RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE –II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE / DR. NATARAJ.BADDRESS / DOOR NO 81 12TH C MAIN 6TH BLOCK RAJAJINAGAR BANGALORE-10.
2. / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE.
3. / COURSE OF
STUDY AND
SUBJECT / M.D. IN RADIO-DIAGNOSIS
4. / DATE OF
ADMISSION / 17TH APRIL 2009
5. / TITLE OF THE TOPIC / MULTI DETECTOR COMPUTED TOMOGRAPHY EVALUATION OF RETROPERITONEAL LESIONS
6. / Brief resume of intended work
6.1. Need for study:
The Multi Detector computed tomography is considered the best imaging modality for the evaluation of the retroperitoneal lesions.
Multi detector computed tomography has advantages of high spatial resolution, multiplanar tomographic or volumetric image display, relatively good soft tissue contrast between normal structures and disease processes ;a short examination time and the capability for whole body imaging. MDCT is the most widely used crosssectional imaging modality to assess the retroperitoneum.9
MDCT is a superior and sensitive technique compared to ultrasonography in assessing the retroperitoneal lesions. MDCT remains the the modality of choice for diagnosis, staging, and monitoring of retroperitoneal diseases.
Familiarity with MDCT and clinical features of various retroperitoneal cystic masses and lesions facilitates accurate diagnosis and treatment.
The noninvasive diagnosis is important because treatment approaches for these conditions ranges from patient monitoring to surgery.
This study is undertaken to use multidetector computer tomography imaging features to evaluate the retroperitoneal lesions.
6.2. REVIEW OF LITERATURE
Computed tomography now permits identification and precise localization of retroperitoneal abscesses.1
Wilms tumour is the most common paediatric solid renal tumor. However, in recent years several other renal masses have been recognized as separate pathologic entities. Knowledge of the distinct clinical and imaging features of these lesions may help suggest a particular diagnosis.2
Primary retroperitoneal neoplasms can arise from any tissue present in the retroperitoneum and represent diverse pathologic types of tumors. CT can demonstrate important characteristics of these tumors. Attention to diagnostic clues is essential in making an accurate radiological diagnosis or narrowing the differential diagnosis and in obtaining clinically significant information.3
Multi-detector row CT with three dimensional post processing allows accurate imaging of the pancreas and peripancreatic structures and displays the anatomy and disease entity in an orientation that simulates a direct surgical approach.4
CT is ideal for the assessment of retroperitoneal disease because it provides discrete sectional images of the organs and retroperitoneal compartment. In patients with retroperitoneal cystic masses, CT may provide important information regarding the anatomic location ,size, and shape of the lesions and involvement of adjacent structures. Familiarity with the CT features of retroperitoneal cysts facilitates accurate diagnosis and treatment.5
One particular advantage of multidetector CT is the ability to obtain high quality off-axis scans, which can be especially helpful in evaluating the surrounding vessels.6
Contrast material-enhanced computed tomography remains the modality of choice for the detection ,diagnosis, staging and monitoring of renal lymphoma.7
Familiarity with the spectrum of imaging features of perirenal tumors and pseudo tumors may facilitate accurate diagnosis and timely treatment.8
Acquired CT data sets may also be reconstructed retrospectively into sagittal, coronal, or oblique planes as needed, and three- dimensional volume rendered images may also be created on a postprocessing workstation.such images are useful or the assessment of spatial relationships between lesions and surrounding anatomic structures, particularly if the masses are large or the organ of origin is unclear.9
AAAs can be detected and differentiated from a tortuous aorta by CT. Measurements of aortic diameter obtained on CT correlate well with those found at surgery (239). CT measurements are fairly reproducible.10
6.3. Objectives of the study:
1 To locate, differentiate and diagnosing the retroperitoneal lesions.
2 To recognize the nature of lesion and its morphology, the extent of the lesions and its involvement with adjacent structures which helps not only in clinching the diagnosis but also helps in staging and thereby preventing unnecessary surgical intervention.
7.0 / Materials and methods
7.1. Source of data:
Data for the study will be collected from patients attending/referred to teaching hospitals attached to Bangalore Medical College and Research Institute, Bangalore (viz. Victoria Hospital, Bowring and Lady Curzon Hospital and Vanivilas Hospital).
7.2. Method of collection of data:
A prospective correlational study will be conducted over a period of two years (November 2009 to November 2011) on 40 patients with symptoms related to retroperitoneal lesions. They will be evaluated with Multidetector Resolution Computed Tomography (SIEMENS SOMATOM EMOTION 6) and findings will be correlated with surgical findings wherever applicable
Hypothesis:
MDCT is a good diagnostic tool in evaluating patients with retroperitoneal lesions and determining the treatment modality.
Inclusion criteria:
1. Clinically suspected patients presenting with symptoms of involvement of retroperitoneal structures.
2. Involvement of retroperitoneal organs detected incidentally by routine ultrasonography of abdomen / referred patients.
