Diffusion tensor imaging in assessment of demyelinating diseases of central nervous system

Background: Conventional MR plays an important role in detection of demyelinating lesions. Involvement of the lesion core, perilesional region and normally appearing white matter (NAWM) cannot be quantified using routine T2/FLAIR sequences. DTI is an important tool in assessment of anisotropy in affected and apparently normal region of brain. 3D Tractography maps are useful in showing white matter fibre loss. Aim was the assessment of white matter damage and neuroaxonal loss using DTI in demyelinating lesionsMethods: Cross sectional observational study including clinically suspected 30 patients of demyelinating disease. Patients were studied in 3Tesla Siemens Skyra MRI scanner with phased array coils. T1w, T2w, FLAIR, DWI, DTI, post contrast T1w images were included and FA, ADC, Tractography maps were generated. ANOVA test and BONFERONI analysis were used.Results: We found mean FA of core lesion was 0.307±0.06, of perilesional region 0.444±0.03 and NAWM 0.567±0.06. The mean ADC value of core of the lesion was 1.24×10-3mm2/sec±0.11×10-3mm2/sec, perilesional region 1.16×10-6mm2/sec ±0.1×10-3mm2/sec and NAWM 1.04×10-3mm2/sec±0.06×10-3mm2/sec.Conclusions: DTI is a useful MR technique that allows quantification of extent of demyelination in the white matter measuring FA and ADC values. The FA values which denote diffusivity and directionality are more reliable marker of demyelination compared to ADC values. DTI Tractography shows white matter tract disruption which may play role in assessing clinical outcome of patients

Magnetic Resonance Imaging of Brain in Evaluation of Floppy Children: A Case Series

How to Cite This Article: Sanyal Sh, Duraisamy Sh, Garga ChU. MRI Brain in Evaluation of Floppy Children: A Case Series. Iran J Child Neurol. Autumn 2015; 9(4): 65-74.AbstractObjectiveHypotonia is a common clinical entity well recognized in pediatric age group, which demands experienced clinical assessment and an extensive array of investigations to establish the underlying disease process. Neuroimaging comes as great help in diagnosing the disease process in rare cases of central hypotonia due to structural malformations of brain and metabolic disorders and should always be included as an important investigation in the assessment of a floppy child. In this article, we discuss the MRI features of eight cases of central and two cases of combined hypotonia and the importance of neuroimaging in understanding the underlying disease in a hypotonic child

Zinner syndrome—a rare developmental anomaly of the mesonephric duct diagnosed on magnetic resonance imaging

AbstractDevelopmental anomalies of the urogenital tract are rare but often encountered. Zinner's syndrome is a rare congenital abnormality of mesonephric (Wolffian) duct consisting of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction due to developmental arrest in early embryogenesis affecting the caudal end of Mullerian duct and only approximately a 100 cases have been reported so far. Radiologic modalities such as intravenous pyelography, ultrasonography, vasovesiculography, contrast enhanced computed tomography, and magnetic resonance imaging are all helpful in diagnosis of this unusual entity. We present here an extremely rare developmental anomaly involving the Mullerian ducts, which would remain undiagnosed but for radiologic imaging. The patient presented with symptoms of lower urinary tract irritation

Niska masa szkieletu ważnym czynnikiem predykcyjnym osteoporozy u mężczyzn zakażonych wirusem HIV w Indiach

