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   2010| January-March  | Volume 20 | Issue 1  
    Online since February 6, 2010

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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 5,888 512
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 8,583 726
Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome
Shahina Bano, Vikas Chaudhary, Sanjay Pande, VL Mehta, AK Sharma
January-March 2010, 20(1):20-25
DOI:10.4103/0971-3026.59747  PMID:20351987
Objective: The aim of our study was to evaluate the usefulness of the pulsatility index (PI) of the umbilical artery (UA) and that of the fetal middle cerebral artery (MCA), as well as the ratio of the MCA PI to the UA PI (C/U ratio), in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome. Materials and Methods: The study population comprised 90 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The UA PI and the MCA PI as well as the C/U ratio were calculated. Results: Of the 90 pregnancies in the study, 24 showed abnormal UA PI. Among these, 21 (87.5%) were SGA and 19 (79.2%) had adverse perinatal outcome. Of the four of the 90 pregnancies that showed abnormal MCA PI, all were SGA and had adverse perinatal outcome. Similarly, of the 20 out of 90 pregnancies that showed abnormal C/U ratio (<1.08), all 20 (100%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. Conclusion: Inferences drawn from the study were: (1) The C/U ratio is a better predictor of SGA fetuses and adverse perinatal outcome than the MCA PI or the UA PI used alone, (2) The UA PI can be used to identify IUGR per se and (3) The MCA PI alone is not a reliable indicator for predicting fetal distress.
  7 11,560 2,677
Mesoaortic entrapment of a left inferior vena cava
Ashish Gupta, Nitish Naik, Gurpreet Singh Gulati
January-March 2010, 20(1):63-65
DOI:10.4103/0971-3026.59758  PMID:20351998
A persistent left inferior vena cava (IVC) is a rare anomaly, with a reported incidence of only 0.2-0.5%. When present, it courses between the superior mesenteric artery and the aorta to continue as the right IVC, similar to the course of a left renal vein (LRV). This anomaly is usually asymptomatic, but there may be vague abdominal complaints if the IVC is compressed in the mesoaortic angle. Although symptomatic compression of the LRV (anterior nutcracker syndrome) is well recognized, there has been only one report in the literature of a similar compression of a persistent left IVC. Because of its rarity, this anomaly may be missed or mistaken for other conditions on imaging. An accurate diagnosis is crucial as the presence of this anomaly may have implications for surgical treatment of aortic lesions or placement of an IVC filter. Magnetic resonance angiography and, more recently, multidetector computed tomography scan, can provide an exquisite three-dimensional demonstration of vascular abnormalities.
  6 3,871 333
Case report: Fibromatosis colli in a neonate
S Smiti, Naveen M Kulkarni, Jyoti Singh
January-March 2010, 20(1):45-46
DOI:10.4103/0971-3026.59753  PMID:20351993
Fibromatosis colli or pseudotumor of infancy of the sternocleidomastoid muscle is a rare cause of a benign neck mass in neonates and infants. If diagnosed correctly, it can be managed conservatively, and unnecessary investigations can be avoided.
  6 6,447 464
CT mimics of peritoneal carcinomatosis
S Smiti, KV Rajagopal
January-March 2010, 20(1):58-62
DOI:10.4103/0971-3026.59757  PMID:20351997
Peritoneal carcinomatosis is a term used to describe widespread metastases of cancerous tumors in the peritoneal cavity. It is most common in carcinomas of the gastrointestinal tract (GIT) and ovaries, and must be considered to be the main diagnosis even when the primary is not known. A wide variety of disease processes mimic peritoneal carcinomatosis. Precise diagnosis based on imaging alone is often difficult and very often the final diagnosis is only obtained after appropriate histopathology or microbiology.
  5 10,292 1,133
Persistent mullerian duct syndrome
Divya Renu, B Ganesh Rao, K Ranganath, Namitha
January-March 2010, 20(1):72-74
DOI:10.4103/0971-3026.59761  PMID:20352001
Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism in which Mullerian duct derivatives are seen in a male patient. This syndrome is characterized by the persistence of Mullerian duct derivatives (i.e. uterus, cervix, fallopian tubes and upper two thirds of vagina) in a phenotypically and karyotypically male patient. In this article we present the USG and MRI features of a case of PMDS with bilateral cryptorchidism and left sided inguinal hernia, containing the uterus and fallopian tubes.
  5 5,651 631
Lipoma arborescens of the elbow
K Ranganath, Ganesh B Rao, Namitha
January-March 2010, 20(1):50-52
DOI:10.4103/0971-3026.59755  PMID:20351995
Lipoma arborescens (LA) is a rare non-neoplastic intra-articular lesion that most commonly affects the knee joint, especially the suprapatellar bursa. It rarely affects the elbow joint. There are a few reports of involvement of the bicipital radial bursa. We report a case of LA, with characteristic MRI features, affecting the elbow joint in a young male.
  5 5,286 396
Primary laryngeal tuberculosis mimicking laryngeal carcinoma: CT scan features
N Ech-Cherif El Kettani, MR El Hassani, N Chakir, M Jiddane
January-March 2010, 20(1):11-12
DOI:10.4103/0971-3026.59745  PMID:20351985
Laryngeal tuberculosis is a rare disease. It is almost always associated with pulmonary tuberculosis. It occurs generally in adults without BCG vaccination or in cases of the acquired immune deficiency syndrome. On laryngoscopy and imaging, it often simulates laryngeal carcinoma, and confirmation is always histological. We report the case of a 36-year-old man who presented to our hospital with dysphonia and dysphagia. Laryngoscopy revealed a lesion of the left vocal cord and the ventricular strip. CT scan found focal, regular thickening of the left vocal cord, associated with irregular thickening of the posterior laryngeal wall. A biopsy confirmed the diagnosis of tuberculosis.
  5 5,875 727
MRI in perianal fistulae
Pushpinder S Khera, Hesham A Badawi, Ahmed H Afifi
January-March 2010, 20(1):53-57
DOI:10.4103/0971-3026.59756  PMID:20351996
MRI has become the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the sphincter muscles orthogonally, with good contrast resolution. In this article we give an outline of the classification of perianal fistulae and present a pictorial assay of sphincter anatomy and the MRI findings in perianal fistulae. This study is based on a retrospective analysis of 43 patients with a clinical diagnosis of perianal fistula. MRI revealed a total of 44 fistulae in 35 patients; eight patients had only perianal sinuses.
  4 15,146 2,744
The subspecialization conundrum
Bhavin Jankharia
January-March 2010, 20(1):1-1
DOI:10.4103/0971-3026.59742  PMID:20351982
  3 2,729 354
Visualization of gastric varices using angiographic C-arm CT during retrograde transvenous sclerotherapy
Jin Iwazawa, Shoichi Ohue, Hisashi Abe, Takashi Mitani
January-March 2010, 20(1):39-41
DOI:10.4103/0971-3026.59751  PMID:20351991
During retrograde transvenous sclerotherapy for gastric varices, sufficient opacification of the target varices on venography is essential for successful treatment. However, venography sometimes cannot identify target varices due to overlapping adjacent collateral vessels or leakage of contrast medium to other outflow veins. We report how C-arm CT images acquired using a flat-panel detector angiography system helped to identify target varices and predict the distribution of a sclerosant, which resulted in safer sclerotherapy and increased operator confidence.
  3 2,855 262
Metaphyseal bands in osteogenesis imperfecta
SS Suresh, John K Thomas
January-March 2010, 20(1):42-44
DOI:10.4103/0971-3026.59752  PMID:20351992
An increasing number of patients with osteogenesis imperfecta are undergoing pamidronate therapy to prevent the incidence of fragility fractures. The authors herein report a child aged 3 years who received five cycles of pamidronate, resulting in metaphyseal bands, known as "zebra lines."
  2 3,794 483
Ribbing disease
Philson J Mukkada, Teenu Franklin, Rangasami Rajeswaran, Santhosh Joseph
January-March 2010, 20(1):47-49
DOI:10.4103/0971-3026.59754  PMID:20351994
Ribbing disease is a rare sclerosing dysplasia that involves long tubular bones, especially the tibia and femur. It occurs after puberty and is reported to be more common in women. In this article we describe how Ribbing disease can be differentiated from diseases like Engelmann-Camurati disease, van Buchem disease, Erdheim-Chester disease, osteoid osteoma, chronic osteomyelitis, stress fracture, etc.
  2 3,728 512
Pictorial essay: Orbital tuberculosis
Mahender K Narula, Vikas Chaudhary, Dhiraj Baruah, Manoj Kathuria, Rama Anand
January-March 2010, 20(1):6-10
DOI:10.4103/0971-3026.59744  PMID:20351984
Tuberculosis of the orbit is rare, even in places where tuberculosis is endemic. The disease may involve soft tissue, the lacrimal gland, or the periosteum or bones of the orbital wall. Intracranial extension, in the form of extradural abscess, and infratemporal fossa extension has been described. This pictorial essay illustrates the imaging findings of nine histopathologically confirmed cases of orbital tuberculosis. All these patients responded to antituberculous treatment.
  2 4,526 781
Cavitatory mesenteric lymph node syndrome: A rare entity
Vibhuti , Kalia Vishal, Anakhvir Gill
January-March 2010, 20(1):66-68
DOI:10.4103/0971-3026.59759  PMID:20351999
Celiac disease is a gluten sensitive enteropathy that involves an abnormal immunological response to glutens in wheat, rye etc. It predominantly involves the small intestinal mucosa, though, extra luminal manifestations can also occur. One rare extraluminal manifestation is cavitatory mesenteric lymph node syndrome. It occurs in refractory celiac disease and is associated with poor prognosis due to various complications. The diagnosis is often made on imaging when cystic mesenteric lymph nodes with fat-fluid levels are seen and this can then be confirmed by histopathological examination. We recently had a typical case where we were able to make this diagnosis.
  1 3,492 348
Paradoxical hepatic tumor: Undifferentiated embryonal sarcoma of the liver
Kushaljit Singh Sodhi, Elhamy Bekhitt, Christian Rickert
January-March 2010, 20(1):69-71
DOI:10.4103/0971-3026.59760  PMID:20352000
Undifferentiated embryonal sarcoma (UES) is a rare primary malignant tumor of the liver that typically presents in late childhood. We report a case of primary UES, which had a typical paradoxical appearance on different imaging modalities.
  1 4,264 397
Practical issues in picture archiving and communication system and networking
Arjun Kalyanpur, Jasbir Singh, Ricky Bedi
January-March 2010, 20(1):2-5
DOI:10.4103/0971-3026.59743  PMID:20351983
Picture Archiving and Communication System (PACS) is a key workflow tool in the functioning of radiology departments worldwide, today, and its utilization is rapidly growing in India. The key challenges in PACS implementation are related to vendor and feature selection, integration with the existing HIS, user training, maintenance and scalability to meet increasing demands. Additionally, the networking requirements that PACS imposes on hospital networks are not insignificant. This article attempts to review these issues from the standpoint of what a prospective or new user needs to know.
  1 7,934 887
Refractory post visual internal urethrotomy bleeding managed by angioembolization
Jayesh V Dhabalia, Girish G Nelivigi, Mahendra Singh Punia, Vikash Kumar
January-March 2010, 20(1):37-38
DOI:10.4103/0971-3026.59750  PMID:20351990
Post visual internal urethrotomy (VIU) bleeding is usually treated successfully with local compression. Angioembolization for post VIU bleeding has not been previously reported to the best of our knowledge. This is a case report of a 55-year-old man who was referred with persistent per urethral bleeding around a Foley catheter, three days following VIU. When standard methods of treatment were unsuccessful, the bleeding was controlled by embolizing the bulbourethral artery with polyvinyl alcohol (PVA) particles.
  1 3,468 225
Image-guided percutaneous drainage of an emphysematous bulla with a fluid level
Naveen Kalra, Senthil Kumar Aiyappan, Surinder K Jindal, Niranjan Khandelwal
January-March 2010, 20(1):34-36
DOI:10.4103/0971-3026.59749  PMID:20351989
We report here a case of a large emphysematous bulla with a fluid level that was managed successfully by percutaneous catheter drainage in a 50 year-old man with chronic obstructive airway disease.
  - 3,700 370
Few useful websites on radiation and radiation safety
IK Indrajit
January-March 2010, 20(1):75-77
  - 5,266 572
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