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

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

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

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

CSF Rhinnorrhea-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

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

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

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

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

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

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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

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."

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

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

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

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

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Hirayama Disease-Dynamic MRI, a rare diagnosis

We report the MR findings in a case of Hirayama disease, a kind of cervical myelopathy related to flexion movements of the neck. In flexion MR studies, we can see the striking and pathognomonic picture of anterior shifting of posterior dura at the lower cervical spinal canal and prominent epidural venous plexus. In non-flexion studies, we find that asymmetric cord atrophy, especially at the lower cervical cord, though subtle, is highly suggestive of Hirayama disease. When it is seen, a flexion MR study is warranted to prove this diagnosis.

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

Calcific Tendonitis of Supraspinatus

This may or may not be the cause for the shoulder pain, and is a common finding on routine shoulder skiagrams

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

Osteochondroma with Bursitis

Patient has history of rapid enlargement of exostosis and it is due to bursa in lesser trochanter at the cap of the osteochondroma, synovial chondromatosis or chondroid metaplasia in bursa needs to be differentiated. Both CT and MRI are useful imaging techniques to differentiate osteochondroma with large bursa formation from malignant transformation of osteochondroma. The lesser trochanter of the femur is the second most common location of large bursa formation. Cartilage thickness has been measured and appears normal.

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

Bladder Carcinoma-MRI

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)

Achalasia Cardia-Barium Swallow

This is classic barium appearance of achalasia cardia on a barium swallow called as bird beak appearance.

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)

Science or Fiction- Cellphone based medical imaging

Reference- Granot Y, Ivorra A, Rubinsky B (2008) A New Concept for Medical Imaging Centered on Cellular Phone Technology. PLoS ONE 3(4): e2075. doi:10.1371/journal.pone.0002075

Full Article here

"According to WHO reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of authors' study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved . feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode."

Teleradiology Providers

Giant Cell Tumour Of Patella-A Rare Location

Radiological differential diagnosis of osteolytic lesions in the patella include non-neoplastic conditions, and benign and malignant neoplasms. Non-neoplastic conditions include dorsal defects, hyperparathyroidism, osteomyelitis, osteochondritis dissecans, and rheumatoid cysts. Benign lesions include chondroblastoma, giant cell tumors, simple bone cysts, hemangioma, osteochondroma, lipoma and osteoblastoma. Malignant tumors include lymphoma, hemangioendothelioma and metastases.

Take Home Message-The patella should not be regarded as an unexpected location for a characteristically epiphyseal lesion such as a giant cell tumor.

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)

Lissencephaly-CT

Sulci are absent with smooth cortical surface. Sylvian fissures are straight oblique resultinga figure of eight appearance of brain.
Diagnosis : Lissencephaly.

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)

Spinal Dermoid-MRI

This is a 25 year old man with a intradural lesion showing lipid content. T1, T2 and Fat Sat images are shown. A diagnosis of dermoid was made.

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)

Quadriceps Injury-MRI

MRI has the highest sensitivity and specificity for disorders of the quadriceps. It shows both complete and partial ruptures, soft tissue hematomas, tendinopathies, soft tissue tumors, myositis ossificans, and fascial defects. Incomplete intrasubstance tears of the rectus femoris and complete tears of the rectus femoris and quadriceps tendon are visible as increased signal intensity on the T2 images. Incomplete intrasubstance ruptures of the rectus tendon and the quadriceps tendon image as focal disruptions of the normal laminated appearance of the tendon.

These are 3-T MR images of rectus femoris tear sent by Dr Philip W Chao MD. His website www.3t-mri.net . This patient was a baseball player.

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. He is perhaps one of the best trained doctors in MRI in the world and Delaware.

Optic Perineuritis-Imaging

Optic perineuritis is an uncommon variety of orbital inflammatory disease that is distinct from demyelinating optic neuritis. In contrast to those with optic neuritis, patients with optic perineuritis are often older at onset and are more likely to show sparing of central vision. Magnetic resonance imaging scans demonstrate enhancement around, rather than within, the optic nerve. Response to corticosteroids is more dramatic than in patients with optic neuritis, and patients are more likely to experience recurrence after stopping treatment.

MRI usually shows Perineural enhancement and “streaky” fat with or without extraocular muscle enhancement. This patient improved dramatically with steroids.

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)

Teleradiology Network

Just trying my hand at the social networking which is new buzz word. Always thought it would be nice to have people interested in Teleradiology in one common platfrom hence this teleradiology centered forum.

Visit Teleradiology Network

Radiology Preliminary Read Concept

Teleradiology Providers offers an offshore service that provides a preliminary report of various radiological studies producing a detailed report that a U.S. radiologist may utilize to prepare the official final diagnostic report. This service is an unique innovation that in a way is a method which allows the so called demon of out-sourcing to be used in a collabrative method. This allows increasing the efficiency of the the radiologists in places wherein they have higher loads (like US) and overcomes the legal barriers, wherein the Indian counterparts are just providing the preliminary report, which is neither final nor binding. This in particular may be useful for clincal trial reporting and plain filsms a model that has been used by Singapore goverment wherein they outsource the x-rays to have their radiologist read the CT and MRIs and hence reduce the waiting lists. Further it increases the workflow just as it is postulated that computer aided diagnosis will help in reducing the loads, i personally feel it is preliminary reads which will ultimately improve the workflow.

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)

AIIMS May 2008 Fully solved and explained

AIIMS May 2008 has been a recent examination for which no authentically collected questions or answers are available. To meet this demand by the students DAMS, Delhi Academy of Medical Sciences, headed by Dr Sumer Sethi, MD Radiology has come out with the first and most authentic solutions for this examination with peepee publsihers. This book has been mainly authored by Dr Kavish Chouhan (24th Rank AIIMS May 2008 and DAMS student), Dr Sumer Sethi (author of many books for PG entrance) and esteemed DAMS faculty. For orders contact us ay -damsdelhi@gmail.com

Regards

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)

Radiology Grand Rounds-XXIV

Here is an update on Medical Imaging and Open source software for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

Apple Macintosh have published a white paper describing how Apple technology can make full-featured diagnostic imaging affordable. The white paper, "Transforming the medical imaging workflow", by renowned radiologist Roger Katen MD, aims to illustrate how Apple's Mac systems, coupled with the OsiriX1 open source application and Mac OS X, can offer a cheaper alternative without sacrificing features or performance.Mac OS X–based solution is increasingly being adopted by radiology practices, and can interact with Microsoft Windows-based systems, such as PACS, HIS and collaborative teleradiology environments.

Here is the complete PDF

Transforming the medical imaging workflow

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. This issue was different from other issues as we did not put up an image case as has been the trend in past few months. This month for the readers we have already put up many cases so we tried to give them something different from the world of medical imaging.

Case by-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)