The role of multiparametric MRI in differentiating uterine leiomyosarcoma from benign degenerative leiomyoma and leiomyoma variants: a retrospective analysis.

AIM: To assess qualitative and quantitative magnetic resonance imaging (MRI) factors that can help distinguish leiomyosarcoma (LMS) from benign degenerative leiomyoma (BDL) and leiomyoma variants (LV) and assess the interobserver agreement for the proposed quantitative factors. MATERIALS AND METHODS: Retrospective analysis of all histopathology proven cases of LV, BDL, and LMS with a preoperative MRI was performed. Twenty-seven cases were included (five LMS, three LV, and 19 BDL) with each case independently read by a pair of radiologists. Lesion size, margins, presence or absence of degeneration, necrosis, and haemorrhage were assessed on MRI along with quantitative factors such as mean T2-weighted (W) and T1W signal intensity, T1W signal heterogeneity, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) ratios as well as dynamic contrast enhancement (DCE) characteristics along with the presence or absence of lymphadenopathy and extra-uterine and peritoneal spread. Mean and standard deviation for quantitative variables and frequency with percentages for qualitative variables were assessed. RESULTS: Infiltrative margins were seen exclusively in the LMS group (n=1), with the remaining LMS cases showing lobulate or rounded smooth margins similar to BDL or LV. A high T2W signal <25% was seen exclusively in the BDL group (n=8). The presence of concomitant necrosis and haemorrhage was seen exclusively in the LMS group (n=2). Quantitative MRI had good inter-reader correlation but was not significantly different between the LMS, BDL, and LV groups. CONCLUSION: LMS, BDL, and LV may have overlapping features on multiparametric MRI making differentiation difficult.

Two cases of small bowel obstruction secondary to a swallowed potato.

Bowel obstruction due to bezoars (compaction of ingested material within the gastrointestinal tract) is a rare, but well documented occurrence. In this paper, we present two cases of potato-induced small bowel obstruction. Both patients were approximately 50 years old and had cerebral palsy and learning disabilities, respectively. They presented with abdominal pain and bilious vomiting, with no medical or surgical history. Diagnosis of small bowel obstruction was confirmed by CT prior to taking the patients to the operating theatre, where whole potatoes were found to be obstructing each patient's bowel lumen. Both patients underwent laparotomy with enterotomy and removal of the potato. They both made a good recovery. Through a literature review of bezoar-induced bowel obstruction, these cases highlight important diagnostic and management principles.

Magnetic resonance imaging in acute cervical spinal cord injury: a correlative study on spinal cord changes and 1 month motor recovery.

STUDY DESIGN: Retrospective study. OBJECTIVES: We aimed to correlate the spinal cord changes as depicted by magnetic resonance imaging (MRI) with the neurological deficit and motor recovery of patients with acute cervical spinal cord injury (SCI). SETTING: A total of 57 patients with acute cervical spine trauma who presented to the Department of Radio Diagnosis, Kasturba Medical College Manipal, Karnataka, India, over a period of 5 years (August 2002 to September 2007) were studied. METHODS: The pattern and extent of spinal cord changes on MRI were compared with the American Spinal Injury Association (ASIA) grade, motor index score (MIS) and the total number of useful muscles in the extremities on admission (ADM) and follow-up. The differences in the recovery rates (RR) among patients with cord edema (EDE), contusion and hemorrhage (HGE) were tested statistically. RESULTS: Spinal cord edema was associated with a better neurological outcome than contusion or hemorrhage, and its overall length showed a negative correlation with the recovery rate (P=0.001). CONCLUSION: MRI is invaluable in evaluating cervical SCI. Cord edema is associated with a better neurological outcome when compared with cord contusion or hemorrhage.

Computed tomographic features of mandibular osteochondroma.

Osteochondroma of the mandibular condyle is fairly rare. We describe a case of this lesion in a 52-year-old woman who presented with symptoms of temporomandibular joint dysfunction. Although a panoramic radiograph demonstrated the bony exostosis, a pre-operative CT examination showed the relationship of the tumour to the condyle and also depicted soft-tissue changes secondary to the growth.