Background: Middle ear cholesteatoma is a potentially dangerous condition owing to the varied extra-cranial as well as intra-cranial complications, it can be associated with. Clinical suspicion and otologic examination sufficiently identifies the pathology but its entire extent and spread is delineated by HRCT examination only, which is presently the "Gold Standard". In this study we tried to evaluate the efficacy of HRCT temporal bone in depiction of extent of pathology in cases of cholesteatoma of middle ear and we tried to verify the findings of HRCT imaging with intra-op findings.Methods: A prospective observational study comprising of 50 patients suspected of middle ear cholesteatoma was carried out at a tertiary care hospital in Lucknow, India. Pre-op evaluation with bilateral temporal bone HRCT imaging followed by suitable surgery was performed. Important pre-operative HRCT and intra-operative surgical findings were correlated for statistical significance. Results: Mesotympanum involvement (96%) was the most common HRCT finding as far as location and extent were concerned and incus erosion (70%) was the most common bony complication. A high sensitivity and specificity (82% -100%) of HRCT was found in detection of Erosion of scutum, tegmen tympani and incus. For findings such as stapes erosion and facial canal erosion on HRCT, a sensitivity of 68.4% and 50% respectively was found when compared to intra-op findings. Conclusions: HRCT temporal bone is a useful tool in pre-operative delineation of the extent of cholesteatoma and the recognition of its manifestations and complications. It can help the operating surgeon in appropriate surgical planning.

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Background: Shoulder joint is an extremely mobile joint with reduced stability. Pain and discomfort due to shoulder joint instability is common cause of orthopedic referrals in young individuals. Diagnostic Arthroscopy is the gold standard in evaluation and planning of definitive repair surgeries. Recent advancements in MR technology with increased accessibility of the general population to MR facilities have enabled non-invasive detection of pathologies associated with shoulder instability. The present study was aimed at determining the diagnostic value of shoulder MRI in shoulder instability as compared to arthroscopy. Materials and Methods: MRI and subsequent arthroscopic evaluation of 182 patients with shoulder pain and instability admitted to a busy orthopedic referral center was done after performing adequate clinical examination and necessary investigations. Results: Sensitivity and specificity of MRI was 95.87% & 89.41%, for detection of Bankart's lesion, 98.24% & 93.24% respectively for Hill Sach's lesion and 86.36% & 97.37% respectively for SLAP tears. High sensitivity and specificity was also found for rotator cuff tears. Conclusion: MRI can give an adequate information with regards to the pathology involved in shoulder instability and can help provide valuable input in planning of repair surgeries and can very well help to avoid unnecessary arthroscopic procedure.

Background: Knee injuries related to organised sports and physical training related activities are a major component of injuries sustained by armed forces personnel. Knee instability caused by meniscal and ligamentous injuries cause varying degree of disabilities to the trained soldier and have a serious implication on the battle preparedness of the armed forces. MRI of the knee being a non-invasive modality is being increasingly used in pre and post op evaluation of patients in such cases.Methods: A prospective observational study comprising of 161 patients of knee injuries sustained due to sports and physical training related activities was carried out. MRI and arthroscopic examination of the knee was done, and various statistical tests were performed to evaluate the accuracy of MRI in comparison to arthroscopy.Results: ACL tears were seen in 122 patients (75.5%), PCL tears were seen in 67 patients (41.6%), while medial and lateral meniscus tears were noted in 93 (57.7%) and 50 (31%) patients respectively. The sensitivity and specificity of MRI in detecting ACL tear, PCL tear and medial meniscus injury ranged from 84% - 90.5% and for lateral meniscus it was 72.92% to 86.73 %. The accuracy of MRI in detecting the tear of ACL, PCL and menisci ranged from 82.61% to 89.97%.Conclusions: The accuracy of MRI in detection of meniscal and ACL tears is very high. Pre-operative MRI in conjunction with adequate history and physical examination can help the clinician to make an accurate diagnosis and can help reduce unnecessary arthrosopic surgeries.

Background: Myocardial infarction is the leading cause of death and disability worldwide. Nuclear perfusion scintigraphy is the gold-standard technique, which is highly specific in differentiating viable from scarred myocardium in patients of myocardial infarction. Dysfunctional myocardium with areas of residual viable tissue may show functional recovery after revascularization. The aim of this study was to determine the effectiveness of Cardiac MRI in detecting viability of myocardial tissue as compared to 99m-TC Sestamibi perfusion scan in patients with myocardial dysfunction who were awaiting revascularization procedures. Study methods: 42 patients (35 male and 07 females) of myocardial infarction in age group 31-76 yrs were evaluated using cardiac MRI and cardiac nuclear perfusion scans and the results were compared. Pearson Chi-Square test and Fisher's Exact Test were used for statistical evaluation. P value <0.005 was considered statistically significant. Results: Both the techniques detected trans-mural myocardial infarcts at similar rates. However, cardiac MRI was able to detect sub-endocardial infarcts in 33% cases, which were totally missed on nuclear perfusion imaging. MRI was found to be more sensitive than nuclear perfusion scans for detecting sub-endocardial infarcts. The sensitivity of delayed hyper enhancement cardiac MRI for detection of viable myocardium was 100 % with a specificity of 47.83 %. The positive predictive value of the modality was 61.29 % with a diagnostic accuracy of 71.43 %. Conclusion: Contrast enhanced MRI was found to detect sub-endocardial infarcts at a higher rate and has high sensitivity in the detection of viable and irreversibly damaged myocardium in comparison to nuclear perfusion scans.