Effect of intravenous administration of zoledronic acid on jaw bone density in cases having skeletal metastasis: A prospective clinical study.

AIM: The objective is to evaluate the effect of intravenous (i.v.) administration of bisphosphonate (zoledronic acid) therapy on the jaw bone density and incidence of any other bony patholog. SETTINGS AND DESIGN: Observational - prospective study. MATERIALS AND METHODS: A total of 57 patients having a history of bony metastasis (excluding the jaw bone) were enrolled following the inclusion/exclusion criteria. Each patient received six doses of 4 mg i.v. bisphosphonate once a month. Multidetector computed tomography (MDCT) of jawbones for each patient was performed before the start of therapy (baseline) and subsequently at 6 and 12 months. Bone density was assessed at 24 predetermined sites (8 sites in maxilla and 16 sites in mandible) and any pathological change in either of the jaw bones was noted. STATISTICAL ANALYSIS USED: Shapiro-Wilk test ,Pearson's Chisquare test and repeated measures analysis of variance. RESULTS: The result showed no statistically significant increase in mean bone density over a period of 1 year in maxilla and mandible. However, a significant increase in bone density was observed from 6 months to 1 year in mandibular anterior cancellous bone. The detailed observation of each MDCT scan showed no pathological change in either of the jaw bones during the study period. CONCLUSION: The administration (i.v.) of six doses of 4 mg bisphosphonate did not lead to a significant change in bone density over a period of 1 year.

Clinical impact of multidetector row computed tomography before bronchial artery embolization in patients with hemoptysis: a prospective study.

PURPOSE: To evaluate prospectively the role and impact of multidetector row computed tomography (MDCT) before bronchial artery embolization (BAE) in patients with hemoptysis. METHODS: MDCT of the thorax was performed in 27 patients (21 men, 6 women; age range, 22-70 years; mean, 39 years) with hemoptysis who were referred for BAE. Transverse, multiplanar reconstruction, and 3-dimensional reconstruction (maximum intensity projection and volume rendered) images were analysed to identify the abnormal hypertrophied bronchial and nonbronchial systemic arteries causing hemoptysis, their origin and course were noted. Digital subtraction angiography was performed with the knowledge of findings of MDCT. Selective arteriogram of abnormal bronchial as well as nonbronchial arteries was performed. Embolization was attempted in 25 of these patients (92.6%) by using polyvinyl alcohol particles (350-500 µm), Gelfoam or Embospheres (400-700 µm). Follow-up was done for a mean period of 20.5 months. RESULTS: Based on MDCT, 2 of 27 patients were found unsuitable for BAE. On computed tomography, 38 arteries (27 bronchial and 11 nonbronchial systemic arteries) were identified as abnormal hypertrophied vessels. On angiography, 34 of these arteries (25 bronchial and 9 nonbronchial systemic arteries) were found to be responsible for hemoptysis. Three of these arteries could not be evaluated during angiography, and 1 artery that was identified as abnormal on computed tomography was found normal on angiography. All 25 bronchial and 9 nonbronchial systemic arteries that cause hemoptysis were detected at MDCT. Embolization was successful in 23 of 25 patients. CONCLUSION: MDCT enables detection and depiction of all bronchial and nonbronchial systemic arteries causing hemoptysis.

Evaluation of the inferior alveolar canal for cysts and tumors of the mandible-comparison of multidetector computed tomography and 3-dimensional volume interpolated breath-hold examination magnetic resonance sequence with curved multiplanar reformatted reconstructions.

OBJECTIVE: To evaluate the mandibular canal using volume interpolated breath-hold examination (VIBE) sequencing in patients with cysts and tumors of the mandible. MATERIALS AND METHODS: Twenty-five patients with mandibular cysts and tumors were recruited for a study in the authors' institution to compare the role of multidetector row computed tomography with magnetic resonance imaging (MRI) in jaw lesions. Of these 25 patients, VIBE was performed in 12 patients (age range, 16 to 52 yrs; 11 male and 1 female patients) and formed the study group. The status (normal/destroyed/attenuated) and position of the inferior alveolar canal (normal/displaced) on panoramic reconstructed computed tomographic (CT) images and curved multiplanar reformatted (MPR) images reconstructed from VIBE images were analyzed. The contralateral normal mandibular canal was used as the control in these patients. RESULTS: In all 12 patients, the inferior alveolar canal on the normal side was visualized as a hyperintense structure in relation to the hypointense bone on the curved MPR VIBE images. In 9 patients, the inferior alveolar canal was equally well visualized on panoramic CT and curved MPR VIBE images. In 2 patients, the inferior alveolar canal was better visualized on curved MPR VIBE images; in 1 patient, the course of the mandibular canal was better seen on panoramic CT images. CONCLUSIONS: MR reconstructions with VIBE sequencing as source images provide images comparable to CT reconstructed images for evaluation of the mandibular canal. Three-dimensional (3D) VIBE sequencing can be added to the MR protocol to visualize the inferior alveolar neurovascular bundle. 3D VIBE sequencing increases the diagnostic capabilities of MRI when used to image mandibular cysts and tumors.

Bone density and miniscrew stability in orthodontic patients.

OBJECTIVES: The purpose of this study was to evaluate bone density in buccal inter-radicular bone between second premolars and first permanent molars and its association with the clinical stability of miniscrews used for en masse retraction of anterior teeth in extraction cases. MATERIALS AND METHODS: Thirty-eight miniscrews were placed in ten patients (8 females, 2 males: mean age, 18.9 +/- 4.12 years) to provide indirect orthodontic anchorage. Twenty miniscrews were placed in the maxilla and eighteen were inserted in the mandible. All of the miniscrews were placed in the buccal inter-radicular bone between the second premolar and the first permanent molar. Bone density at each miniscrew site was recorded by computed tomography and recorded in Hounsfield units (HU) before miniscrew placement. Nickel-titanium closed-coil springs were used to apply an orthodonticforce of 2N within one week following placement. RESULTS: Cortical bone density values ranged from 506.7- 1705.6 HU (Mean, 929.27 +/- 322.12 HU) in the maxilla and 503.8 - 1544.8 HU (Mean, 1116.2 +/- 298.33 HU) in the mandible. Cancellous bone density values ranged from 185.9 - 930.8 HU (Mean, 450.09 +/- 205.66 HU) in the maxilla and 197.3 - 803.6 HU (Mean, 561.87 +/- 170.83 HU) in the mandible. There was no statistically significant difference between right and left sides. A bone density comparison between the maxilla and mandible revealed statistically significant higher values in mandibular cortical bone (p = 0.008), while no significant difference was found in cancellous bone values (p = 0.097). Clinically, the success rate of miniscrews in the maxilla was 100% but only 77.8% in the mandible. Miniscrew failures were associated with peri-implant inflammation and miniscrew proximity to dental roots. No relation was found between bone density and miniscrew stability. CONCLUSION: The present study determined that no definitive association could be established between miniscrew success and bone density.

Magnetic resonance sialography using CISS and HASTE sequences in inflammatory salivary gland diseases: comparison with digital sialography.

BACKGROUND: Inflammatory conditions are the most common pathology affecting the salivary glands. Magnetic resonance (MR) sialography has emerged as an alternative to conventional sialography for evaluation of inflammatory salivary gland diseases. PURPOSE: To prospectively evaluate the role and diagnostic accuracy of MR sialography in the diagnosis of inflammatory salivary gland disease. MATERIAL AND METHODS: Thirty-seven glands in 28 patients (19 males and nine females; mean age 31 years, range 3-65 years) presenting with inflammatory salivary gland disorders underwent MR sialography. Conventional sialography was used as the gold standard and was performed in 26 patients (34 glands). Thus, comparative evaluation was done in 26 patients (34 glands). Axial T1-weighted (T1W) and fat-suppressed T2W sequences, a constructive interference in steady state (CISS) sequence in the axial plane with maximum intensity projection (MIP)/multiplanar reformation (MPR) done in the axial and sagittal oblique planes, and a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in the sagittal oblique direction were performed. RESULTS: Main salivary gland duct was visualized in 32 glands (94.1%) with MR sialography, and in all 34 (100%) glands with conventional sialography. Calculus and strictures were well demonstrated by MR sialography. MR sialography was superior for demonstration of the ductal system proximal to calculus/strictures. Sensitivity and specificity for diagnosis of specific pathology were 87% and 100% with CISS sequence and 90% and 75% with HASTE sequence, respectively. On using a combination of CISS and HASTE sequences, the sensitivity, specificity, and positive and negative predictive values in the diagnosis of specific pathology were 93%, 100%, 100%, and 64%, respectively. CONCLUSION: MR sialography using CISS and HASTE sequences is a promising technique and has the potential to replace conventional sialography in patients with inflammatory salivary gland disorders.

Equivalence randomized controlled trial of bioresorbable versus titanium miniplates in treatment of mandibular fracture: a pilot study.

PURPOSE: The present study was undertaken to test bioresorbable fixation versus titanium for equivalence in terms of clinical union and complications using the American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomized, controlled, equivalence trial. MATERIALS AND METHODS: A total of 40 patients were enrolled and allocated to the titanium group and bioresorbable group using a computerized randomization table. All were plated using standard plating principles. In the bioresorbable group, 2 weeks of maxillomandibular fixation was also used. Evaluation of the study endpoint was done at 8 weeks postoperatively. For statistical analysis, the upper limit of the 95% confidence interval was calculated for failure to achieve the primary outcome variable and compared with the maximal clinically acceptable difference between the standard and test modalities in the failure to achieve clinical union (delta). Delta was predetermined as 2%. The other complications were tested for significance using Fisher's exact test. RESULTS: Of the 40 patients, 21 were in the titanium group and 19 were in the bioresorbable group, with 20 men and 1 woman in the titanium group and 18 men and 1 woman in the bioresorbable group. The mean age was 28.7 years in the titanium group and 26.6 years in the bioresorbable group. In the titanium group, the complications noted were nonunion in 0%, malocclusion in 7.7%, continued postoperative swelling in 0%, chronic pain in 2%, infection in 5.2%, an inability to chew hard food after 8 weeks in 7.7%, the need for alternative treatment in 0%, and the need for reoperation in 31%. In the bioresorbable group, the complications were nonunion in 4.17%, malocclusion in 11.1%, swelling in 8.3%, chronic pain in 37.5%, infection in 0%, an inability to chew hard food in 11.1%, the need for alternative treatment in 11.1%, and need for reoperation for plate removal in 0%. CONCLUSIONS: The small sample size did not allow any meaningful conclusion to be drawn from the present study in terms of the primary question of achieving union. Both groups matched in outcomes when evaluated only on a clinical basis. The avoidance of repeat surgery for plate removal is a definite advantage of using resorbable plates. However, the results are inconclusive in favor of any particular plating system.

MRI and MR sialography of juvenile recurrent parotitis.

BACKGROUND: Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders. OBJECTIVE: To describe the MRI and MR sialographic findings in children with JRP. MATERIALS AND METHODS: MR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1- and T2-W images were also performed. RESULTS: The main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images. CONCLUSION: MRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

Aspiration cytology of mesenchymal hamartoma of the chest wall in an infant: a case report.

BACKGROUND: Mesenchymal hamartoma of the chest wall is an extremely uncommon lesion of infants. Radiologic features simulate a malignant neoplasm; however, pathologic examination demonstrates an admixture of fibroblasts, benign cartilage and woven bone. There is a paucity of cytologic reports of this rare entity in the available literature. CASE: A 5-month-old infant presented with a large right chest wall swelling. Radiologic investigation demonstrated lytic destruction of the right 7th, 8th and 9th ribs with a large soft tissue mass. Fine needle aspiration smears showed lobules of hyaline cartilage and a few spindle cells with abundant chondromyxoid matrix. A cytologic diagnosis of a benign chondroid, possibly hamartomatous lesion was given, which was confirmed as mesenchymal hamartoma on histopathologic examination. CONCLUSION: Mesenchymal hamartoma is a rare chest wall lesion that can be diagnosed on cytology, provided that the cytopathologist is aware of this uncommon entity and appreciates the benign cytologic features.

Ultrasound-guided autologous blood injection in patients with chronic recurrent temporomandibular joint dislocation.

OBJECTIVE: To evaluate the accuracy and effectiveness of ultrasound (US) guided autologous blood injection (ABI) for the treatment of chronic recurrent TMJ dislocation. DESIGN: Prospective cohort study. SETTING: Centre for medical education and research. PARTICIPANTS OR ANIMALS SPECIMENS CADAVERS: Ninteen patients with chronic recurrent TMJ dislocation (Fifteen bilateral and fourteen unilateral). INTERVENTIONS: Autologous blood injected, 2ml in superior joint space (SJS) and 1 ml in peri-capsular tissue (PT) under ultra sound guidance. MAIN OUTCOME MEASURES: Reduction in number of dislocation episodes, maximal mouth opening, pain (visual analogue scale) and TMJ sounds (present or absent) at the end of 2 weeks, 3 months, 6 months and 1 year. RESULTS: At 2 weeks post operatively 18 patients (95%) were asymptomatic only one patient (5%) complained of Recurrence of dislocation and was treated successfully by a 2nd injection. At subsequent follow up visits none reported dislocation. CONCLUSIONS: US guided ABI for patients with chronic recurrent TMJ dislocations serves as an alternative, minimally invasive, highly effective and accurate modality of treatment since it includes exposure without radiation, real-time visualization of soft tissues, visualization of the needle tip advancement, local anesthetic spread relevant to the surrounding structures which can be performed on an outpatient basis.

A prospective study of risk factor profile & incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in northern India.

BACKGROUND & OBJECTIVE: Hospitalization for medical-illness is associated with an increased risk of deep venous thrombosis (DVT). However, there are no published data from India addressing at this issue. We sought to study the risk factor profile and the incidence of DVT among hospitalized medically-ill patients, a tertiary care hospital in northern India. METHODS: All adults admitted to the medical wards and intensive care unit with level 1 or 2 mobility over a period of two years (July 2006 to July 2008) at the All India Institute of Medical Sciences hospital, New Delhi, were prospectively studied. Patients having DVT at admission or an anticipated hospital stay less than 48 h were excluded. The presence of clinical risk factors for DVT was recorded and laboratory evaluation was done for hypercoagulable state. A routine surveillance venous compression Doppler ultrasonography was performed 12 +/- 8 days after hospital admission. RESULTS: Of the 163 patients, 77 (47%) had more than one risk factor for DVT. Five (3%) patients developed DVT; none of them had symptomatic DVT. None of these patients received anticoagulation prior to the development of DVT. The mean age of those who developed DVT was 40 +/- 13 (25-50) yr; two of five were male. The incidence rate of DVT was 2.7 per 1000 person-days of hospital stay [95% confidence interval (CI): 0.87 to 6.27]. None of the factors was found to be significantly associated with the risk of DVT. INTERPRETATION & CONCLUSION: In our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the western population but clearly elevated compared to non hospitalized patients. Large studies from India are required to confirm our findings.

In vivo proton spectroscopy of giant cell tumor of the bone.

OBJECTIVE: The proton MR spectroscopic finding of elevated choline has been reported to be useful in the differentiation of malignant from benign musculoskeletal tumors. This study was designed to evaluate the MR spectroscopy features of giant cell tumor (GCT) of the bone, primarily to determine whether the presence of choline is a frequent occurrence in these tumors and whether MR spectroscopy features can be correlated with clinical, radiologic, and histopathologic findings. SUBJECTS AND METHODS: MRI, dynamic contrast-enhanced MRI, and proton MR spectroscopy were performed in 33 patients with bone tumors on a 1.5-T MR scanner. Of these, 12 patients who had GCT of the bone form the subject material for this study. Dynamic contrast-enhanced MRI and single-voxel proton MR spectroscopy were performed after preliminary evaluation with radiography. Patients were divided into two groups, those with elevated choline levels and those without a choline peak on MR spectroscopy. The clinical and radiologic features, including the Campanacci stage and dynamic MRI findings, were compared in these two groups. Core biopsy was performed in all patients, and in 10 of 12 patients, histopathologic evaluation of the postoperative resected specimen was also performed. RESULTS: Although all 12 tumors were benign on histopathology, four had elevated choline levels. Of these, three (75%) had an aggressive radiographic appearance (Campanacci stage 3). As opposed to this, only three of the eight (37.5%) tumors without a choline peak had an aggressive radiographic appearance. Except for a single case, all tumors showed early enhancement and washout of contrast material on dynamic MRI. CONCLUSION: The results of this study indicate that GCT of bone may show raised choline levels on proton MR spectroscopy. This finding is not an indicator of malignancy in these tumors.

Insulin response to oral glucose in healthy, lean young women and patients with polycystic ovary syndrome.

BACKGROUND AND AIM: Insulin resistance and consequent hyperinsulinemia are common among patients with polycystic ovary syndrome (PCOS). Ethnicity and dietary habits affect insulin levels. There is little published information from India on insulin levels in PCOS patients. Thus the present study aimed to determine the insulin response to oral glucose in women with PCOS and healthy women. METHODS: In a case-control study design, women with PCOS and lean healthy women without a family history of diabetes mellitus underwent oral glucose tolerance testing. Samples were collected at 0, 1 and 2 h after glucose ingestion. RESULTS: Two hundred and eighty-five women with PCOS and 27 lean healthy young women were enrolled into the study. The mean age of controls was 22.8 +/- 4.5 years (range 15-32 years) and their mean body mass index (BMI) was 19.7 +/- 2.6 kg/m(2). Mean blood glucose at 0, 1 and 2 h was 88.2 +/- 7.2, 115.5 +/- 25.5 and 91.8 +/- 20.5 mg/dl, respectively. Corresponding plasma insulin levels were 5.8 +/- 1.1, 32.7 +/- 26.5 and 14.6 +/- 9.6 mIU/l. Peak insulin levels were seen at 1 h and these came down to less than 40% of the peak value by 2 h. Glucose/insulin ratio at 0, 1 and 2 h was 15.6 +/- 3.1, 7.0 +/- 3.1 and 11.4 +/- 7.0. Homeostasis model assessment of insulin resistance (HOMA-IR) was 1.2 +/- 0.2. The age of the PCOS women ranged from 15 to 40 years (mean 23.4 +/- 6.2 years) and their BMI ranged from 16.4 to 50.4 kg/m(2) (mean 27.7 +/- 6.3 kg/m(2)). One hundred and seventy-six (62%) PCOS patients had normal glucose tolerance (NGT), 39 (14%) had impaired fasting glucose (IFG), 49 (17%) had impaired glucose tolerance (IGT) and 21 (7%) had type 2 diabetes mellitus (T2DM). Insulin response was higher in women with PCOS. Peak insulin was observed at 1 h. The difference between 1-h and 2-h post-glucose insulin decreased with worsening glucose tolerance. Both plasma insulin and BMI showed a rising trend from NGT to IFG to IGT. There was no further increase in either insulin or BMI from IGT to T2DM. Glucose/insulin ratio at 0, 1 and 2 h was lower (8.3 +/- 4.2, 2.0 +/- 1.6 and 3.2 +/- 3.5) than that of healthy controls. HOMA-IR was 3.1 +/- 3.0. CONCLUSION: Women with PCOS had an exaggerated insulin response to glucose. Thirty-eight percent of PCOS women had some form of abnormal glucose tolerance. Greater insulin response was seen with impairment of glucose tolerance. Obesity had no effect on fasting insulin or insulin response to oral glucose in PCOS women with NGT.

Fertility among women with classical congenital adrenal hyperplasia: report of seven cases where treatment was started after 9 years of age.

BACKGROUND AND AIM: Androgen excess is believed to be one of the major factors responsible for poor fertility outcomes in females with congenital adrenal hyperplasia (CAH). Some believe that the adverse effect of androgens on fertility could have its origins as early as the antenatal years. To assess the impact of prolonged androgen exposure on fertility in CAH patients, we compiled the data of females with CAH followed in our clinic during the last 25 years who were sexually active and had not been initiated on steroids until age 9 years. STUDY DESIGN AND PATIENTS: This was an observational case study on seven patients with classical CAH who fulfilled the inclusion criteria. The age at initiation of therapy in these females ranged from 9 years to 29 years. RESULTS: All patients had varying degrees of genital ambiguity. The most common presenting complaints were genital ambiguity, non-development of secondary sexual characteristics, hirsutism and primary amenorrhea. Genital surgery was performed in all patients at ages ranging from 12 to 29 years, except for one patient who underwent surgery at age 5 years without a diagnosis of CAH being made. Breast development ensued within 2 to 12 months and periods started in all patients within 2-24 months of steroid initiation. There were 13 pregnancies (seven normal vaginal deliveries, two spontaneous abortions and four pregnancies were medically terminated). CONCLUSIONS: Late initiation of steroid therapy did not affect fertility in our cohort of CAH women. Androgen excess in situations of subnormal cortisol may not adversely affect fertility in females with CAH.

Gender identity of children and young adults with 5alpha-reductase deficiency.

Male pseudohermaphroditism (46,XY DSD) due to 5alpha-reductase deficiency has been recognized for the last few decades. There is scant literature on this entity in India. We compiled data on five patients with this disorder. Four of our five patients were reared as females. Our assessment of these children reveals that they had male gender identity from childhood. Three of the four reared as females chose to change gender role at adolescence, while the fourth is still prepubertal. We conclude that all these patients had male gender identity from early childhood. The parents took note of this only after the appearance of male secondary sexual characteristics at puberty, thereby giving an impression of change in gender identity and gender role.

Insulinoma: reversal of brain magnetic resonance imaging changes following resection.

Insulinoma presents with myriad manifestations and severe neurological deficit may develop due to delay in diagnosis. We report a lady who presented with Glasgow coma scale of E1 M2 V1, which did not improve after correction of hypoglycemia. There was complete reversal of neurological deficit and brain magnetic resonance imaging changes of hypoglycemia on follow-up after resection of pancreatic insulinoma. This is the first report which shows reversal of hypoglycemic changes in MRI after resection of insulinoma. Insulinoma, pre and post surgery provides a model for study of the effect of hypoglycemia and its improvement after euglycemia.

An approach for assessment of tumor volume from mammography in locally advanced breast cancer.

Tumor size is an important independent indicator in patients with carcinoma of the breast. Repeated size measurements during primary systemic therapy produce detailed information about response that could be used to select the most effective treatment regimen and to estimate the patient's prognosis. Measurement of tumor burden with ultrasonography and computed tomography is being used with increasing frequency to assess the effectiveness of cytotoxic anticancer drugs. Standardization of assessment and results reporting are important steps that aim at increasing the amount of usable therapeutic information at the physician's disposal. The purpose of our study is to calculate the tumor volume by mammography after demagnification and compare the tumor volume measured from this method with ultrasonography volumes.

Radiological manifestations of splenic tuberculosis: a 23-patient case series from India.

BACKGROUND & OBJECTIVE: Splenic tuberculosis (TB) is a less common but important manifestation of abdominal TB, especially in India and other developing countries. Its prevalence is increasing with the epidemic of HIV-TB co-infection and subsequent rise in extrapulmonary TB. The range of radiological manifestations of splenic TB is poorly described. Here, we review the ultrasonographic and computed tomographic (CT) images of 23 cases from two large tertiary care centers in India. METHODS: Radiographic images, ultrasonographic in all cases and CT in selected cases, were retrospectively analyzed in a series of 23 patients presenting to two large tertiary care centers in India, with suspected TB and with splenomegaly on physical examination. Images were assessed at baseline and when available following anti-tuberculosis therapy. RESULTS: The ultrasound and CT findings included, in order of most common: single or multiple hypoechoic focal lesions, splenic abscess, calcifications (on CT), and isolated splenomegaly. Five of the six patients with findings of isolated splenomegaly on ultrasound were found to have lesions on CT. INTERPRETATION & CONCLUSION: Ultrasonography of the spleen is an affordable, non-invasive imaging modality, which can be helpful in diagnosis of splenic TB and assessment of therapeutic response. Proper use of this imaging modality in splenic TB should help avoid unnecessary CT imaging or invasive procedures. However, this technique is operator-dependent, and, when extensive intraabdominal involvement is suspected, or the diagnosis is unclear, CT may be necessary.

Thoracic application of multi-detector CT.

Multi-detector CT (MDCT) is the latest advancement in the field of medical imaging. It has considerable advantage over single-detector helical CT in the form of shorter acquisition time, greater coverage, and superior image resolution. All these factors substantially increase the diagnostic accuracy of the examination by providing state-of-the-art image quality. Three-dimensional (3D) isotropic volume imaging is possible with MDCT and, it provides an excellent anatomy of the thorax thereby increasing the diagnostic yield comprehensively. With the advent of MDCT, there is paradigm shift in vascular imaging from conventional catheter angiography to MDCT angiography as this technique provides image quality that equals or surpasses that of conventional angiography. Recent advances in 3D volume rendering allows a fly through the tracheobronchial tree and the thoracic great vessels generating virtual endoscopic views in real-time. It is also helpful in imaging the musculo-skeletal system and the thoracic cage.

Insulinoma: Diagnosis and surgical treatment. Retrospective analysis of 31 cases.

BACKGROUND: Insulinomas are rare tumors that are usually benign, single and curable by simple surgical excision. They can present problems in diagnosis and localization. STUDY DESIGN: Retrospective analysis of patients with insulinoma managed during a 13-year period (1992-2005) at a tertiary-level institution. RESULTS: 31 patients (mean age 38.4 [SD 13.3] years; 16 men) presented with hypoglycemic symptoms for 4.6 (5.5) years. In 22 (71%) patients, the lesion was successfully localized pre-operatively. Of various pre-operative localization techniques, CT angiography (5/6; 83%), intra-arterial digital subtraction angiography (11/17; 65%), dual-phase CT (8/14; 57%) and conventional MRI (4/13; 31%) had high rates of successful tumor localization. Intra-operative palpation and ultrasonography also had localization success rates (22/30 [76%] and 11/12 [92%], respectively); each identified one lesion that the other procedure did not localize. Of the 30 patients who underwent surgery, 28 had solitary tumor. CONCLUSION: Pre-operative investigations to localize insulinoma are helpful despite the availability of intra-operative ultrasound. Dual-phase CT should be the non-invasive investigation of first choice.

Imaging spectrum of pediatric orbital pathology: a pictorial review.

A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.