Consultant Radiologist Research Articles

COMPUTED TOMOGRAPHY OSTEOARTHRITIS KNEE SCORE (COAKS) CONSTRUCTION, REPRODUCIBILITY AND POTENTIAL FOR STRUCTURAL PHENOTYPING

Computed tomography (CT) has been shown to be more sensitive identifying certain structural features of OA than radiography and MRI. The ability to acquire weight bearing CT (WBCT) at the knee is also an important current advantage over MRI that has created an opportunity to assess the entire weight bearing joint in 3-D. This could have implications for longitudinal monitoring of disease progression and the selection of participants in clinical trials according to structural phenotype. 1) To introduce the semi-quantitative CT OA Knee Score (COAKS); 2) to report initial interobserver reproducibility; and 3) to demonstrate its potential for structural disease phenotyping. 106 WBCT examinations were sourced from existing research projects at the Department of Rehabilitation Medicine, University of Kansas Medical Center, USA. A 4-point scoring system (0-3) was created for each cardinal radiographic feature of osteoarthritis (J = joint space width; O = osteophytes; C = subchondral cysts; S = subchondral sclerosis) to be assessed at each joint compartment (MTF = medial tibiofemoral; LTF = lateral tibiofemoral; PF = patellofemoral; PTF = proximal tibiofibular). Brief verbal definitions are given for each feature score in table 1. After initial training and grading of all knees by a musculoskeletal radiology clinical fellow (J.J.H.), a reference atlas was created that included a standardised review guide (including display settings and multiplanar reformat orientations), examples of each score for each feature at each compartment, and common pitfalls. Blinded to the imaging data, 10 test knees and 35 study knees were super-selected by their initial scoring to stratify disease features as evenly as possible. No restrictions were placed on the quality of imaging, the presence of ACL reconstruction (an inclusion criteria for one source study), or imaging review platform. T.D.T. trained another consultant musculoskeletal radiologist (Z.A.), who both assessed the 10 test knees, reviewed performance, then repeated the test assessment. Both then scored the 35 study knees without communication during the assessment period. A cloud score sheet was used in Google Sheets (table 2) with the reference atlas in Google Docs, both accessible online or via the respective smart phone / tablet app. The weighted kappa score for interobserver reproducibility was calculated for each structural feature across all compartments. Compartment feature scores were also plotted as heat maps for each knee to provide a visualisation of structural OA phenotype. The weighted kappa scores (+95% CI) for each feature were: J = 0.87 (0.86-0.89); O = 0.79 (0.76-0.82); C = 0.66 (0.63-0.70); S = 0.84 (0.82-0.86). On average, it took less than 5 minutes to score a single knee. Selected heat maps (figure 1) show how different phenotypes can be ascertained using the COAKS system: RUNA053L is an early MTF phenotype with PF involvement; RUNA045R is a late MTF phenotype with multicompartment disease; RUNA023L is a late LTF phenotype with severe multicompartmental osteophytosis but no other features; RUNA088L is a PF phenotype with small tibiofemoral osteophytes only. A whole joint COAKS score is also possible (out of 48), as is a score by compartment (out of 12) or by feature (out of 12) as desired. COAKS is a feasible semi-quantitative WBCT-based scoring system of knee OA that demonstrates initial substantial to almost perfect inter-observer agreement across radiographic features. The ability of COAKS to score and phenotype the weight bearing knee in 3-D may exceed individual capabilities of MRI and radiography in certain aspects, offering flexibility in phenotyping for patient selection as well as potential sensitivity for longitudinal monitoring of disease severity in clinical trials or cohort studies. It is also possible to use the COAKS in non-weight bearing CT if flagged as such and not used to compare with weight bearing studies.

The role of computed tomography chest in correlating with the severity and outcome of COVID-19 patients admitted in a tertiary care hospital in South India

Aim: To assess the role of computed tomography (CT) chest in correlating with the severity and outcome of COVID-19 Patients. Background and Materials and Methods: A prospective study was done on 160 hospitalized patients who were COVID-19 positive by reverse transcription-polymerase chain reaction in Apollo Hospital, Greams Road, Chennai, India. We collected epidemiological data, comorbidities, clinical manifestations, oxygen requirement, and CT chest details of all patients. All images were reviewed by a single consultant radiologist and CT chest severity scoring was done as per the guidelines published in the American Journal of Radiology. CT chest severity score (CTSS) was then compared with clinical severity and various parameters. Results: This study included 160 hospitalized COVID-19 patients with a mean age of 61 ± 13.97 years. Male (74.4%) patients were more when compared to female patients (25.6%). Majority of the patients were belong to mild category (44.38%), followed by severe (28.7%) and moderate (26.8%) categories. Fever (73.8%) was the most common symptom. Diabetes mellitus (57.5%) was the most common comorbidity of COVID-19 patients in our study, followed by hypertension (55%). The average CTSS of mild category was 7.4 ± 4.7; for moderate category, the mean CTSS was 14.6 ± 5.78; and for severe category, it was 18.3 ± 5.28. There was increasing trend of severity score, as clinical severity increases which was statistically significant (P = 0.0001). The mean CTSS of patients who required no oxygen, low flow oxygen, high flow oxygen, noninvasive ventilation, and intubated patients was 8.3 ± 5.71, 14.84 ± 5.39, 18.17 ± 5.7, 18.17 ± 6.04, and 22.18 ± 4.07, respectively, which was statistically significant (P = 0.0001). The mean CTSS of patients discharged without oxygen requirement was 11.09 ± 6.48 and patients discharged with oxygen requirement was 18.09 ± 6.12 (P = 0.001). The mean CTSS of patients who died was 20.27 ± 4.62. Conclusion: There was a significant correlation between CT chest severity score and clinical severity and oxygen requirement. CT chest is one of the best screening tools for rapid identification as well as to predict the clinical severity; thereby, it helps the clinician in managing the COVID-19 patients at crucial points during the progression of disease.

Diagnostic accuracy and safety of CT-guided Lung and Mediastinal biopsies: a single center study

Background: Computed tomography (CT)-guided percutaneous needle biopsy plays a critical role in establishing tissue diagnosis of malignancy, guiding staging, and planning treatment for pulmonary abnormalities. Aim: To determine diagnostic accuracy and incidence of complications occurring after taking percutaneous CT-guided lung biopsy. Methodology: In this retrospective study, we evaluated 44 CT-guided chest biopsies (31 lung biopsies and 13 mediastinal biopsies) performed at our institution between September 2019 and March 2022. A coaxial core biopsy needle technique was used for all CT-guided biopsies. All procedures were performed by an experienced consultant interventional radiologist using using a commercially available helical multidetector-row CT scanner. Results: There were 29 men and 15 women among the 44 patients, ranging in age from 25 to 65 years. We found technical accuracy (described as tip of core biopsy needle within centre of lesion) of 100% (44/44) and diagnostic accuracy (described as adequate sample for histological assessment) of 97.7% (43/44) in our study. The overall incidence of complications during the procedure were recorded including pneumothorax (n = 2, 4.5%),pulmonary hemorrhage (n = 1, 2.3%), hemoptysis (n = 1, 2.3%). Conclusion: CT-guided chest biopsy is a safe procedure and has good diagnostic accuracy. However, radiologists approaching such interventional procedures must be experienced and well trained so that there are less chances of developing complications after the procedure. Practical implications: We suggest physicians performing chest biopsies to adopt better techniques and use shortest path to the lesion during needle insertion. Although CT-guided chest biopsy has fewer chances of complications, however, interventional radiologists should be conscious of potential complications. Keywords: CT-guided biopsy; Percutaneous biopsy; Imaging, Interventional radiology; Diagnosis.

Integration of Traditional and Innovative Methods in Anatomy Dissections: A Sri Lankan Experience

Introduction: Routine methods of teaching gross anatomy including cadaver dissections have been a keystone of the anatomy curriculum and certain difficulties have led medical educationists to explore teaching using modern technology. This study aims to share the institutional experience of incorporating new methods into routine dissections at the Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.Methodology: Prior to dissections, recommended anatomy 3D software and videos were shown in LED panels. Mock spots were conducted weekly. Applied anatomy sessions were conducted by clinicians. Ultra sound scan (USS) based teaching sessions were conducted by a consultant radiologist. Another study area with multiple illuminators with radiological films was present. Routine feedback was taken from students.Results: The use of LED panels for teaching was found to be helpful by most (82.6%) students. A majority (84%) also found that mock spots were helpful for their studies and 89.2% preferred the use of 3D software. Percentage 82.6% of students found USS guided teaching useful while 85.4% of students found X-ray & CT useful. Majority (91.5%) found the applied anatomy teaching sessions useful. The majority of students’ comments indicated recommendations for them to be continued for future batches.Conclusion: This initiative demonstrates that the combination of traditional and innovative methodologies in the teaching of gross anatomy is favored by students and the applied anatomy sessions can provide vertical integration of the subject.

Chronic neck pain and its association with the angle of the cervical curve

Objective: This study was conducted to investigate the relationship between the angle of the cervical curve and the presence of chronic neck pain. Material and Methods: Case control study was conducted among 363 patients, (females 76.9%), who had neck pain (>3 months) and 349 individuals, (females 58.5%), with no neck pain, aged 20-69 years. Angle of the cervical curve was measured in lateral x-rays of cervical spine using AutoCAD 2014 and cross checked by two Consultant Radiologists. Angle of the cervical curve was categorized as 35°-45°-normal lordosis, <35°-hypolordosis and >45°-hyperlordosis. Percentages of each category were calculated.Results: Among the patients with chronic neck pain, 44.9% (n=163) had hypolordosis, 49% (n=178) had hyperlordosis and 6.1% (n=22) had the normal lordosis. Among the individuals with no neck pain, the majority (80.8%, n=282) had the normal lordosis, 12.3% (n=43) had hypolordosis and 6.9% (n=24) had hyperlordosis. Chi square test showed a statistically significant association between neck pain and the angle of cervical curve (p=0.001). According to Cramer’s V (0.615) there was a strong association between the two variables. For purposes of analysis both hypolordosis or hyperlordosis were categorized as atypical angle. When compared to individuals with a normal lordosis, those with an atypical angle have a 3.3 times risk of having neck pain.Conclusion: Hypolordosis or hyperlordosis, atypical angle of the cervical curve contribute to chronic neck pain.

Association of Type 2 Diabetes Mellitus with Fatty Liver

Objective: To assess the association of fatty liver with type 2 diabetes and other socio-demographic factors among the patients at Pak Emirates military hospital Rawalpindi.
 Study Design: Cross-sectional analytical Study.
 Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Aug 2019 to Jan 2020.
 Methodology: This study was conducted on 300 patients of type 2 diabetes mellitus reporting for a routine checkup at the medical Outpatient department. Fatty liver was diagnosed on ultrasound by a consultant radiologist.
 Results: Out of three hundred patients with diabetes mellitus included in the final analysis, 225(75.0%) were males, and 75(25.0%) were females. 176(58.6%) had fatty liver on ultrasound, while 124(41.4%) had no fatty liver on ultrasound examination at the time of the study. we found that increasing age, long duration of diabetes and poor control of illness had a statistically significant relationship with the presence of fatty liver among the target population (p<0.05).
 Conclusion: Patients with type 2 diabetes had a high frequency of fatty liver on routine ultrasound examinations. In addition,patients with more age, long duration of diabetes mellitus and poor control of illness were at a high risk of developing fatty liver among the study participants.

A radiomic model to classify response to neoadjuvant chemotherapy in breast cancer

BackgroundMedical image analysis has evolved to facilitate the development of methods for high-throughput extraction of quantitative features that can potentially contribute to the diagnostic and treatment paradigm of cancer. There is a need for further improvement in the accuracy of predictive markers of response to neo-adjuvant chemotherapy (NAC). The aim of this study was to develop a radiomic classifier to enhance current approaches to predicting the response to NAC breast cancer.MethodsData on patients treated for breast cancer with NAC prior to surgery who had a pre-NAC dynamic contrast enhanced breast MRI were included. Response to NAC was assessed using the Miller–Payne system on the excised tumor. Tumor segmentation was carried out manually under the supervision of a consultant breast radiologist. Features were selected using least absolute shrinkage selection operator regression. A support vector machine learning model was used to classify response to NAC.Results74 patients were included. Patients were classified as having a poor response to NAC (reduction in cellularity < 90%, n = 44) and an excellent response (> 90% reduction in cellularity, n = 30). 4 radiomics features (discretized kurtosis, NGDLM contrast, GLZLM_SZE and GLZLM_ZP) were identified as pertinent predictors of response to NAC. A SVM model using these features stratified patients into poor and excellent response groups producing an AUC of 0.75. Addition of estrogen receptor status improved the accuracy of the model with an AUC of 0.811.ConclusionThis study identified a radiomic classifier incorporating 4 radiomics features to augment subtype based classification of response to NAC in breast cancer.

Sensitivity and Specificity of Color Duplex Ultrasound Measurement in the Estimation of Internal Carotid Artery Stenosis

Background: Stroke is that the world's leading reason for death and major incapacity. Arterial sclerosis is answerable for over half-hour of all ischemic strokes. Plaque morphology has recently been discovered to assist within the prediction of arterial sclerosis clinical behavior and stroke risk. Purpose: The goal of this study was to gauge the frequency and diagnostic exactitude of artery Doppler imaging to detect arterial blood vessel pathology. Methods: This cross-sectional study was conducted in Combined Military Hospital, Peshawar from1st August 2019 to 31st March 2020. A total of 120 patients were randomly selected. The inclusion criteria was having ischemic cerebrovascular stroke. Doppler ultrasound was performed in every patient by a consultant radiologist. Doppler ultrasound findings were compared with Carotid artery stenosis reports. Results: Mean age in this study was 63.07±3.76 years. Mean duration of disease was 1 year ±3.32 months. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Doppler Ultrasound were 89.5, 76.20, 45.5, 93.88 and 76.9% respectively. The areas under the ROC curves ranged between 0.89 and 0.90 for the laboratory A device and between 0.90 and 0.92 for the laboratory B device. In laboratories A and B, the areas under the ROC curves for ICA PSV were 0.90 and 0.92, respectively. Similar effects were observed when occlusion-affected patients were omitted (0.89 to 0.91, laboratory A; 0.90 to 0.93, laboratory B). Despite the fact that the diagnostic accuracy of the two devices was equivalent, two points on the ROC curves corresponding to the same cut point were infrequently near. Practical implication: The study compared the techniques of Doppler ultrasound for the diagnosis of carotid artery stenosis in patients and measured the best predicted percent angiographic stenosis differed between two vascular laboratories and paved the way for clinicians to focus of the diagnosis of carotid artery stenosis by DU. Conclusion: With the advancement in technology, the accuracy of carotid artery stenosis diagnosis has significantly improved over the decades. From measuring the narrowing carotid artery diameter to evaluating the increased velocity field near the obstruction/lesion site, the identification of additional parameters to characterize plaque vulnerability has become more important in the carotid artery. Keywords: Angiography; Carotid artery stenosis; Cerebrovascular ischemia; Doppler ultrasound sensitivity.

Diagnostic Accuracy of Magnetic Resonance Spectroscopy in Differentiating Malignant and Benign Brain Lesions

The aim of this study is to determine the diagnostic ability of magnetic resonance spectroscopy in separating malignant and benign cerebral masses, when histopathology taken as gold standard. The results of my study will not only resolve this controversy but also If MRS diagnostic accuracy will be found high in distinguishing ring enhancing lesions of brain, then this non-invasive modality can be applied routinely in our general practice for proper treatment selection the lesions in order to reduce the morbidity and mortality of these particular patients. Materials &amp; Methods: We included around 141 cases presenting to us at the Radiology department of Sir Ganga Ram Hospital, Lahore, fulfilling the inclusion criteria was selected after we got approval for the study from IRB committee of university. Informed consent was taken from each patient. We performed magnetic resonance spectroscop in each case using 1.5 Tesla MR system having graded power of 33 mT/m and results of MRS were read and reported by one radiology consultant. Malignant or benign lesions were noted on MRS. After this, each patient was undergone biopsy in the concerned ward by the consultant neurosurgeon and tissue was sent to institutional pathology laboratory for histopathology. Histopathology results were interpreted by the consultant histopathologist (at least 3 years of post-fellowship experience) and benign or malignant lesion was noted Results: All the included cases underwent standard magnetic resonance spectroscopy (MRS) of brain. MRS strengthened the suspicion of malignant brain lesions in 94 (66.67%) cases. Histopathology findings confirmed malignant brain lesions in 90 (63.83%) cases. Conclusion: This study concluded that MRS is the non-obstrusive method of imaging with greater diagnostic accuracy in differentiating malignant and benign brain lesions, and that it has not only made drastically better our capability to identify malignant brain lesions preoperatively, and moreover assists neurosurgeons in taking much better decisions. As a result, we urge that MRS be performed habitually in all suspected instances of intracranial mass lesion for reliable pre-operative identification of malignant brain lesions and selection of appropriate surgical technique. Keywords: MRS. MRI. Brain lesions, brain tumor, CNS tumor, Magnetic resonance spectroscopy

Diagnostic Accuracy of Elastography to Differentiate Between Malignant and Benign Lymph Nodes of Neck and Head Region Taking Histopathology as Gold Standard

Background: The analysis of superficial lymphadenopathy in the cervical, axillary, and inguinal regions is vital in planning therapy for patients. Elastography is a technique currently being used for the evaluation of lymph nodes by means of evaluating tissue elasticity. In medical practice, shear wave-based and strain elastography techniques are being utilized. Strain elastography can be used to assess types of elasticity. Colors inside and around the nodes are estimated in the first place and then a 4-5 scale scoring system is used to score them visually. The present study aimed to assess the diagnostic accuracy of elastography in distinction between malignant and benign lymph nodes of the neck and head region, taking histopathology as the gold standard. Methods: This study was carried out on ninety-six (96) patients of either gender with lymph nodes in the head and neck region admitted to Children Hospital and University of Child Health Sciences Lahore and Mardan Medical Complex. Patients with proven histopathology and gone through surgery in the head and neck region were excluded from the study. Each patient was subjected to the high-resolution elastography with a 7.5 MHz linear array probe. A consultant radiologist performed the elastography in the presence of the researcher and noted the lymph node types. The histopathology report was compared with the findings of elastography. Results: High-resolution elastography was conducted on each patient enrolled in this study and their results were categorized into two distinct groups’ namely positive elastography and negative elastography. In the positive group, malignant lymph node diagnoses were supported in 51 patients by elastography. Out of which 46 were true positive cases and 5 were false-positive cases with no malignant histopathology. Similarly, in elastography, negative patients, only 3 cases were false negative and 42 cases were true negative. The overall diagnostic precision, specificity, negative predictive value, positive predictive value, and sensitivity of elastography was found to be 92%, 89.10%, 92.80%, 89.40%, and 94%, respectively, in order to differentiate malignant lymph nodes from benign lymph nodes in the neck and head region, taking histopathology as the gold standard. Conclusions: The present study demonstrated that elastography is a favorable and invasive technique for the diagnosis and differentiation of malignant lymph nodes from benign lymph nodes with high diagnostic accuracy. It may help in selecting surgical procedures for lymph nodes in the neck and head region. Keywords: Elastography, Sensitivity, Malignant Lymph Nodes.

Patterns of Associated Knee Ligament and Chondral Injuries in First-Time Traumatic Patellar Dislocation: A Retrospective Magnetic Resonance Imaging (MRI) -Based Study.

Introduction First-time acute traumatic patellar dislocation, when managed without a knee magnetic resonance imaging (MRI) scan, may lead to missed diagnoses of important associated knee injuries. The aim of this study was to ascertain the incidence of associated ligamentous and cartilaginous injuries in first-time traumatic patella dislocation. Methods This was a five-year retrospective study on patients aged 16-45 who had knee MRI scans showing the characteristic bone bruise patterns seen in traumatic lateral patellar dislocation. Anonymized data from the hospital picture archiving and communication system (PACS) was obtained with each scan reviewed by a consultant radiologist, a fellowship-trained orthopaedic knee specialist, and an orthopaedic registrar or resident. Results A total of 200 knee MRI scans were screened. 61 eligible knee MRI scans were included in the study. The patients' ages ranged from 16 to 42 years old, with a mean of 25 years. 73.8% were male. A medial patellofemoral ligament (MPFL) tear or rupture occurred in 58 of 61 knees (95%) with MPFL attenuation in three (5%) injured knees. Meniscal injuries were identified in 5 of 61 knees (8.2%), medial collateral ligament (MCL) injuries in 11 of 61 knees (18%), osteochondral injuries and loose bodies in 17 of 61 knees (27.9%), and anterior cruciate ligament (ACL) injury in one knee (1.6%). Conclusions This single-centre MRI-based study has provided information on the incidence of associated chondral and ligamentous injuries in patients with first-time acute traumatic patellar dislocation. This information will be useful for clinicians when counselling patients and will add to the available literature on this injury. An MRI scan should be obtained in cases of suspected first-time traumatic patellar dislocations, especially in active young patients, due to the incidence of other associated traumatic knee lesions that might need surgical treatment and lead to persisting knee symptoms if neglected.

Time-Driven, Activity-Based Costing to Reduce Interventional Radiology Suite Idle Time.

Background With the ever-increasing complexity of today's healthcare environment, it is evident that there is a higher demand to deliver high-quality, accessible, efficient, and affordable healthcare. At the same time,these changes are accompanied by decreasing rates of reimbursement. This can be attributed to the shift from fee-for-service to value-based payment methods in the industry. The reception of such changes in the appropriate manner is crucial to improvement and the much-demanded reform in our healthcare system. To adapt to this changing landscape, hospitals and healthcare systems must incorporate proper measures to identify extraneous spending, control costs, and streamline patient care. Our goal in this study was to use the time-driven, activity-based costing (TDABC) model to quantify the costs at every step as an inpatient goes through the care process in an interventional radiology department. Methodology After identification and mapping of all the steps involved from interventional radiology (IR) consult placement to patient transport to the postoperative recovery area, time data were collected for each step of the process. One of the steps was then selected for intervention.Our focus was on the time interval between one patient leaving after a completed procedure and the next scheduled patient entering the IR suite (heretofore referred to as idle time). To decrease the idle room time between patients, the interventional radiologists, IR administrations, nurse manager, transportation manager, and charge nurse first met as a group to set a realistic initial goal. Pre-intervention data were collected. Results After the collection of pre-intervention data, the average idle time of the IR suite was found to be 40 minutes. After a multidisciplinary discussion, our goal was to reduce this time to 25 minutes. Post-intervention data found the average time decreased to 24 minutes. Calculation of average costs per unit time for staff, IR room, and equipment yielded an approximate cost of $57 per minute of time in the IR suite. Conclusions Considering the near 40% decrease in suite idle time as well as the cost per minute of material, equipment, and staff (at ~80% capacity), this study proves that the TDABC system is a viable method of targeting bottlenecks in operations and streamlining patient care by reducing costs while optimizing the process patients go through during care continuum.

MRI remains highly accurate in the diagnosis of appendicitis in pregnancy when read by radiologists of mixed specialty training and experience.

To audit the accuracy of magnetic resonance imaging (MRI) abdominal studies performed in the diagnosis of appendicitis in pregnant patients when read by radiologists of mixed experience. MRI reports from 45 pregnant women presenting to our emergency department for the investigation of appendicitis between 2009 and 2020 were retrospectively reviewed. Where available, these reports were correlated with surgical and pathology reports as well as follow-up clinical information. Following a review of literature, accuracy targets were set. Statistical analyses including sensitivity, specificity, positive, and negative predictive values were calculated. A total of 18 radiology consultants read 45 MRI abdominal studies in the assessment of appendicitis during pregnancy with 62% (n = 28) of these read by specialist radiologists and the remainder by general radiologists. This yielded an accuracy in diagnosis of 99.8%, sensitivity of 80% (95% CI: 49-94.3%), and specificity of 100% (95% CI: 90-100%). The calculated negative predictive value was 94.6% (95% CI: 82.3-98.5%), and positive predictive value was 100% (95% CI: 90-100%). The appendix was not identified in 19 patients (42%). A statistically significant relationship between the presence of right iliac fossa stranding of the fat OR free fluid was associated with appendicitis (p = 0.01). Alternate diagnoses were identified in 8% (n = 4) of cases. MRI is a highly accurate imaging modality for the assessment of appendicitis in pregnancy. Even with variable reader MRI experience, MRI demonstrates an accuracy of 99.8% and a positive predictive value for acute appendicitis of 100%. Double reading and the possible inclusion of DWI may help further improve accuracy and minimise false-negative rates.

Correlation between Chest Radiograph and Lung Ultrasound with Clinical Appearance in Hyaline Membrane Disease Patients

ABSTRACT Background: Hyaline membrane disease (HMD) is a respiratory distress disease in premature infants due to surfactant deficiency. The combination of clinical, laboratory and radiological features makes it easy to quickly, precisely &amp; accurately establish HMD which is important for early therapy in preventing death. Purpose: Knowing the suitability between chest X-ray &amp; Thorax ultrasound with the clinical picture in HMD patients. Methods: This study is an observational study with a cross sectional method conducted in the radiology &amp; NICU section of Dr. Wahidin Sudirohusodo Makassar from August 2021 to January 2022. Sampling was done by consecutive sampling. The researcher performed a thorax ultrasound &amp; assessed the chest x-ray. The results were verified by two pediatric radiology consultants. Results: The largest sample was in neonates at 34 weeks of gestation, 8 samples (21.1%), sex with 25 samples (65.8%), the highest birth weight between 1000-2000 grams 32 samples (84.2%) , the most preterm etiology was due to severe preeclampsia in 13 samples (34.2%), the most deliveries were by cesarean section 34 samples (89.4%), the highest APGAR Score was in moderate degree 25 samples (65.8%), the highest O2 saturation was between 90 -94%, namely 24 samples (63.2%), the most down scores were moderate degrees 15 samples (39.5%), HMD degrees based on chest radiographs were mostly grade II 25 samples (65.8%), HMD degrees based on thorax ultrasound the most in the moderate degree 19 samples (50%).Conclusion: Ultrasound is considered as the radiological modality of choice because it is safe, inexpensive, easy &amp; sensitive to assess respiratory distress in neonates but is influenced by the operator's ability to apply it.Keywords: hyaline membrane disease, down score, chest radiograph, lung ultrasound

EVALUATING DIAGNOSTIC VALUE OF MAGNETIC RESONANCE SPECTROSCOPY (MRS) FOR DIAGNOSIS OF MALIGNANT BREAST MASSES

To evaluate diagnostic value of magnetic resonance spectroscopy (MRS) for diagnosis of malignant breast masses. The study included 155 patients with breast lesions at Department of Radiology, CH &amp; ICH Multan from January 2021 to June 2021.1.5 Tesla MR system was used for proton magnetic resonance spectroscopy (1H MRS). Consultant radiologist interpreted MR spectroscopy for distinguishing between benign and malignant lesions using histopathology as a gold standard. SPSS 20.0 was used for data analysis. Among 81 MRS positive cases, 76 had malignant lesions (True Positive) and 05 had no malignant lesion (False Positive) on histopathology. Among 74 MRS negative cases, 7 had malignancy on histopathology (False Negative), while 67 had no malignant lesion (True Negative) on histopathology. It was concluded that MRS has high sensitivity and accuracy for diagnosis of malignant breast lesions.

Correlation Between Ultrasonographically Estimated Fetal Weight and Actual Birth Weight in Females Presenting in a Tertiary Care Hospital

Objective: To determine the correlation between ultrasono-graphically estimated fetal weight and actual birth weight in females presenting in a tertiary care hospital.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology Peripheral Nervous System, PNS Shifa Hospital Karachi Pakistan, from Sep 2018 to Jan 2019.&#x0D; Methodology: Fifty pregnant females were enrolled after meeting the inclusion criteria. A consultant radiologist calculated fetal weight by measuring biparietal diameter (BPD), head circumference (HC), femur length (FL) and abdominal circumference (AC) with the help of an ultrasound (USG) machine having a Hadlock 3 weight estimation algorithm. A paediatrician noted actual birth weight with a weighing scale after delivery.&#x0D; Results: The mean fetal weight on ultrasound was 2.52±0.34kg. The mean actual birth weight of the babies was 2.66±0.42 kg. A strong positive correlation (r=0.575, p&lt;0.05) was found between ultrasonographic fetal weight estimation and actual birth weight.&#x0D; Conclusion: Ultrasonography is an accurate, safe, cost-effective and easy available imaging modality for fetal weight estimation.

Study protocol for a multicentre comparative diagnostic accuracy study of tools to establish the presence and severity of peripheral arterial disease in people with diabetes mellitus: the DM PAD study

IntroductionPeripheral arterial disease (PAD) is a key risk factor for cardiovascular disease, foot ulceration and lower limb amputation in people with diabetes. Early diagnosis of PAD can enable optimisation of...

Diagnostic accuracy of magnetic resonance spectroscopy (MRS) for diagnosis of focal brain lesions taking histopathology as gold standard.

Objective: To determine diagnostic accuracy of MRS for diagnosis of malignant brain lesions taking histopathology as gold standard. Study Design: Cross Sectional Validation study. Setting: Department of Radiology, Lahore General Hospital, Lahore. Material &amp; Methods: A total number of 127 patients who were referred for the diagnosis of focal brain lesions were included. In all patients, MRS was done by consultant radiologist to diagnose malignancy. All patients underwent surgery in the neurosurgery department and after surgery biopsy specimen were taken for diagnosis of malignancy using histopathology findings. Results: Mean age of patients was 40.88±11.37 years. There were 88 (69.29%) males and 39 (30.71%) female patients. On MRS, malignancy was diagnosed in 99 (77.95%) patients and on histopathology malignancy was diagnosed in 102 (80.31%) patients. Regarding diagnostic accuracy, MRS was 97.00% sensitive, 94.10% specific, with PPV of 78.60% and NPV of 88.00%. Conclusion: Magnetic resonance spectroscopy (MRS) has good sensitivity and specificity in differentiating neoplasm from non-neoplastic focal brain lesions.

Chest radiograph classification and severity of suspected COVID-19 by different radiologist groups and attending clinicians: multi-reader, multi-case study

ObjectivesTo quantify reader agreement for the British Society of Thoracic Imaging (BSTI) diagnostic and severity classification for COVID-19 on chest radiographs (CXR), in particular agreement for an indeterminate CXR that could instigate CT imaging, from single and paired images.MethodsTwenty readers (four groups of five individuals)—consultant chest (CCR), general consultant (GCR), and specialist registrar (RSR) radiologists, and infectious diseases clinicians (IDR)—assigned BSTI categories and severity in addition to modified Covid-Radiographic Assessment of Lung Edema Score (Covid-RALES), to 305 CXRs (129 paired; 2 time points) from 176 guideline-defined COVID-19 patients. Percentage agreement with a consensus of two chest radiologists was calculated for (1) categorisation to those needing CT (indeterminate) versus those that did not (classic/probable, non-COVID-19); (2) severity; and (3) severity change on paired CXRs using the two scoring systems.ResultsAgreement with consensus for the indeterminate category was low across all groups (28–37%). Agreement for other BSTI categories was highest for classic/probable for the other three reader groups (66–76%) compared to GCR (49%). Agreement for normal was similar across all radiologists (54–61%) but lower for IDR (31%). Agreement for a severe CXR was lower for GCR (65%), compared to the other three reader groups (84–95%). For all groups, agreement for changes across paired CXRs was modest.ConclusionAgreement for the indeterminate BSTI COVID-19 CXR category is low, and generally moderate for the other BSTI categories and for severity change, suggesting that the test, rather than readers, is limited in utility for both deciding disposition and serial monitoring.Key Points• Across different reader groups, agreement for COVID-19 diagnostic categorisation on CXR varies widely.• Agreement varies to a degree that may render CXR alone ineffective for triage, especially for indeterminate cases.• Agreement for serial CXR change is moderate, limiting utility in guiding management.

Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series

BackgroundUnderstanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology. Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechanisms and to prevent associated injuries. The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings in the lumbar spines of asymptomatic elite male adolescent footballers.MethodsA prospective case-series study was carried out. MRI was performed using a 3T Siemens Prisma scanner including a 3D VIBE sequence in 18 asymptomatic male elite adolescent footballers recruited from a professional academy in England (mean age 17.8, range 16.9–18.6 years). The images were independently reported by two consultant musculoskeletal radiologists to achieve consensus opinion. Standardised classification criteria were used to assess and report abnormalities descriptively.ResultsFifteen players (15/18, 83%) showed ≥1 abnormalities, included facet degeneration, synovial cysts, disc degeneration, disc herniation, and pars injury. One player (1/18, 6%) had mild (Grade 1) facet joint arthropathy at L4/L5 and 3/18 (16.7%) showing evidence of bilateral facet joint effusions. Three synovial cysts were identified in 2/18 players (11%), 4/18 players (22%) presented asymptomatic pars injuries, with 4 showing a grade 2 subtotal stress fracture and 1 player a grade 4 chronic stress fracture seen on 3D VIBE sequencing. Disc degeneration at one or more levels was demonstrated in 7/18 players (38%). Disc herniation was present in 5/18 players (27%).ConclusionA range of unsuspected findings on MRI of the lumbar spine are common in elite adolescent footballers.