Carotid atherosclerosis; prevalance in obese patients having hepatic steatosis and its effect on the development of MI

Objectives: To determine the frequency of carotid atherosclerosis in obese patients having hepatic steatosis and its effect on the development of MI. Design: Cross sectional study. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: From January 2012 to June 2013

Patients and Method: A total of 96 patients were included in this study. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of common carotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Ultrasound was done in supine position and elevation of chest by pillow. Patient head will be turned to the opposite side. Intima media thickness was accessed in the distal wall of common carotid artery of both sides 1.0 cm proximal to carotid bulb

Results: Mean age of the patients was 46.69 +/- 11.86 years. Out of 96 patients, 51 [53.1%] were males while remaining 45 patients [46.9%] were females. Presence of carotid atherosclerosis was noted in 96 patients [100.0%]. Out of these patients, myocardial infarction was present in 81 patients [84.4%]. Mean BMI was 30.67 +/- 0.47, mean weight was 91.86 +/- 7.57 Kg and intima media thickness was 0.84 +/- 0.12 mm

Conclusion: Prevalence of atherosclerotic changes in carotid arteries detected by Doppler ultrasound among obese patients having hepatic steatosis and its effect on the development of MI is remarkable

Diagnostic accuracy of perfusion computed tomography in cerebral glioma grading

Objective: To determine the diagnostic accuracy of perfusion computed tomography [PCT] in the grading of cerebral glioma

Study Design: Cross-sectional analytical study

Place and Duration of Study: Department of Radiology, Allied Hospital, Faisalabad, from January to June 2014

Methodology: All the patients with untreated glioma had an initial non-contrast head CT and then PCT using 128 multidetector CT scanner. Perfusion maps of permeability surface [PS] and cerebral blood volume [CBV] were generated and measured. As control, a second volume of interest was placed in the contralateral healthy cortex. PCT parameters were compared with World Health Organization [WHO] glioma grades

Results: Fifty patients of 30 - 70 years of age of both genders [mean 45.13 +/- 5.54], 31 [62%] males and 19 [38%] females were studied

These patients were classified as low-grade glioma group [22 patients] and high-grade glioma group [28 patients]. PS showed the sensitivity of 95.45%, specificity of 92.86% and diagnostic accuracy of 94% in differentiating the low-grade and high-grade glioma by using a cut-off value of 3.6 ml/100 g/minute. By using a cut-off value of CBV of 2.08 [ml/100 g] among low-grade and high-grade glioma group, CBV showed the sensitivity of 77.3%, specificity of 89.3%, and diagnostic accuracy of 84%

Conclusion: The derived parameters [PS and CBV] correlate well with tumor histopathology, differentiating low-grade from high-grade gliomas. PS showed better accuracy for glioma grading

Diagnostic accuracy of modified CT severity index in assessing severity of acute pancreatitis

Objective: To determine the diagnostic accuracy of modified CT severity index in assessing the severe acute pancreatitis keeping APACHE II as gold standard

Study Design: Cross-sectional [validation] study

Place and Duration of Study: Department of Radiology, Allied Hospital, Faisalabad, from February to August 2014

Methodology: A total of 120 patients of either gender aged 20-60 years with epigastric pain radiating to back and having sonographic findings [decreased or heterogeneous pancreatic echogenicity, pancreatic enlargement, peripancreatic fluid collection], supportive of acute pancreatitis were taken. CT with intravenous contrast was performed on 128-slice scanner within 24 hours of presentation. Slice thickness was 3 mm in region of pancreas. Modified CT severity index was calculated. Score above 5 was graded as severe pancreatitis. APACHE II score of >11 considered as gold standard was also calculated within 24 hours of admission

Results: Mean age of the patients was 39.03 +/- 8.71 years. Most of the patients were females 73 [60.8%]. Out of 120 patients, 43 [35.83%] patients had severe acute pancreatitis. Sensitivity, specificity, positive predictive value and negative predictive value of modified CT severity index in assessing the severe acute pancreatitis were 100%, 87%, 81.13% and 100%, respectively. The diagnostic accuracy was yielded as 91.67% considered APACHE II as gold standard

