebri Syndrome, increased intracranial pressure is transmitted to the subarachnoid space surrounding the optic nerve, causing increase in the optic nerve sheath diameter and Optic nerve sheath to optic nerve diameter ratio. Magnetic Resonance Imaging is the image of choice in Pseudotumor Cerebri Syndrome and it can be used to measure precisely the diameter of optic nerve and its surrounding sheath.
To evaluate the diagnostic value of optic nerve sheath diameter, Optic nerve sheath to optic nerve diameter ratio, and their correlation with lumbar puncture opening pressure in Pseudotumor Cerebri Syndrome
In a prospective blinded correlational diagnostic yield study, a 3 tesla Magnetic Resonance Imaging data of 34 patients with Pseudotumor Cerebri Syndrome, and 34 normal control were collected and analyzed, optic nerve sheath diameter and optic nerve diameter were measured in an axis perpendicular to the optic nerve, 3 mm behind the globe.
Both optic nerve sheath diameter and Optic nerve sheath to optic nerve diameter ratio were found to be significantly larger in patient's group compared to control. Lumbar puncture opening pressure in patient was measured and found to be correlated significantly with both optic nerve sheath diameter and optic nerve sheath to optic nerve diameter (r 0.79-p 0.000, r 0.45-p 0.007 respectively). The optic nerve sheath diameter in patients were 5.75 ±0.6 mm, cut-off value for diagnoses of Pseudotumor Cerebri Syndrome was 4.9 mm with a sensitivity of 91% and specificity of 88%. The cut-off value of optic nerve sheath to optic nerve diameter ratio was 2.39 with a sensitivity of 100% and specificity of 97%.
Magnetic Resonance Imaging -determined (optic nerve sheath diameter & optic nerve sheath to optic nerve diameter ratio) have excellent diagnostic value in Pseudotumor Cerebri Syndrome, and they were correlated significantly with LP opening pressure.
KEYWORDS: MRI, Optic nerve, Pseudotumor Cerebri Syndrome

Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison among Different Magnetic Resonance Imaging (MRI) Sequences

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 271-277

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the brain and spinal cord. The cervical spinal cord is commonly affected in multiple sclerosis ,as many as 90% of MS patients which is often associated with an increase in clinical disability. Though rarely seen in other diseases, asymptomatic lesions of the spinal cord can be present in MS and may help lead to the correct diagnosis. Since the integration of MR imaging into the International Panel (McDonald) criteria in 2001,there is increasing international effort to standardize MR imaging protocols.
To evaluate MRI imaging protocols for detection of cervical spinal cord multiple sclerosis lesions using 1.5 T MRI scanner.
A cross sectional analytical study was conducted at Al-Yarmouk Teaching hospital in Baghdad city. Thirty-one known as MS Patients were examined. from October 2016 till December 2017 by Phillips Achieva Nova Dual 1.5T using a SENSE Neurovascular coil .All patients. underwent sagitta1 T2-turbo spin echo(T2-TSE), Sagittal proton density-turbo spin echo(PD-TSE), sagittal short tau inversion recovery-turbo-spin echo(STIR-TSE )and axial T2-fast field echo(T2-FFE).Comparison was done between the sequences in the means of detectability, conspicuity and number of lesions.
Total patients were (31),22 were females and 9 were males .The female to male ratio was (2.4:1). The patient ages ranges between 20-61 years with a mean of age of about 38 years.
Mean Lesion to Cord Contrast Ratio (mean LCCR) of STIR and T2WI MR imaging was lower than PD imaging [p value < 0.01].Despite of STIR and T2WI had comparable LCCR (mean= 0.39), STIR imaging had expressively better Lesion Contrast to Noise Ratio (LCNR) [P value < 0.01]. PD had better LCNR (mean=48.8) as compared to T2 and STIR [p value<0.001].
PD-TSE sequence detected a large number of spinal cord lesions as compared to T2-TSE and STIR-TSE sequences [110 vs. 76 , 76; respectively . P value < 0.001].
PD-TSE improves overall lesion detection ,delineation, conspicuity and edge definition, however it cannot give precise cord morphological data, but it prove to be the sequence of choice in cervical MS plaque detection as it has the higher lesion contrast ,and it is beneficial in overcoming artifacts seen in both STIR and T2-TSE.
STIR-TSE have good signal to noise ratio, although have higher CSF flow artifacts.

Disorders of the Cerebellum In Children , MRI – Clinical Correlation

Ahlam Mohamad Abdulabbas; Muna Abdul Ghani Zghair; Raad Hifdhi Al-Khayat

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 13-18

The recognition of cerebellar anomalies, with the advent of neuro-imaging, has greatly improved, it present a wide variety of clinical and radiological Imaging findings.
1. To describe the spectrum of cerebellar anomalies by MRI .
2. To correlate with clinical presentation.
Sixty six patients(22Females, 44 Males) with the diagnosis of some form of cerebellar malformations, were included in this study, in the Central Teaching Hospital of Pediatrics in Baghdad over 18 months from July 2103 through December 2104. They were arranged for complete clinical and neuro-radiological evaluation. Age ranging from over 1month --- 15 years.
Twenty nine patients ( 43.9 % ) had vermian hypoplasia, ranging from mild to moderate , cerebellar hypoplasia( 19) patients ( 28.7 % ) ,combined anomalies in 16 patients (24.4%)and 2 patients (3 %) with cystic dilatation of the posterior fossa.The bulk of cases fall in the category of 1-- 5 years age group, with the major clinical presentation being motor and speech deficits, 28 ( 80 % ) and 27 (77.1 % ) patients respectively.
Magnetic resonance imaging is the basic modality of choice, in the setting of cerebellar malformation, especially in the association of extreme variability of clinical presentation, and lack of easy availability of the required cytogenetic analysis

The Role of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Obstructive Jaundice

Safa Al-Obaidi

Iraqi Postgraduate Medical Journal, 2007, Volume 6, Issue 1, Pages 7-17

Evaluation of jaundiced patients should include proper history and examination, laboratory investigation and imaging investigations (non invasive like US, CT and MRI or invasive like ERCP and PTC).
The aim of this prospective study is to evaluate the role of US and MRI-MRCP in patients with obstructive jaundice in clinical practice.
This is a prospective study performed on 80 patients (42 female and 38 male) with an average age of 53 years presented with obstructive jaundice for whom abdominal ultrasound (US) and magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) performed in the departments of radiology in Al-Kadhemiyyah teaching hospital and Specialized surgical hospital and Baghdad teaching hospital from October 2003 to October 2005. The final diagnosis was found by endoscopic retrograde cholangiopancreatography (ERCP) and or surgery and confirmed by histopathology.
The most common cause of obstructive jaundice in our study was tumors (41.25%) followed by common bile duct stones (36.25%) then benign strictures (13.75%), hydatid cyst (6.25%) & finally choledochal cyst (2.5%). In this study, MRI-MRCP could differentiate surgical from medical jaundice in all cases, while US could differentiate surgical from medical jaundice in 91.25% of cases. MRI-MRCP correctly defines the level of obstruction in all cases (100%).While US correctly define the level of obstruction in only 86.2 % of the total cases. MRI-MRCP correctly suggests the most possible cause of obstruction in 96.25% of cases. While US correctly suggests the most possible cause in only 36.2 %.
So that US, as a screening modality is useful to confirm or exclude biliary dilatation & to choose patients for MRCP examination. MRI-MRCP is a useful non-invasive and essential method in the preoperative evaluation of patients with obstructive jaundice. In addition MRI-MRCP was superior to US or ERCP in studying the extent & staging of malignant lesions