Consultant Radiologist Research Articles

Normative values of the alpha angle and triangular index measured from the hip radiographs of an African population

IntroductionUndetected femoroacetabular impingement (FAI), caused by asphericity of the femoral head, has been implicated as a leading cause of hip osteoarthritis in later stages. Two known types of impingement of the femur head with the acetabulum include the cam-type and pincer type, and the alpha angle and triangular index are indices applied in determining the presence of FAI in a hip radiograph. ObjectiveTo determine the normal range and upper limit of normal of the alpha angle and triangular index of an African population using non-pathological hip radiographs. Materials and methodsHip radiographs of 104 subjects reported to be normal were retrospectively studied. The images were reassessed jointly by three radiographers and afterwards by three consultant radiologists. The alpha angle and triangular index of selected radiographs were measured with appropriate electronic callipers. Values obtained were correlated with the age and gender of the patients. ResultsThe mean ± SD of the alpha angle for the population studied was 46.70 ± 12.340 with a range of 33.300–96.820 (males: 45.09 ± 12.030, females: 47.32 ± 12.370), and the upper limit of normal obtained was 79.160. The mean triangular index was 1.71±1.38 with a range of 0.03–5.98 (males: 1.77 ± 1.39, females: 1.65 ± 1.36), 4.12 being the upper limit of normal. There was no statistically significant difference between measurements of both indices with age and gender. However, there was excellent agreement between and within raters for both measurements (alpha angle: 0.992; triangular index: 0.924). ConclusionThe upper limits of normal for the alpha angle and triangular index of the studied population are 79.160 and 4.12. Age and gender were independent of the values measured, and the measurements demonstrated excellent inter-rater and intra-rater agreement. A normal range is thus provided, with upper limits beyond which a possible femoroacetabular impingement may be diagnosed.

Assessment of Paranasal Sinus Pathology in Patients Presenting for Brain MRI as Referred From General Practice or Neurologist Physicians.

Objective The aim of this study is to assess the incidence and kinds of paranasal sinus pathology in patients presenting for brain MRI as referred from general practice or neurologist physicians in Qassim region, Saudi Arabia. Methods This cross-sectional study included 210 patients with different neurological indications and presentations who underwent an MRI of the brain and were evaluated by the consultant radiologist for the presence of any paranasal sinuses pathologies such as mucosal thickening, retention cyst, opacification, and ostiomeatal complex obliteration. The analysis was carried out using the chi-square test. Results A total of 210 cases underwent brain MRI to evaluate clinically suspected brain disorders; there were 138 (65.7 %) males and 72 (34.3%) females. Mucosal thickening was the commonest pathological finding (111 cases, 52.9%). retention cysts were present in around 14.3%, meaning 30 cases, and partial opacification was present in around 10%, representing 21 cases. Total opacification was present in three (1.4%) cases. Also, ostiomeatal complex obliteration was present in three (1.4%) cases. Paranasal pathological findings were more in those aged ≤ 35 years, with 75 (35.7%) cases. mucosal thickening, partial opacification, total opacification, and ostiomeatal complex obliteration were more in males, whereas retention cysts were equal in both genders. Conclusion Pathological paranasal sinuses findings commonly occur at brain MRI during neurological disorder evaluation. These findings are usually benign, and mucosal thickening is the commonest. The majority of the pathological findings were observed in those aged ≤ 35 years and in the male gender. Detecting pathological findings in paranasal sinuses helps diagnose lesions unrelated to the suspected neurological disease.

Lunate Fracture Morphology in Kienbock's Disease-A Computed Tomography Study.

Background The pathogenesis of Kienbock's disease is poorly understood. The coronal fracture line is acknowledged as a poor prognostic marker in the disease. Other fracture types in the Kienbock's wrist have subsequently been identified. Questions/Purposes The aim is to study the fracture morphology of the lunate in a cohort of patients using computed tomography. Methods Patient images were acquired using a set protocol with four-dimensional computed tomography scanning. Images were reviewed by two orthopaedic surgeons and a consultant radiologist. Static and dynamic images were assessed and a fracture map created. The relationship of fracture type to other parameters was then analyzed. Results Twenty-three patients were included in the study, including 11 males and 12 females, with a mean age of 43 years. Total frequency of fracture lines in the cohort was coronal - 26, proximal subchondral bone plate type - 24, avulsion - 19, sagittal - 16, and distal subchondral bone plate type - 11. There were statistically significantly more proximal than distal subchondral bone plate fractures ( p = 0.03), and more coronal fractures than distal subchondral bone plate fractures ( p = 0.01). There were statistically significantly more radiolunate ligament-avulsion types ( p <0.001) than other types. The sagittal fracture line through the lunate approximated closely to the ulnar edge of the capitate and the ulnar edge of the radius. Conclusion Study on the fracture morphology in the Kienbock's wrist has improved our understanding of the disease pathogenesis. Fracture lines may correspond to loading points, intrinsic and extrinsic ligament avulsions. These fracture types may play a role in disease progression and are important to identify when considering lunate salvage surgery.

Ultra-low-dose non-contrast CT and CT angiography can be used interchangeably for assessing maximal abdominal aortic diameter.

BackgroundRoutine CT scans may increasingly be used to document normal aortic size and to detect incidental abdominal aortic aneurysms.PurposeTo determine whether ultra-low-dose non-contrast CT (ULDNC-CT) can be used instead of the gold standard CT angiography (CTA) for assessment of maximal abdominal aortic diameter.Materials and MethodsThis retrospective study included 50 patients who underwent CTA and a normal-dose non–contrast CT for suspected renal artery stenosis. ULDNC-CT datasets were generated from the normal-dose non–contrast CT datasets using a simulation technique. Using the centerline technique, radiology consultants (n = 4) and residents (n = 3) determined maximal abdominal aortic diameter. The limits of agreement with the mean (LOAM) was used to access observer agreement. LOAM represents how much a measurement by a single observer may plausibly deviate from the mean of all observers on the specific subject.ResultsObservers completed 1400 measurements encompassing repeated CTA and ULDNC-CT measurements. The mean diameter was 24.0 and 25.0 mm for CTA and ULDNC-CT, respectively, yielding a significant but minor mean difference of 1.0 mm. The 95% LOAM reproducibility was similar for CTA and ULDNC-CT (2.3 vs 2.3 mm). In addition, the 95% LOAM and mean diameters were similar for CTA and ULDNC-CT when observers were grouped as consultants and residents.ConclusionsUltra-low-dose non–contrast CT exhibited similar accuracy and reproducibility of measurements compared with CTA for assessing maximal abdominal aortic diameter supporting that ULDNC-CT can be used interchangeably with CTA in the lower range of aortic sizes.

Concordance Between Resident and Attending Radiologist in Reporting Pneumothorax on Intensive Care Unit and Emergency Room Chest Radiographs.

Introduction Pneumothorax is a common medical emergency and has potentially life-threatening consequences, so it is important for radiology residents and consultants to know its radiographic appearance so that timely diagnosis and appropriate management can be done. Patients with pneumothorax have nonspecific complaints, and clinical examinations are not confirmatory. The chest X-ray is easily available and has high accuracy in the detection of pneumothorax. The aim of this study is to determine theagreement between the on-call radiology resident and the attending radiologist in the diagnosis of pneumothorax on chest radiographs. Materials and methods This cross-sectional study was performed in the Department of Radiology at Aga Khan University Hospital, Karachi. After approval from the ethical review committee (ERC), the study was carried out. A total of 174 patients were included in the study. The resident interpreting the radiograph commented on the pneumothorax and recorded it on the "Comments"sectionof the picture archiving and communication system (PACS). Further entries were made in the department's "Panic Logbook."Subsequently, the final report by the attending radiologist was tallied, and the decision of both the resident and the attending radiologist regarding the presence or absence of pneumothorax was compared for interobserver agreement. Results Of the 174 patients, 139 (79.9%) were male and 35 (20.1%) were female. The mean age of the patients was 45.6 ± 12.4 years. Pneumothorax was reported by the residentin 164 (94.25%)cases, while the attending radiologist reported it in 167 (96%) cases. The remaining 4% of cases were ultimately diagnosed on a CT scan of the chest performed at the request of the primary team; they were too small to be detected on a chest radiograph. The most common side involved was the right side, with 112 (64.4%) cases, followed by the left side with 55 (31.6%) and both sides with five (2.9%), while in two cases, pneumothorax was not reported by the resident and the attending radiologist. The position of the pneumothorax was as follows: apex in 80 (46%), base in 56 (32.2%), and along the lateral border of the lung in 93 (53.4%). Concordance between the resident and the radiologist was found to be 92.5% (kappa =0.20; p = 0.008). Stratification for age, gender, the position of pneumothorax, and the level of residency was also carried out. Conclusion In our setting, there was a high level of agreement (92.5%) between the resident and the attending radiologist in reporting pneumothorax on chest radiographs (kappa =0.20; p = 0.008).

Fully automatic cardiac four chamber and great vessel segmentation on CT pulmonary angiography using deep learning.

IntroductionComputed tomography pulmonary angiography (CTPA) is an essential test in the work-up of suspected pulmonary vascular disease including pulmonary hypertension and pulmonary embolism. Cardiac and great vessel assessments on CTPA are based on visual assessment and manual measurements which are known to have poor reproducibility. The primary aim of this study was to develop an automated whole heart segmentation (four chamber and great vessels) model for CTPA.MethodsA nine structure semantic segmentation model of the heart and great vessels was developed using 200 patients (80/20/100 training/validation/internal testing) with testing in 20 external patients. Ground truth segmentations were performed by consultant cardiothoracic radiologists. Failure analysis was conducted in 1,333 patients with mixed pulmonary vascular disease. Segmentation was achieved using deep learning via a convolutional neural network. Volumetric imaging biomarkers were correlated with invasive haemodynamics in the test cohort.ResultsDice similarity coefficients (DSC) for segmented structures were in the range 0.58–0.93 for both the internal and external test cohorts. The left and right ventricle myocardium segmentations had lower DSC of 0.83 and 0.58 respectively while all other structures had DSC >0.89 in the internal test cohort and >0.87 in the external test cohort. Interobserver comparison found that the left and right ventricle myocardium segmentations showed the most variation between observers: mean DSC (range) of 0.795 (0.785–0.801) and 0.520 (0.482–0.542) respectively. Right ventricle myocardial volume had strong correlation with mean pulmonary artery pressure (Spearman's correlation coefficient = 0.7). The volume of segmented cardiac structures by deep learning had higher or equivalent correlation with invasive haemodynamics than by manual segmentations. The model demonstrated good generalisability to different vendors and hospitals with similar performance in the external test cohort. The failure rates in mixed pulmonary vascular disease were low (<3.9%) indicating good generalisability of the model to different diseases.ConclusionFully automated segmentation of the four cardiac chambers and great vessels has been achieved in CTPA with high accuracy and low rates of failure. DL volumetric biomarkers can potentially improve CTPA cardiac assessment and invasive haemodynamic prediction.

Accuracy of forensic pathologists in incorporating post-mortem CT (PMCT) in forensic death investigation.

