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Fulltext Sonographic renal length and volume of normal Thai children versus their Chinese and Western counterparts

Rongviriyapanich C, Sakunchit T, Sudla C, Mungkung S, Pongnapang N, Yeong CH

Clin Exp Pediatr, 2020 Dec;63(12):491-498.
PMID: 32683809 DOI: 10.3345/cep.2019.01676

BACKGROUND: Renal size is an important indicator in the diagnosis of renal diseases and urinary tract infections in children.
PURPOSE: The purpose of this study is twofold. First, it aimed to measure the renal length and calculate the renal volume of normal Thai children using 2-dimensional ultrasonography (2D-US) and study their correlations with somatic parameters. Second, it aimed to compare the age-specific renal size of normal Thai children with the published data of their Western and Chinese counterparts.
METHODS: A total of 321 children (150 boys, 171 girls; age, 6-15 years) with a normal renal profile were prospectively recruited. All subjects underwent 2D-US by an experienced pediatric radiologist and the renal length, width, and depth were measured. Renal volume was calculated using the ellipsoid formula as recommended. The data were compared between the left and right kidneys, the sexes, and various somatic parameters. The age-specific renal lengths were compared using a nomogram derived from a Western cohort that is currently referred by many Thailand hospitals, while the renal volumes were compared with the published data of a Chinese cohort.
RESULTS: No statistically significant difference (P<0.05) was found between sexes or the right and left kidneys. The renal sizes had strong correlations with height, weight, body surface area, and age but not with body mass index. The renal length of the Thai children was moderately correlated (r=0.59) with that of the Western cohort, while the age-specific renal volume was significantly smaller (P<0.05) than that of the Chinese children.
CONCLUSION: Therefore, we concluded that the age-specific renal length and volume obtained by 2D-US would vary between children in different regions and may not be suitably used as an international standard for diagnosis, although further studies may be needed to confirm our findings.

Matched MeSH terms: Radiologists
Metastatic leiomyosarcoma of the thyroid: A rare entity

Che Jalil NA, Rama Chandran P, Samsudin AHZ, Yahya MM, Wan Abdul Rahman WF

Malays J Pathol, 2021 Apr;43(1):69-73.
PMID: 33903308

Cancer metastasis to the thyroid gland from non-thyroid sites is a rare presentation in clinical practice. The most frequent primary cancers that metastasise to the thyroid are renal cell carcinoma, followed by colorectal, lung and breast. We report a case of a 64-year-old Malay lady who presented with anterior neck swelling 4 years after an initial diagnosis of uterine leiomyosarcoma. She had undergone a hysterectomy procedure four years ago. Fine needle aspiration cytology of the thyroid mass suggested undifferentiated thyroid carcinoma. After multi-disciplinary discussion, the patient underwent thyroidectomy and the final histopathological diagnosis was metastatic leiomyosarcoma of the thyroid. The diagnosis was aided by an immunohistochemistry panel of positive myogenic markers, negative epithelial markers as well as the previous medical history of uterine leiomyosarcoma. Metastatic leiomyosarcoma of the thyroid may mimic primary undifferentiated (anaplastic) thyroid carcinoma (UTC) with a sarcomatoid pattern, medullary thyroid carcinoma (MTC) with spindle cells morphology and spindle cell tumour with thymus-like differentiation (SETTLE). Hence, a multidisciplinary approach must be practised by pathologists, surgeons and radiologists to consider metastatic lesions of the thyroid gland, especially when a previous history of cancer exists or is suspected.

Matched MeSH terms: Radiologists
Guidelines for neuromuscular ultrasound training

Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, et al.

Muscle Nerve, 2019 10;60(4):361-366.
PMID: 31335971 DOI: 10.1002/mus.26642

Neuromuscular ultrasound has become an essential tool in the diagnostic evaluation of various neuromuscular disorders, and, as such, there is growing interest in neuromuscular ultrasound training. Effective training is critical in mastering this modality. Our aim was to develop consensus-based guidelines for neuromuscular ultrasound training courses. A total of 18 experts participated. Expert opinion was sought through the Delphi method using 4 consecutive electronic surveys. A high degree of consensus was achieved with regard to the general structure of neuromuscular ultrasound training; the categorization of training into basic, intermediate, and advanced levels; the learning objectives; and the curriculum for each level. In this study, a group of neuromuscular ultrasound experts established consensus-based guidelines for neuromuscular ultrasound training. These guidelines can be used in the development of the specialty and the standardization of neuromuscular ultrasound training courses and workshops.

