Olfactory fossa depth assessment based on keros classification using computed tomography

Objective: To evaluate the olfactory fossa depth and to categorize it according to Keros classification

Methodology: It was a cross sectional study done on 270 adults , 160 males and 110 females at Ziauddin University Hospital, Clifton, Karachi using CT Para nasal sinuses. The depth of olfactory fossa was evaluated by measuring the height of lateral lamina of cribriform plate

Results: The mean and standard deviation[SD] of right olfactory fossa depth was greater than that of left 6.184+/-1.8237mm and 5.949 +/-1.8003mm [p value 0.006] respectively. Mean +/- [SD] for left olfactory fossa depth was greater in females [6.215+/-1.9271] than in males [5.766+/-1.6896] [p value 0.043]. Keros type II was found to be the most frequent on both right and left sides that is, in 69.26% and 72.96% individuals respectively followed by type III on right side in 18.15% and on left side in 15.19% subjects. Type I was found to be the least frequent in our population with a value of 12.59% on the right side and 11.85% on the left side

Conclusion: Our study shows that most of the population falls in the high risk categories of Keros that is type II and type III thus emphasizing the need of preoperative radiological assessment

Analysis of renal artery morphometery in adults: a study conducted by using multidetector computed tomography angiography

Objective: To determine a reference range of renal artery measurements by using Multidetector Computed Tomography [MDCT] angiography and to find association of renal artery measurements with side of artery, gender and age

Method: Two hundred and fifty study participants without renal artery disease who were presented to Radiology Department, Ziauddin Hospital, Karachi, from November, 2016 to April, 2017 were included in this study. Main renal artery measurements were taken on Multidetector computed angiography and variation with side, gender and age were analyzed. Statistical analysis was done on Statistical Package for Social Sciences [SPSS] version 20. Independent sample T test, one way ANOVA and Pearson's correlation analysis were applied. P-value of < 0.05 was considered significant

Results: A significance difference [p=0.001] was seen between mean right renal artery [diameter 6.66 +/- 0.39 mm; length 44.69 +/- 2.48 mm] and left renal artery [diameter 6.79 +/- 0.36; length 35.10 +/- 2.86 mm]

Females found to have smaller mean diameter and length of renal arteries than males. However, a weak negative correlation was seen between mean renal artery diameter and age [right r= -0.158, p=0.0121; left r=-0.017, p= 0.708]

Conclusion: The mean diameter and mean length were found to be significantly different between right and left main renal artery and between males and females. A significant weak negative correlation was observed between renal artery diameter and age

Bone age assessment methods: a critical review

The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand and wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand and wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand and wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review

applicability of the Greulich and Pyle Atlas for bone age assessment in primary school-going children of Karachi, Pakistan

To assess the degree of applicability of bone age calculated by Greulich and Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Two Hundred and Twenty children [139 males, 81 females] between ages of 56 and 113 months [4.5 to 9.5 years] were randomly selected from 4 primary schools of Shireen Jinnah and Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich and Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. On average, the Greulich and Pyle Atlas underestimates chronological age by 6.65 +/- 13.47 months in females and 15.78 +/- 12.83 months in males [p-values < 0.001]. High correlation was found between chronological age and bone age in both genders [Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001]. Bone age calculated by Greulich and Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required [e.g. medicolegal cases]. However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children