Diagnostic accuracy of pelvic MRI for determination of the cervical involvement in endometrial cancer

Objective: To determine the diagnostic accuracy of pelvic MRI for assessment of the cervical involvement in endometrial cancer. Study Design: Cross-sectional analytical study. Place and Duration of Study: Radiology Department of the Aga Khan University Hospital, Karachi from January 2014 to December 2015

Methodology: Patients with biopsy-proven endometrial cancer were included, who had both their MRI and histopathological diagnosis performed at our institution. Those patients treated with chemo/radiotherapy or had incomplete medical records, were excluded. The extent of cervical involvement by endometrial carcinoma was seen on T2WI images, and findings were correlated after surgery taking histopathology as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated

Results: The mean age of the 56 patients was 60.87 +/-8.80 years [range 37-84 years]. The most common clinical indication was post-menopausal bleeding [n=37, 66.1%]. The most common histological subtype was endometrioid adenocarcinoma [n=50, 89.3%]. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MRI in the detection of cervical invasion were 92.85%, 88.09%, 89.28%, 72.22% and 97.36%, respectively

Conclusion: MRI is a highly sensitive and specific imaging modality for detection of cervical invasion in endometrial carcinoma

unsuspected bleeding Meckel's diverticulum in an adult detected on mesenteric angiography

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from Meckels diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging

Diffusion weighted MR imaging of ring enhancing brain lesions

To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Analytical, descriptive study. Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Diffusion weighted imaging [DWI] was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Uterine artery embolization for the treatment of uterine fibroids: Initial experience

To evaluate the initial results of uterine artery embolization for the treatment of symptomatic uterine fibroids in our local population. Medical records and radiological images of all patients undergoing uterine artery embolization [UAE] in Aga Khan University Hospital [AKUH] between January 2003 and December 2009 were retrospectively analyzed. Fourteen patients [Age range: 19-50 years] with sonographic diagnosis of uterine fibroids associated with menorrhagia and/or pelvic pain underwent uterine artery embolization with use of polyvinyl alcohol [PVA] particles. Single femoral access technique was used in all patients. Clinical improvement was assessed by detailed questionnaire for symptomatic improvement and follow up ultrasounds. All 14 patients underwent technically successful embolization. Five patients were lost to follow up and were not included in the final analysis. Out of remaining 9 patients, eight patients had initially presented with menorrhagia with pelvic pain while one patient had presented with menorrhagia alone. On follow up after one year menorrhagia was significantly reduced in 7 out of 9 patients [77%]. Pelvic pain was improved in 7 out of 8 patients [89%]. Majority of patients experienced post procedure pain of various intensities which was treated conservatively. One patient developed scanty periods, a known complication of this procedure. No other procedure related significant complications were seen. Uterine fibroid embolization represents a promising method of treating fibroid-related menorrhagia and pelvic pain. Further studies with larger patient population will be required for definitive results

Median survival time of patients after transcatheter chemo embolization for hepatocellular carcinoma

To determine the effect on survival after transarterial chemoembolization [TACE] in patients with unresectable hepatocellular carcinoma [HCC]. Longitudinal cohort study. Radiology Department, The Aga Khan University Hospital, Stadium Road, Karachi, from December 1997 to September 2005. Patients undergoing TACE procedure for HCC were prospectively followed. Fortythree patients were enrolled from December 1997 to March 2003 in the study and subjected to chemoembolization therapy. Eight out of 43 patients were excluded from the study, who lost to follow-up. All the patients were followed till their death. Median and mean survival were calculated. The median survival of these 35 patients was 410 days [13.6 months], with 95% confidence interval [236 days lower bound and 536 days upper bound]. Mean survival time was 603 days [20.1 months] with 95% confidence interval [394 days lower bound and 812 days upper bound]. There was significant difference in mean survival time [in days] by Child's Pugh class [c2 = 12.384; df=2, pvalue= 0.002]. The study showed that TACE is an effective palliative treatment. TACE increases the median survival time

Selective hepatic arterial infusion chemotherapy and transcatheter arterial embolization [TAE] therapy for primary and metastatic malignant liver tumors

Large hepatocellular carcinaoma and hepatic metastases have remained a therapeutic challenge for quite a long time. Various methods have been tried such as percutaneous ethanol injection and selective hepatic arterial chemoinfusion. As most primary and secondary neoplasms of the liver receive their blood supply almost exclusively from the hepatic artery, transcatheter embolization of the hepatic artery is also being done in an attempt to control tumour growth. Selective hepatic arterial chemoinfusion followed by transcatheter arterial embolization is being done at Liaquat National Hospital for the management of primary and secondary malignant hepatic tumours. This report comprises three patients with a relatively long term follow up. No serious complication related to embolization occurred in these patients. The results in these and other patients are encouraging in suggesting that the combination of selective hepatic arterial chemoinfusion and transcatheter arterial embolization is an easy and effective method in the management of malignant hepatic masses