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   Table of Contents - Current issue
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October-December 2017
Volume 27 | Issue 4
Page Nos. 367-523

Online since Wednesday, December 13, 2017

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EDITORIAL  

Redefining radiology senior residency – Can we provide an alternative to “The Consultant Job” Highly accessed article p. 367
Chander Mohan
DOI:10.4103/ijri.IJRI_431_17  PMID:29379229
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THORACIC/ CARDIAC Top

Dilemma of diagnosing thoracic sarcoidosis in tuberculosis endemic regions: An imaging-based approach. Part 1 Highly accessed article p. 369
Ashu S Bhalla, A Das, P Naranje, A Goyal, R Guleria, Gopi C Khilnani
DOI:10.4103/ijri.IJRI_200_17  PMID:29379230
Sarcoidosis is a multi-systemic disorder of unknown etiology, although commonly believed to be immune-mediated. Histologically, it is characterized by noncaseating granuloma which contrasts against the caseating granuloma seen in tuberculosis (TB), an infectious disease that closely mimics sarcoidosis, both clinically as well as radiologically. In TB-endemic regions, the overlapping clinico-radiological manifestations create significant diagnostic dilemma, especially since the management options are markedly different in the two entities. Part 1 of this review aims to summarize the clinical, laboratory, and imaging features of sarcoidosis, encompassing both typical and atypical manifestations, in an attempt to distinguish between the two disease entities.
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Dilemma of diagnosing thoracic sarcoidosis in tuberculosis-endemic regions: An imaging-based approach. Part 2 p. 380
Ashu S Bhalla, A Das, P Naranje, A Goyal, R Guleria, Gopi C Khilnani
DOI:10.4103/ijri.IJRI_201_17  PMID:29379231
The second part of the review discusses the role of different existing imaging modalities in the evaluation of thoracic sarcoidosis, including chest radiograph, computed tomography, magnetic resonance imaging, endobronchial ultrasound, and positron emission tomography. While summarizing the advantages and pitfalls of each imaging modality, the authors propose imaging recommendations and an algorithm to be followed in the evaluation of clinically suspected case of sarcoidosis in tuberculosis-endemic regions.
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Appraisal of radiation dose with 64-slice computed tomography perfusion in lung cancer patients with special reference to SSDE: An initial experience in a tertiary care hospital p. 389
Shuchi Bhatt, Ajai K Srivastava, Neha Meena, Shweta Thakur
DOI:10.4103/ijri.IJRI_44_17  PMID:29379232
Context: Computed tomography perfusion (CTP) is an important functional tool for lung cancer. It is expected to deliver high radiation dose, making its accurate estimation important. Size-specific dose estimate (SSDE) is a new dose metric, which includes the scanner output as well as the patient size. Aims: To determine radiation dose [CT dose index (CTDIvol), dose length product (DLP), effective dose (ED), and SSDE] for CTP in lung cancer and the correlation of CTDIvol, DLP, and SSDE with effective diameter and SSDE with weight, body mass index (BMI), and the scan length. Settings and Design: Cross-sectional study in the Department of Radio-diagnosis from October 2015 to March 2016. Patients and Methods: Due ethical approval and informed consent was taken. Thirty consecutive adult patients of lung cancer undergoing CTP study were included; various radiation dose parameters were determined and presented as mean ± SD. Statistical Analysis Used: Paired Student's t-test and Pearson correlation using Statistical Package for the Social Sciences, Version 16. Results: Mean radiation dose was CTDIvol = 270.138 ± 1.627 mGy, DLP = 681 ± 53.496 mGy.cm, ED = 12.501 ± 0.923 mSv, SSDE = 388.90 ± 81.27 mGy. The CTDIvoland DLP had significant positive correlation (r = 0.556, P= 0.000 and r = 0.522, P= 0.003, respectively) with effective diameter. SSDE had strong negative correlation (r = −0.997, P= 0.000) with effective diameter, significant negative correlation with the BMI (r = −0.889; P= 0.000) and weight (r= −0.910, P= 0.000) of patients. Scan length was not significantly correlated in SSDE (r = −0.012, P= 0.951). Conclusions: Smaller sized patients had greater SSDE.