Matched MeSH terms: Radiologists/education
Unusual contribution of the first jejunal vein in the formation of the portal vein

Nayak SB, Shetty SD, Packirisamy V, Vasudeva SK

Morphologie, 2021 May 05.
PMID: 33965324 DOI: 10.1016/j.morpho.2021.04.003

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.

Matched MeSH terms: Radiologists
Fulltext Pinch-off syndrome from a chemoport catheter successfully managed with endovascular retrieval

Chuah JS, Wong WL, Bakin S, Lim RZM, Lee EP, Tan JH

Ann Med Surg (Lond), 2021 May;65:102294.
PMID: 33948169 DOI: 10.1016/j.amsu.2021.102294

Introduction and importance: A totally implantable venous access device (TIVAD), also referred to as 'chemoport', is frequently used for oncology patients. Chemoport insertion via the subclavian vein access may compress the catheter between the first rib and the clavicle, resulting in pinch-off syndrome (POS). The sequela includes catheter transection and subsequent embolization. It is a rare complication with incidence reported to be 1.1-5.0% and can lead to a devastating outcomes.
Case presentation: 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3rd month follow up.
Conclusion: Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.

Matched MeSH terms: Radiologists
Fulltext Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease

Tan AP

Med J Malaysia, 2015 Apr;70(2):100-1.
PMID: 26162386

Retained products of conception (POC) complicates nearly 1% of all pregnancies, occurring with greater frequency after termination of pregnancy than after vaginal or caesarean delivery. The presenting symptoms of retained products of conception are similar to those of gestational trophoblastic disease and hence accurate differentiation is difficult based on clinical history and physical examination alone. The distinction between these two entities is extremely important as the treatment differs dramatically. These patients often need to be further evaluated with either ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis. Hence, radiologists play a vital role in clinching the diagnosis although at times it may be challenging to differentiate between these two entities. Herein, we discuss a case of degenerated retained products of conception which was initially misdiagnosed as invasive trophoblastic disease in a 41-year-old woman whom last known pregnancy was 10 years ago.

Matched MeSH terms: Radiologists
Fulltext Mylohyoid foramen of mandible: a rare exit point of intra-mandibular origin of nerve to mylohyoid

Nayak SB, Soumya KV

Anat Cell Biol, 2020 Mar;53(1):114-116.
PMID: 32274257 DOI: 10.5115/acb.19.186

Nerve to mylohyoid is a branch of inferior alveolar nerve. It arises in the infratemporal fossa and runs in the mylohyoid groove of mandible to reach the submandibular region, where it supplies the anterior belly of digastric and mylohyoid muscles. Though sensory distribution of this nerve have been described, it is predominantly a motor nerve. Here, a rare intra-mandibular origin of nerve to mylohyoid has been presented. This nerve arose from the inferior alveolar nerve inside the mandible and came out to the submandibular region by passing through a small foramen present on the medial surface of the body of the mandible. It ended by supplying the anterior belly of digastric and mylohyoid muscles. The knowledge of this variation could be of importance to maxillofacial surgeons and radiologists.

Matched MeSH terms: Radiologists
"Anterior appendix": a boon for clinicians and radiologists

Nayak SB, Soumya KV

Surg Radiol Anat, 2019 Jun 18.
PMID: 31214757 DOI: 10.1007/s00276-019-02268-x

Vermiform appendix is considered as a vestigial organ, and it has minimal or no role to play in the digestion and absorption of food. It is an enigma to the clinicians due to its variable positions and symptoms caused by its inflammation. In the available literature, there are many reports on various positions, size and disease of appendix. However, there is no report on an anteriorly located appendicular attachment to the caecum. During dissection classes for medical undergraduates, an appendix with its base attached to the anterior wall of the caecum was noted. The entire appendix was attached to the ileum through a mesoappendix and was readily visible when the anterior abdominal wall was reflected. This position could be a boon to the clinicians and radiologists during diagnosis and surgery of the appendix.

