Magnetic Resonance Imaging Appearance of Giant Intracerebral Tuberculoma: A Retrospective Analysis

Background: Giant intracerebral tuberculomas are rare lesions but should be considered in the differential diagnosis of intracranial space-occupying lesion in an endemic region. Objective: The purpose of this study is to analyze the clinical data and magnetic resonance imaging (MRI) findings of giant intracerebral tuberculomas to improve the diagnostic precision. Material and Methods: The clinical and MRI findings of 22 patients of giant intracerebral tuberculoma were analyzed retrospectively. For the statistical analysis independent sample Student t-test was used. Results: For 22 patients included in this sample the giant intracerebral tuberculoma was of size more than 2.5cm. The majority of the giant tuberculomas (19 patients (86.4%))was located in the supratentorial area.T2-weighted hypointense core of giant tuberculoma was observed in 12 patients (54.5%) and T1 hyperintensities were observed in peripheral (wall) of the giant tuberculoma in 14 patients (63.6%). The mean ADC value of the peripheral (wall) of the giant tuberculoma was 1.034± 0.466[SD] x 10-3mm2/s and the core was 0.994± 0.455[SD] x 10-3mm2/s with a statistically significant difference (p-value <0.0005) in between. MR spectroscopy showed raised lipid peak at 0.9 to 1.33 ppm in 10 patients (45.5%),raised lipid-lactate peak in 12 patients (54.5%),raised Choline/Cr ratio more than 1.2 in 14 patients(63.6%) and Choline/Cr ratio less than 1.2 in 5 patients (22.7%). Associated involvement of lung was observed in the 6patients (27.3%), cervical lymph node in 1 patient (4.5%) and spine in 1patient (4.5%). Conclusions: MRI plays a vital role in distinguishing giant intracerebral tuberculomas from other intracranial space-occupying lesions, thereby allows the early institution of anti-tubercular treatment (ATT), decreased patient morbidity, mortality, and prevents unnecessary neurosurgical excision

Dynamic contrast-enhanced MRI and Apparent diffusion coefficient mapping in the characterization of Palpable breast lesions: A prospective observational study

Abstract Background Breast MRI is the imaging modality of choice in patients with palpable breast lesions unequivocal on mammography and ultrasonography. This study aims to evaluate the role of dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient mapping in the characterization and differentiation of various palpable breast lesions. This prospective observational study was conducted in a tertiary care hospital between July 2019 and June 2021. Sixty-six patients with palpable breast lesions were undergone MRI scans of the breasts. The various palpable breast lesions were categorized according to the 5th edition BI-RADS lexicon. The sensitivity of ADC mapping and DCE-MRI was determined for differentiation of various palpable breast lesions according to the BI-RADS category and gold standard histopathological findings. Results Of 66 patients with palpable breast lesions, 36 patients (54.5%) were benign and 30 patients (45.5%) were malignant lesions. Malignant palpable breast lesions had a mean ADC value of 0.939 ± 0.166[SD] × 10−3 mm2/s, and benign lesions had 1.891 ± 0.524[SD] × 10−3 mm2/s where unpaired Student t-test showed statistically significant difference of P value 0.0005. BI-RADS 2 lesions had a mean ADC value of 2.056 ± 0.471[SD] × 10−3 mm2/s, BI-RADS 3 had 1.314 ± 0.151[SD] × 10−3 mm2/s, BI-RADS 4 had 0.935 ± 0.119[SD] × 10−3 mm2/s, and BI-RADS 5 had 0.930 ± 0.943[SD] × 10−3 mm2/s. BI-RADS 2 category showed optimal cutoff mean ADC of 1.508 × 10−3 mm2/s with a sensitivity of 85.7% and specificity of 94.7%, BI-RADS 3 lesions had 1.208 × 10−3 mm2/s with a sensitivity of 75% and specificity of 55.2%, BI-RADS 4 lesions had 1.064 × 10−3 mm2/s with a sensitivity 80% and specificity of 67.9%, and BI-RADS 5 lesions had 1.013 × 10−3 mm2/s with a sensitivity of 80% and specificity of 82.6%. Conclusions Breast MRI is superior to the other imaging modalities for the characterization and differentiation of various palpable breast lesions. The combined use of ADC mapping and DCE-MRI had more sensitivity than conventional MRI, ADC mapping or DCE-MRI alone

Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

Background Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae with anal sphincters, fistula extensions, secondary ramifications and associated complications. Aim To evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Settings and Design A hospital-based cross-sectional study. Materials and Methods The study group composed of 47 patients of perianal fistula. MRI with diffusion-weighted imaging (DWI) was performed with Philips 0.5 T Ingenia scanner. DWI with different b-values (b = 50, b = 400, and b = 800 smm2) were obtained. The MRI findings were correlated with local clinical examination and or surgical findings. Statistical Analysis Used Chi-square test, independent samples t-test, and receiver operating characteristic curve analysis. Result Fifty-nine perianal fistulas in 47 patients were included in the study sample. The visibility of perianal fistula on DWI was less than T2-weighted (T2W) and combined DWI-T2W images. Distinctly visualized (visibility score 2) perianal fistulas were observed in 47 fistulas (79.6%) on DWI, 54 (91.5%) on T2W, and 58 (98.3%) on DWI-T2W images. The mean of apparent diffusion coefficient (ADC) values of active fistula was 0.972 ± 0.127 [SD] 10−3 mm2/s and inactive was 1.232 ± 0.185 [SD] 10−3 mm2/s with a significant difference (p-value < 0.0005). A cut-off mean ADC value of 1.105 × 10−3 mm2/s was used to differentiate active from the inactive fistula with a sensitivity of 87.5% and specificity of 73.3%. Conclusion Combined DWI-T2W evaluation had a better performance in the detection of fistula than DWI or T2W alone. DWI with mean ADC calculation had a good performance in differentiating active from the inactive fistulas