RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE / DR REMYA K VASUDEVAN
ADDRESS / NO 44 ,NETAJI ROAD,NEAR COLES PARK,FRAZER TOWN,BANGLORE 560005
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 / 31/05/2008
5. / TITLE OF THE TOPIC / “MDCT EVALUATION OF NECK LESIONS.”
6. / Brief resume of intended work
6.1.  Need for study:
Pathologies of neck are frequently encountered in our day to day practice. It is important to differentiate a malignant neck lesion from a benign lesion. It is also important to define the site of origin, extent and characterisation of the lesion on contrast administration. Hence the imaging modality that we use should comprise high sensitivity and specificity for the lesion and should be able to distinguish between those lesions which require detailed evaluation from those which does not.
Computed tomography with its unique capacity for displaying soft tissue, bone and airway detail has rapidly become the imaging modality of choice for neck pathologies. Computed tomography provides critical anatomical information about lesions involving the neck. And in malignant process CT can determine the extent of the disease allowing accurate planning for surgery and radiation ports.
This study is an effort to assess the role of MDCT in detection and characterisation of neck pathologies and help in deciding further course of management.
6.2.  Review of literature :
Recent studies have reported that advances in cross sectional imaging now allow detailed evaluation of anatomy and pathology of the neck.8 Specifically, it is capable of documenting tumor size, location and relationship to adjacent structures as well as demonstrate routes of tumour spread and provide clues supporting a specific diagnosis.2
A thorough knowledge about normal Cross sectional anatomy of the neck and meticulous tomographic technique are mandatory. The examination should be planned on the basis of the clinical presentation .2
Intravenous contrast material given as a rapid infusion during the examination provides the best enhancement of the vessels, and thereby improves recognition of key vascular structures.2
CT provides critical information regarding benign and malignant
soft tissue tumours of the neck arising from nerves, vessels,
lymphnode chains, and supporting muscles. , as well as thyroid and
parathyroid.1
Most solid masses encountered are enlarged lymph nodes. Recent studies have proven that CT is valuable modality in characterizing lymph nodes and differentiating between a reactive lymphadenopathy from neoplastic involment.In addition to studying features of palpable lymphnodes CT also enables detection of non palpable lymphnodes thereby improving accuracy of staging.8
Less common non nodal solid masses include neurovascular tumours (paragangliomas, neurofibromas, heamangiomas) primary neoplasms (fibroma,sarcoma),congenital lesions ( teratomas,ectopic thyroid),lesions of the bone and infections and CT provides critical information regarding the origin, site, size and extent of the lesion.8
CT is widely used to diagnose deep seated neck infections. CT is valuable tool to recognize early abscess formation and map out the location and extent of the abscess helping in accurate planning of treatment.5
CT is helpful in defining the extent of paratracheal and thyroid masses by defining the extent of tracheal compression and transmural airway invasion. 7
Recent studies of neck pathologies using MDCT shows that because of shorter examination time motion artifacts are reduced and phonation studies are possible. Thin slicing and nearly isotropic multiplanar reconstruction saves both time and radiation exposure. MPRs are easily done in any plane within seconds enables three dimensional visualization thus improving the diagnostic accuracy.6
Hence, though MRI provides better soft tissue delineation, CT still scores over MRI with respect to better osseous details, better delineation of calcification, wider patient access and lower cost.10
6.3. Objectives of the study:
To evaluate the usefulness of MDCT in detection of neck pathologies and provide information that could accurately determine the choice of management.
7.0 / Materials and methods
7.1 source of data:
Data will be collected from patients with neck lesions attending/referred to teaching hospitals attached to banglore medical college and research institute.(viz Victoria hospital,bowring and lady Curzon hospital&vanivilas hospital)
7.2. Method of collection of data:
A prospective correlational study will be conducted over a period
of two years (november2008 to november2010) on 40 patients with
neck lesions. They will be evaluated with MDCT(siemens somatom emotion 6) and findings will be correlated with surgical/biopsy where ever applicable.
