Does diffusion-weighted magnetic resonance imaging help in the detection of renal parenchymal disease and staging/prognostication in chronic kidney disease?

PURPOSE: Diffusion-weighted imaging (DWI) in renal diseases is an upcoming modality, and its utility as an additional marker is yet to be proven. This study was intended to find the relationship between apparent diffusion coefficient (ADC) values with renal function tests and stages of chronic kidney disease (CKD) to assess renal dysfunction, and to label a cut-off for normal renal function and dysfunction. MATERIAL AND METHODS: A prospective diagnostic study was conducted on 120 patients: 60 with deranged renal function tests (RFT) and 60 with normal RFT. DWI using a 1.5-Tesla MRI (at b-values of 0 and 500 s/mm2) was done. A region of interest of size 1-2 cm2 was placed on renal parenchyma in the region of medulla, one each, over the superior, mid, and lower regions of each kidney separately. ADC values were recorded for renal parenchyma and compared. RESULTS: In patients with renal dysfunction ADC values were significantly lower than in patients with normal function (1.75 ± 0.25 vs. 2.28 ± 0.21 of right kidney and 1.79 ± 0.17 vs. 2.29 ± 0.21 of left kidney [×10-3 mm2/s]; p = 0.001). ADC values of different stages of CKD showed a decreasing trend with increasing stage. CONCLUSIONS: ADC values taken at all poles to get focal involvement of the kidney can be used to measure each kidney separately, and values can be individually correlated with the elevated renal parameters. The cut-off value of the mean ADC for individual kidneys was > 2.28 (×10-3 mm2/s) in normal renal function and < 2.00 (×10-3 mm2/s) in renal dysfunction.

Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity.

BACKGROUND: Aim of the present study was to evaluate the role of MRI in staging of malignant lesions of the oral cavity and to correlate MRI findings with clinical/surgical and anatomical-pathological findings, wherever possible. MATERIAL/METHODS: The study included 50 patients who presented with malignant lesions of the oral cavity and were referred to radiology departments for MRI. All patients included were subjected to a detailed physical examination following which MRI was carried out on Philips Gyroscan Achieva 1.5 Tesla unit. RESULTS: In the study, the highest number of patients were found to have tongue malignancy (82%) followed by buccal mucosa and gingivobuccal sulcus malignancy (18%). The highest number of patients was in the age group of 51-60 years (32%). The incidence was higher in males (96%). There was moderate agreement (k=0.537) for T stage between the clinical and MRI staging assessments. The agreement for N stage between clinical and MRI staging assessments was fair (k=0.328). The final diagnosis was made by histopathology in 22 patients. The agreement for T stage was good/substantial (k=0.790) and for N stage was moderate (k=0.458) between MRI and histopathology staging assessments. CONCLUSIONS: MRI provides satisfactory accuracy for preoperative estimation of tumor thickness and predicting occult cervical nodal metastasis. MRI is the preferred modality in evaluation and staging of oral cavity malignancy which helps a clinician for planning of treatment.

Early-Onset Neonatal Sepsis: Role of C-Reactive Protein, Micro-ESR, and Gastric Aspirate for Polymorphs as Screening Markers.

INTRODUCTION: Early-onset neonatal sepsis is a major cause of morbidness and death in newborn children. Its timely diagnosis is usually a challenge in developing countries like India. AIM: To study the efficacy of C-reactive protein (CRP), micro-ESR, and gastric aspirate for polymorphs in the diagnosis of early-onset neonatal sepsis. MATERIALS AND METHODS: This study included sixty term and preterm children, inborn and referred cases. The children who presented before day seven of life with clinical suspicion of sepsis or who were at high risk of developing sepsis were included. These were further investigated. Significant values for screening tests were taken as C - reactive protein > 0.6 mg/dl, micro-ESR-after 1 hour, fall in the column of blood in capillary tube was measured, and result was taken as mm fall in 1 hr, and gastric aspirate for polymorphs > 5 polymorphs/HPF. Sepsis screen positive result was 2 or more positive tests. The statistical evaluation was done using Fisher, and ANOVA tests using SPSS 20.0 version. RESULTS: Sixty children were included in the study with forty as the referred ones. Most of them had tachypnea (45%). CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity. CONCLUSIONS: Neonatal sepsis screening is required for the detection of infection as the blood culture report may not be positive in all the cases, and even if positive, the result takes few hours. CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity independently as well as when combined.

Comparison of high resolution ultrasonography with clinical findings in patients with ankle pain.

Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis.Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis.

High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy.

AIM OF THE STUDY: High-resolution ultrasonography of the tibial nerve is a fast and non invasive tool for diagnosis of diabetic peripheral neuropathy. Our study was aimed at finding out the correlation of the cross sectional area and maximum thickness of nerve fascicles of the tibial nerve with the presence and severity of diabetic peripheral neuropathy. MATERIAL AND METHODS: 75 patients with type 2 diabetes mellitus clinically diagnosed with diabetic peripheral neuropathy were analysed, and the severity of neuropathy was determined using the Toronto Clinical Neuropathy Score. 58 diabetic patients with no clinical suspicion of diabetic peripheral neuropathy and 75 healthy non-diabetic subjects were taken as controls. The cross sectional area and maximum thickness of nerve fascicles of the tibial nerves were calculated 3 cm cranial to the medial malleolus in both lower limbs. RESULTS: The mean cross sectional area (22.63 +/- 2.66 mm2) and maximum thickness of nerve fascicles (0.70 mm) of the tibial nerves in patients with diabetic peripheral neuropathy compared with both control groups was significantly larger, and statistically significant correlation was found with the Toronto Clinical Neuropathy Score (p < 0.001). The diabetic patients with no signs of peripheral neuropathy had a larger mean cross sectional area (14.40 +/- 1.72 mm2) and maximum thickness of nerve fascicles of the tibial nerve (0.40 mm) than healthy non-diabetic subjects (12.42 +/- 1.01 mm2 and 0.30 mm respectively). CONCLUSION: The cross sectional area and maximum thickness of nerve fascicles of the tibial nerve is larger in diabetic patients with or without peripheral neuropathy than in healthy control subjects, and ultrasonography can be used as a good screening tool in these patients.

Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas.

The aim of the present study was to evaluate the role of Magnetic Resonance Imaging (MRI) to localize and characterize the MR imaging features of cerebellopontine angle schwannomas and to compare with surgical/histopathological findings. It was a prospective study which included 19 patients, who presented with signs and symptoms s/o any lesion in the CP angle and were referred to the radiology department for MRI. All patients included in the study were subjected to detailed clinical history and physical examination following which MRI was carried out on Philips Gyroscan Achieva 1.5 Tesla unit and the standard protocol consisted of T1WI, T2WI, DWI and FLAIR images in axial, sagittal and coronal planes. Hearing abnormality was the most common presenting complaint in patients with CP angle schwannoma's followed by headache and tinnitus. Vestibulocochlear nerve was the most commonly involved nerve in patients with these lesions followed by involvement of trigeminal nerve. MRI was erroneous in giving provisional diagnosis of schwannoma in one case, which on subsequent surgery and histopathology was found to be a meningioma. The sensitivity of MRI for correctly diagnosing vestibular schwannoma was 100 % and specificity was 92.86 % with a positive predictive value of 94.12 % and accuracy of 96.67 %. MRI is considered as an excellent noninvasive investigation for CP angle schwannoma's. It can identify the site and extension of the lesions as well as the characteristic signal. Apart from diagnosing, MR imaging plays an important role in stratifying patients into appropriate treatment options.

Role of CT Colonography in Colonic Lesions and Its Correlation with Conventional Colonoscopic Findings.

BACKGROUND: Preoperative evaluation in patients with colorectal carcinoma is essential for a correct therapeutic plan. Conventional colonoscopy has certain limitations including its inability to detect synchronous lesions in case of distal obstructive mass and inaccurate tumour localization. CT colonography combines cross sectional imaging with virtual colonoscopic images and offers a comprehensive preoperative evaluation in patients with colorectal carcinoma including detection of synchronous lesions with accurate segmental localization and loco regional staging. AIM: The objective was to determine the role of CT colonography in various colonic lesions and to correlate the findings with conventional colonoscopy and histopathological findings. SETTINGS AND DESIGN: This prospective study included 50 patients with clinical symptoms suspicious of colonic pathology. MATERIALS AND METHODS: All the patients underwent both CT colonography and conventional colonoscopy on the same day. CT colonography was performed in supine and prone position. Considering histopathological and/or surgical findings as gold standard, sensitivity and specificity of both the modalities were calculated. RESULTS: Conventional colonoscopy missed two synchronous lesions proximal to occlusive mass and one lesion proximal to the anastomotic site; all were detected with CT colonography. One carpet lesion in rectum and one case of mild ulcerative colitis were missed by CT colonography. Sensitivity and specificity for detection of colorectal cancer were 97.56% and 100%, resp. with PPV and NPV of 100% and 93.75%, for CT colonography and 92.68% and 100%, respectively with PPV and NPV of 100% and 83.3% for conventional colonoscopy. Sensitivity for correct detection of acute and chronic ulcerative colitis of CT colonography was 66.6 % and 100 %, resp. CONCLUSION: CT colonography has higher sensitivity than conventional colonoscopy for detection of colorectal carcinoma, including its ability to detect abnormalities proximal to obstructing lesion, accurate segmental localization of lesions and staging. However, some limitations of CT colonography were difficulty in detection of flat lesions and lack of information about hyperemia and superficial mucosal erosion, where conventional colonoscopy scored over CT colonography.

Role of High Resolution Computed Tomography in Evaluation of Pathologies of Temporal Bone.

BACKGROUND: High Resolution Computed Tomography (HRCT), a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details. Purpose of the present study was to evaluate the normal variations, pathological processes (infections and congenital anomalies) and their extent involving the temporal bone along with their complications on HRCT and to correlate these imaging findings surgically, wherever available. MATERIALS AND METHODS: The prospective study included 50 patients who were referred to the radiology department with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to high resolution computed tomography (HRCT) examination. The imaging findings were correlated with the surgical findings wherever available. The surgical findings were considered as final. RESULTS: From a total of 50 cases, 83.33% had cholesteatoma. The surgical and radiological findings showed a high level of sensitivity (89.29%) in the identification of cholesteatoma. HRCT provides a good sensitivity of 80.65% in the identification of changes to the ossicular chain despite the presence of surrounding soft tissue. HRCT was highly informative in identification of erosion of lateral semicircular canal. In diagnosis of facial canal dehiscence HRCT had a low sensitivity of 33.33%. In the evaluation of any congenital abnormality of the ear HRCT proved to be beneficial in depicting the anatomical details. CONCLUSION: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, changes of the ossicular chain and erosion of the lateral semicircular canal. HRCT findings, in the treatment of any congenital abnormality of the ear were a good guide to the surgeon for planning and management.

Congenital intrahepatic portosystemic shunt--an incidental rare anomaly.

Congenital intrahepatic shunts are rare anomalies that are usually incidental in a child who undergoes an ultrasound examination for some other reasons. Early diagnosis is important, because the condition can lead to hepatic encephalopathy and hypoglycemia. Author's would like to describe the findings of one such patient diagnosed to be having congenital intrahepatic shunt and discuss the clinical importance of this condition.