Exclusion criteria:
1. Patients with renal insufficiency
2. Patients allergic to contrast media.
3. Patients presenting with non retroperitoneal lesions excluded by the initial/routine ultrasonography screening.
Parameters to be measured:
40 patients with clinically suspected retroperitoneal lesions will be subjected for MDCT examination. The visualization of structures, extent of lesions and attenuation values in pre and post contrast imaging will be considered. The management, therapeutic or otherwise will be decided based on the MDCT findings, which will then be correlated with surgical findings wherever applicable.
Statistical Methods:
Chi-square test, Z test. viz: Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV).
The Research hypothesis and statistical methods were framed in consultation with a Biostatistician.
7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly
The study requires the use of multi detector Computed Tomography scanning and administration of intravenous contrast, which will be done with the consent of the patient. computed tomography guided fine needle aspiration cytology/biopsies wherever needed
7.4. Has the ethical clearance been obtained from your institution in case of 7.3
yes
8. / List of references:
Journals :
1. Faerber EN, Leonidas JC, Leape L. Retroperitoneal iliac abscess with periostitis. AJR 1981 Apr;136:828-829
2. Lowe LH, Isuani BH, Heller RM, Stein SM, Johnson JE, Navarro OM et al. pediatric renal masses wilms tumor and beyond. Radiographics 2000;20:1585-1603
.
3. Nishino M, Hayakawa K, Minami M, Yamamoto A , Ueda H, Takasu K. Primary Retroperitoneal Neoplasms CT and MRI imaging Findings with Anatomic and Pathologic Diagnostic Clues. RadioGraphics 2003; 23:45–57
4. Lawler LP, Horton KM, Fishman EK. Peripancreatic masses that simulate Pancreatic disease Spectrum of disease and role of CT. Radiographics. 2003;23:1117-1131.
5. Yang D, Fung DH, Kim H, Kang JH, Kim SH, Kim JH, et al.Retroperitoneal cystic masses CT clinical and pathologic findings and literature review. Radiographics 2004;24:1353-1365.
6. TO,o KF, Raman SS, Yu NC, Kim YJ, Crawford T, kadell BM et al. PancreaticandPeripancreaticdiseasesmimickingPrimarypancreaticNeoplasia. Radiographics 2005;25:949-965.
7. Sheth S, Ali S, Fishman E. Imaging of Renal Lymphoma Patterns of disease with pathologic correlation. Radiographics 2006;26:1151-1168.
8. Surabi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple. et al Neoplastic and Nonneoplastic proliferative disorders of the perirenalspace cross sectional Imagings. Radiographics 2008;28:1005-1017.
Textbooks:
9. Haaga RH, Dogra VS, Forsling M, Gilkeson RC, Ha HK, Sundaram M. CT and MRIof the whole body. 5th ed. Mosby; 2009: P.1953 – 2020 (vol 2)
10. Lee JKT, Sagel SS, Robert J, Stanley RJ, Heiken JP. computed body tomography with MRF correlation. 4th ed. lippin Cott Williams and wilkins; P. 1155-1756.(vol 2)
9. / Signature of the candidate:
10. / Remarks of the Guide:
Retroperitoneal lesions are difficult to evaluate on ultrasound examination, since they are deeper structures. Detailed evaluation of the involved organs may not be possible due to interference by the bowel movements and presence of bowel gas.
MDCT proves to be the modality of choice in evaluating the retroperitoneal lesions since it provides discrete cross sectional images of the organs and retroperitoneal compartments. It also provides important information regarding the anatomical location, size and shape of the lesions and involvement of adjacent structures, which helps in staging of the existing lesions, which in turn helps in the clinical management (surgical, medical / oncological).
MDCT has got added advantages like spatial resolution, multiplanar tomography or volumetric image display, relatively good soft tissue contrast between normal structure and disease process, short examination time and capability for imaging the whole body.
MDCT is the most widely used cross sectional imaging modality to assess the retroperitoneum. This study has not been undertaken by any of the postgraduates in the recent past. Hence I recommend this study.
11. / Name and Designation
11.1.Guide:
11.2. Signature: / DR. NAGARAJ.B.R
D.M.R.D.M.D.R.D.
Professor and Head Unit II
Department of Radio-Diagnosis, Victoria hospital,
Bangalore Medical College and Research Institute,
Bangalore.
11.3 Co-guide (if any):
11.4. Signature: / DR. T DURGANNA
Professor of Surgery
Department of Surgery
Head Unit II
BMC & RI
Victoria Hospital Bangalore.
11.5. Head of the Department:
11.6. Signature: / PROF.SATHISHCHANDRA H.
MDRD,FICR
Professor and Head,
Department of Radio-Diagnosis,
Bangalore Medical College and Research Institute,
Bangalore.
12 / 12.1.Remarks of the Chairman and Principal:
12.2 Signature: