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Lefort I osteotomy is a versatile procedure which is used to correct maxillary deformities. It can be performed solitarily or with other mandibular orthognathic procedures like BSSO to correct dentofacial deformities. Diverse complications are often met post orthognathic surgeries. We report rare complication of pseudoaneurysm in three such patients who presented with different symptoms. Although different treatment options are available for pseudoaneurysms, endovascular embolization is reported to be the superior one. Pre-embolization angiograms in all three patients demonstrated internal maxillary artery pseudoaneurysms. Successful embolization was performed using coils in all these patients with additional use of PVA particles. No further bleeding episodes occurred. [ABSTRACT FROM AUTHOR]

This article, published in the Arab Journal of Interventional Radiology, reviews the pattern of in-stent stenosis after transjugular intrahepatic portosystemic shunt (TIPS) using the Fluency stent graft. The study conducted a retrospective review of 32 patients who underwent TIPS with the Fluency stent graft in combination with bare metal stents. The results showed that the majority of in-stent stenosis occurred at the portal vein end when using the combination of Fluency with a bare metal stent for TIPS creation. The authors suggest that this may be due to the difficulty in identifying portal venous access on fluoroscopy, leaving the proximal parenchymal tract uncovered by the Fluency stent and potentially leading to intimal hyperplasia and TIPS stenosis. [Extracted from the article]

Background: The global burden of patients affected by chronic liver disease (CLD) has shown a steady rise over the last few decades and is now considered the 11th most frequent cause of death globally. In addition, as the world population is facing increased obesity rates coupled with alcohol consumption, these rates are predicted to continue to rise. The Objective was to assess the appearance of Lipiodol retention upon different MRI sequences with a special focus on non-contrast sequences. Lipiodol Transarterial chemoembolization (TACE) has become the standard treatment for unresectable hepatocellular carcinoma (HCC) without vascular invasion. However, data regarding Lipiodol TACE imaging via MRI is limited and results are not familiar to radiologists for regular assessment of treatment response. Methods: After IRB and EC approval, we included all those patients who underwent TACE treatment with Lipiodol and chemotherapeutic agent; having both 4-6-week post-treatment CT and MRI imaging. This criterion was fulfilled by a total of 25 patients. Only lipiodol-containing areas within the lesion were noted for signal intensities on all MRI sequences and labelled as hyperintense, isointense, hypointense and mixed intensity. Data was entered and analyzed by SPSS v27. Frequencies and percentages were calculated for qualitative data. Results: The most sensitive sequence in detecting Lipiodol retention was Fat suppressed T1 imaging sequence, with low signal intensity seen on T1 weighted fat-suppressed sequences in up to 76% of lesions. While on non-fat suppressed T1 weighted images, 60% of Lipiodol retention areas appeared hyperintense. 52% of lesions showed a hypointense appearance on the T2 weighted sequence. A much more variable appearance was seen in Diffusion-weighted imaging sequences demanding cautious interpretation. MR patterns were clearer in patients having more than 50% lipiodol retention on CT and lesion size more than 2 cm. Conclusion: While MRI is deemed as a reliable and most useful imaging modality for assessing HCC's following lipiodol TACE it requires cautious interpretation with knowledge of variable signal appearance seen on different imaging sequences. [ABSTRACT FROM AUTHOR]

Management of renal emergencies has revolutionized over the past years and in that domain intervention radiology has gained an emerging role as the minimally invasive procedures aid at salvaging renal function and minimizing morbidity and mortality. Aim of this study is to highlight emerging importance of newer transcatheter therapies available to intervention radiologists in managing renal emergencies,attending in detail the techniques and clinical outcomes of interventional procedures. METHOD: We compiled few of the procedures performed at Shifa international hospital, Islamabad from January 2017- January 2023. These include: Management of fibromuscular dysplasia. Renal angiomyolipoma embolization. Renal artery giant aneurysm coiling/ embolization. Management of post renal biopsy bleed. Post partial nephrectomy bleed management. Embolization of renal cell carcinoma metastasis to stomach and small bowel. Renal cyst alcohol ablation. CONCLUSION: Knowledge about the disease, procedures of intervention developed for their management and their clinico-therapeutic outcomes can help efficiently treat the patients with renal illnesses. [ABSTRACT FROM AUTHOR]

