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   2017| January-June  | Volume 24 | Issue 1  
    Online since January 11, 2017

 
 
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CASE REPORTS
Malignant infantile osteopetrosis
L Appaji, BS Aruna Kumari, K Govind Babu, Gita R Bhat
January-June 2017, 24(1):76-78
DOI:10.4103/1115-3474.192754  
Background: Malignant infantile osteopetrosis (MIOP) is an autosomal recessive disorder which is characterized by densely sclerotic bone due to defective function of osteoclasts. Overgrowth of bone results in nerve compression and reduction of marrow spaces. It may be complicated by rickets. The main genetic causes are the mutations in the TCIRG1 and CLCN7 genes. Stem cell transplantation offers the only hope for cure. Early diagnosis is of prime importance. Case Presentation: We report a four month old female infant, who was diagnosed to have MIOP while being evaluated for raised total count, thrombocytopenia, hepatosplenomegaly and optic atrophy. An infantogram helped us clinch the diagnosis as she had most of the radiological signs that have been described. She was also found to have co-existent rickets. Mutation analysis and hematopoietic stem cell transplantation were deferred by her parents due to financial constraints. Conclusion: MIOP should be kept in mind when the patient presents with hematological abnormalities such as anemia, thrombocytopenia and leukemoid reaction along with hepatosplenomegaly and optic atrophy. Our case is worthy of mention, because a high index of suspicion and meticulous interpretation of the infantogram helped us arrive at the diagnosis.
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ORIGINAL ARTICLES
Opaque hemithorax: Clinical, histological and radiological assessment of 30 cases at a tertiary care hospital- a preliminary study
Vijay Narsidas Vaidya, Prakash Anantray Vohra, Balaji Wasudeo Ghugare
January-June 2017, 24(1):34-37
DOI:10.4103/1115-3474.198090  
Background: Whitening out of half of the lung field on a chest X-ray is known as opacification of a hemithorax, and its presence usually indicates a significant disease in a patient. This study was done with an aim of finding different etiologies as the cause of complete opacification of a hemithorax on chest radiograph. Materials and Methods: An observational cross-sectional study of patients whose chest radiograph had opaque hemithorax was included and after clinical laboratory and advanced radiological - ultrasonography (USG) and computed tomography investigation of these patients the diagnosis responsible for the complete opacification of half the lung field in chest X-ray was recorded. Results: A total of 30 patients (23 males and 7 females) were enrolled for the study. Out of the 30 patients, 17 involved the left while 13 involved the right hemithorax. Fifteen patients had clear pleural effusion, 13 patients had mass with pleural effusion and 2 patients were postpneumonectomy cases. Mediastinal shift to contralateral side was seen in 18 out of 30 patients having opaque hemithorax. Eleven patients have biochemical features of tuberculosis. All 13 patients with mass and effusion were confirmed to have malignancy on histology. USG could detect malignancy in only ten cases. Chest pain was most frequent symptom and smoking or tobacco habit was associated with 14 cases. Conclusion: Plain pleural effusion was the most common etiology of opaque hemithorax in our study followed by mass with effusion. Among other rarer causes, only pneumonectomy was seen. For other rare causes that may present as opaque hemithorax larger study may be done.
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CASE REPORTS
Atresia of the proximal left common iliac artery complicated by a completely thrombosed saccular aneurysm of the terminal abdominal aorta in a Nigerian female
Charles Chibunna Ani, Augustine Zoomsen Sule
January-June 2017, 24(1):104-108
DOI:10.4103/1115-3474.198154  
Congenital atresia of the common iliac artery is rare. A case of atresia of the left common iliac artery in a 40-year-old mother of three which was complicated by saccular aneurysm of the terminal abdominal aorta is reported. Radiological investigations revealed massive and complete thrombosis of the aneurysmal sac. Atresia of the proximal left common carotid was confirmed at surgery. Postoperative follow-up radiological investigations show return to normal caliber of the abdominal aorta.
