Abnormal Uterine bleeding (AUB) is one of the frequent complaints of female patients of all ages.AUB is present in 33% of women referred to gynecologists and this increases to 69% in peri-menopausal and postmenopausal women. About 10 % of postmenopausal bleeding results from endometrial cancer and imaging is the mainstay for its identification. Imaging plays a vital role in differentiating structural lesions like endometrial carcinomas, myomas and polyps which require surgical management from functional disorders requiring medical management. Transvaginal Ultrasonography (TVUS) is the first line imaging modality for AUB after selecting the patients with inconclusive pelvic ultrasonographic results. Hysterosonography (HSG) also plays a pivotal role. Objectives:To compares between TVUS and HSG in the detection and identification of intrauterine lesions in patients with abnormal uterine bleeding, and comparing the sensitivity and specificity of the respective methods in the detection of such lesions. Methods: Thisstudy was conducted in Department ofRadiology, Mayo Hospital Lahore. Fifty women presented with history of abnormal uterine bleeding were included in this study. Pregnancy was ruled out by transabdominal scan. Transvaginal ultrasound and hysterosonography were performed in all the patients. All the data were coded and analyzed using SPSS version 20. Results:Out of 50 patients, 10 patients had intramyometrial fibroid, 11 had submucosal fibroid, endometrial polyp was found in 17 patients and 2 patients had thickened endometrium (thickness > 8mm). The sensitivity and specificity of TVUS was found to be 83.2% and 82.7% respectively whereas HSG showed sensitivity and specificity of 95.4% and 91.5% respectively. In the detection of the submucosal fibroid and endometrial polyp, HSG showed highest sensitivity and specificity as compared totransvaginal ultrasound. Conclusion:Both the TVUS and HSG have comparable sensitivity and specificity in the detection of endometrial disease in patients presented with abnormal uterine bleeding however HSG is more sensitive in the detection of polyps.

Purpose of the Study: The estimation of the degree of hepatic fibrosis is important for diagnostic and therapeutic management of patients with chronic liver disease, in particular those associated with hepatic viral infections. In cirrhosis portal blood inflow, hepatic resistance and portal venous pressure increase. Doppler sonography is non-invasive diagnostic modality based on hemodynamic parameters. Hemodynamic changes might have developed even in cases with normal findings on B mode sonography. Therefore, assessment of these alterations has importance for early diagnosis and for close follow-up of previously dia-

Objective: The current gold standard for the diagnosis of ureteric stones in patients with a stent in situ is ureteroscopy but this study is planned to determine the positive predictive value of computerized tomography (CT) scan among such patients. Methods: This study involved patients who had ureteral stent in situ and were referred for re-evaluation of residual stones after extracorporeal shock wave lithotripsy. These patients underwent CT-scan for detection of ureteric stone. Later on, ureteroscopy was performed and ureteric stone was confirmed on direct visualization. Results: The mean age of the patients was 32.2±8.9 years. Male to female ratio of 1.7:1. CT scan shows a stone in 252 patients (70.2%) out of which 165 (46.0%) were confirmed on ureteroscopy. This yielded a sensitivity of 88.7 %, specificity of 49.7 %, positive predictive value of 65.5%, negative predictive value of 80.4% and diagnostic accuracy of 69.9% of CT for detecting ureteric calculi in patients with ureteric stents (p value < 0.0001). Conclusion: CT scan owing to its limited diagnostic accuracy cannot replace ureteroscopy for detection of ureteric stones in patients with ureteric stents.

Purpose of the study: The purpose of study was to interrelate CT findings of depressed skull fracture with clinical findings. Study design: This was exploratory study. Place of study: The study was conducted at Mayo Hospital Lahore and Lahore General Hospital. Duration of study: From March 9, 2004 to October 2004. Sample size: Fifty patients irrespective of their age and sex were included. Patients selection: Only the newly admitted patients in the above mentioned hospitals were included in the study. Previously diagnosed depressed skull fracture or the patients having associated facial abdominal and thoracic injuries were excluded. Methodology: Patients having depressed skull fracture were clinically evaluated and thereafter subjected to 4th generation spiral CT scan at the radiology Department of the above mentionedhospitals. Both bone and brain window were taken for various intracranial structures. Results: Analysis of the data for association between the variables of clinical and CT findings revealed that patients with conscious level, with DSF and having mild head injury were less associated with scalp injury (p=0.1156) which is statistically insignificant. DSF with moderate and severe head injury had more probability of scalp injuries. Scalp laceration seen with DSF had association with scalp injury (p<0.001). Conclusion: It is a key for clinician and neurosurgeon to use GCS score in congestion with the CT findings for early management of DSF.

Objective: The purpose of study is to establish accuracy of doppler sonography in diagnosis of early cirrhosis in hepatitis C positive patients, which is based on portal vein velocity and resistive index considering Histopathology as a gold level standard Student Design: It was a cross sectional comparative study (validation study). Place & Duration of Study: The student was held in Radiology department of District Headquarter Teaching Hospital Gujranwala from 1st July 2019 to 30th June 2020. Materials and Methods: The calculated sample size was 50 cases of anti-HCV anti bodies positive on their blood test fulfilling the inclusion criteria were examined for color Doppler ultrasound to see direction and average blood flow in the portal vein. All these cases were undergone core biopsy of liver and histopathology carried out. The results of histopathology were taken as superior quality / gold standard. Results: Mean age of the patients was found to be 42.5 years. The frequency of the hepatitis C in the different age group varied. Out of the 50 about 37 patients (74%) show decrease in the portal vein velocity towards lower limits regardless no ultrasonic appearance of the cirrhosis and remaining 13 patients (26%), show normal velocities towards upper limits. According to this study portal vein velocity in early cirrhosis is between 10-16 cm/sec and these initial cirrhotic changes confirmed on core liver biopsy (gold standard). Sensitivity was found to be 94.4%, specificity 78.5%, diagnostic accuracy 90.0%, both the NPV (negative predictive value) and PPV (positive predictive value) are high (NPV: 78.5%). Practical Implication: To best of our knowledge, there is very little information on this research topic in our area. The design of improved medical strategies to handle such situations and the improvement of their management will be made possible by the availability of such evidence. Conclusion: In our study, the maximum patients (38%) were suffering with this disease for more than 7 years but less than 9 years. 74% patients showed a decrease in the portal vein velocity towards the lower limit, and 26% patients showed normal velocity towards the upper limit. Keyword: Portal Vein, Doppler Ultrasound, Anti HCV, Core Liver Biopsy, Histopathology, Hepatitis C

