Radiology Commons^™

Video Microscope Robotic Arm-Assisted, Neuronavigation-Guided Glioma Resection And Regional Sampling, Muhammad Waqas, Ather Enam, Fauzan A Hashmi, Fatima Mubarak, Fazal Arain

Section of Neurosurgery

High-grade gliomas possess internal pathological heterogeneity. Selective sampling of different tumor regions can help in the study of this heterogeneity. In this report, we have described the use of a novel navigation and optical system for the selective regional sampling of a high-grade glioma lesion. A 45-year-old gentleman presented to us with complaints of intermittent frontal headaches for past eight months. On examination, he had subtle pyramidal weakness in left upper and lower extremities. Magnetic resonance imaging (MRI) showed a large contrast-enhancing, space-occupying lesion in the right frontal lobe causing perilesional edema and midline shift. We marked four different regions …

Bilateral Intracranial Calcifications With Bilateral Facial Cutaneous Naevus: Sturge Weber Syndrome, Muhammad Arif Saeed, Kiran Hilal, Prem Chand

Department of Radiology

Abstract

Sturge Weber syndrome also known as mother spot disease belongs to a group of disorders called phakomatoses (neurocutaneous syndromes involving the central nervous and cutaneous systems). It is a congenital disorder of the vasculature of the meninges, brain, faceand eyes. Clinically, it usually presents with seizures and other neurological complications, including mental retardation, contralateral hemiparesis and glaucoma. Its incidence is estimated at one case in 20 000-50 000 persons with equal frequency in boys and girls. We present a case of 18-months-old boy was brought by parents with history of seizures since birth resulting in fall 1 day back. …

Labrad : Vol 43, Issue 2 - October 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Clinical Applications of Platelet-Rich Plasma
• Rota Virus: Diagnosis & Prevention of Infection
• Anti-Musk Antibodies for Seronegative Myasthenia Gravis
• Clinical Utility of Plasma Homocysteine
• Patient Based Quality Control: Hitting a Moving Target
• Diagnosing Alkaptonuria: A Rare Inherited Metabolic Disease
• Recently Described Soft Tissue Lesions: An Update
• A Snapshot of the Standards of Medical Care -2017: American Diabetes Association Guidelines

Role Of Magnetic Resonance Planimetry And Magnetic Resonance Parkinsonism Index In Discriminating Parkinson’S Disease And Progressive Supranuclear Palsy: A Retrospective Study Based On 1.5 And 3 T Mri, Waseem Mehmood Nizamani, Fatima Mubarak, Muhammad Danish Barakzai,, Muhammad Saad Ahmed

Department of Radiology

OBJECTIVE:
The objective of the study was to assess magnetic resonance (MR) planimetric measurements and MR parkinsonism index (MRPI) in differentiating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) using 1.5 and 3 T MRI scanner.
SUBJECTS AND METHODS:
After ethical approval was obtained, analysis of 34 consecutive patients with PSP, 34 patients with PD and 34 healthy controls (HCs) was performed. HCs were age-matched adults without any history of neurodegenerative disease or movement disorders. Retrospective data from the past 10 years (from January 2006 to December 2015) were obtained from the Hospital Information Management System, and informed consent was …

Diffusion Tensor Imaging For Ruptured Cerebral Arteriovenous Malformation, Muhammad Waqas, Ayesha Siddiqui, Fatima Mubarak, Ather Enam

Section of Neurosurgery

Non-ruptured arteriovenous malformations (AVMs) rarely cause tract disruption. Few studies have described how ruptured AVMs influence white matter (WM) tract morphology. We reviewed consecutive AVM cases treated at a tertiary care hospital where diffusion tensor imaging (DTI) tractography was obtained preoperatively. DTI was performed using the Synaptive Plan (Synaptive Medical Inc., Toronto, Canada). Quality control was performed by clinical application specialist. Perinidal fractional anisotropy (FA) value of corticospinal tracts (CST) was obtained. A reference FA value was obtained from the corresponding area on the contralateral side. Images were evaluated by a consultant neuroradiologist. Radiological findings were correlated with clinical findings. …