Matched MeSH terms: Radiologists
Automatic liver tumor segmentation on computed tomography for patient treatment planning and monitoring

Moghbel M, Mashohor S, Mahmud R, Saripan MI

EXCLI J, 2016;15:406-23.
PMID: 27540353 DOI: 10.17179/excli2016-402

Segmentation of liver tumors from Computed Tomography (CT) and tumor burden analysis play an important role in the choice of therapeutic strategies for liver diseases and treatment monitoring. In this paper, a new segmentation method for liver tumors from contrast-enhanced CT imaging is proposed. As manual segmentation of tumors for liver treatment planning is both labor intensive and time-consuming, a highly accurate automatic tumor segmentation is desired. The proposed framework is fully automatic requiring no user interaction. The proposed segmentation evaluated on real-world clinical data from patients is based on a hybrid method integrating cuckoo optimization and fuzzy c-means algorithm with random walkers algorithm. The accuracy of the proposed method was validated using a clinical liver dataset containing one of the highest numbers of tumors utilized for liver tumor segmentation containing 127 tumors in total with further validation of the results by a consultant radiologist. The proposed method was able to achieve one of the highest accuracies reported in the literature for liver tumor segmentation compared to other segmentation methods with a mean overlap error of 22.78 % and dice similarity coefficient of 0.75 in 3Dircadb dataset and a mean overlap error of 15.61 % and dice similarity coefficient of 0.81 in MIDAS dataset. The proposed method was able to outperform most other tumor segmentation methods reported in the literature while representing an overlap error improvement of 6 % compared to one of the best performing automatic methods in the literature. The proposed framework was able to provide consistently accurate results considering the number of tumors and the variations in tumor contrast enhancements and tumor appearances while the tumor burden was estimated with a mean error of 0.84 % in 3Dircadb dataset.

Matched MeSH terms: Radiologists
Fulltext The value of 18F-fluorodeoxyglucose –positron emission tomography/ computed tomography (18F- FDG PET/CT) in the staging and impact on the management of patients with nasopharyngeal carcinoma

Sethu Thakachy Subha, Fathinul Fikri Ahmad Saad, Abdul Jalil Nordin, Saraiza Abu Bakar

Pertanika Journal of Science & Technology, 2017;25(3):687-696.
MyJurnal

This study sought to prospectively evaluate the influence of contrasted fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDGPET/CT) in the staging of and impact on the management plan for treatment in patients with nasopharyngeal carcinoma (NPC). A total of 14 histologically proven NPC patients (mean age: 44.64±4.01years) were included in the study. These patients underwent contrasted Computed Tomography (CT) as well as 18F-FDGPET/CT imaging. Staging was based on the 7th edition of the American Joint Committee on Cancer Tumor Node Metastases (AJCCTNM) recommendations.The oncologist was asked to prospectively assign a treatment plan for all patients being evaluated by CT and 18F-FDGPET/CT. The treatment plans were compared with the incremental information supplied by the FDG-PET/CT. The maximum standardised uptake value (SUVmax) and the widest dimension of the primary tumour, cervical lymph nodes size and the distant metastatic lesions were quantified on the co-registered PET/CT images by two experienced nuclear radiologists. The contrasted 18F-FDGPET/CT changed the management intent in nine patients (64.7%). A univariate analysis showed that there were significant correlations between SUVmax and the size of the metastatic
lymph nodes (R2 =0.0761, p

Matched MeSH terms: Radiologists
Fulltext “IMMOLIMBTM” problem solving method for low quality image of lower limb angiography procedure

Halmi Shamsudin, Norman Nordin, Sa’don Samian, Hafiz Salahudin, Azrul, A.B., Nik Azuan, N.I., et al.

Jurnal Inovasi Malaysia, 2018;2(1):31-50.
MyJurnal

Angiography procedures is one of the diagnostic imaging procedures for studying blood vessels in the arteries and veins. This angiography examination is performed by injecting a viscous liquid called contrast media into the blood vessels to clearly identify the blocked blood vessels. This procedure involves the exposure of X-Ray in certain blood vessels and is performed by the Interventionist Radiologist. There are several types of angiography examinations which include cerebral angiography, coronary angiography, pulmonary angiography, peripheral angiography and renal angiography. The main problem that occurs during the Lower Limb Angiography examination involving elderly patients aged 60 years and above who suffer from critical diabetes stage in both blood vessels. The problem arise when there is no special immobilize device to support the foot and the patients were in an uncomfortable state for a period of 2-3 hours during the examination. Hence specialists had difficulty to interpret accurately the blood vessel clot in the foot due to less optimum radiograph. IMMOLIMBTM is an innovative invention created from used waste to overcome the foot movements, providing comfort and enhancing optimum diagnostic images.

Matched MeSH terms: Radiologists
Fulltext Computed tomography of blunt spleen injury: a pictorial review

Hassan R, Abd Aziz A, Md Ralib AR, Saat A

Malays J Med Sci, 2011 Jan;18(1):60-7.
PMID: 22135575 MyJurnal

The spleen is one of the organs most frequently injured in blunt abdominal trauma. Computed tomography (CT) scanning can accurately detect splenic injury and is currently the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. The CT features of spleen injury include lacerations, subcapsular or parenchymal haematomas, active haemorrhage, and vascular injuries. We present a pictorial review of the spectrum of CT findings for blunt splenic injuries. This article will be a useful reference for radiologists and surgeons as CT scan is widely used for the assessment of splenic injuries and contributes to the current trend towards nonsurgical management of this injury.

Matched MeSH terms: Radiologists
Fulltext Foundation and methodologies in computer-aided diagnosis systems for breast cancer detection

Jalalian A, Mashohor S, Mahmud R, Karasfi B, Saripan MIB, Ramli ARB

EXCLI J, 2017;16:113-137.
PMID: 28435432 DOI: 10.17179/excli2016-701

Breast cancer is the most prevalent cancer that affects women all over the world. Early detection and treatment of breast cancer could decline the mortality rate. Some issues such as technical reasons, which related to imaging quality and human error, increase misdiagnosis of breast cancer by radiologists. Computer-aided detection systems (CADs) are developed to overcome these restrictions and have been studied in many imaging modalities for breast cancer detection in recent years. The CAD systems improve radiologists' performance in finding and discriminating between the normal and abnormal tissues. These procedures are performed only as a double reader but the absolute decisions are still made by the radiologist. In this study, the recent CAD systems for breast cancer detection on different modalities such as mammography, ultrasound, MRI, and biopsy histopathological images are introduced. The foundation of CAD systems generally consist of four stages: Pre-processing, Segmentation, Feature extraction, and Classification. The approaches which applied to design different stages of CAD system are summarised. Advantages and disadvantages of different segmentation, feature extraction and classification techniques are listed. In addition, the impact of imbalanced datasets in classification outcomes and appropriate methods to solve these issues are discussed. As well as, performance evaluation metrics for various stages of breast cancer detection CAD systems are reviewed.

Matched MeSH terms: Radiologists
Fulltext A Review of Medical Doppler Ultrasonography of Blood Flow in General and Especially in Common Carotid Artery

Oglat AA, Matjafri MZ, Suardi N, Oqlat MA, Abdelrahman MA, Oqlat AA

J Med Ultrasound, 2018 03 28;26(1):3-13.
PMID: 30065507 DOI: 10.4103/JMU.JMU_11_17

Medical Doppler ultrasound is usually utilized in the clinical adjusting to evaluate and estimate blood flow in both the major (large) and the minor (tiny) vessels of the body. The normal and abnormal sign waveforms can be shown by spectral Doppler technique. The sign waveform is individual to each vessel. Thus, it is significant for the operator and the clinicians to understand the normal and abnormal diagnostic in a spectral Doppler show. The aim of this review is to explain the physical principles behind the medical Doppler ultrasound, also, to use some of the mathematical formulas utilized in the medical Doppler ultrasound examination. Furthermore, we discussed the color and spectral flow model of Doppler ultrasound. Finally, we explained spectral Doppler sign waveforms to show both the normal and abnormal signs waveforms that are individual to the common carotid artery, because these signs are important for both the radiologist and sonographer to perceive both the normal and abnormal in a spectral Doppler show.

Matched MeSH terms: Radiologists
Fulltext Iatrogenic submandibular duct rupture complicating sialography: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Sep;16(9):e7882.
PMID: 25593739 DOI: 10.5812/ircmj.7882

INTRODUCTION: Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.
CASE PRESENTATION: We report on a 38-year-old female with sialolithiasis whom had Wharton's duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.
CONCLUSIONS: Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.

Matched MeSH terms: Radiologists
Fulltext Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

Yaacob Y, Nguyen DV, Mohamed Z, Ralib AR, Zakaria R, Muda S

Indian J Radiol Imaging, 2013 Apr;23(2):121-5.
PMID: 24082475 DOI: 10.4103/0971-3026.116543

To report our early experience in image-guided chemoport insertions by interventional radiologists.

Matched MeSH terms: Radiologists
Fulltext Embolisation of a bronchial artery of anomalous origin in massive haemoptysis

Md Ralib AR, Han NT, Hin HS, Muda AS

Malays J Med Sci, 2010 Jul;17(3):55-60.
PMID: 22135550 MyJurnal

Massive haemoptysis is the most dreaded of all respiratory emergencies. Bronchial artery embolisation is known to be a safe and effective procedure in massive haemoptysis. Bronchial artery of anomalous origin presents a diagnostic challenge to interventional radiologists searching for the source of haemorrhage. Here, we report a case of massive haemoptysis secondary to a lung carcinoma with the bronchial artery originating directly from the right subclavian artery. This artery was not evident during the initial flush thoracic aortogram. The anomalous-origin bronchial artery was then embolised using 15% diluted glue with good results. An anomalous-origin bronchial artery should be suspected if the source of haemorrhage is not visualised in the normally expected bronchial artery location.

Matched MeSH terms: Radiologists
Fulltext The Growing Problem of Radiologist Shortage: Malaysia's Perspective

Ramli NM, Mohd Zain NR

Korean J Radiol, 2023 Oct;24(10):936-937.
PMID: 37793663 DOI: 10.3348/kjr.2023.0742
Matched MeSH terms: Radiologists*
ASSESSMENT ON THE INTERCHANGEABILITY OF PERSONAL EFFECTIVE DOSE ALGORITHMS IN FLUOROSCOPY-GUIDED INTERVENTIONS USING BLAND-ALTMAN ANALYSIS

Bohari A, Hashim S, Ghoshal SK, Mohd Mustafa SN

Radiat Prot Dosimetry, 2019 Dec 31;186(4):462-468.
PMID: 31329977 DOI: 10.1093/rpd/ncz051

Long exposure to radiation from fluoroscopy-guided interventions (FGIs) can be detrimental to both patients and radiologists. The effective doses received by the interventional radiology staff after performing 230 FGIs in a year were assessed by using double dosimetry and five various algorithms. The Shapiro-Wilk test revealed normally-distributed data (p < 0.01), while the significant correlation coefficients between the effective doses ranged between 0.88 and 1.00. As for the Bland-Altman analysis, both Niklason and Boetticher algorithms strongly supported the absence of statistical significance between the estimated effective doses. This portrays that the occupational doses received by the interventional radiology staff during FGIs fall within the acceptable limit regardless of the varied algorithms applied. In short, the Niklason and Boetticher algorithms appeared to be the more interchangeable ones for effective evaluation of doses. This is in view of their strong mutual correlations and excellent agreement.

Matched MeSH terms: Radiologists
Fulltext Insufficiency fractures related to low-dose adefovir dipivoxil treatment for chronic hepatitis B

Poh F, Sing WH, Mohan PC

Med J Malaysia, 2015 Feb;70(1):38-41.
PMID: 26032529

We present a case of a 53-year-old woman who developed multifocal insufficiency fractures associated with adefovir dipivoxil (ADV) induced osteomalacia, including recurring metatarsal insufficiency fractures and a subtrochanteric femoral insufficiency fracture requiring surgical fixation. She had received low-dose ADV treatment for 59 months for chronic hepatitis B viral infection at the time of presentation with subtrochanteric fracture. Imaging evidence of multifocal insufficiency fractures and metabolic disease on background of hypophosphatemia is attributed to hypophosphatemic osteomalacia from adefovir-induced renal proximal tubular dysfunction. Radiologists and clinicians should be aware of the possibility of insufficiency fractures in patients receiving ADV therapy to avoid delayed diagnosis and progression of high-risk proximal femoral fractures.

Matched MeSH terms: Radiologists

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