Santhosh Joseph

Ultrasound versus MRI in the diagnosis of fetal head and trunk anomalies

Objective. To compare antenatal sonography and magnetic resonance (MR) imaging (MRI) in the diagnosis of fetal head and trunk anomalies. Methods. Forty pregnant women with fetal anomalies on ultrasound (US) examination underwent MRI. The MR examination was done by a radiologist who was provided with the US data. The MR images were then read by one of the two radiologists who were blinded to the US data. They were however told that the region of interest was (1) head–neck or (2) trunk or (3) both. Antenatal US and MRI findings were compared with postnatal diagnosis. Postnatal evaluation included plain radiograph, US, computed tomography, MRI, surgery, physical evaluation and autopsy. Results. Sixty anomalies were detected in the 40 women studied. This included 36 central nervous system (CNS), 7 thoracic, 7 gastrointestinal, 8 genitourinary and 2 face–neck anomalies. In the evaluation of CNS and thoracic anomalies, more number of confident diagnoses could be obtained by MRI when compared with that by US. In the detection of gastrointestinal and genitourinary anomalies, there was no significant difference between the two modalities. Conclusion. More number of confident diagnoses could be obtained by MRI when compared with that by US, in the evaluation of fetal CNS and thoracic anomalies. MRI can be used in complex fetal anomalies as a supplementary tool following US.

Case Report: Congenital infiltrating lipomatosis of face

Congenital infiltrating lipomatosis of the face is a rare condition characterized by diffuse fatty infiltration of the facial soft tissues. There may be muscle involvement along with associated bony hyperplasia. It is a type of lipomatous tumor that is congenital in origin; it is rare and seen usually in childhood. We recently saw an 11-year-old girl with this condition. She presented with a swelling of the right side of the face that had been present since birth; there were typical findings on plain radiographs, CT, and MRI. The patient underwent cosmetic surgery. Histopathological examination showed mature adipocytes without any capsule.

Role of dynamic MR imaging in obstructive sleep apnoea

The purpose of this study is to assess the role of dynamic MR imaging in the evaluation of obstructive sleep apnea. In this prospective study, MRI was performed in 22 patients (eighteen male and four female, ranging in age from 26 to 70 years) suspected of having obstructive sleep aponea (OSA). 18 of them had a polysomnography study prior to MRI evaluation, which confirmed the presence of OSA. Positive cases were classified according to anatomic location and cause of narrowing. Patients with isolated retropalatal narrowing on MRI were advised uvulopalatopharyngoplasty (UPPP). Two patients had normal findings on MRI, 8 patients had retropalatal narrowing, five had retroglossal narrowing and seven had narrowing at multiple levels. All twenty-patients had collapse of lateral pharyngeal wall. Four patient with isolated retropalatal narrowing, who underwent UPPP after MRI evaluation were found to be cured on 6 month postoperative follow up.Dynamic MR imaging can accurately diagnose the cause and level of upper airway narrowing in patients with OSA. It can characterize and anatomically classify the level of narrowing for planning reparative surgery.

Role of MR cisternography in the diagnosis of cerebrospinal fluid rhinorrhoea with diagnostic nasal endoscopy and surgical correlation

Objectives : To study the usefulness and accuracy of MR cisternography as noninvasive study in the diagnosis of cerebrospinal fluid (CSF) fistula with diagnostic sinonasal endoscopy and surgical correlation. Material and Methods: Twenty four patients with clinically suspected CSF rhinorrhoea were examined for CSF fistula with MR cisternography. The MR imaging technique included 3mm thin T2 weighted coronal and sagittal sections using Fast spin echo. In addition 1.5mm thin T2 weighted coronal sections were also obtained using CISS (Constructive Interference in Steady State) sequence. MR findings were correlated with diagnostic sinonasal endoscopy and surgical findings. Results : MR cisternography demonstrated the presence of fistula in 17 patients, absence of fistula in seven patients. Out of 17 patients with fistula, the diagnosis could be confirmed in 14 patients by diagnostic sinonasal endoscopy/surgery. Out of the seven patients without fistula, there was positive correlation in six patients when they were followed up clinically and by diagnostic nasal endoscopy. However in one patient, fistula was demonstrated on CT cisternography and was confirmed on sinonasal endoscopic surgery. The accuracy, sensitivity of MR cisternography was 96, 94% respectively. Conclusion : MR cisternography is a useful and accurate noninvasive study in localizing the site and extent of CSF fistula.