Background: Novel Corona Virus took the world by storm under the name of COVID-19, metamorphosing the whole health care structure and alienating what we the medical community considered normalcy. The sudden unexpected need for social distancing resulted in dire dependency on imaging for expert diagnosis and management. The purpose of the present study is to describe in-depth strategies that were taken by radiology department at our hospital as a part of a coordinated hospital system-wide response in managing workflow of patients presenting to our hospital for various medical and surgical semi-urgent/urgent indications requiring hospital admission. This article may assist and provide guidance for preparation and management for other radiology departments in the early stages or in dire need of providing services in a secure environment, especially in low-income countries such as ours, while maintaining the quality of radiological reports, dealing with increased workloads. It was a descriptive qualitative study, conducted at Shifa international hospital, Radiology Department, from 28 March to 5 June 2020. Methods: After approval from IRB, a descriptive qualitative study was carried out, which included all patients regardless of age or gender who underwent radiological imaging including CT and radiograph chest, at our department from 28 March to 5 June, 2020. Results: Overall, on a yearly basis, the number of CT scans decreased 30% (total), 53.4% (OPD), and 0.61% (IPD), respectively, in 2020 when compared with figures in 2019. However, no. of HRCTs performed were significantly increased compared to 2019, in same months 568 (0.09%), compared to 2020 where a majority of total CTs performed were HRCTs for COVID alone. Conclusion: The radiology department plays a central role in streamlining the patient inflow admitted for surgical or medical indications and thus needs to be prepared for patient surges and increased volumes, with large influxes of patients to the emergency department that will require diagnostic imaging and interventional services. [ABSTRACT FROM AUTHOR]

We report case of 27 years old male of a rare complication of epidermoid cyst with malignant transformation into squamous cell. Patient underwent surgery 4 months back for resection of epidermoid cyst. The patient presented post-operatively to our setup when he started having pain and swelling at surgical site which was growing progressively. Initial investigations of CT and MRI were done which showed imaging features similar to epidermoid cyst. Re-exploration surgery and histopathology confirmed keratin pearls which are seen in epidermoid cyst. On follow-up, the imaging not only showed post-surgical complications but also interval development of nodular and enhancing masses in the surgical bed. Patient underwent surgery again for postoperative complications. Biopsy was taken from tumor site. Histopathological slides of squamous cells with keratin pearls correlated with our findings of squamous cell carcinoma on imaging. Fewer cases of epidermoid cyst's complication into malignancy are reported in literature. Our purpose is to highlight one of such cases. [ABSTRACT FROM AUTHOR]

