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Abstract Background The term of Double-outlet right ventricle (DORV) is used to describe a spectrum of complex congenital cardiac malformations where anomalies of the ventriculo-arterial alignment are noted where both great arteries (pulmonary artery and aorta) originate completely or predominantly from the right ventricle. The purpose of this study is to evaluate the diagnostic accuracy of electrocardiography (ECG) gated multidetector computed tomography (MDCT) in preoperative assessment of DORV and its associated malformations, providing key anatomic parameters that affect surgical planning. Results A total of 50 patients diagnosed by echocardiography with DORV referred from our institute between September 2018 and August 2020 were enrolled. The location of the ventricular septal defect (VSD) to the great vessels and the alignment of the great vessels to each other as well as other associated malformations that affect the surgical planning were assessed by MDCT. The patients were retrospectively classified into subgroups according to the relative positions of the great arteries, the relationship between the great arteries and the VSD, and the presence of associated malformations according to the classification of Society of Thoracic Surgeons database. The diagnostic value of MDCT and transthoracic echocardiography (TTE) in evaluation of associated cardiac malformations apart from double outlet right ventricle was compared in 20 patients, whom surgeries were performed and surgical results were obtained. Fallot type of DORV was the most common clinical type which represented 48% of the patients in which the VSD is committed to the aorta. The second most common clinical type was Taussig–Bing anomaly which represented 30% of the patients and the VSD was seen committed to the pulmonary artery. The atrio-ventricular septal defect (AVSD)/uni-ventricular type represented 16% of the patients in the current study, with pulmonary and systemic venous anomalies, heterotaxy syndrome and situs anomalies were commonly associated. A total of 53 malformations apart from DORV were found in 20 patients whom performed surgical interventions. MDCT detected different vascular and situs anomalies in those patients with 100% sensitivity and 100% positive predictive value compared to 71.4% and 94% respectively in TTE. On the other hand, in our study TTE was superior to MDCT for detection of intracardiac anomalies with 100% sensitivity and 100% accuracy compared to 87.5% and 95% respectively in MDCT. Conclusions Our study suggested that ECG gated MDCT serves as a rapid, noninvasive imaging modality with good spatial resolution and provides excellent diagnostic image quality and has satisfactory diagnostic accuracy in the preoperative assessment of DORV. It is superior to echocardiography in providing a comprehensive mapping of the anatomy of complex anomalies especially that of extra-cardiac structures such as aorta, systemic veins, pulmonary veins, and pulmonary arteries. However, it can miss tiny intracardiac malformations. So combining the results of MDCT and echocardiography would be beneficial to guarantee the accuracy of diagnosis of DORV.

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is increasing in recognition as a hepatic condition that is unrelated to significant alcoholic consumption, but has rather, been suggested to constitute cardiovascular risk (irrespective of traditional risk factors and high-risk plaque features). Both coronary artery disease and NAFLD share the same pathophysiology and metabolic profile. NAFLD can theoretically be a source/initiator for coronary artery disease (CAD). We aimed to study the association between NAFLD, CAD, the presence of high-risk plaque features, and the severity of stenosis. Results We recruited 800 patients with suspected obstructive CAD and planned for coronary computed tomography angiography (CCTA), Exclusion criteria: heavy alcohol consumption; contraindications to contrast media; unevaluated coronary-artery segments; other known liver disease; and use of oral corticosteroids and/or amiodarone. Non-enhanced Computed Tomography abdomen was performed before the CCTA to detect NAFLD. To study the association between NAFLD and the presence of CAD, patients were classified as to either have, or not have CAD. The CAD group were then further studied for the presence of high-risk plaque features: napkin ring sign, Positive remodelling, Low Hounsfield unit (HU), and Spotty calcium; and their association with NAFLD. Thirty-two per cent of patients had NAFLD and 45% had CAD. A significant association between NAFLD and CAD was found (OR 4.21, 95% CI (confidence interval) (2.83–6.25), p = 0.000). In CAD patients, significant associations were present between NAFLD and high-risk plaque features: Napkin ring sign, Positive remodelling, Low HU, and Spotty calcium (OR 7.88, 95% CI (4.39–14.12), p 50% stenosis or 3V disease, and Total occlusion, respectively, p

