Kedar Jambhekar

Radiological and pathological changes in hemiballism-hemichorea with striatal hyperintensity

We report CT and MRI findings in a 50‐year‐old African‐American woman with hemichorea‐hemiballism (HCHB) and hyperglycemia with striatal hyperintensity. Histopathologic findings following autopsy are also described, and possible explanations for the MR findings of this unique syndrome are presented. J. Magn. Reson. Imaging 2006.

Radiology Education 2.0—On the Cusp of Change: Part 2. eBooks; File Sharing and Synchronization Tools; Websites/Teaching Files; Reference Management Tools and Note Taking Applications

Increasing use of smartphones and handheld computers is accompanied by a rapid growth in the other related industries. Electronic books have revolutionized the centuries-old conventional books and magazines markets and have simplified publishing by reducing the cost and processing time required to create and distribute any given book. We are now able to read, review, store, and share various types of documents via several electronic tools, many of which are available free of charge. Additionally, this electronic revolution has resulted in an explosion of readily available Internet-based educational resources for the residents and has paved the path for educators to reach out to a larger and more diverse student population.

Radiology education 2.0--on the cusp of change: part 1. Tablet computers, online curriculums, remote meeting tools and audience response systems.

We are in the midst of an evolving educational revolution. Use of digital devices such as smart phones and tablet computers is rapidly increasing among radiologists who now regularly use them for medical, technical, and administrative tasks. These electronic tools provide a wide array of new tools to the radiologists allowing for faster, more simplified, and widespread distribution of educational material. The utility, future potential, and limitations of some these powerful tools are discussed in this article.

Intermittent torsion of accessory hepatic lobe: An unusual cause of recurrent right upper quadrant pain

An accessory lobe of the liver is a rare congenital anomaly that can undergo torsion and present as an acute surgical emergency. It is rarely diagnosed preoperatively. We report the preoperative utility of CT scan and MRI in the diagnosis and surgical planning of a case of intermittent accessory hepatic lobe torsion.

Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome

We describe the efficacy of time‐resolved MR angiography in diagnosing a case of pelvic congestion syndrome (PCS). MR angiography, using four‐dimensional (4D) TRAK (Time‐Resolved Angiography using Keyhole) technique was used in an 81‐year‐old woman presenting with low backache, pelvic pain, and left pelvic fullness. Dynamic images were obtained in multiple vascular phases including arterial, arteriovenous, and venous phases. The high temporal resolution of 4D TRAK could demonstrate early retrograde left ovarian vein filling as well as multiple dilated pelvic varices, allowing the prospective diagnosis of PCS to be made. Although uncommon in this age group, the diagnosis was subsequently confirmed on conventional catheter venography with symptomatic relief after successful embolization of the incompetent left ovarian vein. The MRA and correlative catheter venography images are presented in this case report. J. Magn. Reson. Imaging 2010;32:700–704.

Clinical Orthopedic Examination Findings in the Upper Extremity: Correlation with Imaging Studies and Diagnostic Efficacy

Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article.

MR Evaluation of Rectal Cancer: Current Concepts

Magnetic resonance imaging has become more frequently utilized for staging, preoperative planning, and post-neoadjuvant evaluation of rectal cancer. It offers detailed resolution of the layers of the rectal wall, visualization of the mesorectal fascia, and identification of locoregional nodal involvement. Many advances have been made since the original protocols and include the use of phased-array coils, orthogonally obtained images and 3-dimensional sequences, the use of diffusion-weighted and perfusion protocols to better evaluate the tumor before and after neoadjuvant therapy, and the development of techniques to better evaluate metastatic nodes. Magnetic resonance imaging shows similar accuracy to endorectal ultrasound when staging and offers a less invasive technique that is not limited by patient discomfort or decreased luminal size. This article is meant to provide an update on the recent advances in rectal cancer imaging while addressing the controversial issues that exist in staging, technique, and imaging protocol.

MRI Findings in Chronic Lithium Nephropathy: A Case Report

Patients on long term lithium therapy for affective disorders may develop renal toxicity. It may manifest as nephrogenic diabetes insipidus with renal biopsy showing interstitial fibrosis, sclerotic glomeruli and cyst formation. Magnetic resonance imaging demonstrates the presence of microcysts in patients on long-term lithium therapy, suggesting a possible cause for their nephrotoxicity. We describe the typical magnetic resonance imaging appearance of renal microcysts in a 53 year old woman on chronic lithium therapy.

Diabetic Myonecrosis: Likely an Underrecognized Entity

Diabetic myonecrosis is a rare complication of long-standing diabetes mellitus that presents as acute onset of swelling and pain of the affected muscles. The differential diagnosis includes cellulitis/pyomyositis, necrotizing fasciitis, neoplasm, and deep venous thrombosis (DVT). Missed diagnoses can lead to unnecessary invasive diagnostic procedures and inappropriate treatment. The diagnosis is established by the clinical presentation and findings on magnetic resonance imaging (MRI) scan. A 30-year-old African-American man presented with a painful mass affecting the medial aspect of the right thigh for several months. Initial laboratory studies showed white blood cell count of 8800 cells/mm(3), D-dimer value of 0.55 µg/mL, HgBA1c level of 15.1%, glucose level of 352 mg/dL, erythrocyte sedimentation rate of 22 mm/h, and C-reactive protein level of 222 mg/L. An MRI scan was obtained, and diabetic myonecrosis was diagnosed and treated. One year later, the patient had similar symptoms of pain in the contralateral thigh. Repeat workup and MRI scan were obtained. The MRI abnormalities originally seen in the right thigh 1 year earlier were present in the left thigh, with complete resolution of the abnormalities seen in the right thigh. Treatment with bed rest and analgesics resulted in symptom resolution. Patients with diabetic myonecrosis typically have no fever, normal white blood cell count, mildly increased erythrocyte sedimentation rate, and elevated C-reactive protein level in 50% of cases. They lack the radiologic signs of fascial enhancement or well-defined, rim-enhancing collections that are seen in necrotizing fasciitis and pyomyositis/abscess. The onset of severe pain and the lack of mass effect on imaging differentiate diabetic myonecrosis from tumor-like conditions such as vascular malformations or soft tissue tumors. Normal D-dimer levels and ultrasound Doppler examination of the extremity help to rule out DVT. The typical MRI scan findings and clinical presentation can lead to the diagnosis of diabetic myonecrosis, allowing the physician to avoid invasive tests, such as muscle biopsy, and to reassure patients that this condition is self-limiting with appropriate treatment.

Radiology Boot Camp: Facilitating the Transition of Interns into Residents

It is no secret that transitions inmedical education are challengingand inherently stressful. New in-ternsstrugglewithalackofmedicalknowledge, poor organizationalskills, inadequate ability to reflectand self-assess, and underdevelo-ped professionalism, most oftenattributed to a lack of thoroughpreparation in medical school [1-3]. Then, after a year of clinicalpracticeinmedicineorsurgeryoratransitional year, the transition toradiology residency presents a newsetofchallenges.Theradiologyres-ident is no longer the the primarycontact in direct patient care anddecisionmaking,butisexpectedtobe an imaging consultant, operat-ing largely behind the scenes in anunfamiliar specialty [4-6]. Few res-idents gain skills and experienceswith imaging modalities and stud-ies during medical school and in-ternship, so they find themselves asnovices once again [7]. Additionalstresses are created by having toadapt to a hospital-based learningenvironmentand,often,anewpro-gram director and set of peers. Ourspecialty’s reliance on the internetanddigitaldevicesforaccessinged-ucational material requires a highlevel of technological savvy [8,9].Thevolumeandcomplexityofnewinformation to be assimilated canparalyze and demoralize any newradiology resident.Research on “resident readiness”suggests the usefulness of focusededucationalinterventionstoimprovethe clinical orientation process andincrease residents’ confidence [2,6,7,10-13].Asmallbutgrowingcollec-tion of literature has focused on“boot camps,” which are being usedin graduate medical education tomaximize fundamental teachingtime while fostering team building[5,11].Colloquially, “boot camp” refersto military recruit training as anabrupt,oftenshockingtransitiontoanew way of life, with strict disciplineand an emphasis on hard work andphysical conditioning. Companiesalso use boot camps to immerse re-cruitsinbothtechnicalskillsandcor-porateculture.Asaresult,therecruitsdevelop strong bonds to their peersand the organization [14]. Havingpeerstheycanrelyonhelpsresidentscopeandalleviatessomeofthenega-tive effects of high stress levels.The literature on preparation andreadiness for radiology is sparse butemerging. One program’s lecture se-ries designed specifically for incom-ing residents resulted in an increasein residents’ confidence (althoughclinical performance improvementcould not be demonstrated) [7].Inanotherprogram,theadditionofres-ident-to-resident role-oriented pre-sentations decreased anxiety andincreased role awareness more thanlectures alone [6].