Radiology Commons^™

The Role Of Computed Tomography For Identifying Mechanical Bowel Obstruction In A Pakistani Population, Omair Shakil, Syed Nabeel Zafar, Ziaur Rehman, Sarah Saleem, Rehmatullah Khan, Khawaja Muhammad Inam Pal

Section of General Surgery

Objective: To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction.
Methods: It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was …

Late-Onset Visual Loss In Osteopetrosis, Abdul-Majid Wangai, Sheila Waa, Maryam Wangai, Erastus Amayo, Oluoch Olunya

Imaging & Diagnostic Radiology, East Africa

Late-onset visual loss is a complication of nerve entrapment and increased intracranial pressure. We hereby describe the first case in Eastern Africa. A 23 year-old lady presented with sudden blindness, headaches and body weakness. She had previously had treatment for multiple unexplained fractures. Findings of optic nerve entrapment explained this blindness. This case highlights the need to have a high index of suspicion in cases of unexplained fractures with late-onset blindness.

Brain Activation And Connectivity In Non-Disabled Multiple Sclerosis Patients, Rene A. Colorado

Dissertations and Theses (Open Access)

Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. There is no cure for MS and current therapies have limited efficacy. While the majority of individuals with MS develop significant clinical disability, a subset experiences a disease course with minimal impairment even in the presence of significant apparent tissue damage on magnetic resonance imaging (MRI). The current studies combined functional MRI and diffusion tensor imaging (DTI) to elucidate brain mechanisms associated with lack of clinical disability in patients with MS. Recent evidence has implicated cortical reorganization as a mechanism to limit the clinical manifestation of …

In-Vivo Ct Dosimetry During Virtual Colonoscopy, Jonathon W. Mueller

Dissertations and Theses (Open Access)

Virtual colonoscopy (VC) is a minimally invasive means for identifying colorectal polyps and colorectal lesions by insufflating a patient’s bowel, applying contrast agent via rectal catheter, and performing multi-detector computed tomography (MDCT) scans. The technique is recommended for colonic health screening by the American Cancer Society but not funded by the Centers for Medicare and Medicaid Services (CMS) partially because of potential risks from radiation exposure. To date, no in‐vivo organ dose measurements have been performed for MDCT scans; thus, the accuracy of any current dose estimates is currently unknown.

In this study, two TLDs were affixed to the inner …

Comparison Of Stereotactic Core Breast Biopsy And Open Surgical Biopsy Results At A Tertiary Care Hospital In Pakistan., Imrana Masroor, Shaista Afzal, Gulnaz Shafqat, Yasir Jamil Khattak

Department of Radiology

Background:The Purpose of this study was to determine the yield of stereotactic core breast biopsy and its cost-saving potential.

Methods:

This observational study was conducted at the Department of Radiology at Aga Khan Hospital in Karachi. All female Patients (n = 84) undergoing stereotactic core breast biopsy under mammographic guidance from January 2005 to May 2010 were included. Stereotactic core biopsy was performed on a dedicated mammography unit employing a 14-gauge needle with an automated biopsy device. Ten Patients with incomplete medical records were excluded. All breast biopsy results were either compared with surgical findings in cases of malignant …

Cerebral Nocardiosis, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess …

Department Of Radiology-Annual Executive Summary Report-July 1, 2010 To June 30, 2011, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

90 page Department of Radiology Annual Executive Summary Report, July 1, 2010 to June 30, 2011, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Tables of Contents:

Department of Radiology

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications Journal Articles 22

Books and Book Chapters 30

Abstracts 33

Appendix II: Formal Scientific Presentations 44

Appendix III: Honors, Editorial Activities, Service to Regional …

Prevalence Of Low Bone Mineral Density Amongst Resident Doctors At The Aga Khan University Hospital, Nairobi, Rose Ndumia

Master of Medicine in Imaging and Diagnostic Radiology

Objective: This was a cross-sectional study carried out amongst resident doctors training at the Aga Khan University Hospital, Nairobi to determine their bone mineral density and investigate for any association between the bone mineral density and the residents’ lifestyle. Methods: 65 randomly selected residents from various departments in the Aga Khan University Hospital, Nairobi, underwent a Dual Energy X-ray Absorptiometry (DXA) scan and filled out questionnaires to assess their physical activity, sunlight exposure and calcium intake. This was carried out between April and June 2011. Results: 65 residents were included in the final analysis. 50 residents (76.9% with a 95% …

Stratification Of White Matter Hyperintensities In Young And Middle Age Adults Using Hydrogen Magnetic Resonance (H-Mr) Spectroscopy, M’Mene E. Elvis

Master of Medicine in Imaging and Diagnostic Radiology

Objective: The objective of this study was to stratify white matter hyperintensities on the basis of neuronal integrity in young and middle age adults by comparing the level of N-acetyl aspartate and creatine ratios in white matter hyperintensity lesions and normal appearing white matter using hydrogen magnetic resonance (H-MR) spectroscopy at 1.5 Tesla(T) Methods: Fifty consecutive patients who fulfilled the inclusion criteria aged 18-50yrs who were referred for magnetic resonance imaging(MRI) of the brain at the Radiology department of Aga Khan University Hospital over a six month period between January and June 2011 were included in the study. These patients …

Comparison Of Wavelet Compressed Mri Cineloop Images Versus Originally Acquired Non-Modified Mri Images For Detection Of Brain Lesions, Patrice K. Anangwe

Master of Medicine in Imaging and Diagnostic Radiology

Brief background: Image compression has been widely accepted as the solution to the explosion of imaging data since the advent of multiaxial multisequence imaging. However, compromise on diagnostic quality secondary to this modification has been an issue. Many studies have been carried out looking at just noticeable differences but few have been undertaken to look at the difference in ability to detect pathology in original versus cineloop compressed images. This study was done to compare lesion detection ability of cineloop compressed images as compared to original images. Objectives: A comparative study to evaluate detection of brain lesions in wavelet compressed …

Triphasic Computed Tomography (Ct) Scan In Focal Tumoral Liver Lesions, Saima Hafeez, Muhammad Shahbaz Alam, Zafar Sajjad, Zahid Anwar Khan, Waseem Akhter, Fatima Mubarak

Department of Radiology

OBJECTIVE: To assess the diagnostic accuracy of triphasic spiral CT in differentiating benign from malignant focal tumoral liver lesions.

METHODS: The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. By convenient sampling, 45 patients found to have focal tumoral liver lesions were recruited for one year period and their triphasic CT scans findings were evaluated and later correlated with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of triphasic CT scan were calculated.

RESULTS: Among 45 patients, 136 …

Acute Vertebral Compression Fracture: Differentiation Of Malignant And Benign Causes By Diffusion Weighted Magnetic Resonance Imaging, Fatima Mubarak, Waseem Akhtar

Department of Radiology

OBJECTIVE: To evaluate the sensitivity, specificity and accuracy of diffusion weighted (DWI) magnetic resonance imaging (MRI) in the diagnosis and differentiation between benign (osteoporotic/infectious) and malignant vertebral compression fractures in comparison with histology findings and clinical follow up.

METHODS: The study was conducted at the Radiology Department, Aga Khan University Hospital (AKUH) Karachi. It was a one year cross-sectional study from 01/01/2009 to 01/01/2010. Forty patients with sixty three vertebral compression fractures were included. Diffusion-weighted sequences and apparent diffusion coefficient (ADC) images on a 1.5 T MR scanner were obtained in all patients to identify the vertebral compression fracture along …

Magnetic Resonance Spectroscopy In Focal Brain Lesions, Muhammad Shahbaz Alam, Zafar Sajjad, Saima Hafeez, Waseem Akhter

Department of Radiology

OBJECTIVE: To describe the spectrum of Magnetic Resonance spectroscopy in focal brain lesions and determine its diagnostic accuracy using histopathology as gold standard in differentiating neoplastic and non-neoplastic focal brain lesions.

METHODS: The study was conducted in Department of Radiology, Aga Khan University Hospital, Karachi from Dec 2006 till Jan 2009. Fifty three patients found to have focal brain lesions on magnetic resonance imaging (MRI) were included in the study. Magnetic Resonance spectroscopy (MRS) was performed in these focal lesions. These lesions were deemed neoplastic and non-neoplastic on MR Spectrum findings. Correlation of all these findings was done with histopathology …

Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md

Administration & Leadership

No abstract provided.

Religious Experiences Shrink Part Of The Brain, Andrew Newberg, M.D.

Marcus Institute of Integrative Health Faculty Papers

A study links life-changing religious experiences, like being born again, with atrophy in the hippocampus.

The article, “Religious factors and hippocampal atrophy in late life,” by Amy Owen and colleagues at Duke University represents an important advance in our growing understanding of the relationship between the brain and religion. The study showed greater atrophy in the hippocampus in individuals who identify with specific religious groups as well as those with no religious affiliation. It is a surprising result, given that many prior studies have shown religion to have potentially beneficial effects on brain function, anxiety, and depression.

