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The diagnostic value of apparent diffusion coefficient to differentiate benign and malignant meningiomas Marissa, Risa; Rahayu, Rachmi Fauziah; Wujoso, Hari; Subandi, Subandi; Putro, Prasetyo Sarwono; Soewondo, Widiastuti
Universa Medicina Vol. 40 No. 2 (2021)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2021.v40.141-150

BACKGROUNDMeningiomas are the most common primary extra-axial non-glial intracranial tumors. The severe grade of meningioma, according to WHO, has the highest recurrence rate accompanied by high morbidity and mortality rates. Therefore, it is imperative to perform pre-operative assessments so the clinician can give prompt treatment to gain a better prognosis. It is a novel alternative way of predicting meningiomaâ€™s malignancy by calculating the tumorâ€™s apparent diffusion coefficient (ADC) value. The objective of the study was to determine the value of ADC for differentiating benign and malignant meningiomas. METHODSThis cross-sectional study involved 32 subjects with clinically diagnosed or histologically verified meningioma (21 benign and 11 malignant). They underwent a head-magnetic resonance imaging (MRI) examination and biopsy.Â We calculated the ADC value by creating regions of interest (ROIs) on the solid part of the tumor, guided by contrast and fluid-attenuated inversion recovery (FLAIR) sequence. We analyzed the ADC value with independent t-test and Bland-Altman graphs, calculated the average difference, CI 95%, limit of agreement between observers, and ROC. RESULTSMean ADC of malignant meningiomas (0.877 Â± 0.167 x 10-3 mm2/s) was significantly lower than that of benign meningiomas (0.990 Â± 0.105 x 10-3 mm2/s) (p<0.05). The ADC threshold is 0.886 x 10-3 mm2/s with sensitivity 63.6%, specificity 85.7%, positive predictive value 70% and negative predictive value 81.8%. CONCLUSIONThe ADC value measurement provides a discriminative feature to differentiate between benign and malignant meningiomas. However, the clinical applicability still needs to be elucidated, as histopathological confirmation remains the mainstay of definitive diagnosis.

Myocardial Infiltration in Primary Mediastinal B-Cell Lymphoma Detected by Cardiac Magnetic Resonance Imaging Sutedjo, Verawati; Soewondo, Widiastuti; Yuniarti, Mira; Tenggara, Jeffry Beta; Erawati, Dini Rachma
Indonesian Journal of Cancer Vol 17, No 4 (2023): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v17i4.966

Introduction: Cardiac involvement, particularly myocardial infiltration in primary mediastinal lymphoma, is a rare occurrence with an incidence of only 9% in known cases of primary malignancy. Neoplasm infiltration into the myocardium manifests through direct invasion, hematogenous spread, transvenous invasion through the great veins, or lymphangitic spreading in the mediastinal. Myocardial infiltration in lymphoma presents a grim prognosis and its treatment may be associated with specific risks, such as myocardial rupture. Various imaging modalities may detect cardiac involvement, with cardiac magnetic resonance (CMR) imaging considered the gold standard. CMR enables clear delineation of myocardial infiltration, making it valuable for local staging, pretreatment planning, and evaluating treatment response. Case Presentation: : A 37-year-old woman patient was diagnosed with primary mediastinal large B-cell lymphoma. Mild chest discomfort and shortness of breath were observed 3 months before hospital admission. A thorax CT scan showed a heterogeneous contrast-enhancing mass with a central necrotic area in the anterior mediastinum. Following thoracotomy and tumor debulking, the patient complained of severe crushing chest pain radiating to her back, accompanied by new T wave inversion on ECG and elevated cardiac troponin levels a week after surgery. Coronary angiogram results showed a normal coronary artery. Subsequent cardiac MRI showed tumor infiltration into the anterior pericardial space, as well as the myocardium of the left and right ventricles. Chemotherapy was promptly initiated, resulting in a gradual improvement of symptoms. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like IMRT. However, with careful planning, we can still obtain optimum tumor dose, minimize OAR dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on reirradiation, especially in OAR dose tolerance guidelines.

Lung adenocarcinoma size as a predictor of distant metastasis: A CT scan-based measurement Soewondo, Widiastuti; Adzhani, Fityay; Hanafi, Muchtar; Firdaus, Zaka J.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.1024

Previous studies have associated tumor size with metastasis and prognosis in lung carcinoma; however, a precise cut-off for predicting distant metastasis in lung adenocarcinoma remains unclear. The aim of this study was to determine the cut-off point for predicting distant metastasis in lung adenocarcinoma. A cross-sectional study was conducted at Dr. Moewardi Hospital, Surakarta, Indonesia from January 2022 to September 2023. Total sampling was employed, involving patients over 18 years old with a confirmed diagnosis of lung adenocarcinoma based on lung computed tomography (CT) scan findings, who had not yet received chemotherapy and had confirmed metastasis outside the lung. The study's dependent variable was the incidence of distant metastasis, while the independent variable was lung adenocarcinoma size. Two experienced thoracic radiologists measured lung adenocarcinoma size by assessing the longest axis using chest multi-slice computed tomography (MSCT) in the lung window setting. Receiver operating characteristic (ROC) curve analysis determined the optimal tumor size cut-off for predicting distant metastasis. From a total of 956 thoracic cancer patients, 108 were diagnosed with lung adenocarcinoma. After applying the inclusion and exclusion criteria, 89 patients were eligible. In the present study, tumor size predicted 68.1% of distant metastasis cases, with a cut-off point of 7.25 cm, yielding a sensitivity of 61.9% and a specificity of 61.5%. Tumors >7.25 cm had a 2.60-fold higher risk of distant metastasis compared to smaller tumors, with larger tumors more likely to spread to various sites. In conclusion, lung adenocarcinomas larger than 7.25 cm have a 2.60-fold increased risk of distant metastasis, making tumor size a crucial predictive factor. The study provides valuable insights for radiologists and can improve diagnosis accuracy and treatment planning by emphasizing tumor size as a key factor in managing lung adenocarcinoma.

Differences in Post-Operative Complaints between Patients with and without Anatomical Variations of Ostiomeatal Complex Based on CT Scan of Chronic Rhinosinusitis at Dr. Moewardi Hospital Putro, Prasetyo Sarwono; Duswanto, Yudo; Wujoso, Hari; Soewondo, Widiastuti
Indonesian Journal of Medicine Vol. 6 No. 2 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: The ostiomeatal complex has various anomalous variants that can vary in type and number for each person. These anomalies can contribute to the development of chronic rhinosinusitis and the accompanying symptoms. This study aims to determine the differences in post-treatment complaints between patients with and without anatomical variations of the ostiomeatal complex in chronic rhinosinusitis at RSUD Dr. Moewardi.Subjects and Method: A cross-sectional study was conducted in Dr. Moewardi hospital, Surakarta. A sample of 30 of chronic rhinosinusitis patients who were subjected to a CT scan in the radiology department and surgery by an ENT-KL specialist at Dr. Moewardi, from January 2019 to June 2020, was selected for this study. The study variables were anatomical variations of ostimeatal complex and post-operative complaints. Difference of post-operative complaints between chronic rhinosinusitis patients with and without anatomical variations of ostiomeatal complex were described in frequency (n) and percent (%).Results: This study indicated that there is no difference in post-operative complaints between patients with and without anatomical variations of the ostiomeatal complex based on CT Scan of chronic rhinosinusitis (p= 0.856).Conclusion: There is no difference in post-operative complaints between patients with and without anatomical variations of the ostiomeatal complex based on CT Scans of chronic rhinosinusitis.Keywords: ostiomeatal complex, CT scan, post-operative complaintsCorrespondence: Yudo Duswanto. Department of Radiology, Dr. Moewardi Hospital, Surakarta, Indonesia. Email: yudoduswanto7@gmail.com.Indonesian Journal of Medicine (2021), 06(02): 212-219https://doi.org/10.26911/theijmed.2021.06.02.10