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Radiological spectrum of anthracofibrosis: A series of 40 patients with computed tomography, bronchoscopy, and biopsy p. 397
Anandamoyee Dhar, Kunal Sikund, Ajal Lall, Bharat Aggarwal
DOI:10.4103/ijri.IJRI_403_16  PMID:29379233
Introduction: Anthracofibrosis is a lesser known clinical entity. Patients present with chronic symptoms of cough and breathlessness with a history of biofuel/wood fire smoke exposure. There are distinct computed tomography (CT) imaging features of anthracofibrosis that can differentiate it from more common conditions such as tuberculosis (TB) and bronchogenic carcinoma. Findings include multifocal noncontiguous stenosis of bronchial tree, calcified enlarged mediastinal or hilar nodes, and secondary lung parenchymal changes. However, in TB, bronchostenosis usually involves a single lobar bronchus in a contiguous manner with trachea and/or major bronchi also being affected. In this study, we highlight the imaging characteristics of anthracofibrosis. Context: The CT findings of anthracofibrosis closely mimic TB and bronchogenic carcinoma, hence we highlight the key imaging features of anthracofibrosis. Aims and Objectives: To identify and describe the CT imaging features of anthracofibrosis and correlate it with bronchoscopic findings. Setting and Design: Retrospective study. Materials and Methods: Retrospectively, 40 patients were selected who were diagnosed with anthracofibrosis on bronchoscopy and biopsy. However, CT scan records of only 14 patients were available for review. Two radiologists reviewed the scans independently. Results: Most common CT finding was multisegmental noncontiguous bronchostenosis seen in 93% patients mostly involving the right middle lobe. 85% of the cases showed lymph node enlargement involving hilar, peribronchial, and mediastinal nodes. The nodes were calcified in 91.7% of the cases, with 58% showing pressure effect on adjacent bronchi due to nodal enlargement. The next common findings were peribronchial cuffing and bronchial obstruction seen in 57 and 28% of the cases, respectively. Conclusion: The key imaging features of anthracofibrosis on CT are multifocal involvement of bronchi with smooth peribronchial thickening and enlarged calcified lymph nodes.
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Cardiac magnetic resonance techniques: Our experience on wide bore 3 tesla magnetic resonance system p. 404
Onkar B Auti, Kalashree Bandekar, Nikhil Kamat, Vimal Raj
DOI:10.4103/ijri.IJRI_503_16  PMID:29379234
Cardiovascular magnetic resonance (CMR) has become a widely adapted imaging modality in the diagnosis and management of patients with cardiovascular diseases. It provides unparalleled data of cardiac function and myocardial morphology. Majority of CMR imaging is currently being performed on 1.5 Tesla (T) MR systems. Over the last many years, the cardiac imaging protocols have been standardized and optimized in the 1.5T systems. 3T MR systems are now being used more and more in small and large institutions in our country due to their proven advantages in the field of neuro, body, and musculoskeletal imaging. Cardiac imaging on 3T system can be a double-edged sword. On one hand, it may provide nondiagnostic images due to significant artifacts, and on the other hand, it may complete the examination in quick time and provide excellent quality images. It is therefore important for the user to be aware of the potential pitfalls of CMR in 3T systems and also the necessary steps to avoid them. In this study, we discuss various challenges and advantages of performing CMR in a 3T system. We also present potential technical solutions to improve the image quality.
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Levoatrial cardinal vein with normal left ventricle: A forgotten cause of pulmonary arterial hypertension p. 413
Onkar B Auti, Varun Shetty, Vinay Belaval, Vimal Raj
DOI:10.4103/ijri.IJRI_313_16  PMID:29379235
Levoatrial cardinal vein (LACV) is anomalous connection between left atrium or pulmonary veins and systemic veins such as innominate vein or superior vena cava. This persistence of splanchnic circulation occurs when there is left-sided obstructive cardiac lesions such as hypoplastic left heart or mitral atresia. In this report we present three cases of LACV with well-developed left heart, without any obstructive lesions. All our cases presented with pulmonary arterial hypertension (PAH) and had associated intracardiac shunt such as ventricular/atrial septal defect and supracardiac partial anomalous pulmonary venous connection. Apart from the above shunts, LACV contributed to PAH in these cases. It is important to detect and report LACV as this may require surgical correction along with other defects. If LACV goes undetected during imaging workup, it may cause persistent PAH postoperatively.
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PAEDIATRIC Top

Spinal dysraphism illustrated; Embroyology revisited p. 417
Ullas V Acharya, Hima Pendharkar, Dandu R Varma, Nupur Pruthi, Shriram Varadarajan
DOI:10.4103/ijri.IJRI_451_16  PMID:29379236
Spinal cord development occurs through three consecutive periods of gastrulation, primary nerulation and secondary neurulation. Aberration in these stages causes abnormalities of the spine and spinal cord, collectively referred as spinal dysraphism. They can be broadly classified as anomalies of gastrulation (disorders of notochord formation and of integration); anomalies of primary neurulation (premature dysjunction and nondysjunction); combined anomalies of gastrulation and primary neurulation and anomalies of secondary neurulation. Correlation with clinical and embryological data and common imaging findings provides an organized approach in their diagnosis.
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Intracranial translucency as a sonographic marker for detecting open spina bifida at 11–13+6 weeks scan: Our experience p. 427
Madhavi L Teegala, Dhamangaonkar G Vinayak
DOI:10.4103/ijri.IJRI_13_17  PMID:29379237
Aims and Objectives: The fourth ventricle, seen as intracranial translucency (IT) at 11–13+6 weeks, has been reported to be obliterated in cases of open spina bifida (OSB). Our aim was to assess its role in detecting OSB at 11–13+6 weeks. Materials and Methods: This prospective study was conducted at foetal medicine unit from January 2014 to June 2015. All women who underwent both first and mid-trimester scan in our unit were included in the study. IT was categorized as normal, obliterated or not clear. Spine was examined during both scans. Results: Totally, 341 cases were included in the study. IT was found to be obliterated in four cases and not clear in one case. There was demonstrable OSB at 11–13+6 weeks in two cases, at 15–16 weeks in two cases and at 24 weeks in one case. In the remaining 336 cases with normal IT, spine was found to be normal at target scan. Conclusion: Mid-sagittal view of face that is routinely used to measure nuchal translucency (NT) can also be used to detect OSB. It is feasible to integrate IT into the routine 11–13+6 weeks scan.
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Emergent presentation of Langerhans cell histiocytosis in a pediatric patient: Acute cerebellar involvement causing obstructive hydrocephalus requiring posterior fossa decompression p. 432
Dhanashree A Rajderkar, Mrunal L Shah, Jehan L Shah
DOI:10.4103/ijri.IJRI_389_16  PMID:29379238
Langerhans cell histiocytosis (LCH) is a disorder of the monocyte-macrophage system that can be unifocal or systemic. Here, we present a pediatric case who initially presented with osseous LCH but again presented 6 years later emergently with cerebellar symptoms, cerebellar mass and obstructive hydrocephalus. Patient underwent biopsy of the cerebellum which was path proven intracranial LCH.
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A rare case of OEIS complex –newer approach to diagnosis of exstrophy bladder by color doppler and its differentiation from simple omphalocele p. 436
Kavita Aneja
DOI:10.4103/ijri.IJRI_443_16  PMID:29379239
The objective of this article is to present a new approach to diagnose and differentiate similar ventral masses by color Doppler. Two cases of ventral masses, a rare case of OEIS complex (Omphalocele-exstrophy-imperforate anus-spinal defects) with unusual presentation of exstrophy bladder and another of simple omphalocele, were studied by color Doppler for diagnosis and differentiation between the nature of similar masses. Ventral mass with absent bladder, normal kidneys, and normal amniotic fluid index raised the suspicion of exstrophy bladder. Color Doppler depicting altered intrafetal course of umbilical arteries and umbilical arteries coursing along the sides of ventral mass substantiated the diagnosis. The spatial relation between umbilical artery and aorta (which has no mention in the current literature) in sagittal view has been identified as an acute angle in a normal fetus and coined as “K angle” arbitrarily by the author. Color Doppler reveals altered (widened) “K angle” in exstrophy bladder compared to normal fetuses. Other combined anomalies pointed to the diagnosis of OEIS complex. The second case of simple omphalocele depicts normal intrafetal course of umbilical arteries and normal acute umbilical artery–aorta angle (K angle) on color Doppler. Color Doppler aids the early diagnosis of ventral defects. New method by umbilical artery-aorta angle (K angle) assessment on color Doppler helps differentiate exstrophy bladder from omphalocele.
