Radiology Commons^™

Autoimmune Disease Presenting As Acute Abdomen, Wasim A Memon, Saad Siddiqui, Ameer Hamza

Department of Radiology

Mesenteric vasculitis and resultant bowel ischemia is rare but serious complication of autoimmune disorders. Early detection and treatment is the key to avoid potentially fatal outcomes of bowel perforation and peritonitis. In this series, we present patients presenting with acute abdominal pain and having CT imaging features of bowel ischemia who responded well to immunosuppressive therapy. The aim of this work is to familiarize health professionals with possibility and imaging features of mesenteric vasculitis.

Role Of Assessment For Retreatment With Transarterial Chemoembolization Score In Decision Of Retreatment With Trans-Arterial Chemo-Embolization Sessions In Patients With Hepatocellular Carcinoma, Anwar Hussain Abbasi, Shahab Abid, Tanveer Ul Haq, Safia Awan

Department of Family Medicine

Background: The objective behind this study was to determine that Assessment for Retreatment with Transarterial chemoembolization (ART) score is really applicable in patients with hepatocellular carcinoma.
Methods: A cross sectional observational study was conducted on all patients with hepatocellular carcinoma of intermediate stage and undergone ≥2 Transarterial chemoembolization. ART score was assessed before and after each session of Transarterial chemoembolization. Multi-logistic regression analysis was performed to compare the final outcome of patients with ART score of ≥2.5 into groups with two and more than two Trans-arterial chemo-embolization sessions.
Results: A total of 100 HCC patients were recruited for final analysis. …

Ultrasound Shear Wave Elastography And Liver Fibrosis: A Prospective Multicenter Study, Joyce Sande, Suleman Verjee, Sudhir Vinayak, Farin Amersi, Munir Ghesani

Imaging & Diagnostic Radiology, East Africa

Aim: To assess the accuracy of shear wave elastography (SWE) alone and in combination with aminotransferase platelet ratio index (APRI) score in the staging of liver fibrosis.

Methods: A multicenter prospective study was conducted to assess the accuracy of SWE (medians) and APRI to predict biopsy results. The analysis focused on distinguishing the different stages of liver disease, namely, F0 from F1-4, F0-1 from F2-4, F0-2 from F3-4 and F0-3 from F4; F0-F1 from F2-F4 being of primary interest. The area under the receiver operating characteristic (AUROC) curve was computed using logistic regression model. The role of age, gender and …

Training Midwives To Perform Basic Obstetric Point-Of-Care Ultrasound In Rural Areas Using A Tablet Platform And Mobile Phone Transmission Technology—A Wfumb Coe Project, Sudhir Vinayak, Joyce Sande, Harvey Nisenbaum, Christian Pállson Nolsøe

Imaging & Diagnostic Radiology, East Africa

Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, …

Antenatal Umbilical Coiling Index And Newborn Outcomes: Cohort Study, Josephine Mwikali Ndolo, Sudhir Vinayak, Micah Ominde, William Stones

Imaging & Diagnostic Radiology, East Africa

Objectives: We aimed to test the predictive value of antenatal umbilical coiling index (aUCI) among a prospectively recruited cohort of antenatal women.

Methods: Women with singleton pregnancies were recruited at their second‑trimester scan. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and small for gestational age (SGA) using international standard birth weight centiles and preterm birth were investigated (n = 430).

