04:57 CET
EM 3 - The role of radiology in major healthcare challenges faced by Pakistan
Head and Neck Oncologic Imaging GI Tract Chest
Sunday, March 3, 10:30 - 12:00
Room: B
Type of session: ESR meets Pakistan
Topic: Head and Neck, Oncologic Imaging, GI Tract, Chest
Moderators: M. H. Akram (Islamabad/PK), L. E. Derchi (Genoa/IT)

M. H. Akram; Islamabad/PK
Learning Objectives

1. To learn about oral cancer in Pakistan and the role that radiology plays in its management.
2. To appreciate the role of radiology in living donor liver transplant in advanced cases of chronic hepatitis.
3. To understand the variety of radiological findings in tuberculosis.


Infections and malignancies are two major health challenges being faced by Pakistan. Amongst the infections, though gastroenteritis, pneumonia, typhoid and malaria are not uncommon, the major challenges are hepatitis and tuberculosis mainly due to their chronic nature, a variety of presentations, complications and lengthy management. Regarding malignancies; though in Pakistani women the incidence of breast cancer is one of the highest in Asia, the most common cancer which involves a reasonable proportion of both sexes is cancer of the lip and oral cavity. To deal with these three major diseases, radiology is playing a crucial role, not only in diagnosis and early detection of complications but also in the management.

Imaging of oral cancer
N. Ud Din; Lahore/PK
Learning Objectives

1. To understand the peculiar causes of high incidence of oral cancer in different regions of Pakistan.
2. To become familiar with the spectrum and scale of advanced disease in Pakistan.
3. To appreciate the variation in imaging and therapeutic practices across Pakistan.


The actual burden of head and neck cancer in Pakistan is 18.74% of all new cancers. The incidence of oral cancer was highest in males, averaging 11% in 2012. The social and cultural habits across different provinces of the country seem to determine the increasing variable incidence of head and neck cancer in Pakistan. The obvious high risk is associated with the use of betel, areca and chewable tobacco besides family history, smoking habits, occupation and socioeconomic status. In a cross-sectional study, up to 40% of the participants were chewing at least one of these items on a daily basis. The bulk of the oral cancers were along the alveolus. Economic losses related to head and neck cancer in Pakistan totalled US$16.9 billion in 2010, equivalent to 0.26% of the region's economic output. Estimated direct cost of treatment of disease caused by smoking was Rs.68 billion in the year 2000. The economic consequences of head and neck cancer in South Asia are significant. Multidisciplinary management is critical in addressing this burden. The bulk of our patients present with advanced, stages three and four diseases. Staging, treatment planning, follow up and surveillance rely on imaging with CT/MR and PET/CT routinely. Nutrition, speech, hearing, swallowing therapy, rehabilitation support and palliative care are all challenges. Advanced disease at presentation, poor performance status and suboptimum compliance besides limited financial support undermine the treatment outcomes. Approximately 40% of these patients with head and neck tumours die within one year in spite of definite curative treatment.

Interlude: Beautiful Pakistan: from sea to sky-high mountains
A. Majeed; Islamabad/PK
Role of radiology in developing a living donor liver transplant programme
A. I. Rana; Islamabad/PK
Learning Objectives

1. To learn about steps in setting up a successful living donor liver transplant program in Pakistan.
2. To understand requirements of preoperative imaging of potential donors.
3. To learn about various postoperative complications in transplant recipients and role of diagnostic as well interventional radiology in managing them.


Pakistan has one of the highest prevalence rates for viral hepatitis in the world. In a country of approximately 200 million people and a 7% combined burden of hepatitis B virus (HBV) and hepatitis C virus (HCV), it was imperative to have indigenous liver transplantation (LT) program in Pakistan. Living donor liver transplant was initiated in 2012 in our centre, and so far, more than 650 transplants have been performed. Radiology has been at the forefront in this endeavour. Our contribution includes preoperative donor work up with a CT to calculate liver attenuation index, liver volumetric analysis as well as delineation of vascular anatomy for surgical planning. All patients undergo an MRCP as well for biliary anatomy. In the post-operative period, both recipient and donor may require imaging to look for complications such as post-operative collection, vascular complications, or biliary strictures. The most common recipient complication in our patients is a biliary stricture, occurring in about 22% of patients. Our interventional radiologists play an important part in treating these as well as other complications such as post-operative collections, portal vein stenosis or arterial complications.

Interlude: Philanthropic cyber-knife facility in Pakistan
T. Mahmood; Karachi/PK
Many faces of tuberculosis
U. Siddique; Peshawar/PK
Learning Objectives

1. To learn about the prevalence of tuberculosis in Pakistan.
2. To understand the variety of radiological findings in tuberculosis, its diagnosis and complications.


Tuberculosis (TB) is one of the biggest health issues, and in Pakistan, around 430,000 people contract TB with about 70,000 deaths attributed to it, every year. Pakistan ranks 5th globally among the 22 high TB burden countries, contributes an estimated 43% of the disease in the Eastern Mediterranean region and has the fourth highest prevalence of multidrug-resistant TB globally. TB can involve any organ of the body, e.g. respiratory, cardiac, central nervous, musculoskeletal, gastrointestinal and genitourinary systems. Timely diagnosis is paramount since delayed treatment leads to severe morbidity. Therefore radiological workup is necessary for diagnosis. TB can present with a variety of radiological findings. In complicated TB, owing to delayed diagnosis, clinical and radiologic features of TB may mimic malignancy. Although in many cases biopsy or culture specimens are required to make a definitive diagnosis, it is imperative that radiologists understand the typical distribution patterns and imaging manifestations of TB in various organ systems. The goal of this talk would be to delineate the classical imaging findings in many presentations of TB like a stroke with tuberculomas, sciatica in caries spine, chronic diarrhoea in ileocecal TB, constrictive pericarditis causing congestive hepatopathy, cervical adenitis mimicking metastasis and vague pelvic pain in TB related to pelvic inflammatory disease. It is important to define a novel checklist to confirm TB presenting with different faces on imaging. Improvements in TB management can be made by raising the index of suspicion, having better knowledge of specific radiological patterns of disease and extensive screening studies.

Panel discussion: Why are oral cancer, chronic hepatitis and tuberculosis more common in Pakistan, and in which scenarios is the role of radiology crucial in the management of these diseases?
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