Background: Cranioplasty (CP) is a neurosurgical procedure performed after decompressive craniectomy using autologous bone graft or various artificial materials. Aim: To find differences in complications between patients who underwent CP using an autologous bone flap versus a titanium mesh as well as to identify significant risk factors for post-CP complications Study Design: Comparative cross-sectional study. Methodology: A total of 46 patients were included in this study, out of which 37 were males (80.4%) and 9 were females (19.6%). All patients underwent cranioplasty using titanium mesh or autologous bone graft. Results: Comparison of outcome between autologous graft and titanium implant was done. In 45.7% patients, autologous bone graft was used while titanium implant was used in 54.7%. 23.9% patients had developed different types of complications in both groups, out of which 81.9% were from autologous group and 18.1% belonged to titanium graft group. Surgical site infection was noted in 18.1% of patients (equally) in both groups. Craniopalsty infection was noted in 45.4% patients who underwent autologous graft. Hematoma was encountered in 2 patients; both with autologous bone graft and none in patients who had titanium mesh cranioplasty. Removal of autologous bone graft was done in one patient whileremoval was not done in the other arm of study. Bone resorption was seen in five patients, all of which had autologous bone graft. Learning curve is that this technique be followed by neurosurgeons for better outcome. Practical implicatio Titanium mesh cranioplasty is a technique to be followed by junior neurosurgeons for learning and good outcome, decrease duration of hospital stay and preservation of precious resources of hospital. Conclusion: Cranioplasty in which titanium mesh is used is superior to autologous bone grafting as it has lessercomplications. Keywords: Autologous graft, bone resorption, cranioplasty, hematoma, infection, titanium mesh.

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Purpose: To find the incidence of different causes of post cholecystectomy pain on magnetic resonance cholangiopancreatography.Methodology: This is a prospective study of 74 patients with post-operative complain of post-cholecystectomy symptoms. Their ages ranged from 20 to 70 years. Patients with liver transplant were not included. MRCP was performed on 1.5 tesla GE machine at radiology department of our hospital. MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of < 8mm was considered normal, whereas > or = 9mm was considered abnormal. Findings were correlated with LFTs and clinical findings.Results: Our results showed that 86.4%cases with post cholecystectomy pain had positive findings on MRCP. The commonest finding was biliary stones in 37.8 % cases. Post-cholecystectomy biliary complications included retained CBD stones in 28 patients (9 intrahepatic, 18 extra-hepatic and 1 in cystic duct stump), biliary duct injury in 4 patients (2 cases with biliary duct ligation and 2 cases with biliary leakage. Stricture was detected in distal CBD in 9, in CHD in 4 cases, at ampulla in 2, at hilum in 9 and in 9 at anastomotic site of choledochoeneterostomy site. In 10 of our cases, MRCP was negative for any finding. Conclusion:We conclude from our results that that 86.4%cases with post cholecystectomy pain had positive findings on MRCP and the most common cause of post cholecystectomy pain was biliary stones seen in 37.8%. The use of breath-hold 3D-SSFP MRCP is essential in evaluation of post-laparoscopic cholecystectomy biliary complications and in planning for management regimens.Recommendation: MRCP should be performed in patients with post cholecystectomy pain. If the CBD on ultrasound is > or = 10mm and no cause is identified, MRCP is necessary. However, the availability of LFTs raises the diagnostic value of imaging.

superior mesenteric and gastroduodenal arteries. Suspect ECS in large subcapsular tumors with exophytic growth, adjacent organ invasion, hypertrophied extrahepatic collaterals and marginal recurrence abutting the liver capsule after TACE or local ablation. During TACE, no or incomplete tumor blush on selective hepatic arterial run, or defect in lipiodol deposition in the mass suggest ECS. Search for ECS is mandatory if follow up imaging shows peripheral defect in lipiodol deposition or enhancing residual component of primary mass. An alternative treatment should be undertaken if TACE through ECS fails. Conclusion(s):ECS is common in HCC at initial presentation and increases with repeated TACE sessions. For achieving complete tumor response, active search for signs of ECS should be done before, during and after TACE.

Objectives: The purpose of our study was to find out the ideal 3D-MRCP acquisition plane among coronal and axial source datasets for bile duct assessment in patients with persistent post cholecystectomy pain. Methods: This was a cross sectional analytical study carried out in Radiology department of a teaching hospital from 1st January 2016 to 30 May 2017. 78 symptomatic patients for MRCP in the duration were included. Age range was 20 to 70 years and patients had persistent or recurrent post cholecystectomy symptoms like abdominal pain, vomiting or jaundice. Data was collected retrospectively from the hospital’s database so the need of informed consent was waivered off by permission from hospital’s ethical committee. MRCP was performed for all patients on 1.5 tesla GE MRI machine with breath-hold multi-slice acquisition using dedicated multichannel surface coils covering the abdomen. Both 2D and 3D MRCP were done. Coronal MIP was reconstructed based on each dataset. Data was analyzed using Microsoft excel and SPSS version 22. Results were compared for the ideal 3D plane to assess pancreatic and biliary ducts. Results: The encountered post cholecystectomy biliary findings were strictures (48%), retained biliary stones (35.8%), which were located either intrahepatic or extra-hepatic, most commonly in distal CBD causing obstructive jaundice and rest of the patients had either cholangiocarcinoma at hilum, pancreatitis or post op complications like complete bile duct transaction, bile duct ligation etc. The most common finding was biliary stricture. CHD and proximal CBD were better assessed for presence of strictures and stones on 3D coronal (P value <0.05) as compared to the axial images. Peri-ampullary, distal CBD, intrahepatic and hilar confluence duct strictures were better visualized on 3D axial (P value <0.05). 3D axial was also better than coronal raw data sets regarding visualization of calculi in distal CBD, intrahepatic biliary ducts, GB remnant, cystic duct and hilar biliary confluence. 3D coronal was better for post op ligature whereas 3D axial was more helpful deciding the level of duct injury and to assess the site of biliary leakage. Conclusion: The results of our study suggest that 3D axial primary dataset of MRCP is preferable for visualization and evaluation of distal CBD, ampulla and hilar confluence whereas for overall evaluation of bile ducts status, coronal reconstructions with MIP are preferred. Most common finding in our study was biliary strictures.