TeleFast Rad, Dubai (2025)

09/10/2025

☢️What are diffusion tensor imaging & tractography ?

Diffusion Tensor Imaging (DTI) and Tractography are advanced MRI techniques that visualize and analyze the white matter pathways (nerve fiber tracts) in the brain and spinal cord.
Here’s a clear explanation of each:

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🧠 1. Diffusion Tensor Imaging (DTI)

🔸Definition:
DTI is an MRI technique that measures the diffusion (movement) of water molecules within tissues—especially in white matter of the brain.

🔸Key Concept:
• In the brain’s white matter, water molecules tend to move along the direction of axon fibers (anisotropic diffusion) rather than equally in all directions (isotropic diffusion).
• DTI uses this property to infer the orientation and integrity of white matter tracts.

‼️What DTI measures:
• FA (Fractional Anisotropy): how directional the diffusion is; higher FA = healthier, more organized white matter.
• MD (Mean Diffusivity): how freely water diffuses overall; higher MD = possible damage or loss of tissue density.
• AD (Axial Diffusivity): diffusion along the main fiber axis.
• RD (Radial Diffusivity): diffusion perpendicular to the fibers.

✅Clinical uses:
• Detecting white matter injury (e.g., in trauma, multiple sclerosis, or stroke).
• Assessing brain development or aging.
• Evaluating tumor infiltration.
• Pre-surgical planning to avoid important fiber tracts.

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🧩 2. Tractography

🔸Definition:
Tractography is a 3D reconstruction technique based on DTI data that visually maps out the pathways of white matter tracts in the brain.

🔸How it works:
• The DTI provides the direction of diffusion in each small voxel.
• Tractography algorithms connect voxels that share similar diffusion directions, creating virtual “fiber tracts.”

🔸Output:
A 3D map showing the major neural pathways—like the corticospinal tract, corpus callosum fibers, or arcuate fasciculus.

‼️Applications:
• Neurosurgical planning: identify and preserve vital tracts during brain surgery.
• Neurological research: study connectivity and brain network organization.
• Clinical diagnosis: visualize tract disruption after stroke, tumor, or demyelination.

25/09/2025

☢️ACR TI-RADS Scoring System ☢️

✅Each thyroid nodule is scored based on ultrasound features in 5 categories:
🔸1. Composition
• Cystic or almost completely cystic = 0
• Spongiform = 0
• Mixed cystic and solid = 1
• Solid or almost solid = 2
🔸2. Echogenicity
• Anechoic = 0
• Hyperechoic or isoechoic = 1
• Hypoechoic = 2
• Very hypoechoic = 3
🔸3. Shape
• Wider-than-tall = 0
• Taller-than-wide = 3
🔸4. Margin
• Smooth = 0
• Ill-defined = 0
• Lobulated or irregular = 2
• Extra-thyroidal extension = 3
🔸5. Echogenic foci
• None / large comet-tail = 0
• Macrocalcification = 1
• Peripheral (rim) calcification = 2
• Punctate echogenic foci (microcalcifications) = 3

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✅Risk Categories

After summing the points:
🔸TR1 (0 points): Benign → 0% risk
🔸TR2 (2 points): Not suspicious → ~2% risk
🔸TR3 (3 points): Mildly suspicious → ~5% risk
🔸TR4 (4–6 points): Moderately suspicious → ~10% risk
🔸TR5 (≥7 points): Highly suspicious → ~35% risk

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‼️Biopsy Recommendations (FNA thresholds)
🔸• TR1 & TR2: No FNA
🔸• TR3: FNA if ≥2.5 cm (follow-up if ≥1.5 cm)
🔸• TR4: FNA if ≥1.5 cm (follow-up if ≥1 cm)
🔸• TR5: FNA if ≥1 cm (follow-up if ≥0.5 cm)

20/09/2025

☢️Commom question:
‼️ Where barium studies are still useful?

🔸• Oropharyngeal & esophageal motility disorders (achalasia, diffuse esophageal spasm, Zenker’s diverticulum).
🔸• Assessment of swallowing (especially with videofluoroscopy for aspiration risk).
🔸• Functional assessment of the GI tract (strictures, peristalsis).
🔸• Post-surgical anatomy (e.g., gastric bypass, anastomotic leaks). In such situations, Barium is replaced by water soluble contrast medium as it can cause peritoneal irritation in case of leak.
🔸• Small bowel follow-through (though largely replaced by MR enterography/CT enterography, still useful in some cases when these are not available).
🔸• Colonic obstruction (water-soluble contrast first, but barium may follow in certain situations).

❌ Where they are largely replaced:
❎• Upper GI mucosal lesions → now usually done with endoscopy (direct visualization + biopsy).
❎• Colorectal cancer screening → colonoscopy or CT colonography preferred.
❎• Inflammatory bowel disease evaluation → CT/MR enterography more accurate.
• Peptic ulcer disease → endoscopy is gold standard.

27/08/2025

☢️Summary of the Role of Diffusion MRI in brain imaging ☢️

✅Diffusion-Weighted Imaging (DWI) and its derived techniques like Diffusion Tensor Imaging (DTI) play a key role in neuroradiology because it gives information about the microscopic motion of water molecules in brain tissue, which reflects both tissue structure and pathology.

Here’s a structured overview of the role:

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1. Acute Ischemic Stroke
• Most important role: DWI can detect ischemia within minutes of onset (much earlier than CT or conventional MRI).
• Acute infarct appears as restricted diffusion (bright on DWI, dark on ADC map).
• Helps in guiding thrombolysis/thrombectomy decisions.

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2. Brain Tumors
• Diffusion helps differentiate:
• High-grade vs low-grade tumors (high cellularity = restricted diffusion).
• Tumor recurrence vs radiation necrosis (recurrence shows lower ADC).
• Provides information about tumor infiltration and margins.

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3. Infections
• Abscess vs cystic/necrotic tumor: abscess shows marked diffusion restriction due to pus, while necrotic tumor usually does not.
• Encephalitis: areas of restricted diffusion can be seen, especially in herpes simplex encephalitis.

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4. White Matter Diseases
• Multiple Sclerosis (MS): DTI reveals microstructural white matter damage even in normal-appearing white matter.
• Helps quantify fractional anisotropy (FA) and tract integrity.

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5. Traumatic Brain Injury (TBI)
• Detects diffuse axonal injury (DAI) not visible on CT or conventional MRI.
• DTI shows reduced FA in injured tracts.

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6. Epilepsy
• DWI can detect acute seizure-related changes (transient restricted diffusion).
• DTI assists in presurgical mapping of eloquent white matter tracts (e.g., corticospinal tract, arcuate fasciculus).

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7. Other Roles
• Hydrocephalus: differentiates between obstructive vs non-obstructive causes.
• Cerebral infections (e.g., Creutzfeldt-Jakob disease): shows cortical ribboning and basal ganglia hyperintensity on DWI.
• Normal pressure hydrocephalus vs atrophy: diffusion parameters may help.

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✅ In summary:
Diffusion MRI is crucial in early stroke detection, tumor characterization, infection diagnosis, white matter integrity assessment, and pre-surgical brain mapping. It is one of the most clinically impactful MRI techniques in modern neuroradiology.

24/08/2025

☢️ The Lisfranc classification ..

✅The Lisfranc classification is used to describe Lisfranc injuries (tarsometatarsal joint complex injuries), which can range from ligamentous sprains to severe fracture-dislocations.
There are two main systems commonly used:

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✅1. Quenu and Kuss Classification (1909)

Based on the direction and pattern of displacement of the metatarsals:
🔸• Homolateral (Unilateral): All metatarsals displaced in the same direction (usually laterally).
🔸• Isolated (Partial): Only one or two metatarsals displaced, the others remain aligned.
🔸• Divergent: Metatarsals displaced in different directions (some laterally, some medially).

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✅2. Hardcastle Classification (1982) — Modified by Myerson (1986)

This is the most widely used clinically. It expands on Quenu and Kuss:
• 🔸Type A: Total incongruity
• All metatarsals displaced in the same direction (medial or lateral).
• 🔸Type B: Partial incongruity
• B1: Medial displacement of the first metatarsal.
• B2: Lateral displacement of one or more lesser metatarsals (2nd–5th).
• 🔸Type C: Divergent displacement
• C1: Partial divergent (only some metatarsals displaced medially/laterally).
• C2: Total divergent (all metatarsals spread apart in different directions).

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✅ Key point:
• Quenu & Kuss → original, broad pattern-based.
• Hardcastle/Myerson → refined, detailed, and most practical for treatment planning.

$☢️The “ Le Fort Classification “ ..✅The Le Fort classification describes midfacial fractures involving the maxilla and s...$

13/08/2025

☢️The “ Le Fort Classification “ ..

✅The Le Fort classification describes midfacial fractures involving the maxilla and surrounding structures, based on René Le Fort’s experiments in 1901.
It is divided into three main types according to the fracture pattern:

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✅Le Fort I — Horizontal fracture
• Fracture line: Runs above the teeth roots and below the nose, separating the maxilla from the nasal floor and pterygoid plates.
• Involved structures: Alveolar process, hard palate, lower part of nasal septum.
• Clinical signs:
• Mobility of the upper teeth and hard palate as one unit.
• Swelling and bruising of upper lip and nose base.
• Mnemonic: “Floating palate.”