Transverse Vaginal Septum: Report Of Two Patients With Mri Findings, Shaista Afzal, Imrana Masroor, Saira Naz, Shazia Bhurgri

Department of Radiology

The transverse vaginal septum is a rare form of Mullerian duct anomaly, and is a disorder of vertical fusion of Mullerian system with the sinovaginal bulb. Magnetic resonance imaging (MRI)is very useful in the detection, classification and management planning of this rare anomaly. We present two cases of transverse vaginal septum in two patients of different age groups and with different clinical presentations. The findings on MRI, related to presence of vaginal septum and the management work-up, are also discussed.

Diabetes And Coronary Artery Disease: Role Of Functional Imaging, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Carotid Intima Media Thickness Percentiles For Pakistani Population, Waseem Mirza, Mubashir Aslam Arain, Arif Ali, Vaqar Bari, Mirza Kazim Ali, Kainat Fatima

Department of Radiology

Carotid artery intima media thickness estimation is a well-established way of cardio vascular disease evaluation. The purpose of this cross-sectional study was to develop normal carotid intima media thickness percentile values for a Pakistani cohort. Data was collected at the Departments of Radiology and Family Medicine, The Aga Khan University Hospital, Karachi, from April 2014 to August 2015. High frequency ultrasound of carotid was done in 257 patients [97 male (38%), 160 female (62%)] without any known carotid artery disease. Reference ranges (90% range between 5th and 95th centiles) were constructed for each common carotid and internal carotid artery measurement …

Combining Magnetic Resonance Spectroscopy And Magnetic Resonance Imaging In Diagnosing Focal Brain Lesions In Children, Farah Naz Farid, Waseem Mirza, Nauman Hashmani

Section of Ophthalmology

Introduction: We attempted to find the sensitivity and specificity of various pediatric brain masses in the Pakistani population while keeping histopathology or clinical diagnosis as the gold standard.
Methods: This was a retrospective study that was conducted from January 2007 to January 2016. We reviewed the records of 204 patients that presented to the radiology department of Aga Khan University Hospital (AKUH). Out of the 204, 135 pediatric patients in the 0–18 age group with focal brain lesions who underwent magnetic resonance spectroscopy (MRS) and a biopsy or clinical diagnosis were included. If histopathology was available, it was taken as …

Role Of Metastasectomy And Chemotherapy In Carcinoma Of Uterine Cervix, Nasir Ali, Muhammad Atif Mansha, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi

Department of Radiation Oncology

Squamous cell carcinoma of uterine cervix is potentially a curable disease; however, many patients treated with definitive chemoradiotherapy develop distant metastases, with few of them having a single metastatic deposit. There are no guidelines for the treatment of patients with oligometastatic cervical cancer.We present a case of a patient with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB squamous cell carcinoma of uterine cervix. She was successfully treated with concurrent chemoradiotherapy with definitive intent. One year later, she developed a solitary pulmonary nodule for which she underwent resection followed by chemotherapy. She is free of any local or distant …

Intramedullary Cavernoma With Extralesional Haemorrhage, Naureen Farhan Ahmed, Fatima Mubarak, Nida Sajjad

Department of Radiology

Intramedullary cavernomas are rare lesions constituting 5 to 12% of all intramedullary tumours. They are more recognized after introduction of magnetic resonance imaging and detection rates have improved by advance techniques. They may be solitary or multiple or may have associated cranial lesions. They may present with gradual neurological decline or with acute loss of spinal function. In addition neurological deficit depends on the location of the lesion within the spinal cord. We are reporting the case of a 45 year old male who presented with neck pain and progressive right arm weakness with numbness. MRI cervical spine with contrast …

Radiologic Surveillance Of Patients With Viral Hepatitis, Saba Sohail

Department of Radiology

No abstract provided.

Tumor Response Evaluation Criteria: Standardization Ensures Success, Maseeh Uz Zaman, Nosheen Fatima, Mahwish Sajid

Department of Radiology

No abstract provided.