Patient Discomfort Associated With The Use Of Intra-Arterial Iodinated Contrast Media: A Meta-Analysis Of Comparative Randomized Controlled Trials, Peter A. Mccullough, Patrizio Capasso

Radiology Faculty Publications

BACKGROUND: Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM).

METHODS: A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed …

Multiple Courses Of Stereotactic Re-Irradiation In Recurrent Oligodendroglioma: A Case Report., Shannon Fogh, Charles Glass, David W Andrews, Maria Werner-Wasik

Department of Radiation Oncology Faculty Papers

INTRODUCTION: High grade gliomas are an insidious disease associated with an extremely poor prognosis. The role of re-irradiation for recurrent gliomas is unclear but several retrospective studies have indicated mild toxicity and modest outcomes with this regimen. With subsequent progression, it is unclear what options remain and more radiotherapy is rarely offered for fear of surpassing normal central nervous system tissue tolerance and causing significant side effects without significant benefit.

CASE PRESENTATION: In this report, we describe a 37-year-old Caucasian male initially diagnosed with a grade IV oligodendroglioma, who received multiple courses of re-irradiation and experienced a survival of 10 …

Leaking Pseudoaneurysm Of Hepatic Artery: A Potentially Life-Threatening Complication Of A Common Procedure, Muhammad Rizwan Khan, Rushna Raza, Basit Salam

Section of General Surgery

We report a case of leaking pseudoaneurysm of right hepatic artery in a 54-year old female after laparoscopic cholecystectomy who presented with massive gastrointestinal haemorrhage and was successfully managed with angiography and coil embolization.

Focused Abdominal Ct Scan For Acute Appendicitis In Children: Can It Help In Need, Waseem Akhtar, Sumera Ali, Muhammad Arshad, Farzana Nawaz Ali, Naila Nadeem

Department of Radiology

OBJECTIVE: To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendicitis in paediatric population.

METHODS: A cross-sectional study was conducted at the Radiology Department of Aga Khan Hospital, from August 2007 to November 2008. A total of 84 patients (42 males & 42 females) with clinically equivocal signs and symptoms of acute appendicitis referred to radiology department for CT evaluation were studied. CT findings were compared with histopathology and clinical follow-up.

RESULTS: The sensitivity of focused CT for acute appendicitis was 91%; specificity was 69% and accuracy of 76% while PPV and NPV were 58%, …

Extracranial Meningioma: An Unusual Presentation Of A Mass Over Inner Canthus Of Left Eye, Nasir Ali, Mubasher Ikram, Tahir Shafi Khan, Syed Athar Enam, Abdul Qadir Jangda, Farrok Karsan

Section of Otolaryngology, Head & Neck Surgery

ABSTRACT Meningiomas are commonly encountered as intracranial brain tumours, but extracranial meningiomas do occur although seen rarely. Here we present a case of extracranial meningioma presenting as a mass over the medial canthus of left eye and the glabella with extension into the left ethmoid sinuses, without any neurological symptoms or signs. The patient underwent surgical excision, plastic surgical reconstruction and adjuvant radiotherapy after 3-dimensional conformal treatment planning.

Radiologic Technology, Carol L. Watwood

DLPS Faculty Publications

No abstract provided.

Role Of Multidetector Computed Tomography (Mdct) In Patients With Ovarian Masses., Fatima Mubarak, Muhammad Shahbaz Alam, Waseem Akhtar, Saima Hafeez, Noureen Nizamuddin

Department of Radiology

Objective:To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT) in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard. Material And

Methods:

This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred Patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these Patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. …

Transjugular Intrahepatic Portosystemic Shunt (Tips); Review Of Initial Experience At Aga Khan University Hospital, Rana Shoaib Hamid, Tanveer-Ul-Haq, Muhammad Azeemuddin, Zafar Sajjad, Ishtiaq Chishti, Basit Salam

Department of Radiology

OBJECTIVE: To retrospectively assess the therapeutic effectiveness and safety of transjugular intrahepafic portosystemic shunt (TIPS) in patients with portal hypertension related complications.

