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Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.
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Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.
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Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.
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Background: PACS (Picture archiving and communication systems) and digital imaging (DI) has revolutionized radiology bringing about a paradigm shift in the way radiodiagnosis is perceived and practiced with a slew of benefits like elimination of the need for manual handling of films, helping in long term storage of digital images, easy transfer and retrieval of radiographic images. The objective of this study was to analyse the influence of PACS and digital imaging on the workflow in the radiology, performance of the radiographer and image storage and retrieval capabilities.Methods: It was a questionnaire-based study in which questions were asked to the radiographers working in our hospital at five different working sites. Each questionnaire was aimed to evaluate the effect of digital imaging on radiology workflow, improvement in the performance of radiographers, reduction in the work-related frustration levels due to use of digital imaging and finally the utility of digital imaging in image storage, query and retrieval.Results: Among the 50 questionnaires 41 were completed and retrieved. Among the respondents, 90.24% indicated that digital imaging has obviated the need for repeat examinations, 95.12% agreed with the fact that it resulted in the reduction of the number of reject images, 95.1% said it helped them in improving their performances, 92.6% of the respondents said they did not face any issue with its use and 95.1% of the participants agreed that the image query and retrieval could be accomplished in a hassle-free manner.Conclusions: The digital imaging technique not only improves the performance of the radiographers but also increases the workflow of the health care hospitals or clinics. The digital imaging reduces the number of rejected images thus reducing radiation exposure to the patients. Further, it is highly cost-effective and time-saving.
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Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.
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Introduction: Encephalitis is defined as inflammation of thebrain parenchyma. Study was done to determine the role ofDWI/ADC in the early diagnosis of acute viral encephalitis.Material and methods: 26 patients with clinical andlaboratory (CSF, blood culture) evidence of encephalitis wereprospectively evaluated with MRI, DWI/ADC and SWI withpatients divided into three groups on the basis of durationbetween the onset of clinical symptoms and timing of MRIbrain.Results: Of the total 26 patients imaged with age range of 3-70years (mean age 45 years), 20 were males and 6 were femaleswith a male to female ratio of 3.3:1. Group 1 comprised 8patients, group 2 and group 3 comprised 9 patients each. Pvalues were significant (p<0.05) between mean ADC valuesand their respective groups. We also found statisticallysignificant difference between group 2 and group 3 (p=0.041)with no statistically significant difference between groups 1and 2; and groups 1 and 3.Conclusion: MRI plays vital role in patients of acuteencephalitis in not only excluding intracranial space occupyinglesions but also in early diagnosis and specific treatment, thusreducing disease related morbidity and mortality. DWI/ADCis now an essential sequence in the colossal armamentariumof MRI sequences which not only helps in early diagnosis ofacute viral encephalitis but also has prognostic implications.
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Background:Radiological determination of gender relies predominantly on the skeletal radiology and assumes importance in mass natural disasters, bomb explosions, exhumations and warfare where skeletal fragmentation is common. Varied literature is present regarding the role of foramen magnum in establishing gender identification.The objective of the study wasto establish normative values of cross-sectional area of foramen magnum in both genders using NCCT and try to ascertain any significant difference in cross-sectional area in the two genders which may help in gender identification.Methods:NCCT head images of 378 subjects were analysed in individuals beyond the age of skeletal immaturity. Free ROI technique using electronic calliper tool was used. The cross-sectional area of foramen magnum was automatically obtained after tracing its whole inner circumference.Results:Mean cross-sectional area of foramen magnum in females was 806.79±106.58 mm2and was 878.33±98.42 mm2in males. Although the cross-sectional area in males was greater than females no statistically significant difference was found. The correlation coefficient was found to be weaker (R=0.0413). Conclusions: No statistically significant difference was found between the two genders. The correlation coefficient was also weak to draw any inference about the gender of the skull on CT imaging. Further studies are needed to include other parameters like the sagittal and transverse diameters of foramen magnum in a larger sample to show importance of foramen magnum, if any, in helping gender identification of skeletal remains
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Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve
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Background: An enormous number of artefacts are encountered in magnetic resonance imaging (MRI) which jeopardize the image quality. A comprehensive knowledge of the sources and the remedial measures needed is pivotal to enhance and optimize the image quality in magnetic resonance imaging (MRI). Objectives: The primary objectives of the study were to identify different MRI artefacts, to find the reason/cause of these artefacts and to find methods for correction of these artefacts. Materials and methods: This was a prospective study which included all the patients that were referred to our department for various MRI examinations. The study was carried at 1.5 tesla Magnetom Avanto Siemens, Germany. All the MRI examinations were performed by trained technologist in presence of an experienced radiologist. The MR images acquired were studied for the presence of any artefacts during the performance of MRI examination, the MR parameters at which the artefacts appeared and subsequently the remedial measures undertaken. Results: A total of 209 patients comprising 95 females and 114 males, referred to our department for MRI examinations of various body parts were studied. The commonest artefact observed was motion artefact in 43 (20.6%) patients followed by susceptibility artefact and aliasing artefact. Less common artefacts observed were chemical shift artefact, herring bone artefact, Gibb’s artefact, Moiré fringe artefact, zipper artefact and magic angle phenomenon. Arshed Hussain Parry, Abdul Haseeb Wani, Abdul Momin Jan, Tariq Ahmad Gojwari. Artefacts in magnetic resonance imaging (MRI) and their remedies. IAIM, 2019; 6(4): 122-130. Page 123 Conclusion: Thorough understanding of the sources of magnetic resonance imaging (MRI) artefacts and the mechanism of their production enables