Srinivasa Prasad

Cystic pancreatic neoplasms Evaluation by CT and magnetic resonance cholangiopancreatography

CT provides limited assistance in the differentiation between serous and mucinous neoplasms. Because of the variability in the radiographic appearance of serous cystadenomas and overlap in CT characteristics with mucinous neoplasms, most serous neoplasms still require ancillary testing such as biopsy to reach a definitive diagnosis. MRCP is useful in differentiating benign and malignant mucinous tumors including IPMT of the pancreas. The presence of mural nodules is suggestive of malignancy; however, the absence of mural nodules does not indicate that the tumor is benign. A maximum main pancreatic duct diameter of greater than 15 mm and diffuse dilatation of the main pancreatic duct are suggestive of malignancy in main duct-type tumors. Among branch duct-type tumors, malignant tumors tend to be larger than benign tumors; however, this finding is variable. The presence of main pancreatic duct dilatation may be helpful in determining malignancy of branch duct-type tumors.

Tuberculosis of the sternum and clavicle: imaging findings in 15 patients

Abstractu2002Objective. To describe the imaging findings in sterno-clavicular tubercular involvement.nDesign and patients. Fifteen patients with pathologically proven tuberculosis of the sternum and clavicle were retrospectively evaluated. Routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were used in some or all of the patients. Clinical information and imaging features were evaluated in each case.nResults. Eight patients had sterno-clavicular joint (SCJ) involvement, five had isolated sternal involvement and two had isolated clavicular involvement. Seven patients were evaluated with only CT, six with only MRI and two with both. There were eight male and seven female patients, varying in age between 16 and 78 years. Fever, swelling and pain were common presenting symptoms. Two patients were HIV positive. Radiographs were positive in only eight patients. Destruction and signal intensity (SI) changes of the sternum and clavicle, destruction of the cartilage, soft tissue changes representing granulation tissue/abscess, displacement of the adjacent structures (vessels, trachea, etc.) and inflammatory changes in the adjacent structures in the form of cellulitis and myositis were common imaging features.nConclusions. All imaging methods can provide complementary information regarding sterno-clavicular tubercular involvement that is helpful for determination of the therapy. MRI is useful in determining the extent of the lesion, particularly marrow involvement and soft tissue extent.

MR imaging in intramedullary cysticercosis.

Although intramedullary spinal cord cysticercosis (IMC) is uncommon, its presence is being increasingly recognised by magnetic resonance imaging. We studied six patients from an endemic region and present the MRI features and clinical correlation of IMC. Six patients who presented with para- or quadriplegia were studied by contrast enhanced spinal MRI. Prompted by the spinal lesions, all patients underwent brain MRI. Clinical data and laboratory studies were reviewed in all patients. Definite diagnosis was established in the form of response to drug therapy (n=4) and histopathology (n=2). Follow-up MRI studies of spine and brain were obtained in four patients 2xa0months after they started medical treatment, regardless of surgery. Five patients showed fusiform and focal enlargement of the spinal cord (cervical 2, thoracic 3). Well-defined cysts with a slightly hyperintense mural nodule were identified in five patients in T1-weighted images (T1WI). All cysts were hyperintense on T2WI and merged with the surrounding oedema. Oedema extended one to three vertebral levels above or below the cyst. Post-contrast T1WI showed well-defined, ring enhancing lesions with smooth walls in all patients. Symptoms in all patients correlated with the level of the lesions. Brain studies demonstrated lesions in just two patients. Histopathological confirmation was obtained in two patients. Follow-up spinal MRI was normal in two patients, following 2xa0months of treatment while residual and smaller lesions were seen in two patients. Two patients were asymptomatic and denied follow-up MRI. MRI of spinal cysticercosis were typical of and similar to those seen in cerebral lesions in our patients and corresponded to the level of symptoms. All cysts were surrounded by oedema. Two of four patients showed residual lesions after 2xa0months of therapy and 33% of patients showed concomitant intracranial lesions.

Radiographic findings in tuberculosis of the calvarium

Abstract We reviewed the pattern of involvement of the calvarium by tuberculosis (TB) in five patients and the role of imaging in its management. Four patients presented with localised scalp swelling and one with generalized seizures. Radiographs revealed lucent lesions with minimal surrounding sclerosis in the frontal (2), parietal (2) and occipital (1) bones. CT showed lesions involving the entire thickness of the calvarium and accompanying contrast-enhancing soft tissue. The patient presenting with seizures had a ring-enhancing lesion in the parietal lobe in addition to the extra-axial lesions. Although radiographs in all cases demonstrated calvarial TB, CT showed the extent of the defect, involvement of adjacent soft tissues, and in one case an intra-axial lesion. Radiographs suffice for follow-up of these patients.

Imaging in isolated sacral tuberculosis : a review of 15 cases

Abstractu2002Objective. To review imaging studies of isolated involvement of the sacrum due to tuberculosis and determine the role of imaging in the diagnosis and management of these patients.nDesign and patients. A retrospective analysis of 15 cases of isolated sacral tuberculosis imaged with MR imaging was performed. The CT images were also reviewed where available, and the various lesion characteristics were identified. We also reviewed the medical records in an attempt to determine the impact of the imaging studies on the management of these patients.nResults. Fifteen patients (5 male, 10 female) presented with symptoms of 3–15 months’ duration. Chronic localized backache with muscle spasm was the commonest presenting symptom; discharging sinuses with abscess formation was found in six patients, five of whom were children. MR imaging of the sacrum revealed a hypointense marrow signal on T1-weighted images and hyperintense signal on T2-weighted images in 14 of 15 patients, the S2 vertebra being always involved. CT revealed osteolytic changes in the sacrum in all the five patients in whom CT was performed. All patients showed marked clinical improvement within 1 year of anti-tuberculous chemotherapy.nConclusion. Isolated tuberculosis of the sacrum is uncommon but should be suspected in patients presenting with chronic low backache or children with discharging sinuses/abscesses and showing sacral destruction on CT or MR imaging. MR imaging can identify cases and enables early institution of anti- tuberculous chemotherapy.

Giant hypothalamic hamartoma with cystic change: report of two cases and review of the literature

Abstract We describe the MRI findings in two patients with giant hypothalamic hamartomas with cystic areas. Cystic change within hypothalamic hamartomas is rarely reported in the literature.

Re: endovascular management of an inferior gluteal artery pseudoaneurysm secondary to tuberculous cold abscess.

It is well known that, in double IVC, the two cavae may be of nearly equal size, as in our patients, or one may be substantially smaller and several types of infrarenal collaterals exist in double IVCs [1]. In our patients there were no direct major infrarenal connections between the two cavae, leaving the right and left iliac veins to drain exclusively into their respective right and left IVCs. The most common placement position for the IVC filter is in the infrarenal portion because of potential renal dysfunction following filter placement with or without occlusion. In recent years several investigators have reported on the safety and clinical utility of suprarenal placement, especially with TGF, because of the minimal risk of caval occlusion after placement [2]. On the basis of these reports, we positioned one TGF suprarenally in the patient with DVT in the left IVC and he showed no renal dysfunction during follow-up. Dual filter placement in both the right and left IVC for patients with this anomaly has been reported [3], however, to our knowledge, placement of a single suprarenal filter has only been reported in one patient [4]. For patients with DVT in the right IVC several options for filter placement could be considered, including suprarenal placement, single infrarenal placement in the right IVC, and dual infrarenal placement in both the right and left IVC, Considering the minimal risk of IVC occlusion at the site of the TGF, suprarenal or dual placement for both-sided IVC is indicated tbr complete filtration. However, we selected single infrarenal placement in the right IVC of our patient 2 because of the risk of renal dysfunction following filter occlusion, as the patient had antithrombin-Ill deficiency with a thrombogenic tendency. As a matter of fact, the DVT in her right IVC appeared while she was undergoing oral anticoagulation therapy. Placement of an additional filter in the left IVC should be performed when the right IVC is occluded, because recurrent pulmonary thromboembolism through the enlarged pelvic collaterals and ascending lumbar vein and/or hemiazygos vein has been reported [5]. In conclusion, suprarenal placement of the TGF is definitely indicated for patients with DVT in either side of a double IVC, except in patients with thrombogenic disease.

Parenchymal imaging adds diagnostic utility in evaluating haematuria.

To compare the findings of renal ultrasonography (US) in the evaluation of patients with and with no haematuria. The increased use of cross‐sectional imaging and US has led to a dramatic improvement in the diagnosis of renal masses, such that computed tomography and/or US have been integrated into the diagnostic evaluation of haematuria, and many more incidental renal lesions are now detected. Thus it is possible that the lesions identified during evaluation for haematuria are incidental, i.e. identified serendipitously, and unrelated to the haematuria.

Erratum: MR imaging in intramedullary cysticercosis (Neuroradiology))

Although intramedullary spinal cord cysticercosis (IMC) is uncommon, its presence is being increasingly recognised by magnetic resonance imaging. We studied six patients from an endemic region and present the MRI features and clinical correlation of IMC. Six patients who presented with para- or quadriplegia were studied by contrast enhanced spinal MRI. Prompted by the spinal lesions, all patients underwent brain MRI. Clinical data and laboratory studies were reviewed in all patients. Definite diagnosis was established in the form of response to drug therapy (n = 4) and histopathology (n = 2). Follow-up MRI studies of spine and brain were obtained in four patients 2 months after they started medical treatment, regardless of surgery. Five patients showed fusiform and focal enlargement of the spinal cord (cervical 2, thoracic 3). Well-defined cysts with a slightly hyperintense mural nodule were identified in five patients in Ti-weighted images (T1WI). All cysts were hyperintense on T2WI and merged with the surrounding oedema. Oedema extended one to three vertebral levels above or below the cyst. Post-contrast T1WI showed well-defined, ring enhancing lesions with smooth walls in all patients. Symptoms in all patients correlated with the level of the lesions. Brain studies demonstrated lesions in just two patients. Histopathological confirmation was obtained in two patients. Follow-up spinal MRI was normal in two patients, following 2 months of treatment while residual and smaller lesions were seen in two patients. Two patients were asymptomatic and denied follow-up MRI. MRI of spinal cysticercosis were typical of and similar to those seen in cerebral lesions in our patients and corresponded to the level of symptoms. All cysts were surrounded by oedema. Two of four patients showed residual lesions after 2 months of therapy and 33 % of patients showed concomitant intracranial lesions.