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Objective: To determine the diagnostic accuracy of non-invasive hepatic ultrasound score for the diagnosis of non-alcoholic fatty liver disease (NAFLD) by keeping computed tomography. (CT) as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi from Dec 2017 to May 2018. Methodology: All patients from any ethnicity and gender with more than 18 and less than 60 years of age were considered for the study. Hepatic ultrasound score based on the anteroposterior diameter of the right lobe of the liver, deep beam attenuati on was calculated, and results were compared with CT scan findings. Results: A total of 101 patients were included. A total of 69 patients had a total Ultrasound score of 2 or more, fulfilling the study's criteria to be labelled as Non-Alcoholic Fatty Liver Disease. On a CT scan, 71 patients fulfilled the criteria to be labelled as having Non-Alcoholic Fatty Liver Disease. Keeping the Computed Tomography scan gold standard, 59 patients were true positive, and 10 were false positive. The sensitivity and specificity of this score were 83.09 % and 66.67%, respectively. The hepatic ultrasound score had a Positive Predictive Value of 85.50% and a Negative Predictive Value of 62.5%. Conclusion: Ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe is a reliable, reproducible and accurate tool for diagnosing Non-Alcoholic Fatty Liver Disease. [ABSTRACT FROM AUTHOR]

Objective: To study the frequency of pneumothorax and intrapulmonary haemorrhage in computed tomography (CT) guided transthoracic needle lung biopsy (NLB) and the factors that affect the development of these complications in Pakistan through a representative limited data obtained from a tertiary care centre. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Feb 2019. Methodology: A total of 68 patients who underwent CT-guided transthoracic biopsy were evaluated for intra- and immediate (within 04 hours) post-procedural pneumothorax and pulmonary haemorrhage. The factors affecting the development of these complications were evaluated. Results: Complications developed in 30 patients with the frequency of pneumothorax at 26.5 % and frequency of pulmonary haemorrhage at 19.1%. Significant risk factors for the development of pneumothorax were small lesions less than 2.5 cm in diameter (p-value <0.05), increased needle track path within the lung tissue of more than 21 mm (p-value = 0.05), and presence of emphysema in the surrounding lung tissue (p-value <0.05). In addition, smaller lesion size (p-value <0.05) and increased traversed lung parenchyma (p-value <0.05) were also significant factors in the development of intrapulmonary haemorrhage. Conclusion: Significant risk factors for pneumothorax and intrapulmonary haemorrhage are smaller lesion size and length of puncture path. The presence of emphysema is related to the development of pneumothorax. [ABSTRACT FROM AUTHOR]

Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease. Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020. Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed. Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement. A severity index using modified RALE score was calculated for each & both lungs. Results: Nine hundred and thirty two patients were males and 68 were females with an average age of 40.77 years ± 13.58. Out of 1000 patients, 759 (75.9%) had normal chest x-rays. Two hundred and forty one patients had positive findings, ground glass opacities being the most frequent feature 211 (87.6%) showing peripheral 219 (90.9%), bilateral 182 (75.5%) and lower zone predominance 221 (91.7%). The optimal modified RALE score threshold for recognizing severe disease was 4.5 (area under curve, 0.943), with 79.2% sensitivity and 96.3% specificity. Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution. Modified RALE score can be used for objective evaluation of clinically severe patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the spectrum of diseases on F-18 FDG PET/CT imaging at the Armed Forces Institute of Radiology and Imaging, Rawalpindi. Study Design: Cross-sectional study. Place and Duration of the Study: PET/CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul 2019 to Mar 2021. Methodology: The patients were scanned for staging, restaging, interim/response assessment and relapse/recurrence purposes. In addition, the frequency of various cancers and types of scans were determined. Scanning has been performed using GE Health care MiDR PET-CT Scanner. Results: A total of 1573 patients were included in the study. Male patients were 927(58.93%), and female patients were 646(41.06%). The most common diseases encountered were lymphoma 623(39.6%), breast cancer 193(12.2%), lung cancer 12(7.6%), colorectal cancer 88(5.5%) and unknown primary 84(5.3%). Amongst lymphoma, Non-Hodgkin's lymphoma was the most common 276(44.3%), followed by Hodgkin's lymphoma 267(42.8%). Conclusion: F-18 FDG PET/CT hybrid imaging is an important modality and can significantly alter patient management plans. Lymphomas were the most common disease in our spectrum, followed by cancers of the breast, lungs, colon-rectum and unknown primary cases, which can be managed well by PET/CT's routine utilization. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To find out the optimal timeline for the safe disposal of radioactive wastes generated at the end of normal and anomalous productions of 18FFluorodeoxyglucose for positron emission tomographycomputed tomography scans. Study Design: Quasiexperimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug to Dec 2020. Methodology: Wastes generated at the end of 18FFluorodeoxyglucose production were tested for residual radioactivity at 2, 12 and 24 hours after synthesis to ascertain the optimal timeline for discarding. The radiation dose at 5 cm from the surface of the container was also assessed. Results: Fifty productions were included in the study, of which 46(92%) were normal, and 4(8%) were anomalous productions. The mean activity at 2 and 24 hours after the end of synthesis was 4.102±0.831mCi and 0.0047±0.00116mCi, respectively, in normal productions and 45.125±2.332mCi and 0.005±0.00026mCi respectively in anomalous productions. The mean radiation dose at 5cm from the surface of the container at 2 and 24 hours after the end of synthesis was 8.2107±1.665mSv/h and 0.00000966±0.00000212mSv/h in normal productions and 90.32±4.66mSv/h and 0.00975±0.0005- mSv/h respectively in anomalous productions. Conclusion: The residual radioactivity in wastes was negligible 24 hours after the end of synthesis in both normal and anomalous productions. Radioactive wastes from 18FFluorodeoxyglucose production should, therefore, be conserved for at least 24 hours before their disposal to the environment. [ABSTRACT FROM AUTHOR]

Objectives: To know efficacy of combination of standard interferon α2b and ribavirin in chronic hepatitis C. Design: Prospective and analytical. Setting: CMH Bahawalpur. Period: Nov 2008 to Dec 2009. Materials and methods: A total of 126 patients, 104 males and 22 females, fulfilling inclusion and exclusion criteria were started combination treatment. Of these, 110 (87.3%) completed the treatment while 16 (12.7%) patients could not complete the treatment so they were dropped out of this study. Patients were started on Interferon α2b in a dose of three million units sub-cutaneous (s/c) thrice a week along with daily Ribavirin 1000 milligram (mg) and 1200 mg orally for patients weighing less or more than 75 kilogram (kg) respectively. The primary outcomes, normalization of ALT and undetectable HCV-RNA by PCR, were determined at end of three and six months of treatment. Results: From Nov 2008 to Dec 2009, a total of 110 patients were treated with combination of Interferon α2b and Ribavirin for 24 weeks. Sixty eight patients (62%), 52 males and 12 females showed “end of treatment response” (ETR). Conclusions: Results of the study show effectiveness of the combination therapy of standard interferon and ribavirin for Chronic Hepatitis C. Results of this study are comparable to local and international studies. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum with COVID pneumonia is a rare occurrence with or without accompanying subcutaneous emphysema or pneumothorax. The aim of this study was to establish relation of this complication to severity of lung disease and its clinical outcome. The study was conducted for a period of seven months from April to October 2020 in the CT Department of Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan. All COVID positive patients having spontaneous pneumomediastinum on high resolution CT (HRCT) chest were included (n=14). These patients were assessed for severity of lung disease as per CT severity score (CTSS), and were followed up for their clinical outcome. All patients with spontaneous pneumomediastinum had moderate to severe degree of COVID pneumonia; mortality in patients with pneumomediastinum was 50%; and was seen in those patients who had greater severity of lung disease as per the CTSS. Key Words: Spontaneous, Pneumomediastinum, COVID, Pneumothorax, Subcutaneous, Emphysema.

Balo's concentric sclerosis (BCS) is a variant of multiple sclerosis (MS). It may present as a lesior clinically and radiologically indistinguishable from brain tumour particularly on computerized tomography (CT) scans. Diagnosis only gets clear when magnetic resonance imaging and spectroscopy (MRI & MRS) and brain biopsy is done. We report a case of 30 year old male with progressive headache and left hemi paresis for 3 weeks. There was upper motor neuron (UMN) facial palsy on the left with bilateral papilledema. CT scan of brain showed large hypo-dense area in right frontoparietal lobe consistent with brain tumour. On MRI the diagnosis of BCS was made on basis of concentric lesions of myelinated and demyelinated rings. Demyelination wa confirmed on brain biopsy.