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Case Series: Bisystolic Vertebral Artery: Critical Finding or can be Ignored?
Pranav Sharma, Puneet Kochar, Priti Soin, Steven Cohen
J Clin Imaging Sci 2019, 9:2 (31 January 2019)
The carotid Doppler imaging findings in three adults presenting with vertigo, transient speech difficulty and for cardiac prebypass graft surgery revealing two systolic peaks in one of the vertebral arteries. In presteal situations, vertebral artery waveform shows two systolic peaks with sharp first and rounded second systolic peak or two systolic peaks with a deep cleft between the two peaks with antegrade flow. With increase in stenosis to more than 80% there is bidirectional flow and later flow reversal. We discuss the types of presteal vertebral artery waveforms, its clinical implications and brief review of literature.
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Original Article: Volumetric and Shape Analysis of the Subcortical Regions in Schizophrenia Patients: A Pilot Study
Abdullah Abu Jamea, Muhammed Alblowi, Jamaan Alghamdi, Fahad D Alosaimi, Fahad Al-Bader, Shahid Bashir
J Clin Imaging Sci 2019, 9:1 (31 January 2019)
Objective: Investigation of brain structure in disease has been enhanced by developments in shape analysis methods that can identify subtle regional surface distortions. High-resolution magnetic resonance (MR) imaging was used to compare volumetric and shape analysis in schizophrenia (SCZ) patients and healthy controls (CON). Methods: T1-weighted, 1-mm thick MR images were acquired for 15 patients with SCZ and 15 age-matched healthy controls using subcortical volume and shape analysis, which we believe to be complimentary to volumetric measures. Results: SCZ patients showed significant shape differences compared to healthy controls in the right hippocampus (P < 0.005), left and right putamen (P < 0.044 and P < 0.031), left caudate (P < 0.029), right pallidum (P < 0.019), and left thalamus (P < 0.033). Conclusion: Our results provide evidence for subcortical neuroanatomical changes in patients with SCZ. Hence, shape analysis may aid in the identification of structural biomarkers for identifying individuals of SCZ.
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Case Report: Retrograde Pyelogram during intended Cystogram: A Rare complication of a common procedure
Shanmugasundaram Rajaian, Pragatheeswarane Murugavaithianathan, Karrthik Krishnamurthy, Lakshman Murugesan
J Clin Imaging Sci 2018, 8:55 (12 December 2018)
DOI:10.4103/jcis.JCIS_59_18  PMID:30652058
Inadvertent placement of the urinary catheter into the ureter can cause several complications. We describe a rare complication during cystogram due to unrecognized inadvertently placed urinary catheter in ureter, resulting in a life-threatening situation. A 47-year-old multiparous female underwent total laparoscopic hysterectomy for adenomyosis. During early postoperative period, she developed vesicovaginal fistula and transvaginal repair of fistula was done. During filling cystography done at 2 weeks, she developed right loin pain and urosepsis. Contrast extravasation was seen in the right renal subcapsular space with Foley's catheter inside the right ureter. Subsequently, she recovered well.
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Pictorial Essay: Nonconventional Options for Tumor Localization in Breast and Axillary Lymph Nodes: A Pictorial How-To
Naziya Samreen, Christine U Lee, Asha A Bhatt
J Clin Imaging Sci 2018, 8:54 (12 December 2018)
DOI:10.4103/jcis.JCIS_57_18  PMID:30652057
Preoperative localization of breast malignancies using traditional ultrasound and digital techniques can be challenging, particularly after neoadjuvant chemotherapy when the target is not conspicuous. The purpose of this paper is to pictorially present nontraditional techniques that have been helpful in preoperative localization before surgery. We will discuss techniques for breast lesion localization using computed tomography (CT) and magnetic resonance imaging (MRI) as well as axillary lymph node localization using tomosynthesis, CT, and MRI.
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Review Article: Amyotrophic Lateral Sclerosis and its Mimics/Variants: A Comprehensive Review
Vivek S Yedavalli, Abhijit Patil, Parinda Shah
J Clin Imaging Sci 2018, 8:53 (6 December 2018)
DOI:10.4103/jcis.JCIS_40_18  PMID:30652056
Motor neuron diseases (MNDs) are a debilitating subset of diseases, which result in progressive neuronal destruction and eventual loss of voluntary muscular function. These entities are often challenging to distinguish and accurately diagnose given overlapping clinical pictures and overall rarity. This group of diseases has a high morbidity and mortality rate overall and delineating each type of disease can help guide appropriate clinical management and improve quality of life for patients. Of all MNDs, amyotrophic lateral sclerosis (ALS) is by far the most common comprising 80%–90% of cases. However, other mimics and variants of ALS can appear similar both clinically and radiographically. In this review, we delve into the epidemiological, physiological, neuroimaging, and prognostic characteristics and management of ALS and its most common MND mimics/variants. In doing so, we hope to improve accuracy in diagnosis and potential management for this rare group of diseases.
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Original Article: Low Dose versus Standard Single Heartbeat Acquisition Coronary Computed Tomography Angiography
Ernesto Di Cesare, Alessandra Di Sibio, Antonio Gennarelli, Margherita Di Luzio, Ines Casazza, Alessandra Splendiani, Annamaria Di Cesare, Giovanni Luca Gravina, Antonio Barile, Carlo Masciocchi
J Clin Imaging Sci 2018, 8:52 (15 November 2018)
DOI:10.4103/jcis.JCIS_51_18  PMID:30546936
Purpose: The aim of this study was to compare image quality and mean radiation dose between two groups of patients undergoing coronary computed tomography angiography (CCTA) using a 640-slice CT scanner with two protocols with different noise level thresholds expressed as standard deviation (SD). Materials and Methods: Two-hundred and sixty-eight patients underwent a CCTA with 640 slice CT scanner. In the experimental group (135 patients), an SD 51 protocol was employed; in the control group (133 patients), an SD 33 protocol was used. Mean effective dose and image quality with both objective and subjective measures were assessed. Image quality was subjectively assessed using a five-point scoring system. Segments scoring 2, 3, and 4 were considered having diagnostic quality, while segments scoring 0 and 1 were considered having nondiagnostic quality. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between the two groups as well as the effective radiation dose (ED) was finally assessed. Results: Comparative analysis considering diagnostic quality (2, 3, and 4 score) and nondiagnostic (score 0 and 1) quality demonstrated that image quality of SD 51 group is not significantly lower than that of S33 group. The noise was significantly higher in the SD 51 group than in the SD 33 group (P < 0.0001). The SNR and CNR were higher in the SD 33 group than in SD 51 group (P < 0.0001). Mean effective dose was 49% lower in the SD 51 group than in SD 33 group; indeed mean effective dose was 1.43 mSv ± 0.67 in the SD 51 group while it was 2.8 mSv ± 0.57 in the SD 33 group. Conclusion: Comparative analysis shows that using a 640-slice CT with a 51 SD protocol, it is possible to reduce the mean radiation dose while maintaining good diagnostic image quality.
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Original Article: Comparative Performances of Dipyridamole and Regadenoson to Detect Myocardial Ischemia using Cardiac Cadmium-Zinc-Telluride Single-Photon Emission Computerized Tomography
Faycal Ben Bouallegue, Catherine Nganoa, Jonathan Vigne, Denis Agostini, Alain Manrique
J Clin Imaging Sci 2018, 8:51 (15 November 2018)
DOI:10.4103/jcis.JCIS_71_17  PMID:30546935
Objective: We evaluated the relative performances of dipyridamole (Dip) and regadenoson (Reg) in a cohort of patients referred for coronary artery disease diagnosis or follow-up using myocardial perfusion imaging. Materials and Methods: We retrospectively included 515 consecutive patients referred for 99mTc-sestamibi myocardial perfusion single-photon emission computerized tomography (SPECT) on a cadmium-zinc-telluride (CZT) camera after pharmacologic stress. About three quarters (n = 391, 76%) received Dip. Reg was administrated to patients with chronical respiratory disease or with body mass index (BMI) over 38 kg/m2 (n = 124, 24%). Patients with an abnormal stress scan (92%) underwent a rest imaging on the same day. Qualitative interpretation of perfusion images was achieved using QPS software, and the ischemic area was assessed using the 17-segment model. In patients undergoing a stress-rest protocol, perfusion polar plots were postprocessed using automated in-house software to quantify the extension, intensity, and location of the reversible perfusion defect. Statistical comparison between groups was performed using univariate and multivariate analysis. Results: Qualitative analysis concluded to myocardial ischemia in 70% of the patients (69% in the Dip group, 76% in the Reg group, P = ns). In those patients, the number of involved segments (Dip 2.5 ± 1.6, Reg 2.7 ± 1.6, P = ns) and the proportion of patients with an ischemic area larger than two segments (Dip 30%, Reg 37%, P = ns) were comparable. Automated quantification of the reversible perfusion defect demonstrated similar defect extension, intensity, and severity in the two groups. Defect location was identical at the myocardial segment and vascular territory scales. Conclusions: Reg and Dip showed equal performances for ischemic burden characterization using myocardial CZT SPECT.
