Imaging spectrum of renal masses on multi-slice computed tomography

Background: Multi-slice computed tomography (MSCT) is the mainstay for preoperative assessment of many complex renal masses in current clinical practice. Benign renal processes may simulate malignant renal tumors and could be defined correctly by CT. MSCT has also an important role in tumor staging. The purpose of this article is to understand the imaging spectrum of renal masses on MSCT and assess the usefulness of CT in surgical planning and management.Methods: Studied 500 patients with suspected renal lesions who underwent MSCT during the period July 2017 to July 2020 at state-of-art imaging center. CT imaging was done in those patients in whom clinical examination and ultrasonography (USG) revealed possibility of diagnosis of renal masses for further detailed evaluation and deciding management.Results: Out of 500 total subjects, the common age group in this study is 51 to 60 years (25%). Male preponderance (59%) was noted. The most common presentation was pain (84%) followed by lump (29.4%) and haematuria (17.8%). Malignant masses (51%) were more common followed by benign (39%) and inflammatory masses (10%) respectively. Renal cell carcinoma has more incidence (30%) followed by simple cyst (20%). Calcification (19.6%), perinephric extension (78%) and vascular invasion (21.5%) are more common in malignant masses. Conclusion: MSCT is the modality of choice for the diagnosis of renal masses and deciding management approach in current practice. Detection of tumoral spread, invasion of surrounding organs and vascular structure are better with CT. MSCT also has a role in postoperative follow-up of renal masses.

Double outlet of right ventricle: imaging spectrum on multi-slice computed tomography

Background: Multi-slice computed tomography (MSCT) is the main stay of pre-operative assessment of many complex congenital heart diseases (CHD) in current clinical practice, one of them is double outlet of right ventricle (DORV). DORV is one of the conotruncal anomalies that encompasses a wide spectrum of anatomic malformations in which both the aorta and pulmonary arterial trunk arise entirely or predominantly from the morphologically right ventricle (RV). Purpose of this article is to understand spectrum of DORV and associated types of ventricular septal defect (VSD) on MSCT imaging with special emphasis of usefulness of 3-D volume rendered (VR) images in pre surgical evaluation.Methods: A total of 500 paediatric patients (<18 years old), who had undergone MSCT were studied during the period 2014 to 2019 at the tertiary cardiac care centre.Results: 500 patients having primary/suspicious diagnosis of DORV on echocardiography during the said period were enrolled in the study. All the patients who underwent MSCT scan, were studied in detail for: DORV spectrum, associated types of VSD and its relationship to the semilunar valves. Out of 500 total subjects, subaortic VSD was the most common type of VSD observed (53%), followed by subpulmonic VSD (22%), non-committed VSD (18%) and doubly committed VSD (7%). Associations of pulmonary stenosis, subaortic stenosis and aortic co-arctation with various types of VSDs were addressed. Associated other anomalies were also analysed.Conclusions: Advances in MSCT technology has revolutionized pre-surgical diagnosis, management approach and post-operative follow-up of DORV patients. Excellent image qualities along with 3D volume rendered images help surgeon understand complex morphology of DORV variants and associated types of VSD. Significant reduction in intra and post-operative mortality in DORV patients in current era is result of MSCT technology.

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.

MSCT imaging of various shunts and grafts in post operative cases of congenital heart diseases

Background: Multi-slice computed tomography (MSCT) plays an important role in clinical practice in assessing post-operative patients with complex CHD when echocardiography is not contributory.  Despite the great capabilities of MR imaging for anatomic and functional assessment of the heart, it is time-consuming and may require a lengthy period of patient sedation; hence its use in seriously ill or uncooperative patients is often limited. CT has the advantages of widespread availability and short acquisition times. It is imperative for a radiologist to be aware of various palliative as well as corrective procedures and their various imaging findings. Aim of this article is to demonstrate and make one aware of various checklists and imaging findings in paediatric patients who have undergone various shunts and grafts at our tertiary cardiac care centre, their immediate as well as long term complications.Methods: We studied a total of 100 paediatric patients (<12 years old), who had undergone some sort of palliative or corrective shunt or graft placement, on MSCT during the period 2014 to 2018 at our tertiary cardiac care centre.Results: We try to outline details of various shunts and grafts used in congenital heart diseases correction, MSCT technique and imaging appearances and appearances of abnormal post-operative findings.Conclusions: Advances in computed tomography (CT) scanners and electrocardiographic gating techniques have resulted in superior image quality of the aorta and pulmonary arteries for evaluating postoperative congenital heart disease. MSCT is an excellent non-invasive modality for post-operative evaluation of various shunts and grafts.

Psychosocial effect and economic burden on parents of children with locomotor disability.

Objective. To assess the social and financial burden on parents of children with locomotor disability. Methods. A cross-sectional study was conducted in the Institute for Physically Handicapped (IPH), Delhi, where parents of 100 locomotor disabled children of age group 6 to 15 years were interviewed to estimate the socioeconomic burden of caregiving their children. Results. The study observed that the parents of the disabled children were severely burdened in terms of financial burden and mental health. Conclusions. There is an urgent need for support activities for such families at a national level in order to curb the huge economic and social burden of care-giving. Counselling should be an integral part of rehabilitat ion for such families.

Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis.

The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT), in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4%) cases of bacterial meningitis. In contrast, Gram stain and culture showed 16.9 and 23.1% positivity, respectively. LPAT correlated well with Gram stain and culture and can be recommended as an adjunct laboratory test for rapid aetiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.