Radiology Commons^™

Guyon's Canal Syndrome Due To Tortuous Ulnar Artery With Dequervain Stenosing Tenosynovitis, Ligamentous Injuries And Dorsal Intercalated Segmental Instability Syndrome, A Rare Presentation: A Case Report., Muhammad Zeeshan, Farhan Ahmed, Darakhshan Kanwal, Qazi Saad Bin Khalid, Muhammad Nadeem Ahmed

Department of Radiology

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on Patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery. Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve Patient's …

Carotid Artery Disease In Patients Undergoing Elective Coronary Artery Bypass Surgery, Waseem Akhtar, Ayan Sabih, Arif Ali, Mubashir Aslam, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting (CABG) using Doppler sonography.STUDY DESIGN: Observational study.

PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008.

METHODOLOGY: Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. …

The 'Molar Tooth Sign' In Joubert Syndrome, Imaad Ur Rehman, Zablon Bett, Yousuf Husen, Ali Syed Muhammad Akhtar, Faisal Aziz Khan

Department of Radiology

The molar tooth sign is seen in very few conditions and is a very rare paediatric central nervous system congenital anomaly. Molar tooth sign is the result of cerebellar vermis hypoplasia, thick and maloriented superior cerebellar peduncles, and an abnormally deep interpeduncular fossa. In Joubert syndrome this is seen in about 85% of patients. We present a case of 13 months old baby boy with recurrent episodes of fits and hyperpnoea, regression of milestones and developmental delay. MRI examination showed the characteristic molar tooth sign with apposition of cerebellar hemispheres, batwing-shaped fourth ventricle communicating through a thin fissure with foramen …

Malignant Phyllodes Tumour As An Intracystic Growth With Osteosarcomatous Differentiation, Shaista Afzal Saeed, Imrana Masroor

Department of Radiology

Phyllodes tumour is an uncommon fibro epithelial tumour of breast that often presents clinically as a rapidly enlarging lump. On mammography it appears as a soft tissue density well circumscribed mass. Ultrasound shows it to be a solid hypoechoic mass with small cystic spaces. A case of malignant phyllodes tumour with an atypical appearance of intracystic tumour on sonography is reported with pertinent imaging features and histopathological diagnostic criteria. The tumour had undergone osteosarcomatous differentiation.

Application And Advantage Of Functional Magnetic Resonance Imaging And Blood Oxygen Level Dependant (Bold) Imaging Modality, Humera Ahsan, Muhammad Akbar, Atta-Ul-Aleem Bhatti

Department of Radiology

The objective of the study was to introduce the availability of bold imaging facility at Aga Khan University Hospital Karachi for the first time in Pakistan and also to review the practical application and advantages of functional magnetic resonance imaging (fMRI) and blood oxygen level dependant (BOLD) Imaging Procedures. The study was conducted at Aga Khan University Hospital, Karachi from August 2008 to November 2008 .Three patients were selected that had presented with intracranial space occupying lesions. They underwent Functional Magnetic Resonance Imaging (fMRI). The findings of the images were important to describe and localize the eloquent brain areas and …

Cost-Effectiveness Of Clipping Vs Coiling Of Intracranial Aneurysms After Subarachnoid Hemorrhage In A Developing Country-A Prospective Study, Muhammad Zubair Tahir, Ather Enam, Rushna Pervez Ali, Atta Bhatti, Tanveer Ul Haq

Section of Neurosurgery

Background: Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular. treatment vs surgical clipping in a developing country.
Methods: The study population consisted of 55 Patients with aneurysmal subarachnoid hemorrhage (SAH) identified prospectively from January 2004 to June 2007. Of the 55 Patients with ruptured intracranial aneurysms, 31 underwent surgical clipping, whereas 24 were treated via interventional coils. Clinical outcome at 6 …

Labrad : Vol 34, Issue 3 - October 2009, Aga Khan University Hospital, Karachi

LABRAD

• Detection of Amoebic Meningitis by Wet Film of Cerebrospinal Fluid (CSF)
• Biochemical Tests in the Diagnosis of Anaemia
• Pathophysiology and Laboratory Investigation in Anaemia of Chronic Disease
• Haematogones: A pitfall in the Diagnosis of Leukemias/Lymphoma in Children
• Porphyria: The Mysterious Disease
• Imaging Features of Thalassaemia and Sickle Cell Anaemia
• N-Terminal Pro-BNP for Rapid Diagnosis of Heart Failure
• Frozen Section: A Rapid Diagnostic Tool
• Prenatal Diagnosis of ß-Thalassaemia
• Farewell to Administrative Director, Mr Sajid Khan

Congenital Cystic Adenomatoid Malformation: Case Report, K. C. Wafula, S. Waa

Imaging & Diagnostic Radiology, East Africa

Congenital cystic adenomatoid malformation of the lung is a rare lesion that typically manifests as severe progressive respiratory distress in the neonate secondary to expansion of the affected lung. We present a neonate in whom this condition was diagnosed and managed at the Aga Khan University Hospital. In presenting this patient, we hope to highlight the radiological aspects of this condition which, with prompt recognition and management and in the absence of pulmonary hypoplasia, foetal hydrops or other congenital anomalies, has a favourable prognosis.

