Role of High-resolution Ultrasonography in the Evaluation of the Tibial and Median Nerves in Diabetic Peripheral Neuropathy

AIM

To evaluate and measure the mean cross-sectional area of the tibial and median nerves in patients with diabetic peripheral neuropathy, and to study the association between high-resolution ultrasonographic findings in diabetic peripheral neuropathy with the duration of illness, glycosylated haemoglobin values, random blood sugar levels, and aesthesiometry (using monofilament examination).

MATERIAL AND METHODS

A prospective observational study was conducted among 63 patients who were diagnosed with type 2 diabetes mellitus and underwent ultrasound and monofilament examinations. The cross-sectional area of the median nerve of the dominant hand and the tibial nerves was calculated on ultrasound examination.

RESULTS

The mean cross-sectional area of the median and tibial nerves was higher in patients with poor glycaemic control, with the mean cross-sectional area of the median nerve being 10.9, 12.8, 13.0, and 12.9 mm² at various points in the leg in cases where the monofilament examination was negative, as compared to 7.30, 7.78, 7.91, 7.87 mm² in patients with positive monofilament examination results. There was a significant positive correlation between the cross-sectional area of the tibial and median nerves and HbA_1c, duration of diabetes, aesthesiometry, and random blood sugar levels. With an increase in HbA_1c, duration of diabetes, and random blood sugar levels, there was a corresponding increase in the cross-sectional area of the nerves. These findings helped us to identify diabetic peripheral neuropathy.

CONCLUSIONS

High-resolution ultrasonography along with aesthesiometry and HbA_1c values can be an effective and easily available tool for detecting changes secondary to diabetic peripheral neuropathy. The method has a potential to replace or substitute nerve conduction tests in the near future.

Utility of High-Resolution Sonography for Evaluation of Knee Joint Pathologies as a Screening Tool

Objective:

Magnetic resonance imaging (MRI) has been established as the gold standard imaging technique for assessing knee joint pathologies. However, high-resolution sonography (HRS) is affordable, easily available, cost-effective, and can be used for knee joint assessment. This study was conducted to assess the diagnostic yield of HRS in the evaluation of knee joint pathologies compared with MRI.

Materials and Methods:

In the study, 103 patients, with symptomatic knee pain, were included. HRS was performed followed by MRI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Kappa values were calculated to assess the performance of HRS compared with MRI.

Results:

The most frequent pathologies observed on HRS were knee joint effusion (84%) followed by medial meniscal (43%) and lateral meniscal (26%) tear.

Conclusion:

HRS demonstrated good diagnostic accuracy in diagnosis of knee joint pathologies as compared with MRI. Therefore, HRS could be utilized as a screening tool for detection of knee joint pathologies.

Can Radiology Play a Role in Early Diagnosis of Dengue Fever?

Background:

Dengue fever (DF) is a viral hemorrhagic fever causing severe morbidity and mortality in affected patients.

Aims:

The purpose of our study was to evaluate the changing trends in radiological findings in DF, to find if ultrasound is useful in the diagnosis of DF during an epidemic in absence of serological tests, and also to investigate the effects of DF in pregnancy.

Materials and Methods:

A prospective study was conducted in 2013 comprising of 400 patients who were serologically positive for dengue. Out of these, radiological investigations were conducted for 107 patients who were analyzed.

Results:

Out of the 107 patients, 85 patients underwent ultrasound, 12 computed tomography (CT) scans of brain or paranasal sinuses, and 21 chest radiography. The maximum numbers of patients (79%) were in the age group of 20-50 years. The most common ultrasound finding was hepatomegaly that was seen in 62% of the patients. Other findings were splenomegaly (45%), gallbladder (GB) wall edema (45%), right-sided pleural effusion (37%), bilateral pleural effusion (22%), and ascites (36%). Out of 10 pregnant patients, 5 had oligohydramnios, 2 had intrauterine growth restriction, 2 had intrauterine fetal demise, and 5 had a normal antenatal ultrasound.

Conclusion:

Ultrasound findings of hepatosplenomegaly, GB wall edema, right-sided or bilateral pleural effusion, and ascites in patients presenting with signs and symptoms of DF during an epidemic are virtually diagnostic of DF. There have been recent changing trends with hepatosplenomegaly being the more common manifestation, in comparison to ascites and GB wall edema. DF also has catastrophic effects in pregnancy such as oligohydramnios and intrauterine fetal demise.

A Case Report of Metronidazole Induced Neurotoxicity in Liver Abscess Patient and the Usefulness of MRI for its Diagnosis

Metronidazole is a very widely used drug for the treatment of multiple ailments caused by anaerobic bacteria as well as some protozoan parasites. Though its usual side effects are not very serious, yet sometimes it may cause profound adverse effects like neurotoxicity. We present here a case of liver abscess. The patient was treated for a long time with metronidazole and developed sudden onset neurotoxicity which was diagnosed by MRI. The present case also highlights the need of vigilant monitoring of patients on metronidazole for symptoms of neurotoxicity and the usefulness of MRI for diagnosis of the same.

Usefulness of 3D CT in Diagnosis of Cervical Rib Presenting as Supraclavicular Swelling of Short Duration

This is a unique case of cervical rib since the patient presented as a firm neck swelling of short duration which was clinically palpable as a superficial neck mass and referred for FNAC for the same. Since FNAC did not yield any positive result, the patient was then referred for CT which showed bilateral cervical ribs with pseudoarticulation with the 1(st) thoracic rib on the right side which is quite rare. The clinical importance of our case is to keep in mind a differential diagnosis of cervical rib in firm to hard clinically palpable posterior triangle neck masses. It is also important to diagnose cervical ribs in patients undergoing CT of the neck since they are under reported as determined in previous studies.