Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours.

OBJECTIVE: To assess the utility of ultrasound and color Doppler and the Accuracy of International Ovarian Tumor Analysis (IOTA) group classification in the preoperative evaluation of ovarian neoplasms to assess benign or malignant histopathology in the diagnosis of ovarian tumors. METHODS: This observational longitudinal prospective analysis of 60 patients was performed over a period of 2 years (2017- 2019). The mean age of the patients was 43.75 years. Ultrasonography of ovarian masses were evaluated, and cancer antigen-125 (CA-125) levels were evaluated. Based on the IOTA classification, the B and M features of adnexal masses were studied. Color Doppler imaging was performed to evaluate the patterns of vascularity and indices. RESULTS: Sixty patients with 35 benign, 23 malignant, and two borderline lesions were included in the study. In malignant lesions, 17 women (73.9%) were above the age of 45. The CA-125 cut off was ≥35 internatioal units/mL. Based on the IOTA classification, 27/35 (77.1%) benign cases, were correctly identified as benign, 6/35 (17.1%) benign cases were incorrectly identified as malignant, and two (5.7%) were found to be inconclusive. In the malignant group, 17 of the 23 patients were identified as having malignancy. Color Doppler showed three (18.8%) benign tumors had a pulsatality index (PI) of <0.8 and 21 malignant tumors had a PI of <0.8. Four benign tumors had an resistive index (RI) of <0.6 and 100% of malignant tumors had an RI <0.6. CONCLUSION: The IOTA classification is a reliable scoring system for adnexal masses, and color Doppler can help to minimize interobserver variation.

A Rare Case of Hyoid Osteoma.

Solid primary tumors of the hyoid bone are extremely rare. Osteomas are benign, slow-growing, usually asymptomatic, and well-circumscribed tumors broadly attached to the bone surface composed of mature lamellar/cortical-type bone with unknown etiology. Osteomas commonly occur in bones formed by membranous ossification, almost exclusively occurring in the head and commonly involving the paranasal sinus, skull vault, mandible, and nasal bone. We discuss a rare case of osteoma involving the hyoid bone.

Multimodal medical tensor fusion network-based DL framework for abnormality prediction from the radiology CXRs and clinical text reports.

Pulmonary disease is a commonly occurring abnormality throughout this world. The pulmonary diseases include Tuberculosis, Pneumothorax, Cardiomegaly, Pulmonary atelectasis, Pneumonia, etc. A timely prognosis of pulmonary disease is essential. Increasing progress in Deep Learning (DL) techniques has significantly impacted and contributed to the medical domain, specifically in leveraging medical imaging for analysis, prognosis, and therapeutic decisions for clinicians. Many contemporary DL strategies for radiology focus on a single modality of data utilizing imaging features without considering the clinical context that provides more valuable complementary information for clinically consistent prognostic decisions. Also, the selection of the best data fusion strategy is crucial when performing Machine Learning (ML) or DL operation on multimodal heterogeneous data. We investigated multimodal medical fusion strategies leveraging DL techniques to predict pulmonary abnormality from the heterogeneous radiology Chest X-Rays (CXRs) and clinical text reports. In this research, we have proposed two effective unimodal and multimodal subnetworks to predict pulmonary abnormality from the CXR and clinical reports. We have conducted a comprehensive analysis and compared the performance of unimodal and multimodal models. The proposed models were applied to standard augmented data and the synthetic data generated to check the model's ability to predict from the new and unseen data. The proposed models were thoroughly assessed and examined against the publicly available Indiana university dataset and the data collected from the private medical hospital. The proposed multimodal models have given superior results compared to the unimodal models.

A myriad spectrum of seizures on magnetic resonance imaging - A pictorial essay.

Patients with seizures represent a challenging clinical population both in pediatrics and adults. Accurate diagnosis of the cause of a seizure is important in choosing an effective treatment modality, surgical planning, predicting a prognosis, and follow-up. Magnetic resonance (MR) imaging using a dedicated epilepsy protocol plays a key role in the workup of these patients. Additional MR techniques such as T2 relaxometry and MR spectroscopy show a promising role to arrive at a final diagnosis. The spectrum of epileptogenic causes is broad. Radiologists and physicians need to be updated and require a patterned approach in light of clinical history and electroencephalogram findings to arrive at a reasonable differential diagnosis. This pictorial essay aims to review a few of the common and uncommon causes of seizures and their imaging features.

Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome.

To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.