Long Covid-19, Radiological Findings, and Its Management: A Systematic Review Soewondo, Widiastuti; Putro, Prasetyo Sarwono; Hermansah, Muhamad Lukman; Lestari, Lilik; Reviono, Reviono; Harsini, Harsini; Adhiputri, Artrien
Indonesian Journal of Medicine Vol. 6 No. 4 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: COVID-19 is a disease caused by SARS-CoV-2 and has numerous clinical spectrums. Mild respiratory infection is the common clinical manifestation of COVID-19, and the less common is pneumonia accompanied by fever, cough, and breathing difficulty. Long COVID can be defined as prolonged signs and symptoms which cannot be explained for other reasons 4 weeks after being diagnosed with SARS-CoV-2. This study aimed to describe the cause of illness is confirmed or suspected COVID-19 patients, specifically on long COVID.Subjects and Method: We performed literature searches of the latest articles with Medline, CINAHL (EBSCO), Global Health (Ovid), WHO Global Research on COVID-19 database, LitCovid and Google Scholar databases published from 2019 to 2020. Two reviewers searched all articles independently (P and W, with 7 and 10 years of experience, respectively). We conducted a systematic review to provide recent evidence of symptoms and complications in long COVID. We followed PRISMA guidelines.Results: A total of 22 papers was identified and screened for eligibility from medical databases. There were 15 papers included in this review. Reason for the continuous symptoms covid an extent of organ destruction, continuous response of chronic inflammation or immunology reaction, non-specific effect of hospital admission, some critical disease, post ICU syndrome, complications from COVID-19 infection, morbidities and adverse effects of medications used. Common symptoms are fatigue, shortness of breath, cough, chest pain, palpitations, dizziness, arthralgia, myalgia and weakness, sleep problems, sharp pain, gastrointestinal problems, rash and hair loss, impaired balance and ataxia, neurologic problems such as dementia, concentration disorders and poor quality of life.Conclusion: The incidence of long-term manifestations of COVID-19 has been increasing and systemic clinical symptoms affect many organs and systems. This can be due to numerous reasons like post-ICU syndrome, post-viral fatigue syndrome, permanent organ deterioration or others. Correspondence: Widiastuti Soewondo. Department of Radiology, Dr. Moewardi General Hospital/ Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. Email: widiastuti.sprad56@staff.uns.ac.idIndonesian Journal of Medicine (2021), 06(04): 387-392https://doi.org/10.26911/theijmed.2021.06.04.04

Correlation of Brixia Score Changes with Length of Stay in Patient with COVID-19 Sutedjo, Verawati; Soewondo, Widiastuti; Erawati, Dini Rachma
Indonesian Journal of Medicine Vol. 7 No. 3 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: The increase in Covid-19 cases in Indonesia as well as the hospital length of stay is unpredictable. The degree of lung damage in Covid-19 largely determines the severity of the disease, a serial chest X-ray using Brixia score can be used to assess changes in pulmonary parenchymal damage and could predict the length of hospitalization. This study aims to analyze the correlation of Brixia score with the length of hospitalization in Covid-19 patients.Subjects and Method: This cross-sectional study was conducted at Sumber Waras Hospital from November 2021 until January 2022. The samples are Covid-19 confirmed patients who were treated at Sumber Waras hospital. Independent variable is Brixia score and dependent variable is length of hospitalization. Brixia's score assessment from two serial chest X-rays was divided into 4 categories: low to low, low to high, high to low, and high to high. All the categories were analyzed using Kruskall-Wallis method then continued with Mann-Whitney U test. The multivariate variable was analyzed using linear regression.Results: There are 190 samples, the median score of Brixia at the beginning of treatment is 4 (range 0-18), and the median score of Brixia on serial examination is 6 (range 0-18). Patients in low to low category had median 10 days length of hospitalization, low to high category and high to low category had median 11 days, and high to high category had median 8 days. There was no statistically significant correlation between Brixia score and length of hospitalization (p= 0.377).Conclusion: There is no significant relationship between the median Brixia score changes with the length of hospitalization of covid-19 patients.Keywords: Covid-19, hospitalized, Brixia score changes, length of stayCorrespondence: Widiastuti Soewondo. Faculty of Medicine Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Mobile: +6282134368592. Email: widiastuti.sprad56@staff.uns.ac.id.Indonesian Journal of Medicine (2022), 07(03): 262-268https://doi.org/10.26911/theijmed.2022.07.03.02

Correlation between Mortality of COVID-19 Patients with Hypertension and Thorax Radiography Treated in the Intensive Care Unit of Dr. Moewardi Hospital Nurhidayati, Faiza Salsabila; Soewondo, Widiastuti; Dewi, Ratih Tri Kusuma; Putro, Prasetyo Sarwono
Indonesian Journal of Medicine Vol. 7 No. 3 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Coronavirus 2019 or COVID-19, caused by the new SARS-CoV2 virus, has become a pandemic and attacked more than 200 countries, including Indonesia. The most comorbid disease in COVID-19 patients was hypertension. Chest radiography can predict prognosis and mortality in COVID-19 cases and one of the methods that can be used for chest radiographic assessment is the Brixia Score, specifically designed for COVID-19 patients to measure and analyze the severity of lung abnormalities in patients with COVID-19. This study aimed to find the correlation between the mortality of COVID-19 patients with hypertension and chest radiography using the Brixia Score treated in the intensive care unit (ICU) of Dr. Moewardi Hospital.Subjects and Method: This study used an analytic observational study with a cross-sectional approach. The subjects were 84 COVID-19 patients with hypertension who met the exclusion and inclusion criteria. The independent variable is chest radiography and dependent variable is mortality. Sampling was collected by purposive sampling and the data obtained were analyzed using the contingency coefficient test.Results: There was a significant correlation between the mortality of COVID-19 patients with hypertension and chest radiography as assessed using the Brixia Score (p<0.001). The youngest patient was 20 years old and the oldest was 87 years old.Conclusion: There was a correlation between the mortality of COVID-19 patients with hypertension and chest radiography treated in the ICU RSUD Dr. Moewardi, Surakarta.Keywords: COVID-19, mortality, hypertension, chest radiography, Brixia Score, intensive care unitCorrespondence: Widiastuti Soewondo. Faculty of Medicine Universitas Sebelas Maret Surakarta. Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. Email: Widiastuti.sprad56@staff.uns.ac.id. Mobile: 082134368592.Indonesian Journal of Medicine (2022), 07(03): 269-277https://doi.org/10.26911/theijmed.2022.07.03.03

Brixia Score as Predictor of D-Dimer Levels of COVID-19 Patients in Intensive Care Unit Adyanata, Yanuareza Totti; Soewondo, Widiastuti; Arifin, Arifin; Redhono, Dhani
Indonesian Journal of Medicine Vol. 8 No. 1 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Background: COVID-19 is caused by a novel virus that can cause lung abnormalities which can be measured with new chest x-ray scoring system named Brixia score. In COVID-19 patients, coagulation disorders are often found that can be seen through D-Dimer levels. This study aimed to prove the Brixia Score as a predictor of D-Dimer levels.Subjects and Method: This study was an observational analytic study with a cross-sectional approach. The subjects were 94 COVID-19 patients which taken from ICU Melati 1 Dr. Moewardi General Hospital, Surakarta from March 2021 to August 2021 who met the exclusion and inclusion criteria. The independent variable is the Brixia score performed by radiologists and the dependent variable is D-Dimer levels taken from laboratory results. Sampling was obtained by purposive sampling and the data were investigated using the receiver operating characteristic (ROC) curve.Results: 94 samples were obtained for analysis. The average Brixia Score of patients with D-Dimer <2 µg/mL was Mean= 15.85; SD= 1.43 and D-Dimer ≥2 µg/mL was Mean= 17.29; SD= 0.96. There was a significant difference between the Brixia Score of patients with D-Dimer <2 µg/mL and D-Dimer ≥2 µg/mL (p<0.001). Analysis with the ROC curve shows an area under the curve (AUC) of 0.793. The optimal cutoff value of the Brixia Score for predicting D-Dimer levels was 16.5 (sensitivity 77.9%, specificity 73.1%).Conclusion: Brixia Score proved to be a predictor of D-Dimer levels of COVID-19 patients in ICU care.Keywords: COVID-19, ICU, brixia score, predictor, D-Dimer.Correspondence: Widiastuti Soewondo, Radiology Department, Faculty of Medicine, Universitas Sebelas Maret. JL. Ir. Soetami No. 36A, Surakarta 57126, Indonesia. E-mail: widiastuti.sprad56@staff.uns.ac.id. Mobile: 082134368592Indonesian Journal of Medicine (2023), 08(01): 92-99https://doi.org/10.26911/theijmed.2023.08.01.09