Results: aUCI results were consistent with the literature and showed good reproducibility between observers. Abnormal aUCI was not associated with SGA, but there was a …

Papillary Craniopharyngioma: A Clinicopathologic Study Of A Rare Entity From A Major Tertiary Care Center In Pakistan, Muhammad Usman Tariq, Nasir Ud Din, Zubair Ahmad, Wasim Memon

Department of Pathology and Laboratory Medicine

Background: Papillary craniopharyngioma (PCP) are uncommon variants of craniopharyngiomas (CP), which are benign epithelial neoplasms of the sellar and suprasellar region. Histologically, PCPs are typically composed of well-differentiated stratified squamous epithelium; however, focal variations are not uncommon. A distinction from other lesions of the region, despite being difficult to achieve due to the overlapping radiological and clinical features, is important for adequate treatment to be administered.
Objective: Our aim was to study the clinical and histological features of PCP with emphasis on features that are helpful in its distinction from other lesions that are similar in appearance.
Materials and Methods: …

Mammographic Density Assessed On Paired Raw And Processed Digital Images And On Paired Screen-Film And Digital Images Across Three Mammography Systems, Anya Burton, Graham Byrnes, Jennifer Stone, Rulla M. Tamimi, John Heine, Celine Vachon, Vahit Ozmen, Ana Pereira, Maria Luisa Garmendia, Christopher Scott, John H. Hipwell, Caroline Dickens, Joachim Schüz, Mustafa Erkin Aribal, Kimberly Bertrand, Ava Kwong, Graham G. Giles, John Hopper, Beatriz Pérez Gómez, Marina Pollán, Soo-Hwang Teo, Shivaani Mariapun, Nur Aishah Mohd Taib, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Anath Arzee Flugelman, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Reza Sirous, Mehri Sirous, Jong Won Lee, Jisun Kim, Dorria Salem, Rasha Kamal, Mikael Hartman, Hui Miao, Kee-Seng Chia, Chisato Nagata, Sudhir Vinayak, Rose Ndumia, Carla H. Van Gils, Johanna O. P. Wanders, Beata Peplonska, Agnieszka Bukowska, Steve Allen, Sarah Vinnicombe, Sue Moss, Anna M. Chiarelli, Linda Linton, Gertraud Maskarinec, Martin J. Yaffe, Norman F. Boyd, Isabel Dos-Santos-Silva, Valerie A. Mccormack

Imaging & Diagnostic Radiology, East Africa

Background: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/ digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types.

Methods: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read …

Establishment Of Site Specific Multi Disciplinary Tumour Boards In Pakistan -Is It Really Necessary To Discuss All Cancer Cases In Multidisciplinary Tumour Board Meetings?, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Labrad : Vol 42, Issue 2 - October 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Revised Nomenclature of Encapsulated Follicular Variant of Papillary Carcinoma; Now NIFTP in 2016
• Heritable Thrombophilia Screening: When & in Whom
• Massive Transfusion
• A Review of Innovance PFA-200 System
• Radiologic-Pathologic Correlation Osteogenic Tumors
• Pre Albumin or Transthyretin - A Useful Biomarker in the Assessment of Malnutrition
• Urinary Tract Infections (UTIs) in Children: A Pictorial Guide
• Validation of Test Methods in a Clinical Laboratory: A Brief Overview of the Concepts, Aims and Procedures
• Clinical Significance of Stone Composition Analysis in Urolithiasis Management

Establishment And Maintenance Of Quality Of Site-Specific Multidisciplinary Tumor Boards In Pakistan, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Spontaneous Uterine Rupture At 28 Weeks: A Case Report, Mahreen Rasool, Imrana Masroor, Shafia Shakoor, Shama Munim

Department of Radiology

Abstract

Spontaneous Uterine rupture is associated with massive intra-peritoneal bleed which can be fatal if not recognized. We report a case of 32 year old multigravida at 28 weeks of gestation with history of liver cysts, previous caesarean and uterine curettage, who presented with acute abdominal pain and tenderness; ultrasound revealed placenta percreta. CT abdomen showed haemoperitoneum. The patient underwent emergency caesarean hysterectomy due to uterine rupture at the cornual site.

