Tarek El-Diasty

Background: Radiofrequency ablation (RFA) has an established role in effective treatment of renal cell carcinomas (RCCs), as most of RCCs are diagnosed incidentally in early stages. Long-term follow-up is however important to consolidate the technique. Most of the literature contains series of short-term follow-ups of periods shorter than 2 years. This study in hand demonstrates the results of longer-term follow-up than the previously published series. Results: Data analysis of 31 patient records involved in this study demonstrated the high clinical efficacy of RFA for long term, 12-year follow-up, by following the absence of tumor recurrences, as shown on regular interval contrast enhanced computed tomography (CT) and or magnetic resonance imaging (MRI). Conclusions: RFA continues to prove its competent role in treating RCCs on longer-term follow-ups; the smaller the size of a tumor and the more peripheral the tumor is, the more effective the therapy. Even in larger early stages tumors, repeating the ablative sessions results in complete ablation without the need for more invasive surgical interventions.

Background: The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization (RAE) compelled us to report our overall experience on a series of patients. Materials and methods: A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019. History, physical examination, and laboratory data were reviewed for all patients. Abdominal ultrasound was the initial imaging study, and all patients underwent subsequent computed tomography or magnetic resonance imaging. The outcome of RAE was determined based on radiographic and clinical findings. Results: Data from 202 patients were analyzed, with a mean age of 45 ± 15 years, and 71.3% of patients were male. Iatrogenic injury was the most common indication for RAE (54%), followed by renal tumors, trauma, and spontaneous, in 27.7%, 10.4%, and 8.4% of patients, respectively. Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding (40.6%), whereas no lesions were identified on angiography in 32 patients (15.8%), after which RAE was subsequently aborted. Renal arterial embolization was successful in 158 of 170 patients (92.9%) after 1 or more trials (maximum of 4). Microcoil alone or with other embolic materials was the most commonly used material for embolization (85%). Conclusions: Iatrogenic injury was the most common indication for RAE. Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography; however, angiography showed a negative result in 16% of patients, even those with symptoms. When lesions are present on angiography, the overall success of repeated trials of RAE reached 92.9%.

Background: Some COVID-19 patients with similar quantitative CT measurements had variable clinical presentation and outcome. The absence of reasonable clinical explanations, such as pre-existing comorbidities or vascular complications, adds to the confusion. The authors believed that neglecting the impact of certain severe morphologic features could be an alternative radiological explanation. This study aims to optimize the initial CT staging of COVID-19 and propose a new combined morphologic/volumetric CT severity index (CTSI) to solve this clinico-radiological mismatch. Results: This multi-center study included two major steps. The first step of the study entailed a standardized combined morphologic/volumetric CT severity analyses to propose a new optimized CTSI. This was conducted retrospectively during the period from June till September 2020. It included 379 acutely symptomatic COVID-19 patients. They were clinically classified according to their oxygen saturation and respiratory therapeutic requirements into three groups: group A (mild 298/79%), group B (borderline severity 57/15%), and group C (severe/critical 24/6%). The morphologic and volumetric assessment of their HRCT was analyzed according to severity, by two consultant radiologists in consensus. A new 25 point-CTSI has been created, combining eight morphological CT patterns [M1:M8; 8 points] and four grades of volumetric scores [S1:S4; 17 points]. The addition of the M5 pattern (air bubble sign), M6 pattern (early fibrosis and architectural distortion), or M7 pattern (crazy-paving) proved to increase the clinical severity. The second step of the study entailed a standardized blinded/independent validation analysis for the proposed CTSI. This was prospectively conducted on other 132 patients during October 2020 and independently performed by other two consultant radiologists. Validation results reached 80.2% sensitivity, 91.8% specificity, AUROC-curve = 0.8356, and 90.9% accuracy. Conclusion: A new optimized CTSI with accepted validation is proposed for initial staging of COVID-19 patients, using combined morphologic/volumetric assessment instead of the quantitative assessment alone. It could solve the clinico-radiological mismatch among patients with similar quantitative CT results and variable clinical presentation during the absence of pre-existing comorbidities or vascular complications.

The evolution in imaging has had an increasing role in the diagnosis, staging and follow up of bladder cancer. Conventional cystoscopy is crucial in the diagnosis of bladder cancer. However, a cystoscopic procedure cannot always depict carcinoma in situ (CIS) or differentiate benign from malignant tumors prior to biopsy. This review will discuss the standard application, novel imaging modalities and their additive role in patients with bladder cancer. Staging can be performed with CT, but distinguishing between T1 and T2 BCa (bladder cancer) cannot be assessed. MRI can distinguish muscle-invasive from non-muscle-invasive tumors with accurate local staging. Vesical Imaging-Reporting and Data System (VI-RADS) score is a new diagnostic modality used for the prediction of tumor aggressiveness and therapeutic response. Bone scintigraphy is recommended in patients with muscle-invasive BCa with suspected bony metastases. CT shows low sensitivity for nodal staging; however, PET (Positron Emission Tomography)/CT is superior and highly recommended for restaging and determining therapeutic effect. PET/MRI is a new imaging technique in bladder cancer imaging and its role is promising. Texture analysis has shown significant steps in discriminating low-grade from high-grade bladder cancer. Radiomics could be a reliable method for quantitative assessment of the muscle invasion of bladder cancer.

There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.

Objective: The main goal of this study is to determine which parameters [e.g. clinical biomarkers, demographics and image-markers using 4D (3D + b-value) diffusion-weighted MRI (DW-MRI)] are more correlated with transplanted kidney status in patients who have undergone kidney transplantation, and can be used for early assessment of acute renal rejection.Methods:The study included 16 patients with stable graft function and 37 patients with acute rejection (AR), determined by renal biopsy post-transplantation. 3D DW-MRI of each allograft had been acquired using a series of b-values 50 and 100–1000 in steps of 100 smm–2. The kidney was automatically segmented and co-aligned across series for motion correction using geometric deformable models. Volume-averaged apparent diffusion coefficients (ADCs) at each b-value were calculated. All possible subsets of ADC were used, along with patient age, sex, serum plasma creatinine (SPCr) and creatinine clearance (CrCl), as predictors in 211 logistic regression models w...