Monday, January 29, 2007

Lumbar Disc Pathology-Classification

Here is an excellent link for those wanting to learn how to report MRI in degenerative spine by
Dr Peng Hui LEE
Clinical Director of Radiology, Mid Essex Hospitals NHS Trust

Nomenclature and Classification of Lumbar Disc Pathology

Sunday, January 28, 2007

Radiology Grand Rounds-VIII

Welcome to the VIII Edition of the monthly summary of the best in the Radiology Blogsosphere known as “ Radiology Grand Rounds”. Grand Rounds is an old tradition that doctors have. Once a week, they get together and talk about one case in detail. Keeping up with this tradition this Carnival of Medical Imaging has been named “Radiology Grand Rounds”. Every physician would agree that Subspecializtion is the need of the hour in medical field, hence the concept of a specialized Radiology Grand Rounds. Radiology Grand Rounds will be hosted on last Sunday of each month, the schedule and archive will be available at- Radiology Grand Rounds. I would like to thank all the contributors for this edition of Radiology Grand Rounds.

This Edition we will start by informing my readers that we are getting famous, yes the concept of Grand Rounds including Radiology Grand Rounds was featured in Indian Pediatrics current edtion. Indian Pediatrics is one of the top most Indian Indexed Journal.

Anybody who knows about Radiology would know that one of the key arts in the field of diagnostic imaging is writting a proper report which conveys the impression to the referring clinician, i think everyone would agree writting a good report is very crucial to a successful radiology practise. has sent a link to a new database of radiology report templates. It was just placed online and will soon be populated with more report templates. It already has few templates on Ultrasound, rest of the categories are coming up. Good effort. also presents an image gallery of various presentations of tuberculosis. Amazing collection of skeletal tuberculosis at various sites. Title of the series-TB or not TB submitted to them by Dr Priya Chudgar.

Odysseys of George submits to us a very interesting case of a 72 year old lady who presented with anaemia. Look at the images findings are obvious and discussions following the images are very interesting. My Tip-try making the diagnosis before reading the entire discussion.

And another case from him aptly titled breathing on bended tube, this is a case of an elderly man referred for loss of weight, stridor(noisy, harsh breathing) for the last one year which worsened over the last 2 months.

Dr MGK Murthy (Sr Consultant) at Teleradiology Providers talks about differential diagnosis of a supraclinoid aneurysm. He says at times "Meningimas which are cystic, haemangioblstomas and pilocytic astrocytomas could present a diagnostic difficulty.However intense nodular enhancement, lack of perilesional oedema, chronic headache of long duration with no deficit are supportive of aneurysm"

Hot Discussion Topics From Sumer's Radiology Site
(comments and suggestions on each topic are welcome)

That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the VIII edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at if you are interested in hosting future Radiology Grand Rounds. Also visit our sister concern Teleradiology Providers. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds. Be sure to tune in Next Month Last Sunday 25th Feb, when Grand Rounds will be hosted at- Cochin Blogs mail or

Friday, January 26, 2007

Radiology Grand Rounds feature in Indian Pediatrics

Indian Pediatrics Journal in its Pedscapes Column by Dr Sidharth, a fellow blogger from India who runs features the concept of Grand Rounds. Here is the link to the full article. It talks about Medical, Pediatrics, Radiology and Nursing Grand Rounds.
Reference- Concept of Online Grand Rounds (Pedscapses). Indian Pediatrics 2007; 44:58.

