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TUBERCULOSIS
Imaging features of extraaxial musculoskeletal tuberculosis
Adelard I De Backer, Filip M Vanhoenacker, Darshana A Sanghvi
July-September 2009, 19(3):176-186
DOI:10.4103/0971-3026.54873  PMID:19881081
Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB can involve pulmonary as well as extrapulmonary sites. The musculoskeletal system is involved in 1-3% of patients with tuberculosis. Although musculoskeletal TB has become uncommon in the Western world, it remains a huge problem in Asia, Africa, and many developing countries. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB shows a predilection for large joints (hip and knee) and para-articular areas; isolated soft tissue TB is extremely rare. Early diagnosis and prompt treatment are mandatory to prevent serious destruction of joints and skeletal deformity. However, due to the nonspecific and often indolent clinical presentation, the diagnosis may be delayed. Radiological assessment is often the first step in the diagnostic workup of patients with musculoskeletal TB and further investigations are decided by the findings on radiography. Both the radiologist and the clinician should be aware of the possibility of this diagnosis. In this manuscript we review the imaging features of extraspinal bone, joint, and soft tissue TB.
  29 9,951 2,329
Magnetic resonance imaging in central nervous system tuberculosis
Richa Trivedi, Sona Saksena, Rakesh K Gupta
October-December 2009, 19(4):256-265
DOI:10.4103/0971-3026.57205  PMID:19881100
Tuberculosis (TB) in any form is a devastating disease, which in its most severe form involves the central nervous system (CNS), with a high mortality and morbidity. Early diagnosis of CNS TB is necessary for appropriate treatment to reduce this morbidity and mortality. Routine diagnostic techniques involve culture and immunological tests of the tissue and biofluids, which are time-consuming and may delay definitive management. Noninvasive imaging modalities such as computed tomography (CT) scan and magnetic resonance imaging (MRI) are routinely used in the diagnosis of neurotuberculosis, with MRI offering greater inherent sensitivity and specificity than CT scan. In addition to conventional MRI imaging, magnetization transfer imaging, diffusion imaging, and proton magnetic resonance spectroscopy techniques are also being evaluated for better tissue characterization in CNS TB. The current article reviews the role of various MRI techniques in the diagnosis and management of CNS TB.
  26 24,571 5,374
PET/CT
Pictorial essay: PET/CT in tuberculosis
S Harkirat, SS Anand, IK Indrajit, AK Dash
April-June 2008, 18(2):141-147
DOI:10.4103/0971-3026.40299  
  22 8,540 1,135
INTERVENTIONAL RADIOLOGY
Impact of ultrasonography on central venous catheter insertion in intensive care
Gopal B Palepu, Juneja Deven, M Subrahmanyam, S Mohan
July-September 2009, 19(3):191-198
DOI:10.4103/0971-3026.54877  PMID:19881083
Background and Aims: The insertion of central venous catheters (CVCs) is an integral part of the management of critically ill patients. We aimed to study the impact of ultrasonography (USG) on CVC insertion in intensive care. Setting and Design: A prospective study of 450 patients requiring CVC in the intensive care unit (ICU) of a tertiary care hospital. Methods and Materials: The patients were randomized into two groups: to have CVC insertion with USG-guidance or with the anatomic landmark technique (ALT). Data were collected on patient demographics; operator experience; and method, site and side of insertion. Outcome measures included successful insertion of CVC, number of attempts needed and complications. Results: Internal jugular vein (IJV) cannulation was successful in 177/194 patients (91.2%) using ALT and in 200/205 patients (97.6%) using USG guidance, a significant difference of 6.4% (P = 0.006). Using ALT, 72.7% of cannulations could be accomplished in the first attempt as compared with 84.4% with USG guidance (P = 0.004). The overall complication rate was 28/399 (7%), with 19 (9.8%) complications in the ALT group and 9 (4.4%) in the USG group (age-, sex-, and operator-adjusted OR = 0.35, 95% CI: 0.13-0.96; P = 0.03). For subclavian vein catheterization, the success rate was 26/28 (92.9%) in the ALT group and 17/17 (100%) in the USG group (P = 0.52). Using ALT, 71.4% cannulation could be accomplished in the first attempt as compared with 82.4% under USG guidance (P = 0.49). The overall complication rate was 6/45 (13.3%), with 4 (14.3%) complications in the ALT group and 2 (11.8%) in the USG group (P > 0.99). Conclusions: Real-time USG guidance improves success rates, reduces the number of attempts and decreases the complications associated with CVC insertion, especially for the IJV, and should become the standard of care in intensive care.
  21 5,971 859
PET/CT
Forced diuresis and dual-phase 18F-fluorodeoxyglucose-PET/CT scan for restaging of urinary bladder cancers
S Harkirat, SS Anand, MJ Jacob
January-March 2010, 20(1):13-19
DOI:10.4103/0971-3026.59746  PMID:20351986
Context: The results of 18 F-fluorodeoxyglucose (FDG)-PET imaging carried out with the current standard techniques for assessment of urinary tract cancers have been reported to be less than satisfactory because of the urinary excretion of the tracer. Aims: To investigate the role of dual-phase FDG-PET/CT in the restaging of invasive cancers of the urinary bladder, with delayed imaging after forced diuresis and oral hydration as the scanning protocol. Settings and Design: FDG-PET has been considered to be of limited value for the detection of urinary tract cancers because of interference by the FDG excreted in urine. We investigated the efficacy of delayed FDG-PET/CT in the restaging of invasive bladder cancer, with imaging performed after intravenous (IV) administration of a potent diuretic and oral hydration. Materials and Methods: Twenty-nine patients with invasive cancer of the urinary bladder were included in this study. Patients were divided into two groups: Group I (22 patients) included cases with invasive bladder cancer who had not undergone cystectomy and group II (seven patients) included cases with invasive bladder cancer who had undergone cystectomy and urinary diversion procedure. All patients underwent FDG-PET/CT scan from the skull base to the mid-thighs 60 min after IV injection of 370 mega-Becquerel (MBq) of FDG. Additional delayed images were acquired 60-90 min after IV furosemide and oral hydration. PET/CT data were analyzed as PET and CT images studied separately as well as fused PET/CT images and the findings were recorded. The imaging findings were confirmed by cystoscopy, biopsy or follow-up PET/CT. Results: The technique was successful in achieving adequate washout of urinary FDG and overcame the problems posed by the excess FDG in the urinary tract. Hypermetabolic lesions could be easily detected by PET and precisely localized to the bladder wall, perivesical region and pelvic lymph nodes. PET/CT delayed images were able to demonstrate 16 intravesical lesions (in 13 patients), with excellent clarity. Lymph node metastases were detected in a total of six patients. Of these, in two patients, FDG-avid lymph nodes were evident only in the delayed images. The information provided by the postdiuretic delayed images changed the PET/CT interpretation in 14 patients of invasive bladder cancer: Recurrent bladder lesions were identified in 12 patients, pelvic lymph node metastasis (only) in one patient and bladder lesion as well as lymph node metastasis in one patient. Distant metastases were detected by PET/CT in two cases. CT scan was false-negative for early recurrence in the bladder wall for seven of 16 lesions. CT also showed two false-positive lesions. There were no false-positives with PET. Conclusions: Detection of recurrent disease in cases of invasive bladder cancer can be significantly improved by using FDG-PET/CT, with delayed imaging following forced diuresis and oral hydration. Composite PET/CT is superior to CT alone for the restaging of invasive bladder cancers.
  19 5,364 509
HEAD & NECK RADIOLOGY
Eagle syndrome
Deepika Raina, Rajesh Gothi, Sriram Rajan
April-June 2009, 19(2):107-108
DOI:10.4103/0971-3026.50826  PMID:19881063
Eagle syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament, which then may produce a pain sensation due the pressure exerted on various structures in the head and neck. When suspected, imaging helps in identifying the abnormally elongated styloid process or the calcified ligament. In recent years, three-dimensional CT (3DCT) has proved to be valuable in these cases. We report the case of a 62-year-old man with this syndrome in whom imaging with 3DCT conclusively established the diagnosis.
  16 9,654 1,680
INTERVENTIONAL RADIOLOGY
Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes
Rashmi Saraf, Manish Shrivastava, Nishant Kumar, Uday Limaye
January-March 2010, 20(1):26-33
DOI:10.4103/0971-3026.59748  PMID:20351988
Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs) and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula) was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%). Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.
  15 8,096 717
HEAD & NECK RADIOLOGY
Psammomatoid and trabecular variants of juvenile ossifying fibroma-two case reports
Simi Thankappan, Sherin Nair, Valsa Thomas, KP Sharafudeen
April-June 2009, 19(2):116-119
DOI:10.4103/0971-3026.50832  PMID:19881065
Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion occurring in the facial bones. It is highly aggressive and has a strong tendency to recur. It has been recognized as a separate histopathological entity among the fibro-osseous group of lesions. Surgical resection is the preferred line of treatment. Here we report two cases of JOF who reported to the oral medicine and radiology department; the two cases had different clinical features, history, radiological appearance, and aggressiveness. Under the recent classification system, both cases were recognized as histopathological variants of JOF: one psammomatoid and the other trabecular.
  14 7,330 872
MUSCULOSKELETAL
Osteopoikilosis : A case report
R Khot, JS Sikarwar, RP Gupta, GL Sharma
October-December 2005, 15(4):453-454
DOI:10.4103/0971-3026.28771  
  14 4,966 380
BREAST RADIOLOGY
Role of diffusion MRI in characterizing benign and malignant breast lesions
Lalitha Palle, Balaji Reddy
October-December 2009, 19(4):287-290
DOI:10.4103/0971-3026.57209  PMID:19881104
Aims: The aim of this study was to evaluate the role of MRI based diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) for characterizing breast lesions in Indian patients. Materials and Methods : This prospective analysis was performed between October 2006 and June 2008. It includes 200 patients between the ages of 16 and 80 years with solid breast lesions greater than 1 cm in diameter. Of these 200 patients, 80 underwent breast MRI with contrast and DWI. One hundred and twenty patients had only DWI as they had come only for sonomammography. A total of 280 lesions were detected. ADC values were calculated for all the lesions and the highest and lowest values of ADC for benign and malignant lesions were identified. Finally, we compared our findings with those of previous studies. Results : Two hundred and eight lesions were categorized as benign and 72 lesions were categorized as malignant based on the ADC values. Based on previous data, lesions with ADC values from 1.3 to 1.5 mm 2 /s were considered benign where as lesions with ADC values ranging between 0.85 and1.1 mm 2 /s were considered malignant. Two lesions whose ADC values were in the benign range were proven to be malignant tumors after surgery. This method of using ADC values for the detection of malignant lesions showed a sensitivity of 97.22% and a specificity of 100%. The positive predictive value was 100%. Conclusion : DWI is a useful technique for characterizing breast tumors, especially for lesions that cannot be adequately characterized by ultrasonography and routine magnetic resonance imaging.
  12 6,131 1,452
NEURORADIOLOGY
MRI findings in Hirayama disease
Monali Raval, Rima Kumari, Aldrin Anthony Dung Dung, Bhuvnesh Guglani, Nitij Gupta, Rohit Gupta
October-December 2010, 20(4):245-249
DOI:10.4103/0971-3026.73528  PMID:21423896
The objective of the study was to study the magnetic resonance imaging (MRI) features of Hirayama disease on a 3 Tesla MRI scanner. Nine patients with clinically suspected Hirayama disease were evaluated with neutral position, flexion, contrast-enhanced MRI and fast imaging employing steady-state acquisition (FIESTA) sequences. The spectrum of MRI features was evaluated and correlated with the clinical and electromyography findings. MRI findings of localized lower cervical cord atrophy (C5-C7), abnormal curvature, asymmetric cord flattening, loss of attachment of the dorsal dural sac and subjacent laminae in the neutral position, anterior displacement of the dorsal dura on flexion and a prominent epidural space were revealed in all patients on conventional MRI as well as with the dynamic 3D-FIESTA sequence. Intramedullary hyperintensity was seen in four patients on conventional MRI and on the 3D-FIESTA sequence. Flow voids were seen in four patients on conventional MRI sequences and in all patients with the 3D-FIESTA sequence. Contrast enhancement of the epidural component was noted in all the five patients with thoracic extensions. The time taken for conventional and contrast-enhanced MRI was about 30-40 min, while that for the 3D-FIESTA sequence was 6 min. Neutral and flexion position MRI and the 3D-FIESTA sequence compliment each other in displaying the spectrum of findings in Hirayama disease. A flexion study should form an essential part of the screening protocol in patients with suspected Hirayama disease. Newer sequences such as the 3D-FIESTA may help in reducing imaging time and obviating the need for contrast.
  12 10,949 972
VASCULAR AND INTERVENTIONAL
Intracranial dural arteriovenous fistulas: A Review
AK Gupta, AL Periakaruppan
January-March 2009, 19(1):43-48
DOI:10.4103/0971-3026.45344  PMID:19774139
Dural arteriovenous fistulas are fistulas connecting the branches of dural arteries to dural veins or a venous sinus. Digital subtraction angiography remains the gold standard for diagnosing these fistulas. Endovascular treatment is one of the first line options available for their management. This review article reviews the etiopathogenesis, natural history, common classification systems and various available treatment options.
  12 9,490 1,516
BREAST RADIOLOGY
Pictorial essay :Tuberculosis of the breast
Manju Bala Popli
July-September 1999, 9(3):127-132
  11 6,579 0
CHEST RADIOLOGY
Pictorial essay: Allergic bronchopulmonary aspergillosis
Ritesh Agarwal, Ajmal Khan, Mandeep Garg, Ashutosh N Aggarwal, Dheeraj Gupta
October-December 2011, 21(4):242-252
DOI:10.4103/0971-3026.90680  PMID:22223932
Allergic bronchopulmonary aspergillosis (ABPA) is the best-known allergic manifestation of Aspergillus-related hypersensitivity pulmonary disorders. Most patients present with poorly controlled asthma, and the diagnosis can be made on the basis of a combination of clinical, immunological, and radiological findings. The chest radiographic findings are generally nonspecific, although the manifestations of mucoid impaction of the bronchi suggest a diagnosis of ABPA. High-resolution CT scan (HRCT) of the chest has replaced bronchography as the initial investigation of choice in ABPA. HRCT of the chest can be normal in almost one-third of the patients, and at this stage it is referred to as serologic ABPA (ABPA-S). The importance of central bronchiectasis (CB) as a specific finding in ABPA is debatable, as almost 40% of the lobes are involved by peripheral bronchiectasis. High-attenuation mucus (HAM), encountered in 20% of patients with ABPA, is pathognomonic of ABPA. ABPA should be classified based on the presence or absence of HAM as ABPA-S (mild), ABPA-CB (moderate), and ABPA-CB-HAM (severe), as this classification not only reflects immunological severity but also predicts the risk of recurrent relapses.
  11 32,368 2,356
GENITOURINARY
Case series: Diffusion weighted MRI appearance in prostatic abscess
Paramjeet Singh, Mukesh K Yadav, Shrawan K Singh, Anupam Lal, Niranjan Khandelwal
January-March 2011, 21(1):46-48
DOI:10.4103/0971-3026.76054  PMID:21431033
Diffusion: weighted MRI (DWI) is a novel technique that analyzes the diffusion of water molecules in vivo. DWI has been used extensively in the central nervous system. Its use in body imaging is on the rise. In the prostate, it has been used in the evaluation of prostatic carcinoma. We present DWI findings in two patients of prostatic abscess.
  11 7,040 412
OBSTETRIC SYMPOSIUM
Case series: TRAP sequence
M Chandramouly, Namitha
January-March 2009, 19(1):81-83
DOI:10.4103/0971-3026.45352  PMID:19774147
TRAP (twin reversed arterial perfusion) sequence / acardiac twinning is a rare anomaly that occurs in monozygotic monochorionic twins with an incidence of 1% and in 1 in 35,000 pregnancies overall. The anomalous twin appears as a heterogeneous mass, simulating a teratoma or intrauterine fetal demise. As the normal twin faces increased morbidity and mortality, antenatal diagnosis with gray-scale examination, and Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies, aids in proper prenatal management. We report two cases of TRAP sequence that we encountered over a single month, with the two cases having different outcomes.
  11 4,974 666
ABDOMINAL IMAGING
Wandering spleen : Unusual presentation and course of events
N Dahiya, D Karthikeyan, S Vijay, T Kumar, M Vaid
July-September 2002, 12(3):359-362
  10 7,239 0
COMPUTERS IN RADIOLOGY
The diagnostic contribution of CT volumetric rendering techniques in routine practice
Simone Perandini, N Faccioli, A Zaccarella, TJ Re, R Pozzi Mucelli
April-June 2010, 20(2):92-97
DOI:10.4103/0971-3026.63043  PMID:20607017
Computed tomography (CT) volumetric rendering techniques such as maximum intensity projection (MIP), minimum intensity projection (MinIP), shaded surface display (SSD), volume rendering (VR), and virtual endoscopy (VE) provide added diagnostic capabilities. The diagnostic value of such reconstruction techniques is well documented in literature. These techniques permit the exploration of fine anatomical detail that would be difficult to evaluate using axial reconstructions alone. Although these techniques are now widely available, many radiologists are either unfamiliar with them or do not fully utilize their potential in daily clinical practice. This paper is intended to provide an overview of the most common CT volumetric rendering techniques and their practical use in everyday diagnostics.
  10 7,068 817
HEAD & NECK RADIOLOGY
Case Report: Congenital infiltrating lipomatosis of face
Rangasami Rajeswaran, Jyotsna Murthy, Anupama Chandrasekharan, Santhosh Joseph
October-December 2008, 18(4):306-309
DOI:10.4103/0971-3026.43847  PMID:19774187
Congenital infiltrating lipomatosis of the face is a rare condition characterized by diffuse fatty infiltration of the facial soft tissues. There may be muscle involvement along with associated bony hyperplasia. It is a type of lipomatous tumor that is congenital in origin; it is rare and seen usually in childhood. We recently saw an 11-year-old girl with this condition. She presented with a swelling of the right side of the face that had been present since birth; there were typical findings on plain radiographs, CT, and MRI. The patient underwent cosmetic surgery. Histopathological examination showed mature adipocytes without any capsule.
  10 3,809 380
NEURORADIOLOGY
Case Report: Intracranial peripheral primitive neuroectodermal tumor - Ewing's sarcoma of dura with transcalvarial-subgaleal extension: An unusual radiological presentation
Shahina Bano, Sachchida Nand Yadav, Umesh Chandra Garga
October-December 2009, 19(4):305-307
DOI:10.4103/0971-3026.57215  PMID:19881110
The occurrence of the intracranial, peripheral, primitive, neuroectodermal tumor, Ewing's sarcoma (pPNET-ES) of the dura, is very rare. Immunophenotypical as well as genetic analyses play key roles in its diagnosis and differentiation from central PNET. We describe here the CT scan and MRI findings of an interesting case of intracranial pPNET-ES arising from the anterior falx cerebri with a trancalvarial-subgaleal extension.
  10 4,043 624
Applications of 3D CISS sequence for problem solving in neuroimaging
Divyata Hingwala, Somnath Chatterjee, Chandrasekharan Kesavadas, Bejoy Thomas, Tirur Raman Kapilamoorthy
April-June 2011, 21(2):90-97
DOI:10.4103/0971-3026.82283  PMID:21799590
Three-dimensional (3D) constructive interference in steady state (CISS) is a gradient-echo MRI sequence that is used to investigate a wide range of pathologies when routine MRI sequences do not provide the desired anatomic information. The increased sensitivity of the 3D CISS sequence is an outcome of the accentuation of the T2 values between cerebrospinal fluid (CSF) and pathological structures. Apart from its well-recognized applications in the evaluation of the cranial nerves, CSF rhinorrhea and aqueduct stenosis, we have found the CISS sequence to be useful for the cisternal spaces, cavernous sinuses and the ventricular system, where it is useful for detecting subtle CSF-intensity lesions that may be missed on routine spin-echo sequences. This information helps in the management of these conditions. After a brief overview of the physics behind this sequence, we illustrate its clinical applications with representative cases and discuss its potential role in imaging protocols.
  10 17,347 1,169
FAHR disease : A rare neurodegenerative disorder
R Malik, VK Pandya, D Naik
October-December 2004, 14(4):383-384
  10 8,546 5
Clinical applications of functional MRI in epilepsy
Chandrasekharan Kesavadas, Bejoy Thomas
July-September 2008, 18(3):210-217
DOI:10.4103/0971-3026.41829  PMID:19774159
The role of functional MRI (fMRI) in the presurgical evaluation of patients with intractable epilepsy is being increasingly recognized. Real-time fMRI is an easily performable diagnostic technique in the clinical setting. It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively. Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized. This review article describes the biophysical basis of blood-oxygen-level-dependent (BOLD) fMRI and the methodology adopted, including the design, paradigms, the fMRI setup, and data analysis. Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy. Finally, the special issues involved in fMRI of epilepsy patients and the various challenges of clinical fMRI are detailed.
  10 11,495 1,285
CHEST RADIOLOGY
Allergic bronchopulmonary aspergillasis : The spectrum of roentgenologic appearances
Ashok Shah, Naresh Panchal, Anil K Agarwal
July-September 1999, 9(3):107-112
  9 6,706 0
VASCULAR AND INTERVENTIONAL
Image-guided lumbar facet joint infiltration in nonradicular low back pain
Arti Chaturvedi, Sunil Chaturvedi, Rajiv Sivasankar
January-March 2009, 19(1):29-34
DOI:10.4103/0971-3026.44522  PMID:19774136
Objective: To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP). Materials and Methods: Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post-lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks. Results: A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered. Conclusions: Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain.
  9 7,242 623
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