Negative Predictive Value Of Mammography And Sonography In Mastalgia With Negative Physical Findings, Imrana Masroor, Shaista Afzal, Saima Sakhawat, Nadir Khan, Mirza Amanullah Beg, Darakhshan Kawal

Department of Radiology

OBJECTIVE: To determine the negative predictive value of mammography and sonography in patients with focal/ diffuse breast pain with negative physical examination of the breasts.

METHODS: A descriptive study, conducted at Radiology Department ofAga Khan University Hospital from 2006-2007 for a period of 2 years. A total of 207 women were referred for mammography and sonography because of focal or diffuse breast pain. Complete follow-up was available only in 55 patients. The outcome or gold standard was mammograms or ultrasound after an average follow-up period of 18 months with negative/benign findings or histopathology of the suspicious lesion or imaging which …

Staging Of Endometrial Carcinoma By Magnetic Resonance Imaging: Correlation With Surgery And Histopathology, Fatima Mubarak, Mirza Waseem Akhtar, Gul-E-Khanda, Yusuf A Husen

Department of Radiology

OBJECTIVE: To evaluate the accuracy of MRI in staging of endometrial carcinoma, and comparison with surgery and histopathological findings.

METHODS: A one year prospective cross-sectional study was conducted from 10/3/2005 to 31/5/2006, at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty two patients with diagnosis of endometrial carcinoma, referred to radiology department for preoperative staging by MRI and had undergone surgery were included.

RESULTS: MRI was found to be 79% sensitive, 85% specific and 80% accurate for staging endometrial carcinoma while PPV and NPV were 97% and 66% respectively.

CONCLUSION: Magnetic resonance imaging is a good, safe, accurate …

Use Of Magnetic Resonance Spectroscopy (Mrs) To Improve Magnetic Resonance Imaging (Mri) In The Diagnosis Of Intracranial Pathology, Done At Aga Khan University, Joyce Sande

Theses & Dissertations

Introduction: Magnetic Resonance Spectroscopy (MRS)is a potentially useful adjunct to Magnetic Resonance Imaging (MRI) in thecharacterization of focal brain lesions. This study was aimed at showing that by the additional use of MRS (MRI, MRS), the characterization of a focal brain lesion into neoplastic, or non- neoplastic (infective, or degenerative) can be improved, as compared to the use of MRI alone.

Study question: Does the additional use of MRS improve MRI differentiation of neoplastic from non- neoplastic (infective or degenerative) focal brain lesions?

Methods: The design was prospective, analytical and comparative. 80 consecutive patients were enrolled. Conventional MRI of the …

Evaluating The Diagnostic Performance Of An Initial Transvaginal Sonogram (Tvs) In Patients With Suspected Ectopic Pregnancy, Zablon Bett

Theses & Dissertations

Purpose of the study: To evaluate the diagnostic performance of an initial transvaginal sonogram (TVS) in patients with suspected ectopic pregnancy (EP).

Objectives: 1) To determine the accuracy, sensitivity, specificity, positive and negative predictive values of an initial TVS scan in patients with suspected EP. 2) To determine the diagnostic utility of TVS findings as predictors of EP.

Methodology: This was a descriptive, prospective study of 131 consecutive mothers who had TVS for clinical suspicion of EP at the Aga Khan University hospital over a 12 month period between November 2007 and October 2008. The scans were performed in our …

Arterio-Venous Fistula Of Upper Arm Observed With Injection Abscess, Saba Sohail, Misbah Talpur

Department of Radiology

No abstract provided.

Clinical Radiology Research In Pakistan: From Evidence To Practice, Waseem Akhtar, Arif Ali, Mubashir Aslam, Gul-E-Khanda

Department of Radiology

OBJECTIVE: To assess the clinical radiology research productivity in Pakistan by type of publication, sources of funding and name of journals.

METHODS: A systematic search strategy using key words related to techniques and type of clinical radiology was carried out to identify various studies published in Indexed (Medline) and non-indexed (Pakmedinet) medical journals.

