To determine the positive predictive value of magnetic resonance spectroscopy in diagnosing malignant thyroid nodules by taking histopathology as a gold standard

Objective: To determine the positive predictive value of magnetic resonance spectroscopy in diagnosing malignant thyroid nodules by taking histopathology as a gold standard

Methodology: This descriptive cross-sectional study was undertaken at the department of Radiology, CMH Multan from October 2014 to March 2015. 77 patients with malignant thyroid nodules on ultrasonography between ages 30-70 years, of either gender were included. Patients with previous thyroid surgery, already biopsy proven malignant thyroid nodules and, those having contraindication to magnetic resonance spectroscopy [MRS] were excluded. All the patients then underwent MRS for choline peak and choline /creatine [Cho/Cr] ratio. Findings were correlated with histopathology

Results: Mean age of the patients was 46.53 +/- 9.15 years. Out of these 77 patients, 62 [80.52%] were female and 15 [19.48%] were males with female to male ratio of 4:1. MRS supported the diagnosis of malignant thyroid nodules in 60 patients. Histopathology confirmed malignant thyroid nodules in 49 [true positive] cases where as 11 [False Positive] had no malignant lesion on histopathology. Positive predictive value of magnetic resonance spectroscopy [MRS] in diagnosing malignant thyroid nodules was 81.67%

Conclusion: Magnetic resonance spectroscopy [MRS] is a non-invasive modality of choice with high positive predictive value in diagnosing malignant thyroid nodules. It has not only dramatically improved our ability of diagnosing thyroid lesions pre- operatively but also helps the surgeons for proper decision making

Role of uterine artery doppler ultrasound in predicting preeclampsia in primigravida

Objective: To find the accuracy of uterine artery diastolic notching during the second trimester of pregnancy in predicting pre-eclampsia in primigravida patients

Study Design: Descriptive cross sectional study

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging [AFIRI] Rawalpindi; six months duration from 30 Nov 2012 to 31 May 2013

Material and Methods: This study included 199 primigravida women with singleton pregnancy having diastolic notch in uterine arteries between 20 to 23 weeks of gestation. All patients were examined by both grey scale and doppler ultrasonography. Uterine arteries were evaluated with doppler near the point where they crossed the external iliac arteries. The patient was included in study if the presence of diastolic notch was demonstrated. Clinical follow up in gynae and obs department continued throughout the pregnancy to see if they developed preeclampsia. The data were recorded on a previously prepared proforma and analyzed with SPSS 21

Results: The accuracy of uterine artery doppler ultrasound in identifying women who later developed preeclampsia was 48.24%. The frequency of pre-eclampsia with bilateral notch was significantly high in the primigravid of younger age as compare to the primigravid of the older group [p=0.001]. The difference in frequency of developing pre-eclampsia with bilateral notch when compared among 20 to 21 week gestational age and 22 to 23 weeks gestational age was statistically insignificant

Conclusion: Uterine artery diastolic notching between 20 and 23 weeks of gestation is an important risk factor for developing pre-eclampsia. This doppler parameter should, therefore, be included in the risk evaluation for gestational hypertension

Diagnostic accuracy of platelet count to spleen size for prediction of esophageal varices in patients of liver cirrhosis

Objective: To determine the diagnostic accuracy of ratio of platelet count to spleen size for prediction of esophageal varices in patients of liver cirrhosis, keeping upper GI endoscopy as gold standard

Materials and Methods: This cross-sectional validation study was carried out in Radiology Department, Combined Military Hospital, Peshawar from February, 2015 to August, 2015.One hundred and fifty patients of either sex, having liver cirrhosis with no episode of gastrointestinal bleeding, scheduled to undergo upper GI endoscopy were selected.Ultrasound abdomen of these patients was carried out and spleen size was determined in millimeters. Platelet count if already not performed was also carried out.Platelet count was divided by the spleen size to obtain the platelet count to spleen size ratio. Close follow up of the patient was done until he/she underwent upper GI endoscopy for diagnosis of esophageal varices. A correlation was performed between the platelet count to spleen size ratio and findings of upper GI endoscopy

Results: Collected data was analyzed through computer software SPSS11.0.The ratio of platelet count to spleen size as a predictor of esophageal varices in patients of liver cirrhosis demonstrated sensitivity of 92.5%, specificity of 87.5%, positive predictive value of 93.3%, negative predictive value of 86.1% and diagnostic accuracy of 90.8%

Conclusion: The ratio of platelet count to spleen size as a predictor of esophageal varices in patients of liver cirrhosis is found to be high

Assessment of occult cervical lymph node metastasis in primary squamous cell carcinoma of the head and neck by computed tomography

To determine the frequency of occult [node negative] cervical lymph node metastasis in primary head and neck squamous cell carcinoma, using contrast enhanced computed tomography [CT]. Cross sectional descriptive study. Study was conducted in Department of Radiology, Combined Military Hospital Rawalpindi. Duration of the study was 06 months i.e. from 19[th] February 2011 to 19[th] August 2011. A total of 141 cases, fulfilling the inclusion criteria, reporting to the radiology department, were included in the study after seeking written informed consent. All patients underwent contrast enhanced CT scan of the neck from base of skull to root of neck using Asteion Whole Body X-ray CT Scanner [Model TSX-021A]. Images were evaluated for the presence or absence of cervical lymph node metastasis according to the cervical lymph node metastatic criteria at each level of the neck. Of the 141 patients with clinically no head and neck squamous cell carcinoma, 45.4% were found to have lymph node metastases. Frequency of occult metastases in squamous cell carcinoma of oral cavity was 47.6%, oropharynx 23.5%, larynx 33.3% md hypopharynx 78.6%. In clinically node negative neck the risk of lymph node metastases is significantly high in patients of head and neck squamous cell carcinoma in our population AU patients presenting with node negative neck should undergo CT scans for early detection of occult metastasis

Papuloerythroderma of Ofuji - a case report

Papuloerythroderma of Ofuji is an uncommon skin condition seen in elderly patients characterized by pruritic eruption of infiltrating papules with sparing of large folds of skin. Very few cases have been reported in the literature and the frequent association of this rare entity with laboratory abnormalities and malignancy points towards its heterogenous nature. We report a case of Papuloerythroderma of Ofuji having peripheral eosinophilia but not associated with any malignancy

Role of CT scan in meningitis: a hospital based study

To document the features of meningitis and to evaluate the complications of meningitis on computed tomography, Combined Military Hospital and Military Hospital, Rawalpindi, patients of all ages and sex with clinical and / or laboratory diagnosis of meningitis were studied. Computed tomography [CT] scan brain was done before and after intra- venous contrast administration. CT scan brain was normal in 16 [23%] patients and abnormal in 54 [77%]. Exaggerated meningeal enhancement was the most common feature of meningitis, seen in 85.12% cases. Most common site of pathological meningeal enhancement was tentorium cerebelli followed by basal cisterns and sylvian fissure. Hydrocephalus of varying degrees in 66.66%, cerebral infarction in 46.29%, cerebritis in 31.48%, Transependymal cerebro spinal fluid [CSF] leak in 29.92%, tuberculoma in 12.96%, cerebral atrophy in 7.43% and subdural effusion was seen in 1.8% patients. CT scan has been proved helpful in diagnosis and evaluation of the complications of meningitis