PurposeTo determine the role of duplex Doppler ultrasonography (DDU) in patients with acute unilateral renal obstruction.Subjects and methodsA total of 161 patients with suspected renal colic due to urolithiasis were evaluated by DDU followed by intravenous urography (IVU). The mean intra-arterial resistive index (RI) and the difference of mean resistive index between both kidneys (delta RI) were determined for each person. An RI value of ≥0.70 and a delta RI value of ≥0.06 were taken as the discriminatory threshold for obstruction. IVU results were considered the “ reference standard” against which renal DDU findings were compared.ResultsIVU showed both kidneys to be normal in 51 patients and with unilateral ureteric obstruction in 110 patients. The mean RI for obstructed kidneys was 0.67 (0.048), which was significantly higher (P-value <0.05) than a mean RI of contralateral normal kidneys 0.59 (0.04). The mean delta RI in patients with unilateral ureteric obstruction was significantly higher than that in patients with normal kidneys, at 0.076 (0.03) and 0.03 (0.05), respectively. In patients with complete obstruction, sensitivity of RI and delta RI were 77.5% and 92.5% with a specificity of 84.3% and 90.1%, respectively. In patients with partial obstruction, the sensitivity of these values was 22.8% and 62.8% with a specificity of 84.3% and 90.1%.ConclusionDelta RI is more sensitive and specific than RI in acute renal obstruction. However, due to relatively low sensitivity for detection of partial obstruction, DDU cannot replace IVU as the standard imaging technique.

Background: Magnetic Resonance Imaging (MRI) plays a vital role in diagnosing prostatic cancer routinely done before biopsy for the lesion's extent and defining the correct path for ultrasound-guided prostate biopsy.  Diffusion-Weighted Imaging (DWI) is a non-invasive MRI sequence that shows improved sensitivity and specificity in the same setting with no additional cost. The study aims to evaluate the diagnostic accuracy of DWI in the detection of prostatic cancer. Methodology: A cross-sectional study was conducted at the radiology department of Dr. Ziauddin University Hospital between 15/ 04 /2016 to 15/ 4 /2017. A total of 201 patients who were clinically suspected of having prostatic tumors were in this study's inclusion criteria. MRI, including DWI, was done. The final diagnosis was based on an analysis of the histopathology report. Results: Out of 201 males with clinical suspicious of prostatic cancer, 160 were diagnosed with prostatic cancer on histopathology. Of these, 150 were positive on DWI. The sensitivity of diffusion-weighted MRI was found to be 93.7%, 75.60% specificity, and 90.0% diagnostic accuracy (DA) for the diagnosis of prostatic cancer. Conclusion: Diffusion-weighted sequence in MRI examination has a vital role in diagnosing prostatic cancer and should be considered a routine pre-biopsy investigation along with MRI in clinically suspected cases of prostate cancer.

Background: Lateral X-ray of the cervical spine (LCSX) is a common diagnostic tool to detect fractures in hospitalized patients. Its non-invasive nature and cost-effectiveness make it a preferred imaging technique for rapid identification of cervical spine fractures. However, its diagnostic accuracy is still a subject of debate and further research is needed to establish its reliability and validity. This study aimed to determine the diagnostic accuracy of LCSX in detecting fractures in hospitalized patients, using multi-detector computed tomography (MDCT) as the gold standard. Methodology: This cross-sectional retrospective study was conducted at a tertiary care hospital in Karachi. The study included 431 male and female patients aged between 18 to 60 years referred by the primary medical team to the Radiology Department for both LCSX and MDCT to detect cervical spine fractures. Patients with known cases of cervical spine fractures determined by history, examination, and previous radiological modalities like LCSX, MDCT, or MRI at the time of imaging were included. Results: LCSX identified 63 cases (14.6%) as having cervical spine fractures, while 368 cases (85.3%) were reported as not having cervical spine fractures. However, on MDCT, 116 cases (26.9%) out of the 431 cases were found to have cervical spine fractures, while 315 cases (73.08%) were reported as not having cervical spine fractures. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of LCSX were calculated. The sensitivity of LCSX was found to be 58.35%, specificity was 100%, positive predictive value was 100%, negative predictive value was 85.59%, and diagnostic accuracy was 87.70%. Conclusion: LCSX has low sensitivity as a diagnostic tool in detecting cervical spine fractures in trauma patients, resulting in missed diagnoses of critical cervical spine fractures and compromised patient care, which can lead to increased morbidity and mortality.

Objective: To determine the diagnostic accuracy of magnetic resonance spectroscopy(MRS) in detection of prostatic cancer in patients with prostatomegaly and elevated PSA levels, taking biopsy as gold standard. Study Design: Cross sectional study. Duration and place of study: Department of Diagnostic Radiology, Dr. Zia Uddin University Hospital, Karachi from February 1 to August 31,2020. Methods: High risk patients for prostatic carcinoma and patients meeting inclusion criteria were referred to the radiology department of Dr, Zia Uddin hospital for MRI pelvis. Purpose and procedure of study were explained after taking an informed consent. All examinations were performed and the collected data on MR spectroscopic imaging protocol (spectra and associated metabolic ratios) was more pronounced than conventional spin echo sequences. Choline peak elevation and choline-creatinine ratios > 2 in a suspected area as compared to adjacent normal prostatic tissue was labelled as prostate cancer. This information along with the age, duration of symptoms, patient’s educational status, and weight of patient and size of lesion were collected. Results: The specificity sensitivity, positive and negative predictive value and accuracy of MRS for diagnosis of Prostate cancer was 85.40%, 78.84%, 69.64%, 90.48% and 81.22%, respectively. Conclusion: The combined effectiveness of conventional MR images along with metabolic data of MRSI will help to enhance and make presumptive diagnosis of prostate carcinoma. The implementation and standardization of MRS will definitely help in future to diagnose disease in very early stage, thus reducing the chance of morbidity and mortality to a certain level.