Serena Cocca,1 Giulia Mignacco,2 Marco Mandalà,2 Caterina Giannitto,3 Andrea Alessandro Esposito,4 Simone Porcino2 1Department of Ear Nose Throat, Ospedale Misericordia, Grosseto, GR, 58100, Italy; 2Department of Ear Nose Throat, AOUS “S.Maria alle Scotte”-University Hospital of Siena, Siena, SI, 53100, Italy; 3Department of Radiology, Istituto Clinico Humanitas, Rozzano, MI, 20089, Italy; 4Department of Radiology, ASST Bergamo Ovest- Ospedale “Treviglio-Caravaggio”, Treviglio, BG, 24047, ItalyCorrespondence: Serena CoccaDepartment of Ear Nose Throat, Ospedale Misericordia, Via Senese 161, Grosseto, 58100, ItalyTel +39 3201525334Fax +39 0577585470Email serena.cocca@gmail.comAndrea Alessandro EspositoDepartment of Radiology, ASST Bergamo Ovest- Ospedale “Treviglio-Caravaggio”, P.le Ospedale 1, Treviglio, 24047, BG, ItalyTel +39 3475476654Email andrea_esposito@asst-bgovest.itAbstract: Third window lesions are defined as abnormal communications of the inner ear with adjacent spaces, namely the middle ear or cranial cavity. These lesions can occur at multiple anatomic locations, including the superior, posterior, and lateral semicircular canals; vestibule and vestibular aqueduct; and scala vestibuli of the cochlea. Semicircular canal dehiscence (SCD) is the most common condition wherein the temporal bone adjacent to the vestibular apparatus thins or is interrupted completely. Normally, there are two mobile windows: the oval window and round window. SCD results in a third mobile window in the inner ear, which causes an abnormal transmission of acoustic energy (“third-window effect”) towards the vestibular end-organs and causes symptoms. Superior SCD is a well-described pathological condition with potentially debilitating symptoms, instead the dehiscence of the posterior canal is very rare. The diagnosis is difficult and often delayed because the symptoms can be absent or aspecific and confused with other diseases: vestibular disorders, cerebrovascular diseases, trauma, and tumors. We report a rare case about a “double” third window syndrome of twin sisters due to a bone defect of two different semicircular canals. A 34-year-old woman presented to the Otology Department of University Hospital with a worsening of tinnitus, autophony and vertigo. She had been treated for 3 years as if affected to Menière disease. An audiometric exam revealed a right mixed hearing loss with 20– 40 dB air bone gap from 250 to 4000 Hz. Vestibular examinations are unchanged compared to the past exams. But Valsalva maneuver induced pathological oscillopsia, vertigo and torsional up-beating nystagmus. Clinical manifestations may be like other diseases, such as Menière disease or perilymphatic fistula, confounding the diagnosis. Moreover, the appearance of the same symptoms in the patient’s twin sister, confirmed by the radiological investigation, suggested the familiarity for semicircular canal dehiscence. Audiometric and vestibular examinations are important even if diagnosis is impossible without radiological investigation. Indeed, we describe the history, clinical profile and management of twin sisters who had similar symptoms (worsening vertigo induced by pressure, autophony, tinnitus and hearing loss) and different bony labyrinth defects. Surgical management resulted in complete resolution in imbalance 3 months after the surgery. This surprising case of homozygous twin sisters suggests that there may be a genetic aspect to the disease.Keywords: vertigo, tinnitus, semicircular canals, hearing loss, dehiscence, third window
Steven Magera,1 Senai Goitom Sereke,1 Emmy Okello,2 Faith Ameda,1 Geoffrey Erem1 1Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Cardiology, Uganda Heart Institute, Kampala, UgandaCorrespondence: Steven Magera; Senai Goitom Sereke, Email magerasteven4@gmail.com; nayhersen@gmail.comBackground: The burden of cardiovascular diseases, such as aortic and degenerative diseases, grows in the aging population. Chest radiograph still plays an important role in the diagnosis of cardiovascular diseases. Aortic knob diameter in chest radiographs can be used to evaluate early changes of the aortic structure and together with clinical and laboratory findings. This study was aimed at determining the mean values of aortic knob diameter among healthy adults in Uganda.Methods: We conducted a