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   2013| January-March  | Volume 23 | Issue 1  
    Online since June 18, 2013

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Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part I
Suleman Merchant, Alpa Bharati, Neesha Merchant
January-March 2013, 23(1):46-63
DOI:10.4103/0971-3026.113615  PMID:23986618
Tuberculosis (TB) remains a worldwide scourge and its incidence appears to be increasing due to various factors, such as the spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The insidious onset and non-specific constitutional symptoms of genitourinary tuberculosis (GUTB) often lead to delayed diagnosis and rapid progression to a non-functioning kidney. Due to hematogenous dissemination of TB, there is a potential risk of involvement of the contralateral kidney too. Imaging plays an important role in the making of a timely diagnosis and in the planning of treatment, and thus helps to avoid complications such as renal failure. Imaging of GUTB still remains a challenge, mainly on account of the dearth of literature, especially related to the use of the newer modalities such as magnetic resonance imaging (MRI). This two-part article is a comprehensive review of the epidemiology, pathophysiology, and imaging findings in renal TB. Various imaging features of GUTB are outlined, from the pathognomonic lobar calcification on plain film, to finer early changes such as loss of calyceal sharpness and papillary necrosis on intravenous urography (IVU); to uneven caliectasis and urothelial thickening, in the absence of renal pelvic dilatation, as well as the hitherto unreported 'lobar caseation' on ultrasonography (USG). Well-known complications of GUTB such as sinus tracts, fistulae and amyloidosis are described, along with the relatively less well-known complications such as tuberculous interstitial nephritis (TIN), which may remain hidden because of its 'culture negative' nature and thus lead to renal failure. The second part of the article reviews the computed tomography (CT) and MRI features of GUTB and touches upon future imaging techniques along with imaging of TB in transplant recipients and in immunocompromised patients.
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Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part II
Suleman Merchant, Alpa Bharati, Neesha Merchant
January-March 2013, 23(1):64-77
DOI:10.4103/0971-3026.113617  PMID:23986619
This article reviews the computed tomography and magnetic resonance imaging (MRI) features of renal tuberculosis (TB), including TB in transplant recipients and immunocompromised patients. Multi detector computed tomography (MDCT) forms the mainstay of cross-sectional imaging in renal TB. It can easily identify calcification, renal scars, mass lesions, and urothelial thickening. The combination of uneven caliectasis, with urothelial thickening and lack of pelvic dilatation, can also be demonstrated on MDCT. MRI is a sensitive modality for demonstration of features of renal TB, including tissue edema, asymmetric perinephric fat stranding, and thickening of Gerota's fascia, all of which may be clues to focal pyelonephritis of tuberculous origin. Diffusion-weighted MR imaging with apparent diffusion coefficient (ADC) values may help in differentiating hydronephrosis from pyonephrosis. ADC values also have the potential to serve as a sensitive non-invasive biomarker of renal fibrosis. Immunocompromised patients are at increased risk of renal TB. In transplant patients, renal TB, including tuberculous interstitial nephritis, is an important cause of graft dysfunction. Renal TB in patients with HIV more often shows greater parenchymal affection, with poorly formed granulomas and relatively less frequent findings of caseation and stenosis. Atypical mycobacterial infections are also more common in immunocompromised patients.
  22,579 3,523 -
Multimodality imaging of carotid atherosclerotic plaque: Going beyond stenosis
Divyata Hingwala, Chandrasekharan Kesavadas, Padmavathy N Sylaja, Bejoy Thomas, Tirur Raman Kapilamoorthy
January-March 2013, 23(1):26-34
DOI:10.4103/0971-3026.113616  PMID:23986615
Apart from the degree of stenosis, the morphology of carotid atherosclerotic plaques and presence of neovascularization are important factors that may help to evaluate the risk and 'vulnerability' of plaques and may also influence the choice of treatment. In this article, we aim to describe the techniques and imaging findings on CTA, high resolution MRI and contrast enhanced ultrasound in the evaluation of carotid atherosclerotic plaques. We also discuss a few representative cases from our institute with the related clinical implications.
  8,616 1,013 1
Does conventional defecography has a role to play in evaluation of evacuatory disorders in Indian population?
Sheo Kumar, Pankaj Sharma, Gustav Andreisek
January-March 2013, 23(1):92-96
DOI:10.4103/0971-3026.113625  PMID:23986623
Barium studies are one of the best investigations for evaluating submucosal and extrinsic mass lesions. However, barium studies bring less money, are operator dependent and one of the more difficult investigations for radiologists to master. Economic factors have acted as powerful disincentives for performing gastrointestinal (GI) fluoroscopy in most radiology practices. In this pictorial essay, we discuss the role of conventional defecography in evaluating evacuatory disorders in the Indian population.
  8,262 328 -
Dendriform pulmonary ossification: Report of two cases
Lamia Jamjoom, Moulay Meziane, Rahul D Renapurkar
January-March 2013, 23(1):15-18
DOI:10.4103/0971-3026.113613  PMID:23986613
Dendriform pulmonary ossification is a rare form of diffuse pulmonary ossification that is usually detected incidentally on chest radiographs or chest computed tomography (CT) imaging. In this article, we present two patients who were incidentally found to have dendriform pulmonary ossification on chest imaging. The article will present the history and imaging findings of these two cases and then review the clinical, histological, and radiographic manifestations of dendriform pulmonary ossification.
  6,746 305 2
Creating writers for tomorrow: The initial steps
Sanjay N Jain
January-March 2013, 23(1):1-1
DOI:10.4103/0971-3026.113607  PMID:23986609
  6,216 493 -
MRI enterography with divided dose oral preparation: Effect on bowel distension and diagnostic quality
Rakesh Sinha, Sudarshan Rawat
January-March 2013, 23(1):86-91
DOI:10.4103/0971-3026.113623  PMID:23986622
Aim: To assess the impact of an extended oral preparation magnetic resonance (MR) enterography protocol on bowel distension, timing of imaging, and the quality of diagnostic images. Materials and Methods: An analysis of 52 patients who underwent divided oral preparation and 39 patients who underwent standard preparation for MR enterography examination was done. Distension was assessed by measuring the transverse diameters of the jejunum, ileum, and the ileocecal region. Diagnostic quality of the examination was assessed subjectively by two radiologists and graded as poor, diagnostic, and excellent (Grades 1-3). Correlation between bowel diameter and diagnostic quality was assessed using regression analysis. Results: The mean diameters of the jejunum, ileum, and colon in patients who underwent divided preparation were 1.90 ± 0.47, 2.14 ± 0.41, and 4.27 ± 0.96 cm, respectively, and the mean diameters in patients who underwent standard preparation were 1.46 ± 0.47, 2.02 ± 0.47, and 4.45 ± 0.90 cm, respectively. A total of 96.6% of patients on divided dose had diagnostic distension of the bowel (Grades 2 and 3). A total of 87.9% of the patients on standard dose had diagnostic distension of the bowel (Grades 2 and 3). A greater number of patients who underwent divided preparation had diagnostic quality examinations compared to those given standard preparation (96.6% vs. 87.9%). A greater number of patients who underwent divided preparation had Grade 3 quality examinations compared to those on standard preparation (75.5% vs. 68.5%). There was significant difference between diagnostic (Grades 2 and 3) and optimal grades (Grade 3) of the jejunal diameters in patients having divided or standard preparation (89.7% vs. 66.6%, P < 0.05; 40.8% vs. 25%, P < 0.05, respectively). Linear regression showed a positive correlation between increasing bowel diameter and diagnostic grade of the examination (ρ = 0.76). Conclusion: Using an extended oral preparation with divided dose resulted in the majority of patients being scanned in a single visit to the MRI suite. Dividing the oral contrast into aliquots can promote uniform distension of the entire small bowel and provide better bowel distension and improve the diagnostic quality.
  6,009 337 -
"Flow comp off": An easy technique to confirm CSF flow within syrinx and aqueduct
Anitha Sen
January-March 2013, 23(1):97-100
DOI:10.4103/0971-3026.113626  PMID:23986624
Flow compensation, a gradient pulse used for artifact reduction, often used to suppress cerebrospinal fluid (CSF) flow artifacts in spinal magnetic resonance imaging (MRI), can be switched off to make the CSF flow voids within syrinx (syringomyelia) and within aqueduct [normal pressure hydrocephalus (NPH)] more obvious (thus confirming CSF flow). It is a simple method which does not require much time or expertise.
  5,796 373 -
Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem
Shailesh M Prabhu, Subhasis Roy Choudhury, Ravi S Solanki, Gurucharan S Shetty, Surenderkumar Agarwala
January-March 2013, 23(1):8-14
DOI:10.4103/0971-3026.113612  PMID:23986612
Background: Chest tube insertion in congenital cystic lung lesions is an important problem in children with acute respiratory distress having a cystic lucent lesion on chest radiograph. Objective: To evaluate the imaging findings and complications in cases of congenital cystic lung lesions with chest tube insertion and suggest the role of appropriate imaging for management of these patients. Materials and Methods: Chest radiographs and CT scans of children with congenital cystic lung lesions who had inadvertent chest tube insertion preoperatively were retrospectively reviewed for imaging appearances and complications. Results: Fifteen patients comprising 10 cases of congenital cystic adenomatoid malformation (CCAM) and 5 cases of congenital lobar emphysema (CLE) were included. Majority of the cases were infants. CCAM was misdiagnosed as complicated pneumatocele (n = 5) and pneumothorax (n = 5), while CLE was misdiagnosed as tension pneumothorax (n = 5) on the chest radiograph findings. Final diagnosis was made on CT and operative findings with histopathology. Complications noted were pneumothorax, hydropneumothorax, and infection in cases of CCAM, and change in imaging appearance and pneumothorax in cases of CLE. Conclusion: Chest tube insertion in congenital cystic lesions increases the rate of associated complications. Chest CT has a definite role in early diagnosis and deciding appropriate management in these cases.
  5,731 362 -
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
Prakash Muthusami, Ananthakrishnan Ramesh
January-March 2013, 23(1):81-85
DOI:10.4103/0971-3026.113621  PMID:23986621
Objectives: To describe Magnetic Resonance Urography (MRU) appearances of the circumcaval ureter, a rare congenital cause of hydronephrosis. Materials and Methods: Seven cases of circumcaval ureter, suspected on intravenous urography (IVU), underwent subsequent static MRU using heavily T2-weighted sequences. Results: The various appearances of circumcaval ureter on IVU and MRU were studied and compared. The circumcaval portion of the ureter was especially well seen on axial MRU sections, though this portion was routinely not visualized on IVU. In one case with a ureteric calculus, MRU also depicted a circumcaval course of the ureter, thus providing a complete diagnosis. In yet another case, where a circumcaval ureter was suspected on IVU, MRU proved the actual cause of ureteric obstruction to be a crossing vessel. Conclusion: Static MRU using heavily T2-weighted coronal and axial sequences can make or exclude the diagnosis of circumcaval ureter unequivocally.
  5,355 339 -
A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy
Isaac Jebaraj, Binita Riya Chacko, George Koshy Chiramel, Thomas Matthai, Apurve Parameswaran
January-March 2013, 23(1):101-105
DOI:10.4103/0971-3026.113628  PMID:23986625
This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1), the stage of early discal calcification (stage 2), the stage of fibrous ankylosis (stage 3), and the stage of bony ankylosis (stage 4). To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease.
  4,513 288 2
Medical negligence: A difficult challenge for radiology
Chandrashekhar A Sohoni
January-March 2013, 23(1):110-112
DOI:10.4103/0971-3026.113631  PMID:23986627
  4,321 371 -
Congenital duplication of mastoid segment of facial nerve: A rare case report
Ravi Kanth Jakkani, Ragavendra KI, Aruna Karnawat, R Vittal, Anjani D Kumar
January-March 2013, 23(1):35-37
DOI:10.4103/0971-3026.113618  PMID:23986616
Congenital duplication of facial nerve is a very rare anomaly commonly associated with inner and middle ear anomalies. There can be duplication of mastoid, tympanic, or labyrinthine segments. We describe duplication of mastoid segment of facial nerve in a young female who also showed middle ear anomalies and external auditory canal atresia.
  3,799 312 -
Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage
Sridhar G Panughpath, Savith Kumar, Arjun Kalyanpur
January-March 2013, 23(1):4-7
DOI:10.4103/0971-3026.113610  PMID:23986611
Aim: To evaluate the utility of a mobile device to detect and assess intracranial hemorrhage (ICH) on head computed tomographys (CT) performed in the emergency setting. Materials and Methods: 100 head CT scans were randomly selected from our emergency radiology database and anonymized for patient demographics and clinical history. The studies were independently interpreted by two experienced radiologists in a blinded manner, initially on a mobile device (iPad, Apple computers) and subsequently, at an interval of one week, on a regular desktop workstation. Evaluation was directed towards detection, localization and characterization of hemorrhage. The results were assessed for accuracy, sensitivity, specificity and positive predictive value. Statistical significance was ascertained using Fisher's exact test. Results: 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used. Conclusion: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT.
  3,627 281 -
Role of quantitative pharmacokinetic parameter (transfer constant: Ktrans ) in the characterization of breast lesions on MRI
Jena Amarnath, Taneja Sangeeta, Shashi Bhushan Mehta
January-March 2013, 23(1):19-25
DOI:10.4103/0971-3026.113614  PMID:23986614
Background: The semi-quantitative analysis of the time-intensity curves in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has a limited specificity due to overlapping enhancement patterns after gadolinium administration. With the advances in technology and faster sequences, imaging of the entire breast can be done in a few seconds, which allows measuring the transit of contrast (transfer constant: K trans ) through the vascular bed at capillary level that reflects quantitative measure of porosity/permeability of tumor vessels. Aim: Our study aims to evaluate the pharmacokinetic parameter K trans for enhancing breast lesions and correlate it with histopathology, and assess accuracy, sensitivity, and specificity of this parameter in discriminating benign and malignant breast lesions. Materials and Methods: One hundred and fifty-one women with 216 histologically proved enhancing breast lesions underwent high temporal resolution DCE-MRI for the early dynamic analysis for calculation of pharmacokinetic parameters (K trans ) using standard two compartment model. The calculated values of K trans were correlated with histopathology to calculate the sensitivity, specificity, and accuracy. Results: Receiver operating characteristic (ROC) curve analysis revealed a mean K trans value of 0.56, which reliably distinguished benign and malignant breast lesions with a sensitivity of 91.1% and specificity of 90.3% with an overall accuracy of 89.3%. The area under curve (AUC) was 0.907. Conclusion: K trans is a reliable quantitative parameter for characterizing benign and malignant lesions in routine DCE-MRI of breasts.
  3,693 212 -
Coping in a calamity: Radiology during the cloudburst at Leh
Debraj Sen
January-March 2013, 23(1):106-109
DOI:10.4103/0971-3026.113629  PMID:23986626
The service hospital at Leh is a multispeciality hospital situated at an altitude of 11000 feet above mean sea level. On the nights of 4 and 5 Aug 2010, Leh was struck by a cloudburst leading to mudslides and consequently extensive damage to life and property. Being the only functional hospital, over a period of about 48 hours, 331 casualties were received. 549 casualties were received over the week with 108 admissions, 16 major surgeries and 138 minor surgeries. 178 radiographs, 17 CT scans and 09 ultrasound-colour Doppler examinations were performed on an urgent basis over 48 hours apart from the routine radiological investigations. Apart from chronicling the event, we hope that sharing the unique experience of the Radiology Department in dealing with the large influx of patients would provide an insight into the role of Radiology during the disaster and help in planning and developing management protocols during other calamities.
  3,514 190 1
Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction: A retrospective clinical analysis
Nikolaos Chatzis, Roger Pfiffner, Michael Glenck, Paul Stolzmann, Thomas Pfammatter, Pankaj Sharma
January-March 2013, 23(1):38-45
DOI:10.4103/0971-3026.113620  PMID:23986617
Purpose: Percutaneous transhepatic primary biliary stenting (PS) is an alternative to the widely used staged procedure (secondary biliary stenting, SS) for treating obstructive jaundice in cancer patients. To evaluate the efficacy and safety of PS and SS, a retrospective analysis was carried out. Materials and Methods: The percutaneous biliary stenting procedures performed between January 2000 and December 2007 at one hepatobiliary center were retrospectively analyzed, comparing the technical success rates, complications, and length of hospitalization of the two procedures. Of 61 patients (mean age 65.5 ± 13.1 years; range 31.1-92.7 years) suffering from obstructive jaundice caused by primary or metastatic tumors, 30 received PS and 31 received SS. The groups were comparable in the anatomical level of the obstruction, stent configuration, or the concurrent presence of cholangitis. Placement of metallic stents required one session for patients in the PS group and an average of 2.6 ± 1.1 sessions for patients in the SS group. Results: The overall technical success rate was 98.4% with 1 (1/61) failed approach to transcend the occlusion in the SS group. The rate of minor complications was 10% in the PS group and 6.5% in the SS group. The corresponding rates of major complications were 23.3% and 54.8%, respectively. SS patients had a higher rate of complications in general ( P < 0.05), as well as a higher rate of severe complications in particular ( P < 0.05). Procedural mortality was 0% for both the groups. The mean overall length of hospitalization was 7.7 ± 9.6 days for PS and 20.6 ± 19.6 days for SS ( P < 0.001). Conclusion: Primary percutaneous biliary stenting of malignant biliary obstructions is as efficacious and safer than a staged procedure with secondary stenting. By virtue of requiring shorter hospital stays, primary stenting is likely to be more cost-effective.
  3,377 255 -
Multiphasic contrast-enhanced CT and MRI findings of adult mesoblastic nephroma: A report of two cases
Yuqin Ding, Deming He, Jianjun Zhou, Mengsu Zeng
January-March 2013, 23(1):78-80
DOI:10.4103/0971-3026.113619  PMID:23986620
Mesoblastic nephroma (MN) presenting in an adult is extremely rare. The computed tomography (CT) and magnetic resonance imaging (MRI) features of this tumor in adulthood have not been widely reported. We present two additional cases of adult MN and describe the multiphasic contrast-enhanced CT and MRI findings.
  3,146 157 -
Presidential address
Rajesh Kapur
January-March 2013, 23(1):2-3
DOI:10.4103/0971-3026.113608  PMID:23986610
  2,450 106 -

January-March 2013, 23(1):25-25
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