Shruti Chandak

Role of acoustic radiation force impulse and shear wave velocity in prediction of preterm birth: a prospective study

Background Preterm birth is one of the important causes of neonatal morbidity where we rely on subjective criteria such as modified Bishop’s scoring and contemporary sonographic measurement of cervical length. Acoustic radiation force impulse (ARFI) is a technological advancement in elastography that can be employed in prediction of cervical softening and preterm labor. Purpose To evaluate the role of ARFI technique and shear wave velocity (SWV) estimates as a predictor of preterm birth and its comparison with other clinical and sono-elastographic measures. Material and Methods Thirty-four pregnant women (gestation age = 28–37 weeks age) showing features suggestive of preterm labor were included and evaluated with modified Bishop’s score, cervical length by ultrasound (US), ARFI to derive Elastography index (EI), and SWV of the cervix. The patients were later divided into two groups, using the clinical outcome of preterm or term delivery. Results Twenty patients delivered at term (gestational age > 37 weeks) and 14 were preterm. Receiver operating characteristics (ROC) curves showed SWV with highest sensitivity and specificity (93% and 90%, respectively) for the prediction of preterm birth at a cutoff value of 2.83 m/s. EI and modified Bishop’s score were comparable to each other, but were less sensitive techniques. Conclusion Elastographic assessment of antenatal cervix is a novel technique of virtual palpation of internal os and can be utilized as an objective criterion for preterm birth prediction.

A Case Report of Metronidazole Induced Neurotoxicity in Liver Abscess Patient and the Usefulness of MRI for its Diagnosis.

Metronidazole is a very widely used drug for the treatment of multiple ailments caused by anaerobic bacteria as well as some protozoan parasites. Though its usual side effects are not very serious, yet sometimes it may cause profound adverse effects like neurotoxicity. We present here a case of liver abscess. The patient was treated for a long time with metronidazole and developed sudden onset neurotoxicity which was diagnosed by MRI. The present case also highlights the need of vigilant monitoring of patients on metronidazole for symptoms of neurotoxicity and the usefulness of MRI for diagnosis of the same.

Hirayama Disease: Escaping From the Quotidian Imaging

Hirayama disease is a rare type of neurological disease commonly manifesting as brachial monomelic amyotrophy in young males of Asian origin, easily understood as juvenile non-progressive cervical amyotrophy. The first case was reported by Hirayama in 1959. The pathogenesis is attributed towards chronic compression of cervical spinal cord during flexion movements of neck in cases where there is detachment of posterior dura mater. This chronic event, invariably leads to features of cord atrophy along with other MRI features. We report a case of 21-year-old male who presented with atrophy of distal muscles of his right hand and was sent for MRI of cervical spine which revealed prominent posterior epidural venous plexus without significant cord atrophy. Clinico-radiologic profile of the patient leads toward the diagnosis of Hirayama disease which was considered as borderline because of asymmetrical cord atrophy which is a not a routine imaging feature of the entity.

Multicentric giant cell reparative granuloma with extragnathic involvement: Panoramic and computed tomography

Giant cell reparative granuloma is also known as central giant cell granuloma with predilection for the mandible. It is a benign bone tumor, which creates a diagnostic dilemma for radiologist due to their rare occurrence and sometimes aggressive nature. We report a case of young male presenting with a fast growing, large right sided mandibular lump that was bony hard on palpation. There was nasal obstruction along with neck pain. The case was sent for panoramic radiography that revealed multiple radiolucent lesions involving the mandible and the maxillary bone. Further evaluation was done using cross-sectional imaging modality, that is, computed tomography that lead to an elaborate involvement of the mandible and maxilla with incidental lytic involvement of the hyoid bone as well as the C2 vertebral body. Tissue diagnosis was done where diagnosis of giant cell reparative granulomas was confirmed.

Three neglected cases of minor trauma to the craniovertebral junction with potentially disastrous consequences

Os odontoideum is a rare congenital anomaly predisposing to atlantoaxial instability. It may rarely present with a history of trivial trauma followed by slow progressive features of compressive myelopathy. Dens fractures, though not uncommon, may also remain undiagnosed and present later on with nonunion. Hence, it is very important for these patients to undergo proper clinical evaluation and appropriate imaging.