HRCT of pituitary fossa correlation of clinical and CT findings

Purpose of the study was to correlate the clinical features with HRCT [High Resolution Computed Tomography] findings of pituitary fossa. Findings in a series of 30 patients, [22 female and 8 male] who underwent CT scanning of the pituitary fossa are reported majority of them had clinical suspicion of prolactinoma rest have other clinical signs of pituitary disease. Results showed 13 [out of 22] female patients with positive scan and 4 [out of 8] male patients with positive scan. In conclusion, this study conforms the usefulness of high resolution CT scanning of the sellar region in a specific settings

Mammographic criteria for determining the diagnostic value of microcalcifications in the detection of early breast cancer

Objective: To evaluate the importance of microcalcifications in the detection of breast carcinoma in conventional mammography

Material and Methods: This prospective study was carried out at Aga Khan University Hospital [AKUH]. Mammograms of 68 patients with microcalcifications were evaluated. Craniocaudal and oblique views of both breasts were acquired on routine basis with cone compression and magnified views when required

Results: Among 68 patients with microcalcifications, 61 [89%] had clustered microcalcifications while 7 patients [10.29%] had scattered microcalcifications. Microcalcifications can occur in benign and malignant diseases. While evaluating clustered microcalcifications, few criteria have been established to determine malignant clustered microcalcifications, these include specific and nonspecific criteria. Among specific and statistically significant criteria for malignant microcalcifications, which were identified in this study, were irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. In a cluster total number of >30 microcalcifications and at least 10 microcalcifications/cm2 of a cluster are also important in diagnosing a malignant cluster, but are included in nonspecific criteria because they can be present in benign diseases also. Scattered bilateral microcalcifications are usually present in benign breast diseases, but in this study, two patients with breast cancer had profuse bilateral scattered microcalcifications

Conclusion: This study shows that specific and statistically significant criteria for malignant microcalcifications, are irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. Scattered bilateral microcalcifications are usually present in benign breast diseases, but irregular shape and development of new calcifications among diffusely scattered bilateral calcifications, on follow up study, should also raise suspicion for being malignant

evaluation of hepatocellular carcinoma with biphasic contrast enhanced helical CT scan

To evaluate the role of biphasic contrast-enhanced helical CT including Hepatic Arterial Phase [HAP] imaging with Portal Venous Phase [PVP] imaging, in the detection and characterization of hepatocellular carcinomas. The study included 40 patients [M=26, F=14] with histopathologically proven HCC. Age range was between 30-85 years [mean=55] by following consecutive patients with cirrhosis in whom Hepatocellular carcinoma was diagnosed or suspected either by raised serum a [alpha]-fetoprotein level or Ultrasound. Biphasic contrast-enhanced examination revealed a total of 85 lesions in these 40 patients, out of which 13 were unifocal, 12 showed a dominant mass with satellite lesions, 2 showed cluster of contiguous nodules and 13 were multifocal HCCs. Mean diameter was 3.1 cm, ranging from 0.8 to 14 cm. On HAP imaging 85% were detected. [hyperattenuating = 69, hypoattenuating = 3] while on PVP imaging detectibility was only 48% [hyperattenuating=2, hypoattenuating=39]. Hence detectibility was significantly [p=0.008] superior in HAP as compared to PVP imaging. In 7 patients [17%] tumor was visible only on HAP images. Venous invasion was present in 12 patients [30%] while arterio-portal shunting was seen in 5 patients [13%]. Biphasic contrast enhanced helical CT is a useful method in detection and characterization of HCC

role of magnetic resonance cholangiopancreatography [MRCP] in obstructive jaundice

To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001. Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound [n=49], CT [n=11], ERCP [n=25] and biliary surgery [n=17]. Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up. Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive [88%] and specific [96.8%] in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture. Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice