Post Graduate in Radio-Diagnosis

From

Dr.CHANDRASHEKAR H M

Post Graduate in Radio-Diagnosis

Department of Radio-Diagnosis

Mysore Medical College and Research Institute

Mysore

To

REGISTRAR (EVALUATION)

Rajiv Gandhi University of Health Sciences

Bangalore.

Through Proper Channel

Respected Sir,

Subject: Resubmission of Synopsis titled “COMPUTED TOMOGRAPHIC EVALUATION OF MEDIASTINAL MASSES”.

I am here by resubmitting my Synopsis along with the list of Teachers Recognized to Guide the Dissertation work of PG Medical(MD/MS) students by the RGUHS for Department of Radio Diagnosis in MMC & RI, Mysore, which includes the guide allotted to me earlier and along with the corrections advised. I kindly request you to accept my application & do the needful.

Thanking you,

Yours faithfully,

(Dr. chandrashekar h m.)

Forwarded to The Dean and Director, Mysore Medical College and Research Institute, Mysore for further needful action.

PROFESSOR AND HOD

Date: Department of Radio-Diagnosis

Place: Mysore Mysore Medical College and

Research Institute

Mysore.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA

ANNEXURE - II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) / Dr. CHANDRASHEKAR H M
ROOM NO:216, P.G HOSTEL FOR MEN,
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
IRWIN ROAD, MYSORE
2. / NAME OF THE INSTITUTION / MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
MYSORE – 570001
KARNATAKA.
3. / COURSE OF STUDY AND SUBJECT / POST – GRADUATE
MD RADIO-DIAGNOSIS
4. / DATE OF ADMISSION TO COURSE / 22.07.2012
5. / TITLE OF THE TOPIC / “COMPUTED TOMOGRAPHIC
EVALUATION OF MEDIASTINAL MASSES”
6. / BRIEF RESUME OF THE INTENDED WORK
NEED FOR THE STUDY
The mediastinum is extremely complex and interesting area of the body. The multitude of diseases affecting the mediastinum vary considerably, ranging from tumors (benign to extremely malignant) cysts, vascular anomalies, lymph node masses, mediastinitis and mediastinal fibrosis . Hence every possible effort is made to arrive at a specific diagnosis at the earliest.
CT is the imaging modality of choice in the evaluation of mediastinal lesions. CT is an excellent modality for determining the exact location of the mediastinal tumor, as well as its relationship to adjacent structures. It also is useful in differentiating masses that originate in the mediastinum from those that encroach upon the mediastinum from the lung or other structures. CT scans may help in differentiating various tissue attenuations, and they are highly accurate in differentiating fluid, fat, calcification, and cysts from solid tumors.
While both CT and MR provides cross sectional depictions, CT has better spatial resolutions and shorter imaging time, besides being less expensive and being more widely available. Co-existing lung abnormalities and calcifications within the lesions are better appreciated on CT.
CT apart from evaluating the mediastinal mass accurately, also helps in performing CT guided biopsies. Most of these masses are surrounded by vessels and require precise localization. This requirement is well met with the modern CT scanners. Thus, the use of CT scan greatly expedites the diagnostic process by supplanting multiple previously used image studies such as conventional tomography, barium swallow, mediastinoscopy, thoracotomy and angiographic procedures.
This study is conducted to evaluate the data obtained from thoracic CT of mediastinal masses.
REVIEW OF LITERATURE
The study conducted by Shashi H. Ranganath et al concluded that In both asymptomatic and
symptomatic children with mediastinal masses, imaging evaluation plays a paramount
role by providing precise information regarding location, appearance, size, and relationship
to the adjacent mediastinal structures as well as detecting metastases1.
The study conducted by Elsie T. Nguyen et al concluded that contrast-enhanced
CT allows accurate evaluation of pulmonary artery aneurysms and pseudo aneurysms, facilitating prompt diagnosis and treatment2.