Conclusion: Modified CT severity index had high diagnostic accuracy in assessment of severe acute pancreatitis and can be used reliably in early prediction of complications of severe acute pancreatitis

Frequency of abnormal intima media thickness of carotid artery in obese individuals by colour doppler ultrasonography

Objectives: To determine the frequency of abnormal Intima media thickness of Carotid artery in obese individuals by using color Doppler ultrasonography. Design: Descriptive cross-sectional study. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: From August 2011 to june 2012

Methodology: A total of 96 patients were enrolled in this study. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of common carotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Intima media thickness was accessed in the distal wall of common carotid artery of both sides 1.0 cm proximal to carotid bulb

Results: Mean age of the patients was observed 50.1 +/- 5.9 years. Abnormal intima media thickness in right common carotid artery [RCCA] was found to be in 46 [47.9%] patients and in 45 [46.8%] patients in left common carotid artery [LCCA]. Mean values of intima-media thickness [IMTs], luminal diameters [LD] and flow velocity [FV] systolic and diastolic of right common carotid artery [RCCA] as follows, 0.74 +/- 0.17, 6.90 +/- 0.93, 78.91 +/- 17.03 and 21.50 +/- 5.67, respectively. Mean values of intima-media thickness [IMTs], luminal diameters [LD] and flow velocity [FV] systolic and diastolic of left common carotid artery [LCCA] as follows, 0.74 +/- 0.15, 6.85 +/- 0.72, 76.58 +/- 12.49 and 20.41 +/- 5.14, respectively

Conclusion: Carotid intima-media thickness testing by using Colour Doppler Ultrasonography is a powerful and noninvasive tool in the early detection of atherosclerotic plaques and carotid artery wall thickening and is an independent predictor of strokes and heart attacks

Neck lymph nodes characterization on diffusion MRI

Objectives: to evaluate the role of Diffusion-Weighted Imaging [DWI] in differentiating the various causes of enlarged neck lymph nodes

Design: prospective study

Setting: Department of Radiology Allied Hospital, Faisalabad

Period: from July 2013 to December 2013

Patients and Method: thirty four consecutive patients who presented with clinical suspicion of malignant cervical nodes were included in the study, 19 males [55.9%] and 15 females [44.1%]. Their age ranged from 45 to 70 years, mean age 56.62 +/-7.54 years referred to the radiology department of Allied hospital Faisalabad, complaining of neck swelling, ultrasound showed cervical nodes and all the patients underwent both MRI [T1W, T2W, DWI, ADC] and histopathological examination

Results: according to histopathological analysis we divided the examined patients with lymph nodes [n= 34] into 2 categories: malignant lymph nodes 70.6% [n=24] benign lymph nodes 29.4% [n=10]. DWI and ADC [apparent diffusion coefficient] values revealed 26 malignant lesions [76.5%], 8 benign [23.5%]. The accuracy of the DWMRI was 88.23%. A significant difference between benign and malignant cervical nodes on DWI and on ADC maps is reported. The results obtained were 23 true positive, 3 false positive, 7 true negative and 1 false negative case was identified, yielding a sensitivity of 96%, specificity of 70%, NPV= 87.5% and PPV= 88.5%. The difference between the mean ADC values between benign and malignant lesions was statistically significant [P<0.0001]

Conclusion: diffusion-weighted imaging is a valuable tool in the differentiation of benign and malignant lymph nodes

Diagnostic accuracy of cerebral CT perfusion in acute ischemic stroke

Objectives: to determine the diagnostic accuracy of CT Perfusion brain over Non contrast CT for patients presenting with stroke symptoms in the 12-hour window

Design: cross-sectional study

Setting: Department of Radiology Allied Hospital, Faisalabad

Period: from July 2014 to December 2014

Patients and Method: we studied 60 patients of 45-70 years of age of both genders [mean 55.13+/-5.54] [42 [70%] males and 18 [30%] females] with initial clinical symptoms suggestive of acute ischemic stroke. All patients had an initial non-contrast head CT, CT Perfusion [CTP], and follow up brain diffusion MRI at 7th day. The obtained CT perfusion images were used for image processing. Cerebral blood volume, cerebral blood flow and mean transit time were visually estimated and manually traced and the results were compared to diffusion MRI lesions

Results: follow-up DWI for confirmation of acute infarct revealed true recent infarcts in 36 patients. NCCT revealed 23 [38.3%] true acute infarcts, 10 [16.7%] false positive infarcts, 14 [23.3%] true negative and 13 [21.7%] false negative yielding diagnostic accuracy of 61.66%. CTP revealed 30 [50%] true positive acute infarcts with two [3.3%] false positive, 22 [36.7%] true negative and 6 [10%] false negative yielding sensitivity of 83.3%, specificity of 91.67%, PPV=93.75%, NPV=78.57% and diagnostic accuracy of 86.7%. CTP was significantly more sensitive [83.3 vs. 64.2%, p < 0.0001] and accurate [86.7 vs. 61.7%, p < 0.0001] and had a better negative predictive value [78.57 vs. 52.2%] than NCCT

Conclusions: dynamic PCT provides more sensitivity and accuracy than no enhanced CT in detecting acute strokes in the 12-hour window

Frequency of carotid artery stenosis in ischemic stroke

Stroke continues to be a significant cause of morbidity and mortality throughout the world. According to the world health organization, 15 million people suffer stroke worldwide annually. Despite maximal medical management, carotid artery atherosclerosis leading to stenosis continues to portend a poor prognosis. Conservative management frequently fails in this disease, leaving patients at high risk for cerebral infarction and death

Objective: To determine the frequency of carotid artery stenosis in patients with stroke using Doppler Ultrasonography

Study design: cross-sectional analytical study

Setting: outpatient and emergency department of Medical Unit-I, Allied Hospital, Faisalabad

Duration of study: Study was carried out over a period of seven months from 01-03 2014 to 30-09-2014

Subjects and methods: A total of 100 cases were included in this study. Every patient was undergone a list of investigation including lipid profile, electrocardiography [ECG], X-ray chest [PA], computed tomography [CT] scan brain and echocardiography to rule out any cardiac source of embolism

Results: Out of 100 cases, 12 patients [12%] were between 18-40 years old, 34 patients [34%] were 41-60 years of age while 54 patients [54%] were 61-80 years old. Mean age of the patients was 51.9 +/- 5.1. Regarding gender distribution, 62 patients [62%] were male and 38 patients [38%] were female. Of 100 patients, 56 patients [56%] had carotid stenosis on color Doppler Ultrasonography of carotid arteries. 29 patients [51.8%] had mild stenosis, 17 patients [30.3%] had moderate stenosis and 10 patients [17.9%] severe stenosis

Conclusion: It is concluded that carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

Non contrast CT evaluation of lumbar pain presenting in medical emergency

Objective: To evaluate the value of non contrast CT in patient with lumbar pain

Methods: 1432 patient with lumbar pain, presenting in Medical emergency of Allied Hospital were taken, all of them under went Ultrasound abdomen and CT Abdomen. CT abdomen was conducted on optima 660, 128 slice CT scanner

Results: CT showed that out of 1231 patients 998 had either of multiple renal, ureteric and / or vesicle stones. 110 had normal scan and 123 had alternate or incidental diagnosis. Patient with multiple pathologies were excluded from the study which was 201 patients

Conclusion: In comparison with ultrasound CT was superior in detecting Ureteric stones and more correct in renal stones. CT was also superior in detecting alternate or incidental diagnosis

Prolongation of QTc duration and increased heart rate in patients with cirrhosis of liver

Objective: To compare QTc duration and increasedheart rate in patients with cirrhosis with noncirrhoticcontrols

Design: Cross-sectionalanalytical study

Place and Duration of Study:Medical Unit 1 Allied Hospital Faisalabad between1st March 2011 to 30th August 2011

