Frequency of positive ct scan findings in minor head trauma based on nice guidelines

To determine the frequency of positive CT scan findings in cases of minor head injury with GCS score of 13-15 at presentation based on NICE guideline. Cross sectional study. Study was conducted in departments of Radiology CMH Rawalpindi and MH Rawalpindi from 10[th] Feb 2010 to 10[th] Aug 2010. One hundred and thirty five indoor and outdoor cases, fulfilling the inclusion criteria, reporting to the radiology department after head trauma, were included in the study after seeking written informed consent. Computerized tomography [CT scan] of the brain was done. Positive CT scan findings i.e. fracture, extradural, subdural and intraparenchymal hemorrhage were noted. Total number of patients studied in this study was 135 and evaluated after taking written consent from them. Out of total 135 patients 104 [77%] were males and 31[23%] were females. Positive CT scan findings were found in 10[7.4%] patients while 125[95.6%] patients had negative CT findings. Among patients having positive CT scan findings epidural hemorrhage was found in 2 [1.5%] intraparenchymal hemorrhage with fracture in 3 [2.2%], skull fracture in 3 [2.2%] and 1 [0.7%] patient had subdural hemorrhage. CT scan is done in minor head trauma although results are often normal. NICE clinical guideline helps in identification and early management of head injury. The goal of implementing such guideline is to do CT scan only in those who are at risk of developing complications, thus minimizing the cost of CT scanning as well as strain on emergency neurology and radiology departments

MR image spectrum of spinal dysraphism in a military hospital

To demonstrate the spectrum of MR imaging findings in patients with suspected spinal dysraphism in a Military Hospital. Descriptive study. Department of Radiology, Military Hospital Rawalpindi from September 2005 to October 2007. Patients were referred from neurology, neurosurgery and general surgery departments of Military Hospital and Combined Military Hospital Rawalpindi who presented with various neurological problems and skin stigmata having suspicion of spinal dysraphism. A total of 74 patients were evaluated over a period of two years. All 74 [100%] patients suspected of spinal dysraphism showed one or multiple abnormalities out of the whole spectrum on plain MRI spine. Mean age was 6.4 years with the youngest patient sixteen days old and the eldest being 37 years old. Majority of the patients were under six years of age. A wide range of abnormalities were seen with Myelomeningocele found in 29 [39.2%] and along with lipomatous component in 9 [12.2%]. Thirty three [44.6%] patients had diastometomyelia, 10 [13.5%] having associated lipoma of filum terminale while syringomyelia was noted in 36 [48.6%] patients. Moreover, in the majority of patients, dysraphism was at the lower lumbar and upper sacral region. It was concluded that plain MRI spine is a single safe, non-invasive and quick method of describing the gamut of findings in patients of spinal dysraphism

Comparison of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in hepatobiliary disorders

Purpose of this study is to evaluate the diagnostic value of MRCP in hepatobiliary disorders and compare it with ERCP. Descriptive validation study. Radiology Department Military Hospital, Rawalpindi from 15 August 2006- 15 Feburary 2007. Fifty one consecutive patients included 37 males and 14 females were included. Out of 51 patients, 12 had malignant stricture, 05 had benign stricture, 06 had mass at porta hepatis, 05 had cholelithesis, 8 had choledocholithiasis, 03 had both cholelithesis and choledocholithesis, 3 had chronic pancreatitis, 04 had mass head of pancreas, 1 had sclerosing cholangitis and 4 patients had normal studies. MRCP was sensitive and specific. Positive and negative predictive values for choledocholithiasis were 100%, 95.3%, 100% and 97.9%. For cholelithesis and benign stricture 80%, 100%, 100% and 97.9% respectively. ERCP showed 5 cases of cholelitiasis, in comparison to MRCP, which had missed one case. In detecting malignant strictures MRCP was 91.7% sensitive and 100% specific. In cases of periampullary growths, it was difficult to cannulate the endoscope during ERCP. In these cases MRCP showed the level of obstruction non-invasively. MRCP was better in cases for chronic pancreatitis, in defining anatomy of pancreatic duct than ERCP, which has magnification factor of 1.5. Our findings confirm that MRCP, a noninvasive imaging technique of greater value in the diagnosis of hepatobiliary disorders as compared to ERCP

