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   Table of Contents - Current issue
October-December 2019
Volume 29 | Issue 4
Page Nos. 341-482

Online since Tuesday, December 31, 2019

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Is it important to quantify hepatic fibrosis? p. 341
Anirudh Kohli
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Hyperglycemia-induced seizures - Understanding the clinico- radiological association Highly accessed article p. 343
Shivaprakash B Hiremath, Amol A Gautam, Prince J George, Agnes Thomas, Reji Thomas, Geena Benjamin
Objectives: To highlight the typical magnetic resonance imaging (MRI) findings in hyperglycemia-induced seizures and compare the results with similar previous studies with a brief mention of pathophysiological mechanisms. Materials and Methods: This retrospective study included medical and imaging records of six consecutive patients with hyperglycemia-induced seizures. The data analysis included a clinical presentation and biochemical parameters at admission. The MRI sequences were evaluated for region involved, presence of subcortical T2 hypo-intensity, cortical hyper-intensity, and restricted diffusion. Similar previous studies from the National Library of Medicine (NLM) were analyzed and compared with our study. Results: Twenty-four patients were included from four studies in previous literature for comparison. In our study, on imaging, posterior cerebral region was predominantly involved, with parietal involvement in 83.3%, followed by occipital, frontal, and temporal involvement in 33.3% patients compared with occipital in 58.3%, parietal in 45.8%, and frontal and temporal in 16.6% of patients in previous literature. The subcortical T2 hypo-intensity was present in 83.3% of the patients, cortical hyper-intensity in all patients, and restricted diffusion in 66.6% of the patients in our study compared with subcortical T2 hypo-intensity in 95.8% of the patients, cortical hyper-intensity in 62.5%, and restricted diffusion in 58.3% of the patients in previous literature. Conclusion: Although many etiologies present with subcortical T2 hypointensity, cortical hyperintensity, restricted diffusion, and postcontrast enhancement on MRI, the clinical setting of seizures in a patient with uncontrolled hyperglycemia, hyperosmolar state, and absence of ketones should suggest hyperglycemia-induced seizures to avoid misdiagnosis, unnecessary invasive investigations, and initiate timely management. Advances in Knowledge: Our study highlights the presence of posterior predominant subcortical T2, fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN) hypointensity; cortical hyperintensity; and restricted diffusion in hyperglycemia-induced seizures. The presence of T2 and SWAN hypointensity could support the hypothesis of possible deposition of free radicals and iron in the subcortical white matter.
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Neonatal hypoxic encephalopathy: Correlation between post-cooling brain MRI findings and 2 years neurodevelopmental outcome p. 350
Emilia Rosniza Mohammed Rusli, Juriza Ismail, Wong Saw Wei, Shareena Ishak, Rohana Jaafar, Faizah Mohd Zaki
Objective: This study aims to evaluate the magnetic resonance imaging (MRI) brain patterns among hypoxic-ischemic encephalopathy (HIE) babies who underwent post-cooling MRI brain as well as to correlate the post-cooling brain scoring with patient's neurodevelopmental outcome at 2 years. Subjects and Methods: It was a retrospective cross sectional study carried out at a tertiary university hospital. Record of patients diagnosed with neonatal HIE from 2007 until 2016 who completed 72 h of cooling therapy and had MRI brain within 2 weeks of life were included in this study. A new scoring system by Trivedi et al. that emphasizes on subcortical deep gray matter and posterior limb internal capsule injury were utilized upon MRI assessment, using TW, T2W, and diffusion-weighted imaging (DWI) sequences. Cumulative MRI brain score was obtained and graded as none, mild, moderate, and severe brain injury. The MRI brain scoring was then correlated with patient's 2 years neurodevelopmental outcome using Fisher's Exact Test. Results: A total of 23 patients were eligible of which 19 term neonates were included. 13% of these neonates (n = 3) had mild MRI brain injury grading with 52.2% (n = 12) moderate and 34.8% (n = 8) severe. There was no significant correlation seen between MRI brain grading and developmental outcome at 2 years old (P > 0.05). Conclusion: There was no significant correlation between neonatal MRI brain injury grading and 2 years neurodevelopmental outcome. Nevertheless, the new MRI brain scoring by Trivedi et al. is reproducible and comprehensive as it involves various important brain structures, assessed from different MRI sequences.
