Anatomic variation of celiac axis and hepatic artery as evidenced multidetector computed tomography in patients at tertiary care center in Nepal

Introduction: There are many potential anatomic configurations of celiac axis and hepatic artery. Michel’s classified hepatic arterial variations in 10 categories. Knowledge about these variantion in patient is invaluable before surgery. Multidetector computed tomography (MDCT) can accurately depict the vascular anatomy of celiac axis and hepatic artery non-invasively. Aim of this study was to find out the prevalence of different types of anatomical variation of celiac axis and hepatic artery in patients undergoing multiphase CT. Method: Cross-sectional, prospective study was done in Department of Radiology, Patan Hospital, Patan Academy health sciences. MDCT of abdomen of 178 patients with arterial phase images done between December 2021 and March 2022 were evaluated for arterial anatomy of celiac axis and hepatic artery. Arterial anatomy was categorized according to Michel’s classification. Prevalence of each variant anatomy and gender wise prevalence was calculated. Results: CT scans of 178 patients were evaluated out of which 94 were male and 84 were female. Among these individuals 133 (74.7%) had normal anatomy (Type I) and 45 (25.3%) had some sort of variant anatomy. Type III was commonest type of variant anatomy seen in 18 (10.1%) individuals. We found 6(3.4%) individuals with the anatomy other than classified by Michel. Conclusion: There are multiple variation in of celiac axis and hepatic artery anatomy in large number of populations. Knowledge of such anatomical variation will be of great importance for surgeon and interventional radiologist for planning of surgical or vascular procedures and to prevent vascular complication

Diagnostic role of ovarian – adnexal reporting and data system magnetic resonance imaging scoring system for evaluation of indeterminate adnexal lesions

Introduction: Magnetic resonance imaging (MRI) plays an important role in distinguishing malignant from benign adnexal mass which are  indistinguishable from ultrasonography.This can help in early diagnosis and treatment of indeterminate adnexal lesions.This study aims to evaluate the accuracy of ovarian adnexal reporting and data system (O-RADS) MRI score in distinguishing  bening from malignant lesion when compared to histopathology which is the gold standard  and  evaluate MRI features  suggesting malignancy  in such lesions. Method: This was a retrospective study of MRI pelvis carried out in patients with indeterminate adnexal lesions who had MRI pelvis done from 2018 to 2022 at Patan Hospital, Lalitpur, Nepal. Ethical approval was obtained from the institutional review committee of Patan Academy of Health Sciences. MRI diagnosis based on O-RADS MRI score was compared with histopathology diagnosis and sensitivity, specificity were calculated. Chi-square test was used and p-value less than 0.05 was considered statistically significant. Result: Among 175 patients, 135 had benign and 40 had malignant lesions. The sensitivity and specificity of MRI diagnosing indeterminate lesion was 92.5% and 91.85% respectively. Among malignancy, 92.5% had O-RADS MRI score of 4 and 5. Significant statistical association of O-RADS MRI score was found with histopathology diagnosed malignancy. MRI features of malignancy were multilocular, solid cystic lesion with contrast enhancement, septations and diffusion restriction. Malignancy was common in middle aged patients (41-60 y). Conclusion: O-RADS MRI scoring is significantly associated with histopathology-proven adnexal malignancy and hence helps in accurately diagnosing indeterminate adnexal lesions and stratifying the risk of malignancy

Accuracy of magnetic resonance cholangiopancreaticography in the diagnosis of benign and malignant cause of obstructive jaundice: Accuracy of MRCP in obstructive jaundice

Introduction: Magnetic Resonance Cholangiopancreatography (MRCP) is non-invasive technique for overall assessment for obstructive jaundice. This study aims to compare accuracy of MRCP in benign and malignant obstructive jaundice with gold standard but the invasive procedure of Endoscopic Retrograde Cholangiopancreatography (ERCP) and histopathology. Method: This was a retrospective study reviewing MRCP findings of clinically diagnosed obstructive jaundice from 2018 to 2021 at Patan Hospital, Kathmandu, Nepal. Study was conducted after ethical clearance of the institutional review committee. Sensitivity, Specificity, PPV and NPV and overall accuracy of MRCP was compared with the ERCP and histopathology. Chi square test was used for analysis, a p<0.05 considered significant. Result: Among 66 patients, the Sensitivity, Specificity, PPV and NPV of MRCP for biliary obstruction due to malignant pathology were 89.50%, 93.60%, 85.00% and 95.70% respectively. Similarly, for benign etiology, it was 93.60%, 89.50%, 95.70% and 85.00% respectively. The overall diagnostic accuracy was 92.40%. Choledocholithiasis were 31(46.97%) among benign cause and periampullary carcinoma 8(12.12%) among malignant. Conclusion: MRCP is highly sensitive and specific test in the evaluation of benign and malignant biliary pathology. Being noninvasive and can have good diagnostic value despite use of contrast. So minimally invasive procedure ERCP can be reserved for therapeutic or diagnostic biopsy purpose only

CT KUB evaluation of suspected urolithiasis: CT KUB in suspected urolithiasis

Introduction: Non-contrasted computed tomography scan for kidney, ureter, and bladder (CT KUB) for the diagnosis of urolithiasis is important for accurate diagnosis, followup, and management. Unlike USG, CT KUB has more diagnostic yield in urolithiasis and other incidental findings. This study aims to evaluate the use of the CT KUB in suspected urolithiasis, which is presented with severe flank pain. Method: A retrospective observational study was carried out in the Department of Radiology and Imaging, Patan Hospital, Nepal. The CT KUB reports of patients with suspected urolithiasis from a period of 3 years from Jan 2017 to Jan 2020 were analyzed for evidence of urolithiasis and secondary signs of obstruction as ‘diagnostic’ of CT KUB. Other incidental radiological findings were further analysed and categorized into urinary and extra-urinary. Ethical approval was obtained. The association between USG and CT KUB was analysed using the Chi-square test, with a p value of 0.05 considered statistically significant. Result: A total of 414 CT KUB reports were analysed, 230(55.6%) males, 314 patients had USG before CT KUB. Considering CT KUB as a gold standard for the diagnosis of urolithiasis, the accuracy of ultrasound was found to be 85.03%, and sensitivity is 94.09% and specificity of 27.9%. Conclusion:  The majority of the patients included in the study had ultrasound done before CT KUB. The sensitivity of ultrasound was significant considering CT KUB as a gold standard in the diagnosis of urolithaisis. Keywords: Urolithiasis, CT KUB, incidental findings, USG sca