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Computed Tomography with puffed cheek is a new imaging protocol in evaluation of pathologies of the oral vestibule. Puffed cheek CT of the oral vestibule is very useful for defining separate involvement of the buccal and gingival mucosa and other deeper involvement of the oral vestibule. Puffed cheek technique is easy to perform, practicable and of immense diagnostic value and hence should be included as a routine imaging protocol for CT evaluation of the oral vestibule.

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Objective: To study MR appearances in various conditions affecting the knee and to identify the common lesions. Materials and Methods: One hundred and fifteen patients with knee complains and suspected to have meniscal, ligamentous or other pathology were studied using Sigma contour 0.5 T (GE) MR machine. Images were obtained in sagittal, axial and coronal planes using SE, GRE and STIR sequences. Slice thickness of 4mm, FOV of 17 x 17 cm & 192 x 160 matrix were used. Results: Anterior cruciate ligament (ACL) tears accounted for the major cases (36.5 percent) followed by Medial meniscal tears (MM)(36.5 percent and Lateral meniscal tear (17.3 percent). Hyperintensity, discontinuity and nonvisualisation were primary signs of ACL tear. Secondary signs like Posterior cruciate ligament (PCL) buckling, PCL index of greater than 0.5 and uncovered lateral meniscus (LM) were also noted in certain areas. Meniscal tears seen commonly are grade III in medial meniscus and Grade 1in lateral meniscus. Cases of meniscal cyst, synovial chondromatosis, quadriceps tendon tear, osteochondritis dissecans are clearly demonstrated on MR scans. The exact extent of the tumor in the marrow and soft tissues and involvement of joint space was demonstrated with great degree of accuracy. Conclusions: MR imaging of knee is an excellent modality that detects lesions not evident on arthroscopy and helps in planning the treatment of meniscal and ligament injuries. It demonstrates extent of marrow and soft tissue involvement of tumors with great degree of accuracy.

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Objectives: To assess the carotid intima media thickness (IMT) with the help of high resolution ultra sonography and to compare the intima Media thickness of hypertensive patients with that of normotensives. Materials and methods: Two hundred and sixty patients of hypertension were studied over a period of three years and compared with seventy normotensive patients. Carotid Doppler was performed on both sides, independently by two different observers with inter observer variation being insignificant. We used WIPRO-GE Logic 400 MD scanner with 7.5 MHZ linear array superficial probe for Ultrasonography with the patient in supine position and elevation of chest by a pillow. Patient's head turned to the opposite side of examination. About 0.5 to 1.0 cm proximal to the carotid bulb, the site was chosen, intima media thickness assessed. Colour flow mapping was done and velocity and vessel size were assessed. Estimation of lipid profile was done. These values of hypertensive patients were compared with that of normotensives. Results: Normal carotid Intima media thickness is 0.77mm and 0.75mm for the Right and Left sides respectively. Intima media thickness is increased in hypertensive subjects significantly when compared with normotensives. HDL Cholesterol is significantly low and Triglycerides level is increased in hypertensive patients. Conclusion: Our study has revealed that assessment of intima media thickness of carotids as assessed by Ultrasonographic study is significantly increased in all hypertensive patients when compared with normotensives.

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Objectives: To prospectively evaluate the accuracy of anal endosonography in the preoperative evaluation of fistula-in-ano and to compare its efficacy with that of fistulography. Materials and Methods: Fifty patients with a clinical diagnosis of fistula-in-ano were evaluated by fistulography followed by anal endosonography. The results were correlated with findings at surgery. Results: The sensitivity of fistulography in detecting the primary track, secondary extension, internal opening and abscess cavity were 100 per cent, 66.6 per cent, 50 per cent and 30.76 per cent respectively as compared to anal endosonography findings of 98 percent, 100 per cent, 72.72 per cent and 46.15 percent. Moreover, the accurate anatomic relationships of the fistulous track in relation to the sphincteric muscles can be detected by anal endosonography, but it is not possible with fistulography. The combined use of fistulography and anal endosonography improved the sensitivity in detecting the internal opening and abscess cavity if present. Conclusions: Fistulography and anal endosonography are useful adjuncts to clinical examination in preoperative assessment of a fistula-in-ano. They give an added advantage from the surgical point of view. The injection of hydrogen peroxide into the fistulous track during anal endosonography improves its accuracy.

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Objective: To assess the efficacy of partial splenic embolisation in the management of hypersplenism Material and Method: Eleven partial splenic embolisations were performed in nine children suffering from portal hypertension, aged 10 to 15 yrs (mean 12.5 years). All patients had splenomegaly with thrombocytopenia (platelet count less than 60x10, 9/ lit) and leucopenia at the time of the procedure. Portal hypertension was investigated in all patients with endoscopy, liver biopsy & abdominal sonography. Particles of polyvinyl alcohol were used to achieve embolisation of at least 75 percent of the splenic artery thereby causing embolisation of the peripheral splenic branches. Post embolisation arteriogram and ct were obtained to document the extent of devascularisation. Results: Peripheral count had improved significantly after partial splenic embolisation (PSE) and platelet count of more than 450 x 10 9 lit was present in nine of the eleven patients by the end of the seventh day. Leucocyte count rose significantly by day one and seven after PSE compared with counts before the procedure. Reduction in size of the spleen was noticed in all patients. Six out of eight patients showed considerable reduction in size of the oesophageal and gastric varices. All patients had a moderate rise in temperature up to 38.5 degree C along with pain in the left hypochondrium. Segmental atelectasis was seen in three patients. Conclusion: Partial splenic artery embolisation is an effective procedure for the control of Hypersplenism.

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Purpose: To compare CT based three-dimensional rotational (full and skip scan) treatment planning and conventional three-dimensional fixed field (four and six fields) planning in localized carcinoma prostate. Materials and Methods: Seven patients of localized carcinoma prostate were planned by different conformal rotational and fixed fields. All the plans were normalized to deliver 100 percent to the central axis and full 3D calculations were performed. Plan evaluation tools consisted of beam's eye view, multiplanar displays, isodose distribution, cumulative and differential dose volume histograms and OSCAR (Objective Scoring by Colored Areas of Regrets) software. Results: Analysis of dose volume histograms revealed that V95, D95, D05 and D95 for planning target volume (PTV) were comparatively higher when planned by skip scan technique than when planned by fixed field technique (91 percent, 91 percent, 90 percent and 91.4 percent versus 85 percent, 87 percent, 86 percent ad 88 percent). DVH analysis for organs at risk showed that V95, V50 and DM values for rectum and bladder obtained by skip-scan technique was lower than when planning was done by 4/6-field technique (1 percent, 70 percent ad 51 percent versus 13 percent, 91 percent and 55 percent for rectum and 4 percent, 25percent and 51 percent versus 16 percent, 38 percent and 56 percent for urinary bladder respectively). Full rotational technique was the best amongst all as far as doseto B/L femoral heads was concerned (0 percent, 0 percent and 29 percent versus 0 percent, 1 percent and 28 percent respectively)

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