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A case series of tuberous sclerosis complex: Clinico-radiological study and review of the literature
R Kukreja, M Mital, PK Gupta, N Rathee
January-June 2017, 24(1):109-115
DOI:10.4103/1115-3474.198155  
Introduction: Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant disorder characterized by a variety of hamartomatous lesions in various organs. The diagnosis is usually established on the basis of diagnostic criteria related to clinical and/or radiologic findings. Since the classical Vogt triad of seizures, mental retardation, and adenoma sebaceum are seen in only a minority of cases, radiology plays an important role in diagnosis of the disease. The aim of the study is to evaluate the clinico-radiological pattern in this disease. Materials and Methods: A clinical and radiological evaluation of 4 cases of suspected TSC was conducted within a period of 18 months. Results: All the four patients were below 25 years of age. Two patients were female and two were male. All the 4 patients had a history of seizures, while 2 also had mental retardation. One patient had hypomelanotic macules. On imaging, all the 4 patients showed neurological involvement in the form of cortical tubers, subependymal nodules, and white matter abnormalities while only one patient showed radial migration lines. One patient additionally showed the presence of cardiac rhabdomyoma. Conclusion: In addition to clinical examination, imaging plays a very important role in identifying the abnormalities of TSC and other additional features.
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Hemimegalencephaly in a 3-month-old male infant: A case report from port harcourt and review of the literature
Enighe W Ugboma, CE Agi
January-June 2017, 24(1):79-81
DOI:10.4103/1115-3474.192755  
Introduction of magnetic resonance imaging (MRI) in Port Harcourt, South-South geopolitical region of Nigeria, has led to an increase in the number of diagnosis of congenital cerebral malformations within the locality. Reported cases of hemimegalencephaly from Nigeria and indeed from the West African subregion are very scarce. Here, we report a case seen in Port Harcourt where the diagnosis was made possible by MRI and illustrating the imaging features of this rare condition.
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Xanthogranulomatous pyelonephritis complicated by spontaneous pyeloduodenal fistula: Role of computed tomography scan
Aparna Juneja, Basant Kumar, Argha Chaterjee, Hira Lal
January-June 2017, 24(1):68-70
DOI:10.4103/1115-3474.172092  
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory disease of the kidney. It is uncommon in children, and formation of spontaneous pyeloduodenal fistula is exceedingly rare. Computed tomography (CT) scan is useful in comprehensive preoperative evaluation and detection of associated congenital anomalies. It is also accurate in detection and delineation of fistulous tracts. We present a case of XGP in a young girl with malrotation of gut and horseshoe kidney complicated as spontaneous pyeloduodenal fistula and psoas abscess. Here, we demonstrate the role of imaging, especially CT scan, in the preoperative diagnosis of such fistula.
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Ultrasound-guided thrombin injection for the treatment of iatrogenic pseudoaneurysm of the right brachial artery
Sadisu Mohammed Maaji, Madhan Kumar, Sanjeev Kumar, Gurpreet Singh Gulati
January-June 2017, 24(1):71-75
DOI:10.4103/1115-3474.179257  
Iatrogenic vascular injury is an abnormal state that occurs in patients as a result of inadvertent or erroneous treatment by physicians or surgeons. Pseudoaneurysms need to be distinguished from true aneurysms. Pseudoaneurysm is a dilatation of an artery with actual disruption of one or more layers of its wall, rather than with expansion of wall layers. Recently, several reports have suggested that ultrasound-guided thrombin injection is a safe, effective, and rapid therapy for the treatment of pseudoaneurysm and without being associated with the limitations of ultrasound-guided manual compression.We report a case of a 38-year-old patient who had brachial artery pseudoaneurysm and was successfully managed with ultrasound-guided thrombin injection.
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The currarino syndrome presenting as neonatal intestinal obstruction in a Nigerian male child
Sefiya Adebanke Olarinoye-Akorede, Abdullahi O Jimoh, Aliyu O Akano, Nuhu Dang Chom
January-June 2017, 24(1):82-85
DOI:10.4103/1115-3474.192757  
We describe the first documented radiologic findings of complete Currarino triad presenting as neonatal intestinal obstruction in a Nigerian male child. A 1-week-old male neonate was admitted for rectal agenesis and had a divided colostomy during which an anterior sacral meningocele was discovered intraoperatively. The imaging evaluation revealed further, the triad of a partial sacral defect, anorectal atresia, and anterior sacral meningocele. These radiologic findings define the rare association known as the Currarino syndrome (CS). The CS expresses a wide phenotypic expression, and so its diagnosis may be elusive. This case emphasizes the need for physicians to be cognizant of the clinical presentation and radiologic findings of CS. It is a triad to remember in infants with anorectal malformations and even older children or adults presenting with chronic constipation.
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Multisystemic anomalies in conjoined twins: The role of imaging in management
Mohammed Kabir Saleh, Osawe Austine Abebe, Idris Sule Kazaure, Mohammad Abba Suwaid, Abdulkadir Musa Tabari, Kabiru Isyaku, Anas Isma'il
January-June 2017, 24(1):86-89
DOI:10.4103/1115-3474.192758  
Conjoined twins (CT) represent one of the rarest and most challenging congenital malformations arising as an unfortunate complication of monozygous twinning, with an estimated incidence ranging from 1 in 50,000 to 100,000 pregnancies, with an overall true incidence of about 1 in 200,000 live births with around 60% of them being stillborn. The types of the twins may differ depending on the site of fusion or nonseparation. The most commonly encountered types are thoraco-omphalopagus (28%), thoracopagus (18%), omphalopagus (10%), parasitic twins (10%), pygopagus (6-19%), and craniopagus (6%), with the pygopagus twins having the highest survival rate. Because of the highly variable and complex anatomy and associated malformations, skilled clinical assessments aided by detailed radiological studies, appropriate planning, and teamwork are required for the successful separation of the CT. The role of imaging in the diagnosis and management of missed diagnosed intrauterine case of pygopagus type CT was presented. At delivery, they were found to have sacral fusion on radiography with distal, rectal fusion on limited barium enema. Magnetic resonance imaging demonstrated distal spinal cord fusion with vascular anomaly found on computed tomography angiography. The surgical separation of the patients was successful with satisfactory postoperative lives.
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Muscle metastasis from prostate cancer
Andrianah Emmylou Gabrielle Prisca, Rajaonarison Ny Ony Narindra Lova Hasina, Razafindraibe Kanto Adrienne, Ahmad Ahmad
January-June 2017, 24(1):90-92
DOI:10.4103/1115-3474.192759  
We report an exceptional case of prostate cancer metastasis sites discovered on ultrasound, of the abdominal muscle, subcutaneous and liver.
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Vertebrobasilar dolichoectasia
Eswaradass Prasanna Venkatesan, Ramasamy Balakrishnan, Kalidoss Ramadoss, G Gnanashanmugham
January-June 2017, 24(1):93-95
DOI:10.4103/1115-3474.198148  
Vertebrobasilar dolichoectasia (VBD) is an uncommon vasculopathy which causes enlargement, tortuosity, or elongation of vertebral and basilar arteries. It is also called dilative arteriopathy. It is a rare anomaly with an incidence of 0.06%-5.8%. Posterior circulation arteries are more commonly affected than anterior circulation arteries. More than 40% of patients with VBD are asymptomatic. It may also present as ischemic stroke, hemorrhagic stroke, compression of cranial nerves and brainstem. VBD can be due to either atherosclerosis or congenital abnormalities such as Marfan's syndrome, Ehlers-Danlos syndrome, and Fabry's disease. Here, we describe a case of a 60-year-old male who presented with an episode of generalized seizure. His metabolic workup was negative for seizure. As a part of evaluation, he underwent computed tomography (CT) scan of brain and magnetic resonance imaging of the brain with magnetic resonance angiogram (MRA). His CT/MRA revealed VBD. He was treated with phenytoin and made a good recovery. VBD presenting as stroke is well known in literature, but here we report a rare case of VBD presenting as seizure.
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Abdominal wall endometriosis ten years after surgery
Kemal Arda, Halil Ibrahim Serin
January-June 2017, 24(1):96-98
DOI:10.4103/1115-3474.198149  
Endometriosis is the presence of normal and functional endometrial mucosa outside the uterine cavity. Endometriosis near the operation scar (scar endometrioma) is a rare form of extrapelvic endometriosis. It is mostly seen after C-section deliveries. The time for diagnosis of abdominal wall endometriosis (AWE) in the rectus abdominis muscle (RAM) after surgery varies between 2 months and 4 years. Herein, we report a case of a 42-year-old female of AWE in the RAM which was diagnosed 10 years after C-section delivery.
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Asymptomatic unilateral pulmonary hypoplasia/agenesis in adults: A report of six cases
Funsho Komolafe, Mohammed Haroun Dahniya, Yesar Al-Ali, Lemya Al-Zaabi, Fadhil Aziz
January-June 2017, 24(1):99-103
DOI:10.4103/1115-3474.198151  
Bilateral pulmonary agenesis is incompatible with extrauterine life. Unilateral pulmonary hypoplasia or agenesis is rare, the vast majority of cases presenting in the newborn, infancy, or early childhood, with respiratory symptoms. Pulmonary hypoplasia or agenesis presenting in adults is extremely rare, and the initial chest radiographs may present significant interpretation challenges. We report six patients encountered incidentally in a 10-year period, during which approximately 400,000 routine adult chest radiographs were reported. In all six cases, the chest X-ray films were equivocal, and multidetector computed tomography (CT) was required to settle the diagnosis. The cases are presented to draw the attention of radiologists and physicians to this rarity and to avert the kind of initial errors that we made in interpreting their chest radiographs. The invaluable role of multidetector CT in resolving this potential confusion is emphasized. A brief review of the relevant literature is undertaken.
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LETTER TO EDITOR
MSK radiology 4u: The premiere musculoskeletal imaging resource
Christine Azzopardi, Cass Chisholm, Steve James, Rajesh Botchu, A Mark Davies
January-June 2017, 24(1):116-116
DOI:10.4103/1115-3474.192760  
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ORIGINAL ARTICLES
A study of various chest radiological manifestations of pulmonary tuberculosis in both human immunodeficiency virus-positive and human immunodeficiency virus-negative patients in south Indian population
N Ravi, BR Nagaraj, Bagath K Singh, Santosh Kumar
January-June 2017, 24(1):14-19
DOI:10.4103/1115-3474.192751  
Context: The chest radiography is an essential diagnostic tool in assessing the pattern and progression of pulmonary tuberculosis (PTB), which helps in taking suitable clinical decisions. Aims: The aim of this study is to bring out any specific radiologic pattern in PTB among human immunodeficiency virus (HIV) infected and noninfected and make an attempt to systemize reporting and recording radiographic findings. Settings and Design: Patients of all age groups with sputum positivity were included in the study and divided into groups based on gender, age and HIV-infected and noninfected patients. Chest radiographs were taken and assessed for findings. Materials and Methods: Data for the study were taken from sputum acid-fast bacilli positive patient's referred to the Department of Radiodiagnosis for chest X-ray and were evaluated with standard posterior-anterior chest radiograph. Statistical Analysis Used: Documented observations were compiled using  SPSS-16.5 software (IBM). Univariate analysis was carried out for data interpretation. Findings/Results: Chest radiographic pattern change between HIV and noninfected cases. Lymphadenopathy was more common in patients with low CD4 count, predominantly involving the right hilar and mediastinal nodes. Large opacities with mid zone predilection, smaller opacities involving both upper zones, and bilateral lung involvement in patients with HIV coinfection was indicative of low CD4 count. Conclusions: In the present study, it was observed that major chest radiographic pattern change between patients with HIV and noninfected cases were increase in large opacities, decrease in cavity formation, increase in pleural effusion, no apical cap, and no volume loss. Lymphadenopathy was more common in patients with low CD4+ count (<200 cells/dl).
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An investigation into the radiological waste management of selected centers in Kano metropolis, Nigeria
Mohammed Sidi, Chigozie Nwobi, Abdu Hamisu Dambatta
January-June 2017, 24(1):20-24
DOI:10.4103/1115-3474.198079  
Background: There is a need for every radiological facility to have an effective method of waste management for environmental protection and cost-effectiveness. Most of the waste produced by the facilities could be reclaimed and recycled for medical and industrial purposes. Study Aim: This study aims at investigating radiological waste management in some selected centers in Kano metropolis. Materials and Methods: The study design is descriptive in nature. Using purposive sampling method, eleven centers were selected. These are the hospitals and private centers that use automatic, manual, or both processing methods in their units. An unstructured interview was conducted with the technician in-charge of the various processor units. The audio-taped interview was converted to text notes for content analysis. The data were analyzed using standardized, open-ended content approach. Samples of spent solutions were analyzed for silver concentration using quantitative analysis. Results: Film processing units of radiological facilities in Kano metropolis drained their spent radiographic films processing solutions directly into general drainage system without being treated. The waste radiographic films and X-ray film packages were being discarded into dustbins. Quantitative analysis shows a high concentration of silver in the spent solutions; the average concentration of silver in spent developer, rinse, fixer, and wash solutions was found to be 1.4 mg/L, 0.9 mg/L, 5.2 g/L and 2.8 mg/L, respectively. Conclusion: There is no systematic system of waste disposal in Kano metropolis of Nigeria.
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Pattern of lumbosacral magnetic resonance imaging findings in diagnosed cases of disc degenerative disease among Nigerian adults with low back pain
Uzoamaka Rufina Ebubedike, Eric Okechukwu Umeh, Godwin I Ogbole, CA Ndubuisi, Wilfred C Mezue, Samuel C Ohaegbulam
January-June 2017, 24(1):25-29
DOI:10.4103/1115-3474.192752  
Background: Lumbar spine disc degenerative disease (DDD) has been proven to be the most common cause of low back pain which causes musculoskeletal disability. Magnetic resonance imaging (MRI) allows detailed evaluation of all components of the lumbar spine and assesses abnormalities that may be associated with disc degeneration. Objective: To document the frequency of lumbosacral MRI findings in DDD with correlation to age, gender, and lumbar disc level. Methodology: Two hundred and eighty-one out of three hundred archived magnetic resonance images of patients aged 18 years and above investigated for low back pain at Memfys Hospital for Neurosurgery were enrolled into the study. Axial and sagittal magnetic resonance images were acquired at 5 mm slice thickness with 1 mm gap using spin echo pulse sequence. Results: The mean age of the study population was 55.11 years with a range of 18-91 years. Highest frequency of disc degenerative changes fell within 50-59 years age group and L4/L5 level with male preponderance. Positive findings were disc bulge 51.2%, disc protrusion 87.5%, disc extrusion 19.6%, disc sequestration 1.78%, Modic endplate changes 47.4%, Modic I 10.7%, Modic II 15.3%, and Modic III 21.4%. Logistic regression analysis showed that only posterior disc protrusion and disc bulge were significant. Odd ratio 0.062 and 0.015, respectively, while the beta values are −4.190 and −2.780, respectively. Conclusion: The most common lumbosacral MRI findings in diagnosed cases of DDD among patients with low back pain in this study were posterior disc protrusion, posterior disc bulge, and endplate changes.
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The comparison of x-ray attenuations of contrast media in different dilutions: An experimental study
Halil Ibrahim Serin, Kemal Arda, Halil Kara, Hasan Aydin
January-June 2017, 24(1):30-33
DOI:10.4103/1115-3474.198087  
Aims: Iodinated contrast materials are used as contrast material in radiologic examinations. There is an intense competition between the contrast media companies in the contrast market in areas such as price, effectivities, and lack of side effects. This experimental study was carried out for comparing the effectiveness of contrast agents. We measured X-ray attenuations of contrast agents because image quality depends on these attenuation amounts. Materials and Methods: Contrast agents are divided into two main groups in iodinated contrast materials; ionic-iodinated contrast agents and nonionic-iodinated contrast agents. Nonionic contrast materials are iopamidol, iohexol, iopromide, iobitridol, and iomeprol. In this study, by using contrast agents in different dilutions, X-ray attenuations were examined in Hounsfield units by using computed tomography. Results: There was no statistically significant difference between the slopes of five commercial forms according to dilutions. Conclusion: From our study, we concluded that iopamidol, iohexol, iopromide, iobitridol, or iomeprol are same in clinical usage.
