CT-Based Evaluation of Diffuse Idiopathic Skeletal Hyperostosis in Adult Population; Prevalence, Associations and Interobserver Agreement.

Diffuse idiopathic skeletal hyperostosis (DISH), being an asymptomatic condition, is generally discovered incidentally on imaging and it has not received much attention for research on clinical grounds. We assessed the prevalence of DISH, its associated factors, and interobserver agreement for computed tomography (CT)-based diagnosis of DISH. CT scans of chest, abdomen, and pelvis performed for various clinical indications were retrospectively reviewed. Resnick criteria were used for the diagnosis of DISH. Moreover, enthesopathy along with comorbidities was assessed. CT scans were observed by 3 observers having different experience levels. Out of total 416 patients, the prevalence of DISH was 30.8%. Strong positive agreement was observed between observer 1 and 2 (k = 0.89), observer 1 and 3 (k = 0.91), and observer 2 and 3 (k = 0.94). Reporting rate of DISH was 59.3%. Regression analyses showed that enthesopathy was 2.45 times (adjusted odds ratio [AOR]: 2.45, 95% confidence intervals [CI]: 1.48-4.05), diabetic patients were 4.74 times (AOR: 4.74, 95% CI: 2.89-7.78) while hypertensive patients were 2.17 times (AOR: 2.17, 95% CI: 1.30-3.62) more likely to have DISH in comparison to those who do not have DISH. A high prevalence of DISH was observed in our cohort. Enthesopathy and comorbidities like diabetes and hypertension were significant factors associated with DISH. Moreover, excellent agreement was observed in defining DISH on CT according to Resnick criteria.

Gastrointestinal and pancreatic neuroendocrine tumours and carcinomas; a review of rare tumour type.

Neuroendocrine tumours are a rare tumour type involving neuroectodermal cells. They are also termed carcinoids. Gastroenteropancreatic system is most commonly involved. They are classified as low, intermediate or high grade depending upon mitotic index and Ki-67 index. Their diagnosis involves measurement of chromogranin A levels. Ultrasound is the initial imaging modality for their evaluation. Endoscopic ultrasound allows close evaluation of the tumour. Staging is commonly undertaken by computed tomography scan. These tumours typically show hyper-enhancement on arterial phase. Their metastasis to the liver also shows arterial enhancement. Small bowel carcinoids tend to have hepatic and mesenteric spread. Mesenteric spread of disease gives a characteristic spoke wheel appearance. On magnetic resonance imaging, these tumours typically appear as hypointense on T1 weighted image, hyperintense on T2 weighted image and show avid enhancement on postcontrast scan. Surgical resection is appropriate treatment with follow-up at 6-month intervals during the first year. The current review was planned to cover the aetiology, diagnosis, staging, imaging techniques, imaging features and treatment of these rare tumours that need prompt diagnosis.

Sonographic Evaluation of Normal Liver, Spleen, and Renal Parameters in Adult Population: A Multicenter Study.

OBJECTIVE: To determine the normal liver, spleen, and renal parameters in adult patients with no comorbidities. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dow Institute of Radiology, Ojha Campus, LEJ Campus, and Al-Mustafa Hospital Karachi, from October 2016 to March 2017. METHODOLOGY: A total of 3,136 study participants with more than 16 years of age of either gender underwent ultrasound examination. All individuals with morbid conditions like hypertension (HTN), diabetes mellitus (DM), liver cirrhosis, hydronephrosis, renal cyst, and liver mass were excluded. Ultrasound scan was performed and longitudinal and transverse sections were obtained of both kidneys (in full inspiration), spleen and liver. RESULTS: A significant positive correlation was observed between age and spleen size of the individuals (r=0.053, p=0.012). The correlation of BMI and liver size was also found significantly positive (r=0.237, p <0.001). The correlation of age and kidney size was found significantly negative in between age and right kidney (r=-0.074, p <0.001) and left kidney (r=-0.087, p <0.001). Similarly, the correlation of BMI and renal size was found significantly weak positive between BMI and right kidney (r=0.206, p <0.001) and BMI and left kidney (r=0.227, p <0.001). CONCLUSION: BMI was found significantly positively correlated with liver size and both kidneys in study participants. Moreover, spleen was found directly and renal size inversely correlated with age of the individuals.

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging.

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11-90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p<0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.