Comparison of pituitary stalk angle, inter-neural angle and optic tract angle in relation to optic chiasm location on 3-dimensional magnetic resonance imaging.

Optic chiasm location is critical in sellar surgeries and may be obscured by tumor invasion. This study evaluates inter-neural angle, pituitary stalk angle, optic tract angle in prefixed, normal and post fixed optic chiasms using 3-dimensional constructive interface in steady state (CISS) sequences of magnetic resonance imaging (MRI) in essentially normal studies. MRI Brain studies of 154 patients were retrospectively evaluated. Location and height of optic chiasm was noted. Interneural angle between intracranial segments of bilateral optic nerves, pituitary stalk angle between pituitary stalk and optic chiasm, optic tract angle between optic tracts were measured and compared in prefixed, normal and post fixed chiasms using ANOVA test. Optic chiasm was prefixed in 33 (21.4%) cases, normal in 111 (72.1%) cases and postfixed in 10 (6.5%) cases with mean height of optic chiasm of 3.33 mm. There was no statistically significant difference in height and type of optic chiasm between age groups and genders. Statistically significant difference between location of optic chiasm was seen with interneural angle (p = 0.013), was highly significant with pituitary stalk angle (p < 0.001) and was not seen in optic tract angle (p = 0.455). Optic chiasm location was divided into nine groups with frequency being highest in intermediate height, normal fixed chiasms (n = 62, 40.26%) and least in post fixed high, post fixed low groups (n = 1, 0.006%). A wider interneural angle, wider pituitary stalk angle with a more anteriorly placed stalk indicates a prefixed chiasm. 3-dimensional MRI is an effective tool in assessing the optic chiasm location, when its invaded by sellar and suprasellar tumours.

Comparison of anatomical risk factors for noncontact anterior cruciate ligament injury using magnetic resonance imaging.

PURPOSE: To compare the significance of the tibio-femoral geometrical indices (notch width index, medial and lateral tibial slopes) and patellar tendon- tibial shaft angle in predicting non-contact ACL injuries and to compare these factors between genders. METHODS: Retrospective case control study evaluating 66 MRI knee of patients of age group of 18-60 years with 33 cases of noncontact ACL injury and 33 age matched controls. Notch width index, medial and lateral tibial slopes and patellar tendon tibial shaft angles were calculated and compared for statistical significance and was also compared between the genders. ROC curve was for plotted for the significant factors. RESULTS: Statistically significant difference was seen in notch width index and patellar tendon tibial shaft angles with cases showing a narrow notch width index and an increased patellar tendon tibial shaft angle. Gender comparative results showed no statistically significant differences. ROC curve plotted for NWI showed an optimal cut off value of 0.263 with a sensitivity of 88% and a specificity of 52%. ROC curve plotted for PTTS angle showed a cut off value of 26.7 degrees with a sensitivity of 67% and a specificity of 49%. CONCLUSION: Narrow Notch width index and increased Patellar tendon tibial shaft angle are predictors of ACL injury. PTTS angle which has been studied as a function of knee flexion angle, can itself be an independent predictor of ACL injury (at a constant knee flexion angle).

Image Findings of Solid Pseudopapillary Neoplasms of the Pancreas on Multiphasic Multidetector CT Scan-A Single Institute Experience from Southern India.

INTRODUCTION: Solid Pseudopapillary Neoplasms (SPN) are uncommon pancreatic tumours and are slow growing with uncertain malignant potential, showing female preponderance. Postoperative prognosis is good and metastasis is rare. AIM: To summarise the imaging and pathological features of seven cases of SPN in three years period, from January 2013 to January 2016. MATERIALS AND METHODS: In this retrospective study the imaging features of seven cases on triphasic multidetector Computed Tomogram (CT), a 16-slice scanner, were reviewed along with CT-guided Fine Needle Aspiration Cytology (FNAC) and histopathological examination. Statistics were expressed in terms of percentiles. RESULTS: All cases were female patients with an age range of 13-35 years (mean: 23.3 years). On CT assessment, the size of the tumours varied from 2.5-14 cm (mean: 5.3 cm). All these tumours were well capsulated and round to oval in shape. In four out of seven cases, the tumour was located in the tail of pancreas. All the solid enhancing portions showed moderate enhancement of at least 20-30 HU compared to unenhanced scan, on the other hand the cystic parts remained unenhanced with <5 HU variation in comparison to the plain scan. Histopathological examination exhibited characteristic poorly cohesive cuboidal cells arranged in papillaroid pattern having fine nuclear chromatin with nuclear grooves. CONCLUSION: Solid pseudopapillary neoplasm is a high diagnostic possibility in case of a young female having pancreatic mass and needs to be evaluated with triphasic contrast enhanced CT scan, followed by FNAC and or histopathological examination.

Surgically Relevant Bony Anatomical Variations in Paraclinoid Aneurysms-Three-Dimensional Multi-Detector Row Computed Tomography-Based Study.

