Ankur Gadodia

MRI and MR sialography of juvenile recurrent parotitis

BackgroundJuvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders.ObjectiveTo describe the MRI and MR sialographic findings in children with JRP.Materials and methodsMR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1- and T2-W images were also performed.ResultsThe main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images.ConclusionMRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

The role of magnetic resonance imaging in fetal renal anomalies

To evaluate the role of magnetic resonance imaging (MRI) in fetuses with suspected renal anomalies after ultrasonography.

Magnetic resonance sialography using CISS and HASTE sequences in inflammatory salivary gland diseases: Comparison with digital sialography

Background: Inflammatory conditions are the most common pathology affecting the salivary glands. Magnetic resonance (MR) sialography has emerged as an alternative to conventional sialography for evaluation of inflammatory salivary gland diseases. Purpose: To prospectively evaluate the role and diagnostic accuracy of MR sialography in the diagnosis of inflammatory salivary gland disease. Material and Methods: Thirty-seven glands in 28 patients (19 males and nine females; mean age 31 years, range 3–65 years) presenting with inflammatory salivary gland disorders underwent MR sialography. Conventional sialography was used as the gold standard and was performed in 26 patients (34 glands). Thus, comparative evaluation was done in 26 patients (34 glands). Axial T1-weighted (T1W) and fat-suppressed T2W sequences, a constructive interference in steady state (CISS) sequence in the axial plane with maximum intensity projection (MIP)/multiplanar reformation (MPR) done in the axial and sagittal oblique planes, and a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in the sagittal oblique direction were performed. Results: Main salivary gland duct was visualized in 32 glands (94.1%) with MR sialography, and in all 34 (100%) glands with conventional sialography. Calculus and strictures were well demonstrated by MR sialography. MR sialography was superior for demonstration of the ductal system proximal to calculus/strictures. Sensitivity and specificity for diagnosis of specific pathology were 87% and 100% with CISS sequence and 90% and 75% with HASTE sequence, respectively. On using a combination of CISS and HASTE sequences, the sensitivity, specificity, and positive and negative predictive values in the diagnosis of specific pathology were 93%, 100%, 100%, and 64%, respectively. Conclusion: MR sialography using CISS and HASTE sequences is a promising technique and has the potential to replace conventional sialography in patients with inflammatory salivary gland disorders.

Spectrum of Synovial Pathologies: A Pictorial Assay

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Magnetic resonance identification of an accessory submandibular duct and gland: an unusual variant.

UNLABELLED We report a case of an accessory submandibular gland and duct which is extremely rare. MATERIAL AND METHODS A 20-year-old male presented with complaints of painful swelling in the right submandibular region. As a part of the radiological investigation, a radiograph occlusal view was taken digital sialography, magnetic resonance imaging and magnetic resonance sialography were performed. RESULTS Digital sialography revealed a small calculus distal to the punctum with diffuse dilatation of the main duct and intraglandular branches, which passed out spontaneously prior to magnetic resonance examination. The presence of an accessory submandibular duct was well delineated on both digital as well as magnetic resonance sialography. CONCLUSIONS Magnetic resonance sialography is helpful in delineating the anatomy of the submandibular duct non-invasively and without associated radiation exposure. To the best of our knowledge this is the first report of magnetic resonance identifying an accessory submandibular duct and gland.

Antenatal ultrasound and MRI findings of Pena-Shokeir syndrome

IntroductionPena–Shokeir syndrome is an autosomal recessive disorder characterized by arthrogryposis, facial anomalies (micrognathia), camptodactyly, polyhydramnios and lung hypoplasia.Case reportWe report prenatal ultrasonographic, antenatal MR and postnatal examination findings of a fetus with Pena–Shokeir syndrome.ConclusionPena–Shokeir syndrome is a potentially lethal condition and most cases are diagnosed prenatally by ultrasound. Fetal MR can be performed to look associated neurological malformation.

Tuberculous Abdominal Cocoon

A 22-year-old male patient presented with the complaints of upper abdominal colicky pain, intermittent bilious vomiting, and abdominal distension of 3-month duration. There was no history of peritonitis, abdominal surgery, or long-term medication. Clinical examination was unremarkable. Routine laboratory investigations revealed hemoglobin of 11 gm/dL, erythrocyte sedimentation rate (ESR) of 80 min the first hour and normal leukocyte count, platelets, electrolytes, renal, and liver function tests. Chest and abdominal radiograph were normal. Clinical diagnosis of subacute intestinal obstruction was made. Barium meal follow through (BMFT) revealed adherent small bowel loops with delayed transit time (Figure 1). Mucosal pattern and illeoceacal junction were normal. Multi-detector computed tomography (MDCT) of the abdomen showed a 3-mm-thick membrane encasing the small bowel loops and forming a saclike structure (Figure 2A). Sagittal and coronal reformation better demonstrated the entire disease process (Figure 2B). Omental thickening, retroperitoneal adenopathy, and free pelvic fluid were also demonstrated. Ultrasound-guided fine needle aspiration cytology (FNAC) of the omentum revealed caseating granuloma and giant cells. After surgery a post-operative histology confirmed diagnosis of tuberculosis. Figure 1. BMFT image shows adherent small bowel loops clumped in the central abdomen. Figure 2. Multi-detector computed tomography (MDCT) of the abdomen axial (A) and coronal reformatted (B) images reveal a 3-mm-thick membrane encasing the small bowel loops and forming a saclike structure. Described by Foo and others,1 abdominal cocoon is a rare cause of intestinal obstruction characterized by encasement of the small bowel by a thick, fibrous membrane. Sclerosing encapsulating peritonitis (SEP) also known as abdominal cocoon primarily affects adolescent females. The SEP can be classified as idiopathic or secondary to long-term peritoneal dialysis, beta-blocker practolol intake, orthotopic liver transplantation, abdominal surgery, sarcoidosis, systemic lupus erythematosus, gastrointestinal malignancy, and abdominal tuberculosis.2 Abdominal cocoon secondary to tuberculosis is rare with few reported cases.3,4 Clinical manifestations of abdominal cocoon are non-specific and include intestinal obstruction and/or abdominal mass.1–5 A majority of the reported cases were diagnosed incidentally at laparotomy. Preoperative diagnosis of abdominal cocoon is difficult because of non-specific clinical features and reduced awareness. Imaging (barium meal follow through and CT) studies play an important role in the definitive preoperative diagnosis of abdominal cocoon. Radiographs are not specific and may show evidence of small bowel obstruction. The BMFT shows reduced transit time and serpentine or concertina-like configuration of dilated small bowel loops in a fixed U-shaped cluster. The CT best shows the fibrous membrane encasing the bowel loops; thus, helps in reaching a definite diagnosis. Recent reports have emphasized the role of MDCT with saggital and coronal reconstructions in demonstrating the extent of disease for surgical planning and in showing subtle radiological findings.6,7

Magnetic Resonance Imaging of Mandibular Hemophilic Pseudotumor Associated With Factor IX Deficiency: Report of Case With Review of Literature

w f i i a t Hemophilic pseudotumor (HP) is an unusual complication of hemophilia and is characterized by chronic, encapsulated, slow-growing hematomas resulting from recurrent hemorrhages. HP occurs in about 1% to 2% atients with severe hemophilia and was first reported y Starker in 1918. The pseudotumor usually affects he femur, pelvis, tibia, and small bones of the hands nd feet. HP of the mandible is extremely uncomon, with only 15 cases reported to date in Englishiterature studies (Tables 1 and 2). All the reported ases of mandibular HP, with exception of 1 case were due to factor VIII deficiency. To the best of our knowledge, the magnetic resonance imaging findings of mandibular HP have not been previously reported. The purpose of the present study is to report a rare case of mandibular HP in 1 patient with factor IX deficiency (Christmas disease) and describe the magnetic resonance

Metabolic bone disease as a presenting manifestation of primary Sjögren's syndrome: Three cases and review of literature

Primary Sjögrens syndrome (pSS) is a chronic autoimmune disease characterized by a progressive lymphocytic infiltration of the exocrine glands with varying degrees of systemic involvement. Chronic inflammation compromises the glands’ function that leads to dry symptoms in the mouth/eyes. Renal involvement is a well recognized extraglandular manifestation of pSS. Metabolic bone disease (MBD), however, rarely occurs as the primary manifestation of a renal tubule disorder due to pSS. To the best of our knowledge there are only 6 reported cases of metabolic bone disease as the primary manifestation of pSS to date. Four of these had distal renal tubular acidosis (RTA), and 2 had a combined picture of distal and proximal tubular dysfunction. We herein present our experience of 3 cases who presented to us with a clinical picture suggestive of MBD. While investigating these patients, we found evidence of RTA, which was found to be secondary to pSS.

MR sialography of iatrogenic sialocele: comparison with conventional sialography

OBJECTIVE The objective of this study was to compare the conventional sialography with MR sialography in a series of patients with iatrogenic sialocele (sialocyst). METHODS 50 salivary glands in 39 patients with suspected inflammatory disease of the salivary gland underwent conventional sialography and MR sialography. Out of these 39 patients, 6 patients (age range: 16-35 years; 4 males and 2 females; mean age: 23.8 years) had sialoceles and formed our study group. MR sialography findings were compared with conventional sialography findings regarding demonstration of ductal anatomy, the cyst and its communication with the ductal system. RESULTS MR sialography demonstrated the site of communication of the sialocyst with the ductal system in all six patients. MR provided additional information over conventional sialography in five cases. In four cases, the ductal system proximal to the cyst was not opacified on digital sialography but was well visualized in all cases by MR sialography. Constructive interference in steady-state (CISS) sequence demonstrated the intraglandular ducts and communication of cysts with ducts better than half-fourier acquisition single-shot turbo-spin echo (HASTE) images. CONCLUSION Our preliminary results suggest that MR sialography is a robust, non-invasive method for demonstrating the ductal system up to second-order branches, the site of ductal injury and the focal cystic lesion. MR provided at least the same information as conventional sialography in the evaluation of site of communication but provided additional information about the sialocyst and upstream ductal system in five cases. Being a non-invasive modality, we recommend MR sialography as the investigation of choice in the evaluation of an iatrogenic sialocyst.