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Cross-sectional study on incidental spinal findings in magnetic resonance imaging lumbar spine of patients with low back pain
Binoj Varghese, Arun C Babu, Ashok Kumar, PS Priya, Jaison S John, Mohammed Noufal, KM Sivasubramaniyan
January-June 2017, 24(1):38-44
DOI:10.4103/1115-3474.198091  
Background: Incidental finding is an observation, not related to the current medical problem. Various incidental findings can be seen in the lumbar spine (LS) magnetic resonance imaging (MRI) taken for evaluation of low back pain. Aims: To evaluate and analyze the spinal incidental findings in MRI LS of patients with low backache. Settings and Design: A retrospective, cross-sectional analytical study. Materials and Methods: All patients (n = 1269, males: 578, females: 691; mean age: 45 ± 15 years) with low backache, who underwent MRI of the LS at a tertiary care hospital in South India, during a period from January 2011 to August 2015. Two radiologists evaluated these examinations for the presence of incidental findings in consensus. We included fatty vertebral hemangioma (FVH), fatty filum terminale (FFT), extraspinal synovial cyst (SC), Tarlov cyst (TC), enostosis, and limbus vertebrae. Statistical Analysis Used: Calculated the prevalence of incidental findings and analyzed the relationship of these incidental findings with patient demographics. Results: Overall, incidental spinal findings were present in 390 patients (30.7%). FVH was the most common incidental finding (n = 205 patients, 16.16%), followed by extraspinal SC (n = 130 patients, 10.2%), and FFT (114 patients, 9%). A pattern of increasing frequency with age noted in the FVH (P = 0.001), TC (P = 0.017), and enostosis (P = 0.008). There was no significant sex predilection for the incidental findings. Conclusion: Incidental findings are common in LS MRI. Understanding on the nature and prevalence of these lesions is essential for the radiologist, for optimal reporting and for the clinician in appropriate interpretation of radiological reports.
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Role of preoperative multidetector computed tomography diagnosis of solid pseudopapillary tumors of the pancreas with postoperative surgical and histopathological correlation
Rakhee Kumar Paruchuri, Harvarshdan Ramanjaneylu Kuruba, Deepthi Pathapati, Aruna Prayaga
January-June 2017, 24(1):45-51
DOI:10.4103/1115-3474.198105  
Purpose: The purpose of this study was to evaluate the role of preoperative multidetector computed tomography (MDCT) diagnosis of solid pseudopapillary tumors (SPTs) of the pancreas with postoperative surgical and histopathological correlation. Materials and Methods: A prospective study was conducted in our institute for MDCT evaluation of patients with ultrasound-proven pancreatic tumors. Preoperative diagnosis of SPT was given in 10 of 36 total patients evaluated. These findings were correlated with surgical and histopathological findings. Results: A preoperative MDCT diagnosis of SPT was given in 10 patients on the basis of characteristic CT appearances, of which 9 were confirmed by postoperative histopathology. One was a histopathological examination (HPE) proven to be a neuroendocrine tumor. Two MDCT-negative but HPE-positive cases gave a total of 11 of 36 patients. 10 patients were females with a mean age of 27 (range 16-38 years). 6 lesions were identified in the head, with the average size of the lesions being 6.5 cm. No SPTs with malignant features were diagnosed on MDCT or HPE in our study. The sensitivity of MDCT to identify SPT in this series is 81.81%, specificity 96%, positive predictive value of 90%, negative predictive value of 92.31%. Conclusion: MDCT has a high specificity and positive predictive value with higher negative predictive values for diagnosing SPTs. However, atypical lesions pose a diagnostic challenge. A diagnosis with a greater degree of confidence can be made using knowledge of characteristic appearance on MDCT along with clinical correlation. The majority are benign, but follow-up is suggested if signs of aggressiveness are identified radiologically or by HPE.
