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   2014| April-June  | Volume 24 | Issue 2  
    Online since June 12, 2014

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Cysts and cystic-appearing lesions of the knee: A pictorial essay
Nicholas A Telischak, Jim S Wu, Ronald L Eisenberg
April-June 2014, 24(2):182-191
DOI:10.4103/0971-3026.134413  PMID:25024531
Cysts and cystic-appearing lesions around the knee are common and can be divided into true cysts (synovial cysts, bursae, ganglia, and meniscal cysts) and lesions that mimic cysts (hematomas, seromas, abscesses, vascular lesions, and neoplasms). The specific anatomic location of the cystic lesion often permits the correct diagnosis. In difficult cases, identifying a cystic mass in an atypical location and/or visualizing internal solid contrast enhancement on magnetic resonance imaging (MRI) should raise concern for a neoplasm and the need for further evaluation and intervention.
  142,922 8,325 -
Sonography of acute appendicitis and its mimics in children
Kiran M Sargar, Marilyn J Siegel
April-June 2014, 24(2):163-170
DOI:10.4103/0971-3026.134404  PMID:25024527
The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management.
  13,593 798 -
Computed tomography and magnetic resonance imaging in the evaluation of pelvic peritoneal adhesions: What radiologists need to know?
Nitin P Ghonge, Sanchita Dube Ghonge
April-June 2014, 24(2):149-155
DOI:10.4103/0971-3026.134400  PMID:25024524
Pelvic peritoneal adhesions constitute an important cause of concern which affects the life of millions of people worldwide due to complications like abdominal pain, bowel obstruction and infertility along with challenges in surgical exploration. Precise pre-operative diagnosis of the presence and extent of peritoneal adhesions is of great clinical and surgical importance. Diagnostic laparoscopy to detect peritoneal adhesions may itself lead to formation of adhesions. Routine CT and MRI studies are therefore useful non-invasive modalities to achieve this objective. This review article provides a brief background about the causation and patho-physiology of peritoneal adhesions. The article also addresses the range of clinical presentations in these patients, mainly from the gynecologic perspective. This article provides an illustrative review of CT and MRI findings with laparoscopic correlation. A new 'imaging-based grading system' for pre-operative quantification of the burden of peritoneal adhesions is also proposed. Despite practical challenges in accurate pre-operative diagnosis of peritoneal adhesions on imaging, detection of peritoneal adhesions is certainly feasible on routine CT and MRI scans and should be an integral part of image interpretation.
  10,068 722 -
Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly
Nishchint Jain, Ritu Verma
April-June 2014, 24(2):178-181
DOI:10.4103/0971-3026.134411  PMID:25024530
Accessory and Cavitated Uterine Mass (ACUM) is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. It is an accessory cavity lying within an otherwise normal uterus. It is lined by functional endometrium and surrounded by myometrium-like smooth muscle cells; hence, it bears striking macroscopic and microscopic resemblance to the uterus. Hysterosalpingography (HSG), Ultrasonography (USG), and Magnetic Resonance Imaging (MRI) form the mainstay of diagnostic imaging. The entity is often under diagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate diagnosis.
  8,462 544 -
Imaging and intervention in prostate cancer: Current perspectives and future trends
Sanjay Sharma
April-June 2014, 24(2):139-148
DOI:10.4103/0971-3026.134399  PMID:25024523
Prostate cancer is the commonest malignancy in men that causes significant morbidity and mortality worldwide. Screening by digital rectal examination (DRE) and serum prostate-specific antigen (PSA) is used despite its limitations. Gray-scale transrectal ultrasound (TRUS), used to guide multiple random prostatic biopsies, misses up to 20% cancers and frequently underestimates the grade of malignancy. Increasing the number of biopsy cores marginally increases the yield. Evolving techniques of real-time ultrasound elastography (RTE) and contrast-enhanced ultrasound (CEUS) are being investigated to better detect and improve the yield by allowing "targeted" biopsies. Last decade has witnessed rapid developments in magnetic resonance imaging (MRI) for improved management of prostate cancer. In addition to the anatomical information, it is capable of providing functional information through diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and dynamic contrast-enhanced (DCE) MRI. Multi-parametric MRI has the potential to exclude a significant cancer in majority of cases. Inclusion of MRI before prostatic biopsy can reduce the invasiveness of the procedure by limiting the number of cores needed to make a diagnosis and support watchful waiting in others. It is made possible by targeted biopsies as opposed to random. With the availability of minimally invasive therapeutic modalities like high-intensity focused ultrasound (HIFU) and interstitial laser therapy, detecting early cancer is even more relevant today. [18F]--fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG PET/CT) has no role in the initial evaluation of prostate cancer. Choline PET has been recently found to be more useful. Fluoride-PET has a higher sensitivity and resolution than a conventional radionuclide bone scan in detecting skeletal metastases.
