Background: Cranial computed tomography scan is a routinely performed investigation in the evaluation of head injury cases. These scans detect the pathologies caused by the trauma as well as many unexpected incidental findings, the frequency of which are not known. Present study was conducted with the objectives to evaluate the patients with head injury using computed tomography and to determine the prevalence and significance of incidental findings on cranial scans. Material and Methods: This prospective study was conducted in Bangalore medical college and research institute from January 2018 to June 2019. A total of 600 consecutive patients of all age groups with history of head trauma undergoing cranial scans were included in this study. Computed tomographic scans of the brain are obtained from the vertex to foramen magnum level. Two series of axial data sets are obtained, one using soft tissue and another with bone-reconstruction algorithms. Collected data was entered in excel sheets and simple descriptive statistics were used to describe in the form of frequency tables and graphs. Results: The detected incidental findings were divided into two categories based on the plan of management. The mean patient age was 40+/-15.3 years, and male to female ratio was 2: 1. Incidental finding were identified in 28.5% of study sample which were mostly benign and non-critical. Arachnoid cysts (8%), megacisterna magna (5.8%) and calcified granulomas (8.8%) are the commonly noted incidental findings in category 1 and neuroparenhcymal atrophy (7.1%), infarcts (8.7%) and brain tumors (2%) are the commonly identified pathologies in category 2. Conclusion:The incidentally detected findings are both critical and noncritical pathologies. Although most of them are benign, it is important to mention about the findings in the report for counseling and management of the condition and to prevent further complications in future.
Cholesteatoma is a common benign lesion of the middle ear characterised by accumulation of keratinous debris. It is associated with local bony erosions and hence serious intracranial and labyrinthine complications which prompts surgical intervention. Earlier, High resolution computed tomography (HRCT) was used in combination with clinical examination to arrive at a diagnosis. Computed tomography (CT) gives excellent definition of bony structures, but lacks sensitivity in differentiating between various causes of soft tissue densities. Magnetic resonance imaging (MRI) is more useful in evaluation of soft tissue details. We conducted this study with an aim of evaluating the role of diffusion weighted imaging in diagnosis of cholesteatoma and its utility to differentiate cholesteatoma from granulation/ inflammatory tissue. The study was conducted on forty patients between March 2018 and February 2019 who were clinically suspected of chronic suppurative otitis media with cholesteatoma. These patients were subjected to HRCT and Diffusion weighted MRI (DW-MRI) examination of temporal region and findings were correlated with intraoperative and histological features. Our study found that, HRCT had a sensitivity of 83.3% and specificity of 58.3% in detection of cholesteatoma, while MRI was found to accurately predict the presence of cholesteatoma in 91.6% of the cases evaluated. The sensitivity, specificity, positive predictive value and negative predictive value were 91.6%, 91.6%, 95.6% and 84.6%, respectively. Hence, we conclude that diffusion weighted magnetic resonance imaging is a useful technique for cholesteatoma imaging with high sensitivity and specificity. Combination of HRCT and MRI will be helpful to make an accurate diagnosis.
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