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  1. Fulltext Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma
    Che Mohamed SK, Abd Aziz A
    Malays J Med Sci, 2009 Oct;16(4):69-72.
    PMID: 22135515 MyJurnal
    When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury.
    Matched MeSH terms: Radiologists
  2. Fulltext Computed Tomography (CT) Imaging of Injuries from Blunt Abdominal Trauma: A Pictorial Essay
    Hassan R, Abd Aziz A
    Malays J Med Sci, 2010 Apr;17(2):29-39.
    PMID: 22135535 MyJurnal
    Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
    Matched MeSH terms: Radiologists
  3. 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
  4. 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
  5. Fulltext Retrocaval ureter: the importance of intravenous urography
    Hassan R, Aziz AA, Mohamed SK
    Malays J Med Sci, 2011 Oct;18(4):84-7.
    PMID: 22589677
    Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.
    Matched MeSH terms: Radiologists
  6. 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
  7. Fulltext Computed Tomography (CT) of Blunt Abdominal Trauma: The Frequency of Incidental Findings, how it was Documented in Radiology Report and the Implication of These Findings to Acute Trauma Care
    Radhiana H, Siti Kamariah CM, Mohd Nazli K, Azian AA
    Med J Malaysia, 2014 Feb;69(1):46-8.
    PMID: 24814633 MyJurnal
    The wide use of computed tomography (CT) scanning for patients with blunt abdominal trauma can reveal incidental findings that vary in their importance. We evaluated these findings, how it was reported by radiologists and its implication on the trauma care. In 30 out of 154 patients, 32 incidental findings were discovered (19.5%). Out of these 32 findings, only 3 cases (9.4%) were considered significant and required immediate attention from the managing team. In all these 3 cases, the findings were described in the body of the report and highlighted in the conclusion section at the end of the radiology report. However, similar reporting style was used in only 58.4% of cases with moderate clinical concern and 23.5% of cases with little clinical concern. In 41.2% of cases with little concern, the incidental findings were not mentioned in the radiology report. In conclusion, incidental findings in CT scan performed for blunt abdominal trauma were common but many were clinically insignificant. There is little consistency in radiology reporting of these findings especially those with moderate and little clinical concern.
    Matched MeSH terms: Radiologists
  8. 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
  9. 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
  10. 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
  11. Fulltext Onyx in Brain Arteriovenous Malformation Embolisation
    Hashim H, Muda AS, Abdul Aziz A, Abdul Hamid Z
    Malays J Med Sci, 2016 Jul;23(4):59-64.
    PMID: 27660546 MyJurnal DOI: 10.21315/mjms2016.23.4.8
    Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation.
    Matched MeSH terms: Radiologists
  12. 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
  13. 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
  14. Fulltext One stop centre staging by contrast-enhanced 18F-FDG PET/CT in preoperative assessment of ovarian cancer and proposed diagnostic imaging algorithm: a single centre experience in Malaysia
    Subapriya Suppiah, Andi Anggeriana Andi Asri, Fathinul Fikri Ahmad Saad, Hasyma Abu Hassan, Norhafizah Mohtarrudin, Chang, Wing Liong, et al.
    Malaysian Journal of Medicine and Health Sciences, 2017;13(2):29-37.
    MyJurnal
    Introduction: Suspicious adnexal masses need to be investigated thoroughly as it may represent ovarian cancer, which is the fourth most common gynaecological cancer in Malaysia. Conventional cross sectional imaging may reveal non-specific findings, thus lead to unnecessary biopsies. 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has emerged as a useful tool, for characterization of indeterminate adnexal masses. Most studies have been conducted in Western population, and little information is available in Asian population in general and Malaysian population in particular. Methods: Prospective study of women with suspicious adnexal masses, referred to the Centre for Nuclear Diagnostic Imaging, Universiti Putra Malaysia to undergo pre-operative whole-body contrast-enhanced 18F-FDG PET/CT scans from January 2014 to January 2016. Subjects underwent Contrast-Enhanced Computed Tomography (CECT) scans followed by positron emission tomography (PET) scans using a hybrid scanner. Two radiologists analyzed the CECT and PET/CT images by consensus; blinded to the HPE results. Then the PET/CT findings were correlated with HPE results as the gold standard. Results: 11 whole-body PET/CT scans and 18 adnexal masses (12 HPE-proven malignant lesions and 6 benign lesions) were analyzed. The sensitivity, specificity, PPV, and NPV of CECT alone compared to PET/CT was 91.7%, 50.0%, 78.6%, and 75.0% vs. 91.7%, 100%, 100% and 85.7% respectively. Conclusions: Improved diagnostic accuracy for characterizing benign and malignant adnexal masses can be achieved using contrast-enhanced 18F-FDG PET/CT, making it a potential investigation of choice which can help in treatment planning.
    Matched MeSH terms: Radiologists
  15. 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
  16. 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
  17. 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
  18. Radiologists’ Performance at Reduced Recall Rates in Mammography: A Laboratory Study
    Mohd Norsuddin N, Mello-Thoms C, Reed W, Lewis S
    Asian Pac J Cancer Prev, 2019 Feb 26;20(2):537-543.
    PMID: 30803217
    Rationale and objectives: Target recall rates are often used as a performance indicator in mammography screening
    programs with the intention of reducing false positive decisions, over diagnosis and anxiety for participants. However,
    the relationship between target recall rates and cancer detection is unclear, especially when readers are directed to
    adhere to a predetermined rate. The purpose of this study was to explore the effect of setting different recall rates on
    radiologist’s performance. Materials and Methods: Institutional ethics approval was granted and informed consent
    was obtained from each participating radiologist. Five experienced breast imaging radiologists read a single test set
    of 200 mammographic cases (20 abnormal and 180 normal). The radiologists were asked to identify each case that
    they required to be recalled in three different recall conditions; free recall, 15% and 10% and mark the location of any
    suspicious lesions. Results: Wide variability in recall rates was observed when reading at free recall, ranging from
    18.5% to 34.0%. Readers demonstrated significantly reduced performance when reading at prescribed recall rates,
    with lower sensitivity (H=12.891, P=0.002), case location sensitivity (H=12.512, P=0.002) and ROC AUC (H=11.601,
    P=0.003) albeit with an increased specificity (H=12.704, P=0.002). However, no significant changes were evident in
    lesion location sensitivity (H=1.982, P=0.371) and JAFROC FOM (H=1.820, P=0.403). Conclusion: In this laboratory
    study, reducing the number of recalled cases to 10% significantly reduced radiologists’ performance with lower detection
    sensitivity, although a significant improvement in specificity was observed.
    Matched MeSH terms: Radiologists/standards*
  19. "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
  20. 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
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