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NEURO/HEAD & NECK Top

Imaging review of cerebrospinal fluid leaks p. 441
Naga V Vemuri, Lakshmi S P Karanam, Venkatesh Manchikanti, Srinivas Dandamudi, Sampath K Puvvada, Vineet K Vemuri
DOI:10.4103/ijri.IJRI_380_16  PMID:29379240
Cerebrospinal fluid (CSF) leak occurs due to a defect in the dura and skull base. Trauma remains the most common cause of CSF leak; however, a significant number of cases are iatrogenic, and result from a complication of functional endoscopic sinus surgery (FESS). Early diagnosis of CSF leak is of paramount importance to prevent life-threatening complications such as brain abscess and meningitis. Imaging plays a crucial role in the detection and characterization of CSF leaks. Three-dimensional, isotropic, high resolution computed tomography (HRCT) accurately detects the site and size of the bony defect. CT cisternography, though invasive, helps accurately identify the site of CSF leak, especially in the presence of multiple bony defects. Magnetic resonance imaging (MRI) accurately detects CSF leaks and associated complications such as the encephaloceles and meningoceles. In this review, we emphasize the importance and usefulness of 3D T2 DRIVE MR cisternography in localizing CSF leaks. This sequence has the advantages of effective bone and fat suppression, decreased artefacts, faster acquisition times, three-dimensional capability, y and high spatial resolution in addition to providing very bright signal from the CSF.
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Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain p. 447
Supriya Kushwah, Ashok Kumar, Ashish Verma, Sriparna Basu, Ashutosh Kumar
DOI:10.4103/ijri.IJRI_384_16  PMID:29379241
Purpose: To determine the area and extent of injury in hypoxic encephalopathy stages by diffusion tensor imaging (DTI) using parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values and their comparison with controls without any evidence of asphyxia. To correlate the outcome of hypoxia severity clinically and significant changes on DTI parameter. Materials and Methods: DTI was done in 50 cases at median age of 12 and 20 controls at median age of 7 days. FA and apparent diffusion coefficient (ADC) were measured in several regions of interest (ROI). Continuous variables were analyzed using Student's t-test. Categorical variables were compared by Fisher's exact test. Comparison among multiple groups was done using analysis of variance (ANOVA) and post hoc Bonferroni test. Results: Abnormalities were more easily and accurately determined in ROI with the help of FA and ADC values. When compared with controls FA values were significantly decreased and ADC values were significantly increased in cases, in ROI including both right and left side of thalamus, basal ganglia, posterior limb of internal capsule, cerebral peduncle, corticospinal tracts, frontal, parietal, temporal, occipital with P value < 0.05. The extent of injury was maximum in stage-III. There was no significant difference among males and females. Conclusion: Compared to conventional magnetic resonance imaging (MRI), the evaluation of FA and ADC values using DTI can determine the extent and severity of injury in hypoxic encephalopathy. It can be used for early determination of brain injury in these patients.
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Diffusion tensor imaging metrics in cystic intracranial mass lesions p. 457
Amarnath Chellathurai, Priya Muthaiyan, Sathyan Gnanasigamani, Periakarupan Alakappan
DOI:10.4103/ijri.IJRI_130_17  PMID:29379242
Background and Purpose: Conventional MR does not always differentiate various cystic lesions of brain. Our purpose was to explore the utility of DTI in characterization & differentiation of intra cranial cystic mass lesions. Materials and Methods: DTI was done with a clinical 1.5 Tesla system in 62 patients presenting with intra cranial cystic lesions. Parameter maps of the DTI metrics MD, FA, GA, RA, Geometric tensors (CL,CP,CS) were calculated & quantified using regions of interest. Cystic lesions were grouped based on etiology and management. Statistical analysis was performed to test the significance of difference in DTI metrics in differentiation of various groups of cystic lesions of brain. Results: Mann-Whitney U Test was done to analyse the usefulness of various DTI metrics in differentiating the intracranial cysts. Epidermoid cysts showed highest FA, RA, Cl & Cp due to the preferential diffusion of water through the well structured orientation of keratin filaments & flakes within it. Neurocysticercosis showed higher FA, next to epidermoid. Abscesses showed lowest MD. Arachanoid cyst, giant cistern magna, choroid fissure cyst, choroid plexus cyst, ependymal & neuroglial cysts showed higher MD & lower FA, implicating no preferential directional diffusivity. Conclusion: DTI does prove useful in characterization and differentiation of intracranial cystic mass lesions. This study implicates the need for inclusion of DTI in the routine protocol of imaging cystic intracranial mass lesions.
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Evaluation of parenchymal thyroid diseases with multiparametric ultrasonography p. 463
Duzgun Yildirim, Deniz Alis, Alev Bakir, Fethi E Ustabasioglu, Cesur Samanci, Bulent Colakoglu
DOI:10.4103/ijri.IJRI_409_16  PMID:29379243
Aim: Differential diagnosis of parenchymal thyroid diseases by gray-scale ultrasound is quite difficult for a radiologist as the findings are very similar to each other. In this study we aimed to assess some quantitative spectral Doppler parameters, resistivity index (RI), acceleration time (AT), and quantitative elastography [shear wave velocity (SWV)] together to show their reliability for differential diagnosis of parenchymal thyroid diseases. Materials and Methods: We retrospectively reviewed findings of 227 patients (179 females, 48 males) that underwent spectral Doppler ultrasound and acoustic radiation force impulse between October 2013 and March 2016. Ages of the patients were between 18 and 74 years (39.52 ± 12.67). Based on clinical and laboratory findings, patients were divided into five groups (N: Normal, EH: Early Hashimoto, H: Late Hashimoto, M: Nodular Thyroid Disease, HM: Hashimoto + Nodular Thyroid Disease). Detailed statistical analyses were done on parameters such as age, gender, volume information, and RI, AT (ms), SWV (m/s). Results: No significant effect of gender or volume on the differentiation of disease pattern (Chi-square test: P= 0.306, Kruskal-Wallis test: P= 0.290) was found in this study. RI (0.41 ± 0.06) and SWV values (1.19 ± 0.18 m/s) were the lowest. AT values (>55 ms) were the highest in EH group (area under the curve: 0.913). Existence of H decreased RI and SWV values, while it extended AT in a different thyroid disease. Conclusion: Thyroid parenchymal diseases could be classified and differentiated from each other by measuring RI, AT, and SWV values quantitatively. So, in suspicious cases, these parameters could be a reliable asset for differential diagnosis.
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ABDOMEN Top

Review of imaging in post-laparoscopy cholecystectomy complications p. 470
Binit Sureka, Amar Mukund
DOI:10.4103/ijri.IJRI_489_16  PMID:29379244
Laparoscopic cholecystectomy is now considered the procedure of choice for uncomplicated symptomatic gallstone disease worldwide. Various biliary, vascular, gastrointestinal, neurological and local complications may be seen on imaging post surgery. Knowledge of these entities and imaging appearances is indispensable for the radiologist in today's era. We emphasize on the list of potential complications and imaging appearances of this surgical procedure.
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Role of transperineal ultrasound in infective and inflammatory disorders p. 482
Chaitanya I Puranik, Vinod J Wadhwani, Deep M Vora
DOI:10.4103/ijri.IJRI_417_16  PMID:29379245
Aims: To evaluate the role of transperineal ultrasound as screening tool in infective and inflammatory diseases of perianal region. Materials and Methods: Initially, clinical examination of the perineal region of patients (pts) for perianal external opening of tracts, swelling and tenderness is done. The perineal USG was performed using 2 -5 MHz sector probe and 7 -13 MHz linear probe on GE logiq P 5 ultrasound machine. Internal opening of any fistulous tract were described with clockwise position and tracts were traced upto their external opening and perifocal area were screened for any ramification. The Park et al. classification was used for classifying the tracts. Results: Out of 492 pts, 60 pts were normal, 257 pts had fistula, 114 pts had sinuses, 44 pts had only abscess without fistula or sinus and 17 pts had other pathologies with 95% sensitivity (Sn), 100% specificity (Sp) and Positive Predictive Value (PPV) and 95% Negative Predictive Value (NPV) for fistula and 94% Sn, 97% Sp, 89% PPV and 98% NPV for active sinuses and 98% Sp, 96% ppv and 100% NPV and Sn for abscesses. Conclusions: Transperineal Ultrasound should be performed as first line imaging modality for suspicion of low perianal fistula with high sensitivity, specificity, and negative predictive value at much lower cost and less time as compared to perineal MRI.
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INTERVENTION Top

Endovascular uterine artery interventions p. 488
Chandan J Das, Deepak Rathinam, Smita Manchanda, DN Srivastava
DOI:10.4103/ijri.IJRI_204_16  PMID:29379246
Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.
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Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients p. 496
Yashwant Patidar, Praveen Singhal, Shailesh Gupta, Amar Mukund, Shiv K Sarin
DOI:10.4103/ijri.IJRI_490_16  PMID:29379247
Objective: To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients. Materials and Methods: Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4–6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups. Results: Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found. Conclusions: The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.
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Abdominal aorta aneurysm with hostile neck: Early outcomes in outside instruction for use in patients using the treovance® stent graft p. 503
Umberto G Rossi, Pierluca Torcia, Raffaello Dallatana, Davide Santuari, Pietro Mingazzini, Maurizio Cariati
DOI:10.4103/ijri.IJRI_290_16  PMID:29379248
Purpose: The efficacy and safety of endovascular aneurysm repair (EVAR), in patients outside instruction for use (IFU), is very challenging and widely debated. The aim of this study was to evaluate the placement of the Treovance® abdominal aorta stent-graft in patients with hostile proximal necks considered outside IFU. Materials and Methods: Between May 2013 and August 2014, 5 patients with outside IFU underwent EVAR with the Treovance® stent-graft. Technical and clinical successes were evaluated. All 5 patients underwent clinical and imaging follow-up. Results: Technical and clinical successes were achieved in all 5 patients without adjunctive endovascular procedures or surgical conversion. During the mean follow-up of 21 months, no type I/III endoleaks, stent-graft migration nor kinking/occlusion were observed. In all 5 patients, a reduction of the proximal neck angle was observed. Conclusion: In our small series of selected outside IFU patients, EVAR with the Treovance® stent-graft was technically feasible and safe, with satisfactory short-term follow-up results, when performed by experienced operators. Long-term follow-up will be necessary to confirm the durability of our preliminary promising results.
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MISCELLANEOUS Top

Is there a clinical usefulness for radiolabeled somatostatin analogues beyond the consolidated role in NETs? p. 509
Vincenzo Cuccurullo, Giuseppe Danilo Di Stasio, Maria Rosaria Prisco, Luigi Mansi
DOI:10.4103/ijri.IJRI_431_16  PMID:29379249
The somatostatin (SS) receptor scintigraphy (SRS), using octreotide radiolabelled with 111In (Ocreoscan©, OCT), is a consolidated diagnostic procedure in patients with neuroendocrine tumors (NET) because of an increased expression of somatostatin receptors (SS-R) on neoplastic cells. Uptake of SS analogues (SSA) can also be due to SS-R expression on nonmalignant cells when activated as lymphocytes, macrophages, fibroblasts, vascular cells. Because of this uptake, clinical indications can be found either in neoplasms not overexpressing SS-R, as nonsmall cell lung cancer, and in active benign diseases. Nevertheless, clinical application of SRS has not found clinical relevance yet. In this paper, we discuss the nononcologic fields of clinical interest in which SRS could play a clinical role such as diagnosis, prognosis, and therapy of benign and chronic diseases such as sarcoidosis, histiocytosis, rheumatoid arthritis, idiopathic pulmonary fibrosis, and Graves' ophthalmopathy.
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Informed consent in diagnostic radiology practice: Where do we stand? p. 517
Akshay D Baheti, Meenakshi H Thakur, Bhavin Jankharia
DOI:10.4103/ijri.IJRI_157_17  PMID:29379250
We review the evolution of the concept of informed consent from a radiology standpoint, the current international guidelines on the need for obtaining consent in diagnostic radiology practice, and the current Indian scenario, focusing on both practical and medicolegal aspects. We discuss the concept of patient information sheet with signature, a potential way forward benefiting both patients and radiologists.
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Transcatheter embolization of a cystic artery pseudoaneurysm in a cirrhotic patient with perforated acute cholecystitis p. 521
Shekher Maddineni, Marc Michael D Lim, Sam McCabe, Grigory Rozenblit
DOI:10.4103/ijri.IJRI_358_16  PMID:29379251
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