Cardiac MRI for Iron Overload in pediatric thalassemia patients- Right Age to Start in a Resource Constrained Environment.

The aim of this article is to assess the prevalence and severity of myocardial iron overload in thalassemia patients who present for the first time for cardiac MRI and to define the right age to start screening, in a resource-constrained environment. All MRI scans done at our institute for myocardial iron overload assessment in thalassemia patients, between 2015 and 2018 were analysed. Patients up to the age of 30 years were included. There were a total of 600 patients, (Age group between 2 and 30 years). All these scans were retrospectively analysed and severity of myocardial iron overload was categorized as normal, mild, moderate and severe based on the bright blood T2* equivalent values at 1.5 T. Overall prevalence of myocardial iron overload was 32.3%, while the prevalence of myocardial iron overload in patients in the age group 0-10 was 10.2%.There were 40 patients in the age group 0-6 years, of whom, only 2 had myocardial iron overload. In patients less than or equal to 6 years of age, the number of patients with iron overload was very small and this may be used to decide the optimal age for scanning.

Role of MRI in idiopathic inflammatory myopathies: a review article.

Idiopathic inflammatory myopathies are a rare heterogeneous group of chronic, autoimmune conditions characterized by the slow, progressive weakness of the skeletal muscles and inflammatory infiltrates in the muscle tissue. The predominant role of magnetic resonance imaging (MRI) in myositis imaging is to assess disease activity and to identify the target site for biopsy. Its role in phenotyping the disease is less explored. The aim of the present review was to examine the role of MRI in differentiating between the common inflammatory myopathies, i.e. dermatomyositis, polymyositis, and sporadic inclusion body myositis, and to describe the specific spectrum of MRI findings in various inflammatory myopathies.

Survival predictors of interstitial lung disease in India: Follow-up of Interstitial Lung Disease India registry.

BACKGROUND: Predictors of survival for interstitial lung disease (ILD) in the Indian population have not been studied. The primary objective of the study was to assess the Modified-Gender Age and Physiology (M-GAP) score to predict survival in patients with ILD seen in clinical practice. We also analyzed the role of demographic and radiological characteristics in predicting the survival of patients with ILD. MATERIALS AND METHODS: In the ILD India registry, data were collected from 27 centers across 19 cities in India between March 2012 and June 2015. A single follow-up was conducted at 18 centers who agreed to participate in the follow-up in 2017. M-GAP score (range 0-5) was calculated with the following variables: age (≤60 years 0, 61-65 years 1, and >65 years 2), gender (female 0, male 1), and forced vital capacity% (>75% 0, 50%-75% 1, and >75% 2). A score of 0-3 and score of 4 and 5 were classified into Stage 1 and 2, respectively. Other predictors of survival, such as the history of tuberculosis, smoking, and the presence of honeycombing on computed tomography scan, were also evaluated. RESULTS: Nine hundred and seven patients were contacted in 2017. Among them, 309 patients were lost to follow-up; 399 were alive and 199 had died. M-GAP was significantly associated with survival. Similarly, other predictors of survival were ability to perform spirometry (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.34-0.72), past history of tuberculosis (HR: 1.57, 95% CI: 1.07-2.29), current or past history of smoking (HR: 1.51, 95% CI: 1.06-2.16), honeycombing (HR: 1.81, 95% CI: 1.29-2.55), a diagnosis of connective tissue disease -ILD (HR: 0.41, 95% CI: 0.22-0.76), and sarcoidosis (HR: 0.24, 95% CI: 0.08-0.77). CONCLUSION: In a subgroup of patients with newly diagnosed ILD enrolled in ILD India registry and who were available for follow-up, M-GAP score predicted survival. Honeycombing at the time of diagnosis, along with accurate history of smoking, and previous history of tuberculosis were useful indices for predicting survival.

Fibroma of the patellar tendon sheath-a rare case in a young boy.

Fibroma of the tendon sheath is a rare benign fibrocollagenous soft tissue tumor, arising predominantly from the synovium of tendon sheath. Fibromas occur most commonly in relation to the tendons of the fingers, hand, and the wrist. Fibromas related to large joints are rather rare and though amongst the large joints, the knee is a common site. Fibromas of the patellar tendon sheath, specifically, are very rare. To the best of our knowledge, only three cases of fibromas arising from the patellar tendon sheath have been reported in the relevant English medical literature. Herein we describe the fourth biopsy-proven case of fibroma of patellar tendon sheath in a 6-year-old boy.

Longitudinal Followup of Incidentally Detected Pseudotumors in Patients with Metal on Metal Implants: A Retrospective Study.

BACKGROUND: This study describes the significance and temporal evolution of incidentally detected, presumed, metal-induced reactive periprosthetic masses in patients with metal on metal (MoM) hip arthroplasty and its management. The literature concerning the temporal evolution of these lesions is meagre and so it is still unclear, whether asymptomatic patients with periprosthetic collections should undergo revision. MATERIALS AND METHODS: Patients with MoM hip replacements fitted with a recalled implant (ASR, DuPuy) often undergo magnetic resonance imaging with metal artifact reduction sequences to look for complications. From a cohort of 136 asymptomatic patients, with 181 MoM hips, hips with a mention of periprosthetic masses in their reports at first presentation, and a repeat scan within 6 months to 3 years were selected for this retrospective study. Patients with complications such as loosening, osteomyelitis, and muscle/tendon tears were excluded from the study, and the final study cohort consisted of 55 MoM hips and 61 periprosthetic masses. Ethics committee approval is not required in our institution for retrospective studies. The followup scans of each patient were compared, and the periprosthetic masses were described to have progressed, regressed, or remained unchanged. RESULTS: Comparison revealed that 29 of the 61 reactive masses remained unchanged, 20 regressed, while only 12 showed progression. The study, therefore, has maximum power as the outcome of interest, i.e., regression or unchanged status of the pseudotumors, was seen in approximately 80% (more than half) of the study group. The P value of the study was < 0.005. CONCLUSION: Periprosthetic soft tissue masses are not uncommon in patients with MoM hips. The majority of them in asymptomatic individuals remain stable or regress in the short to medium term, and close followup or decisions on revision surgery may not be warranted in asymptomatic patients.

Magnetic resonance imaging features of complications following hip replacement: A pictorial review.

Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients.