Role of Magnetic Resonance Imaging in Evaluation of Perianal Fistula

Introduction: Perianal fistula is an abnormal infected tract that connects the internal opening in the anal canal to the external opening in the perianal skin. It is an important cause of significant patient morbidity related to the lower intestinal tract. Magnetic resonance imaging (MRI) is the imaging modality of choice in the pre-operative assessment of perianal fistulas due to its excellent soft tissue resolution to accurately demonstrate the anatomy of the perianal region and the relationship of the fistulous tracts to the pelvic diaphragm and the ischiorectal fossae. Aims and Objectives: This study aims to assess the role of MRI in evaluation of perianal fistula and to correlate the imaging findings with post-surgical data. Materials and Methods: In this prospective study, 50 patients of all age groups with perianal fistulas were evaluated by MRI in the Department of Radiodiagnosis, Gandhi Medical College and Hamidia Hospital over a period of 1 year. MRI was performed on 1.5 Tesla Hitachi ECHELON SMART - 523 MRI machine using the required protocol and sequences. Fistulas were classified according to St James’s University Hospital MRI classification system and imaging findings were compared with post-surgical data. Results: MRI could detect the presence of fistula in all 50 patients, indicating 100% sensitivity. Most patients (68%) had internal opening on the posterior aspect of anal canal. Active fistulous tract was seen in 43 patients (86%) and chronic fibrosed tracts in 7 patients (14%). The most common type according to MRI grading was Grade I (54%), followed by Grade II (30%), Grade III (8%), and Grade IV (6%), respectively. MRI correctly described the type of fistula in 96% of cases. Conclusion: This study concludes that MRI proved as a valuable imaging modality in evaluation of perianal fistula and should always be performed in patients before surgery.

Renal Doppler Indices in Chronic Liver Disease and its Role in Predicting Hepatorenal Syndrome

Introduction: Hepatorenal syndrome (HRS) is the most serious complication of renal dysfunction in patients with chronic liverdisease (CLD). Renal arterial vasoconstriction may persist for weeks, even months before an increase of blood urea nitrogenor serum creatinine values can be discovered.[1] Duplex Doppler ultrasonography of the kidneys is an easy and non-invasivemethod to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction.[2-4] Intrarenal resistive index(RI) may be superior to serum creatinine levels as an indicator in patients with liver cirrhosis for the detection of patients at riskfor the development of HRS.Objective: The objective of the study was to correlate renal Doppler indices with serum creatinine levels in various stages ofCLD and to determine its role in predicting the risk for developing HRS in patients of CLD.Materials and Methods: Grayscale, color flow, and duplex Doppler ultrasonography were performed inpatients of CLD, whichwere divided into four groups with increasing clinical severities. There serum creatinine level was compared with renal Dopplerindices in various groups of increasing severity.Results: Most common cause of CLD in our study population was alcoholism (62%). About 65% of cases show irregular liversurface, and irregular liver surface is significantly higher in Groups II, III, and IV versus Group 1. Heterogeneous, homogenous,and fatty echo texture were showed by 78%, 11%, and 11%, respectively. Mean peak systolic velocity and end-diastolic velocityin our study are 33.99 cm/s and 11.55 cm/s, respectively. Mean pulsatility index in cases was 1.17. In our present study, RIlevel was significantly higher in cirrhotic patients, and there is a significant association between RI and study groups. As theseverity of liver disease of group increases, the RI value also gets elevated.Conclusion: Intrarenal RI seems to be a helpful predictor to identify a subgroup of CLD patients with a higher risk of developingkidney failure or HRS, which can translate into the early initiation of treatment for impending HRS.

Magnetic Resonance Imaging in Evaluation of Avascular Necrosis of Femoral Head

Introduction: Avascular necrosis (AVN) of the femoral head is one of the common causes of pain and disability of hip. Impairedblood supply and increased intraosseous pressure are predominantly responsible for the necrotic process, which eventuallyresults in collapse of the femoral head. Magnetic resonance imaging (MRI) is the preferred investigation for the evaluation of AVN.Aims and Objectives: This study aims to assess the role of MRI in the evaluation of clinically suspected cases of AVN of hipand to describe the imaging features along with proper staging.Materials and Methods: In this prospective study, 100 patients of all age groups with clinically suspected cases of AVN offemoral head were evaluated by MRI hip in the Department of Radiodiagnosis, Gandhi Medical College and Hamidia Hospitalover a period of 1 year. Detailed history and associated risk factors were asked from all patients. MRI hip was then performedon 1.5 Tesla Hitachi ECHELON SMART - 523 MRI machine using the required protocol and sequences. The imaging findingswere studied and proper staging was given.Results: In our study of 100 cases of AVN, 132 femoral heads were involved (unilateral 68 and bilateral 32 cases). The most commonrisk factor associated was alcohol consumption. The most common quadrant of femoral head affected was anterosuperior (49.3%). Themost common stage of AVN was found to be Grade III – 39.4% (Ficat and Arlet classification), Type C – 47% (Mitchell’s classification),and Stage IIIC – 37.8% (Steinberg classification). MRI could detect early AVN in 50 femoral heads, in which radiographs were normal.Conclusion: This study concludes that MRI is the modality of choice for diagnosing and staging AVN. Early diagnosis andappropriate treatment is associated with better outcome.

