Role of HRCT Temporal Bone in Pre-operative Assessment of Tegmen Height in Chronic Otitis Media Patients.

OBJECTIVES: High-resolution CT (HRCT) temporal bone has emerged as a useful option in pre-operative assessment of tegmen height in chronic otitis media patients. MATERIAL AND METHODS: A total of 60 patients with clinical suspicion of chronic otitis media were enrolled in the study. HRCT evaluation was done using Siemens Somatom Force 384 slice multidetector computed tomography machine. We radiologically assess tegmen height using lateral semicircular canal as a reference point on HRCT. Final result has been based on correlation of radiological and intraoperative findings. Diagnostic efficacy of HRCT temporal bone was evaluated in terms of sensitivity, specificity, PPV, NPV, and accuracy for pre-operative assessment of tegmen height. RESULTS: The correlation between actual tegmen height and estimated tegmen height (by equation) was 0.457 which is highly significant (P < 0.001). In the study, the mean tegmen height of exposed dura (ED) was 5.81 ± 1.71 (95% CI 4.91-6.70) while the mean tegmen height of non-exposed dura (NED) was 8.40 ± 1.31 (95% CI 8.02- 8.78). Highly significant difference was found in mean tegmen height between ED and NED cases (P < 0.001). CONCLUSION: Pre-operative CT assessment of tegmen height is an important parameter in assessing risk of dural injury during tympanomastoid surgeries.

Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis.

OBJECTIVES: The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings. MATERIAL AND METHODS: This cross-sectional study was conducted on 67 patients of 18-65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis. RESULTS: On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV. CONCLUSION: The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

Role of Dual-Energy Computed Tomography in Characterization of Ureteric Calculi and Urinary Obstruction.

Objective The present study was carried out to assess the accuracy of dual-energy computed tomography (DECT) in the morphological and chemical characterization of ureteric calculi along with the prediction of the grade of urinary obstruction. Methods This was a prospective observational study that included 100 cases with ultrasonography (USG)-diagnosed ureteric calculi that underwent surgery or had spontaneous expulsion of ureteric calculi. At enrolment, DECT was performed for an in vivo evaluation of volume, chemical composition, and grade of obstruction by subjective assessment of the perinephric edema. After surgical intervention, in vitro evaluation of volume was done by fluid displacement followed by infrared spectroscopy (IRS) for chemical composition. DECT findings were compared with the biochemical analysis and degree of obstruction was validated against excretory CT urograms. Sensitivity, specificity, and the positive predictive and negative predictive values of DECT were assessed. Results No significant difference was observed between the mean volume of stones by fluid displacement (65.1±77.61 mm3) and DECT assessment (66.09±81.78 mm3). IRS revealed the composition of stones as hydroxyapatite, uric acid, cysteine, oxalic acid, and mixed type in 48, 23, 15, five, and nine cases. The sensitivity and specificity of DECT for hydroxyapatite, uric acid, cysteine, oxalic acid, and mixed types were 89.6% and 88.5%, 82.6% and 97.5%, 86.7% and 96.5%, 80% and 98.9%, and 88.9% and 98.9%, respectively. On CT urography, a total of 35 had a high-grade and 65 had a low-grade obstruction, whereas DECT revealed high- and low-grade obstructions in 42 and 58 cases. The sensitivity and specificity of DECT for a high-grade obstruction were 94.3% and 86.2%. Conclusions The findings of the study showed that DECT provides comprehensive information regarding the morphological, chemical, and anatomical characterization of ureteric stones.

Diagnostic Accuracy of Multidetector CT in Detection of Early Interstitial Lung Disease With Its Role in Characterization.

Background Multidetector CT (MDCT) has emerged as a useful option for early diagnosis of interstitial lung disease (ILD) with adequate accuracy. Methods A total of 80 patients with restricted pulmonary functions and clinical suspicion of ILD were enrolled in the study. MDCT evaluation was done using Siemens Somatom Force 384 slice multidetector computer tomography machine. Pattern analysis for reticular opacities, nodules and lung opacities was done to reach at a diagnosis. Final diagnosis was based on correlation of radiological and clinicopathological findings. Diagnostic efficacy of MDCT was evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detection of ILD. Results Mean age of patients was 58 ± 8.75 years. Majority were females (51.3%). History of chronic obstructive pulmonary disease (COPD), tuberculosis and bronchial asthma was revealed in 31 (38.8%), 26 (32.5%) and 16 (20%) patients, respectively. There were 30 (37.5%) patients having no history of respiratory diseases. MDCT diagnosed ILD in 45 (56.3%) cases. On final diagnosis, ILD was diagnosed in 35 (43.8%) cases (15 usual interstitial pneumonia [UIP], 9 cryptogenic organizing pneumonia [COP], 8 nonspecific interstitial pneumonia [NSIP] and 3 respiratory bronchiolitis associated interstitial lung disease [RBILD]). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT in detection of ILD was 91.4%, 71.1%, 71.1%, 91.4% and 80%, respectively. Conclusion MDCT as a single modality had a high sensitivity for detection of ILD and could be recommended as first line diagnostic imaging technique.

A Comparative Assessment Between High-resolution Ultrasonography and Field Magnetic Resonance Imaging in Supraspinatus Tear Cases and Its Arthroscopic Correlation.

Background Diagnosis of a supraspinatus tear in patients presenting with shoulder pain is a difficult task and often requires the help of an MRI. However, in recent years, high-resolution ultrasonography (USG) has been utilized as a cheaper yet sensitive alternative. The aim of the study is to provide a comparative assessment of supraspinatus tears between USG and MRI in relation to arthroscopic results. Methods A total of 60 patients with shoulder pain for the last three months or more scheduled to undergo arthroscopic surgery for their shoulder disorder were enrolled; those having any congenital deformity of the shoulder or having any contradiction to an MRI were excluded from the assessment. All the patients underwent high-resolution ultrasonography (HRUSG) and MRI evaluation. Both the USG and MRI findings were correlated with the arthroscopic findings. Results On ultrasonography, 34 (56.67%) full-thickness tears and 22 (36.67%) partial-thickness tears of the supraspinatus were detected. On MRI, 36 (60.0%) were diagnosed as a full-thickness tear and 20 (33.33%) as a partial-thickness tear. After arthroscopy, 36 (60.00%) were confirmed as a full-thickness tear and 20 (33.33%) as a partial-thickness tear of the supraspinatus. For a full-thickness tear, the sensitivity and specificity of USG and MRI were 95.0% and 92.5%, and 85% and 92.5%, respectively. For a full-thickness tear, the sensitivity and specificity of the modalities were 94.4% and 100%, respectively. Conclusion HRUSG and MRI both had high comparable accuracy for detection of a supraspinatus tear, however, HRUSG had an edge over MRI in the detection of a partial tear.

Rare Variant of Carcinoma Prostate Masquerading as Benign Prostatic Hyperplasia.

Prostatic ductal adenocarcinoma, is an uncommon entity in the spectrum of prostatic carcinoma. Clinically it is different from common prostatic acinar adenocarcinoma. It is usually more aggressive than prostatic acinar adenocarcinoma. We are presenting a case report on prostatic ductal adenocarcinoma, a cystic variant of prostatic carcinoma in a 55-year-old man who complained of obstructive urinary symptoms with mildly raised prostate-specific antigen (PSA). On further evaluation in our radiology department a cystic lesion with enhancing polypoidal soft tissue component was noted in prostatic parenchyma. Histopathology confirmed the diagnosis of ductal adenocarcinoma.