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   2012| January-March  | Volume 22 | Issue 1  
    Online since April 26, 2012

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Bursae around the knee joints
Priyank S Chatra
January-March 2012, 22(1):27-30
A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance.
  33,337 2,185 3
Utility of gray-scale ultrasound to differentiate benign from malignant thyroid nodules
Manju Bala Popli, Ashita Rastogi, PJS Bhalla, Yachna Solanki
January-March 2012, 22(1):63-68
Objective: The objective was to assess the utility of gray-scale USG to identify patterns of thyroid nodules and to correlate the characteristics of benign and malignant nodules with pathological diagnosis. Materials and Methods: From September 2009 to August 2010, a total of 203 patients (17 males and 186 females), with 240 nodules detected at USG, were included in this study. The characteristics of each nodule were determined. The results were then compared with fine needle aspiration (FNA)/histopathological diagnosis. Results: Of the 240 nodules examined, 44 (18.33%) were found to be malignant on cytopathology. The malignant nodules demonstrated solid or predominantly solid composition (sensitivity 88.6%, specificity 53.5%); presence of microcalcification (sensitivity 65.9%, specificity 97.9%); irregular or poorly defined margins (sensitivity 84%, specificity 88.7%); anteroposterior (AP) diameter > transverse diameter (sensitivity 77.2%, specificity 80.1%); absent or thick incomplete halo (sensitivity 70.4%, specificity 65.8%); and markedly hypoechoic character (sensitivity 65.9%, specificity 84.6%). Among males, malignant nodules were found in 36.8%, whereas in females the occurrence was 16.7%. Conclusion: Gray-scale USG features of thyroid nodules are useful to distinguish patients with clinically significant thyroid nodules from those with innocuous nodules despite the overlap of findings. From our study, it is apparent that the USG findings of poorly defined margins, marked hypoechogenicity, microcalcifications, and a taller-than-wider shape have a high diagnostic accuracy for identifying malignant thyroid nodules.
  21,203 1,392 2
Managing DICOM images: Tips and tricks for the radiologist
Dandu Ravi Varma
January-March 2012, 22(1):4-13
All modalities in radiology practice have become digital, and therefore deal with DICOM images. Image files that are compliant with part 10 of the DICOM standard are generally referred to as "DICOM format files" or simply "DICOM files" and are represented as ".dcm." DICOM differs from other image formats in that it groups information into data sets. A DICOM file consists of a header and image data sets packed into a single file. The information within the header is organized as a constant and standardized series of tags. By extracting data from these tags one can access important information regarding the patient demographics, study parameters, etc. In the interest of patient confidentiality, all information that can be used to identify the patient should be removed before DICOM images are transmitted over a network for educational or other purposes. In addition to the DICOM format, the radiologist routinely encounters images of several file formats such as JPEG, TIFF, GIF, and PNG. Each format has its own unique advantages and disadvantages, which must be taken into consideration when images are archived, used in teaching files, or submitted for publication. Knowledge about these formats and their attributes, such as image resolution, image compression, and image metadata, helps the radiologist in optimizing the archival, organization, and display of images. This article aims to increase the awareness among radiologists regarding DICOM and other image file formats encountered in clinical practice. It also suggests several tips and tricks that can be used by the radiologist so that the digital potential of these images can be fully utilized for maximization of workflow in the radiology practice.
  15,399 998 -
Pictorial essay: Non-coronary applications of cardiac CT
Prabhakar Rajiah
January-March 2012, 22(1):40-46
Recent advances in scanner technology have enabled computed tomography (CT) scan to evolve into a valuable tool in the noninvasive evaluation of coronary artery disease. Due to its high negative predictive value, CT can act as a gatekeeper, determining which patients require cardiac catheterization. Although mainly used for the evaluation of coronary artery disease, cardiac CT is also useful in the evaluation of various non-coronary cardiac conditions involving the pericardium, pulmonary veins, and the coronary veins and valves, as well as in the assessment of cardiomyopathies, masses, and ventricular and valvular function. This review discusses and illustrates the various non-coronary applications of cardiac CT.
  13,487 876 -
Myositis ossificans imaging: keys to successful diagnosis
Alexis Lacout, Mohamed Jarraya, Pierre-Yves Marcy, Juliette Thariat, Robert Yves Carlier
January-March 2012, 22(1):35-39
Myositis ossificans (MO) is an inflammatory pseudotumor of the muscle that may be mistaken clinically and even histologically for a malignant soft tissue tumor. The aim of this article is to report the imaging characteristics of MO, the emphasis being on the early diagnostic clues. USG can be used at an early stage to reveal the 'zone phenomenon,' which is highly suggestive of MO. A short course of nonsteroidal anti-inflammatory drug therapy may be an efficient treatment for early MO.
  10,391 1,074 9
Case report: Percutaneous treatment of multiple honeycomb-like liver hydatid cysts (type III CE2, according to WHO classification)
Mario Corona, Alessandro Cannavale, Antonio Bruni, Emanuele Boatta, Massimiliano Allegritti, Pierleone Lucatelli, Fabrizio Fanelli, Armando Pucci, Carolina Paciotti, Filippo Maria Salvatori
January-March 2012, 22(1):23-26
Percutaneous treatment has been developing as a reliable and effective alternative to surgery in the treatment of liver hydatid cysts. However, percutaneous treatment is strongly recommended only for some types of hydatid cysts (types I and II). We report a patient with type III (CE2, according to the WHO classification) multiple liver hydatid cysts treated with the PAIR (puncture-aspiration-injection-reaspiration) technique. The patient developed a secondary biliary fistula, which ultimately healed.
  9,575 511 -
Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience
Suraj Mammen, Shyamkumar N Keshava, Vinu Moses, Surendra Babu, Santhosh Varughese
January-March 2012, 22(1):14-18
Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution.
  7,618 718 -
In the workup of patients with obscure gastrointestinal bleed, does 64-slice MDCT have a role?
Chinmay Kulkarni, Srikanth Moorthy, KP Sreekumar, R Rajeshkannan, PK Nazar, CJ Sandya, S Sivasubramanian, PV Ramchandran
January-March 2012, 22(1):47-53
Purpose: The purpose was to prospectively determine the sensitivity of 64-slice MDCT in detecting and diagnosing the cause of obscure gastrointestinal bleed (OGIB). Materials and Methods: Our study included 50 patients (male 30, female 20) in the age range of 3-82 years (average age: 58.52 years) who were referred to our radiology department as part of their workup for clinically evident gastrointestinal (GI) bleed or as part of workup for anemia (with and without positive fecal occult blood test). All patients underwent conventional upper endoscopy and colonoscopy before undergoing CT scan. Following a noncontrast scan, all patients underwent triple-phase contrast CT scan using a 64-slice CT scan system. The diagnostic performance of 64-slice MDCT was compared to the results of capsule endoscopy, 99m-technetium-labeled red blood cell scintigraphy (99mTc-RBC scintigraphy), digital subtraction angiography, and surgery whenever available. Results: CT scan showed positive findings in 32 of 50 patients. The sensitivity, specificity, positive predictive value, and negative predictive values of MDCT for detection of bleed were 72.2%, 42.8%, 81.2%, and 44.4%, respectively. Capsule endoscopy was done in 15 patients and was positive in 10 patients; it had a sensitivity of 71.4%. Eleven patients had undergone 99mTc-RBC scintigraphy prior to CT scan, and the result was positive in seven patients (sensitivity 70%). Digital subtraction angiography was performed in only eight patients and among them all except one patient showed findings consistent with the lesions detected on MDCT. Conclusion: MDCT is a sensitive and noninvasive tool that allows rapid detection and localization of OGIB. It can be used as the first-line investigation in patients with negative endoscopy and colonoscopy studies. MDCT and capsule endoscopy have complementary roles in the evaluation of OGIB.
  7,365 489 -
MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer
Sangeeta Taneja, Amarnath Jena, Syed. Mohd. Shuaib Zaidi, Anuj Khurana
January-March 2012, 22(1):69-73
Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well.
  5,766 449 4
Pictorial essay: Role of ultrasound in failed carpal tunnel decompression
Rajesh Botchu, Aman Khan, Kanagaratnam Jeyapalan
January-March 2012, 22(1):31-34
USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.
  5,647 418 -
Multifocal intracranial astrocytoma in a pediatric patient with Ollier disease
Girish Bathla, Sarika Gupta, Cheng Kang Ong
January-March 2012, 22(1):58-62
Ollier disease (OD) is a subtype of enchondromatosis. Historically, it has been distinguished from Maffucci syndrome (MS) by the presence of vascular malformations and nonskeletal neoplasms (NSN) in the latter. However, there is an increasing number of reports of NSN in OD, and this categorization is now being questioned. We report a case of OD complicated by multifocal astrocytoma in a young patient, once again pointing to a possible association between OD and NSN. We also review the available literature and examine the similarities between the reported cases.
  4,899 258 3
Percutaneous transhepatic embolization of biliary leakage with N-butyl cyanoacrylate
Gianpaolo Carrafiello, Anna Maria Ierardi, Filippo Piacentino, Larissa N Cardim
January-March 2012, 22(1):19-22
Biliary leakage is a known complication after biliary surgery. In this report, we describe an uncommon treatment of a common biliary complication, wherein we used percutaneous transhepatic injection of N-butyl cyanoacrylate (NBCA) to treat a biliary leak in an 83-year-old patient.
  4,631 297 4
CT scan diagnosis of hepatic adenoma in a case of von Gierke disease
Bipin Valchandji Daga, Vaibhav R Shah, Rahul B More
January-March 2012, 22(1):54-57
Hepatic adenoma is a well-defined, benign, solitary tumor of the liver. In individuals with glycogen storage disease I, adenoma tends to occur at a relatively younger age and can be multiple (adenomatosis). Imaging plays a pivotal role in diagnosing hepatic adenoma and in differentiating adenoma from other focal hepatic lesions. Especially in patients with von Gierke disease, in addition to the associated hepatomegaly caused by steatohepatitis and the diffusely reduced attenuation of the liver parenchyma seen on CT, there may be more than one hepatic adenoma in up to 40% of patients. Malignant degeneration of hepatic adenoma into hepatocellular carcinoma can occur and hence imaging is important for prompt diagnosis of adenoma and its complications. In this case report, we present a case of liver adenoma diagnosed by CT scan in a patient with von Gierke disease.
  4,280 260 2
Web Review: Special Atlases in radiology and imaging
IK Indrajit
January-March 2012, 22(1):76-77
  3,900 569 -
Heavily T2W 3D-SPACE images for evaluation of cerebrospinal fluid containing spaces
Oktay Algin, Evrim Ozmen
January-March 2012, 22(1):74-75
  3,983 341 3
Bhavin Jankharia
January-March 2012, 22(1):1-1
  2,609 254 -
Presidential address
Harsh Mahajan
January-March 2012, 22(1):2-3
  2,281 176 -
Impact of RTI act: It is time to synchronize computer clocks
Akshay Kumar Saxena, Kushaljit Singh Sodhi, Niranjan Khandelwal
January-March 2012, 22(1):74-74
  1,841 197 1
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