Post catheter diagnostic coronary angiography thrombotic complications at femoral vascular access site- an ultrasound based study

To determine the frequency of atherosclerotic plaques in common femoral artery in patients undergoing coronary angiography. Identify any significant post procedure change in plaque morphology. Determine the number of patients who develop thrombosis at the access site. Descriptive study. The study was carried out in Radiology Department, Military Hospital, Rawalpindi from 10 Aug 2005 - 09 Feb 2006. The patients undergoing coronary angiography were included in the study. Doppler ultrasound of the right common femoral artery [vascular access site] was done prior to and following coronary angiography. The ultrasound examinations were performed on ALOKA Prosound SSD 5500 using 7.5 MHz linear array probe. Out of the 100 patients included in the study, atherosclerotic plaque was detected in 10 patients at the femoral access site. Out of these 10 patients, having a plaque at access site 01 patient developed a thrombus at the access site. The post procedure diameter of the femoral artery was significantly reduced. Despite the advancements in technique and equipment a thrombus can form at the vascular access site. Doppler ultrasonography proves an ideal diagnostic tool in evaluation of cases with suspected access site complications

Frequency and magnetic resonance imaging patterns of tuberculous spondylitis lesions in adults

To find out the frequency and patterns of various lesions in tuberculous spondylitis in adults on magnetic resonance imaging [MRI]. Case series. Radiology Department, Military Hospital [MH] Rawalpindi, from September 2006 to March 2007. Patients with features suggestive of tuberculous spondylitis underwent plain T1-weighted and T2-weighted images and T1-weighted contrast enhanced images in both axial and sagittal sections. The data was analyzed in terms of frequency and patterns of various lesions of tuberculous spondylitis causing abnormal signals in spinal and paraspinal areas. Mean +/- standard deviation were calculated form numerical data using SPSS version 15. Out of 75 patients, 39 were females. The mean age was 42.4 years. Involvement occurred through SV1 vertebral levels. Most common involvement was seen in the thoracic vertebrae [40%] followed by lumbar vertebrae. The most common MRI feature was abnormal signal intensities appearing hypointense on T1W and hyperintense on T2W sequences with heterogeneous enhancement of the vertebral body in all patients. The characteristic findings of spinal tuberculosis included destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disc, and occurrence of paravertebral and epidural abscesses. MR imaging of spinal tuberculosis, characteristically showed contiguous involvement of two vertebrae along with the intervening disc, skip lesions, and paraspinal collections and provides critical information about the involvement of spinal cord and the extent of the disease

Diagnostic accuracy of magnetic resonance imaging in meniscal injuries of knee joint and its role in selection of patients for arthroscopy

Magnetic Resonance Imaging [MRI] is frequently advised to evaluate clinically suspected cases of meniscal injuries in our setup. The objective was to determine the diagnostic accuracy of MRI in meniscal injuries of knee joint and its effectiveness in selection of patients for arthroscopy. A Cross-sectional comparative study was conducted at Radiology Department Military Hospital [MH] Rawalpindi in collaboration with Orthopaedic Department Combined Military Hospital [CMH] Rawalpindi from 31 Jan 2007 to 1 Aug 2007. Fifty-seven patients with clinical suspicion of meniscal injuries were subjected to MRI. Arthroscopy was done only in 34 patients while 23 were excluded on the basis of MRI findings. MRI findings were compared with arthroscopic findings. Medial and lateral menisci were considered separately in each case. Among 57 patients only 30 showed significant tear on MRI. Arthroscopy was done in these cases. Arthroscopy was considered on clinical grounds only in 4 patients who did not show significant tear on MRI. MRI showed Medial Meniscus [MM] injury in 23 patients and Lateral Meniscus [LM] injury in 10 patients. Arthroscopy confirmed MM injury in 17 patients and LM injury in 7 patients. MRI missed two MM and one LM injuries. This showed that MRI has sensitivity of 89.4% and specificity of 62% in diagnosing injuries of MM, while sensitivity of 87% and specificity of 88% in diagnosing injuries of LM. Diagnostic accuracy of MRI in MM and LM injuries was 76.4% and 88.2% respectively. MRI is accurate in diagnosing meniscal injuries of knee joint and is effective in selection of patients for arthroscopy

