Search

Introduction: Urolithiasis is a commonly encountered health problem, and knowledge of the chemical composition of stones is crucial in deciding the management approach and preventing recurrence. Pre-operative assessment of stone composition has become possible after the introduction of Dual-Energy Computed Tomography (DECT). Aim: To compare the accuracy of DECT with biochemical analysis of postoperative stone samples. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, Karnataka, India, between January 2020 to June 2021 on 35 patients who met the inclusion and exclusion criteria. All the patients underwent a non contrast DECT scan of the Kidneys, Ureters and Bladder (KUB) on a 128-slice twin beam single-source DECT scanner. The stone composition was determined using pre-programmed software and was correlated with biochemical analysis. Proportions were compared using chi-square test of significance. The sensitivity and specificity of DECT was determined. Results: Amongst the total 35 patients (mean age of 45.7±14.89 years, 23 patients males and 12 patients females) and 36 calculi analysed, The most frequently encountered calculus in the urinary tract was calcium oxalate n=24 (66.7%). The second most common calculus was Uric Acid (UA) n=5 (13.9%). The DECT findings regarding chemical composition of calculus were confirmed by Fourier Transformation Infrared Spectroscopy (FTIRS). The mean Dual-Energy (DE) ratio for oxalate, UA, hydroxyapatite, cystine and mixed stones was found to be 1.18, 1.01, 1.39, 1.09 and 1.11, respectively. DECT was found to be highly sensitive and specific in the diagnosis of calculi composition based on their DE ratio. It was found to be 95.8% sensitive and 100% specific for differentiating calcium oxalate stones from non oxalate stones and 100% sensitive and 96.8% specific for differentiating UA stones from non UA stones. Conclusion: DECT has high diagnostic accuracy in the pre- operative determination of urinary calculus composition which will guide in management, as UA stones are open to medical therapy while most of the non UA stones need surgical intervention.

Introduction: Intestinal obstruction is a common surgical emergency that is encountered in general surgery units and it contributes to substantial patient morbidity and healthcare costs. Computed Tomography (CT) has emerged as an invaluable diagnostic tool in the evaluation of bowel obstruction and helps in deciding early surgery. The CT gives information on the cause for obstruction, its location, and complications like closed loop obstruction, bowel ischaemia. Aim: 1. To evaluate the accuracy of CT in diagnosing the presence, level and cause of intestinal obstruction. 2. To detect the presence of complications and demonstrate threatening signs of bowel non-viability. 3. To relate CT findings with intraoperative findings. Materials and Methods: A prospective cohort study was done at the Department of Radiology, Mysore Medical College and Research Institute, Mysore, India from April 2021 to September 2021. A total of 40 patients, ≥18 years of age with clinical suspicion of intestinal obstruction, were subjected to Contrast- Enhanced Computed Tomography (CECT) of the abdomen. The sensitivity , specificity, positive and negative predictive values of Muti-detector Computed Tomography (MDCT) were calculated. Data analysis was carried out using Statistical Package for Social Science (SPSS) version 18.5 software. Results: Total of 40 patients were analysed (25 males and 15 females ; mean age: 50.5 years). Small bowel obstruction constituted 75% of cases and large bowel obstruction constituted 25% of the cases. Ileum was the most common site of obstruction. Adhesions were the leading cause seen. Closed loop obstruction with bowel ischaemia and gangrene were observed in five patients (12.5%). Comparison of CT and per-operative findings showed that CT has a high sensitivity, specificity, accuracy of 97.44%, 100%, 97.50%; 92.31%, 100%, 92.50% and 100%, 94.12%, 95%, respectively for determining the level, cause and complications of obstruction. Conclusion: The MDCT has high diagnostic accuracy in diagnosing the level, cause and complications of intestinal obstruction with the highest of 97.50% for identifying the cause of obstruction. CT is 100% sensitive in picking up complications like bowel ischemia. Thus, MDCT were in concordance with intra operative findings for the diagnosis of intestinal obstruction and can guide surgeons in the management of these patients.