Extra Neural Metastasis Of Glioblastoma Multiforme: A Literature Review.

Extra-neural metastases of glioblastoma multiforme are uncommon with unidentified metastatic mechanism. There is no consensus over optimum treatment regimen. The current narrative review was planned to illuminate the presence criteria, sites of metastatic spread, incidence, mechanism, risk factors and management.

CT Chest Severity Score for COVID 19 Pneumonia: A Quantitative Imaging Tool for Severity Assessment of Disease.

OBJECTIVE:   To determine a cut-off value of Chest CT severity score (CT-SS) in order to discriminate between the clinical types of COVID-19 pneumonia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Shifa International Hospital, from 1st March to June 30th, 2020. METHODOLOGY: One hundred and three consecutive patients' RT PCR positive for COVID-19 were included. Two consultant radiologists, with experience of 7 to 10 years in body imaging, evaluated their HRCT studies in consensus and calculated the CT severity score. A scoring of all 20 individual regions in each lung were assigned by the radiologists attributing a score of 0, 1 or 2 to each region, if parenchymal opacification was none, less than 50%, or 50% or more, respectively. The CT severity score was a summation of scores of all 20 regions of both lungs combined with a range of 0 to 40 points. The scores were compared for clinically mild and severe disease. RESULTS: Significant differences were noted regarding the scoring of lung opacity in mild and severe groups in each lung segment, p <0.05. The most significantly involved segments were right lower lobe's medial and lateral basal segment, left upper lobe's superior lingular segment and left lower lobe's medial basal and lateral basal segments. To discriminate mild versus severe disease, CT-SS threshold value turned out to be 19.5 Conclusion: CTSS may be of value for a prompt and objective means of assessing the degree of severity and disease burden in lungs. Key Words: COVID-19, COVID-19 diagnosis, Pneumonia, Novel coronavirus, CT severity score, Respiratory tract infection, Triage, Pandemic, RT-PCR, SARS-COV 2, Outbreak.

Cranial CT scan evaluation of morphological variations and location of pterion in Pakistani male population for lateral neurosurgical approach.

OBJECTIVE: To determine the morphological variations and location of pterion in Pakistani male population. METHODS: This retrospective observational study was carried out in the Department of Radiology, Shifa International Hospital from December 2018 to June 2019. The sample size was calculated by Open Epi web-based calculator. Fifty-three cranial CT scans with slice thickness of 0.5mm; consecutive scans of males were randomly selected. The patients with no craniofacial fracture and ages from 25 to 45 years were included. The dataset was obtained from Toshiba Aquilion One, 360-slice MDCT. The images were imported into the imaging software PACS (WFM), and analyzed in maximum intensity projection mode with three dimensional multiplanar reconstruction viewers. Measurements were taken in lateral projections of skull in Frankfurt plane, as horizontal and vertical distance from the posterolateral margin of frontozygomatic suture to center of pterion. Vertical distance from the superior border of zygomaticotemporal arch to the center of pterion. The morphological types were also recognized. RESULTS: The type of pterion on right side was 94.3% sphenoparietal 5.6% epipteric whereas left side was (90.5%) sphenoparietal (3.7%) epipteric, (3.7%) stellate type, (1.8%) frontotemporal type. The mean horizontal and vertical frontozygomatic measurements on right side were 2.23 ± 0.22cm and 1.25±0.219 cm respectively. The same measurements on the left side were 2.27-±0.25 cm and 1.226-±0.22 cm respectively. The mean zygomaticotemporal measurements on the right and left sides were 3.45 ±0.29cm and 3.44 ±0.25 cm respectively. The mean distance on right and left side of skull was statistically insignificant. CONCLUSION: The study provides useful data for position and location of pterion for safe neurosurgical procedures via pterion. Moreover, the knowledge about different morphological types of pterion help the radiologist to differentiate between a fracture line and normal morphological variety.

SAPHO Syndrome in an Adult Male with Ulcerative Colitis.

Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) syndrome refers to a rare entity expressed by a combination of dermatological and osteoarticular manifestations. We report a case of this unique syndrome initially diagnosed as "Sweet's syndrome" due to more or less similar features. The patient is also a diagnosed case of ulcerative colitis, a rare association with SAPHO syndrome. The clinical picture, laboratory findings and most of all radiological features, ultimately directed us towards the final diagnosis. The purpose of this case report is to raise awareness regarding this unusual syndrome, its clinical manifestations, laboratory and radiological findings, so that proper management can be carried out in time.

MRI Appearances of Colitis Cystica Profunda: A Rare Benign Mimicker of Colorectal Malignancy.

Colitis cystica profunda (CCP) is a rare benign disease characterised by mucin-filled cysts beneath the muscularis mucosae, which commonly involves the rectum and sigmoid colon. The disease process involving rectum is termed as proctitis cystica profunda. Trans-rectal ultrasound (TRUS) and magnetic resonance imaging (MRI) are an aid to diagnosis. However, histological analysis of deep biopsy is diagnostic. We report a case of 21-year male who presented with bleeding per rectum and was diagnosed as solitary ulcer of the rectum (SRUS) on superficial biopsies on sigmoidoscopy. Surgical intervention coupled with MRI findings and histopathological analysis formulated diagnosis of CCP. To our knowledge, we are second to report this entity with its MRI features.