Massive Mature Mediastinal Teratoma With Malignant Transformation: An Unusual Case Report Kalua, Karla; Soewondo, Widiastuti
Indonesian Journal of Medicine Vol. 9 No. 2 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.2.643

Background: Teratoma is a type of germ cell tumor that is rarely found in the anterior mediastinum. Meanwhile, mature mediastinal teratoma with malignant transformation is rare and develops rapidly, with a poor prognosis. This article aims to report one of the uncommon cases of mature teratoma and discuss its imaging features thereby adding insight in providing an accurate diagnosis of this condition. Case Report: This study presents a case of a 26-year-old male patient who has complained of shortness of breath for 3 months and worsening in the last 3 days. The patient passed through a chest radiographic examination and was diagnosed with a mediastinal tumor. The contrast-enhanced chest computed tomography showed a huge mediastinal mass occupying the right and left hemithorax, measuring 16.9 cm x 20.5 cm x 20.9 cm and pressing against the chest wall, esophagus, trachea, great vessels, and the vital organs, lungs as well as heart, causing several complications in patients. Conclusion: Knowledge of the teratoma radiological appearance and the characteristics of the various subtypes is very important in the diagnosis of mediastinal teratoma diagnosis for immediate and appropriate treatment.

Combination of Metformin and Magnesium Citrate Reduces TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 Expressions in Diabetic Model Rats Rahayu, Rachmi Fauziah; Prayitno, Adi; Purwanto, Bambang; Soewondo, Widiastuti; Nurwati, Ida; Pamungkasari, Eti Poncorini; Dirgahayu, Paramasari
The Indonesian Biomedical Journal Vol 16, No 6 (2024)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v16i6.3360

BACKGROUND: Diabetes, which causes various complications, involves pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), nuclear factor kappa B p65 (NF-κB p65), interleukin-6 (IL-6), cluster of differentiation 4 (CD4), and matrix metalloproteinase-9 (MMP-9). Magnesium has demonstrated anti-diabetic properties, but its anti-inflammatory effects in preventing cardiovascular complications remain unclear. This study aimed to evaluate the anti-inflammatory effects of magnesium citrate, alone and in combination with metformin, by measuring TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression in diabetic model rats.METHODS: Thirty male Wistar rats were divided into five groups: normal control, diabetes control, metformin (treated with 9 mg/200 g/day metformin), magnesium citrate (treated with 3.6 mg/200 g/day magnesium citrate), and combination therapy (treated with 4.5 mg/200 g/day metformin + 1.8 mg/200 g/day magnesium citrate). Diabetes was induced in all groups except the normal control group using streptozotocin (STZ) and nicotinamide (NA). TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression levels were measured using enzyme-linked immunosorbent assay (ELISA).RESULTS: Significant differences in TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression levels were observed across all groups (p<0.001). The combination therapy group demonstrated the most significant reduction in all parameters compared to the diabetic control group (p<0.001) and other therapy groups. Both metformin and magnesium citrate monotherapies showed moderate reductions in cytokine levels but were less effective than combination therapy.CONCLUSION: Combination therapy with metformin and magnesium citrate exhibited the most potent anti-inflammatory effects, significantly reducing TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expressions in diabetic Wistar rats. This combination has potential as a therapeutic approach for managing diabetes and its complications.KEYWORDS: diabetes mellitus, inflammation, cytokines, metformin, magnesium citrate

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