Wednesday, January 24, 2007

AJR & Rejection of Manuscripts

"Countries in which English is the primary language had higher acceptance rates than those in which English is not the primary language. Countries with English as the primary language, including Canada, the United Kingdom, and Australia, had rejection patterns similar to that of the United States. Language problems were not a major reason for rejection, except for manuscripts from China. Lack of new or useful knowledge was by far the most common reason for rejection in all countries. High-quality scientific work is key to overcoming barriers to publication. Designing an appropriate study that answers a clearly defined and pertinent question is an important first step. Language problems were not a major cause of rejection, except for manuscripts from China. "

Reasons for Rejection of Manuscripts Submitted to AJR by International Authors. AJR 2007; 188:W113-W116

Tuesday, January 23, 2007

MRI in "Broken Heart syndrome"

"Sudden emotional stress can also result in severe but reversible heart muscle weakness that mimics a classic heart attack. Patients with this condition, called stress cardiomyopathy but known colloquially as "broken heart" syndrome, are often misdiagnosed with a massive heart attack when, indeed, they have suffered from a days-long surge in adrenalin (epinephrine) and other stress hormones that temporarily "stun" the heart. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.
Examination by angiogram showed no blockages in the arteries supplying the heart. Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle. Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage. Catecholamine metabolites, such as metanephrine and normetanephrine, were also.Heart biopsies also showed an injury pattern consistent with a high catecholamine state and not heart attack.A hallmark feature of the syndrome was the heart's unique contraction pattern as viewed by echocardiogram, or ultrasound. While the base of the heart's main pumping chamber, the left ventricle, contracted normally, there was weakened contraction in the middle and upper portions of the muscle. Other characteristics included a distinctive pattern on electrocardiogram, or EKG."
Reference Science Daily

Submissions requested for the next Radiology Grand Rounds

Submissions are requested for the next Radiology Grand Rounds to be hosted on my site on last sunday of this month on 28-1-2007. Send over all your radiology related posts, interesting cases and anything you think is remotely related to radiology send it over to-

Low uptake on PET & malignancy

Benign and malignant pulmonary lesions usually are differentiated by 18F-FDG PET with a semiquantitative 18F-FDG standardized uptake value (SUV) of 2.5. However, the frequency of malignancies with an SUV of less than 2.5 is significant, and pulmonary nodules with low 18F-FDG uptake often present diagnostic challenges. These results suggested that for solid pulmonary lesions with low 18F-FDG uptake, semiquantitative approaches do not improve the accuracy of 18F-FDG PET over that obtained with visual analysis. Pulmonary lesions with visually absent uptake indicate that the probability of malignancies is very low. In contrast, the probability of malignancy in any visually evident lesion is about 60%.
Reference-Accuracy of PET for Diagnosis of Solid Pulmonary Lesions with 18F-FDG Uptake Below the Standardized Uptake Value of 2.5
Journal of Nuclear Medicine Vol. 47 No. 3 426-431

Thursday, January 18, 2007


"When patients with an implanted contraceptive device undergo MRI, it must be ensured that the examination involves no risk to the patient (MR safety) and that the diagnosis is not affected by artifacts or the function of the device compromised (MR compatibility). Two basic types of intrauterine devices can be distinguished: the metal-containing/metal-free intrauterine device (IUD) and the hormone-containing implant, the fully metal-free intrauterine system (IUS), as well as the ESSURE insert made of stainless steel, which has been approved for use in Europe since February 2001.The metal-containing and metal-free IUDs and ESSURE are MRI compatible up to a magnetic field strength of 1.5 T. They do not interact in any relevant way with the external magnetic or high-frequency field and the temperature increase is within the physiologic range. The implants merely produce a local signal void with a shape that depends on their orientation relative to the magnetic field lines. At 3 T, only the metal-free IUD and the IUS are MRI safe in terms of the material used. In contrast, metal-containing IUDs and the ESSURE have not yet been fully evaluated in the 3 T field, which is why they represent a contraindication to MRI. No data are available on the MRI compatibility at 3 T for any of these devices"
How safe is magnetic resonance imaging in patients with contraceptive implants?
Radiologe 2006 Jul;46(7):574-8.

Are CXR in preemployment check up justified?

The legal and medical basis for chest radiographs as part of pre-employment examinations (PEE) at a University Hospital is evaluated. The radiographs are primarily performed to exclude infectious lung disease. A total of 1760 consecutive chest radiographs performed as a routine part of PEEs were reviewed retrospectively. Pathologic findings were categorized as "nonrelevant" or "relevant." No positive finding with respect to tuberculosis or any other infectious disease was found; 94.8% of the chest radiographs were completely normal. Only five findings were regarded as "relevant" for the individual. No employment-relevant diagnosis occurred. The performance of chest radiography as part of a PEE is most often not justified. The practice is expensive, can violate national and European law, and lacks medical justification.
Are chest radiographs justified in pre-employment examinations? Presentation of legal position and medical evidence based on 1760 cases.
Radiologe 2006 Jul;46(7):567-73

CT Angiography and Cancer Risk

"As the number of cardiovascular CT angiography scans continues to grow, researchers are attempting to gauge the potential effects of radiation exposure during the procedure. Although extensive epidemiologic studies are not yet available, new research suggests a measurable risk. A study presented at the American Heart Association meeting by Andrew J. Einstein of the Mount Sinai School of Medicine in New York City found that a single cardiovascular CTA study produced a non-negligible lifetime attributable risk (LAR) of cancer in patients. The risk was greatly influenced by factors such as the patient's age and gender, as well at the scan protocols used."

Reference and full article on Diagnostic Imaging, Study finds measurable cancer risk with CTA

Saturday, January 13, 2007

Polyorchidism-A Case Report

The presence of more than 2 testes is called polyorchidism. It is rare and less than 100 cases are reported in medical literature.Dr Joe presents a case of polyorchidism. The patient presented with a small, painless mass in the left scrotum. Physical examination revealed a small, non-tender lump below the left testes. Sonography revealed a well-defined, solid ovoid mass of less than 2 cms., just below the left testes. It shows same echogencity and echotexture as the testes. This is a very important point that clearly identifies the mass as a supernumerary testes.
D/d: this includes bilobate testes; other differentials include solid masses like fibroma, lipoma and neurofibroma.
Prognosis: polyorchidism is associated with higher risk of malignancy and torsion of the supernumerary testes. Normal spermatogenesis has been reported in the extra testes. Careful follow up examination of the testes is usually sufficient.

Case submitted by-
Consultant Radiologist.

free to view ultrasound gallery

Healthcare in Cochin and more

Tuesday, January 09, 2007

Mammography-comparison with previous mammograns helps

Importance of Comparison of Current and Prior Mammograms in Breast Cancer Screening
DOI: 10.1148/radiol.2421050684, Radiology 2007;242:70-77.

"Without prior mammograms, significantly more annotations were made. When only positive cases were considered, no difference was observed. Reading performance was significantly better when prior screening mammograms were available. At fixed lesion localized fraction, nonlesion localized fraction was reduced by 44% on average when prior mammograms were read. Comparison with prior mammograms significantly improves overall performance and can reduce referrals due to nonlesion locations. Limiting the availability of prior mammograms to cases selected by the reader reduces the beneficial effect of prior mammograms."

Wednesday, January 03, 2007

Ancient Roman Burial Site and Radiology

CT: A New Nondestructive Method for Visualizing and Characterizing Ancient Roman Glass Fragments in Situ in Blocks of Soil By Roel J. Jansen et al.
Reference-RadioGraphics 2006;26:1837-1844
"A rare, complete ancient Roman burial site was discovered near the Dutch village of Bocholtz. In addition to many preserved grave offerings, there were countless fragments of deteriorated glass objects still buried in the ground. This glass was in very poor condition, however, and there was no possibility of excavating it directly. Instead, archeologists working at the site decided to dig up blocks of soil containing the glass fragments. High-resolution spiral computed tomography (CT) with multiplanar reformation, shaded-surface-display rendering, and volume rendering was used to obtain detailed information about the position, number, and form of the deteriorated glass fragments. CT-guided removal of the soil made it possible to restore some of the objects excavated from the blocks. In five of the 14 excavated objects, a correct Isings classification could be made based on the CT findings. In addition, CT was very important for the reconstruction of the layout of the burial chamber, the compilation of a list of grave contents, and the positioning of these contents within the chamber."

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