Abstract Background Tetralogy of Fallot (TOF) is a common congenital cyanotic heart disease in which arrhythmias could develop even after successful operative repair. Pulmonary regurgitation and right ventricular dilatation develop in many cases. The relation between arrhythmias and right ventricular dilatation is not established. Our aim is to assess the relation in between the degree of right ventricular volume affection and the severity of the pulmonary regurgitation, associated arrhythmias and the need for pulmonary valve repair in Egyptian pediatric and adolescent cases after successful TOF repair. Results A cross sectional descriptive study was conducted on 32 cases after successful surgical repair. Transthoracic Doppler echocardiography, 24 h Holter monitoring and cardiac MRI for assessment of pulmonary regurgitation fraction (PRF), ventricular volumes and function were measured. Cases were classified according to right ventricular end diastolic volume index (RVEDVI) into 2 groups with cut off value 150 ml/m2. Mean age of the studied cases was (12.96 ± 3.384) years, mean age at time of surgical repair was (34.23 ± 22.1) months, and mean duration postoperatively was (121.72 ± 41.028) months. Eighteen cases (56%) had RVEDVI ≥ 150 ml/m2, PRF was significantly higher in cases with increased RVEDVI (p value 0.007), with positive significant correlation between RVEDVI and PRF (p value = 0.0001, r = 0.61). Arrhythmias were detected in 18 cases (56%), the most common of which was infrequent supraventricular ectopy. No significant difference in incidence of arrhythmias between the 2 groups (p value = 1) with also no significant correlation between arrhythmias and increased RVEDVI (p value = 0.76, r = 0.05). No difference between cases with and without arrhythmias regarding RVEDVI (p value = 0.56) or PRF (p value = 0.5). Conclusion Holter detected arrhythmias after successful surgical repair of TOF were significantly associated with increased postoperative duration but not with PRF or RVEDVI.

Abstract Background The aim of this work is to evaluate the validity of magnetic resonance (MR) imaging in assessment of pulmonary arteries and ventricular functions with conotruncal anomalies in the pediatric population. Results Between March 2018 and December 2019, 42 patients ranging in age from 6 months to 18 years and diagnosed with conotruncal anomalies by echocardiographic examination were submitted for cardiac MRI followed by assessment of their morphological (intra- and extra-cardiac anatomy) and functional parameters. The most common conotruncal anomaly was tetralogy of Fallot which represented 45% of the cases. Cardiac magnetic resonance (CMR) compared to echocardiography showed 46% agreement in the assessment of right ventricular volumes and function. There was only 37% agreement between echocardiography and MRI in delineation of MAPCAS. Conclusion CMR provides a powerful tool, giving anatomical and physiological information that echocardiography and catheterization alone cannot provide in conotruncal anomalies.

Abstract Background Central nervous system (CNS) anomalies are the most commonly diagnosed abnormalities of all fetal malformations and are usually primarily discovered on routine prenatal ultrasonography (US). Fetal magnetic resonance imaging (MRI) is a non-invasive technology with high soft tissue contrast that is documented to increase the diagnostic accuracy for detection of fetal brain anomalies. The aim of our study is to analyze the value of adding magnetic resonance imaging (MRI) of the fetal brain to antenatal ultrasound in the diagnosis of fetal central nervous system (CNS) anomalies. Results We diagnosed various CNS anomalies including twelve cases with infra- and supra-tentorial arachnoid cysts, six cases had Dandy-Walker malformation (DWM) and its variants, 1 case with mega cisterna magna, 2 cases of holoprosencephaly, 1 case of hydranencephaly, 2 cases with supratentorial hydrocephalus, 1 case of craniopharyngioma, 6 cases with corpus callosum (CC) agenesis, 1 case of extradural hematoma, and 8 cases with Meckel-Gruber syndrome (MGS). MRI diagnosis confirmed the ultrasound finding, without additional information in 23 cases (57.5%%), added an extra finding in 11 cases (27.5%), differentiated between 2 pathologies in 3 cases (7.5%), and changed the diagnosis in 3 cases (7.5 %). The 40 pregnancies resulted in 27 births (67.5%), 2 died directly after birth (5%), 7 terminations (17.5%), and 4 intrauterine fetal deaths (IUFD) (10 %). Conclusion Ultrasound is the gold standard imaging modality for anomaly scan in the second and third trimesters; however, MRI of the fetal brain might be a clinically valuable complement especially when ultrasound examination is inconclusive due to maternal obesity, severe oligohydramnios, or in complicated cases with unclear diagnosis.

