Tuesday, February 28, 2012

Osgood Schlatter disease

There is evidence of bony fragments in relation to the tibial insertion of the patellar tendon which may indicate possible Osgood Schlatter disease . This is 14 year old boy with anterior knee pain.

Telemedicine reaches new heights with in car monitoring

In-car health management services are intended to further patient-centered healthcare, have you ever wondered why can’t some clinical lab tests be performed by an automobile? Believe it or not, several car companies are preparing to introduce these types of features into their automobiles in coming years including Ford and Toyota. Features will include in car glucose monitoring and ECG sensors. Welcome to the future!

Saturday, February 25, 2012

Endocervical Fibroid Polyp-USG

This lady has a small mass in the endocervical canal marked by arrow. The mass is solid and inhomogenous, well outlined by fluid surrounding the tumor.  These ultrasound images suggest pedunculated fibroid of the cervix. The other differential of this mass is polyp of the cervical mass.

Friday, February 24, 2012

Posterior Urethral Valve-Antenatal Ultrasound

This is a case of a 20 weeks pregnant woman for routine scan, the liquor was reduced. Case submitted by Dr Prashant Gupta, Consultant Radiologist.

USG showed:

Dilated urinary bladder (green arrow) with dilated posterior urethra(red arrow) resembling a "key hole"

Dilated urinary bladder with hydronephrotic kidneys.

Wednesday, February 22, 2012

Latest issue of Radiology-Cerebral Circulation Time in MS

Study by Marcello Mancini, MD et al  in Radiology, 262, 947-955 suggest that contrast-enhanced US with CCT assessment may have a role in the evaluation of cerebral blood flow in patients with MS and that a vascular impairment could be associated with MS. The finding of a prolonged CCT at contrast-enhanced US does not result from outflow impairment. Further studies are required to verify these observations and to clarify if CCT and CCSVI have any physiologic and clinical relevance in MS.

Recurrent Shoulder Dislocation MRI

Evidence of deformed humeral head with defect measuring depth of around 5mm in the posterosuperior aspect of the humeral head likely consistent with hill sach's deformity.This type of injury is caused by impaction of the humerus against the anterior rim of the glenoid cavity. 
 Evidence of the cranial migration of the deformed humeral head reducing the acromiohumeral space and showing some impingement of the myotendinous junction of the supraspinatus tendon. There is evidence of detached & displaced anterior labrum from the glenoid rim  along with stripping of the scapular periosteum medially which likely indicates associated bankart's lesion, possibly perthes variant.
There is increased fluid in the glenihumeral joint along with fluid along the biceps tendon. Small osteocartilagenous defect is also noted in the anteromedial  humeral head which may indicate associated bony defect due to humeral avulsion of glenohumeral ligament (HAGL) which may further contribute to shoulder instability.

Free Clinical MRI Text Book-Useful Link.

Very useful link recently discovered by me on the web for Clinical-MRI text book. Shared here for all readers to use and learn This textbook is made available courtesy of the author and copyright holder, Val M. Runge, MD, for individual educational use only, both for viewing on the web and for download.

Monday, February 20, 2012

Pancreatitis CT Teaching File

Pancreas appears bulky and shows heterogenous enhacement along with fluid and stranding in the peripancreatic fat, mesentry and mesocolic region.  There is thickening of the anterior renal and lateroconal fascia with relative preservation of the perirenal fascia. Areas of calcification/calculi are noted in pancreatic uncinate process along with small density in the distal CBD which may indicate associated choledocolithiasis.  These findings are suggestive of acute pancreatitis which may be super imposed on chronic pancreatitis, indicated by parenchymal calcification. 


Coronary CT Angiography- Anatomy

  • Left Main or left coronary artery (LCA)
    • Left anterior descending (LAD)
      • diagonal branches (D1, D2)
      • septal branches
    • Circumflex (Cx)
      • Marginal branches (M1,M2)
  • Right coronary artery
    • Acute marginal branch (AM)
    • AV node branch
    • Posterior descending artery (PDA)

Images by Dr Priya Chudgar, MD

Friday, February 17, 2012

Medical Imaging Mega-Cloud

Medical and IT researchers at Johns Hopkins University, healthcare application software supplier Harris Corp, and virtualization juggernaut VMware have teamed up to create a medical imaging cloud that they hope will become the central, secure repository for US citizens and the doctors who care for them

I think this has more merit in a country like India for penetration of health care. Any firm doing a similar job in India?

Read more

Thursday, February 16, 2012

CSF hydrodynamics and MS-New Etiology Theory

According to an article by Damadian RV, and Chu DThe possible role of cranio-cervical trauma and abnormal CSF hydrodynamics in the genesis of multiple sclerosis. Physiol Chem Phys Med NMR. 2011 ;41:1-17, a new hypothesis in etiopathogenesis of MS was suggested.  We have discussed suspected role of chronic venous sufficiency before in this blog as well.

According to the article:

  • There study was done on 8 patients. The UPRIGHT MRI has demonstrated pronounced anatomic pathology of the cervical spine in five of the MS patients studied and definitive cervical pathology in the other three. 
  • Upright cerebrospinal fluid (CSF) cinematography and quantitative measurements of CSF velocity, CSF flow and CSF pressure gradients in the upright patient revealed that significant obstructions to CSF flow were present in all MS patients. 
  • The obstructions are believed to be responsible for CSF "leakages" of CSF from the ventricles into the surrounding brain parenchyma which "leakages" can be the source of the MS lesions in the brain that give rise to MS symptomatology

Pulmonary Embolism-CTPA

Child with history of breathless and renal disease. Clinicians suspected pulmonary embolism. Arrows are seen marking the embolus in the pulmonary artery extending into the left pulmonary artery along with parenchymal infarction.