  7,532 631 -
Hydrocele of the canal of Nuck - Rare differential for vulval swelling
Anubha Pandey, Shivi Jain, Ashish Verma, Madhu Jain, Arvind Srivastava, Ram C Shukla
April-June 2014, 24(2):175-177
DOI:10.4103/0971-3026.134408  PMID:25024529
Patent canal of Nuck is one of the rare developmental entities in females, presenting clinically as an inguino-labial swelling. The usual content of this sac is fluid being secreted by the peritoneal mesothelium. In rare cases, ovary alone or with fallopian tube may prolapsed out into the sac. We report the rationale use of diagnostic algorithm in a case of ovarian hernia into the patent canal of Nuck, to differentiate it from more common clinical mimics. Furthermore, in the present case, a knowledge of the entity and targeted scrutiny, led to a correct identification of the prolapsed ovary, preventing an unwarranted oophorectomy in the garb of neoplasia.
  7,261 333 -
Simultaneous PET/MRI: Impact on cancer management-A comprehensive review of cases
Amarnath Jena, Sangeeta Taneja, Abhishek Jha
April-June 2014, 24(2):107-116
DOI:10.4103/0971-3026.134381  PMID:25024516
The metabolic mapping of malignancy in whole body in a single examination by PET/CT has gained widespread acceptance where the CT provides an anatomical correlate for the PET. MRI offers advantage over CT in providing better anatomical information owing to its high soft tissue resolution especially in brain, liver, neck, pelvis and bone marrow. Simultaneous PET/MRI is a new multimodal imaging modality that is expected to improve the diagnostic performance of imaging wherein better anatomical and metabolic information can be acquired at the same time and space during a single examination time. Also, MR attributes like diffusion, perfusion and spectroscopy may further add to its diagnostic potential. In this article, we present our initial experience in illustrated cases done with simultaneous PET/MRI and outline its potential for several clinical applications in oncology.
  5,962 303 -
Melorheostosis: Two atypical cases
Binit Sureka, Mahesh Kumar Mittal, KK Udhaya, Mukul Sinha, Aliza Mittal, Brij Bhushan Thukral
April-June 2014, 24(2):192-195
DOI:10.4103/0971-3026.134415  PMID:25024532
Melorheostosis is an uncommon mesenchymal dysplasia that rarely affects the axial skeleton.We describe two atypical cases of melorheostosis with classical imaging findings - the first one involving the cervico-dorsal spine with encroachment of left vertebral artery canal causing attenuation of the left vertebral artery and the second one of mixed sclerosing bony dysplasia (monomelic involvement coexisting with osteopoikilosis).
  5,572 365 -
Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature
Nischal G Kundaragi, Shanmugam Vinayagam, Srinivasa Mudali
April-June 2014, 24(2):171-174
DOI:10.4103/0971-3026.134407  PMID:25024528
Transomental and transmesenteric hernias are rare types of internal hernia, with a reported frequency of upto 4% and 8%, respectively. Combined transomental and transmesocolic hernia is even rare. Only in a few types of internal hernia, the dilated small bowel loops will be seen extending from the antero-superior aspect of the distal stomach and cause stretching effect over the adjacent bowel loops with increase in the size of the herniated bowel segment or intestinal obstruction. We report a rare case of idiopathic combined transomental (across the lesser omentum) and transmesocolic internal hernia with "stretched bowel sign," its diagrammatic representations, and review of literature.
  5,235 311 -
Mentorship-challenges ahead
Sanjay N Jain
April-June 2014, 24(2):95-96
DOI:10.4103/0971-3026.134366  PMID:25024512
  5,038 480 -
MR in complete dorsal pancreatic agenesis: Case report and review of literature
Shruti Thakur, Anupam Jhobta, Dinesh Sharma, Charu S Thakur
April-June 2014, 24(2):156-159
DOI:10.4103/0971-3026.134401  PMID:25024525
The morphogenesis of the pancreas is a complex process having a very low frequency of anatomic variation. The congenital anomalies are rare. Complete pancreatic and ventral pancreatic agenesis are incompatible with life. Dorsal pancreatic agenesis is exceedingly rare with less than 100 cases reported in the world literature. Patients with this anomaly may be asymptomatic or may present with abdominal pain, hyperglycemia, diabetes mellitus, and acute or chronic pancreatitis. Such anomalies are rarely reported; therefore, clinical awareness of agenesis of the dorsal pancreas as a cause of these symptoms can expand the differential diagnosis and improve patient management.
  4,904 334 -
An indigenous model for learning ultrasound-guided interventions
Pushpinder S Khera, Shyamkumar N Keshava
April-June 2014, 24(2):132-134
DOI:10.4103/0971-3026.134394  PMID:25024521
Ultrasound-guided interventions require good hand-eye coordination with respect to probe control and needle orientation. We describe a method of making an ultrasound phantom for practice purpose using an edible jelly mixture. The phantom is easy to make, reproducible, cheap, and simulates in vivo target.
  4,717 437 -
Data mining in radiology
Amit T Kharat, Amarjit Singh, Vilas M Kulkarni, Digish Shah
April-June 2014, 24(2):97-102
DOI:10.4103/0971-3026.134367  PMID:25024513
Data mining facilitates the study of radiology data in various dimensions. It converts large patient image and text datasets into useful information that helps in improving patient care and provides informative reports. Data mining technology analyzes data within the Radiology Information System and Hospital Information System using specialized software which assesses relationships and agreement in available information. By using similar data analysis tools, radiologists can make informed decisions and predict the future outcome of a particular imaging finding. Data, information and knowledge are the components of data mining. Classes, Clusters, Associations, Sequential patterns, Classification, Prediction and Decision tree are the various types of data mining. Data mining has the potential to make delivery of health care affordable and ensure that the best imaging practices are followed. It is a tool for academic research. Data mining is considered to be ethically neutral, however concerns regarding privacy and legality exists which need to be addressed to ensure success of data mining.
  4,145 284 -
Persistent pulmonary interstitial emphysema in a case of Langerhans cell histiocytosis
Pooja Abbey, Mahender K. Narula, Rama Anand, Jagdish Chandra
April-June 2014, 24(2):121-124
DOI:10.4103/0971-3026.134386  PMID:25024518
We present the case of a 10-month-old boy with multisystem Langerhans cell histiocytosis showing thin-walled lung cysts along with computed tomography (CT) evidence of persistent pulmonary interstitial emphysema (PPIE), in the absence of pneumothorax or pneumomediastinum. Follow-up CT performed after 6 months demonstrated complete resolution of interstitial emphysema.
  4,016 257 -
Fetal gastric pseudomass at 30 weeks of gestation and its regression after 17 days of birth
Balakumar Karippaliyil, Misha Kannan, Milind Karippaliyil
April-June 2014, 24(2):160-162
DOI:10.4103/0971-3026.134403  PMID:25024526
Second trimester fetal ultrasonography (USG) occasionally reveals an echogenic intragastric mass. These masses are usually small due to the organized debris from swallowed amniotic fluid, and they normally disappear in the third trimester. This report shows a fetal intragastric echogenic mass detected at 30 weeks of gestation that persisted as a large heterogeneously echoic mass even on the 10 th day after birth. The immediate postnatal USG features were consistent with the possibility of an intragastric soft tissue mass, though abdominal  radiographs and computed tomography (CT) with oral contrast were non-specific. The baby remained asymptomatic in the neonatal period and USG scanning again after a week showed normal stomach and other intra-abdominal visceral echoes.
  4,078 144 -
IgG4-related disease with sinonasal involvement: A case series
Shailesh M Prabhu, Vikas Yadav, Aparna Irodi, Sunithi Mani, Ajoy Mathew Varghese
April-June 2014, 24(2):117-120
DOI:10.4103/0971-3026.134384  PMID:25024517
We present the imaging findings in two cases of IgG4-related disease involving the sinonasal region in the pediatric age group. Imaging findings in IgG4-related disease affecting the nasal cavity and paranasal sinuses have been rarely reported in literature. The diagnosis is made by a combination of clinical, imaging, and histopathologic findings. Radiologists should be aware of the imaging findings of this condition to ensure early diagnosis and treatment.
  3,702 272 -
Automatic scan triggering software "confused": Computed tomography angiography in foot arteriovenous malformation!
Pankaj Gupta, Anindita Sinha, Niranjan Khandelwal
April-June 2014, 24(2):125-128
DOI:10.4103/0971-3026.134387  PMID:25024519
Multidetector computed tomography angiography (MDCTA) has become a well-established modality for limb angiography for a variety of indications. The technique of MDCTA depends on the scanner features including the number of detector rows, rotation speeds and single or dual source energy. Integral to a diagnostic quality CTA is the acquisition timing. Various techniques are available for determining the appropriate timing of scan acquisition which includes fixed delay, test bolus and the bolus tracking technique. The transit times of contrast from the aorta to the peripheral arteries shows a wide variability and is dependent upon the inter individual hemodynamic states. The bolus tracking technique is the most preferred one which allows reliable scan timing with acceptable contrast volume and radiation dose. Pitfalls with all these techniques are well described and we report one such technical pitfall in a case of left foot arteriovenous malformation (AVM) where the bolus tracking technique employed for scan triggering failed to initiate acquisition.
  3,478 159 -
PET reconstruction artifact can be minimized by using sinogram correction and filtered back-projection technique
Ashish Kumar Jha, Nilendu C Purandare, Sneha Shah, Archi Agrawal, Ameya D Puranik, Venkatesh Rangarajan
April-June 2014, 24(2):103-106
DOI:10.4103/0971-3026.134379  PMID:25024515
Filtered Back-Projection (FBP) has become an outdated image reconstruction technique in new-generation positron emission tomography (PET)/computed tomography (CT) scanners. Iterative reconstruction used in all new-generation PET scanners is a much improved reconstruction technique. Though a well-calibrated PET system can only be used for clinical imaging in few situations like ours, when compromised PET scanner with one PET module bypassed was used for PET acquisition, FBP with sinogram correction proved to be a better reconstruction technique to minimize streak artifact present in the image reconstructed by the iterative technique.
  3,430 169 -
Accuracy of ultrasonography in detecting radiolucent soft-tissue foreign bodies
Morteza Tahmasebi, Hamdollah Zareizadeh, Azim Motamedfar
April-June 2014, 24(2):196-200
Background and Objective: Detection of radiolucent soft-tissue foreign bodies is a challenging problem, which is especially further complicated when retained foreign body is highly suggested by clinicians but radiography is negative. So, blind exploration is sometimes hazardous for patients. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft-tissue foreign bodies in the extremities. Materials and Methods: From November 2011 to January 2012, patients with clinically suspected radiolucent soft-tissue foreign body and negative radiography were evaluated by USG with a 12-MHz linear array transducer. The patients with positive clinical and USG examination were included in our study and underwent exploration or USG removal. Results: Fifty-one patients underwent foreign body removal under ultrasonography-guided or surgical exploration and 47 patients had foreign body (31, 12, 3, and 1 case had thorn, wood, glass, and plastic, respectively). Ultrasound was positive in 50 patients. USG falsely predicted the presence of foreign body in four cases and was falsely negative in one of the cases. Accuracy, sensitivity, and positive predictive value were determined as 90.2%, 97.9%, and 92%, respectively. Conclusions: The real-time high-frequency USG is a highly sensitive and accurate tool for detecting and removing radiolucent foreign bodies which are difficult to be visualized by routine radiography.
  3,033 284 -
FRCR 2B Viva: A case-based approach
A Anbarasu
April-June 2014, 24(2):203-203
  2,648 224 -
Intercostal artery pseudoaneurysm complicating corrosive acid poisoning: Diagnosis with CT and treatment with transarterial embolisation
MV Chalapathi Rao, Abhishek A Rathi, Sharath P Reddy, Sambit Sahu
April-June 2014, 24(2):135-138
DOI:10.4103/0971-3026.134397  PMID:25024522
Pseudoaneurysms of intercostal artery are very rare. All the published cases have been caused by trauma, either iatrogenic or otherwise. They can cause hemothorax, retroperitoneal hemorrhage or can present as pulsatile chest mass. Doppler ultrasound, contrast-enhanced CT and conventional angiogram can accurately diagnose this condition. All the reported cases have been treated by embolisation, stenting or surgery. We report an unusual case of intercostal artery pseudoaneurysm arising as a complication of corrosive poisoning presenting with hematemesis and treated by glue embolisation. The authors believe this to be the first case of intercostal artery pseudoaneurysm that is non-traumatic, complicating corrosive poisoning and presenting with hematemesis.
  2,482 134 -
Bilateral transrenal ureteral occlusion by means of n-butyl cyanoacrylate and AMPLATZER vascular plug
Rosario F Grasso, Roberto Luigi Cazzato, Giacomo Luppi, Simona Mercurio, Francesco Giurazza, Riccardo Del Vescovo, Eliodoro Faiella, Bruno Beomonte Zobel
April-June 2014, 24(2):129-131
DOI:10.4103/0971-3026.134390  PMID:25024520
AMPLATZER vascular plug is a widely used embolic agent. In the present paper, we present a case of an 86-year-old female patient who underwent bilateral ureteral occlusion by means of AMPLATZER vascular plug II coupled to n-butyl cyanoacrylate (NBCA) because of recurring pyelonephritis following cystectomy with subsequent bilateral ureterosigmoidostomy (sec. Mainz type II).
  2,348 142 -
Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage
Sridhar G Panughpath, Arjun Kalyanpur
April-June 2014, 24(2):202-202
DOI:10.4103/0971-3026.134420  PMID:25024535
  1,754 109 -
Re:Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage
Sema Yildiz, Nurefsan Boyaci, Dilek Sen Dokumaci, Ekrem Karakaş
April-June 2014, 24(2):201-201
DOI:10.4103/0971-3026.134419  PMID:25024534
  1,657 107 -
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