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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: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with Fine Needle Aspiration Cytology (FNAC)/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The Chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects (median age of 40.5±18.71 years; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, Short:Long axis diameter ratio (S:L) ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

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.

Introduction: The involvement of the blood vessels around the pancreas in pancreatitis may result in devastating complications. The proteolytic enzymes secreted by the inflamed pancreas can directly erode the walls of arteries in and around the pancreas, resulting in haemorrhage or pseudoaneurysms formation. On the other hand, the inflamed tissue may compress or thrombose adjoining veins. Multidetector Computed Tomography (MDCT) serves as an excellent tool for diagnosis and evaluation of complications of pancreatitis and can detect most vascular complications. Aim: To evaluate the MDCT findings of vascular complications associated with pancreatitis. Materials and Methods: This cross-sectional study was conducted on 60 patients at the Department of Radiology in the Tertiary Care Hospital attached to Mysore Medical College and Research Institute, Mysore, India for 12 months from 1st August 2019 to 31st July 2020. Each patient was subjected to unenhanced and contrast-enhanced CT to characterise the vascular complications associated with pancreatitis. The results were tabulated and evaluated descriptively by Microsoft excel 2016 and presented in figures and tables. Results: Of the 60 patients included, Splenic Vein Thrombosis (SVT) was seen in 39 (65%), followed by Portal Vein (PV) thrombosis in 17 (28.3%), Superior Mesenteric Vein (SMV) thrombosis in 14 (23.3%), all the three vein thrombosis was seen in 7 (11.6%) and arterial pseudoaneurysms was seen in 3 (5%). Conclusion: Vascular complications in pancreatitis are not uncommon but should be evaluated in all cases of pancreatitis. Contrast-enhanced CT is the main imaging modality for originally identifying local complications. SVT is one of the most frequently found vascular complications seen in patients of pancreatitis.

Introduction: Acute inflammation process of the pancreas with or without involvement of surrounding tissues and remote organ systems is termed as Acute Pancreatitis (AP). Contrast Enhanced Computed Tomography (CECT) if performed immediately may underestimate the severity. Therefore, ultrasound examination remains the first imaging diagnostic method in suspected cases of AP. The sensitivity of B-mode sonography for the early diagnosis of AP can be increased by the detection of an increase in pancreatic tissue stiffness with Shear Wave Elastography (SWE). Aim: To evaluate the efficacy of SWE in the analysis of AP. Materials and Methods: A cross-sectional study was conducted in Tertiary Care Hospital attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from August 2019 to September 2019. The pancreatic parenchyma of 30 patients with symptoms of AP that included acute onset of severe central epigastric pain, poorly localised tenderness and pain increased by supine positioning radiating to the back. The study also included 40 healthy, asymptomatic volunteer who were examined using B-mode sonography and SWE. Computed Tomography (CT) was performed in all patients with AP with a SEIMENS SOMATOM DEFINITION EDGE 128 slice CT scanner. Elastographic measurements were performed and quantitative SWE values represented in kilopascal (kPa) of the patients and asymptomatic volunteers group were compared. Patients’ amylase and lipase levels were done by biochemical tests. Descriptive and Inferential statistical analysis was carried out in the present study. Student’s t-test (two tailed, independent), Leven’s test for homogeneity of variance and Chi-square test was used to find the significance of study parameters. Results: The mean SWE values for the asymptomatic volunteers with normal pancreatic parenchyma were 9.53±2.62 kPa. The mean SWE values for the pancreatic parenchyma of the patients with AP were 17.23±6.24 kPa. The mean SWE value for the patients with AP was significantly higher than the value for the control group (p

Introduction: Glenoid Dysplasia (GD) also known as posterior glenoid rim deficiency is generally known to be asymptomatic with its incidence being greatly underestimated. Atraumatic pain is the predominant symptom in 21% of subjects with GD. GD has been associated with posterior labral tear and is generally thought to predispose to shoulder instability and consequentially to accelerate degenerative joint disease. Aim: To determine the incidence of GD, the type and extent of GD and to study its association with posterior labral tears on Magnetic Resonance Imaging (MRI). Materials and Methods: A retrospective observational study was done on 98 consecutive MRI shoulder studies obtained over a period of six months from January 2020 to June 2020 in the Department of Radiodiagnosis of Mysore Medical College and Research Institute. Those subjects with fractures, arthritic changes or mass lesions involving the glenoid process were excluded. The postero-inferior glenoid was evaluated for dysplasia on axial T1- Weighted, T2-Weighted and Proton Density with Fat Saturation (PDFS) images (slice thickness, 3-4 mm). Subjects were divided into four categories: Normal, Mild, Moderate, and Severe GD. Once the acquired images were reviewed and assigned in to the above mentioned four categories based on severity of dysplasia, they were further assigned into three categories defining the type of glenoid into three categories: normal curved lazy J and triangular bony deficiency or the Delta type. The caudal most axial scan image which depicted the articular cartilage of the glenoid was taken as the reference image. The Statistical software SPSS version 22.0, and (Robert and Ross) environment ver. 3.2.2 were used for the analysis of the data. Results: In present study of 98 consecutive MRI shoulders, six were rejected due to factor such as poor image quality, infective arthritis and trauma. Of the remaining 92 subjects (75 males and 17 females, mean age 36.73±12.50 years), 54 (58.69%) had a normal glenoid fossa, 25 (27.17%) had mild dysplasia and 13 (14.13%) had moderate dysplasia. We did not have any subjects with severe dysplasia. Of the total 38 cases of GD, 21 (55.26%) cases were of the lazy J variant while 17 (44.73%) cases were of the delta type variant. Among the 38 cases of total dysplasias, 25 cases were of mild GD of which 17 (68%) were of the lazy J variant, while 8 (32%) belonged to the delta variant. Out of the remaining 13 cases of moderate GD, 4 (30.76%) belonged to the lazy J category while the remaining 9 (69.23%) belonged to the delta variant. The difference in incidence of posterior labral tears between the normal (0) and combined mild and moderate dysplasia groups (41.3%) was statistically significant (p

Introduction: Determination of gestational age is important in obstetrics for management of pregnancy and evaluation of foetal development. An error in the gestational age estimation results in prematurity and post maturity and, if expected date of delivery is not known, higher perinatal mortality is the obvious outcome. Aim: To evaluate accuracy of transcerebellar diameter in gestational age estimation, to determine the ratio between transcerebellar diameter and abdominal circumference as a gestational age independent parameter, and to study the change in ultrasonographic appearance of the foetal cerebellum with advancing gestation and its grading. Materials and Methods: In 100 normal singleton pregnant women between 15 to 37 weeks of gestation, Biparietal Diameter (BPD), Head Circumference (HC), Abdominal circumference (AC) and Femur Length (FL) and Transcerebellar Diameter (TCD) were measured for assessing the sonological gestational age. TCD/AC ratio was also calculated and simultaneously, the ultrasonographic appearance of the foetal cerebella with advancing gestation were noted and grouped into three grades. Results: In the present study, statistically significant linear relationship between TCD and gestational age in normal pregnancies was noted. TCD measured in millimeters was almost equal to gestational age up to 23 weeks. The TCD/AC ratio remained fairly constant throughout gestational age with a mean ± SD of 13.76 ± 0.77. As with advancing gestation, foetal cerebellum showed a gradual change in US appearance of the progressing from Grade I to Grade III. Conclusion: Correlation and regression analysis indicated a good correlation of TCD with gestational age and other. Hence, TCD can be used as a single growth parameter to predict the gestational age in cases where LMP (Last Menstrual Period) is uncertain. TCD/AC ratio can be used as a good tool to diagnose asymmetric Intra Uterine Growth Retardation (IUGR) in those with ratio exceeding 2 SDs as it is gestational age independent factor which remained fairly constant throughout gestation. We observed a gradual and progressive change in ultrasound appearance of foetal cerebellum from Grade 1 to Grade 3 with advancing gestation.

Groove pancreatitis is an uncommon form of chronic pancreatitis affecting the "groove" between the pancreatic head, duodenum and common bile duct. Many radiologists remain unfamiliar with this entity, with only a few descriptions of it existing in the radiology and pathology literature. The exact underlying cause of groove pancreatitis is unclear, although there are strong associations with peptic ulcer disease, smoking, long-term alcohol abuse, functional obstruction of the duct of Santorini and Brunner gland hyperplasia. This entity mimics pancreatic carcinoma and often ultimately leads to surgery. Hence it is important for radiologists to be familiar with imaging findings of groove pancreatitis to avoid diagnostic dilemma. Imaging findings in our case showed a soft tissue mass in the pancreaticoduodenal groove with enhancement, consistent with scar tissue and cystic changes within the lesion. It was associated with adjacent duodenal wall thickening with smooth and regular tapering of the pancreatic and common bile ducts.