Purpose. To determine the diagnostic accuracy of contrast enhanced FLAIR sequence of MRI brain in the diagnosis of meningitis. Subjects and Methods. A prospective study of 57 patients with signs and symptoms of meningitis, referred to the radiology department for MRI examination. Out of these, there were 30 males and 27 females. They underwent MRI brain with contrast including postcontrast T1W and FLAIR sequences. Cerebrospinal fluid (CSF) analysis obtained by lumbar puncture after MRI was considered the “reference standard” against which MRI findings were compared. Results. Of 57 patients, 50 were diagnosed as having meningitis on subsequent CSF analysis. Out of these 50, 49 were positive on postcontrast FLAIR images and 34 were positive on postcontrast T1W images. One patient was labeled false positive as CSF analysis showed malignant cells (leptomeningeal carcinomatosis). In the diagnosis of meningitis, the sensitivity of postcontrast FLAIR sequence was 96% and specificity 85.71%, whereas the sensitivity of postcontrast T1W sequence was 68% and specificity 85.71%. Conclusion. Contrast-enhanced FLAIR sequence is more sensitive and specific than contrast-enhanced T1W sequence in the diagnosis of meningitis. It should be routinely used in suspected cases of meningitis.

This study aims to assess the diagnostic accuracy of a single vendor commercially available CT perfusion (CTP) software in predicting stroke. A retrospective analysis on patients presenting with stroke-like symptoms within 6 h with CTP and diffusion-weighted imaging (DWI) was performed. Lesion maps, which overlays areas of computer-detected abnormally elevated mean transit time (MTT) and decreased cerebral blood volume (CBV), were assessed from a commercially available software package and compared to qualitative interpretation of color maps. Using DWI as the gold standard, parameters of diagnostic accuracy were calculated. Point biserial correlation was performed to assess for relationship of lesion size to a true positive result. Sixty-five patients (41 females and 24 males, age range 22–92 years, mean 57) were included in the study. Twenty-two (34 %) had infarcts on DWI. Sensitivity (83 vs. 70 %), specificity (21 vs. 69 %), negative predictive value (77 vs. 84 %), and positive predictive value (29 vs. 50 %) for lesion maps were contrasted to qualitative interpretation of perfusion color maps, respectively. By using the lesion maps to exclude lesions detected qualitatively on color maps, specificity improved (80 %). Point biserial correlation for computer-generated lesions (Rpb = 0.46, p < 0.0001) and lesions detected qualitatively (Rpb = 0.32, p = 0.0016) demonstrated positive correlation between size and infarction. Seventy-three percent (p = 0.018) of lesions which demonstrated an increasing size from CBV, cerebral blood flow, to MTT/time to peak were true positive. Used in isolation, computer-generated lesion maps in CTP provide limited diagnostic utility in predicting infarct, due to their inherently low specificity. However, when used in conjunction with qualitative perfusion color map assessment, the lesion maps can help improve specificity.

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Functional endoscopic sinus surgery (FESS) is an effective treatment for inflammatory sinus disease. The potential for major complications during FESS is high particularly under general anaesthesia. The most serious of these is injury to the eye leading to blindness. We looked at the feasibility of monitoring flash visual evoked potentials (VEP) simultaneously from both eyes during FESS. Five patients were included in this preliminary study. A haptic contact lens connected by fibreoptic cable to a photostimulator was placed on the eyes and stimulus of comparable intensity to a conventional strobe was delivered. We found that an increase in P100 latency to be an indicator of optic nerve compression. However, for this to be useful the diastolic blood pressure should not fall below 50 mmHg, the oxygen saturation should be maintained at 98 per cent and bleeding should be minimized during surgery. The changes in the amplitude of P100 was not found to be useful.While there is no substitute for learning endoscopic surgery by cadaveric dissection and supervised training we believe that in selected cases VEP monitoring can be employed with profit.

Intra-abdominal neoplastic testicular torsion is a very rare clinical condition, which is normally not considered during differential diagnosis of acute abdomen. In any male patient with acute abdominal symptoms and absence of scrotal testis, a high index of suspicion for intra-abdominal testicular torsion should be maintained. An increased diagnostic yield is dependent on an expedient and comprehensive preoperative evaluation. An illustrated case report is presented.