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.
BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography
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