RESULTS: Total of 397 studies were identified out of which 173(43%) from Medline (indexed database) and 220 (57%) from pakmedinet (Indexed and non- indexed database of Pakistan Medical journals). Original articles were 294 (74%) but most of them (68%) were published in non-indexed journals and significantly different …

Knowledge, Attitude And Preventive Practices For Breast Cancer Among Health Care Professionals At Aga Khan Hospital Karachi, Shiyam Kumar, Ayesha Mallick Imam, Nauman Fazal Manzoor, Nehal Masood

Department of Radiation Oncology

OBJECTIVE: To assess the knowledge and practice of risk factors, symptoms and screening for breast cancer among health care professionals.

METHODS: A cross sectional study was carried out at The Aga Khan University Hospital from January 2008 to March 2008. A total of 336 health care workers including consultants (48), fellows (17), residents (76), medical officers (14), interns (37), nurses (94) and fourth and final year medical students (50) were requested to fill a questionnaire designed to assess the knowledge about the risk factors, signs and symptoms, screening tools, breast self examination (BSE) and treatment.

RESULTS: More than two third …

Chorioangioma Of The Placenta With Hydrops Foetalis, Gulnaz Shafqat, Farah Iqbal, Farhan Rizvi

Department of Radiology

Chorioangioma, the non trophoblastic tumour, constitutes the commonest benign growth of the placenta. Though benign, 30% rate of maternal or foetal complications are associated with large masses. Sonography including colour Doppler imaging provides the best modality not only for its diagnosis but also the foetal status. A case of large placental chorioangioma has been reported here resulting in dismal foetal outcome diagnosed on antenatal ultrasound.

Old Disease, New Targets--Part-I, Solid Malignancies, Shiyam Kumar, Nehal Masood, Asim Jamal Shaikh

Department of Radiation Oncology

Targeted agents are now an integral part of treatment regimens for some cancers. Trastuzumab is established in treatment of human epidermal receptor 2 (Her2) positive breast cancers, with improvements in both, the disease free and over all survival. Monoclonal antibody (MoAB) against vascular growth factor receptor (VEGF), bevacizumab and cetuximab a MoAB against epidermal growth factor receptor (EGFR) are establishing their role in a many cancers after making their mark in colorectal cancer. Sorafenib and sunitinib have success stories in renal carcinoma. The Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial has established sorafenib role in advanced hepatocellular carcinoma, while …

Labrad : Vol 34, Issue 2 - May 2009, Aga Khan University Hospital, Karachi

LABRAD

• Acute Leukemia Immunophenotyping with Pakistani Perspective
• PAX5: Immunohistochemistry Marker for B cell Lymphoproliferative Disorders
• Understanding the Water Deprivation Test
• Gonadotropins Releasing Hormone (GnRH) Stimulation Test
• Haematology Quiz
• Red Cell Mass Study
• Semen Analysis: An Invaluable Tool for Infertility Work-up
• Foetal Anomaly Scan
• Diagnosis of Helicobacter Pylori Infection
• Hepatitis C Virus (HCV) Genotyping
• Answer to Haematology Quiz

To Evaluate The Role Of Sonography As An Adjunct To Mammography In Women With Dense Breasts, Imrana Masroor, Mohammad Nadeem Ahmed, Sajida Pasha

Department of Radiology

OBJECTIVE: To assess the role of sonography as an adjunct to mammography in women with dense breast tissue by determining yield and validity of sonography using histopathology/follow-up mammography as gold standard.

METHODS: It was a descriptive analytical study conducted at the Radiology Department of Aga Khan University Hospital, from September 2005 to April 2007. A total of 76, mammographically dense breasts were evaluated with ultrasound. Of these 32 had palpable lumps on mammography, and were excluded from the study. A total of 44 patients had either symptoms of vague nodularity, nipple discharge, mastalgia or had no symptoms and the mammograms …

Diffusion Weighted Image (Dwi) Findings In Methanol Intoxication, Humera Ahsan, Muhammad Akbar, Aamir Hameed

Department of Radiology

Methanol is a toxic substance with extremely devastating effects upon exposure. The case described suffered from such kind of poisoning. MRI brain demonstrated necrosis bilaterally in the Putamen areas which is a classic hallmark finding. Additional Diffusion weighted imaging showed abnormal signal bilaterally in the putamen areas along with Diffusion positive bilateral lesions (possibly infarctions) in both the frontal and occipital lobes that were not evident on MRI with or without contrast.

Evaluation Of Suspected Renal Colic Patients With Unenhanced Low-Dose Multi-Detector Computed Tomography, N. Twahirwa, J. Rees

Imaging & Diagnostic Radiology, East Africa

Objectives: To determine the proportion of correctly diagnosed ureteric calculi and alternate diagnoses using unenhanced low dose multidetector CT KUB.

Design: Descriptive – prospective study.

Setting: Aga Khan University Hospital, Nairobi between November 2006 and October 2007.

