Diagnostic accuracy of Magnetic Resonance Imaging in assessment of Meniscal and ACL tear: Correlation with arthroscopy.

OBJECTIVE: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in injuries related to anterior cruciate ligament and menisci and compare its effectiveness with that of arthroscopy. METHODS: This retrospective cross-sectional study was conducted in the department of Radiology & Medical Imaging of Dallah Hospital, Riyadh, Kingdom of Saudi Arabia from September 2012 to March 2014. Fifty four patients (including 30 men and 24 women) with internal derangement of knee referred from the orthopedic consulting clinics underwent MR imaging followed by arthroscopic evaluation. The presence of meniscal and ligamentous abnormality on the imaging was documented by two trained radiologist. Findings were later compared with arthroscopic findings. RESULTS: The sensitivity, specificity and accuracy of MR imaging for menisci and ACL injury were calculated: 100% sensitivity, 88.4% specificity, 90% positive predictive value, 100% negative predictive value, and 94.4% accuracy were noted for medial meniscal injury. Similarly, MR had sensitivity of 85.7%, specificity of 95%, positive predictive value of 85.7%, negative predictive value of 95%, and accuracy of 92.5% for lateral meniscal injuries. Likewise, anterior cruciate ligament had 91.6% sensitivity, 95.2% specificity, 84.6% positive predictive value, 97.5% negative predictive value, and 94.4% accuracy. CONCLUSION: MRI is extremely helpful in identifying meniscal and anterior cruciate ligaments tears. MR imaging has high negative predictive value making it better choice as screening tool compared to diagnostic arthroscopic evaluation in most patients with soft tissue trauma to knee.

Can outer-to-outer diameter be used alone in diagnosing appendicitis on 128-slice MDCT?

AIM: To assess the frequency of visualization, position and diameter of normal appendix on 128-slice multidetector computed tomography (MDCT) in adult population. METHODS: Retrospective cross sectional study conducted at Radiology Department, Dallah Hospital, Riyadh, Saudi Arabia from March 2013 to October 2013. Non-enhanced computed tomography scans of abdomen and pelvis of 98 patients presenting with hematuria (not associated with abdominal pain, fever or colonic disease) were reviewed by two radiologists, blinded to patient history. The study group included 55 females and 43 males with overall mean age of 54.7 years (range 21 to 94 years). The coronal reformatted images were reviewed in addition to the axial images. The frequency of visualization of appendix was recorded with assessment of position, diameter and luminal contents. RESULTS: The appendix was recorded as definitely visualized in 99% of patients and mean outer-to-outer diameter of the appendix was 5.6 ± 1.3 mm (range 3.0-11.0 mm). CONCLUSION: MDCT with its multiplanar reformation display is extremely useful for visualization of normal appendix. The normal appendix is very variable in its position and diameter. In the absence of other signs, the diagnosis of acute appendix should not be made solely on outer-to-outer appendiceal diameter.

Acardiac twins: a case series.

Acardiac twinning is a severe and rare complication of monochorionic placentation. The acardiac twin does not survive while mortality of the normal twin is about 50-70% as the normal twin has to provide circulation not only for itself but also for acardiac twin. Proper timing of the delivery is of prime importance to the survival of the normal fetus for which emphasis is placed on close sonographic monitoring for early antenatal diagnosis. This series describes three such cases, which are now termed Twin Reversed Arterial Perfusion (TRAP) sequence.

Epiploic appendagitis.

This case report describes epiploic appendagitis in an elderly lady who presented with acute abdomen. The condition was diagnosed on CT scan and the patient treated conservatively.

Endovascular-covered stent treatment of posttraumatic cervical carotid artery pseudoaneurysms.

Pseudoaneurysm involving the cervical portion of the carotid artery can result from prior trauma or dissection. Two patients are reported with posttraumatic carotid artery pseudoaneurysms. In both cases, endovascular-covered stents were placed across the diseased portion of the artery resulting in thrombosis of the aneurysm and preservation of the parent artery without any significant complication. It is therefore concluded that covered stent placement is an alternative approach in treating carotid artery pseudoaneurysms.

Unenhanced helical CT scan for the investigation of acute ureteral colic.

Unenhanced helical CT is presently considered a superior imaging technique for investigating acute urinary colic compared to intravenous urography and ultrasound. It was introduced in Pakistan around the year 2000 and is in the process of being acknowledged as the first line investigation in emergency departments. We have discussed the advantages and the disadvantages of the technique, and have compared it with other imaging modalities.