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Evaluation of cerebral microstructural changes in adult patients with obstructive sleep apnea by MR diffusion kurtosis imaging using a whole-brain atlas p. 356
Sameer Vyas, Paramjeet Singh, Niranjan Khandelwal, Varan Govind, Ashutosh Nath Aggarwal, Manju Mohanty
Purpose: The association between obstructive sleep apnea (OSA) and cognitive impairment is well-recognized, but little is known about neural derangements that underlie this phenomenon. The purpose of this study was to evaluate the utility of diffusion kurtosis imaging (DKI) using a whole-brain atlas to comprehensively assess microstructural tissue changes in the brain of patients with OSA. Methods: This prospective study was conducted in 20 patients with moderate-to-severe OSA and 20 age- and gender-matched controls. MRI data acquisition was performed with 3 Tesla and data was analyzed using a whole-brain atlas. DKI data were processed and transformed into a brain template space to obtain various kurtosis parameters including axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and kurtosis fractional anisotropy (KFA) using a 189-region brain atlas in the same template space. These kurtosis measurements were further analyzed using a student t-test in order to determine kurtosis measurements that present significant differences between the OSA patient set and the control set. Results: Significant differences (P < 0.05) were found in AK (54 regions), RK (10 regions), MK (6 regions) and KFA (41 regions) values in patients with OSA as compared to controls. DKI indices, using an atlas-based whole-brain analysis approach used in our study, showed widespread involvement of the anatomical regions in patients with OSA. Conclusion: The kurtosis parameters are more sensitive in demonstrating abnormalities in brain tissue structural organization at the microstructural level before any detectable changes appear in conventional MRI or other imaging modalities.
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Role of the weight-bearing cone-beam CT in evaluation of flatfoot deformity p. 364
Khushboo Pilania, Bhavin Jankharia, Pradeep Monoot
Introduction: Till date, weight-bearing radiographs have been the cornerstone for planning surgeries on flatfoot. The technique, however, has limitations due to the superimposition of the bones and the lack of reproducibility. Weight-bearing CT with its unique design overcomes these limitations and enables cross-sectional imaging of the foot to be done in the natural weight-bearing position. In this paper, we report our initial experience in weight-bearing cross-sectional imaging of the foot for assessment of flatfoot deformity. Materials and Methods: Around 19 known cases of flatfoot were scanned on the weight-bearing CT. Each foot was then assessed for the various angles and also for the presence/absence of extra-articular talocalcaneal impingement and subfibular impingement. Other associated abnormalities like secondary osteoarthritic changes, were also noted. Results: The Meary, as well as the calcaneal angles, were abnormal, in all but one separate foot. Forefoot abduction was seen in 7 of the 19 feet. The hind foot valgus angle was greater than 10° in all patients. Extra-articular talocalcaneal impingement was seen in 13 of 19 feet. Secondary osteoarthritic changes were seen in 14 feet. Conclusion: Weight-bearing CT scan is a very useful technique for evaluation of flatfoot and associated complications. It overcomes the limitations of the radiographs by providing multiplanar three-dimensional assessment of the foot in the natural weight-bearing position and at the same time being easily reproducible and consistent for the measurements around the foot. The definite advantage over the conventional cross-sectional scanners is the weight-bearing capability.