The study conducted by Sung Shine Shim et al concluded that Stage T1 lung cancers showing peak enhancement of 110 H or greater or net enhancement of 60 H or greater on dynamic CT indicate a high likelihood of hilar or mediastinal nodal metastasis3.
The study conducted by Claudia I. Henschke, PhD, MD et al concluded that Mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a “conservative” manner 4.
The study conducted by Scott C. Gaerte et al concluded that the use of CT and MR imaging is extremely valuable in the evaluation of fat-containing lesions
in the thorax. When such lesions are detected, identification of their location and imaging characteristics significantly reduces the time required for differential diagnosis5.
The study conducted by Boger-Megiddo et al concluded that Recurrence of primary mediastinal B-cell lymphoma in patients who achieve complete remission appears to be confined to the chest. Consequently, chest CT alone is sufficient for routine follow-up of these patients6.
The study conducted by Mi-Young Jeung, MD et al concluded that although cystic masses of mediastinum have similar imaging appearances. Clinical history, anatomic position, and certain details seen at CT or MR imaging allow correct diagnosis in many cases. Familiarity with the radiologic features of these lesions facilitates accurate diagnosis, differentiation from other cyst like lesions, and, thus, optimal patient treatment.7
The study conducted by Woo Kyung Moon et al in 49 patients of TB lymphadenitis concluded that CT findings of nodes with central low attenuation and peripheral rim enhancement suggests active disease and findings of homogeneous and calcified lymph nodes suggests inactive disease. Low attenuation within the nodes had pathologic correspondence to areas of caseous necrosis and may be a reliable indicator of disease activity.8
The study conducted by Pamela M Tecce et al concluded although a number of disease process involves anterior mediastinum, CT can yield useful diagnostic information to facilitate their distribution. In a specific clinical settings, such variables as attenuation, calcification, contrast enhancement, relationship to adjacent structures and associated intra thoracic findings may be suggestive of specific diagnosis.9
The study conducted by Akira Kawashima, MD et al concluded that CT is the study of choice for the evaluation of posterior mediastinal masses. Although there may be some overlap in characteristics among various posterior mediastinal masses, in most cases the correct diagnosis can be made solely on the basis of CT examination.10
AIMS AND OBJECTIVES
1. To study the distribution of mediastinal masses.
2. To study the computed tomographic characteristics of mediastinal
Masses in plain and contrast enhanced CT.
3.To study the involvement of neighboring structures by mediastinal
Masses.
4.To compare CT findings with pathological findings and/or USG/MRI findings wherever
Possible.
7.MATERIALS AND METHODS
7.1 Source of Data:
The main source of data for the study is patients from K.R hospital and P.K.T.B hospital attached to Mysore Medical College And Research Institute, Mysore.
7.2 Method of Collection of Data (Including sampling procedure if any)
All patients referred from department of medicine, surgery, pediatrics and TB & chest disease, to the department of radio diagnosis with the clinically suspected cases of mediastinal masses or who had a chest radiograph with suspicion of mediastinal abnormality.
Minimum of 30 cases are intended to be taken up, however the scope of increasing the number of cases depends on the availability within the study period.
Thorough clinical history and clinical examination is done before CT examination. All the cases taken up for the study are evaluated for the distribution, CT features and also the involvement of adjacent structures using GE High Speed Dual-Slice CT Scanner. Biopsy of the masses taken wherever possible
Sample size:30
Sampling Technique: Purposive sampling technique.
Type of study: Diagnostic Study/ Comparative Study.
Statistical Methods:
1.Descriptive Statistics
2.Cross Tabulations
3.Chi-Square Test
4.Sensitivity,specificity,positive predictive value and negative predictive values using SPSS from Windows Media 20.0
Inclusion Criteria
CT study of mediastinum are conducted in
1. Clinically suspected cases of mediastinal mass/lesion.
2.Patients where the chest radiograph showed the mediastinal mass
Exclusion criteria:
1.Cardiac cases
2. Traumatic cases.
Duration of Study : 2 years
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.
Yes,
All patients will undergo clinical examination as a basic tool of investigation and CT guided biopsy wherever possible.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes.
8. / LIST OF REFERENCES
1. Shashi HR, Edward Y. Lee, Ricardo Restrepo, Ronald L.Eisenberg. Mediastinal masses in
children: AJR 2012; 198:W197–W216.
2. Nguyen ET, Silva CI, Seely JM, Chong S, Lee KS, Muller NL: Pulmonary Artery
Aneurysms and Pseudo aneurysms in Adults: Findings at CT and Radiography: AJR 2007;
188:W126–W134.
3. Shim SS, Lee KS, Chung MJ, Kim H, Kwon OJ, Kim S.
Do Hemodynamic Studies of Stage T1 Lung Cancer Enable the Prediction of Hilar or
Mediastinal Nodal Metastasis? : AJR 2006; 186:981–988.
4. Henschke CI, Lee IJ, Wu N, Farooqi A, Khan A, Yankelevitz D, Altorki NK. CT Screening
for Lung Cancer: Prevalence and Incidence of Mediastinal Masses: Radiology 2006;
239:586–590.
5. Gaerte SC, Meyer CA, Winer- Muram HT, Tarver RD, Conces DJ Jr. Fat-containing
Lesions of the Chest: Radio Graphics 2002; 22:S61–S78.
6. Boger-Megiddo I, Apter S, Spencer JA, Ben-Yehuda D, Nof E, Libson E . Is Chest CT
Sufficient for Follow Up of Primary Mediastinal B-Cell Lymphoma in Remission? :
AJR 2002; 178:165–167.
7. Jeung MY, Gasser B, Gangi A, Bogorin A, Charneau D, Wihlm JM, Dietemann JL, Roy C.
Imaging of Cystic Masses of the Mediastinum: Radio Graphics 2002; 22:S79–S93.
8. Moon WK, Im JG, Yeon KM, Han MC. Mediastinal tuberculous Lymphadenitis: CT
findings of active and inactive disease: AJR 1998:170; 715-718.
9. Tecce PM, Fishman EK, Kuhlman JE. CT evaluation of anterior mediastinum: Spectrum of
Disease: Radiographics1994; 14:973-990.
10. Kawashima A, Fishman EK, Kuhlman JE, Nixon MS. CT of posterior mediastinum:
Radio graphics 1991; 11:1045-1067.
Shim SS, Lee KS, Chung
9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE / Plain chest x ray is the initial imaging modality in evaluation of mediastinal masses. Chest x ray findings may be inconclusive in arriving at diagnosis of mediastinal masses, hence CT evaluation of mediastinal masses helps in the characterization of masses and thus helps in appropriate management.
11 / NAME AND DESIGNATION OF (in block letters)
11.1 Guide
11.2 Signature / DR.SHASHIKUMAR M R
ASSOCIATE PROFESSOR
DEPARTMENT OF RADIO-DIAGNOSIS
MMC&RI, MYSORE.
11.3 Co-Guide (IF ANY)
11.4 Signature
11.5 Head of Department
11.6 Signature / DR.NANJARAJ C P
HEAD OF THE DEPARTMENT
DERARTMENT OF RADIO-DIAGNOSIS
MMC&RI, MYSORE.
12 / 12.1Remarks of the Chairman and Principal
12.2 Signature

ETHICAL COMMITTEE CLEARANCE

1. / Title of Dissertation / : / “COMPUTED TOMOGRAPHIC EVALUATION OF MEDIASTINAL MASSES”.
2. / Name of the Candidate / : / Dr. CHANDRASHEKAR H M
3. / Subject / : / M.D. (RADIO-DIAGNOSIS)
4. / Name of the Guide / : / Dr. SHASHIKUMAR M R
Associate Professor
Department Of Radio-Diagnosis
Mysore Medical College and
Research Institute, Mysore.
5. / Approved / Not Approved
(If not approved, suggestion) / :

SUPERINTENDENT SUPERINTENDENT

K.R. Hospital Cheluvamba Hospital

Mysore Mysore

PROFESSOR HOD PROFESSOR AND HOD

Department of Medicine Department of surgery

MMC & RI MMC& RI

Mysore Mysore

SUPERINTENDENT LAW EXPERT

PKTB sanitarium

Mysore.

DEAN AND DIRECTOR

Mysore Medical College and Research Institute, Mysore

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