Frequency of prenatal central nervous system anomalies detected by ultrasound in a tertiary care hospital

Ultrasound is an effective and noninvasive modality for the prenatal diagnosis of central nervous system anomalies and thus helps in deciding about therapeutic termination. To determine the frequency of central nervous system anomalies using perinatal ultrasound in a tertiary care hospital. Pakistan Institute of Medical Sciences, Islamabad, one year [June 2011 to May 2012] Eleven Thousand Five Hundred [11500] pregnant women referred by obstetricians and gynecologists for routine anomaly scan. Women with fetuses that had anatomical anomalies in non CNS structures [rest of the body] were excluded. Antenatal ultrasound was done by consultant radiologist using high resolution ultrasound unit. Out of 11, 500 pregnant women, CNS anomalies were detected in 48 cases.They included hydrocephalus in 21 [43.8%] anencephaly in 11 [22.9%], spina bifida in 8 [16%], 02 each [4.1%] with encephalocele, arachnoid cysts, hydranencephaly and 01 each with exencephaly and holoprosencephaly. Prenatal ultrasound is a reliable non invasive method for the diagnosis of central nervous system malformations

Ultrasonographic assessment of renal size and its correlation with body mass index in adults without known renal disease

Background: Many conditions affect renal size. To evaluate abnormalities in renal size, knowledge of standardised values for normal renal dimensions is essential as it shows variability in the values of normal renal size depending on body size, age and ethnicity. Ultrasound, being an easily available, noninvasive, safe and less expensive modality, is widely used for evaluation of renal dimensions and repeated follow-ups. The objectives of this study were to determine renal size by ultrasound in adult without any known renal disease, and to determine the relationship of renal size with body mass index. Methods: Study was conducted in the Department of Diagnostic Radiology, Shifa International Hospital and PIMS Islamabad. Renal size was assessed by ultrasound in 4, 035 adult subjects with normal serum creatinine and without any known renal disease, between November 2002 and December 2010. Renal length, width, thickness and volume were obtained and mean renal length and volume were correlated with body mass index and other factors like age, side, gender, weight and height of the subjects. Results: Mean renal length on right side was 101.6 +/- 8.9 mm, renal width 42.7 +/- 7.1 mm, and parenchymal thickness 14.4 +/- 2.9 mm. On left side, mean renal length was 102.7 +/- 9.2 mm, width 47.6 +/- 7.0 mm, and parenchymal thickness 15.1 +/- 3.1 mm. Mean renal volume on right was 99.8 +/- 37.2 cm3 and on left was 124.4 +/- 41.3 cm3 Left renal size was significantly larger than right in both genders. Relationship of mean renal length was significant when correlated with age, side, gender, height and weight, and body mass index. Renal volumes also showed a similar relationship with side, gender, height and weight, and body mass index; but with age such a relationship was seen only for left kidney. Conclusion: Pakistani population has mean renal size smaller than reference values available in international literature. Renal length and volume have a direct relationship with body mass index. Mean renal size is related to the side, age, gender, height and weight as well. Keywords: Body mass index, Renal size, Ultrasound

Diagnostic yield of intravenous urography in a tertiary care hospital

Intravenous urography is the second most common tool after sonography for investigating urological pathology. To compare the effect of various factors like age, gender, symptoms and their duration on the yield of intravenous urography used for investigating uropathology. Retrospective case review study was done at department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, from July - August 2009. Over a period of 2 months, case records of all patients referred to the radiology department for intravenous urography were retrospectively analysed for their indications for referral and the findings of the urogram and variations in the pelvi-calyceal system. Demographic and clinical data for each patient was collected on prescribed proforma. All patients were prepared with low fat diet for 2 days to reduce bowel gases after which a preliminary post micturation control x-ray film was taken which included kidney and urinary bladder. Intravenous water soluble contrast was administered to all patients at a dose of 50 ml of 350-370 strength after which a series of cross kidney films were taken at 0, 5, 15 minutes with full bladder and post micturation films. These timings were modified in some patients with particular circumstances for optimal visualization, and to reduce the radiation dose. Ultrasonography of the kidneys and urinary bladder was also performed in some patients when required and to verify results. Out of 127 patients studied, 93[74%] demonstrated pathology, while 33[26%] did not show any pathology and were thus labeled as normal. Most patients [42] were in the age group 32-39 years and the overall male to female ratio was 2:1 and it remained the same in all 4 age groups from 20-29 to 50-59 years. Calculus disease [stone] was the most common uropathology seen in 82[64.5%] patients. The shorter was the duration of presenting complaints the lesser were the chances of picking pathology on urogram as seen in 43% patients who had few week's complaints and showed a normal urogram. Those having complaints of over a month's duration showed 26% as normal cases and this figure dropped to 20% when presenting complaints were chronic i.e of few year's duration. Use of intravenous urography should not be generalized to all cases. In younger patients with shorter duration of symptoms, ultrasonography should be performed as the first investigation. This non invasive technique will rule out many normal cases. Duration of symptoms should also be taken into account as patients with long standing symptoms are more likely to demonstrate pathology on intravenous urography. Initial intravenous urography facility should be available in all diagnostic centers of tertiary care hospitals

Dural sinus thrombosis: frequency and imaging diagnosis

To determine the frequency of dural sinus thrombosis [DST] and highlight diagnostic importance of its subtle imaging findings in patients presenting for workup of their varied neurologic complaints and symptoms. Observational case series. Study Period: June 2002- May 2005. All new patients undergoing cranial computed tomography [CT] and magnetic resonance [MR] imaging were included in this study which consisted of 1676 consecutive subjects with 1780 examinations. These were reviewed in real time on monitors [as they were being performed] for evidence of DST before printing of hard copies prior to disposition of patients. CT studies were performed on Toshiba Auklet scanner with 5 mm thick axial slices and 1cm inter slice gap. MR imaging was performed on 1.5 Tesla Toshiba Visart scanner with T1 and T2 weighted [T1 and T2W], spin echo, FLAIR and post contrast T1 weighted [T1W] imaging in multiple planes. Subjects with inconclusive but suspicious conventional imaging [CT, MR] were evaluated by magnetic resonance venography [MRV]. Patients presenting for follow-up of established diagnoses including neoplasia, arterial infarcts, hypertensive parenchymal haemorrhages and postsurgical status were excluded. Delta and empty delta were the most commonly observed CT and MR signs diagnostic of DST on pre and postcontrast images and were present in 43 patients. Thrombus was also directly visible within lumen of superior sagittal, transverse and sigmoid sinuses on T1W MR images in 21 individuals. In 12 patients, these signs were either absent or too subtle to be conclusive. However, presence of venous haemorrhagic or non-haemorrhagic brain parenchymal edematous lesions prompted further evaluation by MRV, which confirmed presence of DST in these subjects as well. As a result, a total of 55 patients with a frequency of 3.3% were diagnosed and treated for DST. Frequency of DST in patients with neurological complaints and symptoms is 3.3%, which is significantly higher than has been clinically suspected or recognized. On routine CT and MR studies, diagnostic imaging signs, while highly specific for DST, can be absent or may be masked due to technical factors or associated complications. Presence of brain parenchymal venous haemorrhagic or non-haemorrhagic edematous lesions should prompt judicious and close scrutiny of images on monitors by changing viewing parameters to detect subtle signs of DST. If still in doubt, MRV must be pursued for definitive diagnosis