ABSTRACT
Objectives: To determine the diagnostic accuracy of perfusion CT in grading gliomas taking histopathology as gold standard
Study design: Cross-sectional validation study
Setting: Department of Radiology, Allied/DHQ Hospitals, Faisalabad
Period: Study was carried out over a period of six months from 01-09-2015 to 28-02-2016
Methodology: A total of 105 patients were included in this study. Low radiation dose non contrast CT head was performed to localize the region of interest before obtaining a perfusion scan. For the perfusion scan, 50ml of non ionic contrast is injected at a rate of 4-5ml/sec through an IV line by using an automatic power injector. At 5 seconds into the injection, a cine scan was initiated with the following technique: 80kv,100-120mA and 1 second/ rotation for a duration of 50 seconds. After the initial 50 sec cine scan, 8 more axial images were required, 1 image every 15 seconds for an additional two minutes, thus giving a total acquisition time of 170 sec to assess delayed permeability showing a large heterogeneous lesion with surrounding edema and mass effect on CT brain plain were included in the study
Results: Mean age of the patients was 49.4 +/- 16.1 year. There were 69 males [65.7%] and 36 females [34.3%]. Comparison of perfusion CT findings versus histopathology in diagnosing high grade gliomas showed positive cases 77 and 95, respectively. Sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of perfusion CT was 78.9%, 80.0%, 79.0%, 97.4% and 28.6%, respectively
Conclusion: In conclusion, clinically available perfusion imaging tools by using CT can provide additional information regarding brain tumor vascular estimates, which could be useful imaging biomarkers for preoperative glioma grading and angiogenesis assessment and could also be useful for treatment planning and response assessment
ABSTRACT
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
ABSTRACT
Objectives: To compare Zinc supplementation in HCV related cirrhosis with placebo in terms of mean change in levels of patients HCV viral load. Design: Randomized controlled trial [RCT]. Setting: Department of Medicine Allied Hospital, Faisalabad. Period: From August 2014 to November 2014
Methodology: A total of 120 cases [60 in each group] were included in the study. The patients in study group received 150 mg of elemental Zinc [Syp. Zincate-OK 20 mg/5ml containing 20 mg of elemental zinc] two times in a day with routine treatment protocol of cirrhosis and patients in control group received routine treatment of cirrhosis and placebo in the form of multivitamin. Patients were followed for 4 months. Outcome after zinc supplementation was measured in terms of mean viral load of patients from baseline [at time of admission] by PCR technique
Results: In our study, majority of the patients in both groups were between 41-50 years i.e. 36.67%[n=22] in Cases and 31.67%[n=19] in controls, mean and SD was calculated as 43.65+4.21 in cases and 45.27+3.98 years in controls, 61.67%[n=37] in cases and 68.33%[n=41] in controls were male and 38.33%[n=23] in cases and 31.67%[n=19] in controls were females, mean viral load at the time of admission was recorded as 51.43+23.54 in cases and 52.21+17.46 in controls, p value was 0.28 which shows insignificant difference in both groups, while mean viral load after treatment was calculated as 6.22+2.13 in cases and 28.34+5.95 in controls, p value was computed as 0.000, which shows a significant difference in both groups
Conclusion: We concluded that on comparison of Zinc supplementation in HCV related cirrhosis with placebo in terms of mean change in levels of patients HCV viral load, patients treated with Zinc supplementation had significantly lower viral load which suggests use of zinc supplementation in future in patients with HCV related cirrhosis
ABSTRACT
Objectives: To determine the correlation between higher total cholesterol level and high Barthel Index score in patients with acute ischemic stroke
Methodology: This cross sectional study was conducted at Radiology department and Medical Unit 1, Allied Hospital, Faisalabad for duration of 6 months from January 2015 to June 2015. 200 patients were included through Consecutive [non-probability] sampling technique. All the patients were undergone CT scan Brain from the radiology department of the Allied hospital to determine the respective changes [hypo dense area] of the ischemic stroke. Fasting serum cholesterol was measured in all patients after an overnight fast of 12 hours by drawing blood through 5cc BD syringe by me. Then all the patients were assessed by using Barthel Index score [BI]. Higher total cholesterol and high BI score were labeled after assessing the laboratory and clinical findings. The data was analyzed by using SPSS version 17.0. Spearman Rank correlation coefficient was calculated to BI score in patients with ischemic stroke. P-value<0.05 was considered as significant
Results: The mean age of the patients was noted as 61.76 +/- 11.55 years. In this study 55.50% were males and 44.50% patients were females. The mean total cholesterol value of patients was noted as 251.59 +/- 71.15 mg/dl. Out of 200 patients, 112 [56%] patients had high cholesterol [>200mg/dl] whereas 88 [44%] patient had low cholesterol of [<200mg/dl]. In this study the results showed that the mean value of total Barthel index score was 57.50 +/- 19.52. The study results described that 103 [51.50%] patients had high Barthel index score [>53] whereas 97 [48.50%] patients had low Barthel index score [<53]. Spearman correlation coefficient was calculated between high TC and high BI score as r= 0.631. This value was statistically significant i.e. p-value=0.000
Conclusion: With the help of this study, we found a significant positive relationship between high TC and high BI score in patients presented with ischemic stroke. Now we can better prognosticate the functional outcome of ischemic stroke in our patients
ABSTRACT
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
ABSTRACT
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