Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

Background: Intra uterine growth restricted (IUGR) is when the expected foetal weight is less than 10th percentile for gestational age. The hemodynamics of the feotus takes into account both the umbilical-placental and cerebral vascular beds. Underlying etiology that results in the failure of a foetus to attain its expected growth may vary. However the final infliction is via uteroplacental insufficiency. It is highlighted that inadequate uteroplacental perfusion is the main and primary pathology in growth restriction resulting in an increased umbilical artery impedance. Following this step are the changes in the middle cerebral artery (MCA) which categorically set in as a secondary phenomenon.Methods: Duplex Doppler Sonography is a reliable, non- invasive and rapid diagnostic technique in IUGR patients. Grey scale findings together with colour Doppler characteristics help in the qualitative as well as quantitative evaluation of the Uteroplacental and Fetoplacental circulation. Hence ultrasonography (USG) has become the most widely used, standard and simple way of detecting and confirming IUGR. Ultrasound biometry is the gold standard for assessment of foetal size. Various criteria are used to label a feotus growth restricted; foetal weight less than 10th percentile for gestational age is mostly widely accepted criterion. Others like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. After establishing the diagnosis of IUGR, Doppler imaging becomes a valuable investigating method for monitoring the pregnancy because it provides information about the hemodynamic status of the feotus. Uteroplacental system evaluation takes into account the flow pattern of uterine artery, reflecting any underlying Uteroplacental vascular ischemia. Umbilical artery Doppler waveforms reflect the status of the fetoplacental circulation and any underlying placental insufficiency.Results: Fourteen cases showed absent umbilical artery end diastolic flow and four patients showed reversal of end diastolic flow.: Twenty two patients showed elevated PI. Adverse perinatal outcome was observed in all patients with absent and reversal of end diastolic flow. Out of the twenty two with elevated PI fifteen showed adverse outcome. Thirty six cases showed low MCA PI and six showed a pseudonormalization. A cerebro -placental ratio of < 1.08 was observed in 16 patients, it was calculated in only those pregnancies that showed forward diastolic flow in umbilical artery (n= 22). Fifteen of them showed adverse perinatal outcome.Conclusions: Doppler imaging is of value for monitoring pregnancies complicated with IUGR because it can provide indirect evidence of foetal compromise and is known to improve outcome of high risk pregnancies. Doppler evaluation is complementary to all other surveillance modalities. Because the changes in umbilical, uterine & MCA strongly correlate with pregnancy outcome in growth restricted foetuses the use of foetal biometry & Doppler examination is recommended in all cases of suspected IUGR cases

Nasal dermoid cyst with intracranial extension and an atretic dermal sinus tract

Nasofrontal masses belong to the group of congenital midface anomalies (CMFA) in paediatric age group. Nasofrontal dermoids with patent dermal sinus tract is a rare anomaly resulting from the failure of normal embryogenic process. Most patients present in infancy or early childhood. CT and MRI together are usually required for definitive diagnosis. CT imaging provides vital information about the osseous involvement while MRI is crucial for evaluation of the intracranial extent and detailed tissue characterization. Knowledge of embryonic development is important in understanding the pathologies of nasofrontal masses in paediatric age group

Spectrum of CT and MR findings in Sturge-Weber syndrome: A case report

Sturge-Weber syndrome is an uncommon, sporadically occurring neurocutaneous syndrome characterized by port wine stain (facial nevus flammeus), congenital glaucoma, and anomalous leptomeningeal angiomatous malformation. Port wine stain is usually the first component of the syndrome. Seizures of the side contralateral to the port wine stain occur early in infancy and worsen with age. Radiological investigations, like computed tomography and magnetic resonance imaging are most useful, playing a pivotal role in demonstrating the cerebral changes. We report the case of a 10-month-old infant presenting with port wine stain over face, trunk, and extremities, hemiparesis of the left side of the body, and new onset of seizure. This case highlights the various neurological manifestations of Sturge-Weber syndrome and how imaging helps to characterize each

Pre and Post-operative evaluation of brain neoplasms on Diffusion Tensor Imaging

Context: Complex neural networks are formed by the communication of billions of neurons with each other through their axons. Limitation to the understanding of brain function, due to the lack of non-invasive methods makes it essential to recognize such networks by structural mapping. Aims: We conducted this study with the aim of evaluating various brain neoplasms pre and post operatively and help guide the neurosurgeon for better resection of the tumor.Settings and Design: The study was conducted in Department of Radio-diagnosis, Dr. D. Y. Patil medical college, hospital and research center by using 3T MR scanner (Siemens Magnetom Vida) on 30 histopathologically proven cases of intracerebral neoplasms. The study design was Cross sectional observational study. Statistical analysis used: The data was entered in MS EXCEL spreadsheet and analysis done using licensed Statistical Package for Social Sciences (SPSS) version 21.0.&nbsp; Descriptive statistics (means and SDs) for each parameter were computed for the different tumor groups. The tumor groups were compared by using student or non-parametric sample tests. A ‘p’ value of &lt;0.05 was considered statistically significant.Results: Or study showed that DTI can be helpful in differentiating low from high grade neoplasms. Various white matter tracts adjacent to the neoplasm were visualized and classified into displaced, edematous, infiltrated and destroyed depending upon the type of involvement by the neoplasm. Post operative KPS score showed improvement as compared to the pre-operative KPS score, highlighting value of DTI. Conclusions: Tract visualization can be extremely helpful for neurosurgeons in differentiating salvageable from lost tracts, thus DTI is an important tool in the arsenal of a neurosurgeon. Keywords: DTI, MRI, intracerebral, neoplasm, edem

