Radiology Commons^™

Multiple System Atrophy - The Cerebellar Type With “Hot Cross Bun Sign” On Mri, Rehana Shaikh, Saba Sohail, Nasreen Naz

Department of Radiology

Multiple system atrophy (MSA) is an adult onset, progressive, idiopathic neurodegenerative disease that clinically manifest as MSA-C with cerebellar signs predominant, MSA-P with Parkinsonian features predominant and MSA-A with autonomic signs and symptoms. MRI has an important role in its diagnosis with a characteristic finding described as "hot cross bun" sign seen in MSA of cerebellar type (MSA-C). We have seen two cases of MSA-C referred to Radiology Department, Civil Hospital Karachi in February 2017 and March 2017 who presented with difficulty in walking and speech and foecal and urinary incontinence. The MRI showed atrophy of pons, cerebellum and middle …

Pituitary Stalk Interruption Syndrome Presenting In A Euthyroid Adult With Short Stature, Atif Nawaz, Muhammad Azeemuddin, Jehanzeb Shahid

Department of Radiology

Pituitary stalk interruption syndrome (PSIS) is a distinct and rare clinical entity responsible for congenital hypopituitarism resulting in deficiency of pituitary hormones with deficiency of the growth hormone (100%) and gonadotropins (97.2%) being its most common presentation at the time of hospital encounter (Wang et al., 2015). Isolated sparing of thyroid-stimulating hormone (TSH) with deficiency of the remaining anterior pituitary hormones may be present in PSIS, as is true in our case. Therefore, it should be kept in mind at the time of examination in suspected cases of PSIS.

A Rare Case Of Presacral Epidermoid Cyst In An Adult Male: Emphasis On Diffusion Weighted Magnetic Resonance Sequences In Preoperative Imaging., Muhammad I. Alvi, Fatima Mubarak, Kumail Khandwala, Muhammad Nanish Barakzai, Aisha Memon

Department of Radiology

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cysts have been previously reported in women, however are extremely rare in males. We report a case of presacral epidermoid cyst in a 55-year-old male who presented to our emergency department with acute urinary retention and history of chronic constipation. A non-contrast computed tomography scan was performed with suspicion of urolithiasis, which revealed a well circumscribed low attenuation presacral mass. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed to further characterize the lesion. The mass was returning hypointense T1 and hyperintense T2 …

Non-Ionic Iodinated Contrast-Induced Sialadenitis With Parotid Gland Sparing In Patient Of Hepatocellular Carcinoma, Muhammad Azeemuddin, Mustafa Belal Hafeez Chaudhry, Jehanzeb Shahid, Sarosh Zafar Belal

Department of Radiology

61-years-old male patient presented with complain of neck swelling and soreness following contrast-enhanced (CE) CT examination with resolution of symptoms in 36-48 hours. He is diagnosed with hepatitis C virus and hepatocellular carcinoma (HCC); already treated with radiofrequency ablation for HCC. He had already undergone two CECT examinations before he was referred to our institution for disease staging/treatment. He also underwent three triphasic CT scan examinations at our institution during the course of treatment for treatment response and staging. Patient remained undiagnosed up to his fourth CT scan due to inability to relate symptoms with contrast administration. The patient was …

Negative Predictive Value Of Ultrasound In Predicting Tumor-Free Margins In Specimen Sonography, Saira Naz, Saima Hafeez,, Zainab Hussain, Kiran Hilal

Department of Radiology

OBJECTIVE: To evaluate the success of ultrasound in post-excision specimen visualization, and negative predictive value of ultrasound for estimation of tumor-free margins using histopathology as the gold standard.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from May 2010 till January 2013.

METHODOLOGY:

Sonography of all breast nodules was done before and after exicision by two female radiologists with at least five years clinical experience. All surgeries were performed by the same referring breast surgeons. All nodules were non-palpable and had histopathology as well as specimen sonography performed at AKUH. …

Diagnostic Challenges In Prostate Cancer And 68ga-Psma Pet Imaging: A Game Changer?, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Mahwsih Sajid, Unaiza Zaman, Sidra Zaman

Department of Radiology

Creative Commons Attribution LicenseProstate cancer (PC) is the most frequent solid tumor in men and the third most common cause of cancer mortalityamong men in developed countries. Current imaging modalities like ultrasound (US), computerized tomography (CT),magnetic resonance imaging (MRI) and choline based positron emission (PET) tracing have disappointing sensitivity fordetection of nodal metastasis and small tumor recurrence. This poses a diagnostic challenge in staging of intermediateto high risk PC and restaging of patients with biochemical recurrence (PSA >0.2 ng/ml). Gallium-68 labeled prostatespecific membrane antigen (68Ga-PSMA) PET imaging has now emerged with a higher diagnostic yield. 68Ga-PSMAPET/CT or PET/MRI can be …

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. …

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 …

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 …

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.

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.

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

Department of Radiology

No abstract provided.

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 …

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.

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) …

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 …

A Medical Editor's Utopia, Saba Sohail

Department of Radiology

No abstract provided.

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 …

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.

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 …