Mammographic Density And Ageing: A Collaborative Pooled Analysis Of Cross-Sectional Data From 22 Countries Worldwide, Anya Burton, Gertraud Maskarinec, Beatriz Perez-Gomez, Celine Vachon, Hui Miao, Martín Lajous, Ruy López-Ridaura, Megan Rice, Ana Pereira, Maria Luisa Garmendia, Rulla M. Tamimi, Kimberly Bertrand, Ava Kwong, Giske Ursin, Sudhir Vinayak, Rose Ndumia, Shivaani Mariapun

Imaging & Diagnostic Radiology, East Africa

Background:Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known.

Methods and findings: We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35–85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of …

Correlation Between Ovarian Volume And Polycystic Ovarian Syndrome Using Ultrasound., Ndecho Muriuki Guandaru

Master of Medicine in Imaging and Diagnostic Radiology

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age with a prevalence of 5-10% in different populations. The prevalence of PCOM in patients with PCOS has been shown to be ≥ 90% in different populations. Diagnostic evaluation accounts for a relatively minor part of the total costs of providing care and evaluating women with PCOS. Hence more widespread and liberal screening for the disorder appears be a cost-effective strategy in susceptible patients. PCOM on ultrasound is diagnosed if one of the following is present in one or both of the ovaries; Ovarian volume …

Implementation Of Quality Measures In Site-Specific Multidisciplinary Tumour Boards, Ahmed Nadeem Abbasi, Huriye Senay Kiziltan

Department of Radiation Oncology

No abstract provided.

Association Between Calcaneal Spurs And Plantar Fasciitis: A Study Comparing Heel Plain Radiography And Sonography, Micah Silaba Ominde

Master of Medicine in Imaging and Diagnostic Radiology

Background: Heel pain is a common clinical entity that requires appropriate diagnostic evaluation. Multiple clinical conditions are known to cause heel pain but plantar fasciitis is the most common. Calcaneal spurs are thought to be associated with heel pain and plantar fasciitis but conclusive studies to prove this are sparse. Plain radiography is usually the first line imaging modality for imaging patients with heel pain. Magnetic Resonance Imaging is the gold standard for diagnosing plantar fasciitis but studies have shown ultrasound to be comparable in sensitivity and specificity. The aim is to establish whether a relationship exists between calcaneal spurs …

Diagnostic Value Of Complementary Strain Elastography In The Classification Of Breast Masses, Sarah Muthoni Wambui

Master of Medicine in Imaging and Diagnostic Radiology

Background: Breast cancer is the commonest cancer in women. Ultrasound has a high sensitivity but low specificity in the classification of benign and malignant breast masses. Strain elastography has the potential of increasing the specificity of breast ultrasound in classifying malignant and benign breast masses and reducing the number of benign breast biopsies performed. The diagnostic value of breast elastography in African women is not known. Objective: The aim of this study was to evaluate the additive diagnostic value of strain elastography to conventional ultrasound in the classification of malignant and benign breast masses in an African population. Materials and …

Comparison Of Image Quality In High Pitch Free Breathing Versus Standard Pitch Breath-Holding Computed Tomographic Pulmonary Angiography., Kevin Onyinkwa Ombati

Master of Medicine in Imaging and Diagnostic Radiology

Background: Pulmonary embolism (PE) is the third most common acute cardiovascular disease. Missed diagnosis is responsible for most preventable deaths associated with PE. Artefacts from cardiac and breathing motion are a main pitfall. Advances in Computed Tomographic imaging have enabled rapid imaging in an attempt to overcome these pitfalls. Objective: To compare image quality when using high pitch free breathing versus standard pitch breath holding Computed Tomographic Pulmonary Angiography (CTPA) using a dual source scanner. Methods: This was a randomised control trial whereby patients referred to the radiology department for CTPA examination for suspected pulmonary embolism were randomly selected into …

In Pursuit Of Quality Research: Editors' Perspective, Jamshed Akhtar, Saba Sohail

Department of Radiology

No abstract provided.

Nuclear Medicine Imaging In Emergency Room And Priority Clinical Decision Making, Nosheen Fatima, Maseeh Uz Zaman

Department of Radiology

No abstract provided.

Thyroid Ultrasound: State Of The Art. Part 2 - Focal Thyroid Lesions., Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove,, Xin Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun Mei Xu, Christoph F Dietrich

Department of Radiology

Abstract

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Labrad : Vol 43, Issue 1 - March 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Chikungunya
• Rapid Molecular Diagnosis of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG) Urethritis
• Overview of Rubella Testing
• Most Common Bone and Soft Tissue Infections Seen in our Practice
• Diagnosis of Helicobacter Pylori Infection in Developing Countries- Pros & Cons
• Screening for Neonatal Infections with TORCH Profile
• Blood and Bone Marrow Changes in Viral Infections
• Malaria
• World Rare Disease Day
• Radiology Pathology Correlation

18fdg Pet/Ct: A Sensitive Tool That Needs Better Users' Understanding, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Itopride For Gastric Volume, Gastric Emptying And Drinking Capacity In Functional Dyspepsia, Shahab Abid, Wasim Jafri, Maseeh Uz Zaman, Rakhshanda Bilal, Safia Awan, Aamir Abbas

Section of Gastroenterology

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD).

Methods: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacityof tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ¹³C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink …

Incidence Of Venous Thromboembolism In Cancer Patients Treated With Cisplatin Based Chemotherapy - A Cohort Study, Muhammad Nauman Zahir, Quratulain Shaikh, Munira Shabbir-Moosajee, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed …

Thyroid Ultrasound: State Of The Art Part 1 - Thyroid Ultrasound Reporting And Diffuse Thyroid Diseases, Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove, Xin-Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun-Mei Xu, Christoph F. Dietrich

Imaging & Diagnostic Radiology, East Africa

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Opportunities And Challenges In Realizing Universal Access To Obstetric Ultrasound In Sub-Saharan Africa, Sikolia Wanyonyi, Charles Muriuki Mariara, Sudhir Vinayak, William Stones

Obstetrics and Gynaecology, East Africa

The potential benefits of obstetric ultrasound have yet to be fully realized in sub-Saharan Africa (SSA), despite the region bearing the greatest burden of poor perinatal outcomes. We reviewed the literature for challenges and opportunities of universal access to obstetric ultrasound and explored what is needed to make such access an integral component of maternity care in order to address the massive burden of perinatal morbidity and mortality in SSA. Original peer-reviewed literature was searched in various electronic databases using a ‘realist’ approach. While the available data were inconclusive, they identify many opportunities for potential future research on the subject …

Prostate-Specific Antigen As A Risk Factor For Skeletal Metastasis In Native Ethnic African Men With Prostate Cancer: A Case-Control Study, Mahmood Qureshi, Khalid Makhdomi, William Stones

Imaging & Diagnostic Radiology, East Africa

Prostate cancer is the most common noncutaneous cancer in males. Men of African origin are at a significantly higher risk as reflected in the higher incidence and mortality rates in this racial group. Metastases incidence increases parallel to serum levels of prostate-specific antigen (PSA), contributing significantly to morbidity and mortality. Staging of the disease involves bone scans, which are sensitive in detecting skeletal metastases. Suggestions that these scans may be omitted in some situations in patients with low prostate specific antigen levels have drawn attention to the matter. In this case-control study, using radiology and pathology records, a registry of …

Scar Endometriosis: An Entity Not To Be Forgotten, Kulsoom Fatima, Samina Khanani

Department of Radiology

Scar endometriosis is an uncommon but well-described condition. It is caused by the dissemination of endometrial tissue in the wound at the time of surgery. The deposits can involve uterine scar, abdominal musculature or subcutaneous tissue, with the latter being the most common. It usually presents as a palpable mass at the scar site with or without cyclical pain. We report three cases of scar endometriosis which presented with cyclical pain and swelling at the abdominal wall scar following uterine surgery. The patients underwent imaging which revealed abnormal findings at the scar site suggesting scar endometriosis. In the presence of …