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Das D, Trikha A, Kaur M, Muthiah T, Pandey RK, Ankalji B, Madhusudhan KS, Srivastava DN, Singh PM. Comparison of gastric emptying time between breast-fed and formula milk-fed infants less than 6 months old, using gastric ultrasound-An observational study. Paediatr Anaesth 2024; 34:430-437. [PMID: 38323713 DOI: 10.1111/pan.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Fasting before elective anesthesia care is a standardized practice worldwide. The aim is to decrease the risk of aspiration leading to pulmonary complications such as aspiration pneumonitis during anesthesia care. There are different guidelines for elective preoperative fasting in children. However, there is insufficient literature measuring gastric emptying time after breast milk or formula milk feeding in infants. OBJECTIVE This study used gastric ultrasound to determine the gastric emptying time for breast milk and formula milk in children below 6 months of age. We also compared the calculated gastric volumes among breast-fed and formula milk-fed based on Schmitz's and Spencer's formula. MATERIALS AND METHODS This prospective observational study was conducted at a tertiary care center in India between November (2017-2019). A total of 52 infants less than 6 months of age were recruited. The study population was divided into two groups (breast-fed and formula milk-fed) of 26 patients each. Ultrasound was used to measure the antral cross-sectional area of the stomach and to calculate the gastric volume using the two classical formulas (Schmitz and Spencer's). Gastric emptying was reported when the bull's eye appearance of the gastric antrum was seen or when the antral cross-sectional area was less than 3.07 cm2. RESULTS The number of breast-fed children whose antral cross-sectional was greater than 3.07 cm2 (cut-off value for aspiration risk) beyond 1 h was 14/26 (53.84%) while none (0) children went beyond 3 h. The number of formula-fed children whose antral cross-sectional was greater than 3.07 cm2 beyond 1 h was 17/26 (65.38%) while one child (3.84%) went beyond 3 h. Using Schmitz's formula, mean (SD) gastric emptying times were 0.35 ± 0.68 h (95% CI 0.35 ± 0.185, range 0.165-0.535) for breast-fed patients and 0.35 ± 0.69 h (95% CI 0.35 ± 0.188, range 0.162-0.538) for formula-fed patients, and were thus neither clinically nor statistically different (p = .73) Using Spencer's formula, the mean gastric emptying times were 0.12 ± 0.33 h (95% CI 0.12 ± 0.09, range 0.03-0.21) for breast-fed patients and 0.04 ± 0.20 h (95% CI 0.04 ± 0.05, range -0.01 to 0.09) for formula-fed patients, and were also neither clinically nor statistically different p = .13. CONCLUSION In our series, the gastric emptying times in breast-fed and formula-fed infants less than 6 months old were similar. Our results support the fasting guidelines of the European Society of Anaesthesiology and Intensive Care 2022, that is, 3 h for breastfeeding and 4 h for formula milk feeding. In addition, this shows that the Schmitz's and Spencer's formulae used to calculate the gastric volume based on ultrasound measurement of the antral cross-sectional area are not comparable in infants less than 6 months.
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Affiliation(s)
- Debashis Das
- Department of Anesthesia, Indira Gandhi Memorial Hospital, Male, Maldives
| | - Anjan Trikha
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Manpreet Kaur
- Department of Anesthesiology and Peri operative Medicine, Penn State Milton S, Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Ravinder Kumar Pandey
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Basavraj Ankalji
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Rajendran J, Panwar R, Singh AN, Dash NR, Pal S, Srivastava DN, Sahni P, Madhusudhan KS. Management and outcomes of pseudoaneurysms presenting with late hemorrhage following pancreatic surgery: A six-year experience from a tertiary care center. Indian J Gastroenterol 2023; 42:361-369. [PMID: 37166698 DOI: 10.1007/s12664-023-01357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND/PURPOSE Late hemorrhage following pancreatic surgery is associated with significant morbidity and mortality. Pseudoaneurysm (PSA) is an important source of late hemorrhage, which is effectively and safely managed by embolization. We aim to retrospectively review the outcomes of embolization for pseudoaneurysms causing late post-pancreatectomy hemorrhage over a period of six-years at our tertiary care center. METHODS Between 2014 and 2020, 616 pancreatic surgeries were performed and 25 patients had late hemorrhage (occurring > 24 hours post-operatively). The clinical parameters related to late hemorrhage, associated complications, embolization details, treatment success and their short-and long-term outcomes were analyzed. RESULTS Sixteen of 25 patients had PSA on digital subtraction angiography. Embolization was performed in these patients with technical and clinical success rates of 94.1% and 100%, respectively. Compared to patients without PSA, patients with PSA had significant hemoglobin drop (2.5 g/dL vs. 1.5 g/dL, p = 0.01), higher incidence of sentinel bleed (50% vs. 11.1%, p = 0.05) and lower requirement for surgery for bleeding (0% vs. 44.4%, p = 0.02). Clincally relevant postoperative pancreatic fistula and bile leak were seen in 72% and 52% of patients, respectively. Eight of these embolized patients died due to sepsis. The long-term outcome was good, once the patients were discharged. CONCLUSION Late hemorrhage after pancreatic surgery was associated with high mortality due to complications such as pancreatic fistula and bile leak. Sentinel bleeding was an important clinical indicator of PSA. Angiographic embolization is safe and effective without any adverse short or long-term outcomes.
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Affiliation(s)
- Jayapal Rajendran
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anand Narayan Singh
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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Abstract
The portal vein is the largest vessel supplying the liver. A number of radiological interventions are performed through the portal vein, namely for primary pathologies of the portal vein, for inducing liver hypertrophy or to treat the sequelae of portal hypertension among others. The routes used include direct transhepatic, transjugular, and, uncommonly, trans-splenic and through subcutaneous varices. Portal vein embolization and transjugular intrahepatic portosystemic shunt are among the most common portal vein interventions that are performed to induce hypertrophy of the future liver remnant and to treat complications of portal hypertension, respectively. Other interventions include transhepatic obliteration of varices and shunts, portal vein thrombolysis, portal vein recanalization, pancreatic islet cell transplantation, and embolization of portal vein injuries. We present a detailed illustrative review of the various radiological portal vein interventions.
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Affiliation(s)
- Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
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Ankalagi B, Singh PM, Rewari V, Ramachandran R, Aggarwal R, Soni KD, Das D, Madhusudhan KS, Srivastava DN, Kaur M, Trikha A. Serial Ultrasonographic-measurement of Gastric Residual Volume in Critically Ill Patients for Prediction of Gastric Tube Feed Intolerance. Indian J Crit Care Med 2022; 26:987-992. [PMID: 36213700 PMCID: PMC9492753 DOI: 10.5005/jp-journals-10071-24296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 01/02/2023] Open
Abstract
Objective To study the use of serial ultrasound gastric residual volume (GRV) measurements in predicting feed intolerance in critically ill patients. Patients and methods This study was conducted in various intensive care units (ICUs) of All India Institute of Medical Sciences, New Delhi. Forty-three critically ill patients aged more than 18 years were studied for a total of 130 enteral feeding days. Gastric residual volume was obtained by calculating the antral cross-sectional area (CSA), which is the product of anteroposterior (AP) and craniocaudal (CC) diameters of gastric antrum obtained using ultrasound in the right lateral decubitus position. A baseline measurement was done before the initiation of the enteral feed and termed GRV0, the ultrasound scanning was repeated every 1 hour for the first 4 hours and termed GRV1, GRV2, GRV3, and GRV4, respectively, and the patients were watched for feed intolerance. The receiver operating characteristic (ROC) curves were constructed to correlate the GRV at each time with feed intolerance. Results The data from 43 medical and surgical critically ill patients were analyzed. Out of 130 feeding days, 13 were noted to be feed intolerant. Gastric residual volume at the end of the fourth hour of feed, that is, GRV4 was the best predictor of feed intolerance with 99.3% area under the curve (AUROC), sensitivity of 99%, specificity of 99.3%, and 95% CI, 0.89–0.98 followed by GRV3, with AUROC of 96% and sensitivity and specificity of 92.3 and 96%, respectively, with 95% CI, 0.92–0.99. How to cite this article Ankalagi B, Singh PM, Rewari V, Ramachandran R, Aggarwal R, Soni KD, et al. Serial Ultrasonographic-measurement of Gastric Residual Volume in Critically Ill Patients for Prediction of Gastric Tube Feed Intolerance. Indian J Crit Care Med 2022;26(9):987–992.
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Affiliation(s)
- Basavaraj Ankalagi
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Vimi Rewari
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Debashish Das
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
- Manpreet Kaur, Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 018102255099, e-mail:
| | - Anjan Trikha
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
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Bagga B, Goyal A, Srivastava DN. Ultrasound versus MR Neurography in Peripheral Nerve Diseases: Complimentary Rather than Competitive! Indian J Radiol Imaging 2022; 32:433-434. [PMID: 36177292 PMCID: PMC9514903 DOI: 10.1055/s-0042-1754360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Barun Bagga
- Department of Radiology, NYU Grossman School of Medicine, New York, United States
| | - Ankur Goyal
- Department of Radio-diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radio-diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal A, Das CJ, Khanna N, Sharma R, Srivastava DN, Goyal V, Netaji A. Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy. Br J Radiol 2022; 95:20210290. [PMID: 34558292 PMCID: PMC8722232 DOI: 10.1259/bjr.20210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. METHODS This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. RESULTS Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm2/s respectively. CONCLUSION DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. ADVANCES IN KNOWLEDGE 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm2/s respectively.
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Affiliation(s)
| | | | - Neena Khanna
- Department of Dermatology, AIIMS, New Delhi, India
| | - Raju Sharma
- Department of Radiology, AIIMS, New Delhi, India
| | | | - Vinay Goyal
- Department of Neurology, AIIMS, New Delhi, India
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Abstract
A mass or a tumor may not always be an underlying cause for a clinically apparent swelling. A wide range of myotendinous disorders can present as pseudomasses. These include muscle/myofascial hernia, tendon tears, benign hypertrophy, accessory muscles, tendon xanthomas, diffuse myositis, and exertional compartment syndromes. We have briefly reviewed these lesions highlighting their typical radiological findings and have also highlighted the role of different imaging modalities and the role of dynamic imaging. Although rare, radiologists should be aware of these entities to avoid mislabeling a pseudomass as a mass or malignancy and to detect the abnormality in not-so-apparent masses.