Diagnostic accuracy of 64-slice multidetector computed tomography in evaluation of post-coronary artery bypass grafts in correlation with invasive coronary angiography.

64-slice multidetector computed tomography (MDCT) allows more reliable and non-invasive evaluation of the coronary artery bypass grafts for occlusion or stenosis both in symptomatic and asymptomatic patients and also progression of disease in native coronary vessels.

Case report: Perinephric lymphangiomatosis

Perirenal lymphangiomatosis is a rare benign malformation of the lymphatic system. We report here a case of bilateral perirenal and parapelvic involvement with a normal excretory collecting system.

Assessment of early and late DNA damages in interventional radiologists exposed to protracted low dose and dose rate of X-radiation

Occupational radiation exposures for interventionalists are considered as the highest received doses among medical practitioners and contributing a risk of DNA damage. A significantly higher γ-H2AX foci and unstable chromosomal aberrations (p > 0.001) was observed in Peripheral Blood Lymphocytes (PBL) of medical professionals when compared to healthy volunteers, whereas translocations did not show any difference. The results suggest that low-dose protracted radiation exposure can induce DNA damages in PBL and can get repaired or misrepaired and develop into chromosomal aberrations.

Role of biplane digital subtraction angiography, and 3D rotational angiography in craniopagus twins: A case report, detailed pictorial evaluation, and review of literature

Cranially conjoined twins (craniopagus) are regarded as one of the rarest human malformations. Craniopagus represents 2 to 6% of conjoined twins and is the rarest type of disorder. A conventional angiogram with three dimensions is needed to confirm the exact extent of sharing of the arterial / venous tree. 3D angiography was first proposed by CORNELIUS and advanced into clinical practice by VOIGT in 1975. We present a case of craniopagus vertical type II twins, evaluated for cerebral circulation.

Current trends in endovascular management of intracranial aneurysms (including posterior fossa aneurysms and multiple aneurysms)

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating illness and a major cause of morbidity and mortality.[1] The frequency of aneurysm ranges from 0.4-10%; there is a prevalence of 2.3% in adults without a risk factor for SAH and an annual risk of rupture of 1.9%.[2] Once the aneurysm has bled, there is 15% chance of rebleed in the first few hours, and this is associated with high mortality.[3] Therefore, intracranial aneurysms (IAs) has to be treated surgically or endovascularly. With the publication of the International Subarachnoid Aneurysm Trial (ISAT) results, more and more aneurysms are being treated by endovascular means worldwide.[4] However, each aneurysm should be assessed by an interdisciplinary approach, with the aim being to choose the best option for each patient. Advanced techniques in endovascular therapy have made this modality relatively safe and as effective as surgery in experienced hands.

Entrance surface dose and induced DNA damage in blood lymphocytes of patients exposed to low-dose and low-dose-rate X-irradiation during diagnostic and therapeutic interventional radiology procedures

The ionizing radiation received by patients and health workers due to radiological imaging may increase the risks of radiation effects, such as cancer and cataracts. We have investigated the dose received by specific areas around the head and related this to DNA damage in the blood lymphocytes of subjects exposed to interventional imaging. The entrance surface doses (ESD) to the forehead, neck, and shoulder were measured with a thermoluminescence dosimeter (CaSO4 disc or polycrystalline powder of lithium tetraborate doped with Mn) and compared with that of dose area product (DAP). DNA damage was measured by γ-H2AX, p53ser15, chromosomal aberration (CA), and micronucleus (MN) assays in lymphocytes of patients (n=75), before and 2 and 24h after exposure. The measured ESD values were 230.5±4.9, 189.5±3.55 and 90.7±3.4mGy for the forehead, neck, and shoulder, respectively. The DAP varied from 1.8 to 2047 Gy*cm2, showing a correlation with fluoroscopy time (r=0.417). Received doses did not increase early markers of DNA damage (γ-H2AX and p53ser15 assays), but residual damage (CA and MN frequencies) showed a significant (p<0.001) increase at 2 and 24h post-exposure compared to pre-imaging, despite poor correlation with DAP (r=0.1). Our results show that interventional imaging procedures deliver significant radiation doses and induce measurable DNA damage in lymphocytes of subjects, highlighting the need for rigorous patient safety protocols.