Radiology Commons^™

Mesenteric Panniculitis With Pedal Edema In A 33-Year-Old Pakistani Man: A Case Report And Literature Review., Abdul M Zafar, Muhamad A Rauf, Tabish Chawla, Gule Khanda

Department of Radiology

Introduction:Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death. Case Presentation: A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The Patient underwent an exploratory laparotomy based …

Comparison Of Mandibular Alveolar Bone With Facial Type Using Cbct, Jason M. Loop

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to evaluate the relationship between facial type and cortical bone thickness (mm), cortical bone density (rHU) and trabecular bone density (rHU) in the mandibular alveolar bone. Twenty-five consecutive dolichofacial, 25 consecutive mesiofacial, and 25 consecutive brachyfacial patients with T1 lateral cephalograms and CBCT scans were used in this study. A Ricketts analysis was used to compute the VERT index for each patient. All statistical analyses were performed at the significance level of α = 0.05. The one-way ANOVA and LSD post hoc tests indicated there was a statistically significant relationship between facial type and …

Buccal Bone Changes Following Rapid Maxillary Expansion (Rmf), Long-Term Results, Elena S. Iacob

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to use Cone Beam Computed Tomography (CBCT) images to quantitatively evaluate buccal bone changes of maxillary first premolar (P1), second premolar (P2) and first molar (M1) shortly after Rapid Maxillary Expansion (RME) and at the end of orthodontic treatment, as well as to evaluate the variables that may be associated with the short-term and long-term changes. Forty-seven consecutive patients (25 males and 22 females) with a mean age of 14.5years and who required RME as part of their orthodontic treatment and had pre-RME (T1) and post-RME (T2) CBCT images available were used for the …

Assessment Of Menisci And Ligamentous Injuries Of The Knee On Magnetic Resonance Imaging: Correlation With Arthroscopy, Gul-E Khanda, Waseem Akhtar, Humera Ahsan, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To evaluate the validity of MRI, in the assessment of the meniscal and cruciate ligamenteous injuries of the knee joint and comparison with arthroscopic findings.

METHODS: A one year prospective cross-sectional study from January 2006 to January 2007, was performed on 50 patients (32 males & 18 females) with knee injury presenting at the orthopedic unit of AKUH. The patients were referred to radiology department for MRI evaluation and arthroscopy.

RESULTS: The sensitivity, specificity and accuracy for MRI of the menisci and ligaments were as follows: medial meniscus resulted in 100% sensitivity, 69.27% specificity, 90% PPV, 100% NPV and …

Torsion Of Fallopian Tube, Fimbrial Cyst, Imrana Masroor, Nadir Khan

Department of Radiology

A case of fallopian tube fimbrial cyst torsion with haemorrhage is presented, occurring in a 37-year-old female who had tubal ligation 6 years back. She presented in emergency with acute abdomen. Initial assessment of ovarian cyst haemorrhage or torsion was made. Ultrasound showed cystic structures in left adnexa and complex cyst in right adnexa with suspicion of torsion. Laparoscopy was performed and bilateral fimbrial cysts in fallopian tubes were identified with torsion on right side, and a left ovarian haemorrhagic cyst, which was subsequently confirmed on histopathology. Although fallopian tube torsion of fimbrial cyst is rare, it should be considered …

Labrad : Vol 33, Issue 3 - September 2008, Aga Khan University Hospital, Karachi

LABRAD

• Vitamin D Deficiency: Are We Still Ignoring the Evidence?
• Collection and Transport of Urine for Culture
• Understanding and Interpreting Serum Protein Electrophoresis
• Cystic Fibrosis at a Glance
• What you need to know about Dengue Infection
• CT Colonoscopy: Introduction
• CT Enteroclysis: A New Technique to Evaluate Small Bowel
• CSF-DR: An Important Diagnostic Tool
• G6PD Quantification
• Quality Assurance
• Clinical Laboratory Continuing Medical Education (CME) Seminars
• Meeting Reports

Predictive Measures Of Cognitive Outcome In Adults Sustaining Brain Injury, Herminia De La Rosa-Trujillo

Loma Linda University Electronic Theses, Dissertations & Projects

To date, there is no consistent and accurate outcome prediction method for patients with traumatic brain injury (TBI). Commonly used clinical measures such as the Glasgow Coma Scale (GCS) and traditional radiological methods of x-rays and computed tomography (CT) scans do not always accurately predict patient functional outcome. These radiological methods are adequate in determining gross structural anatomical disturbances, however, they are unable to detect more diffuse cellular damage believed to be responsible for the functional impairments evidenced in patients sustaining TBI. Magnetic resonance imaging allows for various non-invasive sequencing techniques that have demonstrated to be a potentially valuable method …

Orthodontic Mini-Implant Failure: Assessing The Relationship To Bone Quality Using Qcbct, Joshua Schneider

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to evaluate the cortical bone thickness (mm), cortical bone density (HU), and trabecular bone density (HU) of mini-implants sites in both the maxilla and mandible using QCBCT to determine if they had any effect on mini-implant failure rate. Patient characteristics (age, gender, facial type), mini-implant characteristics (date of placement, manufacturer, length, and diameter), and the mini-implant site (region) were also evaluated. One hundred and six mini-implants in 50 consecutive patients with complete patient records, CBCT information, and T1 radiographs were included in the study. Thirty-four of the 106 mini-implants were considered "failures" resulting in …

The Comparative Radiopacity Between Primary And Permanent Teeth, Robert C. Lee

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: This in vitro study compared the radiopacity between human primary and permanent enamel and dentin. It also compared the radiopacity between human anterior and posterior teeth.

Methods: Extracted primary and permanent teeth were used in this study. One mm enamel and one mm dentin slices were cut from each extracted tooth. Radiographs were taken of each enamel and dentin specimen 1 mm in thickness along with an aluminum step-wedge using procedures specified in International Standards Organization (ISO) 4049:2000. A densitometer was used to measure the Optical Density (OD) of the radiographs of the specimen and the accompanying aluminum step-wedge. …

Cephalometric Analysis Using Magnetic Resonance Imaging, Wade A. Williams

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine if T1-weighted 3D magnetic resonance images performed at 3.0 Tesla could be used to conduct routine orthodontic cephalometric analysis.

Methods: Three cranial imaging methods were compared using sixteen non-growing subjects (10 male and 6 female) who were not claustrophobic, did not have any metallic restorations on the distal of first molars, had no medical implants and the female subjects were not pregnant. Sagittal cranial images were produced by three methods: (1) a digital lateral cephalometric (LC) radiograph (Orthophos XG Plus, Sirona^TM, Bensheim, Germany), (2) a 12-inch FOV cone beam …

99mtc-Nannocolloid Localization Of Lymphorenal Fistula Causing Chyluria, Maseeh Uz Zaman, Riffat Parveen Hussain, Khalil Ahmed Khan, Gufran Khan, M. Nadeem Ahmad

Department of Radiology

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb …

Perfusion Imaging In Ischaemic Stroke, Zafar Sajjad

Department of Radiology

Perfusion imaging allows the blood flow to the tissue to be imaged. It is currently widely applied to the management of acute ischaemic stroke. Using either Computerised Tomography or Magnetic Resonance Imaging techniques, perfusion maps can be created in a short enough time to allow their routine use in clinical practice. Perfusion Imaging enables the physician to directly estimate the tissue at risk which can be salvaged with reperfusion, enabling appropriate patient selection. Perfusion imaging however has its limitations which need to be kept in mind when these studies are interpreted. Although perfusion imaging is widely used, the evidence to …

Management Of Pediatric Acute Appendicitis In The Computed Tomographic Era., Kuojen Tsao, Shawn D. St Peter, Patricia A. Valusek, Troy L. Spilde, Scott J. Keckler, Abhilash Nair, Daniel J. Ostlie, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND/PURPOSE: The treatment options for complicated appendicitis in children continue to evolve. Optimal management of complicated appendicitis relies on an accurate preoperative diagnosis. We examined the accuracy of our preoperative diagnosis including computed tomography (CT) and the influence on the management of children with perforated and nonperforated appendicitis.

METHODS: Following IRB approval, a 6-year review of all patients that underwent an appendectomy for suspected appendicitis was performed. Treatments included immediate operations and initial nonoperative management (antibiotic therapy +/- percutaneous drainage of abscess). Appendicitis was confirmed by histological examination.

RESULTS: One thousand seventy-eight patients underwent appendectomy for suspected appendicitis. Preoperative CT …

Radioactive Seed Immobilization Techniques For Interstitial Brachytherapy, K. Yan, T. Podder, I. Buzurovic, Y. Hu, E. Messing, D. Rubens, A. Dicker, R. Valicenti, N. Sarkar, W. Ng, Y. Yu

Department of Radiation Oncology Faculty Papers

Purpose In prostate brachytherapy, seeds can detach from their deposited sites and move locally in the pelvis or migrate to distant sites including the pulmonary and cardiac regions. Undesirable consequences of seed migration include inadequate dose coverage of the prostate and tissue irradiation effects at the site of migration. Thus, it is clinically important to develop seed immobilization techniques.

Methods We first analyze the possible causes for seed movement, and propose three potential techniques for seed immobilization: (1) surgical glue, (2) laser coagulation and (3) diathermy coagulation. The feasibility of each method is explored. Experiments were carried out using fresh …

Immediate Provionalization Of Single Threaded Oxidized Implants On Maxillary Premolars Healed Sites: One-Year Study, Kiyotaka Umezu

Loma Linda University Electronic Theses, Dissertations & Projects

Osseointegrated endosseous implants have been widely used and become a predictable treatment option for completely and partially edentulous patients. The viability and predictability of this treatment modality have been supported with the high success rates in numerous studies. Clinical guideline requires a healing period of 3 to 6 months without functional loading to achieve osseointegration with machine surface implants. Therefore, numerous studies on immediately loaded implants have been conducted in an attempt to minimize or eliminate this healing period. The purpose of this study was to evaluate the success rate of the immediately provisionalized oxidized-surface implants in healed sites supporting …

Predicting Long-Term Memory In Adult Brain Injury Patients Using Mr Spectroscopy, Herminia De La Rosa-Trujillo

Loma Linda University Electronic Theses, Dissertations & Projects

Accurate outcome prediction has proven to be somewhat elusive for patients with traumatic brain injury (TBI). The difficulty is due to the sometimes inaccurate methods of prediction currently available. Despite the advances seen in radiological technology, the traditional methods of x-rays, CT scans and MRIs are not always accurately able to predict patient functional outcome. These radiological methods are adequate in determining gross structural anatomical disturbances, however, they unable to detect more diffuse cellular damage believed to be responsible for the functional impairments evidenced in patients sustaining TBI. Magnetic Resonance Spectroscopy (MRS) is an imaging technique which measures brain metabolites …

Increasing Tumor Volume Is Predictive Of Poor Overall And Progression-Free Survival: Secondary Analysis Of The Radiation Therapy Oncology Group 93-11 Phase I-Ii Radiation Dose-Escalation Study In Patients With Inoperable Non-Small-Cell Lung Cancer, Maria Werner-Wasik, R. Suzanne Swann, Jeffrey Bradley, Mary Graham, Bahman Emami, James Purdy, William Sause

Department of Radiation Oncology Faculty Papers

PURPOSE: Patients with non-small-cell lung cancer (NSCLC) in the Radiation Therapy Oncology Group (RTOG) 93-11 trial received radiation doses of 70.9, 77.4, 83.8, or 90.3 Gy. The locoregional control and survival rates were similar among the various dose levels. We investigated the effect of the gross tumor volume (GTV) on the outcome.

METHODS AND MATERIALS: The GTV was defined as the sum of the volumes of the primary tumor and involved lymph nodes. The tumor response, median survival time (MST), and progression-free survival (PFS) were analyzed separately for smaller (< or =45 cm(3)) vs. larger (>45 cm(3)) tumors.

RESULTS: The distribution of …

Intrasheath Subluxation Of The Peroneal Tendons., Steven M Raikin, Ilan Elias, Levon N Nazarian

Department of Radiology Faculty Papers

BACKGROUND: Dislocation or subluxation of the peroneal tendons out of the peroneal groove under a torn or avulsed superior peroneal retinaculum has been well described. We identified a new subgroup of patients with intrasheath subluxation of these tendons within the peroneal groove and with an otherwise intact retinaculum.

METHODS: The cases of fifty-seven patients with painful snapping of the peroneal tendons posterior to the fibula were reviewed. Of these, forty-three had tendons that could be reproducibly subluxated out of the groove with a dorsiflexion-eversion maneuver of the ankle. Fourteen patients who could not subluxate the tendons out of the groove …

Understanding "Sports Hernia" (Athletic Pubalgia) - The Anatomic And Pathophysiologic Basis For Abdominal And Groin Pain In Athletes, William C. Meyers, Edward Yoo, Octavia Devon, Nikhil Jain, Marcia Horner, Cato Lauencin, Adam Zoga

Department of Radiology Faculty Papers

Recent publicity and some scientific reports suggest increasing success in treating an entity called “sports hernia” - more accurately named athletic pubalgia. The primary purpose of this article is to portray what we believe to be the key concept for understanding this wide variety of abdominal and groin injuries that afflict high performance athletes. These injuries have been plaguing athletes for a long time, and past treatments, based on concepts of occult hernia or simple strains, have generally failed. The former concepts do not take into account the likely mechanisms of injury or various patterns of pain that these athletes …

Chest Radiograph After Central Line Placement Under Fluoroscopy: Utility Or Futility?, Scott J. Keckler, Troy L. Spilde, Brian Ho, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.

METHODS: After obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were …

Labrad : Vol 33, Issue 2 - May 2008, Aga Khan University Hospital, Karachi

LABRAD

• Tartrate Resistant Acid Phosphatase (TRAP): An Important Diagnostic Tool for Hairy Cell Leukaemia
• Heterotopic Pregnancy: A Case Report
• Biochemical Markers of Excessive Alcohol Use
• Osmotic Fragility
• Pattern of Drug Abuse in Patients Presenting at a Referral Lab
• Achondrogenesis
• Molecular Diagnosis of Human Papilloma Virus
• Diagnosis of Clostridium Difficile Associated Diarrhoea
• Pakistan Association of Pathologists – Meeting Report

Cleaning Methods For Ultrasound Probes, Waseem Akhtar Mirza, Syed Hadi Imam, Kharal Mohd Salim, Mubashir Aslam, Syed Arif Ali, I. Masroor, M. Nadeem Ahmad

Department of Radiology

Objective: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections.