Magnetic Resonance Imaging in Evaluation of Hip Pain

Introduction: Hip pain is a common problem and a major disabling condition that affects patients of all ages. Magnetic resonanceimaging (MRI) plays an important role as it provides valuable information regarding various hip pathologies. Thus, it is the modalityof choice for evaluation of hip pain as it has a profound impact on the subsequent treatment and is useful tool for the clinicians.Aims and Objectives: This study aims to assess the role of MRI in evaluation of painful hip joints and to describe the imagingfeatures along with differential diagnosis of the various hip pathologies.Materials and Methods: In this prospective study, 50 patients of all age groups with hip pain were evaluated by MRI hip in theDepartment of Radiodiagnosis, Gandhi Medical College and Hamidia Hospital, over a period of 1 year. MRI hip was performedon 1.5 Tesla Hitachi ECHELON SMART - 523 MRI machine using the required protocol and sequences. The possible diagnosiswas given and non-specific imaging findings were further confirmed by cytology/histopathology wherever indicated.Results: In our study of 50 cases, MRI could detect the exact cause of hip pain in 49 patients. The most common cause wasavascular necrosis of femoral head (50%) followed by infective arthritis (12%). Other causes were transient synovitis, sacroiliitis,osteoarthritis, slipped capital femoral epiphysis, Perthes disease, and various neoplastic conditions of the hip.Conclusion: This study concludes that MRI proved as a valuable imaging modality to accurately diagnose various pathologiesaffecting hip.

Congenital Right Lung Agenesis With Dysplastic Sternum - A Constellation Of Two Rare Cases

Congenital lung agenesis is a rare disease spectrum which includes complete agenesis, lung aplasia (with rudimentary bronchus)and partial agenesis. It is embryological anomaly arising from failure of unilateral lung bud to develop. Sternal dysplasias are veryrare entities with only few reported cases[1] . We present case report of a 1 year old female with complete right lung agenesisassociated with dysplastic sternum and vertebral segmentation anomaly

Evaluation of placental thickness as a sonological indicator for estimation of gestational age of foetus in normal singleton pregnancy.

Background: Gestational age is frequently over or under estimated, as the conventional gestational estimation is based on the last menstrual period and on ultrasonography. Many people are unaware of their last menstrual period and irregular menstruation and ultrasonography is bound to have a bias, thereby posing difficulties in the estimation gestational age. Placental thickness measured at the level of umbilical cord insertion appears to be a new promising parameter for estimation of gestational age of fetus as placenta is a maternal foetal organ and its size is a reflection of the health and size of the foetus. It provides the physiological link between a pregnant woman and the fetus.Measurement of placental thickness is relatively simple and very useful. In our present study we have tried to measure Placental thickness at the level of umbilical cord and determine its relationship with gestational age of foetus in normal singleton pregnancy. Methods: The current crossectional study was conducted at the department of radiodiagnosis, Gandhi medical college and Hamidia hospital, Bhopal from April 2012 to December 2014. This is a hospital based study with a sample size of 199 normal antenatal women. All the subjects were enrolled with detailed oral and written consents. All examinations were performed using GE logic 3 expert scanner with 3.5 MHz convex array transducer. Placental thickness in millimeters was measured at the level of insertion of the umbilical cord. Data was compiled in MS excel sheet and analyzed using online statistical calculator, chi square test and pearson correlation coefficient were applied with value of P <0.05 was considered statistically significant. Results: In the total study group of 199 normal antenatal women, the age ranged between 18yrs to 34 years and the mean age was between 20 and 25 years of age. Anterior placenta was noted to be the most common location amongst the study sample. It is observed that placental thickness correlates with gestational age and gradually increases as gestational age increases. To prove that there was a correlation the between placental thickness and the gestational age, the Pearson correlation coefficient was found to be r = 0.98 and the p value was <0.001, thereby establishing a positive correlation between the two variables, indicating placental thickness measured in millimeters increases with gestational age measured in weeks and were statistically significant. Conclusion: A linear increase in mean placental thickness with gestational age was observed using correlation analysis in our present study conducted to determine the relationship between placental thickness and gestational age. Placental thickness measured in millimeters increases with gestational age from 11 weeks to 37 weeks. Placental thickness can be used as a predictor of the gestational age, in women in whom the last menstrual period is unreliable or is not known. In instances when femoral length was difficult to measure due to excessive foetal movements, Placental thickness was found to be a reliable alternative biometric measurement in calculating gestational age.