Patients andMethods: 50 patients of cirrhosis were selected inGroup-I. An equal number of non-cirrhotic patientswere taken as control and were included in Group-II. ECG was recorded and Heart rate[HR] and QTcinterval was calculated in both the groups.Comparison of increased prolongation of QTc andHeart Rate were done using independent samples ttest with significance level at 0.05

Results: Fiftypatients of cirrhosis of liver were inducted in Group-I with same number of non-cirrhotic patients ascontrol in Group-II. The mean +/- SD of QTc ofGroup-I was 0.472 +/- 0.012 sec and that in Group-IIwas 0.434 +/- 0.014 sec and that for HR in Group-Iand II were 79.26 +/- 10.08 and 74.24 +/- 7.58beats/min respectively. The mean QTc and HRvalues were significantly more in Group-I ascompared to Group-II with p value = 0.0001

Conclusion: Means of both HR and QTc weresignificantly higher in cirrhotic patients as comparedwith non-cirrhotic controls

Arterial phase CT for early detection of HCC in cirrhotic patients

Objective: To know the effectiveness of EarlyArterial phase CT in detecting the small focusof HCC in Cirrhotic Patient

Material andMethods: 135 patient of Cirrhosis werescanned on a Multislice CT scanner with boluschase contrast tracking. All the patient had amass lesion on Ultrasound. Inclusion criterionwas a solitary lesion in the liver. The patientwere scanned in arterial phase, Portal venousphase and delayed phase CT. The scans weredone with an injector using a 100 ml of contrastvolume with the flow rate of 3.5ml / sec

Findings Total lesions identified on scans were210 on early arterial phase of the imaging. 145in portal venous phase and 142 in delayedphase. 43 patient showed multiple lesions -31.8%. That is to suggest that ultrasoundpicked less lesions as compared to CTMaximum number of 210 lesions wereappreciated in early arterial phase of the CT

Conclusion: Early Arterial phase CT is betterfor early detection of smaller sized HCC

CT guided transthoracic Needle Aspiration biopsy; effect of size of the lesion on the rate of pneumothorax

To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, and correlating it with the size of the lesion. Descriptive study. Department of Radiology Mayo Hospital, Lahore. From June 2002 to April 2003, Seventy patients underwent CT guided FNA of the chest masses. Out of Seventy, 18 patients i.e.; 26% developed Pneumothorax. Lesion less than 1 cm, out of 6 patients 3 developed pneumothorax [50%], lesions 1-2 cm 5 out of 11 developed pneumothorax [45%], lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax [35%], lesions between 3-4 cm 2 out of 8 developed pneumothorax [25%], lesion sized 4-5 cm 1 out of 15 developed pneumothorax [6%], and lesion with more than 5 cm size 1 out of 16 developed pneumothorax [6%]. The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses increases as the size of the lesion decreases

Multi-detector ct findings in abdominal tuberculosis

To know the findings of MDCT in cases of Abdominal Tuberculosis. Fifty eight patients with suspicion of abdominal tuberculosis were scanned and the findings were evaluated. All the patients received IV and oral contrast. The patients were referred from the medical and surgical departments of Shalamar Hospital, Lahore. Toshiba 4 Slice Aquilion was used for scanning. The exclusion criterion was patients on Anti tuberculous drugs and urogenital tuberculosis. Following 6 findings were observed in 47 abnormal scans, Out of other 11 scans 9 had other diseases like diverticulitis, Appendicitis and Bowel Lymphoma. 2 were normal. Close medical and Surgical follow up was obtained in all cases. Ascites = 35, Omental / Mesenteric Thickening / Involving = 27, Small Bowel wall thickening = 07, Large bowel wall thickening including Caecal wall thickening = 06, Abdominal Lymphadenopathy= 26, Solid Organ Involvement, Liver=01, Spleen=02. Ascites was the most common finding in Patients with Abdominal Tuberculosis and Involvement of liver being the least common finding amongst the group

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

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

effect of size of the needle on the rate of pneumothorax after ct guided transthoracic needle aspiration biopsy of lung masses

Purpose of Study: To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, using multiple needle sizes

Patients and Method: Seventy patients underwent CT guided FNA of the chest masses