Aim: To analyze clinical manifestations, course and outcome of Langerhans Cell Histiocytosis in children in resource limited settings lacking salvage therapy. Study design: Observational retrospective study Place and duration of study: Department of Haematology/Oncology, The Children’s Hospital, Lahore Pakistan from 1st January 2011 to 31st December 2018. Methodology: Sixty-five patients with age range from<1 to 8 years included analysing their age, gender, clinical classification, course of therapy and outcome. The major treatment was composed of either prednisolone and vinblastine or cytarabine pulses. Results: There were 59% males and 41% females. Forty-seven (72%) patients presented with multi system-LCH with 49% Risk Organ involvement. Most of them 42 (65%) had bone lesions while 15patients (23%) presented with central nervous system involvement. Forty patients (61%) have completed treatment, 11(17%) left against medical advice and 12(18%)patients expired due to progressive disease and worsening infection. Only 2 patients were put on palliation with progressive brain parenchyma disease. 22 patients (34%) had reactivations of disease requiring therapy for more than one-year (p-value=0.06), while 15 (23%) patients received two cycles of initiation therapy before continuation therapy started. The treatment initiated >6 months after the onset of symptoms in 48 (74%) patients. Conclusion: Early diagnosis and timely initiation of therapy are of utmost importance to reduce mortality and morbidity. There is a dire need of social support to reduce treatment abandonment in low-middle-income countries LMIC. Keywords: Paediatric Langerhans cell histiocytosis, Resource-limited settings, Delayed diagnosis, Abandonment

Objectives: To determine the diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR, taking birth weight as gold standard. Study Design: Descriptive, Cross Sectional Study. Setting: Department of Radiology, DHQ Hospital, Faisalabad. Period: 30th May 2016 to 29th November 2016. Material & Methods: Total 129 clinically suspected IUGR, 18 to 40 years of age with singleton pregnancy were included. Patients having Hb< 8.5 g/dl, chromosomal abnormality, chronic infections, severe systemic illness like uncontrolled diabetes mellitus, cardiac disease, renal or hepatic disease were excluded. Colour Doppler Ultrasonography of the cerebral and umbilical artery was performed in every patient and looked for IUGR. Colour Doppler sonography findings were compared with birth weight of baby. Results: Mean age was 30.26 ± 4.67 years. The mean gestational age was 38.60 ± 1.27 weeks. Mean parity was 2.68 ± 0.74. In Colour Doppler Ultrasonography positive patients, 64 were true positive while 09 were false positive. Among, 56 Colour Doppler Ultrasonography negative patients, 07 were false negative while 49 were true negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR, taking birth weight as gold standard was 90.14%, 84.49%, 87.67%, 87.50% and 87.60% respectively. Conclusion: This study concluded that diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR is quite high.

Background: Computed tomography virtual laryngoscopy (CTVL) is favored diagnostic tool in detecting laryngeal carcinoma because it delivers excellent temporal and spatial resolution. Objective: To determine the positive predictive value of computed tomography virtual laryngoscopy in detecting laryngeal carcinoma taking histopathology as gold standard. Methods: A cross sectional survey was conducted at department of Radiology, Mayo Hospital Lahore. The completion of study was done in six months [Feb 16, 2019 till Aug 16, 2019]. After obtaining approval from ethical committee and informed consent from subjects, 64 subjects were included in the study who presented in the Department of the Radiology having carcinoma of larynx on CTVL and then sent to department of ENT of mayo hospital, where they underwent direct laryngoscopy and afterwards biopsy obtained sent to the department of histopathology. All the subjects undergoing CT scan examination on the CT machine of hospital. Contrast injection was given to all subjects undergoing CT scan, through power injector at the rate of 4ml per min and dosage of 0.1ml/kg. Same machine was used to conduct all CT scans and was inferred through same radiologist and all the histopathology was performed by same pathologist to exclude bias. Results: The mean age of patients was 44.38 ± 9.57 years with minimum and maximum age as 22 and 60 years. There were 47(73.4%) male and 17(26.6%) female cases. On histopathology the laryngeal carcinoma was diagnosed in 56(87.5%) of the cases while it was negative in 8(12.5%) of the cases. On CT the laryngeal carcinoma was diagnosed in 59(92.2%) of the cases while it was negative in 5(7.8%) of the cases. The Positive Predictive Value of CT was 89.83%, while its sensitivity was 94.64%, specificity was 25.00%, negative predictive value was 40.00% and diagnostic accuracy was 85.94%. Conclusion: Through the findings of this study it is concluded that positive predictive value of computed tomography virtual laryngoscopy is high (89.83%) in detecting laryngeal carcinoma taking histopathology as gold standard. CT is a precise and non-invasive imaging method in detecting laryngeal carcinoma.