Introduction: This study evaluated prevalence and predictors of osteoporosis and sarcopenia in men with HIV. Material and methods: 220 men with HIV were screened, of which 115 men, 30–50 years-age, having at least 1-year follow-up, underwent hormonal and DEXA analysis. 40 controls were also evaluated. Results: Males with HIV had significantly lower BMD and Z-scores at all sites. Osteoporosis was diagnosed in 64.35%; commonest site being radius total (49.56%), followed by radius 33% (45.21%), radius ultra distal (36.52%), lumbar spine (19.13%), neck of femur (17.39%), total femur and greater trochanter (7.82% each). HIV patients had significantly lower fat mass (FM), lean mass (LM), total fat percent, bone mineral content, gynoid fat, percent skeletal muscle mass (PSMM). Men with osteoporosis had higher use of anti retroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS), tuberculosis, lower FM, LM and PSMM. Logistic regression revealed PSMM, age and delta (Δ) CD4 count (change in CD4 count after 6–12 months of ART, compared to pre-ART) were best predictors of osteoporosis. Greater PSMM was associated with decreased osteoporosis, without adjusting for any variable (Model-1), adjusting for disease duration, tuberculosis and IRIS (Model-2), and model-2 plus gonadotropins and sex steroids (Model-3). Greater ΔCD4 count and age were associated with increased osteoporosis after adjusting for different models. Sarcopenia was observed in 40% men and none in controls. Conclusions: Men with decreased skeletal mass, age, severe immune dysfunction at diagnosis, having rapid increase in CD4 count following ART and IRIS have higher risk of osteoporosis in the long run.Introduction: This study evaluated prevalence and predictors of osteoporosis and sarcopaenia in men with HIV. Material and methods: A total of 220 men with HIV were screened, of which 115 men, 30–50 years-age, having at least one-year follow-up, underwent hormonal and DEXA analysis. Forty controls were also evaluated. Results: Males with HIV had significantly lower BMD and Z-scores at all sites. Osteoporosis was diagnosed in 64.35%, the common­est site being radius total (49.56%), followed by radius 33% (45.21%), radius ultra distal (36.52%), lumbar spine (19.13%), neck of femur (17.39%), and total femur and greater trochanter (7.82% each). HIV patients had significantly lower fat mass (FM), lean mass (LM), total fat percentage, bone mineral content, gynoid fat, and percentage skeletal muscle mass (PSMM). Men with osteoporosis had higher use of anti-retroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS), tuberculosis, and lower FM, LM, and PSMM. Logistic regression revealed that PSMM, age, and delta (Δ) CD4 count (change in CD4 count after 6–12 months of ART, compared to pre-ART) were the best predictors of osteoporosis. Greater PSMM was associated with decreased osteoporosis, without adjusting for any variable (Model-1), adjusting for disease duration, tuberculosis and IRIS (Model-2), and model-2 plus gonadotropins and sex steroids (Model-3). Greater ΔCD4 count and age were associated with increased osteoporosis after adjusting for different models. Sarcopaenia was observed in 40% of men and in none of the controls. Conclusions: Men with decreased skeletal mass, age, severe immune dysfunction at diagnosis, having rapid increase in CD4 count fol­lowing ART and IRIS have higher risk of osteoporosis in the long run. Wnioski: Mężczyźni z obniżoną masą szkieletu, w starszym wieku i z ciężkimi niedoborami immunologicznymi w czasie rozpoznania, u których następuje gwałtowny wzrost liczby limfocytów CD4 po ART i IRIS, cechują się wyższym ryzykiem osteoporozy w perspektywie długoterminowej

Case Report: Intracranial peripheral primitive neuroectodermal tumor – Ewing's sarcoma of dura with transcalvarial–subgaleal extension: An unusual radiological presentation

The occurrence of the intracranial, peripheral, primitive, neuroectodermal tumor, Ewing's sarcoma (pPNET-ES) of the dura, is very rare. Immunophenotypical as well as genetic analyses play key roles in its diagnosis and differentiation from central PNET. We describe here the CT scan and MRI findings of an interesting case of intracranial pPNET-ES arising from the anterior falx cerebri with a trancalvarial–subgaleal extension

Neuroimaging in epilepsy

Epilepsy is a common neurological disorder with diverse etiologies. Neuroimaging plays an important role in workup of patients with epilepsy. It helps to identify brain pathologies that require specific treatment; and also in formulating syndromic and etiological diagnoses so as to give patients and their relatives an accurate prognosis. Magnetic resonance imaging, specially the 3 tesla MRI is the imaging of choice because of its ability to detect small lesions like mesial temporal sclerosis, cortical dysplasias, small tumors, etc that are not detected by conventional MR or CT scan of brain. Identification of these lesions often helps in managing refractory epilepsies more effectively. However, cost and non-availability of MR in large part of the country necessitate the use of CT as an alternative. CT is often the initial investigation and also useful in acute situations. Functional imagings are used for pre-surgical work-up of refractory epilepsy cases with an aim to identify the epileptogenic focus and to delineate functional areas nearing the focus