Subjects: One hundred and four patients underwent low dose multi-detector computed tomography (MDCT) KUB.

Results: Ninety (47 males and 43 females with age range of 17 - 79 years, mean 40 years) were included in the statistical analysis while 14 were excluded. Eighteen out of ninety (20%) were classified as definitely having ureteric calculi on the composite reference. Among the 18, 17 were …

Instituting An Undergraduate Core Clerkship In Radiology: Initial Experiences In Pakistan, Naila Nadeem, Abdul Mueed Zafar, Muhammad Nadeem Ahmad

Department of Radiology

Utilization of radiology as an educational resource carries great potential. Accreditation bodies, physicians and medical students deem it important for a well rounded medical curriculum. Unfortunately this resource is yet to be developed and implemented to an optimal extent. We share the experiences from the first radiology core clerkship in Pakistan at the undergraduate level. An overview of clerkship objectives and structure is followed by discussion on lessons learnt during the initial three years of institution. Development of assessable objectives, integration of radiology with other specialties, and supervised andragogical learning tailored for undergraduate students are emphasized.

Doptaus - A Simple Criterion For Improving Sonographic Diagnosis Of Acute Appendicitis, Saba Sohail, Kausar Jehan Siddiqui

Department of Radiology

Objective: To determine the efficacy of 'Detection Of Pin-point Tenderness on the Appendix on abdominal UltraSound' (DOPTAUS) for improving sonographic diagnosis by junior and senior ultrasound operators.
Methods: An analytical study was done at the Radiology Department, Dow University of Health Sciences and Civil Hospital Karachi from March 2005 to December 2006. Adult patients of either gender with clinically suspected acute appendicitis referred to the department during regular working hours and later operated in the same hospital were included. Each patient was scanned by a junior and a senior ultrasound operator using the conventional criteria first and later focused ultrasound …

Cerebral Fungal Infection With Mycotic Aneurysm Of Basilar Artery And Subarachnoid Haemorrhage, H. Ahsan, F. Ajmal, M. F. Saleem, A. B. Sonawala

Department of Radiology

A 28-year-old Pakistani man was admitted with unresolved severe headaches for the past four weeks. Magnetic resonance (MR) imaging and MR angiography showed an enhancing mass in the sphenoid sinus, bilateral cerebellar infarcts and aneurysmal dilatation of the basilar artery. The differential diagnosis included fungal infection versus neoplastic lesion. The scrappings taken through the endoscope from the sphenoid sinus were initially negative for fungal infection. However, the second biopsy, done after putting him on antifungal, itraconazole 200 mg twice daily, revealed the presence of a fungal infection (aspergillosis). MR imaging revealed extension of the fungal infection from the sphenoid sinus …

Labrad : Vol 34, Issue 1 - January 2009, Aga Khan University Hospital, Karachi

LABRAD

• N-Telopeptide of Type I Collagen (NTx): A Biochemical Tool for Assessing Bone Turnover
• Automated Blood Grouping
• Leukocyte Alkaline Phosphatase (LAP Score)
• Pathology Quiz
• Synovial Fluid Analysis in Important Joint Diseases
• Intraductal Papillary Mucinous Tumor (IPMT) of the Pancreas: A Diagnostic Challenge
• Hepatitis Delta Virus (HDV)
• Answers to Pathology Quiz
• Thyroid Autoimmune Diseases and Thyroid Peroxidase (TPO) Antibody
• Therapeutic Monitoring of Tacrolimus
• Meeting Report: 32 Annual Conference of Pakistan Association of Pathologists
• AKU Clinical Laboratory Continuing Medical Education (CME) Seminar in Bahawalpur

Autoimmune Pancreatitis: Disease Evolution, Staging, Response Assessment, And Ct Features That Predict Response To Corticosteroid Therapy, Dushyant V. Sahani, Nisha I. Sainani, Vikram Deshpande, Mehrine S. Shaikh, Dmitry L. Frinkelberg, Carlos Fernandez-Del Castillo

Department of Radiology

Purpose:To evaluate the evolution of morphologic features of autoimmune pancreatitis (AIP) at computed tomography (CT) and to identify imaging features that can predict AIP response to corticosteroid therapy (CST). Materials and

Methods:

This HIPAA-compliant retrospective study had institutional review board approval. From among a cohort of 63 Patients with AIP, 15 Patients (12 men, three women, mean age, 64.7 years, age range, 30-84 years) who underwent sequential CT examinations before treatment were included to assess the evolution of disease by reviewing pancreatic, peripancreatic, and ductal changes. Of these Patients, 13 received CST and underwent posttreatment CT, these CT studies …

An Audit Of Editorial Processing At Jcpsp: Issues And Compliance, Saba Sohail

Department of Radiology

No abstract provided.