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✅Le Fort II — Pyramidal fracture
• Fracture line: Extends from nasal bridge → medial orbital walls → infraorbital rim → down through maxilla → pterygoid plates.
• Involved structures: Nasal bones, maxilla, inferior orbital rim, lacrimal bones.
• Clinical signs:
• Step deformity at infraorbital rim.
• Nose and upper jaw move together.
• Periorbital edema and ecchymosis (“panda eyes”).
• Mnemonic: “Floating maxilla” (pyramid-shaped mobility).

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✅Le Fort III — Craniofacial disjunction
• Fracture line: Runs through nasofrontal suture, medial orbital walls, orbital floor, zygomatic arches, detaching the entire midface from the skull base.
• Involved structures: Zygomatic arches, orbital rims, ethmoid bone.
• Clinical signs:
• Complete facial mobility from the cranium.
• Severe facial flattening.
• CSF rhinorrhea possible.
• Mnemonic: “Floating face.”

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📌 Key points:
• Pterygoid plate involvement is present in all Le Fort fractures — important radiologic clue.
• Diagnosis confirmed with CT scan (facial bones).
• Often caused by high-energy blunt trauma (e.g., road traffic accidents).

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06/08/2025

☢️FIGO classification of uterine fibroids:

✅The FIGO classification of uterine fibroids (Leiomyomas) is an internationally accepted system developed by the International Federation of Gynecology and Obstetrics (FIGO).
It is based on the relationship of the fibroid to the endometrium and serosa.

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✅FIGO Leiomyoma Classification System

🔸Submucosal Fibroids
• Type 0: Pedunculated intracavitary fibroid (entirely within the uterine cavity, attached by a stalk).
• Type 1: < 50% intramural extension (more than 50% of the fibroid is in the cavity).
• Type 2: ≥ 50% intramural (more than half of the fibroid within the myometrium, but still distorting the cavity).

🔸Other Fibroids
• Type 3: Contacts the endometrium but is 100% intramural.
• Type 4: Completely intramural (does not contact endometrium or serosa).
• Type 5: Subserosal ≥ 50% intramural.
• Type 6: Subserosal < 50% intramural.
• Type 7: Subserosal pedunculated (attached by a stalk).
• Type 8: Other locations (e.g., cervical, parasitic).

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✅Clinical Use
• Guides surgical planning (hysteroscopic, laparoscopic, or open approach).
• Helps in fertility assessment and management decisions.

28/07/2025

☢️What is PI-RAD ?
✅PI-RADS stands for:
Prostate Imaging – Reporting and Data System

✅What it is:
• A standardized system for interpreting and reporting prostate MRI.
• Helps in detecting and assessing the risk of clinically significant prostate cancer.
• Developed by the American College of Radiology (ACR), European Society of Urogenital Radiology (ESUR), and AdMeTech Foundation.

✅Scoring:
• PI-RADS 1 → Very low likelihood of clinically significant cancer
• PI-RADS 2 → Low likelihood
• PI-RADS 3 → Intermediate (equivocal)
• PI-RADS 4 → High likelihood
• PI-RADS 5 → Very high likelihood

✅Main Items / Components of PI-RADS
🔸1. MRI Sequences Used
• T2-weighted imaging (T2WI)
• Best for anatomy and zonal anatomy (especially peripheral zone).
• Diffusion-weighted imaging (DWI) and Apparent Diffusion Coefficient (ADC) maps
• Best for detecting tumors (especially in peripheral zone).
• Dynamic contrast-enhanced (DCE) imaging
• Detects early enhancement of suspicious lesions (mostly supportive in equivocal cases).
🔸2. Scoring Approach by Zone
• Peripheral Zone (PZ)
• DWI is the dominant sequence for scoring.
• Transition Zone (TZ)
• T2-weighted imaging is the dominant sequence for scoring.
• DCE
• Mainly used to upgrade PI-RADS 3 lesions in the peripheral zone.
🔸3. Lesion Assessment & Reporting
• Location of the lesion (sector map)
• Size of the lesion (largest dimension)
• Final PI-RADS score (1–5)
• Clinical recommendation based on the score.

⤵️ In the attached diagram, there is illustration how to assess the lesion and give it the appreciate PI-RAD score.