Results: Out of seventy, 18 patients i.e.; 26 % developed Pneumothorax. With 18G needle 24 patients underwent FNA and seven of them i.e: 25% developed Pneumothorax. With 20G needle, 26% developed pneumothorax and with the 22G needle 25% developed Pneumothorax

Conclusion: The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses remains almost the same regardless of the size of the needle

Usefulness of CT scan in managing blunt renal trauma

Objective to evaluate the usefulness of CT scan in selecting patients for appropriate management of patients presenting with blunt abdominal trauma and haematuria. 23 consecutive patients were referred from the surgical emergency with blunt abdominal trauma and haematuria for CT scan abdomen. CT scan findings were analysed and graded according to the extent of renal as well as vascular injury. These patients were then followed up during their hospital stay and the choice of treatment i.e surgical versus conservative and it outcome was recorded prospectively. 18 patients [78%] had renal trauma. The renal trauma in these 18 patients was classified according to CT findings in to five grades according to classification of the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma. Five patients [27.8%] were in grade 1, three patients [16.6%] in grade 2, three patients [16.6%] in grade 4, four patients [22.4%] in grade 4 and three patients [16.6%] in grade 5.All patients in grades 1, 2 and 3 were treated conservatively whereas all patients in grade 5 had to undergo laparotomy and only one patient in Grade 4 required laprotomy due to rapidly expanding urinoma and deteriorating clinical condition. Five patients had non renal trauma and two of these had a ureteric injury .These patients did not require any exploration. CT scan is an effective method to stage and grade the severity of renal injury and is of extreme help to the surgeons in selecting patients for exploratory surgery

Pneumothorax after CT guided transthoracic needle aspiration biopsy of lung masses

The purpose of this study was to analyze the rate of pneumothorax after CT guided transthoracic needle aspiration biopsy [TNAB] of lung masses, using variable needle sizes. A total of 70 patients underwent this procedure, among them, 18 patients [26%] developed pneumothorax with 18G needles 24 patients underwent FNA and seven of them [25%] developed pneumothorax, with 20G needle, 26% developed pneumothorax and with the 22G needle 25% developed Pneumothorax. As a conclusion the study shows that the rate of pneumothorax after CT guided TNAB of lung masses remains almost the same regardless of the size of the needle

Intracranial menifestations of tuberculosis: an imaging study

In this paper we report various intracranial manifestations of tuberculosis in 48 patients who presented at our hospitals. The object of this study was to see different patterns of intracranial tuberculosis seen on cross sectional imaging in the city of Lahore and its suburbs. In a total of 48 patients, 21 had meningitis, 16 patients were found to have tuberculomas which also included 6 who had accompanying meningitis. Vasculitis resulting in lacunar infarcts was seen in 3 patients. Hydrocephalus was seen in 5 patients and choroid plexus tuberculosis [choroid plexitis] was seen in 3. Intracranial tuberculosis, therefore can have many presentations such as meningitis, tuberculomas or rare varieties such as abscess, cerebritis or choroid plexus involvement. It can also lead to devastating complications such as hydrocephalus and infarcts

CT evaluation of craniocervical junction

The purpose of the study was to evaluate the effectiveness of CT in diagnosing craniocervical junction pathologies. Six consecutive patients who presented with symptoms related to craniocervical junction were evaluated by CT. Two of the patients had history to trauma, two had congenital problems with cervical spine, one had tuberculosis and one had craniocervical junction tumor. CT was found to be extremely helpful in all the cases with superior definition of bone detail when compared to plain films or MRI.

Don't let me die Galactography the art is dying

The fancied and sophisticated investigations always catch the eye of the patient and the mind of clinicians. We are living in an era, which is certainly making headways in the field of medicine. The inventions like the state of art MRI, Computed Tomography and the newer modality of PET scanning certainly do help. For the sake of breast, the screening via mammography still remains the prime investigation but the frequently used method of investigating the ducts i.e; galactograhy or the commonly called Ductography is these days not the favorite of most clinicians these days. This article is a very limited study but it might be helpful in reviving the confidence of the clinicians in the art of Galactograhy