Study Design: Experimental study.

Place and Duration of Study: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007.

Patients and Methods: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning …

The Unifying Dilemma Of The Pakistani Science Journals, Saba Sohail

Department of Radiology

No abstract provided.

Primary Cutaneous B Cell Lymphoma--Leg Type (New Eortc--Who Classification), With Nasal Sinuses Involvement, Asim Jamal Shaikh, Nehal Masood, Aamir Ahsan, Wasim Memon

Department of Radiation Oncology

Primary Cutaneous lymphomas of B cell origin are rare, there remains a controversy in truly classifying these lymphomas and an updated EORTC classification divides them on the basis of their distinct histopthological grounds rather than on the basis of their anatomic location as in WHO classification, while the new WHO- EORTC joint classification maintains some characteristics of both systems, We report an elderly gentleman who primarily had a typical Leg dominant Cutaneous lymphoma of B cell origin uniquely with involvement of nasal Sinusues, bearing the Immunohistochemical staining features of "Cutaneous lymphoma - Leg Type" befitting the new joint WHO-EORTC classification …

Unusual Presentation Of Idiopathic Retroperitoneal Fibrosis: Case Report, N. Twahirwa, J. Rees

Imaging & Diagnostic Radiology, East Africa

Idiopathic retroperitoneal fibrosis (IRF) is an uncommon entity described as progressive proliferation of connective tissues leading to a fibrous plaque-like lesions that encases the aorta and inferior vena cava inferior to the level of the renal arteries. Mass forming retroperitoneal fibrosis is rare. We present a rare case of a unilateral focal retroperitoneal mass simulating a tumour encasing the middle third of the left ureter, with involvement of the ipsilateral scrotum.

Effectiveness Of Assigning Bi-Rads Category-3 To Breast Lesion With Respect To Follow-Up, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up.STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi, from January 2002 to December 2004.

PATIENTS AND METHODS: Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased …

Film Retakes In Digital And Conventional Radiography, Waseem Akhtar, Mubashir Aslam, Arif Ali, Kashif Mirza, Nadeem Ahmad

Department of Radiology

Objective: To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method.

Study Design: Comparative study.

Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006. Patients and Methods: X-rays of different body parts, conducted during the year 2004, with conventional radiography (n=170300), and in 2006 with digital radiography (n=174550), were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, …

Isolated Tuberculous Thyroiditis As Solitary Thyroid Nodule, Maseeh Uz-Zaman, Riffat Hussain, Muhammad Kashif Mirza, Khalil Ahmed Khan, Ghufran Mohammad Khan, M. Nadeem Ahmad

Department of Radiology

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan.

Magnetic Resonance Imaging (Mri) Findings In White Matter Disease Of Brain, Humera Ahsan, Muhammad Zafar Rafique, Fozia Ajmal, Mohsin Wahid, Muhammad Azeemuddin, Farah Iqbal

Department of Radiology

Demyelinating and dysmyelinating white matter diseases are important components of neurological problems. Recently, Magnetic Resonance Imaging (MRI) has played a key role in diagnoses of white matter diseases. Therefore, the purpose of the current study is to evaluate the usefulness of MRI in determining the type and frequency of white matter disease. We studied 35 patients who visited the Radiology Department of the Aga Khan University Hospital (AKUH) for MRI with suspected demyelinating/dysmyelinating disorder from January 2003 to December 2005. Multiple Sclerosis (MS) (17; 48%) and leukodystrophies (10; 29%) were the most common diseases. The MRI helped identify the sites …

Dilated Cisternae Chyli. A Sign Of Uncompensated Cirrhosis At Mr Imaging, Sachit K. Verma, Donald G. Mitchell, Diane Bergin, Yulia Lakhman, Amy Austin, Manisha Verma, David Assis, Steven K. Herrine, Laurence Parker

Department of Radiology Faculty Papers

Background: To retrospectively determine the frequency of dilated cisterna chyli (CC) on MR images in patients with cirrhosis, and to assess its value as a simple diagnostic imaging sign of uncompensated cirrhosis.

Methods: Study population included 257 patients (149 with pathologically proved cirrhosis and 108 control subjects without history of chronic liver diseases) who had 1.5T MR imaging. Cirrhosis patients were divided into compensated and uncompensated groups. Three independent observers qualitatively evaluated visibility of CC 2mm or greater in transverse diameter, identified as a tubular structure with fluid signal intensity (SI). CC diameters greater than 6 mm were defined as …