descriptive cross-sectional study in three selected hospitals in Kampala Uganda. All participants had normal chest radiographs without radiological evidence of cardiovascular disease. Chest radiograph findings extracted included aortic knob diameter, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. All films were independently examined by two experienced radiologists.Results: We analyzed chest radiograph findings of 294 participants, of which 204 (69.4%) were male. Aortic knob diameter increased with age (p – 0.000). The mean aortic knob diameter of males was higher than for females (3.14± 0.34cm versus 2.77± 0.37cm, p – 0.000). The mean aortic knob diameter on the digital screen was higher than plain films (3.03± 0.393cm versus 2.96± 0.392cm, p – 0.000). Aortic knob diameter positively correlated with age (p – 0.000) and aortic arch diameter (p – 0.000). Aortic knob diameter also correlated positively with a transverse thoracic diameter (p – 0.05), transverse heart diameter (p – 0.05), and cardiothoracic ratios (p – 0.05).Conclusion: The aortic knob diameter was higher in males and there was a positive correlation with age, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. Aortic knob diameter measurements should be done on digital rather than printed x-ray films.Keywords: aortic knob, diameter, chest radiograph, cardiovascular, Uganda
Giulia Lastella,1 Andrea Esposito,2 Alice Scarabelli,3 Guido Giovanni Plensich,3 Elvira Stellato,3 Emanuele Avola,3 Caterina Giannitto,4 Massimo Castellani,5 Marco Cuzzocrea,6 Luca Bonomo,7 Gianpaolo Carrafiello5 1Unit of Radiology, Ospedale Città di Sesto San Giovanni, ASST Nord Milano, Sesto San Giovanni, Italy; 2Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy; 3Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy; 4Unit of Radiology, Istituto Clinico Humanitas, Rozzano, Italy; 5Unit of Nuclear Medicine, IRCCS Fondazione Cà Granda, Maggiore Policlinico Hospital, Milan, Italy; 6Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 7Clinica di Radiologia, Ente Ospedaliero Cantonale, Lugano, SwitzerlandCorrespondence: Andrea Esposito, Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy, Tel +393475476654, Email andrea_esposito@asst-bgovest.itPurpose: To compare the diagnostic performance of lung perfusion colormaps derived from computed tomography pulmonary angiography (cmCTPA) by novel semi-automatic post-processing software, with lung perfusion scintigraphy (LPS), for detection of lung perfusion defects (LPDs) in pulmonary embolism (PE).Patients and Methods: Consecutive patients from January 2016 to April 2020 who underwent both computed tomography pulmonary angiography (CTPA) and LPS within 7 days of each other, to rule out PE, were retrospectively enrolled. cmCTPA images were obtained from CTPA images using semi-automatic post-processing software (Pulmonary Artery Analysis, Intellispace Portal Release 11, Philips). The diagnosis of LPD was assessed on LPS images by two nuclear medicine physicians in consensus; CTPA and cmCTPA images were evaluated by two radiologists in consensus, blind to the LPS results. The spatial location of the LPD was assessed according to Boyden’s nomenclature. Agreement between LPS and cmCTPA in the diagnosis of LPD was tested using Cohen’s kappa.Results: Fifty-three patients were enrolled. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of cmCTPA were, respectively, 100%, 40%, 73%, and 100%; disease prevalence was 67%, accuracy was 77%, and positive and negative likelihood ratios were 1.67 and 0, respectively. An almost perfect agreement was found between cmCPTA and LPS in 13 segments (72%) and a substantial agreement was found in the remaining five segments (28%).Conclusion: cmCTPA, owing to its NPV (100%) and its overall high agreement in the number and location of LPDs compared to LPS, may have an upcoming role in the evaluation of lung perfusion in PE.Keywords: nuclear medicine, pulmonary embolism, perfusion imaging, computed tomography angiography, image processing, computer-assisted
Background: Magnetic field inhomogeneity in magnetic resonance imaging (MRI) is caused by the inherent properties of the main magnet, external ferromagnetic components surrounding the magnet, and the patient itself.Significant deviations from magnetic field inhomogeneity can create artifacts in MRI images, thereby compromising image quality.Optimizing magnetic field homogeneity improves image quality and helps to reduce artifacts.The goal of this article therefore is to help radiographers and operators of MRI understand the clinical basis of magnetic field inhomogeneity and its effects on MR images.This would assist them to appreciate the trade-offs between sequence parameters and image quality metrics towards optimizing magnetic field inhomogeneity.Methods: A narrative literature review was conducted from relevant databases using search terms such as MRI, magnetic field inhomogeneity, optimization, magnetic field inhomogeneity artifacts, and MRI shimming.Results: Minimizing field inhomogeneities in MRI is not straightforward but involves a multitude of factors and steps.Magnetic field homogeneity could be optimized to improve MR image quality by choosing the most appropriate pulse sequence/imaging parameters that could best minimize distortion and increase SNR based on the anatomical region of interest (or tissue types) while complementing it with shimming and use of dielectric pads.Conclusion: Future works to investigate the association between the MRI pulse sequence parameters and measurements of MR image quality metrics, based on individual tissue densities, could provide a new window for reducing magnetic field inhomogeneity due to susceptibility and chemical shift effects.
Ali Alghamdi,1 Maaidah Algamdi,2 Khaledah Alatawi,2 Basmah Alghamdi,2 Hana Alanazi,2 Shumukh Alamri,2 Somiah Alamri,2 Zahra Albishi2 1Department of Radiological Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 2Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi ArabiaCorrespondence: Ali Alghamdi, Department of Radiological Science, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, 47512, Saudi Arabia, Tel +966561587982, Email ah.alghamdi@ut.edu.saBackground: Magnetic resonance imaging (MRI) has become one of the most essential diagnostic medical imaging techniques. The most common disadvantage of MRI is that patients may feel anxious before the examination, which can negatively affect them, prevent them from attending or completing the examinations, and cause patient movement during the examination, which accordingly results in misinterpretation issues. Recently, several methods have been suggested to reduce MRI anxiety. Our study aimed to examine nurses’ roles in reducing the levels of patient anxiety during pre-MRI scans by using informative video.Methods: A cross-sectional and interventional study was conducted among MRI patients in Tabuk City. A convenience sample of 16 patients as the case group and 28 patients as the control group was included. A 2-minute informative video clip containing comprehensive instructions about MRI was recorded by the research team in the MRI room and introduced to patients 30 minutes before the scan in the waiting area. An Arabic version questionnaire (State-Trait Anxiety Inventory) was used to measure the pre-MRI-related anxiety of patients in the case and control groups. State-trait anxiety scores were analyzed and compared between groups. Median pulse, oxygen saturation, and blood pressure were also compared between the cases and control groups using a p-value of 0.05.Results: The state anxiety score was significantly higher in cases compared to controls. However, the trait anxiety score was not significantly different between cases and controls. Females showed significantly higher state anxiety scores in the cases than in the controls. Based on the previous MRI experience, the cases group who had undergone a previous MRI had significantly higher state anxiety scores than those in the control group. Based on the educational degree, cases with bachelor’s degree had higher state anxiety scores than their counterparts in the control group.Conclusion: The present study showed that the self-made visual tool used by nurses 30 minutes before MRI scan did not reduce the level of anxiety significantly in patients. However, state anxiety scores increased in females, patients with previous MRI experience, and patients with a higher educational degree. Healthcare professionals may need to consider the negative effect of informative video before MRI.Keywords: magnetic resonance imaging, MRI, anxiety, nurses’ role, informative video, patient, interventions, STAI-Y