Post-mortem computed tomography (PMCT) is now performed routinely in some medical examiner's offices, and the images are typically interpreted by forensic pathologists. In this study, the question of whether pathologists appropriately identify significant PMCT findings and incorporate them into the death investigation report and the cause and manner of death (COD and MOD) statements was addressed. We retrospectively reviewed 200 cases where PMCT was performed. The cases were divided into four categories: (1) full autopsy without radiology consultation (n=77), (2) external exam without radiology consultation (n=79), (3) full autopsy with radiology consultation (n=26), (4) external exam with radiology consultation (n=18). A radiologist (not the consult radiologist) read the PMCT images, and a pathologist (not the case pathologist) reviewed the case pathologist's post-mortem examination report in tandem to determine any PMCT findings omitted from the report. Omitted findings were classified into error types according to a modified Goldman classification including Major 1: Unrecognized fatal injury or pathology that would change COD and/or MOD, and Major 2: Unrecognized fatal injury or pathology that would not change COD and/or MOD. A total of 13 Major errors were identified (6.5%), and none definitively changed the MOD. All four Major-1 errors which could change the COD were found in Category 2. Of 9 Major-2 errors, 2 occurred in Category 1, 6 occurred in Category 2, and 1 occurred in Category 4. In conclusion, forensic pathologists who routinely utilize computed tomography (CT) interpret CT images well enough to reliably certify the COD and MOD.

Expert clinical consensus in the delivery of hydrodilatation for the management of patients with a primary frozen shoulder : a modified Delphi study.

AimsTo achieve expert clinical consensus in the delivery of hydrodilatation for the treatment of primary frozen shoulder to inform clinical practice and the design of an intervention for evaluation.MethodsWe conducted a two-stage, electronic questionnaire-based, modified Delphi survey of shoulder experts in the UK NHS. Round one required positive, negative, or neutral ratings about hydrodilatation. In round two, each participant was reminded of their round one responses and the modal (or ‘group’) response from all participants. This allowed participants to modify their responses in round two. We proposed respectively mandating or encouraging elements of hydrodilatation with 100% and 90% positive consensus, and respectively disallowing or discouraging with 90% and 80% negative consensus. Other elements would be optional.ResultsBetween 4 August 2020 and 4 August 2021, shoulder experts from 47 hospitals in the UK completed the study. There were 106 participants (consultant upper limb orthopaedic surgeons, n = 50; consultant radiologists, n = 52; consultant physiotherapist, n = 1; extended scope physiotherapists, n = 3) who completed round one, of whom 97 (92%) completed round two. No elements of hydrodilatation were “mandated” (100% positive rating). Elements that were “encouraged” (≥ 80% positive rating) were the use of image guidance, local anaesthetic, normal saline, and steroids to deliver the injection. Injecting according to patient tolerance, physiotherapy, and home exercises were also “encouraged”. No elements were “discouraged” (≥ 80% negative rating) although using hypertonic saline was rated as being “disallowed” (≥ 90% negative rating).ConclusionIn the absence of rigorous evidence, our Delphi study allowed us to achieve expert consensus about positive, negative, and neutral ratings of hydrodilatation in the management of frozen shoulder in a hospital setting. This should inform clinical practice and the design of an intervention for evaluation.Cite this article: Bone Jt Open 2022;3(9):701–709.

Osteointegration analysis with serial radiography as a predictor of successful cementless bipolar hemiarthroplasty at surabaya orthopaedic and traumatology hospital

Osteointegration is a direct structural relationship between the bone and the implant surface, a properly osseointegration implant can function without mobility. We aim to evaluate this process using serial radiological examinations, where characteristics such as bone sclerosis and cortical-periosteal thickening will be investigated. A retrospective analytic-observational study was conducted on 96 patients after cementless bipolar hemiarthroplasty operation from January 2012 to January 2021, examined for standing pelvic or hip anterior-posterior radiographs after six weeks, six months, and a year post-procedure at Surabaya Orthopaedic and Traumatology Hospital. Two musculoskeletal radiology consultants blindly evaluated for bone sclerosis, femoral stem positioning or stem angulation, cortical-periosteal thickening, and leg length discrepancy. The study was conducted on 24 male subjects (25%) and 72 female subjects (75%). Bone sclerosis significantly appeared in the six-month evaluation. There was no difference in femoral stem positioning. Cortical-periosteal thickening was found on the medial side according to the valgus position of the stem and began to appear in the 6-month evaluation and became more prominent after one year. No significant leg length discrepancy was found.

889 An Audit of Indications for Emergency Abdominal X-Rays

Abstract Background Historically, abdominal X-rays (AXRs) have played an essential role in diagnosis of the acute abdomen. With the advent of other imaging modalities and the increasing need for efficiency in time, the utility of AXRs has been clarified by the RCR iRefer guidelines. Aim To assess the congruence between indications of AXR requests and the recommendations provided by the RCR iRefer guidelines. Method All AXRs performed over a 6-week period in the trust were identified retrospectively from our electronic database. Initial indications were subsequently compared with the current guidance and consultant radiologist reports. Results Out of 575 AXRs performed, 36 (6%) had no indication documented on the request. Of the remaining 539, 364 (68%) of AXRs performed met the RCR iRefer guidance. Furthermore, 496 (86%) of AXRs performed were reported as normal. 35% of AXRs that met the guidance underwent further imaging, of which 60% showed abnormality. Of those that did not meet the current criteria, abdominal pain and toxic megacolon were the most frequently documented indications. Conclusions One third of AXRs did not meet the RCR iRefer guidelines and were therefore requested inappropriately. Despite the remaining two thirds of requests being appropriate, over one third required further imaging in the form of CT/US. Moreover, less than one fifth of the total scans were interpreted as abnormal. This questions whether the current guidance requires revision and whether this imaging modality is over utilised with little effect on clinical outcomes.

A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK

AIMTo investigate the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK from the perspective of trainees and new consultants.MATERIALS AND METHODSA survey comprising 25 questions was distributed to UK radiology trainees via the regional Junior Radiologists Forum representatives under the auspices of the British Society of Breast Radiology (BSBR).RESULTSSixty-nine eligible responses were received representing all UK training regions. Fifty-five per cent of respondents completing either a core or higher breast rotation felt that the pandemic had a negative effect on their breast training. There was an overall reduction in exposure to the key breast imaging methods when rotations took place during the pandemic. Completing a core breast rotation during the pandemic was less likely to attract trainees to higher breast training. Three out of four breast radiology consultants in their first year after receiving their Certificate of Completion of Training (CCT) felt the pandemic reduced their preparedness for becoming consultants. Positive outcomes included the increased use of online educational resources and remote multidisciplinary meetings.CONCLUSIONSAs well as having a negative impact on breast radiology training overall, the pandemic has had a detrimental effect on attracting trainees to breast radiology as a future career. It is of key importance that trainees have a positive core breast rotation as this experience appears central to many trainees' decisions to pursue higher breast training. Increased use of online learning resources has also been positively received and is a valuable approach to learning that can be maintained in the longer term.

TU7.5 Prostate cancer pick up rate in pure LIKERT 3 lesions on MRI prostate? A retrospective review of 157 cases in a district general hospital

Abstract Introduction LIKERT 4 and 5 lesions picked up on MRI prostate have a high chance of picking up high grade high volume prostate cancer so they under biopsy. It is quite challenging to decide whether to biopsy pure LIKERT 3 lesions. In our retrospective review of 500 prostate MRI scan we looked for correlation between pure LIKERT 3 lesions and the risk of finding prostate cancer after biopsy. Materials and Methods Pre-biopsy Multi parametric MRI prostate was done in 500 cases and reported by two consultant radiologists. 157 mp Prostate MRIs showed one or more pure LIKERT 3 lesions . All 157 cases underwent targeted and saturation biopsies. 91 biopsies (57.96%) out of 157 were benign. 66 biopsies (42%) out of 157 showed prostate cancer. Gleeson score is shown in the table below Conclusion 157 cases with pure LIKERT 3 lesions on MRI prostate 58% were benign. 42% who had positive biopsies low and intermediate risk i.e. Gleeson 6 or 7 (95.4%) prostate cancer was found. High grade prostate cancer i.e. Gleeson 8 and 9 was seen in 3%. Patients with pure LIKERT 3 lesion on mp MRI prostate should be counselled about the risks of finding prostate cancer, likely grade to help them make an informed decision about PSA monitoring only or undergo prostate biopsies.

EP-51 Acute presentations of Jejejunal diverticulosis – a literature review of the uncommon entity

Abstract Introduction Jejunal diverticula are distinctly less common than their colonic counterparts, 60% of patients with small intestinal diverticula have concomitant colonic diverticula. Although Jejunal diverticula are relatively asymptomatic, they can present with life-threatening complications such as perforation, bleeding, obstruction. Due to their rarity, reporting radiologists, as well as emergency surgeons, may be unfamiliar with the imaging findings of complicated Jejunal diverticular disease. Methods A retrospective review of medical records was carried out for a period of 6 years from 2015–2021, in a large district general hospital in Kent, UK. We included all patients who had complications of Jejunal diverticulosis and were treated by the surgical teams during this period, regardless of whether they were managed operatively or conservatively. Following a retrospective review of the medical records epidemiological data, comorbidities of patients, we reviewed the images of CT scans obtained during the emergency admissions retrospectively with a consultant radiologist with more than 20 years of gastrointestinal radiology. Conclusion Although Jejunal diverticula are very rare and mostly asymptomatic, their complications can be lethal. Therefore emergency surgeons should suspect their presence, especially in elderly patients presenting with nonspecific abdominal pain and acute abdomen with no clear etiology identified for complications seen on cross-sectional imaging. A high index of suspicion and Surgical exploration [minimally invasive if the expertise is available] can be both diagnostic and therapeutic.

Accuracy of Mid-Trimester Ultrasound Scan in Foetal Gender Determination at the University College Hospital, Ibadan Nigeria

Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution.&#x0D; Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance.&#x0D; Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively.&#x0D; Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.

Accuracy of Mid-Trimester Ultrasound Scan in Foetal Gender Determination at the University College Hospital, Ibadan Nigeria

Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution.&#x0D; Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance.&#x0D; Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively.&#x0D; Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.

Validity of Carotid Doppler Ultrasound for Detection of Carotid Artery Plaque Keeping Computed Tomography Sensitivity as Reference Standard

Objective: To determine the prevalence and specificity of arterial Doppler imaging pathology identification of artery blood vascular disease Study Design: Cross-sectional Place and Duration: In the department of Radiology, Peshawar Institute of Cardiology MTI, Peshawar for the duration from January 2022 to May 2022. Methods: Total 95 patients of both genders were presented. All the patients were suffering from ischemic cerebrovascular illness. Informed written consent of all the patients were taken for detailed demographics. Doppler ultrasound was performed in every patient by a consultant radiologist. Doppler ultrasound findings were compared with Carotid artery stenosis reports. SPSS 20.0 was used to analyze all data. Results: The mean age of the patients was 52.11±8.40 years and had mean BMI 24.1±13.25 kg/m2. The mean duration of disease was 1.7±6.34 years. 52 (54.7%) were males and 43 (45.3%) were females. There were 56 (58.9%) cases were smokers. Comorbidities were diabetes mellitus, ischemic heart disease, hypertension, ischemic stroke and dyslipidemia. Doppler ultrasound has a 91% overall sensitivity, 77% specificity, 47.3% positive predictive value, 92.5% negative predictive value, and 80% diagnostic accuracy. Conclusion: The accuracy of diagnosing Carotid artery stenosis has greatly increased over time because to technological innovation. The finding of additional measures to describe plaque susceptibility in the carotid artery has grown in importance, from monitoring the carotid artery's shrinking diameter to assessing the enhanced velocity field close to the obstruction/lesion site. The sensitivity, precision, and reliability of Artery stenosis diagnosis have improved because to computer-aided programmes used in a variety of imaging modalities. Keywords: Specificity, Carotid artery stenosis, Doppler ultrasound Sensitivity

IMPACT (Information Medically Pertinent in Acute Computed Tomography) requests: Delphi study to develop criteria standards for adequate clinical information in computed tomography requests in the Australian emergency department.

Inadequate clinical information in medical imaging requests negatively affects the clinical relevance of imaging performed and the quality of resultant radiology reports. Currently, there are no published Australian guidelines on what constitutes adequate clinical information in computed tomography (CT) requests. This study aimed to determine specific items of clinical information radiologists require in CT requests for acute chest, abdomen and blunt trauma examinations, to support optimal reporting. A panel of 24 CT-reporting consultant radiologists participated in this e-Delphi consensus study. Panellists undertook multiple online survey rounds of open-ended, dichotomous and Likert scale questions, receiving feedback following each. Round 1 responses formulated lists for each CT examination. Round 2 set a threshold of 80% agreement after dichotomous scoring. Round 3 accepted items which averaged 4 or more on a 5-point Likert scale. Round 4 required panellists to rank items within the aggregated, accepted lists, based on panellists' perceived level of usefulness. The large numbers of round 1 items (chest: 101, abdomen: 76, blunt trauma: 80) were rationalised and grouped into categories to facilitate efficiency during subsequent rounds. Twenty-three chest, 24 abdomen and 17 blunt trauma items met the 80% agreement threshold in round 2. Items below threshold were included in round 3; numbering 44, 19 and 23 for chest, abdomen and blunt trauma, respectively. Through the e-Delphi process, we formulated clinical information criteria standards for three CT types. The developed standards will guide Australian referrers in providing adequate clinical information in CT requests, to support optimal reporting, diagnosis and treatment.

Appraisal of trimester-specific fetal heart rate and its role in gestational age prediction

IntroductionThe aim of this study was to evaluate and report normal sonographic FHR values among low-risk singleton women across the three trimesters of pregnancy and determine FHR role in gestational age prediction. MethodA prospective cross-sectional study of 2727 low-risk singleton pregnant women was undertaken. FHR measurements were obtained by a consultant radiologist and three experienced sonographers using transabdominal approach from January 2019 to December 2020. Two FHR measurements were taken for each participant. The fetal lie and presentation were also documented in the first trimester. Data were analysed using SPSS version 24 (IBM, Armonk, NY, USA). ResultThe maternal mean ± SD age was 25.8 ± 6.5 years and mean FHR for first, second and third trimesters were 151 ± 16, 145 ± 6 and 125±6 bpm respectively. The mean ± SD gestational age were 10 ± 2, 19 ± 3 and 34 ± 2 weeks for the first, second and third trimester respectively. Using ANOVA, there were statistically significant differences in FHR across the three trimesters (p ≤ 0.05). A positive correlation existed between maternal age and FHR (r = 0.57, p ≤ 0.05). ConclusionThis study has established normal values for FHR in first, second and third trimester respectively. Referring physicians, radiologists, sonographers, obstetricians and gynaecologists may consider FHR of (135–167) bpm (139–151) bpm and (119–131) bpm as normal FHR ranges for the first, second and third trimester respectively. This study has also revealed the possibility of gestational age prediction using FHR with the equation [Gestational Age = 87.8 – (0.47) FHR]. Implications for practiceThis paper provides the most up-to-date sonographic FHR recommendations for fetal management. More importantly, findings from this study also suggests that ultrasound practitioners can use FHR measurements as a reliable alternative for fetal dating.

Diagnostic Accuracy of Contrast Enhanced Flair Magnetic Resonance Imaging in Diagnosis of Meningitis Taking Lumbar Puncture as Gold Standard

Objective: The objective of this article is to determine and compare the diagnostic accuracies of contrastenhanced FLAIR and T1W sequences of MRI brain in the detection of meningitis keeping lumbar puncture asgold standard.Study Design: Cross-sectional validation study.Place and Duration of Study: The study was carried out at Department of Diagnostic Radiology of POFHospital, Wah Cantt from 23 June 2019 to 22 March 2020.Materials and Methods: A total of 173 patients were included in the study by non-probability purposivesampling. Patients of age between 2-70 years, of either gender with suspected meningitis based on clinicalpresentation are included in our study. Patients in whom contrast enhanced MRI and lumbar puncture wascontraindicated, diagnosed patient of meningitis and non-consenting patients were excluded from this study.All patients received intravenous contrast medium gadolinium at rate of 0.2 ml/second. Post gadolinium T1Wand post gadolinium FLAIR images were acquired and evaluated by a consultant radiologist. Findings wererecorded on a prescribed performa. Patients were followed and results of lumbar puncture were collected fromlaboratory.Result: The mean age was 26.4±23.5 year ranging from 2 to 70 years. Out of 173 patients, 98 patients (56.6%)were male and 75 patients (43.4%) were female. Clinical presentations were as follows: poor feeding, irritabilityand lethargy 86 (49.7%), headache 137 (79.2%), nausea/vomiting 125 (72.3%), neck stiffness 89 (51.4%),altered level of consciousness 132 (76.3%), seizures 78 (45.1%) and local neurological deficit 45 (26%).Diagnostic accuracy of contrast enhanced MRI FLAIR in diagnosing meningitis taking lumbar puncture goldstandard showed sensitivity 91%, specificity 85%, PPV 87.6%, NPV 89.4% and diagnostic accuracy 88.4%.Diagnostic accuracy of contrast enhanced MRI T1W in the diagnosis of meningitis taking lumbar puncture goldstandard revealed sensitivity 60.2%, specificity 77.5%, PPV 75.6%, NPV 62.6% and diagnostic accuracy 68.2%.Conclusion: The sensitivity and specificity of post contrast FLAIR sequence is greater as compared to postcontrast T1W sequence to detect meningeal enhancement. Therefore, for all patients with suspicion ofmeningitis, post contrast FLAIR sequence should be added to MRI brain protocol as a routine sequence.How to cite this: Jawwad S, Gul N, Mehmood K, Iqbal B, Afzal K. Diagnostic Accuracy of Contrast Enhanced Flair Magnetic Resonance Imaging in Diagnosis of Meningitis Taking Lumbar Puncture as Gold Standard. Life and Science. 2022; 3(3): 120-126. doi: http://doi.org/10.37185/LnS.1.1.259

The role of dynamic magnetic resonance imaging in exclusion of inguinal hernia in patients suffering from indefinitive groin pain

Rationale and objectivesThe objective of this study was to analyze the role of dynamic magnetic resonance imaging (MRI) in patients who suffered from groin pain and whose physical examination and ultrasound returned inconclusive/indefinite results, as well as in patients receiving an ongoing assessment for a previous herniotomy.Material and methodsFor this study, 25 patients 14 women and 11 men were selected with a mean age of 41.6 years, including clinical complaints, such as groin pain and or a previous herniotomies. These patients underwent dynamic MRI. Reports were created by a radiology resident and a radiology consultant. Clinical and ultrasound documentation were compared to with imaging results from the MRI.ResultsThe results of the dynamic MRI were negative for 23 patients (92%) and positive for two patients (8%). One patient suffered from an indirect hernia and one from a femoral hernia. A repeated hernia was an excluding for the preoperated patients with pain and ongoing assessment.ConclusionsDynamic MRI shows substantially higher diagnostic performance in exclusion of inguinal hernia, when compared to a physical examination and ultrasound. The examination can also be used in assessments to analyze the operation’s results.