Normal anatomical variations of renal artery pedicle: a review of 100 renal angiograms of healthy proposed renal donors

Objectives: To present variations in renal arterial anatomy. To document renal artery number, source, course and patterns

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Angiography suite, Radiology Department, Sindh Institute of Urology and Transplantation from May 2011 to Oct 2011

Materials and Methods: A total of 100 healthy adultswho underwent renal angiography for renal donor assessment in living related transplant programwere included. Both male and female with age group between 20-50 years having normal clotting profile, renal function and normal morphology on IVP were fully evaluated by predesigned performa including number, source, course and pattern of renal artery

Results: Out of 100 cases of healthy renal donors, 66 were male and 34 were female. Fifty four percent were in 20 - 30 years of age group while 30% between 31 - 40 years and 16% in between 41 - 50 years. In 56% right renal artery found to be higher than left, where as 40% had both the arteries at same level. Right renal artery longer in 52% and left in 46%. Only 2% had same length of both renal arteries. Regarding the number, 66% had bilateral single, 24% unilateral double, 6% bilateral double and only 4 % unilateral triple. Out of 100 renal donors with 200 renal pedicles [each donor having 2kidneys], single hilar artery seen in 75% in single hilum with inferior polar aortic branch in 14% and single hilar with suspicious polar aortic branch seen in only 4%. Double hilar arteries seen in 1% and hilar with extrahilar branch in 4%. Triple vessels found in 4% cases

Conclusion: The study shows that normal variation of vascular anatomy of renal pedicle is clinically very important to perform urological interventional procedures and transplantation. This study providesinformation concerning renal artery anatomy not only for interventional radiologists but also to urologic surgeon

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

Gastro esophageal reflux: an over investigated entity in neonates and infants

To determine the outcome of clinically suspected gastro esophageal reflux in neonates and Infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux [GER] were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit [NICU], Paediatric ward and Out Patient Department [OPD] were included in this study. Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life [especially in preterm infants] and usually resolves by 6-12 months of age and should not be over investigated