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A technique for appropriate inferior collimation in chest radiography of asymptomatic negroid adults
Thomas Adejoh, Hyginus C Ezeh, Michael E Aronu, Christian C Nzotta, Stanley O Nwefuru
January-June 2017, 24(1):52-55
DOI:10.4103/1115-3474.198108  
Background: Unnecessary exposure of the abdomen during chest radiography can lead to a substantial increase in radiation dose. Objective: To develop a new technique for reducing unnecessary abdominal irradiation during chest X-ray. Methodology: The work was designed to radiographically test the hypothesis that the umbilicus which is an external landmark that can both be seen and felt is the most appropriate anatomical landmark to consider as inferior collimation border in chest examinations. Computed tomography was used to confirm L3 and L4 as the corresponding dorsal bony landmark of the lower costal margin and umbilicus, respectively. Participants were radiographically examined with a collimation at an axial plane, 5.5 cm superior to the umbilicus. The maximum distance between the most inferior costophrenic angle and the collimation border on the radiograph was also determined. Data were manually tabulated. Results: The radiographs of 222 male and 216 female (n = 438) individuals were analyzed. 5.5 cm collimation coincided with L2 to T11 levels with 61% of individuals having costophrenic angles at T12 while only 3.7% had it high up at T10. No incidence of costophrenic angle cutoff was observed. Conclusion: Inferior collimation for chest X-ray in adults is adequate at an axial plane 5.5 cm superior to the umbilicus along the xipho-umbilical line on a patient at full inspiration. This point is a constant landmark when compared to X-ray beam centering point for chest radiography in the same patient which will be variable.
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Transarterial embolization of nonvariceal gastrointestinal bleeding: Our experience
Sheo Kumar, Basant Kumar, Archana Gupta, Laxmi Kant Bharti, Anuj Thakral
January-June 2017, 24(1):56-60
DOI:10.4103/1115-3474.198113  
Objective: To analyze the technical and clinical outcomes of transarterial embolization in patients with nonvariceal gastrointestinal (GI) bleeding in our institute. Materials and Methods: From July 2009 to June 2013, retrospective data of all patients with nonvariceal GI bleeding who underwent catheter-directed angiography with or without Transarterial Embolization (TAE) were collected and included in the study. All were inpatients at the time of the procedures, and they were followed up till discharge or demise. Results: Out of 152 patients, 127 cases (age - 12-94 years; median age - 47 years) of GI bleeding were included in the study. Male to female ratio was ~4:1. Catheter-directed angiography was tried in all 127 patients. Out of 37 patients (29%) who had a normal angiogram, 26 (70%) improved spontaneously without embolization whereas in 11 (30%) the bleeding source could not be identified even with a repeat angiogram and clinical evidence of haemorrhage requiring surgery. Out of 90 patients (71%) with angiographically visible bleeding; 88 (69.3%) had successful, catheter directed trans-arterial embolization (TAE) whereas in 2 patients (2.2%), the bleeding vessel could not be cannulated (technical failure). Complications were encountered in 11 patients (8.7%) and rebleeding occurred in 3 patients (3.4%). Angiography related mortality was 4.7% (6/127). Conclusion: Endovascular treatment can be performed safely in sick patients. It is technically demanding, and it is not always possible for anatomic reasons or because of distorted anatomy due to previous surgeries.
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Magnetic resonance imaging of lumbosacral intervertebral discs in nigerians with low back pain
Ademola Joseph Adekanmi, Temitope Olugbenga Bello, Omolola Mojisola Atalabi, Kamaldeen O Jimoh, Oluremi Ayoutunde Ogunseyinde
January-June 2017, 24(1):61-67
DOI:10.4103/1115-3474.192753  
Background: Magnetic resonance imaging (MRI) is the modality of choice in diagnostic imaging of the neurological structures related to low back pain (LBP). Particularly, in evaluation of the vertebral discs, its relationship to the nerve roots and related structures with precise diagnosis that guides the patient's management. This study evaluated the spectrum of intervertebral disc findings in LBP patients at two imaging centers in the South-West and North-Central Nigeria. Association between the clinical diagnosis and MRI disc findings was tested. Materials and Methods: This is a retrospective descriptive study. The request cards, reports, and available recorded images of patients referred for MRI for LBP from 2013 till 2015 were retrieved. The extracted patients' information, radiological findings were documented in a data form, with due compliance to confidentiality of the cohort and analyzed by Statistical Package for Social Sciences (SPSS) software (Version 20.0., IBM Corp. Released 2011, IBM SPSS Statistics for Windows, IBM Corp. Armonk, NY, USA) Results were presented as tables and test of association between variables carried out using Pearson t-test. Results: A total number of 205 patients were enrolled. Age range of the subjects was 10-83 years and mean age = 52.5 ± 15.4 years. There were more females with a male to female ratio of 1:1.04. LBP was more common in the fifth decade and least in ≤20 years (3%). MRI disc abnormalities increased with advancing age with statistically significant association between disc abnormalities and the patient's age, lumbar spondylosis, disc prolapse, and spinal canal stenosis. Conclusion: Disc abnormalities increased significantly with advancing age. Lumbar spondylosis, disc prolapse, and spinal canal stenosis are most commonly associated with florid disc abnormalities on MRI.