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Spondyloarthropathy - Is sacroiliac joint imaging sufficient? A study of 431 patients p. 372
Saurabh Gupta, Neha Nischal, Lucky Sharma, Rajiva Gupta, Jatinder Pal Singh
Background: Sacroiliac (SI) joint involvement (sacroiliitis) is considered as major criteria for diagnosing Spondyloarthropathy (SpA), although involvement of spine and hip can also occur. The aim of our study was to assess the utility of including sagittal short-tau inversion recovery (STIR) sequence of dorsolumbar spine and coronal STIR/proton density (PD) fat saturated sequence through both hips, to routine SI joint magnetic resonance (MR) imaging protocol, in patients clinically suspected to have SpA. Material and Methods: A retrospective observational study was conducted between February 2013 and February 2018 on clinically suspected SpA patients referred to our department for imaging. The images obtained using this new SI joint protocol were evaluated for findings suggesting SpA diagnosis as per the Assessment of SpondyloArthritis international Society criteria. Other differentials for similar symptoms were also looked for. Results: Of the 431 patients (313 M and 118 F), 255 had features confirming the diagnosis of SpA and 176 had no radiological manifestations of SpA (56 were normal and 120 had other findings to suggest clinical symptoms; e.g., degenerative SpA, Pott's spine, skeletal metastases, early AVN of hip, cysticercus, iliofemoral impingement). 19/255 patients had normal SI joints but other findings to suggest diagnosis of SpA, e.g. romanus lesions, costovertebritis/costotransversitis, pubic symphysitis, inflammatory hip arthropathy, enthesitis, iliofemoral/trochanteric bursitis. 33/61 patients with chronic sacroiliitis had disease activity in spine or hip. Conclusion: Inclusion of sections through dorsolumbar spine and both hips to routine SI joint protocol, helped in identifying: (a) early disease in 19 patients, who had normal SI joints and may have otherwise been missed with routine only SI joint imaging, (b) additional findings in SpA-related sacroiliitis, (c) disease activity in chronic sacroiliitis, and (d) other causes of low back pain and thus helped in further patient management.
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Is MRI diffusion-weighted imaging a reliable tool for the diagnosis and post-therapeutic follow-up of extremity soft tissue neoplasms? p. 378
Amr Farouk Moustafa, Mai Maher Eldaly, Rania Zeitoun, Ahmed Shokry
Purpose: The aim of this study was to evaluate the benefit of using quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the initial diagnosis and post-therapeutic follow-up of extremity soft tissue masses. Patients and Methods: This study included 90 patients with extremity soft tissue masses. The DWI was obtained with 3 b values, including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done by placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared with the histopathology. Eighteen patients had posttherapeutic magnetic resonance imaging (MRI). Results: Benign masses, fibromatosis, and malignant soft tissue masses had mean ADC values of 1.18 ± 1.0191 × 10−3 mm2/s; 1.31 ± 0.245 × 10−3 mm2/sec; and 1.3 ± 0.7 × 10−3 mm2/s, respectively. Myxomatous malignant masses had an ADC value of 2.6 ± 0.55 × 10−3 mm2/s, while nonmyxomatous malignant masses had an ADC value of 1.1 ± 0.8 × 10−3 mm2/s. ADC cutoff value between benign and non-benign (including malignant and locally aggressive masses) was 0.6 × 10−3 mm2/sec with 98.3% sensitivity and 50% specificity (P = 0.5123). The statistical difference between malignant soft tissue masses (mean ADC 1.309 ± 0.723 × 10−3 mm2/s) and fibromatosis masses (mean ADC value 1.31 ± 0.245 × 10−3 mm2/s) using a comparative T-test proved to be of poor significance level (P value ~ 0.9757). Nine patients with soft tissue sarcomas (STSs) had pre and post-therapeutic MRI examinations showing a mean increase of the recorded ADC values by about 0.28 × 10−3 mm2/s in the post-therapy study as compared with the recorded initial pretreatment values. Analysis of the post-therapy follow-up studies of fibromatosis showed that lesions with favorable response to chemotherapy or radiotherapy (8/12) exhibited significantly lower ADC values than those showing progressive disease course. Conclusion: DWI with ADC mapping of extremity soft tissue tumors are so complicated that they alone may not be of much value in differentiating between benign and malignant tumors; however, it can be used as a tool for monitoring response to treatment.