OBJECTIVE: To evaluate the proportion of surgically relevant anatomical variations such as caroticoclinoid foramen, interclinoid osseous bridge, and anterior clinoid pneumatization in patients with paraclinoid aneurysms based on computed tomography (CT) cerebral angiography studies. MATERIALS AND METHODS: Fifty-four CT cerebral angiography studies showing paraclinoid aneurysms involving the cavernous, clinoid, and supraclinoid internal carotid artery (ICA) were retrospectively evaluated. Source images were processed for three-dimensional reconstructions to evaluate the presence and type of caroticoclinoid foramen, interclinoid osseous bridge, and multiplanar reconstructions with bone algorithm to study the type of pneumatization. RESULTS: The study included 30 female and 24 male patients with mean age of 45.61 (10.47) years. Among the 108 sides studied in 54 patients, caroticoclinoid foramen was seen in 24 cases (22.22%), interclinoid osseous bridge was seen unilaterally in 1 case (0.9%), and pneumatization of anterior clinoid process occurred in 12 cases (11.11%). Incomplete caroticoclinoid foramen (11 cases) and Type I pneumatization (7 cases) were seen to be predominant subtypes. There was no statistically significant gender difference in the occurrence of caroticoclinoid foramen and anterior clinoid pneumatization. Seventy-four aneurysms were detected in 54 patients. Based on their location, 46 aneurysms involved supraclinoid ICA, 18 aneurysms in the clinoid segment, and 10 aneurysms in the cavernous segment. Caroticoclinoid foramen was most prevalent in clinoid aneurysms with 12 cases occurring in the clinoid segment. CONCLUSION: Notable proportions of caroticoclinoid foramen and pneumatization occur in cases of paraclinoid aneurysm. Radiological reports should emphasize on these surgically relevant bony anatomical variations.

Neurotrophic factor mediated neuronal differentiation of human cord blood mesenchymal stem cells and their applicability to assess the developmental neurotoxicity.

Plasticity and developmental capacity of stem cells have now been established as a promising tool to restore the degenerative disorders. The linearity differentiation of human mesenchymal stem cells (hMSCs) into adipogenic, chondrogenic, osteogenic and even in neuronal subtypes has been demonstrated. The number of xenobiotics such as dexamethasone, insulin, isobutyl 1-methyle xanthine and retinoic acid has been reported for the potential to differentiate hMSCs into neuronal subtypes. But, the applicability of indigenous neurotrophic factor-nerve growth factor (NGF) has not been explored for the purpose. Thus, the present investigations were carried out to study the NGF induced neuronal differentiation of hMSCs. Following the isolation, purification and characterization of hMSCs were allowed to differentiate into neuronal subtypes under the influence of NGF (50 ng/mL). At various concentrations of NGF, the neuronal makers were analysed at both mRNA and protein levels. Cells, exposed with NGF were showing the significant and gradual increase in the neuronal markers in differentiating cells. The magnitude of expression of markers was maximum at day 4 of differentiation. NGF at 50 ng/mL concentration was found to induce neuronal differentiation of hMSCs into neuronal subtypes.

Optic Strut and Para-clinoid Region - Assessment by Multi-detector Computed Tomography with Multiplanar and 3 Dimensional Reconstructions.

PURPOSE: To evaluate thickness, location and orientation of optic strut and anterior clinoid process and variations in paraclinoid region, solely based on multidetector computed tomography (MDCT) images with multiplanar (MPR) and 3 dimensional (3D) reconstructions, among Indian population. MATERIALS AND METHODS: Ninety five CT scans of head and paranasal sinuses patients were retrospectively evaluated with MPR and 3D reconstructions to assess optic strut thickness, angle and location, variations like pneumatisation, carotico-clinoid foramen and inter-clinoid osseous ridge. RESULTS: Mean optic strut thickness was 3.64mm (±0.64), optic strut angle was 42.67 (±6.16) degrees. Mean width and length of anterior clinoid process were 10.65mm (±0.79) and 11.20mm (±0.95) respectively. Optic strut attachment to sphenoid body was predominantly sulcal as in 52 cases (54.74%) and was most frequently attached to anterior 2/5(th) of anterior clinoid process, seen in 93 sides (48.95%). Pneumatisation of optic strut occurred in 23 sides. Carotico-clinoid foramen was observed in 42 cases (22.11%), complete foramen in 10 cases (5.26%), incomplete foramen in 24 cases (12.63%) and contact type in 8 cases (4.21%). Inter-clinoid osseous bridge was seen unilaterally in 4 cases. CONCLUSION: The study assesses morphometric features and anatomical variations of paraclinoid region using MDCT 3D and multiplanar reconstructions in Indian population.

The anatomical variations in the neurovascular relations of the sphenoid sinus: an evaluation by coronal computed tomography.

AIM: The sphenoid sinus is deeply situated in the skull and is the least accessible paranasal sinus. The sphenoid sinus is surrounded by vital structures such as the optic nerve and internal carotid artery, and therefore additional radiological assessment of the sphenoid sinus and the related neurovascular structures is inevitable before surgery. The aim of this study was to note the anatomic variations in the relationship of these structures with the sphenoid sinus by analyzing the coronal computed tomography (CT) scans. MATERIAL AND METHODS: The consecutive coronal CT scans of 100 patients that included 43 males and 57 females were evaluated. RESULTS: Variations in the neurovascular boundaries of the sphenoid sinus were a common finding in the present study and were seen in as many as 66% of the cases. Variations involving the Vidian canal were the commonest in our study and were seen in around 42%, followed by those involving the bony canal for internal carotid artery, 33%; maxillary nerve, 21 % and optic nerve, 9%. CONCLUSION: These variations do not represent disease as such, but may increase the risk of endoscopic mishaps. CT of the paranasal sinus region is therefore an essential prerequisite prior to sinonasal and trans-sphenoidal surgeries.

Transpleural central venous catheter discovered during thoracotomy.

We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC) was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were secured surgically.

Symptomatic Morgagni's hernia in an elderly patient.

Hernia of Morgagni occurs through an anterior defect in the diaphragm. Symptoms of these hernias are attributable to the herniated viscera. In our case, there was partial obstruction due to herniation of the distal stomach and pylorus into the right hemithorax that was reduced surgically through a right thoracolapaorotomy. Of special emphasis are the various modalities used to diagnose this condition in our case.