Diagnostic yield of percutaneous computed tomography guided core needle biopsy of lung lesion and its complications in tertiary hospital

Background: Early diagnosis of lung cancer can reduce its mortality and morbidity. Minimally invasive image guided percutaneous core needle biopsy can obtain tissue sample for diagnosis and staging of lung cancer, which is crucial for correct management of lung lesions. Common complications of lung biopsy include pneumothorax, parenchymal haemorrhage and haemoptysis. The study was aimed to determine diagnostic yield and complications of the percutaneous computed tomography (CT) guided core needle biopsy of lung lesion in tertiary hospital.Methods: Hospital based prospective study was performed in 40 patients in Tribhuvan University Teaching Hospital. CT guided biopsy of lung lesions was performed with 18-gauge semi-automated biopsy instrument. The complications following the biopsy were recorded and correlated with different factors using chi-square test. Histopathology report were obtained to measure the diagnostic yield.Results: Among 40 patients who underwent guided lung biopsy, histopathology showed definitive diagnosis in 37 patients; 31 malignant and 6 benign lesions. Parenchymal haemorrhage, pneumothorax and haemoptysis were seen in 13, 8 and 5 respectively; however, none required active intervention. Emphysema in traversing lung and numbers of pleural punctures used were predictive factors of complication (p value <0.05).Conclusions: The study showed percutaneous image guided core needle biopsy has high diagnostic yield with fewer complication rates and is thus recommended for routine biopsies of lung lesions

Comparison Between Computed Tomography and Ultrasonography in Detection of Urinary Tract Calculi

Introduction: In the past decade, developments in CT technology have changed the trend of imaging modalities used in the evaluation of urinary system. The present study was undertaken to compare between Computed Tomography (CT) and Ultrasonography (USG) in detection of urinary tract calculi.  Methods: The prospective, cross-sectional and observational research design was used. The study was conducted in Department of Radiology and Imaging of Tribhuvan University Teaching Hospital from June 2017 to September 2017 in 96 patients. Patients who underwent plain CT abdomen (CT KUB) with suspicion of urolithiasis after performing USG were enrolled in the study. Ultrasound and CT findings were compared on the basis of age, gender, clinical complaints, number of stones and their locaton (site of occurrence). Similarly, specificity, sensitivity, positive predictive value and negative predictive value of USG were calculated using CT as gold standard.  Results: A total number of 96 patients were studied from June 2017 to September 2017. Among them 56 were males and 40 were females with male to female ratio of 1.4:1. The mean age among the males was 34±14.79 years and  females was 38±18.74 years. Flank pain was the commonest complaint recorded in 35.41% of patients. On the CT scan, 80% patients had renal calculi, 15.60% of stones were found in vesico-ureteric junction (VUJ) and 41.66% stones were seen bilaterally. Out of the 22 cases with ureteric calculi, USG detected calculi only in 5 cases and the sensitivity of USG in diagnosing ureteric calculi in comparision to CT was 22.72% with 100 % specificity, 100% PPV and 81% NPV.  Conclusion: Ultrasound has lower sensitivity for the detection of ureteric calculi. CT helps in precise detection of calculi during initial evaluation which is critical for clinical decision making and patient counselling.

Comparative Study of Image Quality and Radiation Dose between 120kVp Filtered Back Projection and 80kVp Iterative Reconstructed Computed Tomography Images

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 trac

Interstitial brachytherapy for internal mammary node in breast cancer: A case report

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

Cerebral venous sinus thrombosis with hemorrhagic infarct: A rare presentation in a risk-defying male patient

Cerebral venous sinus thrombosis (CVST) is a rare but critical cerebrovascular condition characterized by clot formation in cerebral veins or sinuses. We present a case of a 30-year-old male with CVST, an atypical presentation of right-sided weakness and sudden loss of consciousness. While CVST typically manifests as severe headaches and neurological deficits, our patient's unique symptoms pose diagnostic challenges. Advanced imaging techniques, including MRI with venography, played a pivotal role in confirming the diagnosis. Treatment involved anticoagulation therapy and resulted in a favorable outcome. This case highlights the importance of considering CVST in patients with unusual neurological symptoms and the crucial role of early diagnosis and intervention. Advances in diagnostic modalities and treatment options have significantly improved outcomes in CVST patients, emphasizing the need for timely recognition and management