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An analysis on reliability of the lee and wildermuth magnetic resonance imaging grading systems for lumbar neural foraminal stenosis
Binoj Varghese, Arun C Babu
January-June 2017, 24(1):8-13
DOI:10.4103/1115-3474.192750  
Background: There is no uniformly accepted magnetic resonance imaging (MRI) grading system existing for lumbar neural foraminal stenosis (LNFS). Radiologists' reporting on neural foramen stenosis is qualitative and subjective. There are two grading systems proposed by Lee and Wildermuth. Aims : To evaluate the reliability between Lee and Wildermuth grading systems for lumbar foraminal stenosis and analyze their relative merits. Settings and Design: A retrospective, cross-sectional analytical study. Materials and Methods: A total of 136 consecutive patients (63 males and 73 females; mean age 56.3 years) aged above 40 years with low backache found to have degenerative disc disease after MRI of the lumbar spine at a tertiary care hospital in South India from July to September 2015. Two general radiologists reviewed the MRI studies independently for the presence and grading of stenosis at L3/4, L4/5, and L5/S1 neural foramina. They graded neural foramen stenosis with Lee and Wildermuth systems at different occasions and were blinded to all previous grading. Statistical Analysis Used: Interobserver agreement between the radiologists and intraobserver agreement by one radiologist for one system each were analyzed using kappa statistics. Results: Wildermuth system of LNFS showed substantially higher inter- and intra-observer agreements than Lee system. Overall inter-rater and intra-rater agreements (k) for Wildermuth system are 0.700 and 0.762, respectively, and that of Lee system are 0.394 and 0.702. Conclusions: Wildermuth system is more reliable than Lee system for general radiologists. It also accounts slight neural foramen stenosis without perineural fat obliteration unlike in Lee system.
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Normal second and third trimester uterine and umbilical doppler indices among healthy singleton gestation Nigerian women
Ademola Joseph Adekanmi, Adebola Roberts, Abiodun Oludotun Adeyinka, Eric Okechukwu Umeh, Franklin Anor, Joseph Chidi Odo, Adeniyi Olorunfemi Fagbohun
January-June 2017, 24(1):1-7
DOI:10.4103/1115-3474.198078  
Background: Uterine and Umbilical artery Doppler ultrasound is an established and safe tool for quantitative analysis of the utero-placental and the feto-placental blood flow in pregnancy. Aim: To evaluate the Doppler indices in the uterine and umbilical arteries of healthy pregnant women. These will serve as baseline values in predicting impaired blood flow velocimetry in hypertensive disorders of pregnancy that leads to serious maternal and foetal health compromise. Methodology: This was a prospective longitudinal study in consenting singleton gestation women. The right and the left uterine arteries and the umbilical arteries were interrogated. Doppler parameters; Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Resistive Index (RI), Pulsatility Index (PI) and the systolic to diastolic ratio(S/D) were obtained from each healthy pregnant indigenous Nigerian women. Pearson's correlation analysis of the relationship between these parameters and selected maternal demographic parameters was done. P < 0.05 was considered statistically significant. Results: The mean of the normal uterine and umbilical arteries values were different from most published reference values from other parts of the World. No correlation between these indices and maternal parameters were found in this study. Conclusion: Uterine and umbilical artery Doppler indices among normal indigenous pregnant African women are different from those from the developed World. Using other reference values may be inaccurate for pregnant women in our environment.
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