Monday, January 31, 2011

Radiology Museum

Came across this interesting link while surfing and showcases pictures of radiology related antique medical instruments.  Worth  a visit to see this fascinating collection.

Radiology Museum

Iliopsoas Bursitis/ Tenditis-MRI

The iliopsoas bursa is the largest bursal sac in the body; in 15% of normal individuals, it communicates with the hip joint between the iliofemoral and pubofemoral ligaments.  Iliopsoas bursitis can be caused by various hip joint abnormalities such as joint degeneration, rheumatoid arthritis, PVNS, synovial osteochondromatosis, gout, joint infection, or avascular necrosis. Other possible causes include sacro-iliac joint and adjacent spine pathology.

Tuesday, January 25, 2011

IRIA-2011, Teleradiology Panel Discussion

For all those interested in Teleradiology, IRIA 2011, Delhi,  largest Radiology Congress in Indian subcontinent has organised panel discussion-symposia on this topic with may distinguished speakers, including yours truly, who was invited to do similar talk in IRIA 2008. This year my topic is Asian-African Perspective- Teleradiology.  Schedule for the event is given below. All attending the conference are welcome to meet me around this event, to be held in Hotel Ashok and my talk is scheduled for 29, Jan 2011, 16.40pm. Any suggestions for the talk or comments are welcome.

Monday, January 24, 2011


Gliosarcoma is a rare highly malignant (WHO grade IV) primary intra axial neoplasm. It is often considered a histological variant of glioblastoma multiforme (GBM).  Pathologically, the tumour is very similar to a glioblastoma multiforme (GBM) but with an added sarcomatous component (the tumour comprises of both glial and mesenchymal elements). This is a histologically proved case of gliosarcoma.

Saturday, January 22, 2011

Tree-In-Bud Appearance-CT Sign

The tree-in-bud sign is a finding seen on thin-section computed tomographic  images of the lung . Peripheral, small, centrilobular, and well-defined nodules of soft-tissue attenuation are connected to linear, branching opacities that have more than one contiguous branching site, thus resembling a tree in bud. The tree-in-bud sign has primarily been used as a descriptive term for abnormalities found on CT scans of the lung in patients with endobronchial spread of Mycobacterium tuberculosis.

Friday, January 21, 2011

Distal Radioulnar Joint Subluxation

The radius and ulna constitute a bicondylar joint, articulating at distal and proximal radioulnar joints. Between these two joints, the interosseous membrane functions as a suspension bridge. The stability of proximal and distal radioulnar joints is provided by the thick and complex ligamentous structures, known as the annular ligament and the triangular fibrocartilage complex, respectively. The distal radioulnar joint consists of two articular surfaces that are dissimilar in their radius and curvature, the sigmoid notch and the ulnar seat. MRI is useful to evaluate for TFCC injury and to assess DRUJ subluxation.  Note the positive ulnar variance and widening of the DRUJ space is this case.

Thursday, January 20, 2011

Pancreatic Transection-MRI

Complete pancreatic transection is rare and usually occurs in the line of superior mesenteric vessels at the neck of the gland, though it has been reported to occur in the body or tail of the pancreas.  These patients may have associated injury to superior mesenteric portal vein axis and pancreatic ducts.  Early surgical intervention in patients with pancreatic neck transection and ductal disruption reduces pancreas related morbidity.Note the complete transection between head and neck of pancreas with a rounded fluid collection separating the two fractured fragments.

Friday, January 14, 2011

Carcinoma Prostate-Osteoblastic Metastases

The balance between the activities of osteoblasts  and osteoclasts determines the phenotype of metastatic bone lesions, and both osteoblasts and osteoclasts have been implicated — directly or indirectly — in bone metastasis.  Metastases from prostate cancer, most of which are adenocarcinomas, nearly always form osteoblastic lesions in bone; by contrast, bone metastases from kidney, lung or breast cancers more often are osteolytic. This is 61 year old male known case of ca prostate with extensive osteoblastic secondaries seen in plain film and CT sections clearly.  Other causes of osteoblastic secondaries are breast, stomach, carcinoid, TCC bladder.

Thursday, January 13, 2011

Chronic Trauma with Diffuse Axonal Injury-MRI

During the chronic stage of traumatic brain injury, T2*-weighted gradient-echo imaging at high field strength is superior to T1- and T2-weighted MR imaging in the detection of lesions suspicious of diffuse axonal injury. Based on the signal intensity characteristics on T2*-weighted gradient-echo images, most of these lesions are hemorrhagic.

 This is young male patient with old history of RTA and persitent vegetative state. GRE images shows punctate blood products in the bifrontal and left temporal white matter. Focal bleed is also noted in the rostral midbrain and superior cerebellar peduncle, along with cerebellum. Findings in his clinical setting are consistent with diffuse axonal injury.

Wednesday, January 12, 2011

Who earns from Radiology more?