Comparison Of Hemodynamic Effects And Negative Predictive Value Of Normal Adenosine Gated Myocardial Perfusion Scan With Or Without Caffeine Abstinence, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Unaiza Zaman, Rabia Tahseen

Department of Radiology

For vasodilator stress, myocardial perfusion imaging (MPI) with at least 12-h caffeine abstinence is recommended, as it attenuates cardiovascular hyperemic response of adenosine and dipyridamole. However, many published conflicting results have shown no significant effect upon perfusion abnormalities in MPI performed without caffeine abstinence. The aim of this study was to compare the hemodynamic changes and negative predictive value (NPV) of normal MPIs with adenosine stress performed with or without caffeine abstinence. This was a prospective study that accrued 50 patients from May 2013 till September 2013 and followed till November 2014. These patients had a normal adenosine-gated MPI (GMPI) …

Significantly Low Effective Dose From 18fdg Pet/Ct Scans Using Dose Reducing Strategies: "Lesser Is Better", Maseeh Uz Zaman, Nosheen Fatima, Unaiza Zaman, Rabia Tahseen

Department of Surgery Docs

Abstract

BACKGROUND:

Fluorodeoxyglucose (18FDG) PET/CT imaging has become an important component of the management paradigm in oncology. However, the significant imparted radiation exposure is a matter of growing concern especially in younger populations who have better odds of survival. The aim of this study was to estimate the effective dose received by patients having whole body 18FFDG PET/CT scanning as per recent dose reducing guidelines at a tertiary care hospital.

MATERIALS AND METHODS:

This prospective study covered 63 patients with different cancers who were referred for PET/CT study for various indications. Patients were prepared as per departmental protocol and 18FDG …

Imaging Guided Breast Interventions, Imrana Masroor, Shaista Afzal, Saira Naz Sufian

Department of Radiology

Breast imaging is a developing field, with new and upcoming innovations, decreasing the morbidity and mortality related to breast pathologies with main emphasis on breast cancer. Breast imaging has an essential role in the detection and management of breast disease. It includes a multimodality approach, i.e. mammography, ultrasound, magnetic resonance imaging, nuclear medicine techniques and interventional procedures, done for the diagnosis and definitive management of breast abnormalities. The range of methods to perform biopsy of a suspicious breast lesion found on imaging has also increased markedly from the 1990s with hi-technological progress in surgical as well as percutaneous breast biopsy …

Prevalence Of Hepatic Steatosis As Diagnosed On Unenhanced Abdominal Ct, Naushad H. Karim Sokwalla

Master of Medicine in Imaging and Diagnostic Radiology

Background: Hepatic steatosis is the accumulation of triglycerides within hepatocytes. It may be broadly classified into alcoholic and non-alcoholic fatty liver disease, whereby non-alcoholic fatty liver disease is steatosis secondary to causes such as steatogenic medication. Liver biopsy remains the gold standard for diagnosis of hepatic steatosis. However, it is invasive and may potentially suffer from sampling errors. Hepatic steatosis may be diagnosed on unenhanced CT if the hepatic attenuation is less than 40 HU, or if the attenuation of the liver is at least 10 HU less than the spleen. Over the past three decades, non-alcoholic fatty liver disease …

Sonographic Estimation Of The Prevalence Of Hepatic Steatosis In Hiv Monoinfected Patients At Aga Khan University Nairobi., Bernadette Wambui Muthee

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Human immunodeficiency virus disease (HIV) is a worldwide health problem. It is estimated that 38.6 million people are infected with HIV globally. It has remained endemic in the African continent for close to 20 years and is a long term developmental challenge in Africa which bears 69 % of the HIV/AIDS global burden. The introduction of highly active antiretroviral therapy (HAART) has caused dramatic improvement in prognosis of HIV disease. Consequently, this has resulted in substantial reduction in Acquired Immune Deficiency Syndrome (AIDS) related morbidity and mortality. In contrast, this has been accompanied by an upsurge in liver- related …

A Medical Editor's Utopia, Saba Sohail

Department of Radiology

No abstract provided.

Labrad : Vol 42, Issue 1 - April 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Biochemical Bone Profiles Available at Clinical Laboratoryof Aga Khan University Hospital
• Ionized Calcium Determination in Clinical Labortory
• Parathyroid Hormone Disorders and Issues of Testing
• Tubular Maximum Reabsorption Rate of Phosphate to Glomerular Filtration Rate (TmP/GFR)
• Renal Osteodystrophy: A Disturbed Metabolic Aspect of Renal Failure
• Update on Microbiological Diagnosis of Bone and Joint Disorders
• Classification of Tumours of Bone : An Update Based on the 2013 World Health Organization Classification of Tumours of Soft Tissue and Bone
• Recent Developments in Benign Bone Tumours
• Role of Clinical and Radiological Correlation in Orthopaedic Pathology
• CME Seminar on ‘World Osteoporosis Day’

To Asses Inter- And Intra-Observer Variability For Breast Density And Birads Assessment Categories In Mammographic Reporting, Imrana Masroor, Mahreen Rasoor, Shaista Afzal Saeed, Saba Sohail

Department of Radiology

Objective: To evaluate the inter- and intra-observer variability among radiologists in the characterisation of mammograms according to Breast Imaging Reporting and Data System assessment and breast density categories.
Methods: The descriptive cross-sectional study was conducted at Aga Khan University Hospital, Karachi, from January 2014 to June 2014. Using non-probability purposive sampling, all mammograms in the study were interpreted by three radiologists on the basis of Breast Imaging Reporting and Data System categories and by assessing the breast density composition. The inter-observer variability was recorded by comparing the difference in the interpretation and categorisation of each case. Intra-observer variability was noted …

High Prevalence Of Liver Fibrosis In Patients With Human Immunodeficiency Virus Monoinfection And Human Immunodeficiency Virus Hepatitis-B Co-Infection As Assessed By Shear Wave Elastography: Study At A Teaching Hospital In Kenya, Samuel Gitau, Sudhir Vinayak, Micah Ominde, Rodney Adam, Reena Shah

Imaging & Diagnostic Radiology, East Africa

Objectives:The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital.

Materials and Methods:A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients …

Isolated Gastric Tuberculosis Mimicking Malignancy, Wasim Memon, Saad Siddiqui

Department of Radiology

Isolated tuberculosis of upper gastrointestinal tract is a rare pathology, often mimicking malignancy in clinical presentation and radiological features. We present a case of middle aged gentleman with isolated tuberculosis of stomach, proven on histopathology and showing remarkable improvement on follow up.

Institutionalized Training Of Research Editors, Saba Sohail, Jamshed Akhtar

Department of Radiology

No abstract provided.

Magnetic Resonance Cholangiopancreatography In Diagnosis Of Biliary Disorders In Children - Sharing Our Experience., Fahad Ali, Waseem Akhter, Muhammad Arshad

Department of Radiology

Abstract

OBJECTIVE:

To evaluate the role of Magnetic Resonance Cholangio-pancreatography in the diagnosis of biliary disorders in children.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data related to the period between August 2005 and December 2013. All children from age of 1 day to 17 years who had undergone Magnetic Rasonance Cholangio-pancreatography examination for suspected pancreaticobiliary disorders were included. Clinical presentation, Magnetic Rasonance Cholangio-pancreatography findings, operative findings and histopathological results were recorded. Sensitivity and specificity of Magnetic Rasonance Cholangio-pancreatography for different diseases was worked out.

RESULTS:

Of the 50 patients in the study, …

Omental Infarction In A Child, Saad Siddiqui, Anwar Ahmed, Naila Nadeem

Department of Radiology

Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis.

International Consortium On Mammographic Density: Methodology And Population Diversity Captured Across 22 Countries, Valerie A. Mccormacka, Anya Burton, Isabel Dos-Santos-Silva, John H. Hipwell, Caroline Dickens, Dorria Salem, Rasha Kama, Mikael Hartman, Charmaine Pei Ling Lee, Kee-Seng Chia, Vahit Ozmen, Mustafa Erkin Aribal, Anath Arzee Flugelman, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Carla H. Van Gils, Johanna O.P. Wanders, Sudhir Vinayak, Rose Ndumia, Steve Allen, Sarah Vinnicombe, Sue Moss, Jong Won Lee, Jisun Kim, Ana Pereira, Maria Luisa Garmendia, Reza Sirous, Mehri Sirous, Beata Peplonska, Agnieszka Bukowska, Rulla M. Tamimi, Kimberly Bertrand, Chisato Nagata, Ava Kwong, Celine Vachon, Christopher Scott, Beatriz Perez-Gomez, Marina Pollan, Gertraud Maskarinec, Graham Giles, John Hopper, Jennifer Stone, Nadia Rajaram, Soo-Hwang Teo, Shivaani Mariapun, Martin J. Yaffe, Joachim Schüz, Anna M. Chiarelli, Linda Linton, Norman F. Boyd

Imaging & Diagnostic Radiology, East Africa

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether …

Effective Communication Of Critical Radiology Results: The Implementation Of Panic Alert Mechanism, Mumtaz Malik, Sidrah Nausheen

Department of Radiology

Objective: To establish an effective channel of timely communication of life-threatening emergencies to primary physicians by radiology team.Methods: The observational study was conducted at Aga Khan Hospital for Women and Children, Kharadar, Karachi. Data was collected from the log book from July 2012 to June 2013.Amultidisciplinary "Panic Alert" protocol was formulated and implemented in the Radiology unit. All radiological examinations were screened as soon as possible and panic alerts [provisional findings] were communicated to their primary care taker/relevant nursing staff, attendants within 30 minutes from the time of completion of examination. Complete log was maintained. Data was analysed on SPSS …

Labrad : Vol 41, Issue 3 - December 2015, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Overview on Approach to Inherited Bleeding Disorders
• Diagnostic Approach to Haemoglobinopathies
• Transient Abnormal Myelopoiesis
• Urinary Tract Infections (UTI) in Children
• Role of Histopathology in the Diagnosis of Paediatric Renal Tumours
• Role of Histopathology in the Diagnosis of Paediatric Bone and Soft Tissue Small Round Cell Tumours
• Evaluation of Inborn Errors of Metabolism (IEM) In a Nutshell
• An Update on Blood Lead Levels in Children
• Clinical Utility of Immature Platelet Fraction – An advanced 25 Parameter in Laboratory Hematology
• Meeting Report: “Les Confluences” The Society for the Study 30 of Inborn errors of Metabolism (SSIEM) Annual Symposium 2015 in Lyon, France

Frequency And Severity Of Acute Toxicity Of Pelvic Radiotherapy For Gynecological Cancer, Asim Hafiz, Ahmed Nadeem Abbasi, Nasir Ali, Khurshid Ahmed Khan, Bilal Mazhar Qureshi

Department of Radiation Oncology

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer.STUDY Design: A case series.PLACE AND DURATION OF STUDY: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012.METHODOLOGY: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapys side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at …

Accreditation Of Healthcare Facilities: A Friend Or Foe?, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

The Specificity And Sensitivity Of Ultrasonography In The Diagnosis Of Acute Right Lower Quadrant Pain In Women Of Child Bearing Age, Shumaila Arooj, Arfanul Haq, Zafar Amin

Department of Radiology

Abstract

OBJECTIVE:

To assess the sensitivity and specificity of ultrasonography in differentiating causes of acute right lower quadrant pain in women of child-bearing age by taking surgical outcome as the gold standard.

METHODS:

The descriptive analytical study was conducted at PNS Shifa Hospital, Karachi, from July to December 2008, and comprised female patients of child-bearing age who presented with acute right lower quadrant pain and underwent surgery after ultrasonography. SPSS 10 was used for statistical analysis.

RESULTS:

Of the 75 patients, 54(72%) patients were symptomatically and sonographically positive to have either acutely inflamed non-compressible appendix or focal fluid collection in …