Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard. Results: Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%. Conclusions: MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas. doi: https://doi.org/10.12669/pjms.37.1.2489 How to cite this:Munir S, Khan SA, Hanif H, Khan M. Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas. Pak J Med Sci. 2021;37(1):125-130. doi: https://doi.org/10.12669/pjms.37.1.2489 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An ectopic pregnancy (EP) is a condition in which a fertilised ovum implants in a location other than normal endometrial cavity. It is diagnosed by estimation serum beta-HCG level and transvaginal ultrasonography. Despite being a common condition, the complex radiologic appearance of ruptured EP has rarely been described in the literature. We share a unique case of ruptured EP on MR imaging.A 25-year female, P0 G1, presented to Gynaecology/ Obstetrics Department with 2-month amenorrhea and lower abdominal pain. The investogram specifically showed serum -HCG levels within normal limits (42.89 mIU/ml). Ultra-sonography showed a large pelvic indeterminate mass with normal uterus. Doppler study showed no significant flow, which was inconclusive for EP. CT scan showed a complex, heterogeneous, iso-to hyper-dense, solid / cystic, minimally enhancing, mass in the cul-de-sac involving bilateral adnexa. Foci of calcifications were noted within it. The MRI examination of the pelvis revealed a large 11x9x11 cm in APxTRxCC, thick walled T1, T2 hyper-intense complex haemorrhagic mass with fluid-fluid levels and post-contrast rim enhancement. Normal ovaries were seen (Figure 1). No free fluid in the pelvis was seen. At this point, we raised the differentials of haematosalpinx, tubo-ovarian complex, and tubal endometriosis. The patient was vitally stable, so proceeded to salpingectomy; and the sample was sent for histopathology, which showed wall of fallopian tube distended by blood and fibrin with few hyalinised chorionic villi; compatible with ruptured ectopic tubal gestation. We did retro-spective analysis of MRI, which showed fallopian tube defect at left adnexa (Figure 2). It was hypothesised that hematoma in the pelvis was walled off by thick wall and did not lead to hemoperitoneum/free fluid. The patient underwent normal postoperative recovery and survived.