Frequency of metastasis detection with diffusion-weighted whole-body imaging with background body signal suppression

Objective: To determine the frequency of metastasis detection with diffusion-weighted whole-body imaging with background body signal suppression

Study Design: A Cross sectional study

Place and Duration of Study: The study was conducted at Punjab Medical College and Allied hospital Radiology and Oncology departments, Faisalabad from January 14, 2010 to May 28, 2012

Patients and Methods: A total number of 86 patients of all ages and both sexes with histopathological diagnosis of carcinoma presenting to the outdoor department and admitted in oncology department of Punjab Medical college and Affiliated hospital were selected. Whole-body MRI was performed using a 1.5-Tesla system [Intera Release 9; Philips, Best, The Netherlands] with a Mobi-Trak moving tabletop and b value of 1000. Both the T1 weighted and the STIR images at each station were reconstructed. On MRI, a lesion of high signal intensity on DWIBS, a lesion of high signal intensity on STIR images and low signal intensity on T1 weighted images was considered to be a suspected metastasis

Results: Out of 86 patients, 70 [81.4%] had metastasis. Osseous metastasis was detected in 13 [18.6%] patients however in 57 [81.4%] patients, both osseous and extra osseous metastasis were detected. Liver metastasis was detected in 47 [82.5%] patients out of 57 patients with extra osseous metastasis. Adrenal metastasis was found in 12 [21.1%] patients, brain in 13 [22.8%] patients, lung in 19 [33.3%] patients, renal in 6[10.5%] patients and peritoneal dissemination was seen in 5 [8.8%] patients. Nodal metastasis was detected in 57 patients and maximum number of 19 lymph nodes were detected

Conclusion: DWIBS MRI is helpful in the early diagnosis of metastasis

Cranial CT in the evaluation of coup and countercoup head injuries

Objective: To describe the role of Cranial Computed Tomography [CT] in the evaluation of Coup and Countercoup head injuries with its outcome

Study Design: A comparative cross-sectional study

Settings: Radiology Department of PMC/Allied Hospital Faisalabad. Duration: 09 months, October 2012 to June 2013

Sample Size: 150 patients

Materials and Methods: The patients with coup and countercoup head injuries were studied and divided into two groups: Coup injuries [n=117], countercoup injuries [n =33] .The groups were comparable with respect to age, Glasgow Coma Scale [GCS] and outcome. Site of primary impact was determined by CT scan pattern

Results: The mortality rates in each group were compared with respect to age, GCS and CT pattern. Significance was calculated using Chi-Square test. There was a statistically significant difference in mortality between patients with coup injuries [p

Conclusion: Presence of a countercoup component on CT scan may show a worse outcome in head injuries and may warrant closer monitoring and more aggressive management of these patients

Gray scale trans-abdomino-thoracic ultrasonography inevaluation of dengue hemorrhagic fever

Objective: To evaluate ultrasound findings inDengue Haemorrhagic Fever [DHF] and further topredict severity of DHF

Study design: Crosssectional study

Settings: Allied HospitalFaisalabad

Duration of study: 1st July 2011 to 30thNovember 2011

Sample size: 50 Patient

Materialand Methods: Ultrasound was performed on 50patients of ages between 6-59 years with clinicalsuspicion of DHF. Serological tests IgM and IgG onELIZA were performed to confirm the diagnosis,ultrasound was done on 2nd to 08th day all confirmedserologically 50 positive of DHF. These 50 patientdivided into two groups as DHF [Group-I] mild type45 patients and severe type of DHF [Group-II] 05Patient

Result: Group-I patients ultrasoundrevealed gall bladder wall thickening 86.6%,Pericholecystic fluid 44.4%, hepatomegaly 26.6%,splenomegaly 22.2%, ascites17.7%, right pleural effusion 8.8%, left pleuraleffusion nil and pancreatic enlargement 6.6%. InGroup-II ultrasonography revealed gall bladder wallthickening 100%,Pericholecystic fluid 60.0%,hepatomegaly 60.0%, splenomegaly 40.0%, ascites60.0%, right pleural effusion 60.0%, left pleuraleffusion 20.0%, pericardial effusion 20.0%,pancreatic enlargement 40.0% and 60.0% patientwith fulminant hepatic failure