Abstract Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorders. Being a global disease with diffuse myocardial fibrosis, it has a wide range of adverse outcomes ending with sudden cardiac death. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) has become a reference standard for visualization of focal myocardial fibrosis. In the setting of less severe or more diffuse fibrosis, LGE is unlikely to reveal the presence of abnormal tissue given the lack of normal myocardium as a reference. Direct measurement of myocardial T1 time (T1 mapping) may improve these methodologic problems of LGE CMR in the setting of diffuse retention of gadolinium-based contrast material. So, we aim at this study to evaluate the clinical application of CMRI native and post-contrast T1 relaxation in assessing diffuse myocardial fibrosis non-invasively in hypertrophic cardiomyopathy. Results There was a significant difference between the percent of fibrosis detected by measuring the extracellular volume percent compared to that detected by LGE, with the former detecting fibrosis in 45.1% of the examined cardiac segments while the latter showed fibrosis in 20.9% of the cardiac segments. Also, measuring the native T1 values showed evidence of fibrosis in about 32.2% of the cardiac segments superseding the percent of fibrosis detected using the LGE alone. The ejection fraction percent showed a negative correlation with the left ventricular mass with a correlation coefficient value of − 0.139 where both interstitial and replacement fibrosis play an important role in the pathophysiology of diastolic dysfunction as well as impairing the myocardial contractility. Also, in cases of obstruction, the extracellular volume (ECV) is more likely to increase in the basal anterior and antero-septal segments as well as the basal inferior segment with P values 0.015, 0.013, and 0.045, respectively. Conclusion Diffuse fibrosis was found to be difficult to be distinguished using LGE. The unique ability of CMR to use proton relaxation times provides a quantitative measurement to detect increased interstitial volume in diffuse myocardial fibrosis. Moreover, it showed that in cases of obstruction, the segments exposed to the highest pressure are more vulnerable to the fibrotic process denoting a relationship between the pressure gradient and the adverse myocardial remodeling.

Abstract Background The aim of this work is to assess the diagnostic accuracy of MR defecography in ano-rectal dysfunction [ARD] for proper treatment planning. Results MR defecography was done to 30 patients with ARD for detection of its functional and structural causes. Increased perineal descent was detected in 70% of cases, rectocele in 46.7%, rectal intussusception in 40%, cystocele in 26.7%, uterine prolapse in 27.7%, enterocele in 13.3%, and paradoxical puborectalis contraction in 30%. Conclusion MR defecography is an essential diagnostic tool for optimum management of ano-rectal dysfunction patients.

Abstract Background The aim of this work is to assess the uses of cardiac MR in evaluating post-operative congenital heart disease procedures and related complications. Results This is a retrospective study done in between December 2015 and October 2017, including 71 patients with age ranging from 6 months to 33 years (mean age 16.75). All of the patients were referred for post-operative evaluation after echocardiographic examination to exclude post-operative complications and to plan for re-intervention if needed. Forty-three percent of patients suffered from post-operative complications. The most common congenital heart disease coming for post-operative evaluation was tetralogy of Fallot (TOF) which represented 32% of the cases. The most common post-operative complication in all procedures was pulmonary branch stenosis (12.6%) followed by patch dilatation (9.8 %) and right ventricular failure (7%). In 7 patients following TOF repair, there was aneurysmal dilatation of the patch with significant pulmonary regurgitation. The regurgitation fraction was less than 40% in 3 of them, while the remaining 4 cases showed regurgitation fraction of more than 40%, an indication for re-intervention. Conclusion MRI is an extremely useful imaging method for evaluation of normal and abnormal findings after surgical repair for congenital heart disease. It is effective in providing long-term surveillance and identifying post-procedural complications, which allowed us to further intervene on a timely manner when deemed necessary.

Aim of the study: Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient. Patients and methods: This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other. Results: Patients age ranged from 40 days up to 20 years with 62 patients being in the pediatric age group (

Aim of the study: To evaluate the ultrasound efficiency in the assessment of pneumonia in pediatric age group compared to CT as a trial for radiation exposure reduction. Materials and methods: 56 patients of pediatric age group were included (4Â months to 10Â years). They presented to ER with respiratory distress, and pneumonia was suspected clinically. Human ethics committee approval for this study was obtained from the institutional review board of the private center where these cases were done. Both ultrasound and CT were done for all patients by 2 different radiologists being blind to the results of the other examination to minimize the bias. Follow up US was done after adequate medical treatment (7â14Â days) to detect its ability for following the patients up. Results: Ultrasound was able to detect efficiently different pulmonary pathological conditions as consolidation and pleural effusion. Compared to CT, ultrasound showed a sensitivity and specificity of 72.2% and 95% for pneumonia detection respectively with 96.3% PPV, 5% NPV, 3.7% FDR and 80.3% accuracy. Conclusion: Ultrasound could be considered as a good diagnostic and follow up tool when pneumonia especially in pediatric age group is suspected yet well trained radiologists and high resolution equipments are required. Keywords: Ultrasound, CT, Pneumonia, Pediatric

Objective: To assess the efficiency of dual energy contrast enhanced mammography in the assessment of the indeterminate breast lesions (BIRADS 3 and BIRADS 4). Materials and methods: 34 female having 39 indeterminate breast lesions (BIRADS 3 and BIRADS 4) by digital mammography were further examined by dual energy contrast enhanced mammography. Two images were acquired at low and high energy in MLO view after 2 min and in CC view at 4 min post iodinated contrast injection (1.5 ml/kg with flow of 4 ml/s). Images were processed to obtain subtracted images to enhance the areas of the contrast uptake. Results: Results from pathology were detected for all cases. Contrast enhanced digital mammography showed specificity, sensitivity, PPV, NPV, FDR, FPR and accuracy of 93.75%, 91.3%, 88.2%, 95.4%, 11.7%, 8.6% and 92.3% respectively compared to full field digital mammography which were 68.75%, 69.5%, 61.1%, 76.1%, 38.8%, 30% and 69.2% respectively. Conclusion: Contrast-enhanced digital mammography is a useful tool to be used for breast cancer detection especially in indeterminate lesions (BIRADS 3 and 4).

Objective: To assess ultrasound accuracy in rotator cuff tears detection with delineation of the extent of the injury (partial/full thickness tear) compared to MRI. Methods: Forty patients were referred with clinical suspicion of rotator cuff tear. Human ethics committee approval was obtained. Ultrasound and MRI were done for all patients by 2 different radiologists being blind to the results of the other examination to minimize the bias. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Results: Ultrasound detected different tendon pathologies (tendinitis, partial and full thickness tears), in addition to the causal factors. Compared to MRI, ultrasound sensitivity for tendinitis detection was 85% with 86% NPV and 90% accuracy, while for partial thickness tears, its sensitivity, specificity, PPV, NPV and accuracy were 88%, 89%, 94%, 80% and 83% respectively. But in full thickness tears its sensitivity and specificity were 100% each. Conclusion: Ultrasound and MRI are comparable in both sensitivity and specificity. Since US is less expensive and more available, it could be considered as the screening method when rotator cuff integrity is the main question, if well-trained radiologists and high resolution equipments are available.