Monday, December 31, 2007

Radiology Blog-now four years old


Wishing all our readers of this blog a very happy and prosperous new year 2008. The concept of this blog is to provide and discuss radiology related information and has been doing so for last four years (since 2004). I welcome all our readers to actively participate by commenting on the cases and submitting their own radiology related experiences.

Our sister concern- Teleradiology Providers

Sunday, December 30, 2007

Pilocytic Astrocytoma- MRI Findings




"Four predominant imaging patterns of pilocytic astrocytoma have been described: (a) mass with a nonenhancing cyst and an intensely enhancing mural nodule, (b) mass with an enhancing cyst wall and an intensely enhancing mural nodule, (c) necrotic mass with a central nonenhancing zone, and (d) predominantly solid mass with minimal to no cystlike component. Although most cyst walls do not enhance, some may enhance intensely, even as much as the mural nodule; however, cyst wall enhancement is not necessarily indicative of tumor involvement . Beliefs vary among neurosurgeons regarding whether to resect the cyst itself in cases of pilocytic astrocytoma. Some advocate complete resection, others biopsy, and still others no resection . Removal of the cyst wall has not been linked with improved survival ."


Case submitted by

Dr MGK Murthy, Dr Sumer Sethi


Tuesday, December 25, 2007

Social Networking for Radiologists

Just came across a new site radRounds which seems like a Facebook counterpart for a Radiologist with a aim of linking radiologists to each other and new opportunities in radiology. Seems like a great idea. Must check.

For Radiology Outsourcing--

Sunday, December 23, 2007

Radiology Grand Rounds XIX




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


Glomus tumours
Synonyms are paragangliomas and chemodectomas
Location is usually jugular bulb, middle ear, carotid body, vagus nerve, periaortic, larynx, ciliary ganglion, mandible, nose and fallopian canal


Origin is embryonic neuroepithelium in close association with autonomic nervous system
4% are functional
4% are metastatic
Mostly benign and hypervascular



Imaging
CT findings
-destruction, expansion, involvement of sites as mentioned above no soft tissue component, intense enhancement with salt and pepper appearance.
MRI shows better delineation of characteristics, extent across CV junction, encasement of vessels, involvement of cranial nerves and IAM as well as intracranial extent


Treatment is controversial
For a small lesion may be only radiosurgery
For a bigger lesion combination of surgery with radiation


The Glasscock-Jackson and Fisch classifications of glomus tumors are widely used. The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to mortality and morbidity.
Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)
Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the pterous apex
Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canal
Type C2 tumor - Tumor invading the vertical portion of the carotid canal
Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal
Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter
Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter


Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy

Friday, December 21, 2007

Electrophysiology and Multislice CT

According to Saremi F et al in Radiographics. 2007 Nov-Dec;27(6):1539-65,
"Given its capacity to provide relevant anatomic information in exquisite detail, multidetector computed tomography (CT) has the potential to allow faster and more accurate placement of intracardiac ablation catheters and pacemaker leads relative to the anatomy of interest. High-resolution reformatted images from 64-detector CT data provide accurate anatomic information for locating important landmarks relative to the cardiac conduction system or to current electrophysiologic interventions and cardiac resynchronization therapy."

Seems like yet another upcoming application of Cardiac MDCT.

Tuesday, December 18, 2007

Rare Complication of Ultrasound Scanning

SUTTON PA et al in British Journal of Radiology (2007) 80, 1024
doi: 10.1259/bjr/98506488
Report a very interesting complication of a patient who developed acute confusional stae post ultrasound. The investigations sent by them all returned normal, with the exception of a venous sodium measurement of 119 mmol L–1. On further questioning, the patient's husband revealed that she had been told to "drink as much as she could" prior to the ultrasound scan, and had therefore consumed several litres of water over the course of the afternoon. The confusion settled with fluid restriction, and venous sodium normalized over the next few hours.
ooops......

Again highlights the importance of good communication between medical staff and patients.

Thursday, December 13, 2007

Rhinolith-CT Findings


Calcified concretion in the nasal cavity, formed around a foreign body acting as a nidus is called a Rhinolith.



Case submitted by
Dr MGK Murthy, MD,DNB
Dr Sumer Sethi, MD


Friday, December 07, 2007

High Intensity Focused Ultrasound In RSNA News

"RESEARCHERS at Duke University Medical Center report using mechanical high-intensity focused ultrasound (HIFU) to activate the immune system to recognize and attack malignant tumors, pointing the way toward a whole new field in cancer therapy for radiologists. The study was detailed in the August 3, 2007, issue of the Journal of Translational Medicine."

Sounds like interventional Radiology is looking at new horizons yet unseen.
Further details--
doi:10.1186/1479-5876-5-34
The electronic version of this article is the complete one and can be found online.

High intensity focused ultrasound (HIFU) is an emerging non-invasive treatment modality for localized treatment of cancers. While current clinical strategies employ HIFU exclusively for thermal ablation of the target sites, biological responses associated with both thermal and mechanical damage from focused ultrasound have not been thoroughly investigated. In particular, endogenous danger signals from HIFU-damaged tumor cells may trigger the activation of dendritic cells. This response may play a critical role in a HIFU-elicited anti-tumor immune response which can be harnessed for more effective treatment.

Cerebral Vasculitis- MR Angiogram



We had a young male patient showing characteristically on MRI brain multiple bilateral gray/white matter infarcts were noted in a young patient. They were all supratentorial in distribution, a point further supported by literature. (Radiology 1992;192 :65-72. ). Further evaluation was done with MR angiography There were multiple areas of alternate narrowing and dilatations giving rise to “string of beads” appearance involving the right MCA and ACA.
These are characteristic of vasculitis.


Differential diagnosis considered was -
-Infectious- Bacterial/viral
Tuberculosis is a common cause.
-Non infectious-collagen vascular disorders, neurosarcoidosis, drug abuse, PAN. Other like-GCA, Takasayu, Wegeners.
-Also such appearance can be mimicked by-neoplasm/SAH

- PRIMARY ANGITIS OF THE CNS (PACNS) can be a diagnosis of exclusion

Case submitted by Dr Sumer Sethi, MD, Dr Jaya Shankar, MD



PACS Vendor versus Blogger's freedom

Whatever anybody might think of Dalai's PACS blog and his somewhat forthright criticism of various products and vendors everybody is dismayed to hear about the process by which one big PACS company allegedly went about forcing him to withdraw his comments.Surely there would have been a more appropriate way to handle this and we all sure have right to criticism.

And as one of the contributors on this forum says-
"I may not agree with what you say, but I will defend to the death, your right to say it"

Sunday, December 02, 2007

Radiologist Salary versus Medical Practise Profits


SALARIES are on the rise for both interventional and non-interventional diagnostic radiologists,
reflecting a trend seen among medical specialties across the nation. However, many practices are still losing money as a result of the higher costs of doing business. (According to the American Medical Group Association (AMGA) 2006 Medical Compensation and Financial Survey)
Source- RSNA News

Probably this further supports the collabrative model used by Teleradiology Providers, where we offer the preliminary reads by Indian radiologists thereby benefiting the practise by increasing the work output to generate more revenues.

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