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Background MR imaging plays a significant role in detection and characterization of different brain diseases. The role of the post-contrast T1-weighted image magnetic resonance imaging (T1W MRI) sequence has been widely established in previous studies and clinical practice. In this study, we aim to share our experience as regards the added value of contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) sequence in the diagnosis of various intracranial pathological conditions and evaluate its usefulness in comparison with post-contrast T1W images. Results Based on the final radiological diagnosis, the total cases were subdivided into three categories, and the majority of our cases were tumors (81.2%), followed by multiple sclerosis (11.8%), and the least was central nervous system infection (7.1%). CE-FLAIR showed superior enhancement in 35 cases (50.7) and equal enhancement in 25 cases (36.3%). However, it showed less enhancement than post-contrast T1W images in 9 cases (13%). Excellent inter-observer agreement (97.65%) was noted. Regarding lesion conspicuity, good delineation was found in the majority of cases (64.7%), fair delineation in 12.9%, and no delineation in 22.4%. A statistically significant difference was found in signal intensity of lesion between pre- and post-contrast FLAIR sequences. Contrast to background ratio was statistically significant in CE FLAIR images in comparison to CE T1 images. Conclusion CE-FLAIR imaging should be used as a routine or adjunctive sequence to CE-T1WI to enhance early detection and increase the diagnostic confidence in MRI examination of different brain pathological conditions.

Objective To evaluate the efficacy of shockwave lithotripsy in the long-term in the treatment of calcular acute urinary retention (AUR). Methods From March 2015 to February 2017, a prospective study was conducted, and included a total of 50 male patients who were diagnosed with AUR as a result of urethral or vesical radio-opaque stone(s) at the Mansoura Urology and Nephrology Center. All patients underwent extracorporeal shockwave therapy. Results A total of 47 of 50 patients (94%) were included, as only they underwent an initial successful treatment by shockwave lithotripsy. The mean (SD) age was 44.5 (11.8) years, the mean (SD) stone greatest dimension was 12.2 (3) mm, 33 stones (70.2%) were migratory and 14 stones (27.6%) were secondary in nature. At long-term follow-up of this patient cohort, there was recurrence of vesical stones in none, two (4%), and seven (15%) at 6-, 12- and 18-month intervals, respectively. The mean (SD) age of the nine recurrent cases (19%) was 52.3 (5.7) years and eight were secondary with one migratory in nature. Conclusion Shockwave lithotripsy is a successful modality of treatment in vesical stones; however, it should be used with caution in patients aged >50 years and with a history suggestive of infravesical obstruction.

Objective To report our experience with different approaches for management of pouch stones in children with an ileal-based urinary reservoir. Methods A retrospective review was performed through our electronic database of children who underwent ileal-based urinary reservoirs between 2000 and 2009. Patients who were diagnosed with reservoir calculi were identified. Perioperative medical records were reviewed for patients’ demographics, diversion details, stone criteria, mode of treatment, complications, and recurrence rate. Results In all, there were 26 patients with pouch stones [11 boys (42%) and 15 girls (58%)], with a mean (range) age of 11 (4–16) years. The main presentation was incidentally discovered in 10 patients (39%), haematuria in nine (34%), pain in six (23%), and urinary retention in one (4%). In all, 15 cases were post bladder augmentation and 11 post bladder neck closure augmentation ileocystoplasty and continent cutaneous outlet. All cases underwent urinary diversion for non-malignant causes. The mean (range) stone size was 4 (1–10) cm and mean (range) HU was 672 (205–1091). In all, 22 children had positive urine cultures, whilst four were sterile. Nine (35%) children required open poucholithotomy, whilst 17 (65%) were managed endoscopically. A percutaneous approach was used in eight children and urethral access was used in nine. Mechanical extraction was performed in seven children and stone disintegration was required in 10. Pouch injury occurred in two children, which required prolonged catheterisation. Six children developed stone recurrence after 3–12 months, all were after endoscopic disintegration and all required redo endoscopic extraction. Conclusion Pouch stone is an established long-term complication of urinary diversion. Open and endoscopic approaches are feasible in this cohort, but the recurrence rate is high with the endoscopic approach.