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Affiliation(s)
| | - Ankur Goyal
- Department of Radiodiagnosis, AIIMS, New Delhi, India
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Bansal A, Goyal A, Gamanagatti S, Srivastava DN, Manhas V. Current updates in image-guided musculoskeletal interventions. J Clin Orthop Trauma 2021; 22:101601. [PMID: 34631410 PMCID: PMC8479789 DOI: 10.1016/j.jcot.2021.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Image-guided musculoskeletal interventions are frequently done in clinical practice. Even then, the literature regarding their effectiveness is relatively scarce. Image guidance adds value over the conventional landmark-based approach and should be preferred. We hereby try to list the commonly performed procedures along with the current practice guidelines regarding their clinical indications and periprocedural care.
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Affiliation(s)
- Abhinav Bansal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.
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Affiliation(s)
- Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Rathinam
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Srivastava
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Goyal A, Wadgera N, Srivastava DN, Ansari MT, Dawar R. Imaging of traumatic peripheral nerve injuries. J Clin Orthop Trauma 2021; 21:101510. [PMID: 34386344 PMCID: PMC8333344 DOI: 10.1016/j.jcot.2021.101510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Nerves are commonly injured in case of blunt or penetrating trauma to the extremities. Patients with nerve injuries have profound consequences and thus a timely decision for operative management is a very important. Conventionally, management decisions have been based on clinical findings, patient course and electrophysiological studies. However, imaging modalities have an enormous role not only in localizing and grading of the nerve injuries but also in the follow-up of the nerve recovery. High-resolution ultrasound (HUS) is the modality of choice for evaluation of peripheral nerves. Magnetic resonance neurography (MRN) plays a complementary role, enabling better assessment of muscle changes and deeper nerves. Corresponding to the injured layer of the cross-section of the nerve, imaging manifestations differ in different grades of injury. Since imaging cannot detect ultrastructural changes at the microscopic level, thus there may be overlap in the imaging findings. Herewith, we discuss the imaging findings in different grades of nerve injury and propose a simple 3-tier grading for imaging (HUS and MRN) assessment of peripheral nerve injuries.
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Affiliation(s)
- Ankur Goyal
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India,Corresponding author. Department of Radio-diagnosis All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Nagesh Wadgera
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Deep Narayan Srivastava
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Mohammed Tahir Ansari
- All India Institute of Medical Sciences, Department of Orthopaedics, New Delhi, 110029, India
| | - Rakesh Dawar
- All India Institute of Medical Sciences, Department of Plastic Surgery, New Delhi, 110029, India
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Madhusudhan KS, Srivastava DN, Garg KV, Khandelwal N. Computed Tomography of the Chest in COVID-19: A Pictorial Review of Indian Patients. Ann Natl Acad Med Sci 2021. [DOI: 10.1055/s-0041-1728973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThe Coronavirus disease 2019, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has evolved into a pandemic and has affected more than 130 million people globally to date and continues to infect more. The disease primarily involves the respiratory system and manifests as fever, dry cough, dyspnea, and myalgia. Nearly half of the infected patients may be asymptomatic. The real-time reverse transcriptase polymerase chain reaction (RT-PCR) performed on the blood or respiratory samples is the diagnostic test with high accuracy. Although imaging with CT is not routinely indicated in this disease, this modality may provide a quick answer and assist in making a diagnosis in certain situations. In addition, imaging with CT also aids in evaluating the progress of the disease and in prognostication. A thorough knowledge of the common findings on the CT scan helps a radiologist in suggesting a diagnosis when it is performed in unsuspected patients. In this review, we describe the common and uncommon chest findings of COVID-19 on the CT scan.
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Affiliation(s)
- Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Razik A, Das CJ, Sharma R, Malla S, Sharma S, Seth A, Srivastava DN. Utility of first order MRI-Texture analysis parameters in the prediction of histologic grade and muscle invasion in urinary bladder cancer: a preliminary study. Br J Radiol 2021; 94:20201114. [PMID: 33882245 DOI: 10.1259/bjr.20201114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To explore the utility of first-order MRI-texture analysis (TA) parameters in predicting histologic grade and muscle invasion in urinary bladder cancer (UBC). METHODS After ethical clearance, 40 patients with UBC, who were imaged on a 3.0-Tesla scanner, were retrospectively included. Using the TexRADTM platform, two readers placed freehand ROI on the sections demonstrating the largest dimension of the tumor, evaluating only one tumor per patient. Interobserver reproducibility was assessed using the intraclass correlation coefficient (ICC). Mann-Whitney U test and ROC curve analysis were used to identify statistical significance and select parameters with high class separation capacity (AUC >0.8), respectively. Pearson's test was used to identify redundancy in the results. RESULTS All texture parameters showed excellent ICC. The best parameters in differentiating high and low-grade tumors were mean/ mean of positive pixels (MPP) at SSF 0 (AUC: 0.897) and kurtosis at SSF 5 (AUC: 0.828) on the ADC images. In differentiating muscle invasive from non-muscle invasive tumors, mean/ MPP at SSF 0 on the ADC images showed AUC >0.8; however, this finding resulted from the confounding effect of high-grade histology on the ADC values of muscle invasive tumors. CONCLUSION MRI-TA generated few parameters which were reproducible and useful in predicting histologic grade. No independent parameters predicted muscle invasion. ADVANCES IN KNOWLEDGE There is lacuna in the literature concerning the role of MRI-TA in the prediction of histologic grade and muscle invasion in UBC. Our study generated a few first-order parameters which were useful in predicting high-grade histology.
