Introduction: Stroke is life threatening & debilitating neurological disease, defined as focal neurological deficit of sudden onset lasting >24 hours & vascular in origin. Significant association between ischemic type of stroke with carotid artery disease seen, more prevalent with carotid artery stenosis.  Objectives: This study was done to show association between extracranial carotid artery disease & cerebrovascular accidents (CVAs) with the help of Color Doppler Sonography (CDS). The association between carotid artery disease with associated risk factors were also assessed.  Methodology: In this ethically approved prospective study, carotid CDS was done in 79 consecutive patients with diagnosis of acute ischemic stroke (AIS). The various parameters studied included peak systolic velocity (PSV) of internal carotid artery (ICA) & common carotid artery (CCA), ICA/CCA PSV ratio & plaque characteristics. The data collected was analyzed with appropriate statistical test of significance was calculated.  Results: Total 79 patients with AIS included out of which 53 were males & 26 were females. The most common presenting complains were hemiparesis (30.4%) & most commonly associated risk factors included hypertension (62.02%). Right sided strokes were most common (44.3%) & middle cerebral artery was most commonly involved vascular territory. Significant stenosis (≥50%) of carotid artery was seen in 27 patients with ICA most common site (45.8%) for plaque formation. Bilateral carotid artery involvement (52.1%) with hypoechoic echotexture of atheromatous plaques (46.6%) was most responsible for significant stenosis & increased intima media thickness. Increased value of PSV & EDV was seen in the stenotic area in the proportion of stenosis with increased PSV ICA/CCA ratio of more than three indicates >60% stenosis.  Conclusion: The present study showed well documented role of carotid doppler in detection of site & extent of carotid artery stenosis due to atheromatous plaques of various characteristics playing critical role in thromboembolic phenomenon responsible for development of stroke.

Introduction: Facet joint arthropathy is one of the myriad of abnormalities for low back pain and since conventional Magnetic resonance Imaging detects the facet joint pathologies poorly when compared to fat suppressed MRI sequences, fat suppressed MRI promises to be contributory to proper diagnosis and management. Objective: The objective of this study was to find the prevalence of lumbar facet joint arthrosis among patients with low back pain and comparing conventional versus fat saturated sequence in detecting the MRI findings of facet joint arthrosis. Methodology: A cross sectional study was conducted at the Department of Radiodiagnosis and Department of Orthopedics at Birat Medical College Teaching Hospital from February 15, 2020 to May 15, 2020. Ethical clearance was taken and 100 participants having low back pain were enrolled for Magnetic Resonance imaging after informed consent. Data were Results: 57% study participants were found to have facet joint arthrosis (FJA) in their lumbar spine and on comparing the detection rate of the grades of arthrosis between the conventional and FS MRI, the difference in diagnosis of grade 2 and grade 3 changes of FJA were 87.9% and 42.9% respectively whereas no difference was found in diagnosing grade 4 changes in both the sequences. Data was entered in MS excel and analysed by SPSS. Conclusion: This study showed that facet joint arthrosis is frequently seen in the patients presenting with low back pain and these changes are better diagnosed by fat saturated MRI sequence as compared to conventional sequence.

Introduction: Ultrasound (USG) is the most commonly used imaging method to evaluate thyroid nodules. The sonographic features of thyroid nodules are very important to determine whether the nodule is benign or malignant. Fine Needle Aspiration Cytology (FNAC) is the gold standard to determine whether the nodule is benign or malignant. Objective: The purpose of this study was to compare ultrasound and color Doppler features of thyroid nodules with ultrasound-guided FNAC results to determine the relative importance of these features in predicting the risk of malignancy. Methodology: This prospective cross-sectional study was conducted in Birat medical college teaching hospital in Tankisinuwari, Morang, Nepal. The study was conducted from September 2019 to April 2021.  In total sixty-one patients with thyroid nodules were evaluated for sonographic characteristics. Finally, USG guided FNA for cytopathological examination was performed. Both descriptive and inferential statistics were used to analyze the result. Results: Out of the 61 patients, 34 (55.7%) were females and 27 (44.2%) were males. Majority of the malignant nodules were solid 11 (91.6%), whereas cystic and mixed nodules were predominantly seen in benign nodules 18 (36.7%) and 30 (61.2%) respectively. In malignant nodules 10 (83.3%) were heterogeneous and 2 (16.6%) were isoechoic. In benign nodules 29 (59.1%) were heterogeneous and 15 (30.6%) were anechoic with comet-tail artifact and 5 (10.2%) were isoechoic. Among 12 malignant cases, internal and peripheral vascularity were equally present in six cases each. Benign nodules showed peripheral vascularity in 48 (97.9%) and internal vascularity was noted in only one nodule. All of the malignant nodules showed calcification. None of the benign nodules showed micro-calcification. In malignant cases, cervical lymph nodes were present in 7 (58.3%) and absent in 5 (41.6%). In benign cases, cervical lymph nodes were present in 4 (8.1%) and absent in 45 (91.83%). Conclusion: The ultrasound features associated with malignancy in thyroid nodules are predominantly solid component, presence of micro-calcifications and internal vascularity. Enlarged cervical lymph nodes are good predictors for malignancy. USG guided FNAC confirms the suspicious features of thyroid nodules seen on USG.

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions. Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury. Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated. Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05). Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male.

Introduction: Ultrasound is a safe, highly cost effective and non-invasive imaging technique without any absolute contraindication. It is also one of the most useful investigations in all medical specialities worldwide. The trend of use of ultrasound in the diagnosis and management of various musculoskeletal disorders (MSD) is tremendously rising in orthopedics practice in Nepal over the last few years. Objectives: The study was conducted to fulfill the existing lacunae in medical literature about use and benefits of ultrasound in context of Nepal. The objective of the study was to assess the effectiveness of ultrasound in the diagnosis of MSD among patients attending orthopedic department. Methodology: All the consecutive patients who visited department of orthopedics and received the diagnosis of MSD and had undergone ultrasonography from February 2017 to February 2019 were included in the study. The effectiveness of ultrasound was evaluated by assessing the correlation between clinical and ultrasound based diagnosis. Results: Out of 420 patients, majorities were female (55%). Out of 6 different anatomical sites identified, maximum patients had problem around wrist and hand (31%) followed by ankle and foot (22.9%). Similarly the most common diagnosis was related to tendon pathology including tendonitis, tenosynovitis and tendinopathy (31.9%). There was statistically significant correlation between ultrasound and clinical diagnosis with P value <0.01. Conclusion: Overuse tendon injury are common pathology around wrist and ankle that can be diagnosed by ultrasound along with many other MSD. The use of ultrasound is gradually widening in scope but has to be performed by the expert to improve the diagnostic accuracy and also to avoid misleading diagnoses.  Since there is significant correlation between clinical and ultrasound based diagnosis, it can be beneficial even for young doctors for making effective diagnosis of MSD.