Tuesday, July 15, 2008

Scoliosis with diastematomyelia

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Diastematomyelia is a common association with congenital scoliosis.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

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Tuberous Sclerosis



"Cortical tubers, or hamartomas, are the most characteristic lesions of tuberous sclerosis. The appearance of cortical tubers on MRIs varies with patient age. In neonates and young children, the cortical tubers and subependymal nodules are hyperintense on T1-weighted images and hypointense on T2-weighted images. In older children and adults, the cortical and subependymal lesions are isointense or hypointense on T1-weighted images. They are hyperintense relative to gray matter, as well as white matter, on T2-weighted images, depending on the presence of calcification."

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Friday, July 11, 2008

Radiology Education-Link

the Radiology Assistant is the educational web site of the Radiological Society of The Netherlands.Their focus is on common radiological issues in a problem oriented way for radiology residents and radiologists.

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Thursday, July 10, 2008

Dural Ectasia-MRI




This is case of this is dural ectasia without neurofibromatosis in the brain and spine showing scalloping, hydrosyrinx and tonsilar herniation.



Case by Dr MGK Murthy, Sr Consultant Radiologist
&
Dr.Sumer K Sethi, MD, Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

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Wednesday, July 09, 2008

Acoustic Neuroma-MRI



MRI Brain revealed a well defined, lobulated, heterogenous, multicystic mass lesion in the right cerebello pontine angle extending into the jugular foramen on the right side with mass effect and obstructive hydrocephalous. A right retro mastoid sub occipital craniectomy & microsurgical tumour decompression was done. Part of the tumor extending into jugular foramen was left behind as it was closely adherent to lower cranial nerves. Neurilemmoma was confirmed on histology.



Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

3T MRI for musculoskeletal system


3T-MRI (3 Tesla magnetic resonance imaging) is MRI done with a stronger magnet. Magnet “strength” is like “pixels” in digital cameras. The stronger the magnet—or greater the number of pixels—the better the images. “Tesla” is a unit of “magnetic field.” By using a magnet that has 3 Teslas (“3T”), we get better and sharper pictures, and can get them in less time weaker magnets. A 3T-MRI produces better images than 1.5, OPEN MRI or any MRI with a weaker magnetic field.
Musculoskeletal MRI is better at 3T for several reasons. 3T has higher “signal to noise” than other MRI scanners and this makes MR imaging of the joints faster, sharper (higher resolution) and more detailed (for trabecular detail). Increased trabecular detail—known to be better at higher field strengths—shows stress fractures much more clearly and important as treatment for a bone bruise can be different from the treatment you would receive for a fracture.

3T MRI is also twice as sensitive to contrast enhancement. This makes indirect arthrography an option at 3T. With a 3T MRI, we can give you an arthrogram without having to inject contrast into the joint. This reduces the costs and saves you, the patient, the pain and possible infection related to an injection. Complications are also reduced; sometimes injections do not actually get into the joint. Studies on our 3T MRI cost the same as MRIs on lesser scanners and are more detailed in contrast and enhancement.

Fat saturation of the joints is also improved at 3T. So when you combine fat saturation (fat sat) with “contrast” better, more sensitive, studies of areas of inflammation, tumors and healing result. Increased blood flow and enhancement is easier to detect when you use fat sat and is easier to detect at 3T. The images our machine produces are so incredible that some orthopedic surgeons say they have NEVER seen such detail on an MRI. Hamstring injuries look much better and more extensive at 3T, as do “groin hernias.” At 3T, using this combination of fat saturation and contrast, areas of subtle inflammation—previously undetectable—are now visible. Also, we are able to scan with a very small field of view, which is essentially like being able to enlarge (or do a close-up of) the area we are studying. This is a great advantage when scanning hands and feet. Details of the bones, joints and wrists that were previously only seen in pathological or autopsy specimens are visible on these more powerful, 3t MRI scanners. We are able to see details of the response to treatment of rheumatoid arthritis medication in a non-invasive manner. .

