Manavjit Singh Sandhu

Real time spatial compound ultrasound in the evaluation of meniscal injuries: A comparison study with conventional ultrasound and MRI

The aim of this study was to compare real time spatial compound ultrasound (RTCS) and conventional ultrasound with MRI in the evaluation of meniscal injuries. Thirty five patients with clinical suspicion of meniscal injury underwent ultrasound of knee alternating between conventional and compound sonography followed by MRI of the knee on a 1.5 T MR system. The images were compared for their quality and ability to detect meniscal tear. Compound ultrasound significantly improved definition of soft tissue planes, reduced speckle and other noise, improved contrast resolution (p value<0.05) with improved confidence in detection of tears in doubtful cases. Interobserver variability was seen only for conventional ultrasound and the sensitivity, specificity, accuracy were 83.3%, 87.5% and 85.7% for the first observer and 80%, 87.5% and 84.3% for second observer. For compound ultrasound it was same for both the observers with sensitivity, specificity and accuracy being 90% each. Although compound ultrasound improves image quality in the evaluation of meniscal injuries the benefit with respect to detection of tears is only marginal. It is a valuable tool for screening the patients before MRI and we recommend that instead of conventional ultrasound, compound ultrasound should be routinely used for sonographic evaluation of meniscal injuries.

High-Attenuation Mucus Impaction in Patients With Allergic Bronchopulmonary Aspergillosis: Objective Criteria on High-Resolution Computed Tomography and Correlation With Serologic Parameters.

The aim of the study was to correlate the high-resolution computed tomography (HRCT) finding of high-attenuation mucus (HAM) impaction, including mean CT density and immunologic parameters in patients with allergic bronchopulmonary aspergillosis (ABPA). The institutional review board approved the study, and informed written consent was obtained. A total of 100 consecutive patients diagnosed with ABPA between June 2012 and December 2013 undergoing HRCT were enrolled. HRCT scan of the chest was evaluated for central bronchiectasis, mucoid impaction, and number of involved bronchial segments. Findings of mucoid impaction in patients were classified as HAM and non-HAM. CT attenuation values and mean CT density were calculated. Serologic parameters were assessed for total immunoglobin E (IgE), specific IgE, and absolute eosinophil count. Patients with HAM impaction on HRCT were found to have significantly higher levels of total IgE (P < 0.001), specific IgE (P = 0.03), and number of bronchial segments affected (P < 0.001). We found a CT density value of 70 Hounsfield units (HU) as an adequate cutoff value for HAM impaction. CT density >100HU is correlated with significantly higher values of serologic parameters. The present study suggests a relation between absolute HU values of HAM impaction and absolute value of serologic parameters in ABPA.

Comparison of neutral and positive enteral contrast media for MDCT enteroclysis.

OBJECTIVE To compare neutral and positive enteral contrast media for MDCT enteroclysis (MDCTE) in various small bowel diseases. MATERIALS AND METHODS 40 patients with suspicion of small bowel diseases were divided randomly into two equal groups. In one group, water was used as neutral enteral contrast and in other group, 2% water soluble iodinated contrast was used as positive enteral contrast. All MDCTE were done on a 16-slice multidetector row CT unit. The findings of MDCTE were compared with the standards of reference. RESULTS There were 12 cases of abdominal tuberculosis (30%), 5 cases of bowel masses (12%), 4 cases of Crohns disease (10%), 3 cases of small bowel adhesions (7%), 2 cases of midgut volvulus (5%), 2 cases of segmental enteritis (5%) and 12 of all cases (30%) were normal. There was no statistically significant difference between neutral and positive enteral contrast with regards to bowel distention, contrast reflux and evaluation of duodenum. Abnormal bowel wall enhancement was appreciated only with use of neutral enteral contrast (n=12). Evaluation of ileocaecal junction was possible in all 20 patients (100%) with positive enteral contrast but in only 17 patients (85%) with neutral enteral contrast. Overall sensitivity and specificity of MDCTE with use of neutral contrast medium (100 and 88% respectively) was greater for evaluation of small bowel diseases, when compared to MDCTE using positive enteral contrast medium (92.8 and 83.3% respectively). CONCLUSIONS Water is a good enteral contrast medium for MDCT enteroclysis examination and allows better evaluation of abnormal bowel wall enhancement. Ileocaecal junction evaluation is better with positive enteral contrast medium.

Role of digital tomosynthesis and dual energy subtraction digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis

OBJECTIVE To assess the role of digital tomosynthesis (DTS) and dual energy subtraction digital radiography (DES-DR) in detection of parenchymal lesions in active pulmonary tuberculosis (TB) and to compare them with digital radiography (DR). MATERIALS AND METHODS This prospective study was approved by our institutional review committee. DTS and DES-DR were performed in 62 patients with active pulmonary TB within one week of multidetector computed tomography (MDCT) study. Findings of active pulmonary TB, that is consolidation, cavitation and nodules were noted on digital radiography (DR), DTS and DES-DR in all patients. Sensitivity, specificity, positive and negative predictive values of all 3 modalities was calculated with MDCT as reference standard. In addition presence of centrilobular nodules was also noted on DTS. RESULTS Our study comprised of 62 patients (33 males, 29 females with age range 18-82 years). Sensitivity and specificity of DTS for detection of nodules and cavitation was better than DR and DES-DR. Sensitivity and specificity of DTS for detection of consolidation was comparable to DR and DES-DR. DES-DR performed better than DR in detection of nodules and cavitation. DTS was also able to detect centrilobular nodules with sensitivity and specificity of 57.4% and 86.5% respectively. CONCLUSION DTS and DES-DR perform better than DR in detection of nodules, consolidation and cavitation in pulmonary TB. DTS gives better results than DES-DR, particularly in detection of cavitation and has moderate sensitivity for detection of centrilobular nodules. Thus DTS can be used for evaluation of patients of suspected pulmonary TB, thereby giving a more confident diagnosis of active disease and also in follow up.

Rare complications of cesarean scar

Cesarean scar pregnancy (CSP) and cesarean scar dehiscence (CSD) are the most dreaded complications of cesarean scar (CS). As the incidence of CS is increasing worldwide, so is the incidence of CSP, especially in cases with assisted reproduction techniques. It is of utmost importance to diagnose CSP in the early first trimester, as it can lead to myometrial rupture with fatal outcome. On the other hand, CSD may be encountered during pregnancy or in the postpartum period. CSD in the postpartum period is very rare and can cause secondary postpartum hemorrhage (PPH) leading to increased maternal morbidity or even death if not diagnosed and managed promptly. Both complications can be diagnosed on ultrasonography (USG) and confirmed on magnetic resonance imaging (MRI). These two conditions carry high morbidity and mortality. In this article, we highlight the role of imaging in the early diagnosis and management of these conditions.

Right atrial and inferior vena caval thrombosis in a case of amebic liver abscess.

A 58-year-old man, who was a chronic alcoholic for the previous 20 years, presented with complaints of fever and malaise of 12 days duration. There was no history of diarrhea, dysentery, or vomiting. On examination, the vital signs were: blood pressure 110/80 mm Hg, pulse 84 beats/min, and respiratory rate 30 breaths/min. The patient was febrile and mildly icteric. The liver was enlarged 5 cm below the right costal margin, and was firm, tender, and smooth. Central nervous system, cardiovascular, and respiratory examinations were normal. Laboratory examinations revealed the following: hemoglobin level of 9.2 g/dL, leukocyte count 16,800 with neutrophilia of 80%, serum bilirubin levels of 5.9 mg/dL, blood urea nitrogen 58.5 mg/dL, and serum creatinine of 1.16 mg/dL. Blood cultures proved to be sterile. Ultrasound imaging of the abdomen showed hepatomegaly with a large hypoechoic lesion measuring 7.2 8.7 cm in the right lobe of the liver, involving segment VII. A helical computed tomography (CT) scan of the abdomen was done to characterize this focal hepatic lesion. The lesion was found to have cystic attenuation (12–20 HU) with thin and irregular walls. A hypodense filling defect suggestive of thrombus was seen in the inferior vena cava (IVC) (Figure 1) that extended into the

Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis

IntroductionUltrasound is usually the first diagnostic investigation for the assessment of liver lesions. Apart from conventional sonography (CS), new grey-scale sonographic techniques have been developed which have increased the application of ultrasound in liver imaging. The present study was undertaken to compare image quality of CS, real-time compound sonography (RTCS), tissue harmonic sonography (THS) and tissue harmonic compound sonography (THCS) in focal liver lesions.Materials and methods100 patients with focal hepatic lesions were enroled. Lesions were divided into solid and cystic group. Solid lesions were evaluated for lesion conspicuity and elimination of artefacts. For cystic lesions, lesion conspicuity, posterior acoustic enhancement and internal echoes within the lesion were evaluated. Grading was done using 3–5-point scales. Overall image quality was assessed depending on the total points.Results78 solid and 22 cystic liver lesions were included. THCS showed superior results for lesion conspicuity, elimination of artefacts and overall image quality in solid lesions. RTCS showed similar results as THCS for lesion conspicuity and overall image quality in solid lesions. THS gave better results in cystic lesions for all imaging parameters. Results of THCS though slightly inferior, showed no significant difference from THS, in cystic lesions. CS was found to have least diagnostic value in characterisation.ConclusionsFor evaluation of focal hepatic lesions, a combination of compound and harmonic sonography, i.e. THCS, is the preferred sonographic technique.RiassuntoIntroduzionel’ecografia è di solito l’indagine radiologica iniziale, non invasiva e semplice, per la valutazione delle lesioni epatiche. Oltre alla tradizionale ecografia in scala di grigi (CS), sono state sviluppate delle nuove tecniche, che hanno aumentato le applicazioni dell’ecografia nell’imaging del fegato. Il presente studio è stato intrapreso per confrontare la qualità delle immagini in: CS, ecografia in tempo reale con compound (RTCS), armonica tissutale (THS) e armonica tissutale con compound (THC) nello studio delle lesioni focali epatiche.Materiali e Metodisono stati arruolati 100 pazienti con lesioni focali epatiche. Le lesioni sono state divise in solide e cistiche. Per le lesioni solide sono stati valutati la visibilità e l’eliminazione di artefatti. Per le lesioni cistica sono stati valutati la visibilità, il rinforzo acustico posteriore e gli echi all’interno delle lesioni. La classificazione è stata effettuata utilizzando una scala da 3 a 5. La qualità generale dell’immagine è stata valutata in base al totale dei punti.Risultatisono state incluse 78 lesioni epatiche solide e 22 cistiche. La THC ha mostrato risultati superiori per la visibilità delle lesioni, l’eliminazione di artefatti e la qualità complessiva dell’immagine delle lesioni solide. La RTCS ha mostrato risultati simili a quelli di THC per la visibilità delle lesioni e la qualità complessiva dell’immagine delle lesioni solide. THS ha dato risultati migliori per tutti i parametri di imaging delle lesioni cistiche. I risultati della THC, anche se leggermente inferiori, non hanno mostrato differenze significativa dalla THS, nelle lesioni cistiche. E’ stato valutato che la CS abbia un valore diagnostica minore nella caratterizzazione.Conclusioniper la valutazione delle lesioni focali epatiche, una combinazione di compound ed armonica tissutale (THC) è la tecnica ecografica da preferire.

Primary Ewing's sarcoma of occipital bone

Ewings sarcoma commonly involves the long bones. Primary Ewings sarcoma of the cranium is rare and is difficult to distinguish from other tumors involving the cranium. Radiological features and immuno-histochemistry are helpful in diagnosing this tumor. In this report we present a rare case of primary Ewings sarcoma of the occipital bone and discuss the differential diagnostic options.

Urolithiasis: Comparison of diagnostic performance of digital tomosynthesis and ultrasound. Which one to choose and when?

OBJECTIVE To assess the diagnostic performance of digital tomosynthesis (DT) in detecting urolithiasis and compare it with ultrasonography (USG), keeping standard volumetric multi-detector computed tomography (MDCT) as the reference. MATERIALS AND METHODS This prospective analytical study was approved by our institutional ethical committee. A total of 66 patients were enrolled who had either clinical suspicion of urolithiasis or history of recurrent urolithiasis. All patients underwent DT, USG and MDCT within 24 h. In all these three investigations, the calculi were categorised according to their location and size by two radiologists. Sensitivity, specificity, positive and negative predictive values of DT and USG were calculated with MDCT as a reference standard. RESULTS Our study comprised of 66 patients (36 males and 30 females with age range of 19-73 years). A total of 121 calculi were assessed with 52 calculi <5 mm in size, 32 calculi measuring 5-10 mm and 37 calculi >10 mm. Kappa test of agreement was used to assess the interobserver agreement for all observations. The measurement of agreement kappa value was 1. The overall sensitivity of DT and USG in detecting urolithaisis was 50% (p value <0.001) and 50.4% (p value 0.005) respectively. No statistically significant difference was noted between USG and DT in detecting urolithiasis. The sensitivity of DT and USG in detecting renal calculi was 47.1% and 50.9% respectively and the sensitivity of DT and USG in detecting ureteric calculi was 74.9% and 39.2% respectively. We observed statistically significant difference between USG and DT in detecting ureteric calculi. CONCLUSION In our study, there was no statistically significant difference noted between USG and DT in diagnosis of urolithiasis. DT performed significantly better than USG in detecting ureteric calculi with a higher sensitivity. Hence, we are tempted to opine that DT may be preferred over USG for initial evaluation of patients with suspected ureteric calculi. However considering the strength of ultrasound in demonstrating associated signs as hydroureteronephosis, we are still of the opinion, that both DT and USG should be used as complementary techniques in resolving these common clinical screnarios.

Multi detector CT Imaging of Abdominal and Diaphragmatic Hernias: Pictorial Essay

Diagnosis of abdominal wall hernia is often a clinical problem, especially in occult or in obese patients. Multidetector CT is an accurate method of detecting various types of abdominal and diaphragmatic hernias. It clearly demonstrates the anatomical sites of hernial sac, its contents and possible complications.