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January-March 2018
Volume 28 | Issue 1
Page Nos. 1-135

Online since Tuesday, March 27, 2018

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EDITORIAL  

Turf wars in radiology research: “Are the honoraries ready to come out and defend their territory?” p. 1
Chander Mohan
DOI:10.4103/ijri.IJRI_87_18  PMID:29692516
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PRESIDENTIAL ADDRESS Top

Presidential address p. 3
K Mohanan
DOI:10.4103/ijri.IJRI_114_18  PMID:29692517
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NEURORADIOLOGY & HEAD AND NECK IMAGING Top

Transient global amnesia: Diffusion MRI findings Highly accessed article p. 6
Tarun P Jain, Ronak Patel, Yash Gawarikar
DOI:10.4103/ijri.IJRI_12_17  PMID:29692518
Introduction: Aim of this study is to identify and describe the MRI findings in patients with Transient Global Amnesia (TGA), specifically on Diffusion Weighted Imaging (DWI) sequence. Methods: MRI findings in 12 patients with clinical diagnosis of TGA were retrospectively analysed. MRI brain was performed with a 3T scanner on 11 patients and 1.5T scanner on 1 patient. DWI were acquired at B value of 1000 s/mm2 in 4 patients, 2000 s/mm2 in 2 patients and both 1000 and 2000 s/mm2 in 6 patients. Results: There were 7 female and 5 male patients. The mean age was 65.67 years (range 61-74 years). The median time interval between the onset of symptom and MRI scan was 47.5 hours, range 25-114 hours. 11 of the 12 patients showed punctate foci of restricted diffusion in hippocampus (mean size 3.7 mm (range 2-6.5 mm). 10 patients showed foci in left hippocampus. Nine patients showed a single focus, 1 patient showed three foci and 1 patient showed four foci. In 6 patients who had DWI MRI at both B values, scans at B value of 1000 s/mm2 revealed abnormality in 4 patients, while higher B value imaging improved sensitivity in one patient and one patient had a negative scan at both B values. Conclusion: We have highlighted the MRI finding of typical punctate foci of bright signal in hippocampus seen on DWI in patients diagnosed with TGA. Detection on a routine stroke MRI protocol can avoid need for dedicated TGA protocols or repeat scan, improving the workflow.
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Doppler indices of superior thyroid artery in clinically euthyroid adults Highly accessed article p. 10
Upendra Kumar Joish, Y Kavitha, R Harikiran Reddy, Anitha S Prabhu, M Chetan Kumar, MC Siddharth
DOI:10.4103/ijri.IJRI_194_17  PMID:29692519
Context: Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA). Aims: To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals. Settings and Design: Prospective cross-sectional observational study. Materials and Methods: A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated. Results: A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders. Conclusion: Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.
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Hemiagenesis of thyroid with dual thyroid ectopia: A rare case report p. 14
Pankaj S Jha, Varsha Rote-Kaginalkar, Prashant Titare, Manoj B Jadhav
DOI:10.4103/ijri.IJRI_292_17  PMID:29692520
Developmental defects of the thyroid gland are very rare. The common developmental abnormalities are ectopic thyroid, hemiagenesis and agenesis of thyroid gland. These developmental defects may or may not be associated with deranged thyroid function tests. Ultrasonography (USG) is the initial modality of choice for thyroid hemiagenesis but further evaluation by computed tomography (CT) scan or nuclear scan should be done to look for ectopic thyroid tissue rest. Here, we report a rare case of a 9-year-old female having hemiagenesis of the right thyroid lobe and isthmus along with dual ectopic thyroid tissue at prehyoid and infrahyoid regions of the neck presenting as a midline neck swelling and subclinical hypothyroidism.
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Clinicoradiological aspects of pontine tegmental cap dysplasia: Case report of a rare hindbrain malformation p. 18
Aanchal Bhayana, Sunil K Bajaj, Ritu N Misra, S Senthil Kumaran
DOI:10.4103/ijri.IJRI_25_17  PMID:29692521
Malformations involving the brainstem are very rare and present with a varied spectrum of clinical symptoms due to multiple cranial nerve palsies and pyramidal tract involvement. Of these, pontine tegmental cap dysplasia is a very unusual malformation, characterized by ventral pons hypoplasia and an ectopic dorsal band of tissue, projecting into the fourth ventricle, from dorsal pontine tegmentum. A 4-year-old male child, presenting with left facial nerve palsy, revealed hypoplastic ventral pons and an ectopic structure on magnetic resonance imaging (MRI). The ectopic structure was isointense to pons, arose from the left side of dorsal pontine tegmentum, at pontomedullary junction and protruded into the fourth ventricle, impinging upon the left seventh and eighth cranial nerves. Diffusion tensor imaging (DTI) depicted abnormal white matter tracts in ectopic tissue with absent transverse pontine fibres and abnormal middle and superior cerebellar peduncles. The typical MRI appearance, coupled with DTI, helped us reach an accurate diagnosis of pontine tegmental cap dysplasia, in a setting of neurological dysfunction.
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Frontal subcutaneous lipoma associated with interhemispheric lipoma, lipomeningocele, and corpus callosal dysgenesis in a young adult: CT and MRI findings p. 22
Nidhi Aggarwal, Kushal B Gehlot, Sunil D Kumar, N K Kardam Alsaba Khan
DOI:10.4103/ijri.IJRI_280_17  PMID:29692522
Intracranial lipomas are rare incidental lesions. Rokitansky first described a corpus callosal lipoma on the posterior part of the corpus callosum in 1856. Since then many cases have been reported. We report the imaging findings of an interhemispheric lipoma extending into subcutaneous plane associated with spinal lipomeningocele and corpus callosal dysgenesis. Computed tomography and magnetic resonance imaging findings are characteristic. All cases have been reported in pediatric age group till now. Such a case in this age group has not been reported earlier.
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GENITOURINARY RADIOLOGY Top

Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner! p. 27
Ankur Goyal, Raju Sharma, Ashu S Bhalla, Shivanand Gamanagatti, Amlesh Seth
DOI:10.4103/ijri.IJRI_40_17  PMID:29692523
Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC). Materials and Methods: One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging. Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi. Conclusions: Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.
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Different etiologies of an unusual disease: Colouterine fistula – Report of two cases p. 37
Rohit Aggarwal, Venkatraman Indiran, Prabakaran Maduraimuthu
DOI:10.4103/ijri.IJRI_172_17  PMID:29692524
Colouterine fistula is an extremely rare condition, as the uterus is a thick, muscular organ. Here, we present two different etiologies for this rare condition—diverticulitis and malignancy. A 77-year-old female with colouterine fistula due to diverticulitis presented with complaints of lower abdominal pain localized particularly in the left iliac fossa and fever. Another case was of 73-year-old female with colouterine fistula due to malignancy who presented with abdominal pain, blood in stools, and whitish discharge from vagina. Both cases were evaluated with contrast-enhanced computed tomography (CECT). The presence of air and fluid within the uterus on ultrasound or CT scan, prompts the possibility of colouterine fistula with CECT providing accurate preoperative assessment.
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Hernia uteri inguinalis in ovotesticular disorder of sexual differentiation: A rare complication and role of imaging p. 41
Janardhana Ponnatapura
DOI:10.4103/ijri.IJRI_178_17  PMID:29692525
Neonate with ambiguous genitalia can cause great apprehension for the family as well as for healthcare providers. We report a rare complication of delayed diagnosis of hernia uteri inguinalis in ovotesticular disorder of sexual differentiation (DSD) in 20-year-old male patient who presented with pain and swelling in left inguinal region since 1 month. He had a past surgical history of repair of hypospadias 10 years back. On imaging, the left inguinal hernia sac contained nonfunctioning uterus and one ovary in the left scrotal sac and one testis in the right scrotal sac. Further investigation confirmed genotypically female (46XX) with negative sex determining region-Y gene on fluorescence in situ hybridization. The patient was given psychiatric counseling and wished to remain as male. The left inguinal hernia was repaired with excision of nonfunctioning uterus, ovary, and fallopian tube. Hernia uteri inguinalis is rare complication seen in DSD with only three cases being reported worldwide thus far, including our case.
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Utility of ureteric jet: A simple yet useful tool for the evaluation of complex urogenital anomaly p. 45
Pranav K Santhalia, Disha Mittal, Arun K Gupta, Manisha Jana
DOI:10.4103/ijri.IJRI_208_17  PMID:29692526
In infants and young children with suspicion of genitourinary tract anomalies, ultrasonography (USG) is usually the first imaging modality. Advantages of USG are well described. In the evaluation of complex congenital urogenital anomalies, ultrasound examination needs to be tailored according to the clinical suspicion and to yield maximum information. Primary megaureter is a congenital anomaly, which is associated with dilatation of ureter above an adynamic segment at the vesicoureteric junction (VUJ). Two different types are described in the literature: refluxing and obstructive. Absence of ureteric jet on USG in conjunction with vesicoureteric reflux (VUR) on voiding cystourethrogram (VCUG) prompts to the diagnosis of refluxing type of obstructed megaureter. Here we describe a case of duplex moiety with refluxing type of obstructed megaureter, where gray-scale USG and real-time color Doppler evaluation of the ureteric jet established the diagnosis. The aperistaltic segment of lower ureter near the VUJ with an absence of ureteric jet for the same moiety suggested the possibility of an obstructed megaureter. VUR was demonstrated on VCUG; thus, pointing toward a diagnosis of obstructed refluxing megaureter.
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GASTROINTESTINAL RADIOLOGY AND HEPATOLOGY Top

Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases p. 49
Binit Sureka, Archana Rastogi, Amar Mukund, Shalini Thapar, Ajeet Singh Bhadoria, Tushar Kanti Chattopadhyay
DOI:10.4103/ijri.IJRI_421_16  PMID:29692527
Purpose: To study the imaging findings in gangrenous acute cholecystitis. Materials and Methods: Retrospective analysis of imaging findings in 31 histopathologically confirmed cases of gangrenous cholecystitis was done. The following imaging findings were analyzed: wall thickness, gallbladder distension, intraluminal membranes, mural striation, edema, wall enhancement, gallstones, gas, pericholecystic fluid, stranding, hemorrhage, hyperaemia in adjacent liver, mucosal/wall irregularity, complications. Statistical Analysis: Appropriate statistical tests were used using SPSS.22.0 software. The two proportions were compared using Chi-square or Fisher exact test and two means were compared using student t test. Results: Mean gallbladder wall thickening was 6 ± 1.93 mm. Gallstones, mural edema, mural striation, pericholecystic fluid, intraluminal membranes, gas were seen in 30, 27, 18, 20, 14 and 3 cases respectively. The mean short-axis distension of gallbladder lumen was 4.24 ± 0.91 cm. Gallbladder wall enhancement was studied in only 10 cases. Complete absence of enhancement was seen in 1, focal decreased enhancement in 8 cases. Mucosal/wall irregularity was seen in 28 cases. 74.2% cases had ≥4 cm gallbladder distension. Intraluminal membranes were present in 14 cases with mean short-axis distension of 4.6 cm and absent in 17 (P = 0.041), in 11 cases with mural striation (P = 0.036). Mean wall thickening was 6.69mm in patients with intraluminal membranes and 5.46 mm with absence of membranes (P = .078). Conclusion: Presence of more than one of these findings - gallbladder distension (short axis diameter of ≥4 cm), intraluminal membranes, mural striation, absent or decreased enhancement of gallbladder wall suggest high probability of gangrenous change in acute cholecystitis.
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Comparative diagnostic test accuracy of post-esophagectomy water-soluble computed tomography and fluoroscopic swallow studies: A meta-analysis p. 55
Timothy E Murray, Martina Morrin
DOI:10.4103/ijri.IJRI_262_17  PMID:29692528
Aims: Both fluoroscopic water-soluble contrast swallow (FWSCS) and CT water-soluble contrast swallow (CTWSCS) are widely performed as a routine in the post-esophagectomy patient to assess for anastomotic leak. Several prospective studies have compared FWSCS and CTWSCS; however, no synthesis of the data exists. Materials and Methods: Systematic review and meta-analysis of diagnostic test accuracy studies comparing FWSCS and CTWSCS in the adult patient following esophagectomy for malignancy was performed in accordance with PRISMA guidelines. Results: Three diagnostic test accuracy studies met the inclusion criteria, directly comparing FWSCS and CTWSCS in 185 patients. FWSCS demonstrated high specificity (98%), but low sensitivity (64%). CTWSCS can be categorized as normal, mediastinal gas without contrast leak, or leakage of oral contrast. Visible leakage of oral contrast demonstrated high specificity (98%) but low sensitivity (56%). The presence of mediastinal gas increased sensitivity (84%), but reduced specificity (85%). The higher sensitivity of CTWSCS over FWSCS failed to reach significance (P = 0.125). Conclusion: CTWSCS shares the high specificity of FWSCS. Its higher sensitivity increases its utility as a rule-out test in the postoperative period. Additional factors that may influence decision-making are described.
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Portal vein thrombosis after donor liver biopsy: Case report p. 61
Shahnawaz Bashir, Kartik Mittal, Rohit Khisti, Ankusha Yadav, Amar Mukund, Viniyendra Pamecha
DOI:10.4103/ijri.IJRI_26_17  PMID:29692529
Percutaneous plugged liver biopsy is a safe procedure with a low complication rate. Portal vein thrombosis has not been reported after percutaneous liver biopsy in the literature. We present a case of portal vein thrombosis after percutaneous plugged liver biopsy in a voluntary liver donor, which was subsequently treated with catheter-directed percutaneous transhepatic thrombolysis. In future, healthy patients undergoing liver biopsies are expected to increase for donor evaluation. More refinements of technique and hardware in the future may further decrease the rate of complications. However, if they occur, they need to be recognized and managed at the earliest.
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Primary presentation of Jeune's syndrome as gastric motility disorder in an infant: A case report p. 65
Amit Katyan, Shabnam Bhandari Grover, Heena Rajani, Deepak Bagga, Neha Antil
DOI:10.4103/ijri.IJRI_303_17  PMID:29692530
We report a case of a 4-week-old female neonate with Jeune's asphyxiating thoracic dystrophy (JATD) and coexistent situs anomaly, primarily presenting as gastric motility disorder. The child presented with abdominal distension and nonbilious vomiting since birth with failure to thrive. However, skeletal survey revealed JATD. Upper gastrointestinal contrast study showed situs inversus with delayed gastric emptying. Pyloric biopsy and intraoperative antro-duodenal manometry confirmed association of gastric motility disorder. Awareness of the unusual possibility of primary presentation of Jeune syndrome as gastric motility disorder will improve the management approach in such infants.
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MUSCULOSKELETAL RADIOLOGY Top

Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas? p. 70
Mai Maher ElDaly, Amr Farouk Ibrahim Moustafa, Suzan Mohamed Samy Abdel-Meguid, Ahmed Mohamed Shokry, Nagui Abd El Wahab
DOI:10.4103/ijri.IJRI_251_17  PMID:29692531
Purpose: The aim of this study was to evaluate contrast-enhanced magnetic resonance imaging (CE-MRI) and quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the detection of recurrent/residual postoperative soft tissue sarcomas. Materials and Methods: This study included 36 patients; 27 patients had postoperative recurrent/residual soft tissue sarcomas and 9 patients had postoperative and treatment-related changes (inflammation/fibrosis). 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 via placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared to histopathology. Results: Our results showed that including CE-MRI improved the diagnostic accuracy and sensitivity in recurrence detection compared to conventional non-enhanced sequences. However, it showed low specificity (55.56%) with a high false-positive rate that may lead to an unnecessary biopsy of a mass such as region of postoperative scar tissue. Conclusion: The joint use of gadolinium-enhanced MRI and quantitative DWI with ADC mapping offer added value in the detection of recurrent/residual postoperative soft tissue sarcoma. This combined use increased both the diagnostic sensitivity and specificity with a cut-off average ADC value for detecting nonmyxoid recurrent/residual lesions ≤1.3 × 10−3 mm2/s (100% specificity and 90.48% sensitivity). Our results showed limited value of DWI with ADC mapping in assessing myxoid sarcomatous tumor recurrences.
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Emphysematous osteomyelitis: Report of two cases and review of literature p. 78
Sachin Khanduri, Meenu Singh, Aakshit Goyal, Simran Singh
DOI:10.4103/ijri.IJRI_28_17  PMID:29692532
Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.
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INTERVENTION RADIOLOGY & VASCULAR Top

Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture p. 81
Hiroyuki Tokue, Azusa Tokue, Yoshito Tsushima
DOI:10.4103/ijri.IJRI_112_17  PMID:29692533
Background: There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol. Materials and Methods: Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45–78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student's t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan–Meier method and compared using the log-rank test. Results: The mean observation period was 264 ± 84 days (range: 104–425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05). Conclusion: Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.
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Ultrasound-guided peripheral nerve interventions for common pain disorders p. 85
BP Krishna Prasad, Binu Joy, Vijayakumar A Raghavendra, Ajith Toms, Danny George, Brijesh Ray
DOI:10.4103/ijri.IJRI_108_17  PMID:29692534
There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.
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t-PA power-pulse spray with rheolytic mechanical thrombectomy using cross-sectional image-guided portal vein access for single setting treatment of subacute superior mesenteric vein thrombosis p. 93
Mubin I Syed, Ryan M Gallagher, Rukan S Ahmed, Azim Shaikh, Edward Roberto, Sumeet Patel
DOI:10.4103/ijri.IJRI_215_17  PMID:29692535
Background: Isolated superior mesenteric vein (SMV) thrombosis is a rare but potentially fatal condition if untreated. Current treatments include transjugular or transhepatic approaches for rheolytic mechanical thrombectomy and subsequent infusions of thrombolytics. Tissue plasminogen activator (t-PA) power-pulse spray can provide benefit in a single setting without thrombolytic infusions. Computed tomography (CT) guidance for portal vein access is underutilized in this setting. Materials and Methods: Case 1 discusses acute SMV thrombosis treated with rheolytic mechanical thrombectomy alone using ultrasound guidance for portal vein access. Case 2 discusses subacute SMV thrombosis treated with the addition of t-PA power-pulse spray to the rheolytic mechanical thrombectomy, using CT guidance for portal vein access. Results: With rheolytic mechanical thrombectomy alone, the patient in Case 1 had significant improvement in abdominal pain. Follow-up CT demonstrated no residual SMV thrombosis and the patient continued to do well in long-term follow-up. With the addition of t-PA power-pulse spray to rheolytic mechanical thrombectomy, the patient in Case 2 with subacute SMV thrombosis dramatically improved postprocedure with resolution of abdominal pain. Follow-up imaging demonstrated patency to the SMV and partial resolution of thrombus. The patient continued to do well at 2-year follow-up. Conclusions: Adding t-PA power-pulse spray to rheolytic mechanical thrombectomy can provide benefit in a single setting versus mechanical thrombectomy alone and prevent the need for subsequent infusions of thrombolytic therapy. CT guidance is a useful alternative of localization for portal vein access via the transhepatic route that is nonoperator-dependent and helpful in the case of obese patients.
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THORAACIC IMAGING Top