This question is often asked in the radiology circles these days. Is it true that non-radiologists are earning more from radiology than radiologists themselves? Answer to this unfortunately, is true for India atleast. Diagnostics forms a major cash cow in the healthcare industry.  Diagnostic centres,  along with pathology labs is usually regarded as one of the cleaner business in healthcare. No surgeries, negligible mortalities further add to the charm of this business.  This would have made most of the radiologists millionaires in India, however, truth is to the contrary.  Leading business houses and investors like Ranbaxy, Piramal, and even Lal Pathology labs have been attracted to this segment in recent past.  Radiologist owned centres are getting fewer by the day.  We need more entrepreneur radiologists in India to prevent radiology to be totally taken over by businessmen like hospitals and corporate have taken over nursing homes and small time clinics. Another factor that is eating into radiologists money is incentives offered to the referring physicians, which are particularly higher in Northen India segment.  If these things are not taken into account and younger enterprising radiologists don’t come forward to keep control of this business, it will be difficult to  remain biggest shareholder in the diagnostics business. 

Monday, January 10, 2011

AIPG 2011 Radiology Recall Questions

Aortic knuckle shadow on PA CXR, obliterated by consolidation of which portion of lung?
upper lingula 
lower lingula 
apex of lower lobe 
posterior part of upper lobe

Answer- Posterior part of upper lobe.

CT least accurate for: 
a. 1 cm of aneurysm in hepatic artery 
b.1 cm of lymph node in para-aortic region
c.1 cm of pancreas mass in tail
d. 1cm gall stone

answer-d) 1cm gall stones

Dose of radiation reqd for haematological syndrome: 
a. 2.5 cGY 
b. 10 cgy 
c. 100 cgy 
d. 200 cgy

Answer- 100cGy

Best investigation for bone metastases:
c.bone scan 
d. x ray

Answer- c) Bone scan

Answers by Delhi Academy of Medical Sciences (P) Ltd

Saturday, January 08, 2011

Carpal Tunnel Lipoma-MRI

There is evidence of mixed signal intensity oblong lesion with fatty and low signal intensity areas in the carpal tunnel with bulging of the flexor retinaculum. Differentials include perineural lipomatous lesion of the median nerve. This is a 25 year old female patient.

Friday, January 07, 2011

Optic Neuritis-MRI

Optic neuritis is defined as inflammation of the optic nerve. It is one of the causes of acute loss of vision associated with pain. Optic neuritis can be the initial episode for a patient who will subsequently develop multiple sclerosis.  Thin fat-suppressed T2-weighted images, such as short tau inversion recovery sequences, through the optic nerves may show characteristic high-signal intensity foci in the minimally or nonexpanded nerve. These lesions frequently enhance following intravenous contrast administration, which is not seen in a healthy optic nerve.  In our case DWI was also used which shows expanded left optic nerve with bright signal on DWI and enhancement on CEMRI. In this patient MRI brain had no evidence of MS.

Thursday, January 06, 2011

Schizophrenia with Arachnoid cyst-Doubtful Association

This is 45 year old male with schizophrenia and reveals prominent anterior temporal CSF space which may indicate arachnoid cyst along with  asymmetric atrophy of the temporal lobes. It is difficult to tell whether the lesion was innocent or not regarding this patient's overall psychiatric picture.  Although, literature review has revealed some cases of arachnoid cyst associated with psychosis.

" Arachnoid cysts are rare, benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid (CSF). In most cases they are diagnosed by accident. Until recently, the coexistence of arachnoid cysts with psychiatric disturbances had not been closely covered in the literature. However, the appearance of some references that focus on a possible link between arachnoid cysts and psychotic symptoms has increased the interest in this subject and raised questions about the etiopathogeny and the therapeutic approach involved." [2]

"Studies have demonstrated various other structural abnormalities. Most studies do not find abnormalities of whole brain/intracranial contents, while lateral ventricle & third ventricle enlargement is frequently reported. The temporal lobe was the brain parenchymal region with the most consistently documented abnormalities. Volume decreases especially involving the superior temporal gyrus. About two thirds of the studies of subcortical structures of thalamus, corpus callosum and basal ganglia show positive findings, as do almost all studies of cavum septi pellucidi (CSP). " [1]

Reference --
  1. Biol Psychiatry. 1999 May 1;45(9):1099-119. MRI anatomy of schizophrenia.
  2. Arachnoid cyst in a patient with psychosis: Case report. Annals of General Psychiatry 2007, 6:16

Rheumatoid Arthritis- Hip

There is marrow edema and synovial collection involving the right hip in a 70 year old female. Pathological examination of the surgery specimens revealed significant synovial hypertrophy and diagnosis of Rheumatoid arthritis was made.

Wednesday, January 05, 2011

Ulnar Variance

A short ulna, or minus ulnar variance, leads to increased application of force to the radial side of the wrist and to the lunate bone, which may underlie the association of negative ulnar variance and Kienbocks disease. This is a case showing short ulna or negative ulnar variance.  On the other hand, long ulna, or positive ulnar variance, causes the ulnar impaction syndrome.

Tuesday, January 04, 2011

Now MRI provides insight into birthing process

MRI scans live birth

“ Berlin’s CharitĂ© Hospital has achieved a world-first by creating MRI images of a baby being born in order to provide extraordinary insights into the birthing process.”

Saturday, January 01, 2011

Juvenile angiofibroma-CT

Juvenile angiofibroma (JNA) is a benign tumor that tends to occur in the nasopharynx of prepubertal and adolescent males. This is 14year old male with epistaxis.  The tumor starts adjacent to the sphenopalatine foramen.  This tumour is enhancing, bilobed or dumbbell-shaped, with one portion of the tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa. This mass is seen to erode into sphenoid sinus and displaces the posterior antral wall anteriorly (antral bow sign)

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