The role of in-vivo proton magnetic resonance spectroscopy in gallbladder cancer patients: A metabolomic approach

Background: Gallbladder carcinoma (GBC) is considered as a rare disease but it is the fifth most common malignancy of the gastrointestinal tract. Many diagnostic test are used to diagnose a case of GBC comprises laboratory studies and imaging tests.Proton MR Spectroscopy is able to detect and identify a large number of low concentration metabolites. It helps in detailed understanding of metabolic basis of physiology of disease and to diagnose the disease in its early stage.In this study we aim to identify the metabolides in benign malignant and normal gall bladder tissue and compare the metabolic profile of gall bladder tissue with histopathology report. Methods: The cross sectional study, total 119 patients were included in this study on the basis of well explained inclusion and exclusion criteria. Group I includes 51 patients with car cinoma gall bladder, Group II consists of 41 patients of benign gall bladder disease and Group III contain 27 patients with diseases other than hepato-biliary disease. 1H NMR metabolic profiling was done for the detection in metabolic changes. The Chi-square test, student’s t test and ANOVA were used for statistical analysis. Results: The area under curve of choline peak was significantly greater in group I (66.71) as compared to group II (14.85) and group III (5.44). The Lipid AUC and Lipid/Choline Ratio were significantly reduced in group I (222.61 and 5.01) as compared to group II (242.46 and 22.81) and group III (254.56 and 71.32). The Bilirubin total, Bilirubin Direct, SGPT, SGOT and ALP were significa ntly higher in group I. The change of MRI mass/ stone size was significantly positive correlated with choline AUC. Conclusion: The in-vivo MRS is a good tool to differentiate the malignant and benign Gallbladder tissue on the basis of metabolic profile of Gallbladder tissue with short time consuming, with no increased risk of contamination and metastasis of disease and good tool to differentiate between malignant and benign

Magnetic resonance-retrograde pyelography: A novel technique for evaluation of chyluria

There are no standardized radiological investigations in a patient with chyluria. Retrograde pyelography (RGP) is usually done to demonstrate pyelo-lymphatic reflux before invasive therapy in the form of sclerotherapy and surgery. We describe magnetic resonance-RGP using gadolinium to demonstrate pyelo-lymphatic reflux in addition to the other intra-abdominal details provided by MRI. The advantages of this technique include avoidance of ionic contrast media and radiation exposure and possibility of better understanding of the disease pathophysiology

Diagnostic role of magnetic resonance angiography in Swyer James syndrome: Case series of two cases

Swyer James syndrome is a rare syndrome which occurs due to viral illness in early childhood. The post infective obliterative bronchiolitis results in arrest of lung growth and alveolarization with reduced vascularity resulting in classical radiological features. We describe two cases of patients fulfilling all the criteria of the syndrome - 1) Unilateral hyperlucent small lung in chest radiograph with air trapping on expiration, small ipsilateral hila and pulmonary artery. 2) Diffuse decrease in attenuation of lung parenchyma with bronchiectasis and reduction in vascularity. 3) Unilateral pruned tree appearance on angiography (MRA). The clinical presentation was recurrent chest infection in a child and infrequent bouts of hemoptysis in a middle aged female. The study demonstrates the role of magnetic resonance angiography in diagnosing the condition

Case report: MR spectroscopy in pantothenate kinase-2 associated neurodegeneration

We report a case of a 13-year-old girl with Hallervorden-Spatz disease (HSD) or pantothenate kinase-2 associated neurodegeneration (PKAN). HSD is a rare neurodegenerative disorder, which is characterized by a rapidly progressive extrapyramidal syndrome, dementia with optic atrophy, and retinal degeneration. It is associated with accumulation of cysteine-iron complex in the globus pallidi and substantia nigra. The MRI "eye of the tiger" sign is the characteristic. MRI spectroscopy is also characteristic. It shows markedly decreased NAA/Cr values in the globus pallidi and substantia nigra with increased mI/Cr values that suggest of gliosis

Macrodystrophia lipomatosa – MR imaging of a rare congenital anomaly: review of 3 cases

Macrodystrophia lipomatosa (MDL) results from progressive overgrowth of all the mesenchymal elements, with a disproportionate increase in fibro-adipose tissue. This rare congenital abnormality occurs most frequently in the distribution of the median nerve in the upper, and medial plantar nerve in the lower, extremity. Excess of unencapsulated fibro-adipose tissue on magnetic resonance imaging (MRI) is virtually diagnostic and can differentiate this entity from other diseases with similar presentations. Involvement of the ulnar aspect of the hand, though rare, has been described; however, the lateral aspect of the foot as seen in our second case has not been reported, to the best of our knowledge

Magnetic resonance imaging (MRI) in Duane retraction syndrome

Purpose: To study the magnetic resonance imaging (MRI) findings in Duane retraction syndrome (DRS). Materials and Methods: In this case–control study, 16 consecutive cases of Duane syndrome underwent MRI of the brain and orbit, after informed consent. MRI (fast imaging enhancing state acquisition) was done with special focus on pontomedullary junction to look for the status of abducens nerve and associated abnormalities along with quasi-coronal sections of orbit to estimate thickness and cross sectional area of horizontal extra-ocular muscles (EOMs). Thickness and cross-sectional area of EOMs were compared to the contralateral side and to age-matched controls. Results: Of 16 cases, 14 had DRS Type I, and 2 had DRS Type II. MRI revealed absent abducens nerve on the ipsilesional side in 12 out of 14 in DRS I, whereas two DRS II patients revealed intact abducens nerve on the affected side. Thickness and cross-sectional area of the horizontal recti was statistically comparable to the contralateral side and age-matched controls. Conclusions: All the DRS patients in study had structurally normal horizontal recti muscles, whereas 12 out of 14 of DRS-I patients had an absent abducens nerve on MRI