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Dual energy CT and research of the bone marrow edema: Comparison with MRI imaging p. 386
Luca Saba, Massimo De Filippo, Francesco Saba, Federica Fellini, Pierre-Yves Marcy, Robert Dagan, Philippe Voituriez, Jacques Aelvoet, Gérard Klotz, Roland Bernard, Valérie Salinesi, Serge Agostini
Aims: To evaluate the diagnostic accuracy of the Dual Energy Computed Tomography (DECT) in the research of the bone marrow edema. Methods and Material: The MRI images of 100 patients with episodes of articular and or bone pains with or without traumatic lesion were prospectively evaluated during a period between March 2018 and February 2019. In the presence of bone marrow edema, a DECT was performed. The measurement of the density of the bone marrow edema in the DECT was compared with healthy bone in the same patient by two operators. Result: The DECT and MRI images of 15 patients with bone marrow edema were compared. The mean of pathologic bone marrow edema was 1008.20 (Standard Deviation (SD) 23.00), for healthy bone marrow 947.53 (SD 16.42), and t = 11.75, with a statistical significance P < 0.05 (Statistical significance 95%). The agreement between the measurements of the two radiologists has a statistical significance (P < 0.05). Conclusion: The DECT presents an excellent diagnostic accuracy to detect the bone marrow edema, comparable to MRI. The utility of these recent possibilities is maximum where access to MRI is still very difficult.
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The role of an IVC filter retrieval clinic—A single center retrospective analysis p. 391
Philip A Schuchardt, Junaid T Yasin, Ryan M Davis, Sanjit O Tewari, Ambarish P Bhat
Background: Inferior vena cava (IVC) filter placement still plays an essential role in preventing pulmonary embolism (PE) in patients with contraindications to anticoagulant therapy. However, IVC filter placement does have long-term risks which may be mitigated by retrieving them as soon as clinically acceptable. A dedicated IVC filter clinic provides a potential means of assuring adequate follow-up and retrieval. Aim: To assess the efficacy of our Inferior vena cava (IVC) filter retrieval clinic at improving the rate of patient follow-up, effective filter management, and retrieval rates. Materials and Methods: During the period of August 2017 through July 2018, 70 IVC filters were placed at our institution, and these patients were automatically enrolled into our IVC filter retrieval clinic for quarterly follow-up. We retrospectively reviewed data including appropriateness for removal at 3 months, overall retrieval rates, removal technique(s) employed, and technical success. Results: 62.9% of the potentially retrievable filters were removed during the study period. The technical success of extraction, using a combination of standard and advanced techniques, was 91.7%. Overall, 15% of the patients were lost to follow-up. Conclusion: Our findings add to the growing body of literature to support the need for a robust IVC filter retrieval clinic to ensure adequate follow-up and timely retrieval of IVC filters.
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Stem cell therapy in critical limb ischemia: Current scenario and future trends p. 397
Arun Sharma, Mumun Sinha, Niraj Nirmal Pandey, SH Chandrashekhara
Critical limb ischemia (CLI) represents the most severe manifestation of peripheral arterial disease (PAD). It imposes a huge economic burden and is associated with high short-term mortality and adverse cardiovascular outcomes. Prompt recognition and early revascularization, surgical or endovascular, with the aim of improving the inline bloodflow to the ischemic limb, are currently the standard of care. However, this strategy may not always be feasible or effective; hence, evaluation of newer pharmacological or angiogenic therapies for alleviating the symptoms of this alarming condition is of utmost importance. Cell-based therapies have shown promise in smaller studies; however, large-scale studies, demonstrating definite survival benefits, are entailed to ascertain their role in the management of CLI.
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Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer p. 404
Ankush Jajodia, Vivek Mahawar, Arvind K Chaturvedi, Avinash Rao, Rishu Singla, Swarupa Mitra, Sumit Goyal, Sikha Kesan, Sunil Pasricha, Udip Maheshwari, Rupal Tripathi, Venkata Pradeep Babu Koyyala
Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.
