Correlation between Femoral Intercondylar Notch Width and Anterior Cruciate and Posterior Cruciate Ligament Widths on MRI of Knee Joint.

Background Anatomic variations have been implicated as one of the intrinsic causes of injuries to the cruciate ligaments which can induce a functional deficiency to the knee. Narrow cruciate ligament widths as well as narrow femoral intercondylar notch widths can increase the risk of these ligaments rupturing. Objective To correlate the width of the femoral intercondylar notch (ICN) with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) widths on MRI of the knee joint. Method A total of 46 patients who met the inclusion criteria were evaluated. Intercondylar notch was identified on coronal T1W images while anterior cruciate ligament and posterior cruciate ligament were identified on proton density coronal images. All the widths were measured in the same plane at a mid-coronal level where anterior cruciate ligament and posterior cruciate ligament cross each other. Result Our result showed a significant correlation between the widths of intercondylar notch and anterior cruciate ligament (r = 0.68, p < 0.001) and between intercondylar notch width (INW) and posterior cruciate ligament width (r = 0.65, p < 0.001). Overall, the mean intercondylar notch width measured was 17.5 ±2.5 mm (range 11.8 to 21.8 mm), the mean anterior cruciate ligament width was 5.9 ±1.3 mm (range 3.3 to 8.6 mm), and the mean posterior cruciate ligament width was 8.9 ±1.5 mm (range 5.9 to 11.8 mm). A statistically significant difference was observed between males and females for mean widths of intercondylar notch (p < 0.001) and posterior cruciate ligament (p=0.01). However, no statistically significant difference was seen for anterior cruciate ligament width (p=0.07) between the two genders. Conclusion Measurement of the femoral intercondylar notch width can be used as an indicator of anterior cruciate ligament and posterior cruciate ligament widths which can further assist to identify the individuals who are more susceptible to cruciate ligament injuries.

Correlation between Sonoelastography and Histopathological Findings in Evaluation of Chronic Renal Allograft Disease.

Background Non-invasive evaluation tool for allograft kidney is important to predict chronic allograft dysfunction as it can be alternative to the invasive biopsy which is prone to so many complications. Sonoelastography can assess the stiffness of the allograft renal parenchyma, which is prone to undergo interstitial fibrosis. Objective To correlate sonoelastography with histopathology findings in the renal allografts. Method Sonoelastography was done in 60 renal allograft recipients prior to their biopsy for various indications. Estimated glomerular filtration rate (eGFR) of the patient were also obtained. Histopathology reports were collected to determine Banff score of interstitial fibrosis. Descriptive measurements (Mean ± standard deviation, Frequencies, Proportions) were calculated. Correlations among the variables were measured using Pearson's correlation, independent sample t-test, and ANOVA. Result The mean strain index (SI) was lower in higher grades of fibrosis. There was significant difference in mean SI (F=18.264; df= 2,57; p < 0.001) among the histological grades of fibrosis. Also a significant difference in SI among mild and moderate (S.E. 0.27, p value < 0.001), mild and severe (S.E. 0.213, p value < 0.001) as well as moderate and severe fibrosis (S.E. 0.244, p value < 0.001) was seen. Significant correlation of eGFR with SI (p < 0.001) was also seen. Conclusion Strain index, measured with sonoelastography, significantly correlated with different grades of tissue fibrosis. Thus it can be used as alternative method for evaluation of renal allograft patients to avoid complications of biopsy.

Comparative Study of Common Bile Duct Diameter between Normal and Post Cholecystectomy Cases Using Trans-abdominal Ultrasonography.

Background Increase in common bile duct diameter can occur because of different causes. Post cholecystectomy status is one of the potential causes. Many studies done in the past show different results and are hence inconclusive. Objective To see if the post cholecystectomy cases would have a statistically significant change in common bile duct diameter. Method We carried out a study in 100 cases (46 post cholecystectomy cases and 54 cases with intact gall bladder, measuring their common bile duct diameters and performing an unpaired t test to see if the mean in common bile duct among these two groups of cases was statistically significant. Result One hundred cases, 46 post cholecystectomy cases and 54 cases with intact gall bladder were included in our study. An unpaired t-test was used to compare the common bile duct diameters in these two groups. Our findings showed that the difference in common bile duct diameter between the cases with intact gall bladder and those who underwent cholecystectomy was significant for both one tailed and two tailed studies (p < 0.001). Hence, it can be stated that post cholecystectomy status increases the common bile duct diameter. Conclusion An increased Common bile duct diameter in post cholecystectomy case could be because of the post cholecystectomy status itself and not due to some other obstructive cause. So careful decision is necessary before subjecting the patient to further invasive/non-invasive investigations and treatments.

Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer.

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

Computed Tomographic Evaluation of Craniocerebral Trauma in Dhulikhel Hospital.

Background Craniocerebral trauma is common health problem in emergency department of any hospital. CT is commonly indicated to to rule out any significant intracranial abnormalities in these patients, so that timely intervention of the significant intracranial pathologies can be done. Objective The study is done to evaluate CT findings of head injury patients in Dhulikhel Hospital. Method This prospective hospital based study was done in Department of Radiology of Dhulikhel Hospital in the period of January 2015 to December 2015. CT findings of the head trauma patients undergoing CT in the Department of Radiology were reviewed and analysed. Result The study was done in 484 patients, 165 female and 319 male patients. Mean age of the patients was 30.87 ± 19.25 years. Among them 205 patients showed abnormal CT findings, scalp injury being the commonest one, followed by skull fracture. 60 patients showed abnormal intracranial findings. There was significant correlation of skull fracture and abnormal intracranial findings in this study. Conclusion This study provided the normal and abnormal CT findings in head of the craniocerebral trauma patients in Dhulikhel Hospital. Abnormal CT findings were predominantly extra-cranial and were overlapping with intracranial abnormal findings.

Correlation between Preoperative High Resolution Computed Tomography (CT) Findings with Surgical Findings in Chronic Otitis Media (COM) Squamosal Type.

Background The exact role of High resolution computed tomography (HRCT) temporal bone in preoperative assessment of Chronic suppurative otitis media atticoantral disease still remains controversial. Objective To evaluate the role of high resolution computed tomography temporal bone in Chronic suppurative otitis media atticoantral disease and to compare preoperative computed tomographic findings with intra-operative findings. Method Prospective, analytical study conducted among 65 patients with chronic suppurative otitis media atticoantral disease in Department of Radiodiagnosis, Kathmandu University Dhulikhel Hospital between January 2015 to July 2016. The operative findings were compared with results of imaging. The parameters of comparison were erosion of ossicles, scutum, facial canal, lateral semicircular canal, sigmoid and tegmen plate along with extension of disease to sinus tympani and facial recess. Sensitivity, specificity, negative predictive value, positive predictive values were calculated. Result High resolution computed tomography temporal bone offered sensitivity (Se) and specificity (Sp) of 100% for visualization of sigmoid and tegmen plate erosion. The performance of HRCT in detecting malleus (Se=100%, Sp=95.23%), incus (Se=100%,Sp=80.48%) and stapes (Se=96.55%, Sp=71.42%) erosion was excellent. It offered precise information about facial canal erosion (Se=100%, Sp=75%), scutum erosion (Se=100%, Sp=96.87%) and extension of disease to facial recess and sinus tympani (Se=83.33%,Sp=100%). high resolution computed tomography showed specificity of 100% for lateral semicircular canal erosion (Sp=100%) but with low sensitivity (Se=53.84%). Conclusion The findings of high resolution computed tomography and intra-operative findings were well comparable except for lateral semicircular canal erosion. high resolution computed tomography temporal bone acts as a road map for surgeon to identify the extent of disease, plan for appropriate procedure that is required and prepare for potential complications that can be encountered during surgery.

Imaging in Infertile Female Patients Who Underwent Hysterosalpingography Investigation at Dhulikhel Hospital.

Background Fallopian tube and uterine abnormalities are the most common cause of female infertility, accounting for 30% of cases. Hysterosalpingography is the safe, minimal invasive radiographic technique for evaluation of uterine cavity and fallopian tubes defects. The purpose of the study was to assess the various uterine and tubal abnormalities leading to infertility Objective To assess the abnormalities in uterus and fallopian tubes detected on Hysterosalpingography (as causative factors of infertility in a tertiary care centre for proper decision making in treatment. Method This is the prospective cross sectional study done in department of radiology Dhulikhel hospital, Kathmandu University Hospital between January 2015 to January 2016 with complain of infertility. Hysterosalpingography was performed using ionic contrast medium (10-20 ml of 76% urograffin) under digital fluoroscopy. Radiographic films were obtained and analyzed. Demographic data and radiological findings were reviewed and the obtained data analyzed with SPSS version 16. Result Out of the total 100 patient, 75 had primary infertility while 25 had secondary infertility. The age ranged from 19 to 43 years with mean age of 27.75 years. Normal Hysterosalpingography findings were seen in 37% cases. Tubal abnormalities were seen in 34%, uterine abnormalities in 23% and both tubal and uterine abnormalities in 6% patients. The most common tubal abnormality detected on Hysterosalpingography was tubal block 75%. Out of the 30 patients who had tubal block, unilateral block was noted in 76.7% patients whereas bilateral block was noted in 23.3%. Hydrosalphinx was seen in 25% cases with tubal abnormality. Among the 29 cases with various uterine abnormalities, bicornuate uterus 9% was the most common abnormality Conclusion Hysterosalpingography is an easily available radiographic procedure that can demonstrate a wide variety of uterine and tubal abnormalities for the initial assessment of infertility which can avoid unnecessary and sometimes more aggressive procedures.

Prevalence of Anatomical Variations of the Sinonasal Region and their Relationship with Chronic Rhinosinusitis.

Background Precise knowledge of anatomic variations of nose and paranasal sinus complex is essential for achieving best surgical results during endoscopic sinus surgery. Computed tomography is the gold standard investigation for evaluation of paranasal sinuses and adjacent structures. Objective To study prevalence of anatomical variations of nose, paranasal sinuses and osteomeatal complex and to identify a probable association between anatomical variations and chronic rhinosinusitis. Method Prospective, analytical study conducted in 218 patients with Chronic rhinosinusitis in Department of Radiology, Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Volumetric axial CT scan was done in 128 slice CT scanner in 3mm thickness from frontal sinus to floor of maxillary sinus with thin multiplanar reconstruction. Radiological findings were reviewed and obtained data analyzed with SPSS version 16. Pearson chi square test and Pearson correlation coefficient were used for statistical analysis. Result The most common anatomical variation was pneumatized agger nasi cells followed by concha bullosa and deviated nasal septum respectively. Statistical significance were seen between ipsilateral agger nasi cell and frontal sinusitis (p< 0.001), ipsilateral haller cell and concha bullosa with maxillary sinusitis (p<0.001) and onodi cell with sphenoid sinusitis (p<0.001), However, no obvious statistical correlation was noted between deviated nasal septum with ipsilateral maxillary sinusitis. Conclusion Precise knowledge of anatomic variations of the paranasal sinuses is important in chronic rhinosinusitis to prevent possible complications during surgery. Computed tomography is the modality of choice in evaluation of paranasal sinuses and adjacent structures.

Multi-Detector Computed Tomography Evaluation of Normal Appendix.

Background Appendix is a blind-ended tubular structure arising from caecum, with variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency radiological investigation. Objective To assess visualization rate, size and position of normal appendix by Computed Tomography (CT). Method This cross-sectional observational study was done in 198 individuals undergoing abdominal CT without suspicion of acute appendicitis and without any pathology localized within right iliac fossa. Axial and coronal reformatted images of nonenhanced and contrast enhanced CT of abdomen were evaluated for visualization of appendix. Visualized appendices arising from caecum were traced and tip localized. Contents within the appendicular lumen were also evaluated and maximum transverse diameter of appendix measured. The relationship between appendicular diameter, intraluminal content and position with different age groups & gender were also derived. Result Visualization rates of appendix were 90% (93% male and 87% female) in nonenhanced CT and 97% (99.8% male and 95.4% female) in enhanced CT. The mean diameter of the appendix was 6.2 ± 1.16 mm. Most common location of the tip of appendix was pelvic position, followed by retrocaecal position. Most of the appendices showed intraluminal air. Conclusion Multi-Detector Computed Tomography is superior over ultrasonography (USG) in detection of appendix. Modifications of CT protocol reduce limitations of CT over ultrasound in evaluation of appendix. Ultrasound size criteria for appendicitis (>6 mm) is not applicable in CT as normal appendix can measure >6 mm in CT.

Clinical Evaluation of Fused/Ankylosed Hip with Severe Flexion Deformity after Conversion to Total Hip Arthroplasty.

INTRODUCTION: Fused or Ankylosed hip is late complication of chronic inflammatory disorder with progressive changes in and around articular as well as periarticular structures with alteration in bio-force line of body which later lead to severe flexion deformity of joint. This not only results decreased movements of hip, it's also increase pain around the hip, back and contralateral hip. METHODS: Retrospectively, all patients aged 18 years or older undergoing THA between June 2006 to June 2012 were reviewed with selection criteria. The five ankylosed hips (three left and two right) with severe flexion deformities which ankylosed spontaneously were successfully converted to THA at time period of 2006 to June 2012. Range of motion, Harris Hip Score and flexion deformity angle at preoperative, postoperative and follow-up periods were used as evaluation. RESULTS: Mean follow up is 42 months. Mean HHS increased from 21.6±4.97 to 81.8±4.02 points with one excellent, two good and two fair cases. The FDA is corrected to mean 8°±10.95 postoperatively and 4°±5.47 at final follow up from 81.6°±4.39 with two hips of 10° residual deformity. Hip ROM is improved as flexion 70° to 100°, adduction 10° to 20°, abduction 10° to 30°, internal rotation 5° to 10° and external rotation 2° to 50° from 0° activity. As complications, one hip had loose prosthesis, two had early postoperative dislocations, one had Deep Vein Thrombosis and one had femoral nerve palsy with quadriceps weakness. CONCLUSIONS: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties.

Bilateral Ovarian Teratoma: One Parasitic Twisted In-situ and Another Parasitic at the Hepato Renal Space.

Parasitic ovarian dermoid cysts are very rare. We report a rare case of bilateral ovarian dermoid cysts with parasitic teratoma at the hepato renal space measuring 11x11x6 cm while the other was twisted measuring 10x6x5 cm.Right ovary and tube were absent. The mass found at the hepato renal space was surrounded by and adherent to the omentum with viable tubal fimbria like structure at upper surface. Histopathologically both masses were confirmed as mature ovarian teratoma. The etiology of parasitic teratoma would be due to torsion followed by autoamputation and reimplantation of the right ovarian dermoid cyst.