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Aims and Objectives The purpose of our study is to [1] determine the activity of disease based on the HRCT findings (2) to define indications for the use of HRCT in evaluation of Pulmonary TB and (3) to determine whether additional information provided by HRCT alters clinical management of the disease. Materials and Methods The present study was carried out at Shree Sayajirao General Hospital (SSGH), Baroda, Gujarat, India from January 2002 to December 2002. Twenty five patients with sputum positive post-primary pulmonary TB were studied prospectively with chest radiographs and HRCT. The diagnosis of active TB was based on detection of acid-fast bacilli in sputum. None of the patients in our study population was HIV positive. All patients underwent x-ray chest and HRCT chest (Philips Tomoscan, Best, Netherlands). The pattern, extent and severity of HRCT findings were recorded and compared with the plain x-ray findings. The gathered information and investigations were subjected to statistical analysis. Results Our study population consisted of sputum positive (AFB positive) 25 patients, 22 of them were newly diagnosed/suspected post-primary tuberculosis (GROUP 1) and 3 of them had taken six months of AKT (GROUP 2). Our study included 22 males and 3 females with average age of 38 years (range, 14-65 years.) In total chest radiographic signs of active tuberculosis were seen in twelve (48%) patients. HRCT showed evidences of active tuberculosis in all 22 patients of newly diagnosed tuberculosis; and in 2 out of 3 patients with prior history of AKT. Thus, total of 24 (96%) patients had evidence of active pulmonary TB on HRCT. One patient with prior history of AKT showed evidence of pulmonary Koch's sequel. Conclusion Although chest radiography remains the foremost imaging technique in the evaluation of pulmonary TB, HRCT can be useful in certain circumstances and can provide important information in the diagnosis and management of the disease. HRCT is helpful in the distinction of active form inactive TB. HRCT is better than plain chest radiograph in identification of extent of pulmonary TB, especially subtle areas of consolidation, cavitation, bronchogenic and miliary spread. HRCT is recommended when the radiographic findings are normal or inconclusive and tuberculosis is suspected clinically for the confirmation of diagnosis and determination of activity.

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Osteopetrosis is a rare metabolic disease. Dental abnormalities may be attributed to the pathological changes in osteopetrosis. Patients with disease seem to be especially susceptible to osteomyelitis of mandible. A 9 yrs old girl presented with complaints of jaw swelling on left side with multiple discharging sinuses since last seven months. The radiograph of left mandible (oblique lateral view) showed periodontal involvement of associated molars with loss of lamina dura with small sequestrum with irregularity and erosions of the mandibular cortical margins. The patient was diagnosed as a case of osteopetrosis with superadded mandibular osteomyelitis.

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Objectives : Examinations performed using CT scanners impart high radiation dose to patients and use of this modality is on the increase in the present day scenario. This study was intended to evaluate and optimize radiation dose imparted to patients during CT examination of brain performed using spiral CT scanner. Materials and Methods : One hundred and one patients who underwent CT examination of brain were included in the study. The effective dose to patients was calculated using volume computed tomography dose index (CTDIvol) and dose length product (DLP) values. Patients were categorized according to the type of examination involved. Patients who underwent a complete examination of brain (non-contrast as well as contrast) were categorized in Group A and patients who underwent either a non-contrast or contrast examination were categorized as Group B. Results : The effective dose to patients ranged from 0.65 mSv to 0.93 mSv for Group A patients and 0.28 mSv to 0.53 mSv for Group B patients. Conclusion : There was a reduction of doses imparted to patients undergoing CT examination of the brain using optimized exposure parameters without any loss of diagnostic information.

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Objectives To establish the role of routine MR sequences in diagnosis of dural venous sinus thrombosis. Materials and Methods - As dural venous sinus thrombosis has a non specific presentation, all the patients coming to our department for MRI head between March 2003 and May 2005 were looked for abnormal signal intensity within the dural sinuses. Twenty seven cases having loss of normal flow void within the major dural venous sinuses on routine sequences (FSE T2, SE T1 & FLAIR) were thought of having dural sinus thrombosis and so were further evaluated by MR venography. This study was carried out using 0.2 Tesla open magnet MR scanner (GE signa profile 4). Results - On routine MR sequences absence of dural sinus flow void was noted in twenty seven patients and suspicion of cerebral venous thrombosis was raised. The diagnosis of thrombosis was confirmed in twenty three patients by 2-D TOF MR venography and no thrombosis could be demonstrated in remaining four patients. Thirteen patients had multiple sinus involved whereas in ten patients only single sinus was involved. Out of these twenty three patients, apart from thrombosis, six had infarcts, three had mastoiditis and one of them had cerebellar abscess too. Hemorrhage was noted in five patients and the most interesting fact was that nine patients had normal brain parenchyma. Conclusion - Dural venous sinus thrombosis appears as loss of normal flow void on routine sequences especially on FSE T2W and FLAIR images. This fact may help us suspect DVT, and the finding can be confirmed by MR venography so that further management can be planned promptly.

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OBJECTIVES : The purpose of this study is to assess the role of spiral CT angiography in suspected cases of pulmonary embolism and to do comparative evaluation of CT angiography with conventional pulmonary angiography. MATERIAL AND METHODS : Twenty five patients of suspected pulmonary embolism (PE) underwent spiral CT angiography from the level of arch of aorta to the dome of diaphragm .Scanning was done with collimation of 5mm and an interval of 5mm at 130 mA and 120 kV. 100 cc of contrast containing 300 mg I/ ml, diluted with 60cc of normal saline in ratio 5:3 was injected at a flow rate of 3ml/sec with a scan delay of 20 seconds. Retro - reconstruction was done at 3mm interval. RESULTS : Spiral CTA showed a sensitivity of 80 % and a specificity of 85.7% for the diagnosis of pulmonary embolism. It also provided ancillary findings in the form of parenchymal and mediastinal structural information. CONCLUSION : CTA is an effective alternative to PA in diagnosis of suspected cases of PE. With its non- invasive nature, low cost, over and above high sensitivity and specificity, it may be used as the first line of investigation in the diagnosis of PE.

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Tolosa-Hunt syndrome (THS) is a painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We present a case of THS disease evaluated on a 1.5 Tesla MR scanner.

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