Accuracy of straight leg raise test in patients with lumbar disc herniation keeping magnetic resonance imaging as a reference standard

Objective: To determine the accuracy of straight leg raise [SLR] test in patients with lumbar disc herniation keeping magnetic resonance imaging [MRI] as a reference

Study Design: Validation study

Place and Duration of Study: Radiology department of Combined Military Hospital [CMH], Quetta, over a period of 16 months from 1st Dec 2012 to 31st May 2013

Material and Methods: Total 225 cases with lower back pain were included through non probability-consecutive sampling. Informed consent was taken. The patients were assessed for positive or negative SLR test. Then all patients underwent MRI of lumbosacral spine. Data was collected through a specially structured proforma. Data was analyzed by SPSS version 10

Results: SLR test was found to be positive in 114 [50.7%] cases while negative in 111 [49.3%] cases. Lumbar disc herniation on MRI was found to be positive in 122 [54.2%] cases while negative in 103 [45.8%] cases. Sensitivity, specificity, positive and negative predictive values of SLR test were found to be 82.8%, 87.4%, 88.6% and 81.1% respectively. Accuracy of SLR test was found to be 84.9%

Conclusion: We concluded that SLR test is accurate enough to diagnose disc herniation with reference to MRI. Now we can advise SLR test for assessment of disc herniation where MRI is not available or unaffordable for the patients

study of doppler waveform pattern of hepatic veins in patients of acute viral hepatitis in comparison with control population

The objective of this study was to evaluate hepatic vein flow patterns in adults with acute viral hepatitis and to compare the findings with a control group of healthy people using Doppler ultrasound. Cross-sectional comparative study Radiology Department Military Hospital and Combined Military Hospital Rawalpindi from 15 May 2007 to 15 November 2007. Eighty patients who underwent doppler ultrasound at Military Hospital and Combined Military Hospital Rawalpindi during the study period were divided into two groups of 40 each. Cases were selected from the Out Patient Departments of Military Hospital and Combined Military Hospital Rawalpindi. Group I comprised patients with diagnosis of acute viral hepatitis based on clinical and laboratory findings. Group II included the control group comprising 40 healthy volunteers. Doppler ultrasound of hepatic veins was carried out in both the groups of patients. Abnormal wave pattern of hepatic veins on Doppler ultrasound was noted in 35 [87.5%] in group I and in 1[0.25%] of group II. One patient having abnormal Doppler wave pattern in group II subsequently developed acute viral hepatitis. Doppler ultrasound assessment of wave pattern in hepatic veins is an accurate method to differentiate a diseased liver from a normal one. Doppler ultrasound of hepatic veins is a good technique to study disease status of liver

Role of chest X-ray in diagnosis and assessment of severity of high altitude pulmonary edema

High-altitude pulmonary edema [HAPE] is a life threatening illness in climbers who rapidly ascend to a high altitude of more than 3000 meters. Accurate diagnosis and assessment of this disorder is a challenge to radiologist at high altitude medical setup where X-ray chest is the only imaging procedure available. A descriptive study was carried out to diagnose and assess the severity of high altitude pulmonary edema on the basis of radiological scoring on chest X-ray. Thirty-one suspected patients of HAPE were evacuated from high altitude >4000 meters to CMH Skardu on basis of clinical features. Poster anterior chest radiographs were taken by X-ray machine [Siemens, Germany]. Each chest X-ray was evaluated in detail for severity of HAVE by radiological score. Ten X-ray chests of persons who did not develop HAPE were included as quality control. Out of these 31 provisionally diagnosed patients of HAPE, 26 [84%] showed radiological finding of high altitude pulmonary edema that varied from fine reticular pattern of interstitial edema to diffuse air space consolidation. X-ray chest of these patients showed mild HAPE in 14 patients [45%] and moderate HAPE in 11 patients [36%]. One patient [3%] had severe HAPE. It was observed that 15 patients [48%] had cleared their pulmonary fluid on the 2nd day while remaining patients showed normal Xray chest on the 4th day of start of symptoms. It is concluded that X-Ray Chest can play an important role in prompt diagnosis of HAPE and assessment of severity of this potentially life threatening illness by radiological scoring system for further management of these patients at high altitude medical setup

Differentiation of pulmonary embolism from high altitude pulmonary edema

To differentiate the high altitude pulmonary edema [HAPE] from pulmonary embolism [PE] by clinical probability model of PE, lactate dehydrogenase [LDH], aspartate transaminase [AST] and D-dimer assays at high altitude. Design: A prospective study. Place and Duration of Study: The study was carried out at CMH, Skardu, from October 2001 to December 2002. Subjects and Consecutive 40 patients evacuated from height > 3000 meters with symptoms of PE or HAPE were included. Clinical pretest probabilities scores of PE, Minutex D-dimer assay [Biopool international] and cardiac enzymes estimation by IFCC approved methods, were used for diagnosis. Mann-Whitney U test was applied by using SPSS and level of significance was taken at [p<0.05]. Out of 40 subjects, 31 HAPE and 9 patients of PE were initially diagnosed on the basis of clinical features, D-dimer assay and V-Q scanning. Out of 9 patients of PE; 3 had plasma D-dimer between 250-500 ng/ml and 6 > 500ng/ml. Plasma D-dimer of 500 ng/ml was considered as cut-off value; 6 [66.7%] patients of PE could be diagnosed and 30 [96.7%] cases of HAPE excluded indicating very good negative predictive value. Serum LDH, AST and CK were raised above the reference ranges in 8 [89%], 7 [78%] and 3 [33%] patients of PE as compared to 11 [35%], 6 [19%] and 9 [29%] of HAPE respectively. Clinical assessment in combination with D-dimer assay, LDH and AST can be used for timely differentiation of PE from HAPE at high altitude where diagnostic imaging procedures are not available