Pattern of Presentation of Mammography in a Developing Country

Introduction: Breast cancer is the second commonest cancer (7.2%) in Nepal and almost 54%of patients present in the advanced stage. It is the leading cause of cancer death in females.The objective of the study was to determine the type of mammography, composition of breastdensity and BIRADS category.Methods: The study was conducted in a tertiary hospital from Jan 1st to Oct 30th of 2019according to non-probability convenience sampling. A total of 388 persons were included inthe study. The mammographic findings were assessed by categories based on the BIRADSsystem.Results: Mammography for screening was 38 percent and diagnostic was 68 percent. Commonbreast compositions were B and C. More frequent BIRADS categories were seen in 1 and 2.Conclusion: Dense breast is common in mammography. BIRADS categories 1 and 2 weremore common than other categories.

CT Evaluation of Optic Nerve Sheath Diameter in Traumatic Brain Injury and its Correlation with Rotterdam CT Scoring

Introduction: Elevated intracranial pressure is one of the fatal events associated with traumatic brain injury. Optic nerve sheath diameter measurement is an indirect way of assessing intracranial pressure. Optic nerve sheath diameter and Rotterdam score are prognosticators of traumatic brain injury. This study aimed to measure the optic nerve sheath diameter in the initial CT scan and correlate with the Rotterdam score.Methods: Retrospective analytical study comprising consecutive patients from July 2019 to December 2019 who underwent decompressive craniotomy for traumatic brain injuries were included. Optic nerve sheath diameter was measured 3mm behind the eyeball in axial images and Rotterdam CT Score was done on the same CT image in another setting. The receiver operating characteristics curve was plotted to measure the accuracy of optic nerve sheath diameter in predicting the severity of traumatic brain injury.Results: Sixty patients with a mean age of 42.5±14.6years were included. The mean optic nerve sheath diameter with Rotterdam Score of 1, 2 and 3 was 3.8±0.64mm and with Rotterdam Score of 4, 5 and 6 was 5.1±0.66mm. The area under the curve of severe Rotterdam CT Score vs optic nerve sheath diameter was 0.915 (p<0.0001, 95% CI 0.84-0.98) and spearman Rho correlation coefficient value was 0.83 suggesting positive relation.Conclusion: Higher mean optic nerve sheath diameter was observed with a severe Rotterdam CT score. Thus, optic nerve sheath diameter of initial CT scan in traumatic brain injury cases could be an important radiological tool to rule out the presence of raised intracranial pressure.

Radiological Evaluation of Inferior Turbinate in Patients with Deviated Nasal Septum using Computed Tomography

Introduction: Compensatory hypertrophy of inferior turbinate in the contralateral side of the deviated nasal septum is a known phenomenon. The objective of this study was to establish the relationship between the nasal septum and inferior turbinate and to determine the dimension and composition of inferior turbinate hypertrophy.Methods: This prospective, cross-sectional study was performed on 52 patients who were referred for Computed tomography of PNS with deviated nasal septum having compensatory hypertrophy of contralateral inferior turbinate. Non-hypertrophied inferior turbinate on the side of deviation was taken as a control group. Deviation angle, mucosal thickness including medial and lateral and bone thickness were evaluated using three-dimensional CT scan and compared to the control group.Result: Dimensions of the bony and mucosal components of the inferior turbinate were significantly greater than those of the control group. This study included 52 patients (M- 30, F- 22) having a mean age of 37 years. Out of 52, the septum deviated to the left side in 56% and 44% to the right side. The average angle of deviation was 10.12°. There was a statistically significant correlation (p<0.05) between total turbinate thickness and angle of deviation. A statistically significant correlation (p<0.05) was also observed between medial mucosa and bone thickness.Conclusion: Compensatory hypertrophy of inferior turbinate in patients with deviated nasal septum not only involves the mucosal component but also the bone itself. Pre-operative CT scan of PNS helps evaluate dimension and composition of inferior turbinate and assists to decide on surgical technique to fix turbinate.

Morphological Study on Magnetic Resonance Imaging of the Normal Pituitary Gland in Nepalese Population: Age and Sex-Related Changes

Introduction: The pituitary gland is the master endocrine gland that secretes important hormones and controls other glands. Its size, shape and volume vary with age and sex and also in various pathological conditions. This study was conducted to identify the size, shape and volume of the normal pituitary gland in different age groups of both genders using Magnetic Resonance Imaging (MRI).Methods: A retrospective study of the brain MRI Images of 203 patients was done in the Radiology and Imaging department of Pokhara Academy of Health Sciences, Nepal. Anterior-posterior dimension, transverse dimension, height and shape of the pituitary gland were noted and volume was calculated. Descriptive analysis and relationship of pituitary parameters with age and sex were assessed using ANOVA and Chi-square tests.Results: The pituitary height and volume was maximum in the 11-20years age group. Similarly, the mean height and volume of the pituitary gland in female patients of each age group were greater than that of male patients in the same age group. The inferential analysis revealed significant differences for mean pituitary height and volume with age but not with gender. The upper surface convexity was maximum in the age group 11-20years.Conclusion: The study has shown a clear trend with regards to the morphology of the pituitary gland with the age and sex of the individual highlighting the size, shape and volume of the pituitary gland should be taken into consideration while evaluating the glands for any neuroendocrine disorders.

