Indian Journal of Radiology Indian Journal of Radiology  

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   2012| July-September  | Volume 22 | Issue 3  
    Online since February 15, 2013

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Imaging in oral cancers
Supreeta Arya, Devendra Chaukar, Prathamesh Pai
July-September 2012, 22(3):195-208
DOI:10.4103/0971-3026.107182  PMID:23599568
Oral cavity squamous cell cancers form a significant percentage of the cancers seen in India. While clinical examination allows direct visualization, it cannot evaluate deep extension of disease. Cross-sectional imaging has become the cornerstone in the pretreatment evaluation of these cancers and provides accurate information about the extent and depth of disease that can help decide the appropriate management strategy and indicate prognosis. Early cancers are treated with a single modality, either surgery or radiotherapy while advanced cancers are offered a combination of surgery, radiotherapy and chemotherapy. Imaging can decide resectability, help plan the precise extent of resection, and indicate whether organ conservation therapy should be offered. Quality of life issues necessitate preservation of form and function and pretreatment imaging helps plan appropriate reconstruction and counsel patients regarding lifestyle changes. Oral cavity has several subsites and the focus of the review is squamous cancers of the gingivobuccal region, oral tongue and retromolar trigone as these are most frequently encountered in the subcontinent. References for this review were identified by searching Medline and PubMed databases. Only articles published in English language literature were selected. This review aims to familiarize the radiologist with the relevant anatomy of the oral cavity, discuss the specific issues that influence prognosis and management at the above subsites, the optimal imaging methods, the role of imaging in accurately staging these cancers and in influencing management. A checklist for reporting will emphasize the information to be conveyed by the radiologist.
  116,568 17,129 1
Imaging in laryngeal cancers
Varsha M Joshi, Vineet Wadhwa, Suresh K Mukherji
July-September 2012, 22(3):209-226
DOI:10.4103/0971-3026.107183  PMID:23599569
Imaging plays an important complementary role to clinical examination and endoscopic biopsy in the evaluation of laryngeal cancers. A vast majority of these cancers are squamous cell carcinomas (SCC). Cross-sectional imaging with contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging allows excellent depiction of the intricate anatomy of the larynx and the characteristic patterns of submucosal tumor extension. CT, MRI and more recently PET-CT, also provide vital information about the status of cervical nodal disease, systemic metastases and any synchronous malignancies. Additionally, certain imaging-based parameters like tumor volume and cartilaginous abnormalities have been used to predict the success of primary radiotherapy or surgery in these patients. Integration of radiological findings with endoscopic evaluation greatly improves the pretherapeutic staging accuracy of laryngeal cancers, and significantly impacts the choice of management strategies in these patients. Imaging studies also help in the post-therapeutic surveillance and follow-up of patients with laryngeal cancers. In this article, we review the currently used laryngeal imaging techniques and protocols, the key anatomic structures relevant to tumor spread and the characteristic patterns of submucosal extension and invasion of laryngeal cancer. The role of CT, MRI and PET-CT in the evaluation of patients with laryngeal SCC and the impact of imaging findings on prognosis and clinical management is also discussed.
  81,665 13,636 -
Multiparametric magnetic resonance imaging of prostate cancer
Sandeep S Hedgire, Tamara N Oei, Shaunagh Mcdermott, Kai Cao, Zena M Patel, Mukesh G Harisinghani
July-September 2012, 22(3):160-169
DOI:10.4103/0971-3026.107176  PMID:23599562
In India, prostate cancer has an incidence rate of 3.9 per 100,000 men and is responsible for 9% of cancer-related mortality. It is the only malignancy that is diagnosed with an apparently blind technique, i.e., transrectal sextant biopsy. With increasing numbers of high-Tesla magnetic resonance imaging (MRI) equipment being installed in India, the radiologist needs to be cognizant about endorectal MRI and multiparametric imaging for prostate cancer. In this review article, we aim to highlight the utility of multiparamteric MRI in prostate cancer. It plays a crucial role, mainly in initial staging, restaging, and post-treatment follow-up.
  26,526 2,603 2
Multimodality imaging of the orbit
Pradipta C Hande, Inder Talwar
July-September 2012, 22(3):227-239
DOI:10.4103/0971-3026.107184  PMID:23599570
The role of imaging is well established in the evaluation of orbital diseases. Ultrasonography, Computed tomography and Magnetic resonance imaging are complementary modalities, which allow direct visualization of regional anatomy, accurate localization and help to characterize lesions to make a reliable radiological diagnosis. The purpose of this pictorial essay is to highlight the imaging features of commonly encountered pathologies which involve the orbit.
  22,853 1,792 -
HRCT evaluation of microtia: A retrospective study
Aruna R Patil, Ashu Bhalla, Pankaj Gupta, Deepali Goyal, Sreenivas Vishnubhatla, Anurag Ramavat, Suresh Sharma
July-September 2012, 22(3):188-194
DOI:10.4103/0971-3026.107181  PMID:23599567
Purpose: To determine external, middle, and inner ear abnormalities on high-resolution computed tomography (HRCT) of temporal bone in patients with microtia and to predict anatomic external and middle ear anomalies as well as the degree of functional hearing impairment based on clinical grades of microtia. Materials and Methods: It was a retrospective study conducted on Indian population. Fifty-two patients with microtia were evaluated for external, middle, and inner ear anomalies on HRCT of temporal bone. Clinical grading of microtia was done based on criteria proposed by Weerda et al. in 37 patients and degree of hearing loss was assessed using pure tone audiometry or brainstem-evoked response in 32 patients. Independent statistical correlations of clinical grades of micotia with both external and middle ear anomalies detected on HRCT and the degree of hearing loss were finally obtained. Results: The external, middle, and inner ear anomalies were present in 93.1%, 74.5%, and 2.7% patients, respectively. Combined cartilaginous and bony external auditory canal atresia (EAC) was the most common anatomic abnormality in our group of microtia patients. Hypoplastic mesotympanum represented the commonest middle ear anomaly. The incidence of combined ossicular dysplasia and facial canal anomalies was lower as compared to other population groups; however, we recorded a greater incidence of cholesteatoma. Both these factors can have a substantial impact on outcome of patients planned for surgery. We found no significant association between grades of microtia and external or middle ear anomalies. Similarly, no significant association was found between lower grades of microtia (grade I and II) and degree of hearing loss. However, association between grade III microtia and degree of hearing loss was significant. A significant association between congenital cholesteatoma and degree of pneumatization of atretic plate and mastoid process not previously studied was also recorded in our study.
  10,932 1,377 1
From the Guest Editor
Sanjay Jain
July-September 2012, 22(3):149-149
DOI:10.4103/0971-3026.107164  PMID:23599559
  7,540 1,543 -
Cloud computing for radiologists
Amit T Kharat, Amjad Safvi, SS Thind, Amarjit Singh
July-September 2012, 22(3):150-154
DOI:10.4103/0971-3026.107166  PMID:23599560
Cloud computing is a concept wherein a computer grid is created using the Internet with the sole purpose of utilizing shared resources such as computer software, hardware, on a pay-per-use model. Using Cloud computing, radiology users can efficiently manage multimodality imaging units by using the latest software and hardware without paying huge upfront costs. Cloud computing systems usually work on public, private, hybrid, or community models. Using the various components of a Cloud, such as applications, client, infrastructure, storage, services, and processing power, Cloud computing can help imaging units rapidly scale and descale operations and avoid huge spending on maintenance of costly applications and storage. Cloud computing allows flexibility in imaging. It sets free radiology from the confines of a hospital and creates a virtual mobile office. The downsides to Cloud computing involve security and privacy issues which need to be addressed to ensure the success of Cloud computing in the future.
  7,398 863 2
Atypical femoral fractures related to bisphosphonate therapy
Tarun Pankaj Jain, Murray Thorn
July-September 2012, 22(3):178-181
DOI:10.4103/0971-3026.107178  PMID:23599564
Bisphosphonates (BP) are a commonly prescribed class of drugs for the prevention of osteoporosis-related fractures. Paradoxically, however, they have recently been linked to atypical fractures in the shaft of the femur. Since many physicians including radiologists, are not aware of this entity, the incidence is likely underreported. These fractures usually occur in the sub-trochanteric region of the femur in the setting of low-energy trauma. It starts as a fracture line involving the lateral cortex and then progresses medially to give rise to a complete fracture. The fracture line is usually transverse, and there is a medial spike associated with a complete fracture. These fractures can be bilateral. Awareness of these atypical fractures and their radiological appearance should enable their early and accurate detection and thus lead to specific treatment.
  7,352 294 2
Diffusion-weighted MRI in assessment of renal dysfunction
Ankur Goyal, Raju Sharma, Ashu S Bhalla, Shivanand Gamanagatti, Amlesh Seth
July-September 2012, 22(3):155-159
DOI:10.4103/0971-3026.107169  PMID:23599561
Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) in renal diseases is an evolving field and its potential is yet to be fully realized. Purpose: To study the relationship between apparent diffusion coefficient (ADC) values of renal parenchyma and serum markers of renal function and stage of chronic kidney disease (CKD). Materials and Methods: A retrospective review was performed of all adult patients who underwent DW-MRI (at b-values of 0 and 500 s/mm 2 ) for renal lesions from January 2009 to September 2010 and revealed 88 patients, of which 22 patients had renal dysfunction and 66 had normal renal function. Of these 22, 15 patients were known cases of CKD and were staged depending on disease severity. ADC values were determined for renal parenchyma and compared. Receiver operating characteristic (ROC) curves were drawn to establish cut-off ADC values. Pearson's correlation coefficient (R) was calculated between ADC and renal function parameters. Results: ADC values in patients with renal dysfunction were significantly lower than in patients with normal renal function (2.1133 ± 0.2851 vs. 2.3198 ± 0.1246 (×10 -3 mm 2 /s)). ADC values lower than 2.0354 (×10 -3 mm 2 /s) were seen only with renal dysfunction and higher than 2.4516 (×10 -3 mm 2 /s) were seen only with normal function. There was significant inverse correlation between ADC and serum creatinine ( R = -0.530), blood urea (R= -0.502), and significant linear correlation ( R = 0.784) with estimated glomerular filtration rate (eGFR). ADC values showed a statistically significant decreasing trend with increasing stage of CKD. Conclusion: ADC values may serve as an additional marker for the presence and degree of renal dysfunction.
  6,782 858 4
Pituitary stalk transection syndrome: Comparison of clinico-radiological features in adults and children with review of literature
Chinmay Kulkarni, Srikanth Moorthy, Sreekumar K Pullara, R Rajeshkannan, Ambika G Unnikrishnan
July-September 2012, 22(3):182-185
DOI:10.4103/0971-3026.107179  PMID:23599565
Hypo-pituitarism results from impaired production of one or more of anterior pituitary trophic hormones. A rare cause of hypo-pituitarism is pituitary stalk transection syndrome. The MRI features of this condition in children and its association with hormonal deficiencies have been reported earlier. Reports on adults with this disorder are scarce, with only one small case series published in the recent literature. We studied the hormonal deficiency pattern and MRI findings of 12 patients with pituitary stalk transection syndrome who presented to our department between 2004 and 2011. Six patients were children and six were adults (≥18 years). This article compares the adult clinico-radiological phenotype of pituitary transection syndrome with the pediatric group of patients with same condition.
  6,144 398 1
Magnetic resonance imaging in the evaluation of congestive cardiac failure
Prabhakar Rajiah
July-September 2012, 22(3):170-177
DOI:10.4103/0971-3026.107177  PMID:23599563
Congestive cardiac failure is the end-result of various cardiac disorders, and is a major contributor to morbidity, mortality, and financial burden throughout the world. Due to advances in the knowledge of the disease and scanner technology, magnetic resonance imaging (MRI) is playing an increasingly important role in the evaluation of cardiac failure, including in establishing diagnosis, problem solving, risk stratification, and monitoring of therapy. This review discusses and illustrates the role of MRI in the assessment of congestive cardiac failure.
  5,910 354 -
Contrast injected, scan triggered, but where has contrast gone?
Pankaj Gupta, Gupreet Singh Gulati, Munish Guleria
July-September 2012, 22(3):186-187
DOI:10.4103/0971-3026.107180  PMID:23599566
Intra-arterial injections during CT scan examinations are a rare occurrence in day-to-day radiology practice but are of potential significance when they do occur. They render an imaging study non-diagnostic, and for imaging techniques like CT scan, expose patient to undue radiation dose. Equally disturbing for both patient and clinicians, including radiologists, is the need for repeat imaging. For certain emergency indications, such an event may yield erroneous results and severely hamper patient's management. We report one such event that occurred in our cardiac CT scan section with the aim to raise awareness about such events among our colleagues.
  3,950 275 -
Synchronizing computer clocks: The challenge of multiple time zones in teleradiology
Anjali Agrawal, Arjun Kalyanpur
July-September 2012, 22(3):240-240
DOI:10.4103/0971-3026.107186  PMID:23599571
  2,749 117 -
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