Correlation of doppler waveform abnormalities of hepatic veins with histological findings in chronic liver disease [HCV infection]

To study the relationship of the abnormalities in Doppler waveform of hepatic veins with histologic findings in chronic liver disease [HCV infection]. cross- sectional study. Radiology Department Military Hospital Rawalpindi. The duration of study was one year from February 2004 to February 2005. 50 patients with non de-compensated HCV infection were studied, who were subjected to biopsy by medical specialists. Their Doppler waveforms of hepatic veins were noted. On histopathology, 4 cases [8%] had no evidence of fibrosis, 27 cases [54%] had mild, 15 cases [30%] had moderate and 4 cases [8%] had severe fibrosis. Three patterns of waveform were observed. These waveforms include normal triphasic waveform [type O], decreased amplitude of phasic oscillations without the reversed flow phase [type 1] and completely flat waveform [type 2]. Among 33 cases of type 0 flow, majority [85%] had either mild fibrosis. Twelve cases that had type 1 flow, majority [92%] had mild to moderate fibrosis. Out of 5 cases that were observed ultrasound type 2 flow, all had either moderate or severe fibrosis. The degree of fibrosis was related directly to the hepatic vein waveforms abnormalities [p<0.001]. Ultrasonographic abnormalities of Doppler waveforms of hepatic veins are equivalent to histology in predicting the progression of CLD

Congenital fetal anomalies antenatal ultrasound detection

A study carried out in two PAF hospitals radiology departments to determine the frequency of different anomalies by ultrasonographic detection. We subjected the pregnant ladies for ultrasonography who had basic screening done in obstetric department and had suspicion of some anomaly and were sent for detailed scanning. Other groups of patients were those who had bad obstetric history and sent from gynecological department for detailed scanning. About 200 patients were scanned, Out of these 134 had different anomalies and the commonest was from central nervous system with relatively more prevalent in cousin marriages. The study concluded in a small section of population showed the preponderance of neural tube defects as detected by ultrasonography but an area which was not subjected to detailed scanning was cardiac anomaly scanning due to non-availability of equipment and expertise in peripheral hospitals and may be possible in dedicated tertiary care hospitals

Role of MRI in differentiating various causes of non-traumatic paraparesis and tetraparesis

To assess the frequency of various causes of non-traumatic paraparesis and tetraparesis in adults based only on the findings of magnetic resonance imaging [MRI]. Design: Non-interventional descriptive study carried out from May 2001 to October 2002 at Radiology Department, CMH, Rawalpindi. Patients and A total of 100 adult patients who presented with non-traumatic paraparesis or tetraparesis, were studied. MRI spine of all the patients and MRI brain of selected patients, was carried out. Based on MRI findings alone causes of non-traumatic paraparesis and tetraparesis were categorized. Paraparesis was more frequent than tetraparesis. Cord compression was found in 72% cases. Neoplastic compression, infective spondylitis and non-compressive myelopathies were the main causes of paraparesis while spondylotic myelopathy was the main cause of tetraparesis. Based upon MRI findings causes of non-traumatic paraparesis or tetraparesis can be subcategorized into spondylotic, infective or neoplastic cord compression and non-compressive myelopathies. Further subcategorization of neoplastic lesions according to their compartment of origin can also be done