Neuroradiology remains the most fascinating dimension of radiology; encompassing a variety of interesting radiological signs manifested in the brain with particular neurological disease. Interestingly most of these signs resemble different animals, birds or insects in the brain. Understanding and recognizing these signs aids in successful interpretation of the scans and aids in establishing appropriate diagnosis. The aim of this study is to illustrate these typical neuro-radiological signs resembling various animals and to briefly outline the underlying pathogenesis. METHOD: We compiled all these cases with interesting neuro-radiological signs manifested on MRI brain performed at Shifa international hospital, Islamabad from January 2016-December 2019. These include:. 1. Hallervorden Spatz disease; Eye of tiger sign 2. Wilson disease; Face of the giant Panda sign 3. Central pontine myelinolysis; Owl eye appearance 4. Glioma; Butterfly sign 5. Joubert syndrome; Bat wing fourth ventricle 6. Metachromicleukodystrophy; Tigroid pattern 7. Dysplastic cerebellar gangliocytoma; Tigroid or leopard skin pattern 8. Meningioma: Tail sign 9. Corpus callosum agenesis; Steer horn ventricles 10. Penguin sign; Progressive supranuclear palsy 11. Caput medusa; DVA. CONCLUSION: Knowledge of these easily decipherable animal based signs in brain is important as it helps in narrowing down the elaborate list of differentials and also facilitates in making imaging based diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) chest in determination of corona virus disease (COVID-19) taking polymerase chain reaction (PCR) as gold standard. Methods: This diagnostic cross-sectional study was conducted at Shifa International Hospital Islamabad (SIH) from February 2020 to April 2020. All patients suspected for COVID 19 pneumonia were consecutively enrolled. Diagnosis was done via both HRCT chest and PCR assay. Patient's demographic characteristics and PCR results were retrieved from hospital database. Diagnostic accuracy was explored by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy. Results: Of 250 patients, the mean age was 58.5 years ± 14.7 years. HRCT findings in positive scans showed that of 181 patients, majority of the patients presented with multifocal peripheral rounded ground glass opacities (GGOs) with crazy paving observed in 77 (42.5%), multifocal peripheral rounded in GGOs 51 (28.1%), and multifocal peripheral rounded GGOs with crazy paving and consolidations 45 (24.8%). Furthermore, bilateral lungs and multifocal multilobar involvement of lungs was observed in 179 (98.8%) each. While peripheral lung involvement was observed in 176 (97.2%) patients. The sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy of HRCT chest in diagnosing COVID-19 pneumonia was 93.4%, 53.5%, 71.2%, 86.9%, and 75.6% respectively. Conclusion: HRCT chest has a higher sensitivity and comparable diagnostic accuracy to PCR testing in diagnosing COVID 19 pneumonia and thus in the epidemic areas, it can be used as an important adjunct to PCR testing. [ABSTRACT FROM AUTHOR]

PURPOSE: COVID pneumonia, emerged as a pandemic, is a highly communicable viral infection, pathogen being novel corona virus. Though the definitive diagnosis is established by a positive RT-PCR throat swab; radiological imaging may also provide an important adjunct towards the diagnosis of novel corona virus infection. The first line imaging modalities being radiograph and computed tomography (CT) chest. Purpose of the study wasto document the common imaging appearances of emerging novel corona virus disease on CT scan. MATERIALS AND METHODS: All the consecutive patients presenting to Shifa International hospital (SIH), Islamabad from February 2020, to May 2020, having RT-PCR positive COVID- 19 infection were enrolled retrospectively with CT chest performed at admission. These imaging scans were evaluated by two independent Consultant Radiologists. Data was analyzed on SPSS v21 and displayed as frequency percentages. RESULTS: 150 patients (115 (76.7%) men, 35 (23.3%) women; mean age 57.39 ±13.5 standard deviation) were included in the study. The characteristic CT features of COVID 19 pneumonia included ground-glass opacities (GGOs) in 138 patients (92%) which were bilateral, multifocal and multilobar. Among these 138 patients with bilateral and multifocal ground-glass opacities (GGOs) with concomitant consolidations were present in 41 (29.7%) and crazy paving was seen in 105/138 scans (76%). 5 out of 150 patients lacked these GGOs and showed consolidations without GGOs. Other imaging features included subpleural lines in 10 patients (6%), vascular dilatation in 22 patients (14.6%) and air bronchograms in 30 patients (20%). Pleural effusion in 3 scans (2%). None of the initial cases showed enlarged lymph nodes. 7 out of 150 scans (4.6%) had no positive findings. Predominantly peripheral and bilateral distribution in 146 of 150 scans (97.3%). CONCLUSION: According to our initial experience, the imaging appearances of COVID 19 infection on CT chest compromises of predominantly bilateral, multilobar and multifocal GGOs. Crazing paving and concomitant consolidations may or may not be seen. Other commonly reported features were subpleural lines, vascular dilatation and air bronchograms with pleural effusions being the least common. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the survival rate and main reasons of failure of tunneled central venous catheters (Groshong). STUDY DESIGN: Retrospective cross-sectional analysis. PLACE OF STUDY: Department of Interventional Radiology, Shifa International Hospital, Islamabad. DURATION OF STUDY: Two years (January 2010 to December 2011) MATERIALS AND METHODS: A retrospective analysis was carried out on 72 patients in whom Groshong catheters were placed and then followed from January 2010 to December 2011. The data was collected from hospital information system (HIS) and patients medical record, and was analysed for different indicators such as catheter survival and main reasons of its failure. RESULTS: Of 72 patients, half of patients were lost to follow. Among the remaining half, 19 (52.7%) catheters achieved their desired function. Among remaining 17 catheters, 5 were removed due to blockage and 12 due to infection with infection rate of 0.46 per 1000 catheter days. The catheter survival rates according to Kaplan Meier analysis at 1, 3 and 6 month were 82%, 47% and 42% respectively. CONCLUSION: Groshong catheters can be used as vascular access for longer duration especially in oncology patients. Infection is commonest reason of their premature removal. [ABSTRACT FROM AUTHOR]

Objective: To compare the percutaneous radiologically guided gastrostomy (PeRG) tubes of wide caliber with narrow caliber tubes. Methodology: This retrospective study was performed on 36 patients who were referred to Radiology department for PeRG tube placement between 2008 till 2012. Comparison of wide caliber gastrostomy tubes (18-24 Fr) was done with narrow caliber tubes (14 Fr) considering procedure success rate, procedure related complications and catheter related minor and major complications. Results: Out of 36 patients, 18 patients were present in each group. Mean age of patients was 53.944 ±19.380. Procedure success rate was 100 % in both groups and procedure related immediate complications were none in either groups. Peri-catheter leakage was observed in 1 patient in each group. Tube occlusion was present in 2 patients in narrow caliber group. Two patients had severe pain in wide caliber group and also 3 patients had wound infection in this group. Conclusion: Regardless of the type of radiologic catheter placed, PeRG can be considered as safe and highly successful procedure. Use of a 24 Fr gastrostomy tubes may show promising results if placed under radiological guidance with comparable technical success and complication rates to other caliber tubes. [ABSTRACT FROM AUTHOR]

Objective: To compare bone marrow biopsy needle (BMBN) with bone biopsy needle (BBN) in CT guided core biopsies considering size of core, diagnostic yield and cost of needles. Methodology: Retrospective study was done on 50 out of 68 patients referred to Interventional Radiology department for CT guided bone biopsy from 2008 till 2013. Grading of specimen length was done as small, medium and large. Diagnostic yield was determined on basis of clinical, imaging and histopathology data. Local cost of both needle types was determined. Comparison was made and statistical analysis was performed. Results: Biopsy was performed by BBN in 16 patients and by BMBN in 34 patients. Overall diagnostic yield of bone biopsies was 82 % (41 of 50 biopsies). Diagnostic yield with BMBN was 85 % and with BBN was 75 %. Overall longer specimen length was obtained using BMBN. Statistically, there was no significant difference between them in diagnostic yield and specimen length; however, BMBN costs almost one half than BBN. Conclusion: Diagnostic yield and sample length using bone marrow biopsy needle proved to be equivalent to bone biopsy needle. Bone marrow biopsy needle has an added benefit of being low in cost. Despite being a non-coaxial technique these needles can achieve diagnostic yield comparable to that of coaxial techniques as reported in past literature. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of pneumothorax following ultrasound guided thoracentesis in our department and its association with gauge of needle in causation of pneumothorax. Methadology: This is descriptive cross sectional study conducted at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital (SIH), Islamabad from January 2010 to April, 2012. A total of 359 ultrasound guided thoracentesis were performed followed by a chest radiograph between January 2010 and April, 2012 fulfilling the inclusion criteria. All procedures were performed by radiology consultants and residents. Generally 18 and 16 G cannulas were used. A few were done with 16 and 18 G spinal needle and 21G syringe needle. Relevant data was collected from hospital data base system on the performa and was analyzed for demographic variables, frequency of pneumothorax, and its association with operator's experience (residents or consultants) and gauge of needle by applying chi square test. P value of < 0.05 was considered significant. Results: 309 patients had thoracocentesis while performed by residents and 50 by consultants. Pneumothorax occurred in 22 of these 359 cases with an overall frequency of 6 %. In 219 patients 18 G cannula was used and 8 of these developed pneumothorax (3.6%). In 94 patients 16 G cannula was used. Pneumothorax occurred in 11 (11.6%). Statistical analysis confirmed that the frequency of pneumothorax was significantly increased following use of 16G as compared to 18G (p=0.02). Conclusion: The frequency of pneumothorax following ultrasound guided thoracentesis increases significantly with use of 16G as compared to 18G (p=0.02). [ABSTRACT FROM AUTHOR]