Interrupted aortic arch by multi-detector computed tomography angiography: A case report with radiological review

Interrupted aortic arch (IAA) is a rare congenital vascular malformation, which is defined as lack of luminal continuity, between the ascending and descending thoracic aorta. Many times it is associated with various congenital cardiac anomalies. Early diagnosis is mandatory to assess the patient condition and to plan medical and surgical treatment. Traditionally, chest X-ray, echocardiography, and conventional catheter angiography are the imaging tools being used. Multi-detector computed tomography (MDCT) can accurately diagnose and characterize the various forms of IAA and associated cardiac defects. We report a case of 8-year-old male child detected to have Type A IAA on MDCT with an associated ventricular septal defect and patent ductusarteriosus

Role of advanced magnetic resonance imaging techniques in diagnosis of cerebral toxoplasmosis in immunocompromised patients: A case report

Cerebral toxoplasmosis commonly affects patients with advanced HIV infection. Toxoplasmosis can be severe and debilitating in patients with Central Nervous System (CNS) involvement and the condition may be fatal in patients if not suspected and treated early and adequately. Hence, imaging plays an important role in diagnosis and following during treatment in cases of suspected toxoplasmosis. We report a case of a 51-years-old man who was a known sero-positive since 2 years and presented with altered sensorium. Magnetic Resonance Imaging (MRI) scan of the brain showed multiple heterogeneously enhancing lesions in bilateral cerebral as well as cerebellar hemispheres and some of them showed "eccentric target sign." MR spectroscopy showed features of reduced NAA, mildly increased choline, and lipid lactate peak. MR perfusion study showed reduced perfusion favoring diagnosis of cerebellar toxoplasmosis. Patient was started on a combination of pyrimethamine plus sulfadiazine for toxoplasmosis. Follow up MRI after 20 days and 45 days from start of treatment showed significant resolution of the lesions supporting our radiological diagnosis

Rapid magnetic resonance imaging protocol for detecting femoral head avascular necrosis: A case series-it′s utility in the general population in developing countries

Introduction: Osteonecrosis of the femoral head is an increasing cause of musculoskeletal disability, common among the younger population, between the third and fifth decade of life, affecting mainly men, thereby requiring prompt diagnosis and early intervention. Aims and Objectives: The aim was to formulate a limited magnetic resonance imaging (MRI) examination protocol for detection of avascular necrosis (AVN) in clinically suspected cases that can be performed rapidly and will be inexpensive. Materials and Methods: Forty-five patients suspected clinically and or on conventional radiography for AVN of the femoral head were referred for MRI hip. MRI hip was done on 1.5 T Siemens Avanto. Of 45, 36 were detected to have AVN (total 58 hips), whereas 9 did not have AVN on MRI. Initially, coronal T1-weighted image (T1WI) sequence was obtained as limited MRI protocol, followed by complete MRI examination. Results: Maximum patients belonged to age group 31-40 (30.5%). 32 (88.88%) patients were males and 4 (11.11%) were females. Bilateral AVN was detected in 44 (61.1%) and unilateral in 14 patients (38.8%). Pre collapsed stage (Stages I and II) was detected in 18 hips (31.03%), collapsed stage (Stages III and IV) was detected in 40 hips (68.9%). Peripheral low-intensity rim was seen on T1WI in all 58 cases of AVN. Double line sign on T2-weighted image was seen in 33/58 (56.8%). Conclusion: Our study concluded that coronal T1W sequence is an easy, rapid and cost-effective method of detecting unilateral or bilateral AVN

Characteristics of Ring enhancing lesions in brain in correlation with MRI and MR spectroscopy

Background:The aim of this study was to analyze and identify various characteristic changes of multiple ring-enhancing lesions in the brain on conventional MRI and proton MR spectroscopy which leads to an early diagnosis, treatment, response assessment and minimize the complications in such patients.Materials and method:It is a type of descriptive study, consisting of 50 patients that were suspected clinically with ring-enhancing lesions were referred to the department of Radio-diagnosis and underwent scanning in 1.5 Tesla MRI over a period of 2 years.Results:Out of 50 patients, 19 were diagnosed as neurocysticercosis, 16 as Tuberculomas, 7 as Intracranial Abscess, 4 as metastasis, 3 as primary brain neoplasms, and 1 as Tumefactive Demyelination. Neurocysticercosis was found to be the most common of the pathology diagnosed with Seizures being the most common complaint in patients.Conclusion:The use of MRI along with MR spectroscopy is of vital importance and primary research tool in neuro diagnosis. The most common ring enhancing lesions experienced in developing countries like India is NCC and tuberculomas. Accurate diagnosis and characteristics of these lesions can be achieved by MR spectroscopy on a routine MRI scan by analyzing the quantity and ratio of tissue metabolites