13/07/2025

☢️ Neonatal hip ultasround☢️

Neonatal hip ultrasound is a non-invasive imaging technique used to evaluate the hips of newborns and infants, primarily to detect developmental dysplasia of the hip (DDH) — a condition where the hip joint is not properly formed.

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✅ Why It’s Done
• Screening for DDH in:
• Breech babies
• Girls (higher risk)
• First-born children
• Babies with a family history of DDH
• Babies with clinical signs (e.g., hip click, limited abduction)
• To monitor hip development over time in infants at risk

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🖥️ Technique

Performed with the baby in a lateral decubitus position (on the side), using a high-frequency linear transducer (7.5–12 MHz).

Two views are essential:
1. Coronal view in the neutral position
• Visualizes the relationship between the femoral head and acetabulum.
• Used to measure:
• Alpha angle (bony coverage): should be >60°
• Beta angle (cartilaginous roof)
2. Transverse view with flexion (dynamic view)
• Assesses femoral head movement in/out of acetabulum.
• Useful for detecting subluxation or dislocation during stress maneuvers (Barlow/Ortolani).

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📊 Graf Classification System (most common)

Used to categorize the hips based on alpha and beta angles (check the firstly uploaded image)

🧒 When to Perform
• Routine screening: 4–6 weeks of age
• At-risk infants: As early as 2 weeks, with follow-up

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🩺 Clinical Relevance

Early diagnosis and treatment of DDH are crucial to:
• Avoid long-term complications (limb length discrepancy, limp, arthritis)
• Reduce the need for surgery

Neonatal hip ultrasound is most commonly used for evaluating developmental dysplasia of the hip (DDH), but it has other clinical applications as well. Here are the key additional uses:

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✅ Other uses than DDH assesment !

🔹 1. Septic Arthritis or Osteomyelitis
• Detects joint effusion, which may indicate infection.
• Helps guide aspiration or drainage.
• May show adjacent bone involvement or soft tissue edema.

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🔹 2. Hip Effusion (Non-infectious)
• Differentiates between transient synovitis and infectious arthritis.
• Useful in infants with fever and limping or refusal to move the limb.

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🔹 3. Trauma Assessment
• Evaluate for:
• Joint effusion
• Fracture-related soft tissue changes
• Hemarthrosis
• Especially useful when X-rays are inconclusive in infants due to non-ossified bones.

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🔹 4. Guided Procedures
• Aspiration or injection under ultrasound guidance (e.g., in septic arthritis or hemarthrosis).

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🔹 5. Neonatal Tumors or Masses
• Identifies soft tissue or bony masses (e.g., teratomas, hemangiomas).
• Differentiates solid from cystic lesions.

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🔹 6. Vascular Abnormalities
• Assesses femoral artery and vein flow.
• Identifies vascular malformations or thrombosis, especially in infants with femoral catheterization.

09/07/2025

☢️ What is O-RADS ?

✅O‑RADS stands for Ovarian‑Adnexal Reporting and Data System, a standardized framework developed by the American College of Radiology (ACR) in 2018. It’s used by radiologists to consistently classify lesions on the ovaries and adnexa (including fallopian tubes and surrounding tissues) found during ultrasound or MRI examinations .

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🔍 Key Components

1. Dual Imaging Approach
• O‑RADS US (Ultrasound):
• Assigns categories from 0 to 5, indicating increasing risk of malignancy:
• 0 – Incomplete assessment
• 1 – Normal
• 2 – Almost certainly benign (

17/06/2025

☢️Bucket handle tear & its MRI features☢️

✅ A bucket handle tear is a specific type of meniscal tear in the knee, commonly involving the medial meniscus. It is a longitudinal, displaced tear where a central fragment of the meniscus is torn and flipped centrally into the intercondylar notch, resembling the handle of a bucket.

🦴☢️MRI features of a bucket handle meniscal tear
🛑Absent bow tie sign: On sagittal images, the normal meniscus body (seen on 2+ slices) disappears or appears on only 1 slice.
🛑Double PCL sign: A displaced meniscal fragment lies anterior to the posterior cruciate ligament, mimicking a second PCL.
🛑Intercondylar notch sign: The torn meniscal fragment is seen lying within the intercondylar notch.
🛑Flipped meniscus sign: The torn piece is displaced anteriorly and appears in front of the ACL.
🛑Double anterior horn sign: Both anterior and displaced posterior horns appear in the anterior compartment.
🛑Truncated meniscus: The expected normal crescent-shaped meniscus is missing from its location.
🛑Enlarged anterior horn: The anterior horn looks bulkier than normal due to displacement of the torn fragment

05/06/2025

Eid Adha Mubarak

TeleFast Rad

09/10/2025

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