The extra power of 3T MRI lets us scan most areas in contiguous (and thinner) sections. This means we are able to scan up to 30% more of the body. Due to time considerations, other MRI scanners scan with a “skip”—scanning one or more slice and then skipping a section before scanning the next slice. A very small tumor or lesion might hide in the area that is “skipped.” Because 3T imaging is faster as well as stronger, we are able to scan everything in the area of question without making the patient stay in the scanner for hours. Contiguous imaging means there is simply nowhere for an abnormality to hide. Our scans are often 512x512 matrix and 2mm thin—about 8 times the resolution of any other scanner. At 3T, we can do this in 3 minutes. This translates into several important advantages. Scanning more quickly means the patient doesn’t have to remain still for as long a period, which means the chances of getting a motion-free scan are greatly increased. The 3-minute scan mentioned above is actually done in two parts (two runs) so you only have to stay still for 1.5 minutes at a time to get motion-free images. This means that even the most fidgety or claustrophobic person can usually get a diagnostic scan. Higher signal to noise (which is doubled at 3T) theoretically means the scan can be done four times faster than at 1.5T (we do not recommend getting an MRI at less than 1.5T). In practice, however, we prefer to say we scan “twice as fast.” People have a harder and harder time remaining absolutely still for long periods of time. Being able to produce a better scan in half the time is a great step forward.

Bringing more sensitivity to trabecular detail makes our bony imaging much more detailed and greatly increases sensitivity to bone marrow tumors and subtle stress fractures.
The ability to scan with thinner sections and higher resolution also directly impacts our ability to see abnormalities. Images of lower resolution and detail are less likely to show abnormalities. Being able to scan with more pixels has given us the ability to see very subtle things, like small areas of arteriovenous shunting, or subtle areas of inflammation or microtrauma. Individual fibers of the anterior cruciate ligament of the knee or the subtle fibers of the calcaneofibular ligament in the ankle are visible at 3T. We see more and, as a direct result, can diagnose more abnormalities.

Ionizing radiation is a very big problem in our current society. Most patients are never told that the risk of getting cancer is 1/500 for children per CT scan and 1/1000 in adults. And a CTA (computer tomography angiographic) study is even worse at 3 times the amount of radiation. CT colonoscopy can be up to 4 times the radiation dose.

This is a 3-T MR editorial submitted by Dr Philip W Chao MD. His website www.3t-mri.net .
Dr Philip W Chao has worked in Delaware to produce the best MRIs possible since 1990. He has monitored hundreds of thousands of MRIs over his career at the University of Pennsylvania and working for the people of Delaware. He is a board certified neuroradiologist and recently passed his maintenance of certification examination in 2006. He is also trained in body MRI and was the body MRI fellow at the University of Pensylvania from 1988 through 1990.

Sunday, July 06, 2008

Primary Bone Lymphoma



This is case which was previously MRI to be infective, ATT started and no response was noted and lesions increased subesequently. It was not thought to be AVN as head has not collapsed. Acetabulum is normal. There is fluid along with soft tissue invasion and no periosteal response. All point to primary bone lymphoma -femur common site

Primary bone lymphoma is defined as a tumor involving a single focus with unequivocal evidence of lymphoma in the bone lesion. It is rare. Most cases are of the diffuse large B-cell category. The age distribution is bimodal with peaks in the second to third decade, and a second peak in the fifth to sixth decade with women more commonly affected in the older age group. There is a wide pattern of bone involvement with the spine forming the most frequent site of axial lesions, and the femur is the most common site overall.


Further reading
Appl Radiol 33(3):36-44, 2004.

Case by Dr MGK Murthy, Sr Consultant Radiologist

&

Dr.Sumer K Sethi, MD, Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Osteogenesis Imperfecta



At times a picture speaks louder than words...

Saturday, July 05, 2008

Acute Pyelonephritis


This a a young female presented with symptoms of urinary tract infection with CT shwoing bulky right kidney with inhomogenous striated nephrogram, likely acute pyelonephritis.


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Central Pontine Myelinolysis


This is 19-month old girl with severe diahorrhea, MRI brain showing altered signal intensity in the central pons. Rarely reported in this age group but can be central pontine myelinolysis.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Myositis Ossificans



Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

This is a post head injury follow up case shwoing myositis ossificans surrounding the hip joint.

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Wednesday, July 02, 2008

Chronic Pancreatitis-CT


Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Colloid Cyst-MRI




Here is classical image of colloid cyst located in relation to the foramen of monro appearing hyperintense on T1 WI and hypointense on T2 WI.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Tuesday, July 01, 2008

Agenesis of the corpus callosum



A case of seizure disorder with partial agenesis (hypoplasia), the anterior portion (posterior genu and anterior body) is formed, but the posterior portion (posterior body and splenium) is not formed. The rostrum and the anterior/inferior genu are also not formed. Note the colpocephaly.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Lymphocytic Hypophysitis-MRI



This is a case of histopathologically proved case of lymphocytic hypophysitis. MRI revealed enlargement of the pituitary gland and fossa, with traingular-dumbell shaped mass with significant heterogenous post contrast enhancement. There is suprasellar extension and alteration of the optic chiasm. Pituitary stalk cannot be identified.


Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Hypoxic Brain Injury-MRI





This is patient who had a cardiorespiratory arrest and MRI was done which revealed hypoxic injury. T2/FLAIR and diffusion images are provided, and show symmetrical hyperintensity in the bilateral thalami, basal ganglia and brainstem.

Monday, June 30, 2008

Radiology Grand Rounds-XXV


Here is a case of Renal Hydatid for the Radiology Grand Rounds submitted by Dr MGK Murthy and Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds


Echinococcosis is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. Adult worm lives in the proximal small bowel of the definitive host, attached by hooklets to the mucosa. Eggs are released into the host's intestine and excreted in the feces. Humans may become intermediate hosts through contact with a definitive host (usually a domesticated dog) or ingestion of contaminated water or vegetables. The ovum loses its protective layer as it is digested in the duodenum. Once the parasitic embryo passes through the intestinal wall to reach the portal venous system or lymphatic system, the liver acts as the first line of defense and is therefore the most frequently involved organ. Renal hydatid is rare accounting for 2% usually. There are no clincal symptoms except cystic rupture into the collecting system, which leads to acute renal colic and hydatiduria .

Imaging findings in hydatid disease depend on the stage of cyst growth (ie, whether the cyst is unilocular, contains daughter cysts, or is partially or completely calcified [dead]) . A difference in attenuation and signal intensity between the fluid in the central portion of the cyst and that in the peripheral cysts is a typical finding in echinococcosis due to a difference in content .Daughter vesicles (brood capsules) are small spheres that are formed from rests of the germinal layer and appear as cysts within a cyst. They contain the scolices and hooklets, along with sodium chloride, proteins, glucose, ions, lipids, and polysaccharides . When daughter cysts are separated by the hydatid matrix, they demonstrate a "wheel spoke" pattern .


Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Thursday, June 26, 2008

Giant Hemangioma of Liver-Triple Phase CT




Cavernous hemangioma is the most common benign hepatic tumor. It typically occurs in women. Lesions measuring more than 4 cm in diameter are known as "giant hemangiomas" and often cause symptoms such as vague abdominal distention and pain. The constellation of giant hemangioma, thrombocytopenia, and localized consumption coagulopathy is known as the Kasabach–Merritt syndrome. This is a case of 40 year old female with giant hemangioma of liver with triple phase CT showing classical centripetal fill-in.

Dr Jaya Shankar, MD and Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Wednesday, June 25, 2008

CSF Rhinnorrhea-CT


Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Renal Cell Carcinoma-CT


Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Sunday, June 22, 2008

Hydatid Cyst- CT


Imaging--Separation of the laminated membrane from the penicyst produces a split wall or floating membrane appearance.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

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Saturday, June 21, 2008

Central Neurocytoma-CT Imaging




Imaging of central neurocytoma is usually characteristic. Most of them occur as an exophytic, well circumscribed, globular mass that protrudes into the ventricles. Calcifications are common. This is a postoperative post shunting case of neurocytomas, note the intraventricular nature of tumour, calcification and operative pneumocephalus. Tumour showed immunoactivity for synaptophysin. Radiological differential diagnoses include oligodendroglioma, ependymoma, subependymal giant cell astrocytoma, and intraventricular meningioma.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Friday, June 20, 2008

Pigmented Villonodular Synovitis of Shoulder




These are MRI pictures of a case of PVNS. Pigmented villonodular synovitis is well known in knee and shoulder involvement is reported rarely. Note the erosive defects in the humeral head.

Case by Dr MGK Murthy, Sr Consultant Radiologist
&
Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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Contrast Induced Nephropathy

"In Radiology 2008;248:97-105 Shaun A. Nguyen et al compared effects of iso-osmolality contrast with a low-osmolality agent on renal function and concluded Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups."

Thursday, June 19, 2008

Sonographic gel put to novel use

Seung Ho Kim et al used sonography transmission gel as Endorectal Contrast Agent for Tumor Visualization in Rectal Cancer in MRI and concluded that it is an effective and safe endorectal contrast agent for rectal MRI. Published in AJR 2008; 191:186-189

Wednesday, June 18, 2008

Tethered Spinal Cord





Here is a case of epidural/intradural lipoma showing signal suprresion on fat sat images and a low lying tethered spinal cord.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

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Cord Astrocytoma



This is cervical cord astrocytoma with associated syrinx seen on Gd-MRI scan of a child.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

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Chiari Malformation-MRI




MRI images showng lumbosacral myelomeningocele, dorsal syringohydromyelia and tonsillar herniation, classical Chiari II malformation.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

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