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Affiliation(s)
- Abdul Razik
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chandan J Das
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Raju Sharma
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sundeep Malla
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sanjay Sharma
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amlesh Seth
- Departments of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deep Narayan Srivastava
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sirohi B, Shrikhande SV, Gaikwad V, Patel A, Patkar S, Goel M, Bal M, Sharma A, Shrimali RK, Bhatia V, Kulkarni S, Srivastava DN, Kaur T, Dhaliwal RS, Rath GK. Indian Council of Medical Research consensus document on hepatocellular carcinoma. Indian J Med Res 2021; 152:468-474. [PMID: 33707388 PMCID: PMC8157895 DOI: 10.4103/ijmr.ijmr_404_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This document aims to assist oncologists in making clinical decisions encountered while managing their patients with hepatocellular carcinoma (HCC), specific to Indian practice, based on consensus among experts. Most patients are staged by Barcelona Clinic Liver Cancer (BCLC) staging system which comprises patient performance status, Child-Pugh status, number and size of nodules, portal vein invasion and metastasis. Patients should receive multidisciplinary care. Surgical resection and transplant forms the mainstay of curative treatment. Ablative techniques are used for small tumours (<3 cm) in patients who are not candidates for surgical resection (Child B and C). Patients with advanced (HCC should be assessed on an individual basis to determine whether targeted therapy, interventional radiology procedures or best supportive care should be provided. In advanced HCC, immunotherapy, newer targeted therapies and modern radiation therapy have shown promising results. Patients should be offered regular surveillance after completion of curative resection or treatment of advanced disease.
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Affiliation(s)
- Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | - Shailesh V Shrikhande
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vinay Gaikwad
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Paras Hospital, Gurugram, Haryana, India
| | - Amol Patel
- Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
| | - Shraddha Patkar
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Gastrointestinal & Hepato-Pancreato-biliary Service, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Vikram Bhatia
- Department of Gastroenterology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - R S Dhaliwal
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Pulappadi VP, Srivastava DN, Madhusudhan KS. Diagnosis and management of hemorrhagic complications of percutaneous transhepatic biliary drainage: a primer for residents. Br J Radiol 2021; 94:20200879. [PMID: 33529044 DOI: 10.1259/bjr.20200879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.
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Affiliation(s)
- Vishnu Prasad Pulappadi
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Behera RK, Srivastava DN, Kumar P, Pal S, Ranjan N, Garg P, Sahni P, Madhusudhan KS. Right-sided versus left-sided percutaneous transhepatic biliary drainage in the management of malignant biliary obstruction: a randomized controlled study. Abdom Radiol (NY) 2021; 46:768-775. [PMID: 32700212 DOI: 10.1007/s00261-020-02651-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
AIM To compare the technical difficulty, safety, radiation exposure and success rates between right-sided and left-sided percutaneous transhepatic biliary drainage (RPTBD and LPTBD) in patients with malignant biliary obstruction (MBO). MATERIALS AND METHODS Fifty patients (28 males, 22 females; mean age 51.78 years) with MBO were randomized to undergo either RPTBD or LPTBD during the study period between June 2016 and May 2018. The procedure time, fluoroscopy time, radiation doses to the operators and patients, technical success, clinical success, complications and effect on quality of life were evaluated and compared between the two groups. RESULTS Twenty-five patients were included in each group. The technical success was 100% in both groups. There was no significant difference between RPTBD and LPTBD groups in terms of major complications [4% and 12%, respectively; p = 0.297] and minor complications [40% and 32%, respectively; p = 0.597]. Further, the average procedure time (37.80 ± 13.07 min vs 41.04 ± 14.94 min), fluoroscopy time (5.88 ± 4.2 min vs 5.97 ± 3.8 min), radiation doses to the operator (136.84 ± 106.67 μSv vs 130.40 ± 106.46 μSv) and to the patient (8.23 ± 5.80 Gycm2 vs 11.74 ± 11.28 Gycm2) were not significantly different between the groups. Clinical success was achieved in 21 patients (84%) of RPTBD group and 17 patients (68%) of LPTBD group with no significant difference (p = 0.416) between them. CONCLUSION There was no significant difference between RPTBD and LPTBD with reference to the technique, safety, radiation dose, success rates and impact on quality of life suggesting no laterality advantage for biliary drainage in cases of MBO.