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Case Report: A Case of Mistaken Identity: Glutaric Aciduria Type I Masquerading as Postmeningitic Hydrocephalus
Heena Rajani, Shabnam Bhandari Grover, Neha Antil, Amit Katyan
J Clin Imaging Sci 2018, 8:50 (15 November 2018)
DOI:10.4103/jcis.JCIS_56_18  PMID:30546934
We report the characteristic neuroimaging features of a rare metabolic leukodystrophy in an 8-year-old boy, born of consanguineous parenthood. The child presented with macrocrania, regression of milestones, and dystonia. The patient was referred for magnetic resonance imaging with a clinical diagnosis of postmeningitic hydrocephalus. Imaging revealed ventriculomegaly, diffuse brain atrophy, bilaterally symmetric widened sylvian fissure with temporal lobe hypoplasia, periventricular white-matter hyperintensities, and atrophy with hyperintensity in bilateral basal ganglia was also seen. These imaging features were signatory to arrive at a diagnosis of glutaric aciduria type 1. This disorder may mimic other neurological diseases such as postmeningitic hydrocephalus, which delays the diagnosis. Since early diagnosis and treatment can arrest progression, increased awareness about this condition among radiologists will certainly prevent erroneous diagnosis as had occurred in our patient.
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Case Report: Bilateral Fracture of the Handle Malleus: A Case Report and Review of the Literature
Ilson Sepulveda, J Patricio Ulloa, Alfredo Santamaría, Francisco Rivas-Rodriguez
J Clin Imaging Sci 2018, 8:49 (15 November 2018)
DOI:10.4103/jcis.JCIS_44_18  PMID:30546933
Malleus fracture is a rare condition. Usually, the handle of the malleus is involved, and we do not find reports in the literature of this condition in the bilateral presentation. It is present as sudden conductive hearing loss commonly after digital manipulation of the external auditory canal. The diagnosis is based principally on clinical examination by otomicroscopy and audiometry. Cone-beam computed tomography emerging as a powerful tool in the field of otolaryngology, especially for explorations of paranasal sinuses and temporal bone, due to imaging with a high resolution and few artifacts with lower dose radiation in comparison with multislice computed tomography.
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Review Article: Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions
Alexander T Kessler, Alok A Bhatt
J Clin Imaging Sci 2018, 8:48 (15 November 2018)
DOI:10.4103/jcis.JCIS_46_18  PMID:30546932
The salivary glands are small structures in the head and neck, but can give rise to a wide variety of benign and malignant pathology. When this occurs, patients may present with palpable swelling, although it is quite common that they are asymptomatic and a salivary gland mass was discovered as an incidental finding on imaging performed for another reason. It is, therefore, critical that radiologists pay careful attention to the salivary glands and have working knowledge of the key differentiating features of the most common neoplastic and nonneoplastic etiologies of salivary gland masses. The purpose of this review is to provide a succinct image-rich article illustrating the various causes of salivary gland masses via an extensive review of the primary literature. In Part 2, we discuss neoplasms and tumor-like lesions of the salivary glands with a key emphasis on specific imaging features of the most common pathologic entities.
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Review Article: Review of the Major and Minor Salivary Glands, Part 1: Anatomy, Infectious, and Inflammatory Processes
Alexander T Kessler, Alok A Bhatt
J Clin Imaging Sci 2018, 8:47 (15 November 2018)
DOI:10.4103/jcis.JCIS_45_18  PMID:30546931
The major and minor salivary glands of the head and neck are important structures that contribute to many of the normal physiologic processes of the aerodigestive tract. The major salivary glands are routinely included within the field of view of standard neuroimaging, and although easily identifiable, salivary pathology is relatively rare and often easy to overlook. Knowledge of the normal and abnormal imaging appearance of the salivary glands is critical for forming useful differential diagnoses, as well as initiating proper clinical workup for what are often incidental findings. The purpose of this review is to provide a succinct image-rich article illustrating relevant anatomy and pathology of the salivary glands via an extensive review of the primary literature. In Part 1, we review anatomy as well as provide an in-depth discussion of the various infectious and inflammatory processes that can affect the salivary glands.
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Case Report: Upper Gastrointestinal Bleed Embolization with Onyx®: The “Tattoo Effect”
Driss Raissi, Qian Yu, S Houssam Mardini
J Clin Imaging Sci 2018, 8:46 (15 November 2018)
DOI:10.4103/jcis.JCIS_64_18  PMID:30546930
Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a “tattoo effect.” Knowledge of the agents used by the interventional radiologist, clinical correlation, and close follow-up can be of paramount importance to avoid unnecessary surgical intervention. Here, we report a case demonstrating this “tattoo effect” on the gastric mucosa following UGIB embolization.
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Case Report: Chudley-McCullough Syndrome
Meltem Ozdemir, Alper Dilli
J Clin Imaging Sci 2018, 8:45 (15 November 2018)
DOI:10.4103/jcis.JCIS_39_18  PMID:30546929
Chudley-McCullough syndrome (CMS), an autosomal recessive condition first reported by Chudley et al., in 1997, comprises profound sensorineural hearing loss and specific brain abnormalities. The hearing loss may be congenital or early onset. Brain abnormalities are striking, but despite these brain malformations, individuals with CMS do not present significant neurodevelopmental abnormalities. Recently, the cause of CMS has been shown to be the inactivating mutations in G protein signaling modulator 2. We aimed to present a 36-year-old male who has the characteristic clinical and neuroimaging findings of CMS.
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Case Report: Waardenburg Syndrome and Left Persistent Superior Vena Cava
Driss Raissi, Alexander Christie, Kimberly Applegate
J Clin Imaging Sci 2018, 8:44 (15 November 2018)
DOI:10.4103/jcis.JCIS_31_18  PMID:30546928
Waardenburg syndrome (WS) is a rare genetic disorder secondary to neural crest cell developmental abnormalities. It is predominantly described as an auditory–pigmentary syndrome with diverse patient presentation, typically involving congenital sensorineural hearing loss and pigmentation abnormalities of the skin, hair, and iris. Other developmental abnormalities that may be associated with this syndrome are Hirschsprung's disease and a myriad of cardiovascular congenital defects. We present a case of a young girl with WS who found to have a persistent left superior vena cava (PLSVC) draining into the coronary sinus. The prevalence of PLSVC is increased in patients with chromosomal and genetic abnormalities. However, we are the first to report its presence in association with WS while discussing the challenges that may arise during central venous catheter placement in patients with PLSVC.
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Original Article: Utility of Magnetic Resonance Imaging Brain Epilepsy Protocol in New-Onset Seizures: How is it Different in Developing Countries?
Janardhana Ponnatapura, Suresh Vemanna, Sandeep Ballal, Avisha Singla
J Clin Imaging Sci 2018, 8:43 (15 November 2018)
DOI:10.4103/jcis.JCIS_38_18  PMID:30546927
Introduction: Magnetic resonance imaging (MRI) is the current imaging tool of choice in the investigation of patients with seizures. The advent of high-resolution MRI with a dedicated seizure protocol has significantly increased the chances of identifying a cause, resulting in a positive clinical impact on the management of these patients. Aims: The aims of this study were to evaluate the diagnostic efficacy of standard MRI, identify whether there is an increase in the diagnostic yield with the addition of dedicated seizure protocol, and compare the diagnostic yields of MRI and electroencephalogram (EEG) individually and in combination. Subjects and Methods: This is a prospective study of 129 consecutive patients who presented with new-onset seizures over an 18-month period. The MRI scans performed on 1.5T were reviewed for their diagnostic yield and their association with abnormal electrical activity on EEG. Chi-square test of significance (P < 0.05) was used to test for the difference in proportion. The correlation between MRI brain and EEG was studied using McNemer test. Results: MRI detected potentially epileptogenic lesions in 59 patients (47%). The frequency of epileptogenic lesions was highest in patients who had focal-onset seizures (81%). The most common lesion type was infection and inflammation (28%), with neurocysticercosis being the most common, followed by mesial temporal sclerosis, ischemia, and tumor. About 37% of epileptogenic lesions were missed by standard protocol, which were detected on a dedicated seizure protocol MRI. The diagnostic yield of EEG was 31%. Abnormal MRI and EEG were concordant in 18% of patients, with EEG being normal in 37% of patients with epileptogenic lesions. Conclusions: MRI detects epileptogenic lesions in almost one half who presented with new-onset seizures and of these, more than third of them were detected using a “dedicated seizure protocol.” While almost 50% with seizures will have a cause identified on MRI, the sensitivity can be substantially improved by utilizing a dedicated seizure protocol.
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Case Report: A Rare Case of Laryngopyocele with Airway Obstruction
Sun Yu Lam, Hin Yue Lau
J Clin Imaging Sci 2018, 8:42 (15 November 2018)
DOI:10.4103/jcis.JCIS_50_18  PMID:30546926
Laryngocele is a rare entity and can be defined as an abnormal cystic dilatation of saccule of the laryngeal ventricle with communication to the lumen of larynx. Laryngopyocele is a rare complication of laryngocele when it is infected. Patients may present with fever, neck swelling, shortness of breath, and hoarseness. Acute presentation can develop rapidly with alarming symptom, such as stridor, which signifies airway obstruction and warrants immediate treatment and airway protection. Computed tomography and endoscopy are useful in making the diagnosis and delineate the severity of disease. Laryngopyocele should be treated with antibiotics, drainage of purulent content, and followed by definitive surgical excision.
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Case Report: Caliber-persistent labial artery: A report of a rarely recognized lip swelling
Malarkodi Thanthoni, P Rajeev, S Sathasivasubramanian
J Clin Imaging Sci 2018, 8:41 (20 September 2018)
DOI:10.4103/jcis.JCIS_43_18  PMID:30283723
Calibre-persistent labial artery (CPLA) is a commonly underdiagnosed vascular lesion of the lip. CPLA is an arterial branch that penetrates the submucosal tissue without loss of calibre. Clinical diagnosis is significant as misdiagnosis can lead to profuse haemorrhage following an excisional biopsy or surgical excision. Colour Doppler ultrasonography is a safe and non-invasive diagnostic tool to confirm the diagnosis. Here, we report a case of a 24-year-old man who complained of an asymptomatic pulsating non-progressive nodule on the left side of upper lip initially diagnosed as peripheral angiomatous lesion. Diagnosis was confirmed by high-resolution Colour Doppler Ultrasonography. The purpose of this case report is to highlight the clinical importance and diagnosis of a rarely reported soft tissue swelling of the lip to the attention of clinicians.
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Original Article: Monitoring Iron Overload: Relationship between R2* Relaxometry of the Liver and Serum Ferritin under Different Therapies
Michaela Plaikner, Christian Kremser, Heinz Zoller, Werner Jaschke, Benjamin Henninger
J Clin Imaging Sci 2018, 8:40 (18 September 2018)
DOI:10.4103/jcis.JCIS_30_18  PMID:30283722
Objective: The objective of this study was to evaluate the relationship between hepatic magnetic resonance imaging (MRI) with R2* relaxometry and serum ferritin in therapy monitoring of patients with iron overload. Further, a possible influence of the chosen therapy (phlebotomy or chelation) was assessed. Materials and Methods: We retrospectively evaluated 42 patients with baseline and follow-up R2* relaxometry and determination of serum ferritin before and during therapeutic phlebotomy or iron chelation therapy or watchful waiting, respectively. Linear regression analysis was used to analyze the correlation between changes of R2* and serum ferritin. Regression lines for different groups were compared with analysis of covariance. Results: We found a moderate positive statistical correlation (r = 0.509) between serum ferritin and R2*, a moderate positive correlation between absolute R2* changes and serum ferritin changes (r = 0.497), and a strong correlation for percentage changes (r = 0.712). The correlation analysis between relative changes of R2* and serum ferritin for the different therapies resulted in a strong correlation between phlebotomy and chelation (r = 0.855/0.727) and a moderate for no applied therapy (r = 0.536). In 22/92 paired examinations, a discordance of R2* and ferritin was found, particularly involving patients under chelation. Conclusions: Despite the good correlation between serum ferritin and R2* relaxometry in monitoring iron overload, treatment response may be misinterpreted when only serum ferritin is considered. Although ferritin is an acceptable and far cheaper tool for monitoring, MRI should be performed for confirmation, especially in case of unexpected ferritin changes, particularly under chelation therapy.
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Case Report: Timely Identification of Pregnancy in Noncommunicating Horn of Unicornuate Uterus by Three-Dimensional Transvaginal Ultrasonography
Aarti Deenadayal Tolani, Kadambari , Anupama Deenadayal, Suhasini Donthi, Indira Rani Yellenki, Mamata Deenadayal
J Clin Imaging Sci 2018, 8:39 (18 September 2018)
DOI:10.4103/jcis.JCIS_25_18  PMID:30283721
Pregnancy in the rudimentary horn of a unicornuate uterus is uncommon and needs to be diagnosed at early stages to avoid uterine rupture to avert the high morbidity and mortality. In this case report, we discussed the advantage of three-dimensional transvaginal ultrasonography (3D TV-USG) in assessing the early pregnancy in the noncommunicating rudimentary horn of uterus. A 23-year-old woman approached us for routine pregnancy scan. The location of 5-week pregnancy was confirmed in the right noncommunicating horn of a unicornuate uterus by 3D TV-USG. She has undergone laparohysteroscopy, and excision of a gravid rudimentary horn was done. After an interval of 6 months, the patient received fertility treatment and conceived consequently. Although magnetic resonance imaging (MRI) is an excellent way of diagnosing uterine anomalies, the procedure is expensive, time-consuming, and not widely available. 3D USG is less expensive and more readily accessible for early diagnosis of uterine anomalies, particularly in health-care centers where MRI is not readily available or affordable.
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Case Report: Adding Value to the Magnetic Resonance Examination in a Case of Brachial Plexus Birth Palsy
Ajay Prashanth Dsouza, Sachin Tandon, Munire Gundogan, Abdalla Ali Abdalla
J Clin Imaging Sci 2018, 8:38 (24 August 2018)
DOI:10.4103/jcis.JCIS_26_18  PMID:30197829
We report a case of brachial plexus birth palsy in an infant with the inability to move the left upper limb since birth. There was neither history of birth trauma nor any complications during delivery. Magnetic resonance imaging (MRI) of brachial plexus showed postganglionic injury with musculoskeletal abnormalities. The child underwent surgical repair of the plexus and is on physical rehabilitation. In this case report, we discuss the utility of a single MRI examination with an elaborate discussion on various MRI signs of brachial plexus injury including secondary musculoskeletal manifestations. The case reiterates the significance of two-in-one approach while imaging these cases with MRI. Apart from reporting the damage to the brachial plexus, the radiologist should actively search for glenohumeral dysplasia. Awareness of classification and assessment of glenohumeral dysplasia should be routinely included as an integral part of imaging report as it adds incremental value to the overall patient management and functional outcome.
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Original Article: Contrast-enhanced Computed Tomography Imaging of Splenic Artery Aneurysms and Pseudoaneurysms: A Single-center Experience
Jacob Therakathu, Hirenkumar Kamleshkumar Panwala, Salil Bhargava, Anu Eapen, Shyamkumar Nidugala Keshava, Deepu David
J Clin Imaging Sci 2018, 8:37 (24 August 2018)
DOI:10.4103/jcis.JCIS_21_18  PMID:30197828
Aim: The aim of our study was to evaluate the computed tomography (CT) imaging features of splenic artery aneurysm and pseudoaneurysm and to identify the disease conditions related to the same. We also wanted to ascertain any relationship between these associated disease conditions and the imaging features of the aneurysms. Materials and Methods: This retrospective study included patients diagnosed to have splenic artery aneurysms on contrast-enhanced CT examination between January 2001 and January 2016. Data were obtained from the picture archiving and communication system. The size, number, location, morphology, the presence of thrombosis, calcification, and rupture of the aneurysms were evaluated. Results: A total of 45 patients were identified with a mean age of 45 years. Splenic artery aneurysms were idiopathic in 12 (26.6%) patients. In the remaining patients, the main associated disease conditions included pancreatitis 15 (33%), chronic liver disease with portal hypertension 8 (18%), and extrahepatic portal vein obstruction (EHPVO) 6 (13%). Statistically significant findings included the relationship between EHPVO and multiple aneurysms (P = 0.002), chronic liver disease and fusiform aneurysm (P = 0.008), and smaller size of idiopathic aneurysms (P < 0.001). Conclusion: Based on this study, splenic artery aneurysms were associated with a variety of etiologies. The characteristics of the aneurysms such as size, location, and morphology vary with the associated disease conditions. These variations may have implications for the management.
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Case Report: Clinical Significance of T2*gradient-recalled Echo/susceptibility-weighted Imaging Sequences in Evaluating Superficial Siderosis in the Setting of Intracerebral Tumors: Pilocytic Astrocytoma
Sankarsh N Jetty, Zain Badar, Douglas Drumsla, Rajiv Mangla
J Clin Imaging Sci 2018, 8:36 (24 August 2018)
DOI:10.4103/jcis.JCIS_60_17  PMID:30197827
Superficial siderosis is the slow accumulation of hemosiderin on the pial surfaces of the brain and spinal cord. The most common cause of intracranial superficial siderosis is secondary to subarachnoid hemorrhage. Rarely, superficial siderosis can also be caused by tumors. Superficial siderosis presents clinically as hearing loss and gait instability that progressively worsen. The diagnosis is primarily made by magnetic resonance imaging; however, susceptibility-weighted imaging (SWI) and T2* gradient echo (GRE) sequences demonstrate the highest sensitivity in detecting this condition. To the best of our knowledge, there has been only one previous case of superficial siderosis secondary to a pilocytic astrocytoma of the spine. However, we present a case of intracerebral pilocytic astrocytoma resulting in superficial siderosis, with emphasis on acquisition and use of T2*GRE/SWI sequences.
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Case Report: The “Lightning bolt” Sign on Computed Tomography during Percutaneous Renal Mass Cryoablation
Qian Yu, Driss Raissi
J Clin Imaging Sci 2018, 8:35 (24 August 2018)
DOI:10.4103/jcis.JCIS_36_18  PMID:30197826
Ice-ball fracture is a rare and often overlooked entity that may lead to intraprocedural hemorrhage after percutaneous cryoablation of renal masses. There is scant literature on ice-ball fractures associated with percutaneous renal cryoablation. Immediate recognition of the lightning bolt sign during intraprocedural computed tomography can help identify patients who may have developed this complication.
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Original Article: A Study on the Use of Radiation-Protective Apron among Interventionists in Radiology
Roshan Samuel Livingstone, Anna Varghese, Shyamkumar N Keshava
J Clin Imaging Sci 2018, 8:34 (24 August 2018)
DOI:10.4103/jcis.JCIS_34_18  PMID:30197825
Objective: Radiation-protective aprons are commonly used by interventionists to protect against the harmful effects of ionizing radiation. Choice of appropriate aprons with respect to lead equivalence and weight is necessary for effective protection and reduced physical strain. This study evaluates the knowledge and practice of using radiation-protective aprons by interventionists. Materials and Methods: Ninety-one interventional radiologists who attended an annual interventional conference were provided with a questionnaire which included age, years of experience, area of expertise, type and weight of apron used, and physical strain caused due to the use of apron. Results: About 14.3% of the interventionists practiced in an angiographic suite for less than an hour a day, 45% for 2–4 h, 21% for 4–6 h, 10% for 6–10 h, and the rest above 10 h/day. About 68% of the interventionists wore 0.5 mm lead-equivalent (Pbeq) aprons; 15.4% with 0.25 mm Pbeq; about 5.5% with 0.35 mm Pbeqaprons, and the remaining were not aware of the lead equivalence. About 47% reported that they had body aches due to wearing single-sided aprons. Interventionists working more than 10 h/day wearing single-sided lead apron predominantly complained of shoulder pain and back pain. Conclusion: A large fraction of interventionists reported that they had physical strain. It is suggestive for interventionists to wear correct fit and light-weight aprons with appropriate lead equivalence.
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Case Report: Unusual Locations of Pancreatic Pseudocysts in Lumbar Triangle, Psoas Muscle and Intercostal Space, and Obturator Externus
Sanjay Mhalasakant Khaladkar, Akshay Mahadev Waghmode
J Clin Imaging Sci 2018, 8:33 (24 August 2018)
DOI:10.4103/jcis.JCIS_29_18  PMID:30197824
Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11th intercostal space, was detected.
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Case Report: Mucinous Neoplasm of the Appendix as a Mimic of Cystic Adnexal Pathology
Chris Hutchinson, Jonathan Lyske, Vimal Patel, Gavin Low
J Clin Imaging Sci 2018, 8:32 (24 August 2018)
DOI:10.4103/jcis.JCIS_27_18  PMID:30197823
Pelvic pain presents a common diagnostic conundrum with a myriad of causes ranging from benign and trivial to malignant and emergent. We present a case where a mucinous neoplasm of the appendix acted as a mimic for tubular adnexal pathology on imaging. With the associated imaging findings on ultrasound, computed tomography, and magnetic resonance imaging, we wish to raise awareness of mucinous tumors of the appendix when tubular right adnexal pathology is present both in the presence of pelvic or abdominal pain or when noted incidentally. Tubular pathology such as uncomplicated paraovarian cysts or hydrosalpinx is frequently treated conservatively with long-interval follow-up imaging or left to clinical follow-up. Thus, if incorrectly diagnosed as tubular pathology, an appendix mucocele or mucinous neoplasm of the appendix is likely to be undertreated. We wish to clarify some of the confusion around nomenclature and classification of the multiple entities that are comprised by the terms mucocele and mucinous tumor of the appendix.
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Original Article: Computed Tomography Evaluation of the Arterial Supply to Segment 4 of the Liver
Tharani Putta, Reetu Amrita John, Anu Eapen, Anuradha Chandramohan, Betty Simon, Manbha L Rymbai, Philip Joseph
J Clin Imaging Sci 2018, 8:31 (24 August 2018)
DOI:10.4103/jcis.JCIS_24_18  PMID:30197822
Introduction: In a setting of living-donor liver transplant and patients undergoing extended hepatic resections for both primary and metastatic liver tumors, preoperative assessment of hepatic arterial anatomy is very important because of the risk of ischemic complications in the event of inadvertent injury to the arterial supply. Anatomical variations in hepatic arterial supply to the liver are very common and seen in nearly half the population. Identifying anomalous origin of segment 4 hepatic artery is vital since this vessel can cross the transection plane and can result in liver ischemia and liver failure. The purpose of our study is to study the variations in hepatic arterial anatomy to segment 4 of the liver in the Indian population. Materials and Methods: A retrospective evaluation of 637 consecutive computed tomography (CT) angiograms over a period of 1 year was performed, and we analyzed the arterial supply to segment 4 of the liver. Results: We found that the arterial supply to segment 4 of the liver originated from left hepatic artery (LHA) in majority of cases, 76.3%. LHA along with the accessory LHA supplied this segment in 6.4%, whereas the accessory LHA solely supplied this segment in 0.4%. The right hepatic artery (RHA) was seen to supply this segment in 10.2%. Dual supply with branches from the RHA and LHA was seen in 6.6% of patients. Conclusion: Preoperative mapping of segment 4 hepatic arterial supply using CT angiography will act as a roadmap to surgeons as they attempt to carefully dissect and preserve this segments' arterial supply. Depending on the anatomical variation, surgical techniques will vary to ensure safety of segment 4 arterial supply.
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Review Article: The Use of Imaging in Management of Patients with Low Back Pain
Dinesh Rao, Gaelyn Scuderi, Chris Scuderi, Reetu Grewal, Sukhwinder JS Sandhu
J Clin Imaging Sci 2018, 8:30 (24 August 2018)
DOI:10.4103/jcis.JCIS_16_18  PMID:30197821
Lower back pain (LBP) is one of the most common chief complaints encountered in primary care. Advanced imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), are frequently ordered in the setting of LBP. Structural abnormalities are commonly identified by CT and MRI in patients complaining of low back pain, however, these findings are also found in asymptomatic patients. In the past decade, multiple guidelines have been published to help providers identify patients in whom the use of advanced imaging is appropriate. In this article, we review common conditions associated with LBP that require advanced imaging along with their clinical and associated imaging findings.
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Review Article: Congenital pulmonary artery anomalies: A review and approach to classification
Leslie E Hirsig, Priya G Sharma, Nupur Verma, Dhanashree A Rajderkar
J Clin Imaging Sci 2018, 8:29 (31 July 2018)
DOI:10.4103/jcis.JCIS_9_18  PMID:30147993
Congenital pulmonary artery anomalies are infrequent but given improved prenatal diagnosis and care, and neonatal surgical advances, over the past two decades are not uncommonly encountered by cardiothoracic imagers. An understanding of their etiology, classifications, associated anomalies, and surgical management can be helpful to avoid under or overdiagnosis. Timely diagnosis assisted by familiarity with imaging findings across modalities and recognition of surgical findings allows for medical management and surgical planning for these patients, with more patients reaching adulthood than ever before.
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Pictorial Essay: Tomosynthesis-guided core biopsy of the breast: Why and how to use it
Kyungmin Shin, Davis Teichgraeber, Sarah Martaindale, Gary J Whitman
J Clin Imaging Sci 2018, 8:28 (31 July 2018)
DOI:10.4103/jcis.JCIS_10_18  PMID:30147992
Digital breast tomosynthesis (DBT) has become an important tool in breast imaging. It decreases the call-back rate while increasing the cancer detection rate on screening mammography and is useful for diagnostic examination of noncalcified lesions and for the evaluation of patients presenting with clinical symptoms. Management challenges and dilemmas that are encountered with abnormalities detected on DBT and lacking a sonographic correlate can now be addressed with tomosynthesis-guided core biopsy.
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Original Article: Linear atelectasis around the hilum on chest radiography: A novel sign of early lung cancer
Kerem Ozturk, Esra Soylu, Ugur Topal
J Clin Imaging Sci 2018, 8:27 (20 July 2018)
DOI:10.4103/jcis.JCIS_35_18  PMID:30123672
Background: Linear atelectasis is a focal area of subsegmental atelectasis with a linear shape. Linear atelectasis may occur as a consequence of subsegmental bronchial obstruction. Aims: We propose an early roentgen sign of obstructing lung tumors, namely perihilar linear atelectasis, and ascertain whether this phenomenon could be used as a sign to detect radiographically occult primary lung cancer. Materials and Methods: We performed a retrospective review of 45,000 posteroanterior chest radiographs to determine the frequency of appearance and characteristics of perihilar linear atelectasis. The perihilar region of chest radiographs was evaluated for the presence of linear atelectasis. When linear atelectasis was found, the total thickness was measured. Student's t-test was used to evaluate statistical significance, correlating the thickness of atelectasis and the presence of obstructing central primary lung cancer. Results: Perihilar linear atelectasis was demonstrated in 58 patients. Atelectasis was caused by an obstructing tumor in 21 (36%) cases and a variety of other conditions in 37 (64%) patients. A statistically significant relationship (P < 0.001) was observed between the dimension of perihilar linear atelectasis and primary lung cancer, with 16 of 19 patients with thick (>5.5 mm) perihilar linear atelectasis found to have primary lung cancer. Conclusion: Thick perihilar linear atelectasis is a new diagnostic roentgen sign that suggests subsegmental bronchial obstruction. In this patient subgroup, who are otherwise asymptomatic, a persistent linear atelectasis can be due to primary lung cancer.
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Case Series: Large vallecular masses; Differential diagnosis and imaging features
Ashim Kumar Lahiri, Krishna Kiran Somashekar, Bernd Wittkop, Christopher Ayshford
J Clin Imaging Sci 2018, 8:26 (28 June 2018)
DOI:10.4103/2156-7514.235510  PMID:30034930
Large vallecular masses are an uncommon disease entity which includes a wide spectrum of rare pathologies. These masses may present as purely vallecular in location or appear as an extension from adjacent anatomical sites like tongue base including lingual tonsils, epiglottis, palatine tonsils, epiglottis, and the remainder of supraglottis. Literature review reveals very rare conditions presenting as vallecular mass lesions. The imaging features are generally diagnostic for characterization. However, these masses can exhibit indeterminate appearance at imaging. We present a series of five cases which includes two rare presentations: a case of low-grade cribriform adenocarcinoma of the base of tongue and a vallecular lipoma. The other three cases presented for differential diagnosis including benign vallecular cysts and two cases to show that malignant masses arising from neighboring anatomical sites such as tongue base or supraglottic larynx can exhibit significant vallecular component.
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Technical Innovation: Normalized subtraction of serial brain magnetic resonance images and fludeoxyglucose-Positron emission tomography images for tumor treatment monitoring: Case report and method description
Nghi C Nguyen, Medhat M Osman
J Clin Imaging Sci 2018, 8:25 (28 June 2018)
DOI:10.4103/2156-7514.235509  PMID:30034929
A 60-year-old Caucasian male with a long history of cigarette smoking was diagnosed with epidermal growth factor receptor-mutation negative lung adenocarcinoma. The single cerebral metastasis in the right frontal lobe was treated with stereotactic radiosurgery and systemic chemotherapies. Normalized subtraction (NS) method was used to evaluate the serial brain magnetic resonance (MR) and fludeoxyglucose-positron emission tomography (FDG-PET) findings retrospectively, and the potential benefit of concurrent NS of serial MR images (MRIs) and PET images was demonstrated. MIM 4.1 (MIM Software Inc., Cleveland, OH) was used to co-register MRI with PET data and to perform NS on the serial MRI and PET data. MIM 4.1 provides fully automated alignment of imaging data by maximization of mutual information. Cortical regions distant from the brain lesion were used to adjust for the intensity differences between scans, so the voxel differences in normal brain regions were near zero in the NS images. A difference of 15% or greater in voxel densities was used for both MRI and PET, above or below which a change in MR signal intensity and FDG avidity was considered significant. The use of NS, in this case, allowed for an enhanced correlation of morphologic and functional information, which may have added value in the early treatment monitoring of brain tumors and help distinguish recurrent tumor from postradiation changes.
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Case Report: A rare cause of obstructive jaundice: Cecal herniation through the foramen of winslow
Ivan Welaratne, Afshin Nasoodi
J Clin Imaging Sci 2018, 8:24 (18 June 2018)
DOI:10.4103/2156-7514.234666  PMID:30034928
Internal abdominal hernias are rarely reported in the literature and have a very low rate of preoperative diagnosis. It is even rarer that they present with jaundice. A 59-year-old Caucasian female presented with a short history of jaundice, dark urine, epigastric pain, vomiting, and obstipation. Her liver biochemistry profile revealed a mixed cholestatic/hepatocellular pattern with significantly elevated bilirubin. She urgently underwent abdominal imaging which provided a preoperative diagnosis of internal herniation of the cecum within the lesser sac through the foramen of Winslow. The dilated bowel was compressing the common bile duct explaining the jaundice. This was repaired intraoperatively by anchoring the mobile cecum. In this case, we highlight the importance of maintaining a high index of suspicion for internal herniation on abdominal imaging with clinical evidence of intestinal obstruction. A foramen of Winslow hernia should be further suspected in the presence of jaundice.
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Original Article: Computed tomography and magnetic resonance imaging manifestations of spinal monostotic fibrous dysplasia
Yu Zhang, Chuanyu Zhang, Shaohua Wang, Hexiang Wang, Yupeng Zhu, Dapeng Hao
J Clin Imaging Sci 2018, 8:23 (18 June 2018)
DOI:10.4103/2156-7514.234658  PMID:30034927
Aim: The purpose of the study was to analyze and summarize the computed tomography (CT) and magnetic resonance imaging (MRI) findings of spinal monostotic fibrous dysplasia (MFD) as well as evaluate the clinical value of CT and MRI in MFD diagnosis. Materials and Methods: CT (n = 4) and MRI (n = 5) images of six patients with pathologically confirmed spinal MFD were examined. The assessed image features included location, shape, rib involvement, vertebral collapse, margin, attenuation, and sclerotic rim on CT, as well as signal intensity, dark signal rim, and enhancement pattern on MRI. Results: In total, four of six patients underwent CT scanning. The most common findings on CT scanning were expansile lesions (n = 4), sclerotic rims (n = 4), and ground-glass opacity (GGO) (n = 4). In total, five of six patients underwent MRI. The lesions were low-signal intensity (n = 2), low-to-isointense signal intensity (n = 1), and low-signal intensity with several isointense portions (n = 2) on T1-weighted imaging (T1WI). The lesions were low-signal intensity (n = 1), isointense to high intensity (n = 1), and isointense signal intensity with several high portions (n = 3) on T2WI. A dark signal rim was found in most cases on T1WI and T2WI (n = 4). The lesions (n = 2) showed obvious enhancement. Conclusions: The CT and MRI manifestations of spinal MFD have the following characteristics: expansile lesion, GGO, sclerotic rim, and no obvious soft-tissue mass. The combined use of CT and MRI examinations is necessary for patients with suspected spinal MFD.
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Original Article: Assessment of the inferior petrosal sinus on T1-Weighted contrast-enhanced magnetic resonance imaging
Karthikram Raghuram, Aditya Durgam, Stephen Sartin
J Clin Imaging Sci 2018, 8:22 (18 June 2018)
DOI:10.4103/2156-7514.234657  PMID:30034926
Context: Skull base venous anatomy. Aims: While prior studies have focused on the efficacy of conventional fluoroscopic venography and multidetector computed tomography venography to evaluate the inferior petrosal sinus (IPS) before image-guided intervention (such as dural venous sinus sampling), we believe that routine magnetic resonance imaging (MRI) may provide reliable structural information helpful for planning without the need for further imaging. Settings and Design: Retrospective review of brain MRI. Materials and Methods: Retrospective analysis was carried out on IPSs on contrast-enhanced T1-weighted MR images. Qualitative measurements were made regarding the grade of patency of the IPS, variation in IPS drainage pattern, and grading of the ipsilateral transverse and sigmoid sinuses (TS and SS). Statistical Analysis Used: Pearson's product-moment correlation. Results: Evaluation of a total of 148 IPSs revealed that 91% of cases were grade 3 or grade 2 (either fully or mostly visualized), with 65% of cases demonstrating “typical” (type A) drainage directly into the internal jugular vein and no statistically significant correlation between the patency of the IPS and the dominance of the ipsilateral TS/SS. A bilateral concordance rate of 77% was also observed. Conclusions: Our analysis indicates that routine thin-slice contrast-enhanced T1-weighted MRI can provide sufficient anatomic detail to identify typical drainage pattern of the IPS in a majority of cases. In cases where routine drainage was not identified, spatial resolution was not sufficient to further delineate complex drainage anatomy. No correlation was observed between the TS/SS dominance and patency of the ipsilateral IPS.
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Review Article: Benign Sclerosing and Fibrosing Conditions of the Abdomen and Their Potential Mimics
Joseph H Mullineux, Catalin V Ivan, Jay Pancholi, Ratan Verma, Arumugam Rajesh, Sadhna Verma, James A Stephenson
J Clin Imaging Sci 2018, 8:21 (31 May 2018)
DOI:10.4103/2156-7514.233661  PMID:29963328
The process of abnormal reparative or reactive processes in the abdominal cavity, can lead to sclerosis and fibrous deposition. The relatively recent discovery of an IgG4 subgroup of immune mediated sclerosing disease 1,2 has thrown some light on the pathophysiology of these conditions. Firstly, our pictorial review aims to describe imaging findings to enhance the general radiologist's recognition and interpretation of this varied group of benign sclerotic and fibrotic abdominal processes. Secondly, along with the imaging findings, we bring into discussion the potential mimics of these pathologic processes to minimise interpretational errors. Moreover, some of the mimics of these processes are in the spectrum of malignant disease. Most importantly, to ensure a correct diagnosis thorough clinical and histopathological assessment are required to support the imaging findings presented in this review.
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Case Report: Osteolipoma in the Forearm
Natalie Siu Kwan Ip, Hon Wai Lau, Wai Yu Wong, Ming Keung Yuen
J Clin Imaging Sci 2018, 8:20 (3 May 2018)
DOI:10.4103/2156-7514.231905  PMID:29862130
A case of left distal forearm and wrist osteolipoma in a 56 year old female is reported. The patient presented with a 3 year history of nontender left wrist mass. Radiographs demonstrated a lobulated mass of mixed low density and calcifications, not adjacent to and with no connection to underlying bone. Ultrasound showed a spheroid hyperechoic lesion with internal heterogeneity and rim of calcifications. Magnetic resonance imaging revealed a lesion with predominantly fat characteristics on T1 weighted and T2 weighted sequences, with rim of peripheral calcification and specks of internal calcification. Histological examination after excision of the mass showed the lesion to be an osteolipoma. Osteolipoma is a rare variant of lipoma with osseous metaplasia and should be considered in the differential of a fat containing mass with ossification.
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Original Article: Role of noninvasive imaging of cerebral arterial system in ischemic stroke: Comparison of transcranial color-coded doppler sonography with magnetic resonance angiography
Betty Simon, Sunithi Elizabeth Mani, Shyamkumar Nidugala Keshava, Mathew Alexander, Sanjith Aaron
J Clin Imaging Sci 2018, 8:19 (20 April 2018)
DOI:10.4103/2156-7514.230767  PMID:29770267
Aim: To determine the accuracy of transcranial color-coded Doppler sonography (TCCS) in the evaluation of cerebral arterial system in patients with ischemic stroke attending a tertiary care hospital in South India. Objectives: (1) To describe the topographical distribution of atherosclerotic lesions in the cerebral circulation in patients presenting with ischemic stroke from the Indian subcontinent and (2) to determine the accuracy of TCCS for detection and quantification of intracranial stenoses in various segments of the intracerebral arterial system in comparison with magnetic resonance angiography (MRA). Materials and Methods: The demographic profile and risk factors of consecutive patients who presented to neurology outpatient department with cerebral ischemia and scheduled for MRA were determined. These patients had undergone neck Doppler, TCCS, and MRA. The agreement between the MRA and TCCS was assessed using kappa statistics. The sensitivity, specificity, and positive and negative predictive values of TCCS as compared to MRA were calculated. Results: Ninety patients were included in the final analysis. Intracranial atherosclerosis was found in 35.6% of cases. The agreement between TCCS and MRA in detecting lesions for the different arterial segments in the intracranial circulation was 0.83 for anterior cerebral artery (ACA), 0.66 for M1 segment of middle cerebral artery (MCA), 0.45 for M2 segment of MCA, 0.86 for terminal internal carotid artery (TICA), 0.46 for posterior cerebral artery (PCA), and 0.81 for vertebral artery (VA). The sensitivity for the detection of hemodynamically significant arterial lesions in different vascular segments was 100%, 70%, 33.3%, 90.9%, 33.3%, and 72.7% for ACA, M1, M2, TICA, PCA, and VA, respectively. Conclusion: Intracranial atherosclerosis was found to be the predominant distribution of cerebral atherosclerosis. TCCS is a safe method for evaluation of proximal basal cerebral arteries in the intracranial circulation with relatively better sensitivity in the anterior circulation.
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Case Report: Renal Granulomatosis Post Intravesical Bacillus Calmette–Guerin Therapy for Non-muscle-invasive Bladder Cancer
Karen Tran-Harding, Rashmi T Nair, Halemane Ganesh
J Clin Imaging Sci 2018, 8:18 (18 April 2018)
DOI:10.4103/2156-7514.230280  PMID:29770266
Intravesical Bacillus Calmette–Guerin (BCG) immunotherapy is a proven, effective treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Minor side effects are common and expected but systemic effects can occur in <5% of treated patients. We present a rare case of a 49-year-old male that presented with fever and chills after 3 weeks of intravesical BCG therapy post transurethral resection of bladder tumor. New renal lesions were present on contrast-enhanced computed tomography scan which was histologically proven to be necrotizing renal granulomatosis.
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Case Report: Herniation of Packing Material into a Bronchopleural Fistula after Right Pneumonectomy and Clagett Window
Iclal Ocak, Gideon Bollino, Diane Strollo
J Clin Imaging Sci 2018, 8:17 (18 April 2018)
DOI:10.4103/2156-7514.230279  PMID:29770265
Diagnosis of a bronchopleural fistula (BPF) can be challenging in patients after pneumonectomy and Clagett window. Herein, we present a case of pneumonectomy for advanced lung cancer complicated by a BPF. Herniation of packing material from the open-chest cavity into the fistula and airways on computed tomography was an important clue to making the diagnosis.
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Original Article: Calcified Triticeous Cartilage Detected on Digital Panoramic Radiographs in a Sample of Lebanese Population
Georges Aoun, Ibrahim Nasseh
J Clin Imaging Sci 2018, 8:16 (18 April 2018)
DOI:10.4103/2156-7514.230278  PMID:29770264
Objective: Triticeous cartilage is a small ovoid structure belonging to the laryngeal skeleton. When calcified, it becomes visible on panoramic radiographs and be mistaken for a carotid artery calcification (CAC) associated with cerebrovascular accidents. This study aimed to estimate the prevalence of calcified triticeous cartilage (CTC) detected by means of digital panoramic radiographs in a sample of Lebanese population. Materials and Methods: Digital panoramic radiographs of 500 Lebanese adult patients (281 females and 219 males) with a mean age of 47.9 years were included in this study and examined for CTC. The IBM® SPSS® for Windows version 20.0 (SPSS, Chicago, IL, USA) was used to carry out statistical analysis of the data collected. Results: Nearly 10.6% (53 out of 500) of the radiographs examined presented CTC. Of all the calcifications, 11 were on the right side, 5 on the left side, and 37 were bilateral. The cases detected belonged to 31 females and 22 males with an average age of 55.6 years (ranging from 24 to 85 years). Chi-square test did not show any statistical connection between gender and CTC, while Spearman's correlation analysis showed low positive correlation with age (r = 0.146). Conclusion: CTC can be detected on panoramic radiographs taken in daily dental practice; its identification is essential to avoid misdiagnosis with other calcifications in the neck region closely related to life-threatening risks such as CAC.
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Original Article: Evaluation of quantitative and qualitative renal outcome following nephron sparing surgery
Gautam Ram Choudhary, Arup Kumar Mandal, Uttam Mete, Ravimohan Mavuduru, Anish Bhatacharia, Anupam Lal, Suresh Goyal
J Clin Imaging Sci 2018, 8:15 (16 April 2018)
DOI:10.4103/2156-7514.230189  PMID:29770263
Purpose: Preservation of renal function after nephron-sparing surgery (NSS) is multifactorial and the impact of individual factors on it is still a debate. This prospective study investigates the impact of factors responsible for quantitative and functional outcome after NSS. Patients and Methods: Fifty-two patients of localized renal mass (≤7 cm) were included in the study. A contrast-enhanced computed tomography abdomen was performed for characterization of tumor. Glomerular filtration rate (GFR) was calculated using Tc99m-diethylenetriamine pentaacetic acid (DTPA) scan and Cockcroft-Gault (CG) formula. All relevant intra- and peri-operative events were noted. Follow-up work up performed at 3 months. Results: Overall, the mean ischemia time was 30.6 min, with 7.7% decrease in renal volume in the operated moiety. In follow-up, the total and ipsilateral GFR decreased. Change in renal parenchymal volume, total GFR by CG and DTPA, split GFR of tumor-bearing moiety was significant in follow-up. Size, stage, polar location of tumor, duration of surgery, type of ischemia, preoperative chronic kidney disease, and need of blood transfusion did not affect change in renal volume and function in the follow-up period. Conclusion: Renal parenchymal loss and duration of ischemia have impact on the follow-up renal function.
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Review Article: Cross-sectional imaging of parotid gland nodules: A brief practical guide
Giuseppe Cicero, Tommaso D'angelo, Sergio Racchiusa, Ignazio Salamone, Carmela Visalli, Antonio Bottari, Alfredo Blandino, Silvio Mazziotti
J Clin Imaging Sci 2018, 8:14 (16 April 2018)
DOI:10.4103/2156-7514.230188  PMID:29770262
Clinical evaluation and ultrasound examination are the first steps in the evaluation of a patient with a swelling of the parotid region. After the detection of a nodular lesion, cytological or histological confirmation is usually performed to achieve the diagnosis, while the choice of cross-sectional imaging (computed tomography scan and magnetic resonance imaging) may significantly vary from one physician to another, on the basis of the degree of confidence that both radiologist and surgeon have with this kind of imaging. This work focuses on some essential “reporting points” in cross-sectional imaging evaluation of parotid nodules, chiefly helpful to the radiologist when the ultrasonography assessment is considered incomplete and requires a further evaluation.
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Original Article: A factor increasing venous contamination on bolus chase three-dimensional magnetic resonance imaging: Charcot neuroarthropathy
Mehmet B Cildag, Mustafa B Ertuğrul, Ömer FK Köseoğlu, David G Armstrong
J Clin Imaging Sci 2018, 8:13 (5 April 2018)
DOI:10.4103/2156-7514.229380  PMID:29682401
Background: The study aimed to evaluate the ratio of venous contamination in diabetic cases without foot lesion, with foot lesion and with Charcot neuroarthropathy (CN). Materials and Methods: Bolus-chase three-dimensional magnetic resonance (MR) of 396 extremities of patients with diabetes mellitus was analyzed, retrospectively. Extremities were divided into three groups as follows: diabetic patients without foot ulcer or Charcot arthropathy (Group A), patients with diabetic foot ulcers (Group B) and patients with CN accompanying diabetic foot ulcers (Group C). Furthermore, amount of venous contamination classified as no venous contamination, mild venous contamination, and severe venous contamination. The relationship between venous contamination and extremity groups was investigated. Results: Severe venous contamination was seen in Group A, Group B, and Group C, 5.6%, 15.2%, and 34.1%, respectively. Statistically significant difference was seen between groups with regard to venous contamination. Conclusion: Venous contamination following bolus chase MR was higher in patients with CN.
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Original Article: Laboratory Tests, Liver Vessels Color Doppler Sonography, and FibroScan Findings in Patients with Nonalcoholic Fatty Liver Disease: An Observation Study
Ahmad Alizadeh, Fariborz Mansour-Ghanaei, Ava Roozdar, Farahnaz Joukar, Masood Sepehrimanesh, Seyedeh Amineh Hojati, Alireza Mansour-Ghanaei
J Clin Imaging Sci 2018, 8:12 (3 April 2018)
DOI:10.4103/2156-7514.229168  PMID:29692949
Objective: Determination of the amount of parenchymal damage in nonalcoholic fatty liver disease (NAFLD) is crucial to choose the best treatment and management. Aim: Here, the associations between laboratory data and severity of steatosis and fibrosis plus hepatic vessel Doppler indices in NAFLD patients were investigated. Patients and Methods: Fifty patients (20 males and 30 females) with NAFLD criteria were enrolled. Fatty liver was graded by sonography (SGFL) and FibroScan (FGFL). In addition, liver fibrosis was graded through FGLF. Damages to the portal, hepatic, and splenic veins were evaluated by color Doppler/dopplex. Serum liver enzymes and C-reactive protein (CRP) were also measured. Results: Significant association existed between SGFL and FGFL (P = 0.006). Portal vein pulsatility index (PI) and phasicity plus the triphasic and monophasic pattern of hepatic veins significantly associated with fatty liver grade evaluated by sonography. Splenic vein Peak systolic velocity and PI showed significant association with FGFL. Eventually, elevated liver enzymes and CRP significantly correlated with FGLF. Conclusion: We found that the severity of fatty liver is correlated with hepatic and portal veins damages; however, the degree of parenchymal fibrosis was independent to these indices and can be directly evaluated by FGFL. In addition, elevated liver enzymes and CRP correlated with the degree of fibrosis.
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Original Article: Evaluation of Orthopedic Metal Artifact Reduction Application in Three-Dimensional Computed Tomography Reconstruction of Spinal Instrumentation: A Single Saudi Center Experience
Amir Monir Ali
J Clin Imaging Sci 2018, 8:11 (12 March 2018)
DOI:10.4103/2156-7514.227125  PMID:29619282
Aim of the Study: The aim of the study was to evaluate the commercially available orthopedic metal artifact reduction (OMAR) technique in postoperative three-dimensional computed tomography (3DCT) reconstruction studies after spinal instrumentation and to investigate its clinical application. Materials and Methods: One hundred and twenty (120) patients with spinal metallic implants were included in the study. All had 3DCT reconstruction examinations using the OMAR software after obtaining the informed consents and approval of the Institution Ethical Committee. The degree of the artifacts, the related muscular density, the clearness of intermuscular fat planes, and definition of the adjacent vertebrae were qualitatively evaluated. The diagnostic satisfaction and quality of the 3D reconstruction images were thoroughly assessed. Results: The majority (96.7%) of 3DCT reconstruction images performed were considered satisfactory to excellent for diagnosis. Only 3.3% of the reconstructed images had rendered unacceptable diagnostic quality. Conclusion: OMAR can effectively reduce metallic artifacts in patients with spinal instrumentation with highly diagnostic 3DCT reconstruction images.
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Pictorial Essay: Incremental Value of Magnetic Resonance Imaging in Further Characterizing Hypodense Mediastinal and Paracardiac Lesions Identified on Computed Tomography
Abhishek Chaturvedi, Chris Gange, Hakan Sahin, Apeksha Chaturvedi
J Clin Imaging Sci 2018, 8:10 (12 March 2018)
DOI:10.4103/2156-7514.227124  PMID:29619281
Mediastinal and paracardiac lesions are usually first diagnosed on a chest radiograph or echocardiogram. Often, a computed tomography is obtained to further delineate these lesions. CT may be suboptimal for evaluation of enhancement characteristics and direct extension into the adjacent mediastinal structures. With its intrinsic superior soft-tissue characterization, magnetic resonance imaging (MRI) can better delineate these lesions, their internal tissue characteristics, and identify adhesion/invasion into adjacent structures. This pictorial essay provides a brief synopsis of the key MRI sequences and their utility in further characterizing mediastinal and paracardiac lesions.
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Original Article: Radiation reduction in low dose pulsed fluoroscopy versus standard dose continuous fluoroscopy during fluoroscopically-guided lumbar punctures: A prospective controlled study
Shyam Sabat, Einat Slonimsky
J Clin Imaging Sci 2018, 8:9 (9 March 2018)
DOI:10.4103/2156-7514.227044  PMID:29619280
Purpose: The purpose of this study was to evaluate radiation dose reduction in fluoroscopically guided lumbar punctures (FGLP) using “pulsed fluoroscopy in a low dose mode” compared with the commonly used “continuous fluoroscopy in a standard dose mode” while maintaining the technical success. Materials and Methods: Thirty-five consecutive patients who underwent FGLP divided randomly to seventeen patients in the control group with standard dose continuous FGLP and eighteen patients in the study group with low-dose low-frame-rate of 3 frames per second (fps) FGLP. Entrance surface dose measurements from a dosimeter device were recorded as well as the dose area product (DAP). Results: A total of 35 patients with average age of 52 years (range: 15–87 [±17 standard deviation [SD]) were evaluated. Average entrance surface dose of the study group was significantly lower (3.81 mGy [range: 0.21–11.14, [±2.8 SD]) compared with the control group (22.45 mGy [range: 1.23–73.44, [±19.41 [SD]). The average DAP of the study group (10 mGy·cm2 [range: 1–41, [±9.8 SD]) was also significantly lower than the control group (65 mGy·cm2 [range: 5–199, [±53 SD]). Success rate was similar between the study and control groups. Conclusion: Low dose pulsed fluoroscopy of 3 fps significantly reduces radiation exposure by about 600% compared with standard dose continuous fluoroscopy in FGLP. Utilizing this radiation saving strategy will allow to dramatically reduce radiation exposure, without impacting the technical success rate.
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Pictorial Essay: Computed tomography-guided pulmonary nodule microcoil localization technique, misplacement errors, and complications: A pictorial essay
Sultan R Alharbi
J Clin Imaging Sci 2018, 8:8 (9 March 2018)
DOI:10.4103/2156-7514.227043  PMID:29619279
Computed tomography-guided pulmonary nodule microcoil localization is done preoperatively to fluoroscopic-guided video-assisted thoracoscopic surgical resection. This pictorial essay explains and illustrates the microcoil localization technique, various microcoil placement errors, intraoperative fluoroscopy-guided resection, and postmicrocoil localization complications.
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Case Report: Necrotizing fasciitis of thoracic and abdominal wall with emphysematous pyelonephritis and retroperitoneal abscess
Sanjay Mhalasakant Khaladkar, Kunaal Mahesh Jain, Rajesh Kuber, Sidappa Gandage
J Clin Imaging Sci 2018, 8:7 (21 February 2018)
DOI:10.4103/2156-7514.225957  PMID:29541493
Emphysematous pyelonephritis is a life-threatening severe form of pyelonephritis usually occurring in patients with diabetes mellitus with or without obstructive uropathies in whom there is necrotizing infection leading to the gas production of an unclear mechanism involving the renal parenchyma and the collecting system. Necrotizing fasciitis is characterized by progressive necrosis of fat and fascia due to deep-seated infection of subcutaneous tissue. It has a fulminant course with considerable mortality. Diabetes Mellitus is a common predisposing factor. The combined occurrence of emphysematous pyelonephritis and necrotizing fasciitis is extremely unusual. Early recognition and management is mandatory to avoid mortality. We report a case of a 53-year-old female, a known case of Type II diabetes mellitus, who presented with necrotizing fasciitis of thoracic and abdominal wall with emphysematous pyelonephritis in the left kidney with a retroperitoneal abscess.
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Case Report: Diagnosis and management of piriformis syndrome: a rare anatomic variant analyzed by magnetic resonance imaging Highly accessed article
Tae Hoon Ro, Lance Edmonds
J Clin Imaging Sci 2018, 8:6 (21 February 2018)
DOI:10.4103/2156-7514.225958  PMID:29541492
Piriformis syndrome is an uncommon condition that causes significant pain in the posterior lower buttocks and leg due to entrapment of the sciatic nerve at the level of the piriformis muscle. In the typical anatomical presentation, the sciatic nerve exits directly ventral and inferior to the piriformis muscle and continues down the posterior leg. Several causes that have been linked to this condition include trauma, differences in leg length, hip arthroplasty, inflammation, neoplastic mass effect, and anatomic variations. A female presented with left-sided lower back and buttock pain with radiation down the posterior leg. After magnetic resonance imaging was performed, an uncommon sciatic anatomical form was identified. Although research is limited, surgical intervention shows promising results for these conditions. Accurate diagnosis and imaging modalities may help in the appropriate management of these patients.
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Original Article: Role of acoustic radiation force impulse elastography in the characterization of focal solid hepatic lesions
Harshavardhan Nagolu, Sudhakar Kattoju, Chidambaranathan Natesan, Meera Krishnakumar, Sunil Kumar
J Clin Imaging Sci 2018, 8:5 (21 February 2018)
DOI:10.4103/2156-7514.225959  PMID:29541491
Objective: The purpose of the study is to investigate the usefulness of acoustic radiation force impulse (ARFI) elastography in the characterization of focal solid liver lesions as benign, malignant, or metastatic using ARFI two-dimensional (2D) imaging and ARFI quantification (shear wave velocities [SWVs]). Materials and Methods: Sixty lesions were included in this study. The lesions were classified into three groups: Group I included benign lesions (n = 25), Group II included malignant lesions (n = 27), and Group III included metastatic lesions (n = 8). ARFI elastography was performed in all these patients using a Siemens ACUSON S 2000TM ultrasound machine. Stiffness and size of the lesions were assessed on ARFI 2D images in correlation with B-mode ultrasound images. SWVs were obtained in these lesions for the quantification of stiffness. Results: In ARFI 2D images, malignant lesions were predominantly stiffer and larger, while benign lesions were softer and similar in size (P < 0.05). The mean SWVs in benign, malignant, and metastatic lesions were 1.30 ± 0.35 m/s, 2.93 ± 0.75 m/s, and 2.77 ± 0.90 m/s, respectively. The area under receiver operating characteristic curve of SWV for differentiating benign from malignant lesions was 0.877, suggesting fair accuracy (95% confidence interval: 0.777–0.976); with a cutoff value of 2 m/s, showing sensitivity: 92%; specificity: 96%; positive predictive value: 96%; negative predictive value: 93% (P < 0.05). Statistically significant difference exists in SWV of benign and malignant or metastatic lesions. Conclusion: ARFI elastography with 2D imaging and quantification might be useful in the characterization of benign and malignant liver lesions.
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