Objective: To audit the radiology department of a health facility, focusing on contrast extravasations management pre- and post-implementation of a standard protocol., Methods: The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan and comprised reported computed tomography contrast extravasation incidents from January 2017 to December 2019 in the retrospective phase before the implementation of a standard protocol. Post-implementation, re-audit was done prospectively to assess compliance from January 2020 to May 2021. Overall score of >80% was chosen arbitrarily as a qualifying standard for adequate documentation., Results: Of the 49 total cases, 26(53%) related to the first phase and 23(47%) to the second. In the first phase, 2(20%) of the 10 parameters cleared the cut-off mark; 'study performed' 25(96%) and 'limb assessment by technician' 26(100%). In the second phase, 2(20%) parameters failed to clear the cut-off mark; site of cannula/extravasation' 18(78.3%) and 'volume of contrast' 15(65%)., Conclusions: Lack of early identification and appropriate management, especially in cases of large-volume extravasation, may result in significant morbidity.

Objective: To look for survival rate and major reasons behind the failure of tunnelled dialysis catheters in patients on haemodialysis., Methods: The retrospective study was conducted at the Department of Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 100 consecutive subjects from a list of patients in whom tunnelled cuffed catheters were placed from February 2009 to January 2011 and were followed up for two years. Data was collected on a proforma from the hospital database and medical records of patients. SPSS 19 was used for statistical analysis., Results: Of the total 122 catheters placed in 100 patients, 49 (40.16%) were lost to follow-up. Of the remaining 73 (59.83%) catheters, 38 (52%) had achieved their desired function, while 35 (48%) failed to achieve the target duration. Among the reasons of catheter failure, infection was the commonest at 13 (37.14%) with infection rate of 0.24 per 1000 catheter days. According to Kaplan Meier analysis, catheter survival rates at 60, 90 and 180 days were 89%, 77% and 64% respectively. Mean effective duration of catheter was 129 +/- 117 days., Conclusion: Tunnelled dialysis catheters can be safely used as vascular access till the maturation of fistula and may be an alternative to Arterio-Venous Fistula or graft for long-term vascular access if indicated.

Objective: To evaluate the results of uterine fibroid embolisation as a treatment option for symptomatic uterine fibroids in the local population., Methods: The retrospective study was done at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 12 patients with symptomatic uterine fibroids who had undergone uterine fibroid embolisation with the use of polyvinyl alcohol between May 2008 and July 2012. All of these patients had been assessed by a gynaecologist. Pre-embolisation workup was done by pelvic Magnetic Resonance Imaging. A detailed questionnaire was prepared to assess clinical improvement and interval change in fibroid size on follow-up imaging., Results: A technically successful embolisation was done in all patients. All patients experienced immediate postprocedure pain, but responded to conservative treatment. Clinical follow-up showed a significant reduction in symptoms within six months of the procedure, with 88% improvement in menorrhagia and 100% improvement in pain. Follow-up imaging showed reduction in fibroid sizes ranging from 17-63%. Two patients developed infection, which is a known complication of this procedure., Conclusion: Uterine fibroid embolisation is a well-recognised treatment option for symptomatic uterine fibroids. Ascertaining its long-term results in our local population will, however, require additional studies with larger patient populations.

We present the report of a young male patient who was diagnosed with acute bilateral medial medullary infarction (MMI) on diffusion-weighted magnetic resonance imaging (DW-MRI). Corroboration with the apparent diffusion co-efficient (ADC) map enabled timely and accurate diagnosis of the rare stroke syndrome. On follow up 9 months after the diagnosis and subsequent treatment, the patient showed significant improvement on all fronts.