Background and objectives: Esophageal and gastric fundic varices are common in liver cirrhosis pa... more Background and objectives: Esophageal and gastric fundic varices are common in liver cirrhosis patients. Ultrasound with Doppler study assesses liver cirrhosis severity, measuring portal vein and splenic indices’ association with gastroesophageal varices. Methodology: This study was conducted on 64 subjects with sonographic features of chronic liver disease who were referred for routine follow-up scans. Portal vein diameter, average velocity, splenic index, congestion index, and portal vein area and velocity were measured. Result: Subjects with gastro-esophageal varices had significantly larger portal vein diameters (14.7 ± 1.64 mm) compared to those without varices (12.05 ± 1.26 mm) (P<0.05). Conversely, subjects without varices exhibited higher portal vein velocity (PVV) of (17.9 ± 0.6 cm/sec) than with varices (13.91 ± 2.01 cm/sec) (P=0.0005). The splenic index was higher in subjects with varices (1120 ± 494 cm3) than those without varices (419 cm3) (P<0.05). The congestion...
Background and Objectives: Renal allograft biopsy is the gold standard for diagnosing chronic all... more Background and Objectives: Renal allograft biopsy is the gold standard for diagnosing chronic allograft nephropathy, but noninvasive methods are needed to avoid unnecessary biopsies. Doppler ultrasonography, particularly the resistive index (RI), correlates with renal allograft dysfunction. This study aims to assess the relationship between renal sonographic parameters and biochemical parameters in diagnosing graft interstitial fibrosis. Methods: The study evaluated 60 renal allograft recipients for sonographic renal morphological features and Doppler indices. The estimated glomerular filtration rate (eGFR) was calculated, and cortical fibrosis after the biopsy was determined using the Banff score. Continuous variables like mean and SD were calculated, and categorical variables were reported using frequencies and proportions. Associations were examined using independent sample t-tests, χ 2tests, and multivariate regression analysis. Results: The mean eGFR was 75.23±25.45 ml/min/1.73...
Journal of Karnali Academy of Health Sciences, Dec 30, 2023
Background: Iterative Reconstruction techniques have been shown to produce diagnostically accepta... more Background: Iterative Reconstruction techniques have been shown to produce diagnostically acceptable images at low doses to the patient. This study aimed to compare the image quality and radiation dose between 120kVp Filtered Back Projection and 80kVp Iterative Reconstructed (SAFIRE) CT images. Methods: This cross-sectional study was performed on patients referred for CT Urography examinations for various clinical indications to the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital. Data were collected for a period of four months (From August to November 2019) after approval from the Institutional Review Committee of the Institute of Medicine. Convenience sampling was employed and a total of 96 examinations were included. Among them 48 were male and 48 were female. Data were obtained from the 128-slice MDCT Siemens Somaton Definition AS+ CT scanner. Venous phase scans were obtained with Protocol A (120kVp and Filtered Back Projection) and non-contrast scans were obtained with Protocol B (80kVp and SAFIRE). The mAs (tube current-time product) was fixed at 200 for both protocols. Results: There was a 72.5% reduction in Size Specific Dose Estimate (SSDE) in Protocol B compared to Protocol A. However, there was a 13.17% increase in noise in Protocol B compared to Protocol A. Image quality evaluation showed a 98.95% acceptability for the low dose i.e. Protocol B images. Conclusion: CT using low kVp (80kVp) and low current (200mAs) along with an iterative reconstruction algorithm (SAFIRE) can provide diagnostically acceptable images at very low doses for examinations of the Urinary tract
Background Appendix is a blind-ended tubular structure arising from caecum, with variable intralu... more 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.
Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered dista... more Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. Methods: A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node...
Key Clinical MessagePancreas divisum (PD) can be one of the causes of unexplained chronic abdomin... more Key Clinical MessagePancreas divisum (PD) can be one of the causes of unexplained chronic abdominal pain. In PD, the dominant duct drains the majority of the pancreas via the minor papilla, which can be conveyed in the imaging as crossing duct sign.We report a case a of 16‐year‐old man who presented with unexplained chronic abdominal pain. Contrast‐enhanced computed tomography and magnetic resonance cholangiopancreatography showed a bulky pancreas, but his pancreatic enzymes were normal. The crossing duct sign was prominent in imaging, which confirmed the diagnosis of PD.