Postcontrast Fluid-Attenuated Inversion Recovery (FLAIR) Sequence MR Imaging in Detecting Intracranial Pathology.

BACKGROUND: Imaging sequences for detection of meningeal and parenchymal lesions are critical in intracranial pathology. Our study analysed FLAIR MRI sequence for evaluating postcontrast enhancement. OBJECTIVES: FLAIR imaging sequences have been used in evaluation of enhancement in the brain. We conducted a study of FLAIR imaging sequences to better delineate postcontrast enhancement. MATERIALS AND METHODS: In this prospective hospital-based observational study, postcontrast T1 MTC and delayed postcontrast T2 FLAIR and T1 FLAIR images of 66 patients with intracranial pathology were assessed by experienced radiologists from November 2017 to November 2019. RESULTS: 28 cases of meningeal enhancement were identified in delayed postcontrast T2 FLAIR images. Low-grade gliomas included in the study showed postcontrast enhancement on postcontrast T1 MTC images. Multiple sclerosis lesions were better seen on postcontrast T1 FLAIR. In extraaxial lesions of 11 cases of meningioma, brighter enhancement was seen on delayed postcontrast T2 FLAIR images. CONCLUSION: We found that delayed postcontrast T2 FLAIR was better in detection of meningeal enhancement in infectious meningitis and in meningitis carcinomatosis than T1 MTC images. In delayed postcontrast T2 FLAIR images, intra-axial parenchyma lesions appeared more conspicuous or similar to T1 MTC images. Delayed postcontrast T1 FLAIR images provided better anatomic delineation of intra-axial lesions.

A curious case of vanishing pituitary adenoma.

Pituitary macroadenoma is the most common suprasellar lesion in adults. If symptomatic, it is managed surgically via transsphenoidal resection. Patients commonly present with headache and visual disturbances. If the tumour is large enough, it may have mass effect and patient may present with symptoms of elevated intracranial pressure like severe headache, nausea and vomiting. Functional adenomas may cause endocrine dysfunction. Here, we present a case of pituitary macroadenoma in a young adult female who presented with headache. Initial CT and MRI revealed a pituitary macroadenoma. However, repeat imaging done preoperatively showed complete regression of the lesion and a normal appearing pituitary gland.

A rare case of epidermoid cyst in urinary bladder.

Epidermoid cyst in urinary bladder is a rare pathology with only one known case published prior to this study. In this article, we described imaging findings of epidermoid cyst in the urinary bladder and other parts of urogenital system. Plain CT KUB was performed on Multidetector 16 slice computed tomography scanner-GE Bright speed Elite and plain magnetic resonance imaging on 1.5 T Siemens Magnetom Avanto.

Clinical relevance of reporting fatty liver on ultrasound in asymptomatic patients during routine health checkups.

OBJECTIVE: Ultrasonography is an efficient technique for detecting fatty liver. Its sensitivity and specificity in detecting moderate to severe fatty liver are comparable to those of histology. Fatty liver is associated with abnormal lipid and lipoprotein metabolism and insulin resistance, metabolic syndrome, cardiovascular/renal disease, type 2 diabetes, and other conditions. This study was performed to compare the serum lipid profiles and serum glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), and glycosylated hemoglobin (HbA1c) levels in patients diagnosed with fatty liver on ultrasonography versus controls without fatty liver and evaluate the clinical relevance of an ultrasound diagnosis of fatty liver in routine health checkups. METHODS: This hospital-based cross-sectional study included 390 patients who underwent health checkups; 226 were diagnosed with fatty liver (cases) and 164 were not (controls). The lipid profile, serum GOT and GPT levels, and HbA1c level were compared between the cases and controls. RESULTS: The cases had considerably higher levels of lipids, liver enzymes (serum GOT and GPT), and HbA1c than controls. CONCLUSION: Ultrasonography is a noninvasive simple tool for early detection of fatty liver in asymptomatic patients and can help clinicians achieve early detection of metabolic syndrome.

Reliability and Validity of Standing Back Extension Test for Detecting Motor Control Impairment in Subjects with Low Back Pain.

INTRODUCTION: Low back pain is a chronic health problem with high socioeconomic impact. Specific diagnosis or treatment approach has not yet effectively established to treat chronic low back pain. Standing Back Extension Test is one of the clinical measures to detect the passive extension subgroup of Motor Control Impairment (MCI); which could have an impact on spinal stability leading to recurrent chronic low back pain. Reliability and validity of this test is not fully established. AIM: To determine the intra-rater and inter-rater reliability and concurrent validity of the Standing Back Extension Test for detecting MCI of the lumbar spine. MATERIALS AND METHODS: A total of 50 subjects were included in the study, 25 patients with Non Specific Low Back Pain (NSLBP) (12 men, 13 women) and 25 healthy controls (12 men, 13 women) were recruited into the study. All subjects performed the test movement. Two raters blinded to the subjects rated the test performance as either 'Positive' or 'Negative' based on the predetermined rating protocol. The thickness of Transverse Abdominis (TrA) muscle was assessed using Rehabilitative Ultrasound Imaging (RUSI). STATISTICAL TEST USED: For reliability, the kappa coefficient with percent agreement was calculated and for assessing the validity Receiver Operator Characteristic (ROC) curves and Area under the Curve (AUC) were constructed. RESULTS: The standing back extension test showed very good intra-rater (k=0.87 with an agreement of 96%) and good inter-rater (k=0.78 with an agreement of 94%) reliability and high AUC for TrA muscle. CONCLUSION: The standing back extension test was found to be a reliable and a valid measure to detect passive extension subgroup for MCI in subjects with low back pain.

MRI sequence and characteristic features in 'giant cell tumor' of clivus.

Giant cell tumours of the clivus are rare. These tumours present in the second and third decades of life and they are slightly more frequent in women than in men. We are presenting a case of a 20 years young patient who came with the complaints of headache, retro-orbital pain and recurrent transient bleeding from the nose since two and half months. MRI of the brain with contrast was done and its features were suggestive of a Giant cell tumour of the clivus. A transnasal endoscopic biopsy was done under general anaesthesia and the histopathology report suggested that the features were of a giant cell tumour. Excision of the mass was done by Transnasal endoscopy. Post operatively, the patient did not recover from the lateral rectus palsy which was there on the right side. The patient was discharged with an advice of a follow up and radiotherapy. Radiation therapy and chemotherapy may be effective as adjuvant treatments. Even though a recurrence usually occurs within 4 years of the initial treatment, these patients will need to be carefully followed for the remainder of their lives.

Infratemporal fossa abscess: a diagnostic dilemma.

An abscess in the infratemporal fossa is a rare complication of dental extraction. Although it is a recognized entity, only a handful of cases have been reported in the literature. We describe a case of abscess in the infratemporal fossa of a 55-year-old woman with noninsulin-dependent (type 2) diabetes who presented with left-sided facial pain and marked trismus. The abscess was managed successfully with external drainage. We have made an attempt to comprehensively review the literature on this rare condition, with special emphasis on its anatomic complexity and varied clinical presentation, and we provide a detailed discussion of the diagnosis and management of this condition.

Hemifacial microsomia.

Hemifacial microsomia (HFM) is a craniofacial disorder characterized by a wide spectrum of anomalies, including conductive hearing loss due to external and middle ear deformities [1]. Hemifacial microsomia is the second most common developmental craniofacial anomaly after cleft lip and palate. Diagnostic imaging is important for presurgical evaluation of patients with this anomaly; however the broad spectrum of abnormalies encountered in patients with hemifacial microsomia can be confusing [2]. We present a case of a hemifacial microsomia in 12 year old male.

WAGR syndrome--a case report.

The WAGR syndrome is a multiple congenital anomaly-mental retardation syndrome caused by interstitial deletion of the distal portion of chromosome 11p13. It is a contiguous gene deletion syndrome, and WAGR is an acronym for the primary features: W for Wilms tumor, A for aniridia, G for genital anomalies, and R for mental retardation. Wilms tumor and male genital anomalies are caused by deletion of the WT1 tumor-suppressor gene, and aniridia is caused by deletion of PAX6 ocular developmental gene. Mental retardation is presumed to be a consequence of deletion of multiple as yet unidentified genes in the region. Individuals with the WAGR syndrome have a high risk for developing Wilms tumor and late-onset renal failure, and should be monitored for these complications.

Pseudoaneurysm of internal carotid artery.

Pseudoaneurysms of the extracranial Internal Carotid Artery (ICA) are rare. Here it is reported a case of posttraumatic extracranial ICA pseudoaneurysm in a three-year-old boy. The pseudoaneurysm arising from the extracranial ICA was initially diagnosed by DSA. Later on confirmed by Doppler and MRA. The imaging features are described with a brief review of literature.