Whirlpool Sign-Ultrasound

This was a case of a 6 days old boy who had continuous vomiting most of the time bilious in nature. He was sent to rule out  hypertrophic pyloric stenosis (HPS). Case submitted by : Dr Prashant Gupta and Dr Himani Agarwal, Consultant Radiologists. 

The first image shows a normal pylorus (measurements not shown) 

The second and 3rd images reveal a "whirlpool" appearance of mesenteric root with mesenteric vessels twisted around it. Also note the "beak" like termination of the Duodenum as it crosses the midline. These findings suggest a midgut volvulus that has a similar presentation to HPS.

Tuesday, February 14, 2012

Basal Vein of Rosenthal Thrombosis-MRV

A 24 yr old female started having seizures lateralised to left side after delivery a month back. MRI brain was done which showed : edema in the right temporo-parietal region with no restricted diffusion, no post contrast enhancement.The region of edema did not conform to an arterial vascular territory. no hemorrhage was detected on GRE images. Considering classical history an MRV was done. Case Submitted by : Dr Prashant Gupta and Dr Himani Agarwal, Consultant Radiologists.

On first review all the major dural sinuses were normal. However on reviewing the source images with THICK MIP we found attenuated right deep sylvian vein and a non visualised right basal vein of rosenthal. (marked in RED).

Learning points (especially for residents)
- Look at other vessels other than major dural sinuses.
- Always review source images in thick and thin MIP in ALL planes.
- Edema not conforming to arterial territories needs a meticulous hunt for venous thrombosis, especially if the patient has a typical history.

Saturday, February 11, 2012

ACR Dose Index Registry-Success Story

According to the ACR Website-Since its launch less than a year ago, more than one million computed tomography (CT) scans have been contributed to the American College of Radiology Dose Index Registry (DIR) and compiled for analysis. Data collected from the DIR — which allows imaging facilities to compare their CT dose indices to regional and national values — is used to establish national benchmarks for CT dose indices to help ensure that patients receive safe, quality imaging care.  

Do we have a similar initiative in India?

Wednesday, February 08, 2012

Signs of ACL tear on MRI- Resident's Corner

Case showing most of the signs of ACL tear on MRI, submitted by Dr Prashant Gupta and Dr Himani Agarwal






Thymic Sail Sign-Plain Film

Frontal chest radiograph shows the thymic sail sign, which is created by the right lobe of the thymus abutting the minor fissure.

Tuesday, February 07, 2012

MDCT helps in detecting prostate cancer in 2200 year old mummy

Researchers subjected the mummy to ‬MDCT‭ ‬scans, which  revealed round and dense tumours between its pelvis and lumbar spine and these bone lesions were considered very suggestive of metastatic prostate cancer.  An interesting question was raised by this finding-as commonly environmental factors and modern lifestyle are known to be risk factors for cancers, but finding cancer in this old mummy possibly points to genetic origin being more predominant.

Read more:  Daily Mail UK

Monday, February 06, 2012

Glutaric Aciduria -CT

 Glutaric Aciduria Type I (GA-I) is an autosomal recessively inherited inborn error of metabolism characterized by the deficiency of the mitochondrial enzyme glutaryl CoA dehydrogenase  that catalyzes the dehydrogenation - decarboxylation of glutaric acid, an intermediary metabolite in the degradation pathway of lysine, hydroxylysin and tryptophan. CT brain shows widening of sylvian fissures. Features characteristic of GA I on MRI are fronto-temporal atrophy and bat-wing dilatation of the sylvian fissures, signal abnormality in both putamen and in the fronto-parietal deep white matter. Case Submitted by Dr Sofiane Zentout, Radiologist

Friday, February 03, 2012

Petrous Apex Cephaloceles-MRI

64 yr old female with non specific h/o headache.MRI scan (axial T1 and T2) showed well defined cystic lesions at both petrous apices with no surrounding edema, NCCT (not shown) showed no bony destruction.Sag T2 showed partial empty sella, however other signs of pseudo-tumor cerebri such as papilledema and prominent CSF around optic nerves was not seen. Both lesions were in direct continuity with meckel's cave. These are B/L petrous apex cephaloceles.  Case by : Dr Prashant Gupta  and Dr Himani Agarwal, Consultant Radiologists.

Learning points:
- not true "cephaloceles" as they do not contain brain tissue.
- actually they are herniation of posterolateral meckels cave into anteromedial petrous apex.
- etiology is debatable but said to be due to increased CSF pulsations.
- rare case reports of association with partial empty sella(as seen here)
- one of the "do not touch" petrous apex lesions

Grey matter heterotopia-MRI

 Grey matter heterotopias are believed to be due interruption of the normal migration of neurons from the periventricular telencephalic germinal matrix to the cortex and may be due to either genetic abnormalities or infection / trauma. Neuroblasts proliferate in the germinal matrix between  7 and 8 weeks of gestation. Migration take place from 8 to 26 weeks gestation, and is maximal between 8 and 16 weeks. This is best evaluated by MRI but CT may show with heterotopic grey matter having slightly higher density than the surrounding white matter and can thus be seen if sufficiently large. This is a case of young child with refractory epilepsy with CT shows areas of heterotopic gray matter. MRI was suggested.

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