HYPOTHESIS:
MDCT IS PRIME IMAGING MODALITY FOR ENABLING THE DETECTION,LOCATION AND CHARACTERIZATION OF PATIENTS WITH NECK LESIONS, AND IS AN EFFECTIVE AID IN DIAGNOSING THEREBY LEADING TO THE APPROPRIATE MANAGEMENT(TREATMENT MODALITY)
Inclusion criteria:
·  Patients presenting with palpable neck masses
·  Neck lesions detected on ultrasound.
·  Patients presenting with symptoms related to neck area.
Exclusion criteria:
All patients with history of trauma, will be excluded from my study.
Parameters to be measured:
40 patients with neck lesions will be subjected for CT examnation. Then a classification scheme for categorizing neck lesions on the basis of the site of orgin of the lesion and characterisaton of contrast administration will be worked out.
Statistical Methods:
Sensitivity and specificity.
Research Hypothesis and statistical methods will be framed in consultation with bio statistitian
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 Computed Tomography scanning and administration of intravenous contrast, which will be done with the consent of the patient.Doubtful cases will be seen on ultrasound and interventional procedures will be undertaken with the consent of the patient for the confirmation of the diagnosis.
7.4. Has the ethical clearance been obtained from your institution in case of 7.3
Yes
List of references:
Journals :
1.  Debroahl.reede, Margret Anne Whelan, Thomas Bergeron, computed tomography of infrahyoid neck, radiology 1982 ;145:397-402.
2.  Carlos m Martinez, bob w.gayler, Haskins kashima, Stanley s.seigelman. Computed tomography of the neck, Radiographics 1983;201:327-336.
3.  A john silver,micheal e madwad,sadek k hilal etal,computed tomography of carotid and related cervical spaces,radiology 1984;150:729-735
4.  Svojanen, JN; MvKherji, SK; Supuy, DE; Takahashi, JH; Costello, P. Spiral CT in evaluation of head and neck lesion, Radiology. 1992;183:281-3
5.  Lawerence E ginsberg, inflammatory and infectious lesions of the neck,seminars in ultrasound,ct and mri.1997;18:205-219.
6.  H.Imro, chr.czerny and a disisamer, head and neck imaging with mdct2003:42:s23-s31.
7.  Ishigaki,shimamoto,satake etal .multislice spiral ct of thyroid nodules comparison with ultrasound,radiate Med,2004;22:346-353.
8.  Paul silver man.lymphnode imaging:multidetector CT(MDCT);Pubmed:2005:5 (spec No A) S57-S67
.
8. Textbooks:
9. CT with MRI correlation joseph k.t ..lee .stuart s segal,Robert j Stanley,jay
.k.heiken 4th edition,volume volume1/2005,145.
9.  CT and MR Imaging of the Whole Body by John R. Haaga, Charles F.Lan
zieri and Robert C. Gilkeson – 4th Edition-Volume 2/2003 : 1271, 1321.
9. / Signature of the candidate:
10. / Remarks of the Guide:
Neck masses are frequently encountered in the referral hospitals. Early and precise diagnosis helps in the line of management (surgical/therapeutic) depending upon type of lesion, location thereby reducing the morbity and mortality.
Plain radiography has got limitations. So has conventional CT. MDCT is superior to conventional CT in 2 ways
·  Shorter scan time
·  Thinner collimation.
Reconstructed images of MDCT shows better resolution due to thinner collimation. Details of the lesion are better delineated and helps in identifying the orgin and extent of involvement (staging) thus helping the surgeon/onchologist in deciding the best approach, considering vital adjacent structures in the neck.
Not many studies have been conducted in the recent past on the role of new generation CT scanners in evaluating neck masses. Hence I recommend this study.
11. / Name and Designation
11.1.Guide:
11.2. Signature: / DR.B.R NAGARAJ.DMRD, MDRD
Professor,
Department of Radio-Diagnosis, Bangalore Medical College and Research Institute,
Bangalore.
11.3 Co-guide (if any):
11.4. Signature: / DR.H.S.SATHISH M.S(ENT)
PROFF AND HOD
Sri venketaswara ENT institute.
Victoria hospital
Bangalore medical college and research institute.
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: