Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

Study DesignA retrospective study of the ventral displacement of dorsal spinal cord (VDDSC) spectrum pathophysiology and grading.PurposeThis study aimed at examining the pathophysiology of VDDSC between D3 and D7, using magnetic resonance imaging (MRI) correlation and severity grading.Overview of LiteratureThe pathologies that lead to VDDSC were previously discussed in various articles. We attempted to group these pathological conditions under a single spectrum, and grade them according to their severity.MethodsWe reviewed the MRI images of the dorsal spines of 1,350 patients over a period of 4 years (February 2013–February 2017); all MRI images were analyzed by two experienced radiologists.ResultsOf the 1,350 patients, 28 exhibited VDDSC between D3 and D7. Additional findings included ventral transdural herniation of the spinal cord (n=10), anterior spinal cord adhesion (n=7), arachnoid web (n=6), and arachnoid cyst (n=5).ConclusionsWe grouped the pathologies that lead to VDDSC at the thoracic level into a single spectrum of varying severity and graded VDDSC, from mild to severe

An interesting case of metabolic dystonia: L-2 hydroxyglutaric aciduria

L-2-hydroxyglutaric aciduria (L-2-HGA), a neurometabolic disorder caused by mutations in the L-2 hydroxyglutarate dehydrogenase (L-2-HGDH) gene, presents with psychomotor retardation, cerebellar ataxia, extrapyramidal symptoms, macrocephaly and seizures. Characteristic magnetic resonance imaging findings include subcortical cerebral white matter abnormalities with T2 hyperintensities of the dentate nucleus, globus pallidus, putamen and caudate nucleus. The diagnosis can be confirmed by elevated urinary L-2 hydroxyglutaric acid and mutational analysis of the L-2-HGDH gene. We report two siblings with dystonia diagnosed by classical neuroimaging findings with elevated urinary 2 hydroxyglutaric acid. Riboflavin therapy has shown promising results in a subset of cases, thus highlighting the importance of making the diagnosis in these patients

Diffusion tensor imaging metrics in cystic intracranial mass lesions

Background and Purpose: Conventional MR does not always differentiate various cystic lesions of brain. Our purpose was to explore the utility of DTI in characterization & differentiation of intra cranial cystic mass lesions. Materials and Methods: DTI was done with a clinical 1.5 Tesla system in 62 patients presenting with intra cranial cystic lesions. Parameter maps of the DTI metrics MD, FA, GA, RA, Geometric tensors (CL,CP,CS) were calculated & quantified using regions of interest. Cystic lesions were grouped based on etiology and management. Statistical analysis was performed to test the significance of difference in DTI metrics in differentiation of various groups of cystic lesions of brain. Results: Mann-Whitney U Test was done to analyse the usefulness of various DTI metrics in differentiating the intracranial cysts. Epidermoid cysts showed highest FA, RA, Cl & Cp due to the preferential diffusion of water through the well structured orientation of keratin filaments & flakes within it. Neurocysticercosis showed higher FA, next to epidermoid. Abscesses showed lowest MD. Arachanoid cyst, giant cistern magna, choroid fissure cyst, choroid plexus cyst, ependymal & neuroglial cysts showed higher MD & lower FA, implicating no preferential directional diffusivity. Conclusion: DTI does prove useful in characterization and differentiation of intracranial cystic mass lesions. This study implicates the need for inclusion of DTI in the routine protocol of imaging cystic intracranial mass lesions

Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging

Abstract Objective: The purpose of this study was to correlate the magnetic resonance imaging (MRI) findings of adhesive capsulitis with clinical stages and thereby propose a MR staging system. Materials and Methods: This study consisted of 74 patients with clinically diagnosed adhesive capsulitis. The edema of the inferior glenohumeral ligament (IGHL), pericapsular edema, thickness of anterior band of IGHL, axillary pouch, thickness of coracohumeral ligament, and obliteration of fat in the subcoracoid triangle were evaluated by MRI. Results: Thickening of the anterior band of IGHL showed most significant correlation with the clinical stages. The distribution of edema of IGHL and pericapsular edema also showed significant correlation with the clinical stages of adhesive capsulitis. Pericapsular edema and IGHL edema was not observed in stage IV. Conclusion: MR is a useful tool for evaluation and prediction of clinical stage of adhesive capsulitis.</jats:p

Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging

Objective: The purpose of this study was to correlate the magnetic resonance imaging (MRI) findings of adhesive capsulitis with clinical stages and thereby propose a MR staging system. Materials and Methods: This study consisted of 74 patients with clinically diagnosed adhesive capsulitis. The edema of the inferior glenohumeral ligament (IGHL), pericapsular edema, thickness of anterior band of IGHL, axillary pouch, thickness of coracohumeral ligament, and obliteration of fat in the subcoracoid triangle were evaluated by MRI. Results: Thickening of the anterior band of IGHL showed most significant correlation with the clinical stages. The distribution of edema of IGHL and pericapsular edema also showed significant correlation with the clinical stages of adhesive capsulitis. Pericapsular edema and IGHL edema was not observed in stage IV. Conclusion: MR is a useful tool for evaluation and prediction of clinical stage of adhesive capsulitis

Role of MR Enterography in Evaluation of Disease Activity in Pediatric Crohn’s Disease: Correlation between MR Enterography and Pediatric Crohn’s Disease Activity Index Scores

AbstractObjectives The aim of the study was to assess the role of MR Enterography (MRE) in the diagnosis and follow-up of children with Crohn’s disease (CD) and to correlate disease activity indices with known MRE features of active disease.Methods This was a retrospective study including 24 patients (median age 11 years, 17 males) with clinically and histologically proven CD who underwent MRE. Two previously validated MRE scores—Magnetic Resonance Enterography Global Score (MEGS) and CD MRI index (CDMI)—were calculated. A correlative analysis was made between the Pediatric Crohn’s Disease Activity Index (PCDAI) score and MRE scores as well as individually with each MR variable. Comparison of both the MR scores was made between patients with different disease activity.Results MEGS and PCDAI scores showed strong positive correlation (r = 0.724, p = &lt; 0.001); CDMI and PCDAI scores showed moderate positive correlation (r = 0.661, p = 0.0004). There was statistically significant difference in the MR scores between patients grouped by clinical activity. Among individual MR variables, mural thickness and enhancement best predicted the disease activity.Conclusions MRE-based scores and findings correlate with clinical activity in pediatric CD. Thereby, MRE can be considered a valuable tool in the management of CD, predicting disease activity and offering a potential alternative to endoscopy in monitoring patients during follow-up.</jats:p

Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus

Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans

Primary diffuse leptomeningeal oligodendrogliomatosis: A case report and literature review

Primary leptomeningeal oligodendrogliomatosis (PLO) is a rare low-grade intracranial and spinal canal subarachnoid neoplasm without an obvious primary neoplasm in the brain or spinal cord parenchyma. We present here the serial progression of radiological findings of this rare disease in a 2-year-old male child whose clinical status deteriorated over a period of 4 months with the main complaint of partial seizures. During this period, the MR findings progressed from mild hydrocephalus with minimal leptomeningeal enhancement to leptomeningeal multiple cystic lesions in the entire neuraxis including the spine

POSTOPERATIVE EVALUATION AND EXPECTED COMPLICATIONS OF PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA CARDIA - USING LOW DOSE MULTI DETECTOR COMPUTED TOMOGRAPHY WITH ORAL CONTRAST

Background: Per Oral Endoscopic Myotomy (POEM) is a promising new endoscopic method for the treatment of achalasia cardia. Available current data from various meta-analyses shows short term success with minimal adverse events. Here we aim to study the post procedural adverse events of POEM procedure using postoperative low dose multi detector CT chest with oral contrast. Methods: A retrospective study involving 43 patients who underwent POEM procedure for achalasia, were evaluated on postoperative day 1 chest CT study with oral contrast. Results: 30 out of the 43 patients (69.8%) had pleural effusion. 29 cases (67.5%) had small pleural effusion and one case (2.3%) had moderate effusion. None had large pleural effusion. Small left pneumothorax was noted in 1 patient (2.3%), which was however not severe enough to produce respiratory complaints or necessitated intercostal drain tube placement. One patient had 2 mucosal defects in the lower oesophagus with submucosal and extra luminal contrast leak, causing mediastinal collection and communication with left pleural cavity resulting in empyema which required intercostal drainage. Minimal intramural contrast leak with no extraluminal leak or mediastinal collection was present in 5 patients (11.6%), and all 5 were managed with second clipping. Bilteral lower lobe consolidation was noted in 1 case (2.3%), suggesting the possibility of aspiration. The patient had an uneventful postoperative course obviating the necessity of any further specific management. Minimal basal atelectasis were seen in 8 patients (18.4%), few linear opacities suggestive of pneumonitis were seen in 2 patients (4.6%), pneumomediastinum was found in 11 patients (25.5%), pneumoperitoneum in 24 patients (60.5%) and subcutaneous emphysema in 12 patients (28%). None of them were severe enough to produce clinical effects and none required any specific intervention. Conclusion: POEM procedure being preferred now in the management of achalasia cardia, it is of pertinent importance for the radiologists to be aware of the adverse events that could occur post procedure, and to differentiate the expected postoperative findings from the more sinister complications like perforation, which causes significant morbidity and mortality.</jats:p