To be or not to be a Specialist

N/A

Measurement of Subpubic Angle in Radiograph

Introduction: Subpubic angle, an important parameter used for sex determination in the pelvis, is the angle between two inferior pubic rami below the symphysis pubis. This study was carried out to determine the subpubic angle among the individuals referred for pelvic and KUB radiographs in the department of Radiology and Imaging, Tribhuvan University, Teaching Hospital.Methods: Prospective cross-sectional study was done on 120 individuals. The subpubic angle was measured by drawing two tangent lines on the inferior border of the pubic rami. The subpubic angle of both sexes was measured. An independent sample t-test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects was obtained using Pearson Correlation Coefficients in males and females.Results: The range of the subpubic angle in male was 82o to 122° and the mean was 104.72°±10.47°. In females, the range was 96o to 159° and the mean was 137.15°±11.92° with a significant statistical difference from the angle in male (p<0.05). The subpubic angle was not significantly correlated with age in males (r=0.029, p=0.824) whereas, in females, the correlation of subpubic angle with age was significant (r=-0.303, p=0.019).Conclusion: The mean subpubic angle was significantly wider in females than in males in this study. We found a weak negative correlation between subpubic angle and age in females whereas in the male there was no correlation between age and subpubic angle.

Paediatrician’s Suspicion and Radiologist’s Precision in Diagnosing Hirschprung’s Disease in a Child: Case Report

Hirschprung’s disease (HD) is also called as aganglionic megacolon. The entity falls in the group of congenital motor disorders. The usual presentation is in the form of not passing of meconium, abdominal distension with or without vomiting. We present a 2-years old child who was brought with complaints of constipation and difficulty in passing stool. The child was evaluated radiologically by plain radiography, ultrasonography (USG) and barium enema and was diagnosed as a case of short segment type of Hirschsprung disease. The parents had been counselled and advised for pull-through surgery for the child. It is a dilemma for the paediatrician to confirm the diagnosis of Hirschprung’s disease until a radiologically confirmed diagnosis is made. Many cases are delayed for the treatment because of non-diagnosis or delayed diagnosis. The importance lies in the early diagnosis for further surgical management.

Correlation of Portal and Splenic Vein Diameter with Presence and Size of Esophageal and Gastric Varices in Liver Cirrhosis Patients on MDCT

Introduction: Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension. Multidetector Computed Tomography (MDCT) may be helpful in the evaluation of such gastroesophageal varices and predicting their risk of haemorrhage.Methods: After obtaining ethical clearance and consent, 50 patients meeting the inclusion criteria were included and MDCT obtained. The diameters of the portal vein (PV), splenic vein (SV) and left gastric vein (LGV) were measured and originating vein of LGV determined. Pattern, location and diameter of varix was evaluated. Association between the diameters of the originating vein and the grade and pattern of the esophagael and gastric fundic varices was determined.Results: Of the 50 patients, 41 had gastroesophageal (GE) varices equal to or larger than 1mm with 34% having high-risk varices. The SV was predominantly the originating vein of the LGV. Cutoff SV diameter of 7.75mm and LGV diameter of 5.75mm had a sensitivity of 77.8% with a specificity of 73.2% and 75.6% respectively for the presence of varices.Conclusions: In our study, EV and GEV was more common and mostly supplied by LGV while isolated gastric fundic varices were supplied by non LGV veins only. The diameters of SV and LGV were associated with the presence and grade of esophageal and gastric fundic varices. MDCT is an important non-invasive modality in patients with portal hypertension and should be used for diagnosis, risk stratification and monitoring of varices.

Review of the Guidelines For Radiology Practice During COVID -19 Pandemic by Nepal Radiologists’ Association

Nepal is also affected by Corona Virus Disease (COVID-19) pandemic which is likely to last for several months. The Reverse Transcriptase-Polymerase Chain Reaction is the current gold standard diagnostic test. Chest X-ray or Computed Tomography scan is considered inappropriate according to most society recommendations for screening though are emerging as frontline diagnostic modalities in conjunction with clinical history and laboratory parameters.Multiple guidelines have been released by prominent radiological societies worldwide to facilitate preparedness of radiology department in the war against COVID-19. Based on these, the Nepal Radiologists’ Association has proposed its guidelines, endorsed by the Nepal Medical Council, practical in our context, with the aim to limit exposure to the infection while ensuring best use of imaging, protection of health care personnel and other patients and maintenance of uninterrupted radiology department operations.This review article aims to summarize the highlights from various guidelines focusing on role of chest X-ray and Computed Tomography including the indications, specific findings, reporting format and important differentials and also addresses the safety issues.

Spectrum of Imaging Findings in Oriental Cerebral Schistosomiasis and Their Categorization by MRI

Introduction: To describe the spectrum of imaging findings in oriental cerebral schistosomiasis and characterizing different stages by MRI.Methods: A retrospective review of the clinical and MRI images of twenty nine pathologically proven cases of neuroschistomiasis was performed. Patients with either absence of complete MR examination, previously treated patients were excluded from the study. MRI images were analyzed and lesions were evaluated for the following parameters - distribution, size, clusterity, perilesional edema, mass effect, intralesional hemorrhage, necrosis, cystic degeneration, any abnormal enhancements, any atypical features as abscess,vasculitis, infarctions, or focal atrophy and encephalomalacia.Results: Lesions were only supratentorial in 25 cases, only infratentorial in 3 cases while were both supratentorial and infratentorial in 1 case. Lesions were unilateral in 26 cases. Significant mass effect was noted in 8 cases. All nodular and mass lesions were hyperintense or isointense in T1WI while all but two lesions were hyperintense in T2WI. Lesions were predominantly as clustered nodules (12 cases). All nodules enhanced homogeneously except three that demonstrated ring like enhancement. Masses were demonstrated either homogeneous (2 cases) or heterogeneous in enhancement (2 cases). Central linear enhancement was noted in 12 cases, leptomeningeal enhancement in 10 cases while gyral enhancement was noted in 1 case.Conclusions: Radiological presentation of neuroschistosomiasis varies at different stages of infection as well as among the asymptomatic groups. Recognition of spectrum of presentation has an implied role in the overall management and outcome in cases