Introduction: Dimensions of the foramen magnum are clinically important because of the vital stru... more Introduction: Dimensions of the foramen magnum are clinically important because of the vital structures passing through it and for sex determination of the skull. The objective of this study was to measure various dimensions of the foramen magnum in Computed Tomography (CT) and correlate them with sex. Methods: Descriptive cross-sectional study was done on 120 CT head images in the Department of Radiology and Imaging, from July to October 2019. The shape of the foramen magnum (FM), anteroposterior diameter (APD), transverse diameter (TD), FM area and FM index were calculated. Statistical analysis was done with SPSS 25 and Excel 2016. Discriminant function analysis and binary logistic regression analysis were used for gender verification. RESULTS: The mean values of the APD, TD, area and FM index in males and females were 33.56 ± 4.30 mm, 29.76 ± 4.10 mm, 792.94 ± 191.60 mm2, 85.01 ± 8.67 and 30.01 ± 2.04 mm, 25.33 ± 4.6 mm, 599.63± 128.13 mm2, 83.17 ± 7.78 respectively. All dimens...
This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for i... more This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for internal mammary nodal recurrence in a 68-year-old woman with triple-negative breast cancer. The patient had previously undergone mastectomy followed by chemotherapy and radiotherapy. However, an internal mammary node was discovered during a routine follow-up a year later, which was confirmed as metastatic carcinoma by fine needle aspiration, with no other metastatic lesions. The patient underwent interstitial brachytherapy under ultrasound and computed tomography (CT) guidance, with a prescribed dose of 20 Gray in one fraction. Follow-up CT scan imaging over a 2-year period of treatment showed a complete resolution of internal mammary node. Therefore, brachytherapy may be considered a potential treatment option for cases of isolated internal mammary node recurrence in breast cancer.
Testicular seminoma needs to be considered as a differential diagnosis for intra-abdominal mass i... more Testicular seminoma needs to be considered as a differential diagnosis for intra-abdominal mass in the male patient if there is a history of undescended testis. The risk of developing seminoma in an undescended testis is about 4-7.5 times greater than in a normally located testis.The risk of seminoma in undescended testis is increased even after orchidopexy.The identification of the draining gonadal vein can play a key role in the diagnosis of the testicular tumor in undescended intra-abdominally located testis. We report a case of seminoma in the retroperitoneal undescended testis in 50 years old male admitted for abdominal pain and distension
Background Increase in common bile duct diameter can occur because of different causes. Post chol... more 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 ...
Background The exact role of High resolution computed tomography (HRCT) temporal bone in preopera... more 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 val...
Background Fallopian tube and uterine abnormalities are the most common cause of female infertili... more 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 r...
Background and objectives: Esophageal and gastric fundic varices are common in liver cirrhosis pa... more Background and objectives: Esophageal and gastric fundic varices are common in liver cirrhosis patients. Ultrasound with Doppler study assesses liver cirrhosis severity, measuring portal vein and splenic indices’ association with gastroesophageal varices. Methodology: This study was conducted on 64 subjects with sonographic features of chronic liver disease who were referred for routine follow-up scans. Portal vein diameter, average velocity, splenic index, congestion index, and portal vein area and velocity were measured. Result: Subjects with gastro-esophageal varices had significantly larger portal vein diameters (14.7 ± 1.64 mm) compared to those without varices (12.05 ± 1.26 mm) (P<0.05). Conversely, subjects without varices exhibited higher portal vein velocity (PVV) of (17.9 ± 0.6 cm/sec) than with varices (13.91 ± 2.01 cm/sec) (P=0.0005). The splenic index was higher in subjects with varices (1120 ± 494 cm3) than those without varices (419 cm3) (P<0.05). The congestion...
Background and Objectives: Renal allograft biopsy is the gold standard for diagnosing chronic all... more Background and Objectives: Renal allograft biopsy is the gold standard for diagnosing chronic allograft nephropathy, but noninvasive methods are needed to avoid unnecessary biopsies. Doppler ultrasonography, particularly the resistive index (RI), correlates with renal allograft dysfunction. This study aims to assess the relationship between renal sonographic parameters and biochemical parameters in diagnosing graft interstitial fibrosis. Methods: The study evaluated 60 renal allograft recipients for sonographic renal morphological features and Doppler indices. The estimated glomerular filtration rate (eGFR) was calculated, and cortical fibrosis after the biopsy was determined using the Banff score. Continuous variables like mean and SD were calculated, and categorical variables were reported using frequencies and proportions. Associations were examined using independent sample t-tests, χ 2tests, and multivariate regression analysis. Results: The mean eGFR was 75.23±25.45 ml/min/1.73...
Journal of Karnali Academy of Health Sciences, Dec 30, 2023
Background: Iterative Reconstruction techniques have been shown to produce diagnostically accepta... more Background: Iterative Reconstruction techniques have been shown to produce diagnostically acceptable images at low doses to the patient. This study aimed to compare the image quality and radiation dose between 120kVp Filtered Back Projection and 80kVp Iterative Reconstructed (SAFIRE) CT images. Methods: This cross-sectional study was performed on patients referred for CT Urography examinations for various clinical indications to the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital. Data were collected for a period of four months (From August to November 2019) after approval from the Institutional Review Committee of the Institute of Medicine. Convenience sampling was employed and a total of 96 examinations were included. Among them 48 were male and 48 were female. Data were obtained from the 128-slice MDCT Siemens Somaton Definition AS+ CT scanner. Venous phase scans were obtained with Protocol A (120kVp and Filtered Back Projection) and non-contrast scans were obtained with Protocol B (80kVp and SAFIRE). The mAs (tube current-time product) was fixed at 200 for both protocols. Results: There was a 72.5% reduction in Size Specific Dose Estimate (SSDE) in Protocol B compared to Protocol A. However, there was a 13.17% increase in noise in Protocol B compared to Protocol A. Image quality evaluation showed a 98.95% acceptability for the low dose i.e. Protocol B images. Conclusion: CT using low kVp (80kVp) and low current (200mAs) along with an iterative reconstruction algorithm (SAFIRE) can provide diagnostically acceptable images at very low doses for examinations of the Urinary tract
Background Appendix is a blind-ended tubular structure arising from caecum, with variable intralu... more 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.
Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered dista... more Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. Methods: A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node...
Key Clinical MessagePancreas divisum (PD) can be one of the causes of unexplained chronic abdomin... more Key Clinical MessagePancreas divisum (PD) can be one of the causes of unexplained chronic abdominal pain. In PD, the dominant duct drains the majority of the pancreas via the minor papilla, which can be conveyed in the imaging as crossing duct sign.We report a case a of 16‐year‐old man who presented with unexplained chronic abdominal pain. Contrast‐enhanced computed tomography and magnetic resonance cholangiopancreatography showed a bulky pancreas, but his pancreatic enzymes were normal. The crossing duct sign was prominent in imaging, which confirmed the diagnosis of PD.
Introduction: Dimensions of the foramen magnum are clinically important because of the vital stru... more Introduction: Dimensions of the foramen magnum are clinically important because of the vital structures passing through it and for sex determination of the skull. The objective of this study was to measure various dimensions of the foramen magnum in Computed Tomography (CT) and correlate them with sex. Methods: Descriptive cross-sectional study was done on 120 CT head images in the Department of Radiology and Imaging, from July to October 2019. The shape of the foramen magnum (FM), anteroposterior diameter (APD), transverse diameter (TD), FM area and FM index were calculated. Statistical analysis was done with SPSS 25 and Excel 2016. Discriminant function analysis and binary logistic regression analysis were used for gender verification. RESULTS: The mean values of the APD, TD, area and FM index in males and females were 33.56 ± 4.30 mm, 29.76 ± 4.10 mm, 792.94 ± 191.60 mm2, 85.01 ± 8.67 and 30.01 ± 2.04 mm, 25.33 ± 4.6 mm, 599.63± 128.13 mm2, 83.17 ± 7.78 respectively. All dimens...
This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for i... more This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for internal mammary nodal recurrence in a 68-year-old woman with triple-negative breast cancer. The patient had previously undergone mastectomy followed by chemotherapy and radiotherapy. However, an internal mammary node was discovered during a routine follow-up a year later, which was confirmed as metastatic carcinoma by fine needle aspiration, with no other metastatic lesions. The patient underwent interstitial brachytherapy under ultrasound and computed tomography (CT) guidance, with a prescribed dose of 20 Gray in one fraction. Follow-up CT scan imaging over a 2-year period of treatment showed a complete resolution of internal mammary node. Therefore, brachytherapy may be considered a potential treatment option for cases of isolated internal mammary node recurrence in breast cancer.
Testicular seminoma needs to be considered as a differential diagnosis for intra-abdominal mass i... more Testicular seminoma needs to be considered as a differential diagnosis for intra-abdominal mass in the male patient if there is a history of undescended testis. The risk of developing seminoma in an undescended testis is about 4-7.5 times greater than in a normally located testis.The risk of seminoma in undescended testis is increased even after orchidopexy.The identification of the draining gonadal vein can play a key role in the diagnosis of the testicular tumor in undescended intra-abdominally located testis. We report a case of seminoma in the retroperitoneal undescended testis in 50 years old male admitted for abdominal pain and distension
Background Increase in common bile duct diameter can occur because of different causes. Post chol... more 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 ...
Background The exact role of High resolution computed tomography (HRCT) temporal bone in preopera... more 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 val...
Background Fallopian tube and uterine abnormalities are the most common cause of female infertili... more 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 r...
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