role of 320 slice CT angiography in predicting vascular trauma

Objective: To determine the accuracy of multidetector CT angiography [MDCT angiography] as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up

Study Design: Descriptive analytical study

Place and Duration of Study: Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013 Methodology: Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT [Aquilion One[TM]] and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography [DSA]. Sensitivity and specificity was calculated

Results: The age of the patients ranged from 7 to 90 years with 94% [48] males and 6% [3] females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one [41%] patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen [29.5%] patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%

Conclusion: MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries

Multidetector ct patterns of peritoneal involvement in patients with abdominopelvic malignancies

To determine the patterns of peritoneal involvement in patients with abdominopelvic malignancies. Retrospective observational study. Shifa International Hospital, Islamabad, Pakistan, from May 2004 to May 2012. Two hundred and three patients with histopathologically proven abdominopelvic malignancies with peritoneal involvement who underwent contrast-enhanced CT abdomen and pelvis were identified through electronic data base system and were included in this study after ethical committee approval. Peritoneal disease pattern, predominant sites of involvement and associated findings of ascites, lymph nodes and metastasis were assessed. Patients with tuberculosis and lymphoproliferative disorders were excluded. The malignancies showing peritoneal involvement, in decreasing order of frequency, were ovarian cancer [n=118], colorectal cancer [n=45], pancreatic cancer [n=11], gastric cancer [n=7], endometrial cancer [n=6], gallbladder/ cholangio-carcinoma and hepatocellular cancer [n=5 each], cervical cancer [n=3], renal cell carcinoma [n=2] and transitional cell urinary bladder cancer [n=1]. The most common pattern of peritoneal involvement was mixed in 79 patients [39%], omental caking in 74 patients [37%] and nodular deposits in 50 patients [24%]. The most common sites of peritoneal involvement were pelvic peritoneum followed by greater omentum. Peritoneal involvement is the commonest with ovarian and colorectal carcinoma. Mixed pattern of peritoneal disease was most frequently seen in these patients followed by omental caking and nodular peritoneal deposits

review of patterns of CT scan appearances of abdominal Tuberculosis

To assess role of CT in diagnostic workup of abdominal tuberculosis. In this descriptive study, through electronic database, out of 7000 CT abdomens performed between January, 2002 to August, 2013, 30 patients with suggestion of Abdominal TB based upon CT and clinical findings were identified. Out of these 30 cases, twenty one patients were confirmed to have abdominal TB based upon histopathological data and response to anti tuberculous treatment and were included in the study and the remaining 9 patients were excluded from the study. Out of 21 confirmed abdominal TB cases, majority [n=13] were females. Peritoneal involvement was the most common feature seen in all 21 [100%] patients. Smudgy pattern, with or without smooth marginal enhancement, was the most commonly seen pattern of peritoneal involvement. Wet peritonitis [peritonitis with ascites] was seen in 14 [66%] out of 21 patients while dry peritonitis was seen in 7 [34%] patients. Lymphadenopathy was the second most common feature seen in 13 [62%] out of 21 patients. Bowel involvement was demonstrated in 11[52%] patients. Ileocecal region was the commonest site of bowel involvement seen in 7 of these 11 patients. Liver lesions were observed in 2 patients and splenic and pancreatic lesions were identified in 1 patient each. Smudgy pattern of peritoneal involvement, enlarged necrotic abdominal lymph nodes, high density ascites and ileocecal involvement are the most common abnormalities seen in patients of abdominal tuberculosis in our local population.