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  Citation statistics : Table of Contents
   2012| October-December  | Volume 22 | Issue 4  
    Online since May 7, 2013

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Radiology and the mobile device: Radiology in motion
Sridhar G Panughpath, Arjun Kalyanpur
October-December 2012, 22(4):246-250
DOI:10.4103/0971-3026.111469  PMID:23833412
The use of mobile devices is revolutionizing the way we communicate, interact, are entertained, and organize our lives. With healthcare in general and radiology in particular becoming increasingly digital, the use of such devices in radiologic practice is inevitable. This article reviews the current status of the use of mobile devices in the clinical practice of radiology, namely in emergency teleradiology. Technical parameters such as luminance and resolution are discussed. The article also discusses the benefits of such mobility vis-à-vis the current limitations of the technologies available.
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Fusion of intravenous contrast-enhanced C-arm CT and pretreatment imaging for ablation margin assessment of liver tumors: A preliminary study
Jin Iwazawa, Naoko Hashimoto, Takashi Mitani, Shoichi Ohue
October-December 2012, 22(4):251-253
DOI:10.4103/0971-3026.111470  PMID:23833413
The aim of this preliminary study was to evaluate the feasibility of assessing ablation margins after radiofrequency ablation (RFA) of liver tumors from fusion images of post-treatment C-arm computed tomography (CT) images fused to pretreatment images. Five patients with liver tumors underwent RFA. Intravenous contrast-enhanced C-arm CT images were obtained for all patients immediately after RFA, and multi-detector CT (MDCT) images were obtained 3-7 days later. The C-arm CT and MDCT images were fused to pretreatment images using a multimodality image fusion software. The minimum ablation margins were assessed in the C-arm CT and MDCT fusion images. Ablation margins after RFA of liver tumors can be measured using intravenous contrast-enhanced C-arm CT images fused with pretreatment images. This technique has the potential for use in the intra-procedural assessment of liver tumor ablation.
  2 2,562 156
Pictorial essay: Salivary gland imaging
Rajul Rastogi, Sumeet Bhargava, Govindarajan Janardan Mallarajapatna, Sudhir Kumar Singh
October-December 2012, 22(4):325-333
DOI:10.4103/0971-3026.111487  PMID:23833425
Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.
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Vendor neutral archive in PACS
Tapesh Kumar Agarwal, Sanjeev
October-December 2012, 22(4):242-245
DOI:10.4103/0971-3026.111468  PMID:23833411
An archive is a location containing a collection of records, documents, or other materials of historical importance. An integral part of Picture Archiving and Communication System (PACS) is archiving. When a hospital needs to migrate a PACS vendor, the complete earlier data need to be migrated in the format of the newly procured PACS. It is both time and money consuming. To address this issue, the new concept of vendor neutral archive (VNA) has emerged. A VNA simply decouples the PACS and workstations at the archival layer. This is achieved by developing an application engine that receives, integrates, and transmits the data using the different syntax of a Digital Imaging and Communication in Medicine (DICOM) format. Transferring the data belonging to the old PACS to a new one is performed by a process called migration of data. In VNA, a number of different data migration techniques are available to facilitate transfer from the old PACS to the new one, the choice depending on the speed of migration and the importance of data. The techniques include simple DICOM migration, prefetch-based DICOM migration, medium migration, and the expensive non-DICOM migration. "Vendor neutral" may not be a suitable term, and "architecture neutral," "PACS neutral," "content neutral," or "third-party neutral" are probably better and preferred terms. Notwithstanding this, the VNA acronym has come to stay in both the medical IT user terminology and in vendor nomenclature, and radiologists need to be aware of its impact in PACS across the globe.
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Soft tissue attenuation in middle ear on HRCT: Pictorial review
Arangasamy Anbarasu, Kiruthika Chandrasekaran, Sivasubramanian Balakrishnan
October-December 2012, 22(4):298-304
DOI:10.4103/0971-3026.111483  PMID:23833422
Middle ear disease is a common clinical entity; imaging, especially High resolution Computed Tomography (HRCT), plays a crucial role in diagnosis and assessing the disease extent, helping to decide appropriate management. Temporal bone imaging is challenging and involves thorough understanding of the anatomy, especially in relation to HRCT imaging. Most of the middle ear pathologies appear as "soft tissue" on imaging. Careful analysis of the soft tissue on the HRCT is crucial in achieving the right diagnosis; clinical information is essential and the imaging findings need correlation with clinical presentation and otoscopic findings. The purpose of this pictorial essay is to enlist the pathologies that present as soft tissue in middle ear and to provide a structured and practical imaging approach that will serve as a guide for confident reporting in daily practice.
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Pictorial essay: Role of magnetic resonance imaging in evaluation of brachial plexus pathologies
Malini Lawande, Deepak P Patkar, Sona Pungavkar
October-December 2012, 22(4):344-349
DOI:10.4103/0971-3026.111489  PMID:23833427
Brachial plexopathies, traumatic and nontraumatic, often present with vague symptoms. Clinical examination and electrophysiological studies are useful but may not localize the lesion accurately. Magnetic resonance imaging (MRI) with its multiplanar imaging capability and soft tissue contrast resolution plays an important role in evaluation of the abnormal brachial plexus.
  1 29,218 4,547
Etiology and significance of incidentally detected focal colonic uptake on FDG PET/CT
Nilendu C Purandare, Sachin K Gawade, Ameya D Puranik, Archi Agrawal, Sneha Shah, Venkatesh Rangarajan
October-December 2012, 22(4):260-266
DOI:10.4103/0971-3026.111476  PMID:23833416
Background: Incidental colonic uptake of 18F-flurodeoxyglucose (FDG) is not an infrequent finding encountered during whole body positron emission tomography (PET) imaging. Almost all studies on this topic are in Western populations, which have a markedly different epidemiological profile for colorectal premalignant and malignant conditions as compared to that of the Indian subcontinent. Aim: The purpose of this study was to assess the etiology of incidentally detected focal FDG uptake in the colon by comparing it with colonoscopy and histopathology. Materials and Methods : Electronic medical records of patients who underwent FDG PET/computed tomography (CT) at our institution for a 2΍-year period from January 2009 to July 2011 were reviewed. There were 32 out of 9000 (0.35%) patients whose PET/CT reports mentioned incidental focal colonic FDG uptake, of which 24 patients subsequently underwent colonoscopy. Lesions which appeared neoplastic on colonoscopy were confirmed with histopathology obtained after biopsy or surgery. Colonoscopy and pathology findings were considered as gold standard. Results: Among the 24 patients who underwent a colonoscopy, 3 patients had normal findings (12.5%). A positive colonoscopy was noted in 21 patients (87.5%) with the lesion coinciding with the location described in the PET/CT report. Adenomatous polyps were detected in 12 patients (37.5%), whereas in 8 patients (25%) malignant lesions were confirmed [adenocarcinoma n = 5, non-Hodgkin's lymphoma (NHL) n = 2, malignant melanoma n = 1]. In one patient, colonic uptake was diagnosed as inflammatory. The mean standardized uptake value max (SUV max ) for the 12 premalignant lesions was 16.9 ± 9.6 (range 7.5-37.4) and the mean SUV max for the 8 malignant lesions was 12.9 ± 5.5 (range 6.7-21.6). The difference in SUV max between the premalignant adenomatous polyps and the malignant lesions was not statistically significant ( P = 0.316). Conclusions: Our study shows that a significant proportion of patients (62.5%, 20/32) showing an incidental focal FDG uptake will harbor premalignant (adenomatous polyps) or malignant lesions, and further evaluation with colonoscopy and biopsy is warranted in such cases.
  1 4,160 173
Shoulder ultrasound: What you need to know
Jatinder Pal Singh
October-December 2012, 22(4):284-292
DOI:10.4103/0971-3026.111481  PMID:23833420
Shoulder ultrasound is consistently used in the assessment of rotator cuff and is as accurate as magnetic resonance imaging in the detection of rotator cuff tear. It can be used as a focused examination providing rapid, real-time diagnosis, and treatment in desired clinical situations. This article presents a simplified approach to scanning and image-guided intervention, and discusses common sonographically apparent shoulder pathologies.
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Case Series: Pericardial gossypibomas detected after cardiovascular surgery: Imaging findings
Cengiz Erol, Mustafa Koplay, Yahya Paksoy, Fikret Kanat
October-December 2012, 22(4):276-278
DOI:10.4103/0971-3026.111479  PMID:23833418
We present the chest radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) findings of three pericardial gossypibomas, which are rarely reported and an exceptional complication of cardiovascular surgery. The diagnosis is usually possible with surgical history, high clinical suspicion, and awareness of variable imaging findings. Usage of sponges with radiopaque markers facilitates early detection by chest radiographs and CT. In case of radiolucent gossypibomas, specific MRI features help to differentiate this pathology from other masses and diffusion-weighted images can be used to distinguish it from an abscess.
  - 3,064 160
Role of transabdominal ultrasound of lung bases and follow-up in premature neonates with respiratory distress soon after birth
Chirag Kamal Ahuja, Akshay Kumar Saxena, Kushaljeet Singh Sodhi, Praveen Kumar, Niranjan Khandelwal
October-December 2012, 22(4):279-283
DOI:10.4103/0971-3026.111480  PMID:23833419
Background: Chest radiography has been the traditional method of diagnostic evaluation of patients of hyaline membrane disease (HMD). Lung sonography (USG) has been lately explored as an alternative modality. Aims: To explore the application of transabdominal USG of lung bases (TASL) in the evaluation of HMD in premature neonates with respiratory distress soon after birth. Settings and Design: Tertiary care institutional setup. Study duration-18 months. Follow-up-variable, up to 1 month. Prospective descriptive study. Materials and Methods: Eighty-eight consecutive patients admitted in the neonatal intensive care unit (NICU) with gestational age <32 weeks having respiratory distress within 6 h of birth were enrolled. The diagnosis of HMD was made if the patient had negative gastric shake test and/or suggestive chest radiograph. TASL was performed in all patients within the first 24 h of life and biweekly subsequently. USG was interpreted as normal, HMD pattern, or broncho-pulmonary dysplasia (BPD) pattern. Biweekly follow-up was done for patients showing HMD till normalization of the sonographic HMD pattern, development of the sonographic BPD pattern, or death/discharge of the neonate from the hospital. Results and Conclusions: TASL showed 85.7% sensitivity, 75% specificity, 88.88% positive predictive value, and 69.2% negative predictive value for the diagnosis of HMD. The abnormal sonographic findings on day 14 had 94.1% accuracy for prediction of eventual occurrence of clinical BPD. TASL is complementary to chest radiograph in the diagnosis of HMD. It is also useful for the early prediction of BPD with the potential of reducing the cumulative radiation dose to these neonates.
  - 4,564 531
Last issue as Editor-in-Chief
Bhavin Jankharia
October-December 2012, 22(4):241-241
DOI:10.4103/0971-3026.111467  PMID:23833410
  - 2,070 139
Selective doxorubicin drug eluting beads chemoembolization of hypovascular hepatocellular carcinoma using cone beam computed tomography
Naveen Kalra, Divyesh Mahajan, Yogesh Chawla, N Khandelwal
October-December 2012, 22(4):254-256
DOI:10.4103/0971-3026.111472  PMID:23833414
Hepatocellular carcinoma (HCC) of the liver is the third most common cause of cancer-related deaths in the world. Only one-third of patients with HCC are suitable candidates for hepatic resection. Transarterial chemoembolization (TACE) is performed in unresectable HCC. Drug-eluting beads (DEB) TACE is a modification of TACE, in which doxorubicin beads are used as embolizing material.These beads deliver the drug and embolize the vessels; however, it carries the risk of non-target embolization and it is difficult in cases with absent arterial blush on digital subtraction angiography (DSA). This is resolved using C-arm cone-beam computed tomography in the DSA suite. It identifies the tumor-feeding vessels, their area of supply, and differentiates between tumor and normal liver parenchyma. In addition, it is very useful in the embolization of hypovascular HCC. It helps and guides the radiologist in performing TACE effectively and also prevents non-target embolization of normal liver parenchyma.
  - 3,058 177
Combined thrombin-collagen injection for the management of an iatrogenic pseudoanuerysm in the popliteal region
Eoghan McCarthy, Niamh O'Mahony, Mark Ryan, Michael Guiney
October-December 2012, 22(4):257-259
DOI:10.4103/0971-3026.111474  PMID:23833415
Pseudoaneurysm formation is a rare but recognized complication of total knee arthroplasty (TKR), with fewer than 20 cases described in the literature. Multiple management techniques have been described for such pseudoaneurysms. As thrombin injection is an established technique, we report a case of a post-TKR tibioperoneal pseudoaneurysm successfully occluded via percutaneous injection of a dual thrombin-collagen preparation.
  - 2,545 100
Imaging of skull base: Pictorial essay
Abhijit A Raut, Prashant S Naphade, Ashish Chawla
October-December 2012, 22(4):305-316
DOI:10.4103/0971-3026.111485  PMID:23833423
The skull base anatomy is complex. Numerous vital neurovascular structures pass through multiple channels and foramina located in the base skull. With the advent of computerized tomography (CT) and magnetic resonance imaging (MRI), accurate preoperative lesion localization and evaluation of its relationship with adjacent neurovascular structures is possible. It is imperative that the radiologist and skull base surgeons are familiar with this complex anatomy for localizing the skull base lesion, reaching appropriate differential diagnosis, and deciding the optimal surgical approach. CT and MRI are complementary to each other and are often used together for the demonstration of the full disease extent. This article focuses on the radiological anatomy of the skull base and discusses few of the common pathologies affecting the skull base.
  - 117,153 10,535
Pictorial essay: Anatomical variations of paranasal sinuses on multidetector computed tomography-How does it help FESS surgeons?
Uma Devi Murali Appavoo Reddy, Bhawna Dev
October-December 2012, 22(4):317-324
DOI:10.4103/0971-3026.111486  PMID:23833424
With the advent of multidetector computed tomography (MDCT), imaging of paranasal sinuses prior to functional endoscopic sinus surgery (FESS) has become mandatory. Multiplanar imaging, particularly coronal reformations, offers precise information regarding the anatomy of the sinuses and its variations, which is an essential requisite before surgery.
  - 108,180 14,363
Cystic masses of neck: A pictorial review
Mahesh Kumar Mittal, Amita Malik, Binit Sureka, Brij Bhushan Thukral
October-December 2012, 22(4):334-343
DOI:10.4103/0971-3026.111488  PMID:23833426
Cystic masses of neck consist of a variety of pathologic entities. The age of presentation and clinical examination narrow down the differential diagnosis; however, imaging is essential for accurate diagnosis and pretreatment planning. Ultrasound is often used for initial evaluation. Computed tomography (CT) provides additional information with regard to the extent and internal composition of the mass. Fine-needle aspiration cytology (FNAC) has a supplementary role for confirmation of diagnosis. Magnetic resonance imaging may be needed in some cases for preoperative assessment.
  - 80,695 5,366
Pictorial essay: Vascular interventions in extra cranial head and neck
Suyash S Kulkarni, Nitin S Shetty, Tejas P Dharia, Ashwin M Polnaya
October-December 2012, 22(4):350-357
DOI:10.4103/0971-3026.111490  PMID:23833428
Medicine is an ever changing field and interventional radiology (IR) procedures are becoming increasingly popular because of high efficacy and its minimally invasive nature of the procedure. Management of disease processes in the extra cranial head and neck (ECHN) has always been a challenge due to the complex anatomy of the region. Cross sectional imaging of the ECHN has grown and evolved tremendously and occupies a pivotal and integral position in the clinical management of variety of head and neck pathologies. Advances in angiographic technologies including flat panel detector systems, biplane, and 3-dimensional rotational angiography have consolidated and expanded the role of IR in the management of various ECHN pathologies. The ECHN is at cross roads between the origins of great vessels and the cerebral vasculature. Thorough knowledge of functional and technical aspects of neuroangiography is essential before embarking on head and neck vascular interventions. The vessels of the head and neck can be involved by infectious and inflammatory conditions, get irradiated during radiotherapy and injured due to trauma or iatrogenic cause. The ECHN is also a common site for various hypervascular neoplasms and vascular malformations, which can be treated with endovascular and percutaneous embolization. This pictorial essay provides a review of variety of ECHN pathologies which were managed by various IR procedures using different approaches.
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Neural fibrolipoma in pharyngeal mucosal space: A rare occurrence
Nishith Kumar, MK Mittal, Mukul Sinha, BB Thukral
October-December 2012, 22(4):358-360
DOI:10.4103/0971-3026.111491  PMID:23833429
Neural fibrolipoma is a rare lesion presenting in early childhood, as a slow-growing fusiform swelling of a nerve, usually in the forearm or wrist (median nerve), associated with symptoms of compression neuropathy. There are only few case reports of neural fibrolipoma in neck and no such case has been reported in pharyngeal mucosal space.
  - 3,273 196
A pictoral review on somatostatin receptor scintigraphy in neuroendocrine tumors: The role of multimodality imaging with SRS and GLUT receptor imaging with FDG PET-CT
Sneha Shah, Nilendu Purandare, Archi Agrawal, Venkatesh Rangarajan
October-December 2012, 22(4):267-275
DOI:10.4103/0971-3026.111478  PMID:23833417
Somatostatin receptor scintigraphy is considered as a comprehensive imaging modality for many neuroendocrine tumors. Multiple radiotracers using combinations of gamma or positron emitting radionuclides and tracers are now available. Newer radiopharmaceuticals using 99m Tc labeled with TOC, TATE, NOC are good alternatives to the 68 - Gallium radiotracers where the PET facility is not available. The pictoral depicts the role of SRS using 99m TC - HYNIC -TOC radiotracers in staging and treatment planning of NETs. Characterization of the tumor biology using combined SRS and FDG PET/CT is also demonstrated with a proposed categorization method. The emerging role of SRS in tailored targeted radionuclide therapy is outlined in brief.
  - 4,783 347
Sonography of scrotal trauma
Meka Srinivasa Rao, Kalyanpur Arjun
October-December 2012, 22(4):293-297
DOI:10.4103/0971-3026.111482  PMID:23833421
The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.
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