Wednesday, December 31, 2008

Upcoming Molecular Imaging Conference- Annoucement

This may be the single most important event this year for your radiology practice and pathology group. The Molecular Summit on February 10th – 11th 2009 in Philiadelphia is the most exciting intersection of genomic technologies in medicine today! Innovators are pushing forward to integrate molecular imaging and molecular diagnostics in ways that shift current paradigms in patient care and Molecular Summit brings all the key players together at one time and one place.


Justin M. Clark

Monday, December 29, 2008

Superior Saggital Sinus Thrombosis-MRI

These are MRI images of superior sagital thrombosis note the high signal in the sinus in the axial images and thrombosis seen on the MR venogram.
Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Rotator Cuff Tear-MRI

These are coronal and sagittal MRI images showing tear of the supraspinatus tendon tear with fluid in the subacromial bursa and myotedinous retraction.

Case by Dr Sumer Sethi, MD

Friday, December 26, 2008

Radiology Post Tsunami

"Found this interesting article in Emergency Radiology describing radiological findings in tsunami victims. Most common findings were trauma involved musculoskeleton, retained foreign bodies in soft tissues, pneumonia/aspiration, and tsunami sinusitis."

Tuesday, December 23, 2008

Post Traumatic Wrist MRI

Controversy surround the etiology of kienboecks disease (lunatomalacia).
Few of the theories are (a) In manual workers chronic repetitive trauma is considered to damage supplying arteries of the lunate . : Arteries entering the lunate from the dorsal and palmar pole form an intraosseous vascular network with the proximal pole supplied by terminal arteries only . (b)Another theory of compression or avulsion fractures as the primary cause of lunatomalacia is nowadays rejected by many authors. (c)According to an observation by Hulten , lunatomalacia is associated with a negative ulnar variance in 78% of the test population. Due to inadequate force transmission from the ulna to the wrist, the lunate is exposed to an increased axial load in the radiolunate articular cornpartnient. (d)Most recently, the possibility of venous congestion is discussed as a cause of lunatomalacia with intraosseous measurements showing significantly higher pressures .
MRI Staging with signal on T1
Stage 1- Low signal, and shows homogenous enhancement refd as edema considered as prognostically good
2-Low signal on T1 shows pathcy inhomogenous enhancement and is refd as partial necrosis
3-Low signal on T1 absent enhancement and refd as complete necrosis
Differential diagnosis includes the rare fractures of the lunate without consecutive necrosis, the ulnolunar impaction syndrome, and intraosseous ganglia originating from the scapholunar or lunotriquetral ligament
Staging classification of Kienbock's disease on radiological and MRI criteria.Stage (MRI and conventional radiography) Lichtman and Ross
I Normal radiographic appearance,diagnosis by MRI
II Increased spongiosal sclerosis,initial fracture of the proximal pole possible
III (a) Lunate collapse without carpal instabilityIII (b) Progessive lunate collapse with carpal instability
IV Progessive carpal collapse and ostcoarthritis (SLAC wrist) in our case proximal pole of scaphoid shows the fracture but marrow signal is normal and no AVN is seen.
Case by Dr MGK Murthy, Sr Consultant Radiologist

Teleradiology Providers

Thursday, December 18, 2008

Multiple Arachnoid Cysts-CT

Arachnoid cysts are CSF-filled intraarachnoidal collections. They are most commonly located in the middle cranial fossa followed by suprasellar and quadrigeminal cisterns, posterior fossa, cerebral convexities, and interhemispheric fissure. This is an exceptional case with the coexistence of multiple arachnoid cysts in three different locations.

Primary Choledocholithiasis-MRCP

"Up to 85% of CBD stones are secondary from GB. Primary CBD stones are caused by conditions leading to bile stasis and chronic bactibilia. Up to 90% of patients with brown pigment CBD stones have bile culture results positive for bacteria. Primary duct stones are usually brown pigment stones. Brown stones differ from black pigment stones by having a higher content of cholesterol . In Western population Biliary stasis is secondary to factors such as sphincter of Oddi dysfunction, benign biliary strictures, sclerosing cholangitis, and cystic dilatation of the bile ducts. Bile stasis promotes growth of bacteria, which produce phospholipase A1, thus releasing fatty acids from biliary phospholipids. The duct epithelium and/or bacteria (eg, Escherichia coli) produce beta-glucuronidase in amounts sufficient to deconjugate bilirubin diglucuronide. The presence of free fatty acids, deconjugated bilirubin, and bile acids leads to the formation of insoluble calcium bilirubinate particles. With the loss of bile acids, cholesterol becomes insoluble, resulting in the formation of biliary sludge. The sludge also contains mucin and bacterial cytoskeletons, which further aid in stone formation. In Asian populations, infestation with A lumbricoides and C sinensis may promote stasis by either blocking the biliary ducts or by damaging the duct walls, resulting in stricture formation. Bactibilia is also common in these instances, probably secondary to episodic portal bacteremia. Some authors have suggested that the stones are formed because of the bactibilia alone and that the parasites' presence is just a coincidence. "
Case By Dr MGK Murthy, Sr Consultant Radiologist

Tuesday, December 16, 2008

Sacral Agenesis-MRI

This is a 17yr old male who presented with neurogenic bladder. MRI reveals partial sacral agenesis, kyphoscoliosis, intradural lipoma and open sacral canal. Spinal cord is lowlying and tethered.

Monday, December 15, 2008

Blogging in the corporate sector

"In the beginning there were blogs. The blogs were by the people. The blogs were the people.
The opening lines of the book Corporate Blogging in India truly depicts the phenomenal growth of blogosphere. The effectiveness of this social platform was clearly evident recently when examples of microblogging through websites like Twitter could be seen actively contributing to mainstream media during the recent Mumbai terror attacks."
Surely, Blogging today in India is mainstream from Amitabh to Aamir Khan to the Corporate Biggies to the Boy Next Door, Blogging has caught everybodies attention now. Even the medical fraternity is not far behind.
Source- Yahoo News

Thursday, December 11, 2008

Glioblastoma Multiforme-MRI

These are post gd images of a biopsy proven case of GBM showing characteristic non-homogenous enhancement, necrotic areas, spread along white matter tracts and perilesional edema.

Monday, December 08, 2008

Bilateral Subdural hematomas-CT

Bilateral subdural hematomas especially when they are isodense may be missed on CT. A classical sign is "Rabbit Ear Sign" in which frontal horns point posteriorly.

Saturday, December 06, 2008

Add your picture to the CT scan to get more careful read

I read this in the Times of India and though it sounds kind of comic but somewhere makes some sense.
"Imagine sitting in a dark room all day, evaluating CT scans and other medical images on a computer screen but never actually seeing real patients. That’s life for many radiologists. But an intriguing Israeli study found adding photos of patients’ faces to the file made these doctors more meticulous when looking at the X-rays. They reported more details and said they felt more empathy for patients who were otherwise strangers. Adding patients’ photos is a simple, low-tech way to reap rewards for both doctors and their patients, the researchers concluded."

Thursday, December 04, 2008

Low Cost Teleradiology for Stoke- Thai Study

According a Thai study by Kanitpong Phabphal et al in J Telemed Telecare 2008;14:439-442, They have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.

Monday, December 01, 2008

Architecture for Radiology

New blog about Architecture for radiology is here- Architecture for Radiology

Radiation Concerns in Children

The Alliance for Radiation Safety in Pediatric Imaging – the Image Gently Alliance -is a coalition of health care organizations dedicated to providing safe, high quality pediatric imaging nationwide. The primary objective of the Alliance is to raise awareness in the imaging community of the need to adjust radiation dose when imaging children. The ultimate goal of the Alliance is to change practice.

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