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.

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.

Juvenile-onset Huntington’s Disease: A Rare Case Report

Juvenile-onset Huntington’s disease (JHD) is a rare autosomal dominant neurodegenerative disorder of the central nervoussystem characterized by the presence of abnormal involuntary movements, rigidity, and ataxic gait. We are presenting a rarecase of a 9-year-old male who was referred to the Radiology Department of Gandhi Medical College and Hamidia Hospital formagnetic resonance imaging (MRI) brain with complaints of progressive impairment of gait, bradykinesia, and marked posturalinstability for the past 2 years. The patient also had a history of episodes of seizures for 4 years. MRI findings revealed: Atrophyof bilateral caudate nuclei and putamina of basal ganglia.

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.