This study aimed to evaluate the diagnostic performance of different imaging techniques for preoperative detection of pelvic fistula. Imaging and classification of female genital abnormalities considerably pelvic floor fistulas are significant. We conducted a systematic review of the available literature to highlight the effectiveness of different radiological imaging techniques (X-RAY,U/S,CT,MRI) for the diagnosis of different types of pelvic fistulas to see the limitations of conventional scanning and testing over modern imaging techniques and to show the effectiveness of choosing one imaging modality over other depending upon multiple dynamics e.g., site and types of fistula. The controlled and regular research cases (n= 9) available in English from 2011 to 2020 were included in criteria of research. The evidence databases were used for assessment of certain studies analytically by way of PEDro scale and explicated under decision guidelines. In all relevant articles were identified and included in this systematic review. The radiological techniques showed improved diagnostic performance that established the effectiveness of imaging advancement for administration and treatment of pelvic fistula. Conventional methods have less sensitivity and specificity as compared to modern techniques. X-RAY fistulography and ultrasonography has less sensitivity and specifity as compared to CT scan but still found beneficial in the diagnosis of colovaginal, uterovesical fistula and considered as the most basic clue about the existence of a malignant fistula respectively.it is verified that MDCT is the safer accurate and offered more detailed defects in diagnosis of urogenital, urethrorectal, lower urogenital tract fistulas, upper and middle vaginal fistulas colovesical fistulas(along with X-RAY) and prostate symphyseal fistula(along with MRI).It has been concluded that MRI can access colovesical fistulas inherited vaginal fistulas and prostate symphyseal fistulas(along with CT) more efficiently. It has been concluded that diagnostic imaging for all pelvic fistula is useful, to help the physicians, particularly radiologists, in diagnosis of pelvic fistulas. The choice of imaging technique is dependent upon multiple factors. Advanced medical imaging techniques XRAY,MDCT MRI) are considered more recommended choices as compared to conventional imaging.
Meniscal tears are mostly seen worldwide. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. MRI can be referred as the non-invasive gold standard investigation to help establishing diagnosis of meniscal tears, but it economically unaffordable to most of patients and needs long examination times. Ultrasound is a possible alternative to MRI. It is simple, convenient and an inexpensive and non-invasive method. The use of ultrasound in identifying meniscal tears has been proposed, but its diagnostic accuracy remains controversial. The objective of the research is to define the diagnostic accurateness of ultrasound scan in detecting meniscal tears taking magnetic resonance imaging as gold standard. It was a diagnostic cross-sectional study in which 78 patients visiting Department of Diagnostic Radiology, Doctors Hospital, Lahore were included. Convenient sampling technique was used. Written informed consent was taken from all the patients. Patients were investigated with the help of ultrasound and results were noted on the designed proforma, subsequently the results were compared to the MRI scan of the knee joint. Data was entered and statistically analyzed using SPSS 21.0. Frequency tables were generated for all variables. For quantitative data like age mean and standard deviation were calculated and for qualitative data like sex and meniscal tears percentages were calculated. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value was given. Bar and pie charts were used to present categorical data. Kappa analysis was utilized. The mean age of the patients was 38.18+12.818 years, 82.1% were males and 47.4% had sports trauma. Out of 48 medial meniscus tear on USG, 38(48.7%) were true positive and 10(12.8%) were false positive on MRI. Out of 10 lateral meniscus tear on USG, 9(11.5%) were true positive and 1(1.3%) was false positive on MRI. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of ultrasound for medial meniscus tears were 95.00%, 73.68%, 79.16%, 93.33% and 84.61% while for lateral meniscus tears were 75.00%, 98.48%, 90.00%, 95.58% and 94.87%, respectively. Study concluded that ultrasound has good diagnostic accuracy when compared with magnetic resonance imaging in detecting meniscal tears.
The Cesarean section (CS) delivery is a most frequent surgical technique worldwide. The CS increasing rate and its related problems have drawn an attention towards CS related morbidity. As recommended by WHO, C-section could be carried out only when required medically. In mid-pregnancy cervical extended length predicts the probability of CS early in the pregnancy. The objective of the study is to find the predictive accuracy of cervical length (CL) on transabdominal ultrasound for cesarean section in mid trimester taking mode of delivery as gold standard. It was a cross sectional study in which 362 females were enrolled. Females were undergoing transabdominal ultrasonography for assessment of cervical length. A 2x2 contingency table was generated to calculate sensitivity, specificity, positive predictive valve (PPV), negative predictive value (NPV) and diagnostic accuracy of transabdominal ultrasound taking actual mode of delivery as gold standard. The mean age of the females was 27.92 + 5.75 years while mean parity and mean CL were 2.22 + 1.30 and 35.83 + 7.96 mm, respectively. Among 30 females who had cervical length <25 mm, 24 had CS and 6 had spontaneous vaginal delivery (SVD). Among 332 females who had cervical length >25 mm, 96 had CS and 236 had SVD. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of transabdominal ultrasound for cesarean section were 20.0%, 97.5%, 80.0%, 71.1% and 71.8%, respectively. Study concluded that cesarean section takes place among pregnant females when cervical length is ≤25mm on transabdominal ultrasound during mid trimester.
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