Conclusion: Transabdomino-thoracic sonography can be used asadjunct modality in patients with suspected DHF todetect early signs suggestive of the disease prior toobtaining serologic confirmation test results,especially in a dengue fever epidemic area and alsouseful tool to predict severity of the disease

Depressed skull fracture; Interrelationship between CT evaluation of and its clinical findings

The purpose of study was to interrelate CT findings of depressed skull fracture with clinical findings. This was exploratory study. The study was conducted at Mayo Hospital Lahore and Lahore General Hospital. From March 9,2004 to October 2004. Fifty patients irrespective of their age and sex were included. Only the newly admitted patients in the above mentioned hospitals were included in the study. Previously diagnosed depressed skull fracture or the patients having associated facial abdominal and thoracic injuries were excluded. Patients having depressed skull fracture were clinically evaluated and thereafter subjected to 4[th] generation spiral CT scan at the radiology department of the above mentioned hospitals. Both bone and brain window were taken for various intracranial structures. Analysis of the data for association between the variables of clinical and CT findings revealed that patients with conscious level, with DSF and having mild head injury were less associated with scalp injury [p=0.1156] which is statistically insignificant. DSF with moderate and severe head injury had more probability of scalp injuries. Scalp laceration seen with DSF had association with scalp injury [p<0.001]. It is a key for clinician and neurosurgeon to use GCS score in congestion with the CT findings for early management of DSF

Evaluation and determination of prognostic factors in typhoid ileal perforation

To determine the prognostic factors of typhoid ileal perforation. A prospective study. The study was conducted in the departments of A and E and surgery at Allied Hospital Faisalabad, from September 1st, 2008 to August 31st, 2009. With informed consent, the study was conducted on 56 who underwent laparotomy for peritonitis due to typhoid ileal perforation as per inclusion and exclusion criteria. The ileal perforations were managed by either primary simple transverse closure or primary defunctioning loop ileostomy. The prognostic evaluation was assessed by the impact of pre operative prognostic factors and per operative findings on post operative complications and mortality. For statistical significance, the data was analyzed by SPSS. Among the total 56 patients, thirty four [61%] patients were managed by primary simple transverse closure while 22 [39%] patients had primary defunctioning loop ileostomy. The age and sex had no effect on the prognosis of typhoid ileal perforation. Mortality rate was 5.4%. Different post operative complications and their rates were burst abdomen 23%, residual intra abdominal abscess 16%, fecal fistula 7% and septicemia 5.4%. Twenty eight [50%] patients developed wound infection which reflected only morbidity. Mortality remained nil in all those cases who had early presentation, admission-operation interval shorter than 12hours, size of perforation less than 1cm, amount of pus/fecal fluid less than1000ml and had primary simple closure. Three mortalities [5.4%] occurred among the cases with primary loop ileostomy due to a significant impact of pre operative and per operative prognostic factors on post operative complications and had a significant association with late presentation, admission-operation interval longer than 12hours, multiple perforations with size more than 1cm, amount of pus/fecal fluid greater than 1000ml. Late presentation, longer admission-operation interval, multiple perforations, size of perforations more than 1 cm and massive amount of intra peritoneal feco-purulent fluid significantly and adversely affect the prognosis of typhoid ileal perforation irrespective the surgical procedure used to manage the perforation

Imaging of ambiguous genitalia

To establish the role of imaging in Ambiguous Genitalia. June 2006 to June 2008. Place: Radiology Department, Mayo Hospital, Lahore and Allied Hospital Faisalabad. 12 cases referred to us with Ambiguous Genitalia were taken and evaluated with Ultrasound and Magnetic Resonance Imaging. Following findings were observed, incomplete scrotal fusion with Ambiguous genitalia was observed in 41.7% infants. Whereas testis were localized in 33.3% by ultrasound and remaining by MRI. Imaging diagnosed that 66.7% were male and remaining female. Lab tests and surgical evidence prove that imaging results were in agreement. Imaging has a conclusive role in Ambiguous Genitalia and Ultrasound is the first modality to look for Internal Genitalia