Role of multiparametric MRI in detection of prostatic lesions; of evaluation contrast enhanced MRI, diffusion weighted imaging and MR spectroscopy in malignant and benign prostatic lesions

Background: Prostate cancer is the most commonly diagnosed cancer in males and one of the leading causes of cancer-related death in men. Pretreatment assessment of prostate cancer is divided into detection, localization, and staging; accurate assessment is a prerequisite for optimal clinical management and therapy selection. The purpose of the study is to determine the diagnostic accuracy of multiparametric MRI for prostatic cancer detection using T2 weighted MR imaging, diffusion weighted imaging (DWI) and contrast enhanced MRI. To determine the use of MR spectroscopy in prostatic lesions.Methods: It is a prospective single institutional study done on 29 patients with prostate lesions and elevated PSA level. Axial, coronal and sagittal images were obtained using T1WI, T2WI and STIR sequences. Advanced sequences like Diffusion weighted images, Spectroscopy and post gadolinium T1WI were taken after the basic MRI images.Results: Study was done in 29 patients, age was ranging between 51years to 90 years, mean age is 70.7 years. On multiparametric MRI findings 45% were detected malignant lesions and 55% patients detected benign lesions. On biopsy correlation 42% of these cases turned out to be malignant and 58% as benign lesions. Detection of malignancy by T2WI imaging alone given sensitivity of 80.1% and specificity of 85.4%.By DWI alone sensitivity was 85.7% and specificity was 89.4%,on MRS sensitivity is 90.6% and specificity was 91.1%. Combined (MRI+DWI+MRS) gave sensitivity of 92.3% and specificity of 94.4% for detection of malignant prostatic lesion. Positive predictive value is 90% and negative predictive value was 88%.Conclusions: The best characterization of prostatic cancer in individual patients will most likely result from a multiparametric exam. Recent advances include additional functional and physiologic MR imaging techniques (diffusion weighted imaging, MR spectroscopy, and perfusion imaging), which allow extension of the obtainable information beyond anatomic assessment. Multiparametric MR imaging provides the highest accuracy in diagnosis and staging of prostate cancer

Left common carotid artery arising from brachiocephalic trunk and their aberrant course displacing trachea

Bovine arch commonly refer a group of congenital variations in the branches of arch of aorta, in which there is aberrant origin of left common carotid artery. These are usually detected incidentally, however rarely they can cause dysphagia lusoria. We report a case of bovine arch and aberrant left common carotid artery in a 62 years old female who had come with complaint of mild dyspnea. On radiograph there was superior mediastinal widening and shift of trachea to right side. CT scan was advised for further evaluation. On CECT there was only two main branches arised from arch of aorta, brachiocephalic trunk and right subclavian artery. There was aberrant origin of left common carotid artery seen from brachiocephalic trunk. The brachiocephalic trunk was very tortuous and displacing trachea to right side

Post craniectomy paradoxical brain herniation: a case report with radiological review

Sinking skin flap (SSF) syndrome and paradoxical brain herniation are rare complications after craniectomy. On CT scan, there is shrunken appearance of the skin flap at craniectomy site. The meningogaleal complex is drawn inwards and is resting on underlying deformed brain with resultant concave surface. It results due to altered CSF hydrodynamics. Paradoxical brain herniation is rare complications which occur in patients who undergo cerebrospinal fluid (CSF) drainage procedures like lumbar puncture (LP), external ventricular drainage, ventriculo-peritoneal shunting and post craniectomy. Its early detection on imaging is essential as it is a neurosurgical emergency. We report a case of 75 year old male previously operated for left chronic subdural hematoma in the left fronto-temporo-parietal region presenting with altered consciousness and inability to walk. Plain CT scan showed craniectomy defect in the left fronto-temporo-parietal region with indrawing of meningogaleal complex suggestive of Shrunken Skin Flap. There was mass effect on the left lateral ventricle and third ventricle with shift of the midline structures towards right (1cm) with evidence of subfalcine herniation suggestive of paradoxical brain herniation

Role of multiparametric MRI in detection of prostatic lesions; of evaluation contrast enhanced MRI, diffusion weighted imaging and MR spectroscopy in malignant and benign prostatic lesions

Background: Prostate cancer is the most commonly diagnosed cancer in males and one of the leading causes of cancer-related death in men. Pretreatment assessment of prostate cancer is divided into detection, localization, and staging; accurate assessment is a prerequisite for optimal clinical management and therapy selection. The purpose of the study is to determine the diagnostic accuracy of multiparametric MRI for prostatic cancer detection using T2 weighted MR imaging, diffusion weighted imaging (DWI) and contrast enhanced MRI. To determine the use of MR spectroscopy in prostatic lesions.Methods: It is a prospective single institutional study done on 29 patients with prostate lesions and elevated PSA level. Axial, coronal and sagittal images were obtained using T1WI, T2WI and STIR sequences. Advanced sequences like Diffusion weighted images, Spectroscopy and post gadolinium T1WI were taken after the basic MRI images.Results: Study was done in 29 patients, age was ranging between 51years to 90 years, mean age is 70.7 years. On multiparametric MRI findings 45% were detected malignant lesions and 55% patients detected benign lesions. On biopsy correlation 42% of these cases turned out to be malignant and 58% as benign lesions. Detection of malignancy by T2WI imaging alone given sensitivity of 80.1% and specificity of 85.4%.By DWI alone sensitivity was 85.7% and specificity was 89.4%,on MRS sensitivity is 90.6% and specificity was 91.1%. Combined (MRI+DWI+MRS) gave sensitivity of 92.3% and specificity of 94.4% for detection of malignant prostatic lesion. Positive predictive value is 90% and negative predictive value was 88%.Conclusions: The best characterization of prostatic cancer in individual patients will most likely result from a multiparametric exam. Recent advances include additional functional and physiologic MR imaging techniques (diffusion weighted imaging, MR spectroscopy, and perfusion imaging), which allow extension of the obtainable information beyond anatomic assessment. Multiparametric MR imaging provides the highest accuracy in diagnosis and staging of prostate cancer

Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously

Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously

Ultrasonographic diagnosis of an unusual vesical hemangioma presenting as hydroureteronephrosis

Vesical hemangiomas are rare and benign tumors of mesenchymal origin. They usually present with multiple episodes of hematuria and the diagnosis is usually achieved patho-logically. We present a rare case of vesical hemangioma at vesicoureteric junction that presented with abdominal pain secondary to hydroureteronephrosis and the diagnosis was suspected on ultrasonography and confirmed later by pathology

Klippel–trenaunay syndrome: A case report with radiological review

Klippel–Trenaunay Syndrome is a congenital disorder with a rare incidence of 3-5/1,00,000. It is characterized by a triad of capillary malformation (hemangioma or port-wine stain), venous varicosities, and bony or, soft-tissue hypertrophy. The malformation in the capillary is usually limited to a single extremity though multiple extremities can be involved. This disease is subject to significant morbidities such as bleeding, deep vein thrombosis, and embolic complications. Our case study was a young male of 6 years suffering since birth, from a painful port-wine stain on the lateral aspect of the right thigh, enlarged right femur, and soft tissues. Vascular Doppler ultrasound, skeletal X-ray, and magnetic resonance imaging of the limb indicated a Klippel–Trenaunay disease. This article describes a case study of a child presenting with Klippel–Trenaunay including a review of the syndrome and treatment recommendations

Acute gastric dilatation secondary to septicaemia in newborn: A rare entity

Acute gastric dilatation in a newborn is a rarely encountered clinical entity. Such dilatation without any obstruction is furthermore rare. The authors hereby present a rare case of acute gastric dilatation that developed in a two-days old child who was born premature and was suffering from septicaemia and respiratory distress. The causes and the differential diagnosis of the rare condition are discussed