Background. Concomitant vascular injury might adversely impact outcomes after iatrogenic bile duct injury (IBDI). Whether a new HPB center should embark upon repair of complex biliary injuries with associated vascular injuries during learning curve is unknown. The objective of this study was to determine outcome of surgical management of IBDI with and without vascular injuries in a new HPB center during its learning curve. Methods. We retrospectively reviewed patients who underwent surgical management of IBDI at our center. A total of 39 patients were included. Patients without (Group 1) and with vascular injuries (Group 2) were compared. Outcome was defined as 90-day morbidity and mortality. Results. Median age was 39 (20–80) years. There were 10 (25.6%) vascular injuries. E2 injuries were associated significantly with high frequency of vascular injuries (66% versus 15.1%) (P = 0.01). Right hepatectomy was performed in three patients. Out of these, two had a right hepatic duct stricture and one patient had combined right arterial and portal venous injury. The number of patients who developed postoperative complications was not significantly different between the two groups (11.1% versus 23.4%) (P = 0.6). Conclusion. Learning curve is not a negative prognostic variable in the surgical management of iatrogenic vasculobiliary injuries after cholecystectomy.

Objective: To investigate the variations in normal Doppler indices of the portal vein during the post-operative period following living donor liver transplantation (LDLT). Methodology: This retrospective cohort study was carried out at Pakistan Kidney and Liver Institute and Research Centre from July 1 to December 31 2021. It included all adult patients over 16 years of age who underwent Living Donor Liver Transplant (LDLT). Triplex Doppler ultrasound of LDLT recipients was performed intraoperatively and postoperatively for 5 consecutive days. Subsequent scans were performed at 2 weeks, 4 months, and 6 months after the transplant. Portal vein velocities were taken at the extrahepatic part, anastomosis, and intrahepatic part. Statistical analysis was performed using SPSS version 20. Results: The study involved 91 patients, with ages ranging from 17 to 73 years and a mean age of 44.9 years. Among the recipients, 79% were male and 21% were female. The portal venous velocities varied between 31 cm/s and 357 cm/s. All patients had antegrade portal venous flow. The portal venous velocities normalized within 4-6 months following LDLT. Conclusion: A wide range of portal venous velocities can be encountered following LDLT without clinically significant outcome and these usually normalize within 4-6 months following LDLT.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant. Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD). Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver. Results: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%). Conclusion: In patients with NAFLD, segments VII and VIII show the greatest while segments I and IV show the least fat infiltration. Hepatic fat preferentially gets deposited more in the right lobe of the liver.

Aim: To assess the effect of respiratory maneuvers on hepatic vein waveforms and flow velocity in patients without liver or cardiac disease. Methods: This prospective cross-sectional study was conducted in the Radiology Department of Pakistan Kidney and Liver Institute and Research Center, Lahore (PKLI & RC) after approval from Institutional Review Board (IRB). The sample size of 70 patients was selected using the WHO sample size calculator, after applying the inclusion and exclusion criteria. Doppler waveforms and maximum velocities (Vmax) of the middle hepatic vein were recorded during normal respiration, after quiet expiration, and following breath-hold after deep inspiration. The waveforms were classified as triphasic, biphasic, or monophasic. Results: The maximum velocities (Vmax) during normal respiration, after quiet expiration, and following deep inspiration were 26.67±9.41, 24.08±6.77 and 19.31±.61 respectively. During normal breathing, the middle hepatic vein waveforms were triphasic, biphasic and monophasic in 80%, 6%, and 14% of the patients respectively. After quiet expiration, these percentages were 82%, 4% & 14% respectively and following breath-hold after deep inspiration, these percentages were 41%, 14% and 45%, respectively (p<0.05). Conclusion: The hepatic venous velocities were lower after deep inspiration. Their waveforms showed significant change from triphasic pattern to monophasic pattern following deep inspiration. Therefore, the respiratory variations must be considered during hepatic vein Doppler ultrasound assessment. Keywords MeSH: Hepatic veins, velocities, waveforms, inspiration, expiration.

Aim: Diagnostic accuracy of DW-MRI in diagnosing brain abscess taking histopathology as gold standard. Methodology: A total of 407 patients having focal brain lesion on MRI of age 20-50 years of either gender were included. Patients with history of brain surgery, already established diagnosis on histopathology, claustrophobia and pregnant or breast feeding females were excluded. DW-MRI was done and conventional MRI sequences on 1.5 tesla MRI machine and presence or absence of brain abscess was noted. DW-MRI findings were correlated with histopathology. Results: Mean age was 38.53 ± 7.59 years. Out of these 407 patients, 262 (64.37%) were male and 145 (35.63%) were females with ratio of 1.8:1. Mean duration of disease was 4.87 ± 2.40 months. Mean size of lesion was 7.69 ± 4.52 mm. In DW-MRI positive patients, 221 were true positive and 32 were false positive. Among 154, DW-MRI negative patients, 18 were false negative whereas 136 were true negative (P-value=0.01). So in diagnosis of abscess in brain, sensitivity, specificity, PPV, NPV and DA of DW-MRI was 92.5%, 80.96%, 87.4%, 88.3% and 87.7% respectively. Conclusion: DW-MRI is the non-invasive modality of choice having high diagnostic accuracy (DA) i.. 87.7% in diagnosing brain abscess with sensitivity of 92.5% and specificity of 80.96%. Keywords: Brain abscess, diffusion weighted imaging, sensitivity.