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Samrakshan: An Indian radiological and imaging association program to reduce perinatal mortality in India Highly accessed article p. 412
Rijo M Choorakuttil, Hemant Patel, Rajalingam Bavaharan, Palanisamy Devarajan, Saneej Kanhirat, Ramesh S Shenoy, Om P Tiwari, Rajendra K Sodani, Lalit K Sharma, Praveen K Nirmalan
Context: India has a high perinatal mortality rate. The Indian Radiological and Imaging Association (IRIA) is supplementing efforts to address perinatal mortality in India through the Samrakshan program. Aims: To describe various elements of the Samrakshan program that aims to reduce perinatal mortality in India. Methods: Samrakshan focuses on two priority areas, preeclampsia (PE) and fetal growth restriction (FGR). Samrakshan aims at technical skill upgradation, specifically focused on improved interpretative ability, prognostic and therapeutic efficacy using Doppler studies, a free online learning platform and offline continuous medical educations (CMEs), building an evidence base from the program to develop policy and guidelines, and improving synergy with the RAKSHA program of IRIA and other fetal care stakeholders. Results: Two courses on Doppler studies focused on first trimester and third trimester, supplemented by case discussions and journal articles, have started on the online platform with 230 registrants. The first statewide CME was held at Indore. Samrakshan screening identified 10 (17.24%, 95% CI: 8.59, 29.43) women at high risk for preterm PE and 29 (50.00%, 95% CI 36.58, 63.42) women at high risk for FGR in the first trimester. Ten fetuses (7.63%, 95% CI: 3.72, 13.59) including 9 with stage 1 FGR were identified in the third-trimester screening. Conclusions: Samrakshan is a flagship program of IRIA that aims to reduce perinatal mortality in India through a synergistic, holistic approach that complements and supplements existing efforts in India.
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Chest radiography in adult critical care unit: A pictorial review Highly accessed article p. 418
Sanjay N Jain, Tanvi Modi, Yashant Aswani, Ravi U Varma
Patients in the intensive care units suffer from a myriad of cardiopulmonary processes for which portable chest radiography is the most utilized imaging modality. A pragmatic approach toward evaluating the nearly similar radiographic findings seen in most of the pathologies with comparative review and strong clinical acumen can help the radiologists and clinicians achieve a rapid and precise diagnosis.
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Acute encephalopathy with biphasic seizures and late reduced diffusion (central sparing type)—MRI and MR spectroscopy findings p. 426
Rahul S Ranjan, Gaurav Arya, Vikas K Yadav
Acute encephalopathy with biphasic seizure and late reduced diffusion (AESD) is a clinico-radiologic syndrome of acute encephalopathy characterized by biphasic seizure and altered consciousness in acute phase followed by restricted diffusion in bilateral cerebral parenchyma on magnetic resonance imaging (MRI) in the subacute stage. Here, we present the MRI and magnetic resonance spectroscopy (MRS) findings in a case of AESD presenting in 4-year child and diagnosed based on clinico-radiological correlation.
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Metronidazole induced encephalopathy: A rare side effect with a common drug p. 431
Venkatesh Vaithiyam, Ranveer S Jadon, Animesh Ray, Smita Manchanda, Ved P Meena, Piyush Ranjan, Naval K Vikram
In hospitals, seizures and encephalopathy are one of the common complications observed in critically ill patients. Drug intoxication, metabolic derangements, and anatomical abnormalities can cause altered mental status. We encountered an uncommon case with a diagnostic dilemma due to persistent encephalopathy, where metronidazole toxicity was an etiological factor. A 45-year-old male, who was admitted with the diagnosis of ruptured amoebic liver abscess. During the course of his management, he developed seizures and altered sensorium. After excluding other etiologies for in-hospital de novo seizure, a suspicion of metronidazole toxicity was considered. MRI brain was done which suggested the same. Metronidazole induced encephalopathy (MIE) is an uncommon adverse effect of treatment with metronidazole. Diagnosis is made by identifying specific radiological findings. It characteristically affects the cerebellum and subcortical structures. While the clinical and neuroimaging changes are usually reversible, persistent encephalopathy with poor outcomes may occur as seen in our case.
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Hypertrophic olivary degeneration: A case report p. 435
Meltem Özdemir, Aynur Turan, Rasime Pelin Kavak, Alper Dilli
Hypertrophic olivary degeneration is a rare occurrence in which different pathological processes including enlargement and vacuolation of the neurons, demyelination of the white matter, and fibrillary gliosis of the inferior olivary nucleus take place. It mostly develops secondary to a destructive lesion involving the Guillain–Mollaret pathway. The mostly reported destructive lesions causing hypertrophic olivary degeneration are stroke, trauma, tumors, neurosurgical interventions, and gamma knife treatment of brainstem cavernoma. It presents with symptomatic palatal tremor, and typically appears as an expansive nonenhancing nodular lesion that shows increased signal intensity on magnetic resonance imaging (MRI). The identification of hypertrophic olivary degeneration on MRI is of great importance as its MRI appearance is very similar to those of more severe pathologies, including tumors, infarction, demyelinating lesions, and infections. We present a case of hypertrophic olivary degeneration in a patient with a history of ischemic stroke two years before the development of palatal tremor.
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Imaging in a rare case of intramuscular angioleiomyoma around the knee joint p. 438
Vinay Maurya, R Ravikumar, Krishnendu Sarkar, Richa Ranjan
Angioleiomyoma are rare benign tumors originating from smooth muscles of veins. They are found more commonly in extremities and are seen in subcutaneous tissue. Intramuscular angioleiomyoma is rare and can be confused with hemangioma. Though they do not have any characteristic imaging features but they should be considered in the differential diagnosis due to certain specific imaging findings on MRI which are discussed in this article.
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Imaging diagnosis of Crouzon syndrome in two cases confirmed on genetic studies - with a brief review p. 442
Shabnam Bhandari Grover, Aanchal Bhayana, Hemal Grover, Seema Kapoor, Harish Chellani
Crouzon syndrome is the most common form of craniofacial dysostosis, characterised by a classical triad of abnormal skull shape, abnormal facies, and exophthalmos. The clinically overt dental abnormalities in these patients, distracts clinicians from the developmental neurological defects and therefore this entity remains relatively under - highlighted in radiology literature. We report and highlight the role of imaging in diagnosis of Crouzon syndrome in two patients, and discuss the relevant differential diagnosis. Moreover, our report is among the few Indian studies in which Crouzon syndrome was confirmed by genetic studies. The classical clinical triad of Crouzon syndrome was observed in both patients. The skull radiographs and cranial CT with 3D reconstruction VRT (Volume rendered technique), revealed characteristic radiological features. Genetic studies reconfirmed the clinical and radiological diagnosis of Crouzon syndrome, in both patients.
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Prenatal diagnosis of congenital harlequin ichthyosis with fetal MRI p. 448
Kiran A Kale, Nitin P Ghonge, Anita Kaul
Most of the fetal deformities are caused due to genetic abnormalities. Although magnetic resonance imaging (MRI) may be used to accurately diagnose these deformities, it has been reported that gene analysis is a more accurate diagnostic method. Harlequin ichthyosis (HI) or Ichthyosis fetalis (IF) is a rare and extremely severe hereditary skin disorder with autosomal recessive inheritance. The ultrasound features have been described well and the diagnosis can be made with a fair degree of confidence. However, the final diagnosis needs to be established by prenatal invasive tests. In the present study, we describe the diagnosis of HI in the third trimester on fetal MRI referred to our department with suspicion of anterior encephalocele which was later confirmed through postnatal genetic evaluation.
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Prenatally diagnosed case of tricuspid valve dysplasia: A case report with review of the literature p. 452
Prateek Agarwal, Rajesh Agarwal
We present a case of fetal tricuspid valve dysplasia (TVD) and pulmonary atresia, diagnosed during a routine obstetric ultrasound scan. Serial fetal echocardiographic evaluations revealed progressively augmented prodigious thickening of the tricuspid valvular and subvalvular structures, which eventually extensively obliterated the right ventricle cavity. Thickened dysplastic valve displayed a “cotton-wool” appearance. Unusual configurations of three vessels in the three-vessel view were also observed on a consecutive gray scale and color Doppler scans. During pregnancy, the fetus exhibited satisfactory growth parameters, and complications of progressive hemodynamic compromise associated with TVD and pulmonary atresia such as grievous hydrops or arrhythmia did not develop till 39 weeks of gravidity.
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Perineal scar endometriosis p. 457
S Shanmuga Jayanthan, G Shashikala, N Arathi
Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterine cavity. It is a benign condition commonly observed in women of the reproductive age group. It can occur in both pelvic and extra-pelvic sites. Moreover, pelvic endometriosis is relatively common, as compared to extra-pelvic endometriosis. The most frequent site for pelvic endometriosis is ovary. It can also affect rectum, uterosacral ligaments, rectovaginal septum, urinary bladder. Extra-pelvic endometriosis is rare and when it occurs, does so more frequently in surgical scar sites, especially in caesarean section scar. Endometriosis in an episiotomy scar is extremely rare but can lead to significant morbidity in patients due to local infiltration. This condition can be diagnosed by the presence of the classical clinical triad of history of episiotomy, tender nodule at the scar site and cyclical pain. Magnetic resonance imaging (MRI) is a very useful imaging modality to diagnose and assess the deeper extension of the lesion. Herein, we report one such case of episiotomy scar endometriosis in the perineum.
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Hepatic arterial communicating arcades—Case series and review of literature p. 462
Nischal G Kundaragi, Sonal Asthana, Jayanth Reddy, Rajiv Lochan
This case series describes the hepatic arterial communicating arcades and their importance in the endovascular management of hepatic artery pseudoaneurysm, pediatric post liver transplant lobar arterial occlusion, and lobar arterial stenosis due to gall bladder carcinoma. We describe new types of arterial communicating arcades which have not been described earlier.
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Osseous metaplasia of antrochoanal polyp: Case report and radiological–pathological correlation p. 468
Samrat Mandal, Arindam Bhandari, Sunil Jalan, Rajib Kumar Mondal
Osseous metaplasia of inflammatory sinonasal polyp is an extremely rare entity. Correct preoperative diagnosis by noncontrast CT scan is needed to rule out other more common bony neoplasms in paranasal sinuses and for accurate surgical planning. Here, we present a case of 20-year-old patient with an antrochoanal polyp with osseous metaplasia. We describe the lesion and discuss the radiological differential diagnosis thereby providing a brief review of literature of the few published cases worldwide along with histopathological correlation.
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Teratoma involving adrenal gland – A case report and review of literature p. 472
Amit Ban, Jay Satapara, Ketan Rathod, Nandini Bahri
Teratomas are germ cell tumors which are mainly gonadal in origin. Other common extra-gonadal sites are mediastinal, sacro-coccygeal and pineal regions. Adrenal teratomas are extremely rare and primary adrenal teratomas are even rarer. We reported a case of primary adrenal teratoma in a 60-year-old male. We reviewed literature from 2000 to till date, and found 29 adult cases and 6 paediatric cases of adrenal teratoma. Usually, they are asymptomatic and identified as an incidental finding. Imaging modality such as USG, CT and MRI are useful in diagnosis. Though these tumors are mostly benign, malignant transformation may occur. Treatment includes surgical removal.
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Holography applications for orthopaedics p. 477
Abid Haleem, Mohd Javaid, Raju Vaishya
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Segmental spinal dysgenesis: A rare congenital spinal malformation p. 480
Suprava Naik, Sanjeev K Bhoi, Keshaba Panigrahi, Nerbadyswari Deep
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Quality of radiology training in India p. 481
Ankita Ahuja, Chinmay P Mehta, Palak B Popat, Akshay D Baheti
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