Performance of quantitative CT parameters in assessment of disease severity in COPD: A prospective study p. 99
Ishan Kumar, Ashish Verma, Avinash Jain, SK Agarwal
DOI:10.4103/ijri.IJRI_296_17  PMID:29692536
Background: Both emphysematous destruction of lung parenchyma and airway remodeling is thought to contribute to airflow limitation in cases of chronic obstructive pulmonary disease (COPD). Objective: To evaluate the value of quantitative computed tomography (QCT) parameters of emphysema and airway disease with disease severity in patients with COPD. Materials and Methods: We prospectively studied 50 patients with COPD, which included nonsmokers and patients with different degrees of cumulative smoking exposure. Three QCT parameters namely LAA% (low attenuation area percentage), WA% (Wall area percentage), and pi10 were calculated as per the standard technique. Forced expiratory volume in 1 s (FEV1), BODE score, and MMRC dyspnea scale were used as measures of disease severity. Results: FEV1 was inversely and significantly associated with all three QCT parameters. Receiver operated characteristic curves in prediction of GOLD class 3 COPD yielded cut-off values of 12.2, 61.45, and 3.5 for LAA%, WA%, and pi10, respectively, with high sensitivities and specificities. In multiple linear regression model, however, only LAA% proved to be significantly associated with FEV1, BODE, and dyspnea. Conclusion: QCT indices of both emphysema and airway disease influence FEV1, dyspnea, and BODE score in patients with COPD. Emphysema, however, appears to be more closely related to disease severity.
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PAEDIATRIC IMAGING Top

Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course p. 107
Eleza T Golden, Paula Dickson, Stephen Simoneaux
DOI:10.4103/ijri.IJRI_67_17  PMID:29692537
Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings. Materials and Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords “soft tissue calcification” and “chest.” The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Age when calcifications were first detected, location, resolution, and associated laboratory abnormalities were recorded. Results: Nine patients were identified. None had skin lesions. All patients had congenital heart disease and had experienced cardiac/respiratory arrest and/or severe hypotension 1–6 weeks before soft tissue calcifications occurred. Calcifications resolved by 9 weeks to 5 months in 3 patients. The remaining were either deceased or lacked follow-up imaging. Renal ultrasound was performed in all but 1 patient. Nephrocalcinosis was only seen in 1 patient. Conclusion: Brown fat necrosis is subclinical, diagnosed on plain film, and likely self-limited. It occurs in term and preterm infants who have undergone significant systemic stress and carries a poor prognosis.
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Orphan disease: Cherubism, optic atrophy, and short stature p. 111
Balaji Jeevanandham, Rajoo Ramachandran, Vignesh Dhanapal, Ilanchezhian Subramanian, Venkata Sai
DOI:10.4103/ijri.IJRI_203_17  PMID:29692538
A 12-year-old female presented with complaints of progressive visual impairment in both her eyes. On clinical examination, she was short for her age and her ophthalmoscopic examination revealed bilateral optic atrophy. Computed tomography of the patient revealed multiple expansile lytic lesions of mandible suggesting cherubism. The optic atrophy was confirmed on magnetic resonance imaging, which additionally revealed bilateral retrocerebellar arachnoid cysts. This association of cherubism with optic atrophy and short stature was grouped as orphan disease by National Institutes of Health and only one case was reported in the literature so far.
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BREAST IMAGING Top

Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital p. 115
Divya Singla, Arvind K Chaturvedi, Abhinav Aggarwal, SA Rao, Dibyamohan Hazarika, Vivek Mahawar
DOI:10.4103/ijri.IJRI_107_17  PMID:29692539
Introduction: Breast cancer is one of the leading cancers in females worldwide, and its incidence has been rising at an exponential pace in the last 10 years even in India. Mammography has been the mainstay for detection of breast cancer over decades and has gradually advanced from screen film to full-field digital mammography. Recently, tomosynthesis has evolved as an advanced imaging investigation for early diagnosis of breast lesions in both diagnostic and screening settings. Aim of Study: To compare and evaluate the impact of digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) in the interpretation of BIRADS score in both diagnostic and screening settings. Settings and Design: A 1-year prospective longitudinal study was conducted in the Department of Radio-diagnosis in our institute using Hologic Selenia Dimensions for mammography as well as tomosynthesis. Materials and Methods: One hundred women known or suspected (opportunistic screening) for breast cancer were evaluated either with FFDM alone or both FFDM and DBT. Sensitivity, specificity, positive predictive value, negative predictive value, and P value were used to assess the various diagnostic criteria in our study. Results: Addition of DBT to FFDM results in a statistically significant increase in the sensitivity, specificity, and positive predictive value, and a statistically significant decrease in the false positive rates. Similar results were noted in both diagnostic and screening cases. It was observed that, in most cases, i.e. a total of 47, DBT did not change the BIRADS scoring; however, its addition increased the diagnostic confidence. BIRADS was upgraded and downgraded in 14 and 31 cases, respectively, with the addition of DBT to FFDM. New lesions were seen with addition of DBT to FFDM in 8 cases. Conclusion: Addition of DBT to FFDM results in increase in sensitivity, specificity, positive predictive value, and a statistically significant decrease in false positive rates in both diagnostic and screening cases. As addition of tomosynthesis results in a significant decrease in recall rate, it should be added, at least, in all screening mammography programs.
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Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade p. 123
Kanika Gupta, Meenakshisundaram Kumaresan, Bhuvaneswari Venkatesan, Tushar Chandra, Aruna Patil, Maya Menon
DOI:10.4103/ijri.IJRI_257_17  PMID:29692540
Context: Assessment of individual sonographic features provides vital clues about the biological behavior of breast masses and can assist in determining histological grade of malignancy and thereby prognosis. Aims: Assessment of individual sonographic features of biopsy proven invasive ductal breast carcinomas as predictors of malignancy grade. Settings and Design: A retrospective analysis of sonographic findings of 103 biopsy proven invasive ductal breast carcinomas. Materials and Methods: Tumor characteristics on gray-scale ultrasound and color flow were assessed using American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) Atlas Fifth Edition. The sonographic findings of masses were individually correlated with their histopathologic grades. Statistical Analysis Used: Chi square test, ordinal regression, and Goodman and Kruskal tau test. Results: Breast mass showing reversal/lack of diastolic flow has a high probability of belonging to histological high grade tumor ( β 1.566, P 0.0001). The masses with abrupt interface boundary are more likely grade 3 ( β 1.524, P 0.001) in comparison to masses with echogenic halos. The suspicious calcifications present in and outside the mass is a finding associated with histologically high grade tumors. The invasive ductal carcinomas (IDCs) with complex solid and cystic echotexture are more likely to be of high histological grade ( β 1.146, P 0.04) as compared to masses with hypoechoic echotexture. Conclusions: Certain ultrasound features are associated with tumor grade on histopathology. If the radiologist is cognizant of these sonographic features, ultrasound can be a potent modality for predicting histopathological grade of IDCs of the breast, especially in settings where advanced tests such as receptor and molecular analyses are limited.
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LETTERS TO THE EDITOR Top

Spontaneous pneumomediastinum, pneumothorax, pneumorrhachis, pneumoretroperitoneum, surgical emphysemaAdult cervical lung herniation: Importance of valsalva manoeuvre in imaging p. 132
Bogala Shilpa, Rashmi Sudhir, M V T Krishna Mohan, Veeraiah Koppula
DOI:10.4103/ijri.IJRI_168_17  PMID:29692541
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Adult cervical lung herniation: Importance of valsalva manoeuvre in imaging p. 134
Rupinder Singh, Ramanjeet Kaur
DOI:10.4103/ijri.IJRI_282_17  PMID:29692542
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