METHODS: Over a period of 7.5 years 19 patients (10 males and 9 females, age range 25-69 years) were referred for TIPS at our radiology department. Thirteen patients suffered from liver cirrhosis while 6 had Budd Chiari syndrome. All patients were evaluated with colour doppler ultrasonography and cross sectional imaging. Shunt procedures were performed under sedation or general anaesthesia through internal jugular approach. Metallic self expandable uncovered stents were placed in 15 patients and covered stent in 1 …

Goldston Syndrome, Zainab Hussain, Imrana Masroor, Qurrat-Ul-Ain Haider, Tariq Alam

Department of Radiology

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation (DWM). The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of Oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on …

Comparisons Of Three Analytical Techniques For Measuring Absolute And Relative Temperature Changes During Ultrasound Treatment, Michael G. Miller

Dissertations

Ultrasound is a thermal modality that utilizes acoustic energy to promote heating. While there are many factors that affect heating of body tissues, the effects of skinfold thickness and skin temperature upon ultrasound heating have not been studied extensively. In addition, while temperature typically follows a linear trend, past research typically uses ANOVA or regression analysis to examine this relationship; but these models examine the within-subject effects (time) and between effects (usually groups) at the group level, not the individual level. Therefore, the purposes of this study are to determine if skin temperature and skinfold thickness are predictors for intramuscular …

Diagnostic Accuracy Of Clinical Examination In Cervical Spine Injuries In Awake And Alert Blunt Trauma Patients, Manzar Hussain, Gohar Javed

Section of Neurosurgery

Study design: Observational, case series.
Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi.
Overview of literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny.
Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of …

Loss Of Neuronal Integrity During Progressive Hiv-1 Infection Of Humanized Mice., Prasanta Dash, Santhi Gorantla, Howard Gendelman, Jaclyn Knibbe, George P. Casale, Edward Makarov, Adrian A. Epstein, Harris A. Gelbard, Michael D. Boska, Larisa Y. Poluektova

Journal Articles: Radiology

Neuronal damage induced by ongoing human immunodeficiency virus type 1 (HIV-1) infection was investigated in humanized NOD/scid-IL-2Rγ(c)(null) mice transplanted at birth with human CD34-positive hematopoietic stem cells. Mice infected at 5 months of age and followed for up to 15 weeks maintained significant plasma viral loads and showed reduced numbers of CD4(+) T-cells. Prospective serial proton magnetic resonance spectroscopy tests showed selective reductions in cortical N-acetyl aspartate in infected animals. Diffusion tensor imaging revealed structural changes in cortical gray matter. Postmortem immunofluorescence brain tissue examinations for neuronal and glial markers, captured by multispectral imaging microscopy and quantified by morphometric and …

Improving The Tracking And Removal Of Retrievable Inferior Vena Cava Filters., Anthony D Goei, Shellie C Josephs, Thomas B Kinney, Charles E Ray, David Sacks

Reading Hospital Interventional Radiology

Therapeutic and prophylactic inferior vena cava (IVC) filters should be placed based on currently accepted indications to prevent a fatal pulmonary embolism (PE). The protective effect of filters is offset by the potential for lower extremity deep venous thrombosis (DVT), caval thrombosis, and possible otherwise unnecessary life-long anticoagulation (AC). The duration of treatment for most DVTs or PEs is 3 to 6 months of AC/filter. Filters should be retrieved when duration of treatment for a DVT/PE has been met, the risk of a PE is no longer high, and/or there is no longer a contraindication to AC. An effective system …

Dynamic Contrast Enhanced Mri Breast For Lesion Detection And Characterization With Histopathological Co Relation: Preliminary Experience At Tertiary Care Hospital, Gulnaz Shafqat, Ajmal Agha, Imrana Masror, Mahwash Rehan, Shaista Afzal

Department of Radiology

OBJECTIVE: To determine the morphological and enhancement characteristics significantly associated with malignant breast lesions on dynamic contrast enhanced MRI by considering the histopathological findings as a gold standard.

METHODS: A retrospective analysis was performed on 70 patients who underwent MRI breast during the study period because of suspicious mammographic abnormalities. MR imaging was performed on 1.5 tesla machine with dynamic contrast enhancement by using dedicated breast coil. MR Images of breast were evaluated on a workstation and reported on the basis of morphological appearance of lesion and time activity curves. Histopathological analysis of the lesion was done either after mastectomy …

Knowledge, Attitudes And Practices (Kap) Regarding Sexuality, Sexual Behaviors And Contraceptives Among College/University Students In Karachi, Pakistan, Fozia Ajmal, Ajmal Agha, Nabila Zareen, Mehtab S Karim

Department of Radiology

OBJECTIVE: To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan.

STUDY DESIGN: Cross-sectional observational study.

PLACE AND DURATION OF STUDY: Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006.

METHODOLOGY: Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception …