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   2013| April-June  | Volume 23 | Issue 2  
    Online since August 16, 2013

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Acute Wallerian degeneration of middle cerebellar peduncles due to basilar artery thrombosis
Foram Gala, Anton Becker, Markus Pfeiffer, Spyros Kollias
April-June 2013, 23(2):164-167
DOI:10.4103/0971-3026.116581  PMID:24082483
Wallerian degeneration (WD) is the process of demyelination and disintegration of the distal axonal segment following the interruption of the axonal integrity or damage to the neuron. We report a patient having WD of middle cerebellar peduncles due to pontine infarction caused by basilar artery thrombosis. We review the anatomy and discuss the pathogenesis of this condition.
  9,423 393 -
Initial experience with Angioseal : Safety and efficacy of the endovascular closure device
Sachin Modi, Rakesh Gadvi, Suresh Babu
April-June 2013, 23(2):134-138
DOI:10.4103/0971-3026.116566  PMID:24082477
Background: Vascular access site management is crucial to safe, efficient, and comfortable diagnostic or interventional percutaneous procedures. The Angioseal vascular closure device has been shown to be safe and effective in reducing the time to hemostasis following angiographic or interventional procedures. Relatively few studies have been conducted in the UK to assess the safety and efficacy of the device in a local setting. Materials and Methods: Data were retrospectively reviewed on 147 patients who underwent either diagnostic angiography or percutaneous interventional procedures from January 2008 to October 2009, and who had the femoral access site closed by 6F VIP Angioseal. A total of 147 patients (F: 49, M: 98), including 80 right femoral punctures, 57 left femoral punctures, and 10 bilateral punctures were reviewed using radiological reports and patients' clinical data. Data on antiplatelet and anticoagulant therapy were recorded. All procedures were carried out by two interventional radiologists at a single institution, under similar operating conditions. Results: There were a total of six complications (4.47%), of which one was a major complication (0.75%), i.e., retroperitoneal bleed. There were five minor complications (3.73%), which included device deployment failure (2), device malfunction (2), and a superficial hematoma (>6 cm). Total complications were 6 out of 157 (3.8%) [95% CI = 0.8-6.8%)]. Successful hemostasis was achieved in less than 5 min in over 97% of patients. Successful device deployment was seen in over 98% of cases. Conclusion: We conclude that in our experience, the Angioseal vascular closure device is a safe and efficient means of achieving hemostasis post antegrade or retrograde puncture for diagnostic and percutaneous intervention procedures.
  7,027 207 -
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
Divyata R Hingwala, Neelima Radhakrishnan, Chandrasekharan Kesavadas, Bejoy Thomas, Tirur Raman Kapilamoorthy, Vishnupuri V Radhakrishnan
April-June 2013, 23(2):155-163
DOI:10.4103/0971-3026.116579  PMID:24082482
Neuroenteric cysts are developmental cysts that should be differentiated from other, more common non-neoplastic cysts as well as cystic neoplasms. While these lesions may have varied imaging findings, T1 hyperintense prepontine lesion due to mucinous/proteinaceous content is characteristic. Location and imaging characteristics aid in formulating the correct diagnosis of neuroepithelial/neuroenteric cysts. Magnetic resonance spectroscopy (MRS) has the specific finding of N-Acetyl Aspartate (NAA)-like peak at 2.02 ppm which is not seen in other cystic lesions. In this study, we aim to discuss the imaging findings of these lesions on conventional and advanced MRI findings and provide radiologic-pathologic correlation. We also briefly describe the pathogenesis, embryology and radiological differential diagnoses of these cysts.
  6,764 452 -
MR enterography in children: Principles, technique, and clinical applications
Govind B Chavhan, Paul S Babyn, Thomas Walters
April-June 2013, 23(2):173-178
DOI:10.4103/0971-3026.116567  PMID:24082485
MR enterography is a constantly advancing technique for assessment of bowel with newer technology and sequences. It is being increasingly used for the assessment of inflammatory bowel disease and has almost replaced barium follow through examinations in many institutions. Its lack of radiation makes it an attractive alternative for bowel evaluation in children. It has been proved to be highly sensitive in the detection of Crohn disease in adults and children. It is also superior to barium studies in showing extra-enteric findings and detecting complications such as fistulas and abscesses. Even though at present it is almost exclusively used for the evaluation of inflammatory bowel disease, it has the potential to be used in other conditions affecting the bowel. The principles, MR enterography technique pertinent to children, and its utility in the assessment of Crohn disease in children are discussed in this review.
  6,512 453 -
Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications
Yazmin Yaacob, Dang V Nguyen, Zahiah Mohamed, A Razali A Ralib, Rozman Zakaria, Sobri Muda
April-June 2013, 23(2):121-125
DOI:10.4103/0971-3026.116543  PMID:24082475
Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.
  6,380 429 -
The McKusick-Kaufman hydrometrocolpos-polydactyly syndrome: A rare case report
Swapnil P Yewalkar, Vikas K Yadav, GJ Khadse
April-June 2013, 23(2):183-185
DOI:10.4103/0971-3026.116573  PMID:24082487
A combination of hydrometrocolpos, polydactyly, and cardiac anomlies is the cardinal feature of McKusick-Kaufman syndrome. Neonatal hydrometrocolpos is rare Mullerian duct anomaly caused by obstruction of the vagina. There is an accumulation of mucus secretions proximal to the obstruction. The secretions are secondary to intrauterine and postnatal stimulation of uterine and cervical glands by maternal estrogens. Here, we report a case of 1-day-old neonate who presented with abdominal distension. Ultrasound and computed tomography findings revealed a large abdominopelvic cystic mass posterior to the urinary bladder. Other associated findings were polydactyly and bilateral hydronephosis. Laparotomy confirmed the findings of hydrometrocolpos caused by stenosis/atresia of lower vagina.
  4,731 256 -
The sway of interventions today…
Sanjay N Jain
April-June 2013, 23(2):119-120
DOI:10.4103/0971-3026.116540  PMID:24082474
  4,331 421 -
Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause
Rahul G Hegde, Tushar M Kalekar, Meenakshi I Gajbhiye, Amol S Bandgar, Shephali S Pawar, Gopal J Khadse
April-June 2013, 23(2):168-172
DOI:10.4103/0971-3026.116562  PMID:24082484
We report two cases of esophagobronchial fistulae diagnosed by Multi-detector computed tomography (MDCT) oral contrast swallow examination. It is helpful to supplement the CT study with an oral contrast swallow as it aids in confirmation of a suspected fistula and also demonstrates the fistula tract better. We present the clinical details and the imaging findings on MDCT of two cases of esophagobronchial fistulae - one secondary to chronic chest tuberculosis and the other secondary to a squamous cell carcinoma of the upper esophagus - followed by discussion of the etiology, pathogenesis, and imaging of these fistulae.
  4,048 340 -
Giant sacrococcygeal teratoma embolization
Umberto G Rossi, Maurizio Cariati, Paolo Tomà
April-June 2013, 23(2):145-147
DOI:10.4103/0971-3026.116571  PMID:24082479
Resection of giant sacrococcygeal teratoma with high-vasculature in newborns can be a fatal procedure due to massive bleeding of the tumor. Endovascular embolization of the arteries that supply the tumor may lead to minimal blood loss. We present a case of giant high-vascular sacrococcygeal teratoma type-1 that was embolized in an infant born at 35 weeks gestation. This procedure lead to a safe, surgical resection with minimal bleeding: 12 ml.
  4,046 153 -
Cystic adventitial disease of popliteal artery with significant stenosis
Ranjana Gupta, Puneet Mittal, Praveen Gupta, Nancy Jindal
April-June 2013, 23(2):148-150
DOI:10.4103/0971-3026.116572  PMID:24082480
Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein.
  3,966 212 -
Sonographic features of agenesis of dorsal pancreas
S Boopathy Vijayaraghavan, Swapna Gouru, Sathiya Senthil
April-June 2013, 23(2):179-182
DOI:10.4103/0971-3026.116570  PMID:24082486
Agenesis of dorsal pancreas is an extremely rare congenital anomaly that occurs due to failure of the dorsal pancreatic bud to form the body and tail of the pancreas. We report the sonographic appearance of this condition in six cases.
  3,400 274 -
Role of radiofrequency ablation in unresectable hepatocellular carcinoma: An Indian experience
Naveen Kalra, Mandeep Kang, Anmol Bhatia, Ajay K Duseja, Radha K Dhiman, Virendra K Arya, Arvind Rajwanshi, Yogesh K Chawla, Niranjan Khandelwal
April-June 2013, 23(2):139-144
DOI:10.4103/0971-3026.116569  PMID:24082478
Aims: To evaluate the role of radiofrequency ablation (RFA) as an ablative technique in patients with unresectable hepatocellular carcinoma (HCC). Settings and Design: A tertiary care center, prospective study. Materials and Methods: The subjects comprised 31 patients (30 males, one female; age range 32-75 years) with HCC (41 lesions) who were treated with image-guided RFA. The follow-up period ranged from 3 months to 6 years, and included a multiphasic computed tomography (CT) at 1, 3 and 6 months post-RFA, and every 6 months thereafter. Patient outcome was evaluated and the tumor recurrence, survival and complications were assessed. Statistical Analysis Used: Discrete categorical data were presented as n (%) and continuous data as mean ± SD. Pearson correlation coefficient was used to determine the relationship between the different variables. Kaplan-Meier survival curve and Log-rank test were used to test the significance of difference between the survival time of the different groups. Results: The ablation success rate was 80.5% (33/41 HCC lesions). 12.2% (5/41) of the lesions were managed with repeat RFA due to tumor residue. 4.9% (2/41) of the lesions were managed with repeated RFA and transarterial chemoembolization. Eight patients had tumor recurrence (five patients (16.1%) had local recurrence and three patients (9.6%) had distant recurrence). Eleven patients died within 3.5-20 months post-RFA. The survival rate at 1 year in patients who completed at least 1 year of follow-up was 63.3%. There was one major complication (1/31, 3.2%) in a patient with a subcapsular lesion and ascites. This patient developed hemoperitoneum in the immediate postprocedure period and was managed with endovascular treatment. She, however, had hepatic decompensation and died 48 h post-RFA. Conclusion: RFA is an effective and safe treatment for small unresectable HCC.
  3,294 269 -
Endovascular treatment of hepatocellular carcinoma with drug eluting microparticles (DC-Beads): CT evaluation of response to the treatment
Emanuele Boatta, Mario Corona, Alessandro Cannavale, Fabrizio Fanelli, Carlo Cirelli, Lorenzo de Medici
April-June 2013, 23(2):126-133
DOI:10.4103/0971-3026.116564  PMID:24082476
Background and Study Aims: Our aim was to assess the efficacy and tolerability of drug-eluting beads-transarterial chemoembolization (DEB-TACE) in the treatment of hepatocellular carcinoma (HCC), evaluating the response to the treatment after 1, 6, 12, and 24 months with multidetector computed tomography (MDCT) comparing European Association for the study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Materials and Methods: We enrolled 154 patients with uni- or multifocal HCC who underwent a DEB-TACE. A total of 278 HCC nodules were treated. CT follow-up was performed at 1, 6, 12, and 24 months after the procedure according to the EASL and RECIST criteria evaluating overall target and target nodule response. We also analyzed the shrinking of nodules in relation to response to treatment. Results: A total of 278 nodules of HCC underwent TACE by using DC-Beads: At 24, months complete response was similar for EASL and RECIST criteria (112 vs. 121 nodules) with optimal accordance between methods and readers with k = 0.9. Partial Response resulted significantly different among the two methods within the first month, otherwise was similar after 24-month follow-up. Similar results in both methods were found for nodules classified as Stable Disease (P > 0.05). Progressive Disease results were similar in both the groups according to both the classification criteria without any significant difference (P > 0.05). Conclusion: Our study confirmed that EASL and mRECIST criteria are both effective methods for patient follow-up, however with some technical differences.
  3,123 239 -
Embolization of a large high-flow renal arteriovenous fistula using 035″ and 018″ detachable coils
Dinesh K Sundarakumar, Ghazwan M Kroma, Crysela M Smith, Jorge E Lopera, Rajeev Suri
April-June 2013, 23(2):151-154
DOI:10.4103/0971-3026.116574  PMID:24082481
Transcatheter embolization of renal arteriovenous fistula (AVF) is a minimally invasive procedure that, in some occasions, can replace surgery and potentially save the kidney. The embolization techniques for the renal AVFs have evolved considerably with the availability of newer hardwares. Still, the risk of inadvertent migration of the embolization materials to the pulmonary circulation is a concern. This article describes a novel technique of coiling the feeding segmental artery to a large high-flow renal AVF using 035″ and 018″ detachable coils only, and briefly reviews the previously described strategies to safely embolize renal AVFs.
  3,173 187 -
Multiparametric magnetic resonance imaging of prostate cancer
Ali Kemal Sivrioglu, AK Mehmet, Kemal Kara, Güner Sönmez
April-June 2013, 23(2):188-188
DOI:10.4103/0971-3026.116580  PMID:24082490
  2,201 267 -
Diffusion-weighted MRI in assessment of renal dysfunction
Ali Kemal Sivrioglu, AK Mehmet, Kemal Kara, Mehmet Deveer
April-June 2013, 23(2):186-186
DOI:10.4103/0971-3026.116576  PMID:24082488
  2,065 234 -
Authors' reply
Ankur Goyal, Raju Sharma, Ashu S Bhalla, Shivanand Gamanagatti, Amlesh Seth
April-June 2013, 23(2):186-187
  1,867 93 -
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