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Marri UK, Das P, Shalimar, Kalaivani M, Srivastava DN, Madhusudhan KS. Noninvasive Staging of Liver Fibrosis Using 5-Minute Delayed Dual-Energy CT: Comparison with US Elastography and Correlation with Histologic Findings. Radiology 2021; 298:600-608. [PMID: 33399510 DOI: 10.1148/radiol.2021202232] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Normalized iodine concentration (NIC) (ratio of iodine concentration of liver to that of aorta) of liver at delayed dual-energy CT (DECT) may reflect the amount of fibrosis based on the extent of iodine uptake. Purpose To stage liver fibrosis by using 5-minute delayed DECT and compare findings with those of transient elastography (TE), shear-wave elastography (SWE), and histologic examination. Materials and Methods This prospective study included patients with chronic liver disease who were scheduled to undergo multiphase abdominal CT and liver biopsy from January 2017 to September 2018. Fifty individuals being screened as renal donors comprised the control group. Study participants underwent TE, SWE, multiphasic DECT (including 5-minute delayed dual-energy scanning), and liver biopsy. Multiphasic DECT and SWE were performed in the control group. The NIC of the right lobe of the liver (RNIC) was compared with liver stiffness (LS) as measured with TE and SWE and with the METAVIR fibrosis stage (ranging from F0 to F4). Diagnostic performance was assessed by using areas under the receiver operating characteristic curve (AUCs). Results A total of 107 participants (mean age, 35 years ± 12 [standard deviation]; 57 men) and 50 control subjects (mean age, 47 years ± 11; 29 women) were evaluated. The RNIC showed strong correlation with METAVIR stage (Spearman ρ = 0.81, P < .001). The AUC for RNIC with each METAVIR stage ranged between 0.86 (95% CI: 0.76, 0.97) and 0.96 (95% CI: 0.92, 0.99). The cut-off value of RNIC was 0.24 (sensitivity: 85% [86 of 101 participants; 95% CI: 77%, 91%]; specificity: 83% [84 of 101 participants; 95% CI: 42%, 98%]) for stage F1 fibrosis and 0.29 (sensitivity: 84% [67 of 80 participants; 95% CI: 74%, 90%]; specificity: 81% [65 of 80 participants; 95% CI: 63%, 92%]) for stage F2 fibrosis. RNIC correlated well with LS as measured with TE and SWE (Spearman ρ = 0.60 and 0.64, respectively; P < .001). Conclusion Normalized iodine concentration of liver at 5-minute delayed dual-energy CT showed strong correlation with the histologic stages of liver fibrosis and good diagnostic performance in estimating liver fibrosis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Chandarana and Shanbhogue in this issue.
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Affiliation(s)
- Uday Kumar Marri
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Prasenjit Das
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Shalimar
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mani Kalaivani
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Deep Narayan Srivastava
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- From the Departments of Radiodiagnosis and Interventional Radiology (U.K.M., D.N.S., K.S.M.), Pathology (P.D.), Gastroenterology (Shalimar), and Biostatistics (M.K.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 2 Lower limb. Eur J Radiol 2020; 135:109482. [PMID: 33360825 DOI: 10.1016/j.ejrad.2020.109482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/15/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Nayak M, Kumar V, Yadav R, Srivastava DN, Pandit H, Malhotra R. Lateral Coronal Bowing of Femur and/or Tibia Amplifies the Varus Malalignment of Lower Limb as well as Increases Functional Disability in Patients with Knee Osteoarthritis. Indian J Orthop 2020; 55:88-96. [PMID: 34122760 PMCID: PMC8149558 DOI: 10.1007/s43465-020-00303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/24/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE In the present study, we aimed at assessing the effect of femoral and tibial coronal bowing on varus malalignment and Oxford knee score (OKS) at different grades of knee osteoarthritis (OA). MATERIALS AND METHODS This prospective observational study was conducted at a tertiary referral centre in New Delhi, India. Consecutive patients presenting to the "knee OA" outpatient clinics were invited to take part in the study conducted over a 12-month period. All consented patients underwent long-leg standing alignment radiographs using standardised technique and patient reported knee pain and function were recorded using Oxford knee score. The following radiological parameters were measured from weight-bearing long-leg radiographs of 824 varus aligned limbs via a morphometric software (Matlab R2009a) (1) hip-knee-ankle angle (HKAA), (2) femoral bowing, (3) tibial bowing. The knees were graded according to Kellegren and Lawrence grade (K&L) and OKS was recorded. 3 groups of HKAA were made based on the angle, A (0° to - 3°), B (- 3° to - 10°) and C (< - 10°). Both the femoral and tibial bow were also categorized into three groups depending upon the angle; in-range (- 2° to + 2°), varus (< - 2°), valgus (> + 2°). RESULTS The mean (± SD) of HKAA, femoral bow and tibial bow of the whole cohort was - 6.97° ± 5.64°, - 1.54° ± 4.31° and - 1.96° ± 3.5°, respectively. An increase in the lateral bow of both femur and tibia was seen with an increase in the severity of OA. A consequent increase in the varus malalignment was observed with an increase in the lateral bow of both femur as well as the tibia at all grades of OA, with significant correlation observed between HKAA with Femoral bowing and HKAA with tibial bowing. The mean OKS for femoral bow, in-range, varus and valgus was 30.6 ± 11.5, 21.3 ± 11.5 and 35.3 ± 11.4, respectively, and for tibial bow, in-range, varus and valgus was 27.6 ± 11.5, 26. ± 11.5 and 28 ± 11.4, respectively. The difference in the mean OKS was observed to be significant when the varus bow group was compared to in range as well as valgus group (p < 0.01) for both femur and tibia for all the grades of OA. CONCLUSION The present study shows a significant correlation between varus malalignment and the bowing of extremities. Varus coronal bowing of both femur and tibia were seen to have significantly lower mean OKS as compared to valgus bowing or in-range bowing at all grades of knee OA.
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Affiliation(s)
- Mayur Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rahul Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Hemant Pandit
- Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
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Abstract
Gallbladder cancer is the most common malignancy of the biliary tract. It is also the most aggressive biliary tumor with the shortest median survival duration. Complete surgical resection, the only potentially curative treatment, can be accomplished only in those patients who are diagnosed at an early stage of the disease. Majority (90%) of the patients present at an advanced stage and the management involves a multidisciplinary approach. The role of imaging in gallbladder cancer cannot be overemphasized. Imaging is crucial not only in detecting, staging, and planning management but also in guiding radiological interventions. This article discusses the role of a radiologist in the diagnosis and management of gallbladder cancer.
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Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal A, Garg K, Srivastava DN. Letter to the Editor Regarding “Diffusion Tensor Imaging Characteristics in Hirayama Disease: Case Report and Review of the Literature”. World Neurosurg 2020; 142:572. [DOI: 10.1016/j.wneu.2020.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
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Agarwal A, Srivastava DN, Madhusudhan KS. Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist. Br J Radiol 2020; 93:20200528. [PMID: 32706982 DOI: 10.1259/bjr.20200528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Corrosive injury is a devastating injury which carries significant morbidity. The upper gastrointestinal tract is predominantly affected with severity ranging from mild inflammation to full thickness necrosis which may result in perforation and death. Among the complications, stricture formation is most common, causing dysphagia and malnutrition. Endoscopy has a pivotal role in the diagnosis and management, with a few shortcomings. Imaging has an important role to play. Besides radiography, there is an increasing role of CT scan in the emergency setting with good accuracy in identifying patients who are likely to benefit from surgery. Further, CT scan has a role in the diagnosis of complications. Oral contrast studies help in assessing the severity and extent of stricture formation and associated fistulous complications in the subacute and chronic phase. The scope of intervention radiology for this condition is increasing. Fluoroscopy-guided balloon dilatation, drainage of collections or mucoceles, endovascular embolization of point bleeders, placement of feeding jejunostomy and image-guided biopsy are among the procedures that are being performed. Through this review we aim to stress the role the radiologist plays in the diagnosis and follow-up of these patients and in performing radiological interventions. Besides this, we have also highlighted few salient points to help understand the pathophysiology and management of such injuries which is paramount to ensure a good long-term outcome.
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Affiliation(s)
- Ayushi Agarwal
- Department of Radiodiagnosis All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
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Misra S, Srivastava DN. COVID-19: Current Issues and Challenges. Annals of the National Academy of Medical Sciences (India) 2020. [DOI: 10.1055/s-0040-1716999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sanjeev Misra
- Professor of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deep Narayan Srivastava
- Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi
- Honorary Secretary, National Academy of Medical Sciences (India), New Delhi, India
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
- Honorary Secretary, National Academy of Medical Sciences (India), New Delhi, India
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Madhusudhan KS, Srivastava DN. Current Status of Computed Tomography in Novel Coronavirus Disease 2019 Pneumonia. Annals of the National Academy of Medical Sciences (India) 2020. [DOI: 10.1055/s-0040-1713345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AbstarctThe novel coronavirus disease, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), has developed into a pandemic affecting more than three million people worldwide. It predominantly affects the respiratory system and patients present with fever, dry cough, dyspnea, and myalgia. The confirmatory diagnostic test is real-time reverse transcriptase polymerase chain reaction on blood or respiratory samples. Imaging with computed tomography, although not routinely recommended, may not only assist in making a diagnosis but also in assessing disease progression, assessing complications, and in prognostication. This review describes the objectives, techniques, imaging features, and reporting of computed tomography findings of SARS-CoV2 pneumonia.
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Selvanayagam R, Kumar V, Malhotra R, Srivastava DN, Digge VK. A prospective randomized study comparing navigation versus conventional total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 27:2309499019848079. [PMID: 31117880 DOI: 10.1177/2309499019848079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Navigation is associated with improved accuracy in alignment. However, its influence on clinical outcome is inconclusive. The aim of this study was to compare the component alignment and functional outcome in patients undergoing navigation-assisted and conventional total knee replacement (TKR). MATERIALS AND METHOD A prospective randomized study consisting of two groups (group A and group B) was carried out. Group A consisted of patients undergoing TKR using conventional jig-based method, whereas group B consisted of patients undergoing TKR using computer navigation-assisted method. We measured and compared the coronal and sagittal plane alignment in X-ray and rotational alignment in computed tomography scan between both groups. Functional outcome was analysed using Knee Society Score (KSS) and Western Ontario and McMaster University scale (WOMAC) score. RESULTS A total of 50 patients were randomized into two groups A and B each with 25 patients. Navigation was associated with more accuracy in mechanical axis alignment ( p = 0.011) and femoral component rotation ( p = 0.033). The mean follow-up was 4.6 years (range 48-62 months). There was no statistically significant difference between the groups with respect to KSS and WOMAC score at the minimum follow-up of 4 years. CONCLUSION We concluded that even though navigation-assisted system is associated with better accuracy, there was no difference in clinical outcome at an average follow-up of 4.6 years.
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Affiliation(s)
- Rajkumar Selvanayagam
- 1 Department of Orthopaedics, All India Institute of Medical Science, New Delhi, India
| | - Vijay Kumar
- 1 Department of Orthopaedics, All India Institute of Medical Science, New Delhi, India
| | - Rajesh Malhotra
- 1 Department of Orthopaedics, All India Institute of Medical Science, New Delhi, India
| | | | - Vijay Kumar Digge
- 1 Department of Orthopaedics, All India Institute of Medical Science, New Delhi, India
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Nayak M, Kumar V, Yadav R, Maredupaka S, Srivastava DN, Malhotra R, Pandit H. Coronal Alignment of the Lower Extremity: A Gender-Based Radio-Graphic Analysis in Indian Patients. Indian J Orthop 2020; 54:504-512. [PMID: 32549966 PMCID: PMC7271308 DOI: 10.1007/s43465-020-00050-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Variation in the shape of the femur and tibia has been shown to influence hip-kneeankle-axis angle (HKAA) and bears a role in reconstructive surgeries such as total knee arthroplasty (TKA). However, data on the axial alignment of the lower extremity specific to sex largely remains unavailable. Thus, we conducted a study with an aim to measure alignment and calculate differences in both the sexes in Indian population. MATERIALS AND METHODS The following radiological parameters were measured from weight-bearing long leg radiographs of 966 limbs of Indian subjects via a morphometric software (Matlab R2009a) (1) Hip-Knee-Ankle angle (HKAA), (2) femoral bowing, (3) tibial bowing, (4) condylar plateau angle (CPA). The knees were classified according to the Kellegren and Lawrence grading and the differences between both the sexes were calculated with appropriate statistical tests. RESULTS 56.04% of the subjects were female. An increase in the mean age was observed for both the genders with an increase in the severity of OA. Height did not show any significant association with the alignment of the limb. The mean HKAA observed was - 5.88° ± 0.35° in females and - 4.99° ± 0.41° in males. The overall mean femoral bow and tibial bow was - 1.26° ± 0.24°, - 1.60° ± 0.18° in females and - 1.09 ± 0.28, - 1.47° ± 0.21° in males. The mean condylar plateau angle was higher in females - 2.67 ± 0.34 as compared to males - 2.35° ± 0.39°. A greater lateral bow was seen in males at higher grades of OA for femur and at lower grades of OA for tibia. CONCLUSION This study provides gender-based differences in the various axial radio-graphic parameters in a long leg radio-graphs in Indian population which might help in a better understanding of the etiopathogenesis of osteoarthritis and also help planning and execution of reconstructive surgeries such as TKA.
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Affiliation(s)
- Mayur Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rahul Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Siddhartha Maredupaka
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Hemant Pandit
- Chapel Allerton Hospital, University of Leeds, Leeds, UK
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Nayak M, Kumar V, Kanojiya G, Mellon S, Srivastava DN, Pandit H, Malhotra R. A radiographic analysis of alignment in 966 lower extremities with knee pain and its association with osteoarthritis in Indian population. J Orthop 2019; 20:207-212. [PMID: 32025151 DOI: 10.1016/j.jor.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022] Open
Abstract
Purpose This study aimed to investigate the alignment based on deformity in knees affected by osteoarthritis (OA) at different stages and evaluate its association with OA. Material and methods The following radiological parameters were measured from weight bearing long leg radiographs of 966 legs in the Indian subjects via a morphometric software (Matlab R2009a) (1)Hip-Knee-Ankle angle (HKAA), (2) Femoral bowing, (3) Tibial Bowing, (4) Condylar Plateau angle (CPA). The knees were classified according to the Kellegren and Lawrence grading and these parameters were evaluated with OA for its association using appropriate statistical tests. Results The mean HKAA angle was 174.5° ±6.5°, 65.8% of the limbs were in found to be in varus (<177°) and 3.8% in valgus (>183°). The mean femoral and tibial bowing was -1.19 ± 4.95° and -1.54 ± 3.58° respectively. 55.8% of femorae and 41.4% of the tibia were observed to have varus bowing while 24.12% of femorae and 12.11% the tibia were observed to have valgus bowing. An increase in odds of disease severity was observed with femoral and tibial bowing >2°. With an increase in the grades of OA a significant increase in the lateral bow of both femur and tibia was observed. The mean condylar plateau angle was observed to be -2.53° ±7.9°. Positive association was seen between the varus CPA, HKA and OA (p < 0.01). Conclusion This study describes the various radiological parameters in Indian patients at different grades of OA and might elucidate the role of these factors in OA initiation and progression.
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Affiliation(s)
- Mayur Nayak
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Vijay Kumar
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Gourav Kanojiya
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Stephen Mellon
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Hemant Pandit
- Orthopaedics and Honorary Consultant, Chapel Allerton Hospital, University of Leeds, UK
| | - Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has currently become an inseparable tool in the gastroenterologist's armamentarium for treatment of pancreaticobiliary disorders. Given the increase in number of therapeutic ERCP procedures today, the need for prompt and correct diagnosis of its complications is pivotal. This review discusses the mechanisms, risk factors, imaging findings and general management aspects of common and rare complications of ERCP. Furthermore, the review elaborates on imaging indications, recommended protocol and normal imaging findings post ERCP.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radio Diagnosis, All India Institute of Medical Science, Ansari Nagar, New Delhi, 110029, India
| | - Deep Narayan Srivastava
- Department of Radio Diagnosis, All India Institute of Medical Science, Ansari Nagar, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Radio Diagnosis, All India Institute of Medical Science, Ansari Nagar, New Delhi, 110029, India
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Garg B, Manhas V, Vardhan A, Srivastava DN, Das CJ, Vibha D, Gupta V, Malhotra R, Kotwal P. Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study. J Hand Surg Am 2019; 44:157.e1-157.e5. [PMID: 29934085 DOI: 10.1016/j.jhsa.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. METHODS A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery. RESULTS The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) also showed statistically significant improvement of 0.5 + 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%. CONCLUSIONS Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Anand Vardhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Department of Community Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sanjiv Sharma
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Madhusudhan KS, Kilambi R, Shalimar, Sahni P, Sharma R, Srivastava DN, Gupta AK. Measurement of splenic stiffness by 2D-shear wave elastography in patients with extrahepatic portal vein obstruction. Br J Radiol 2018; 91:20180401. [PMID: 30226081 DOI: 10.1259/bjr.20180401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE: To assess the accuracy of splenic stiffness (SS) measured by 2D-shear wave elastography (SWE) for predicting variceal bleeding in the patients with extrahepatic portal vein obstruction (EHPVO). METHODS: 52 patients with EHPVO (mean age: 22.29 years; 26 each males and females) were included in the study after obtaining approval from the institute ethics committee. All patients initially underwent upper gastrointestinal endoscopy followed by ultrasonography, including 2D-SWE on the Aixplorer Supersonic Imagine scanner. The SS was measured through the anterior abdominal wall and an average of three measurements was taken. The SS was then compared with clinical symptoms, variceal grade, and other ultrasonography (USG) parameters. USG parameters were also compared with variceal grade. RESULTS: The mean SS was 44.92 ± 12.35 kPa. There was no significant difference in the mean SS of patients with high grade varices (44.30 kPa; n = 25) from those with low grade varices (46.91 kPa; n = 20). The ROC analysis showed a poor area under the curve of 0.477 for the prediction of high grade varices by the SS. The SS did not show any significant correlation with other ultrasonography parameters except splenic size, with which there was a weak but significant correlation. The measurement of SS by 2D-SWE was reliable and Cronbach's alpha was 0.905. CONCLUSION: The SS measured by 2D-SWE is not an accurate predictor of variceal grade and thus bleeding in patients of EHPVO. ADVANCES IN KNOWLEDGE: EHPVO is a vascular pathology with most patients showing splenomegaly and preserved liver function. Although, elastography of spleen has been shown to be useful in patients with cirrhosis for predicting portal hypertension, it does not seem to be helpful in patients with EHPVO.
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Affiliation(s)
| | - Ragini Kilambi
- 2 Department of Gastrointestinal Surgery, All India Institute of Medical Sciences , New Delhi , India
| | - Shalimar
- 3 Department of Gastroenterology, All India Institute of Medical Sciences , New Delhi , India
| | - Peush Sahni
- 2 Department of Gastrointestinal Surgery, All India Institute of Medical Sciences , New Delhi , India
| | - Raju Sharma
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
| | | | - Arun Kumar Gupta
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
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Aggarwal A, Srivastava DN, Jana M, Sharma R, Gamanagatti S, Kumar A, Kumar V, Malhotra R, Goyal V, Garg K. Comparison of Different Sequences of Magnetic Resonance Imaging and Ultrasonography with Nerve Conduction Studies in Peripheral Neuropathies. World Neurosurg 2017; 108:185-200. [DOI: 10.1016/j.wneu.2017.08.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 02/08/2023]
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Aggarwal A, Jana M, Kumar V, Srivastava DN, Garg K. MR neurography in intraosseous median nerve entrapment. World J Radiol 2017; 9:400-404. [PMID: 29104742 PMCID: PMC5661168 DOI: 10.4329/wjr.v9.i10.400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/08/2017] [Accepted: 07/10/2017] [Indexed: 02/07/2023] Open
Abstract
Intraosseous entrapment of the median nerve is an uncommon complication of elbow dislocation and fractures. The condition is seen to occur in adolescent age group with a remote history of trauma. We report two rare cases of type 2 intraosseous median nerve entrapment. Though the diagnosis of median neuropathy is made with clinical tests and neurophysiological studies, however exact site of entrapment and presurgical mapping of nerve is done accurately with MR neurography. Imaging thus plays a pivotal role in management of this condition.
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Affiliation(s)
- Ankita Aggarwal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vijay Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110029, India
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Madhusudhan KS, Gamanagatti S, Srivastava DN, Gupta AK. Radiological interventions in malignant biliary obstruction. World J Radiol 2016; 8:518-529. [PMID: 27247718 PMCID: PMC4882409 DOI: 10.4329/wjr.v8.i5.518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/18/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction.
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Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
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Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Rathinam D, Madhusudhan KS, Srivastava DN, Dash NR, Gupta AK. Esophageal mucocele after surgical isolation of thoracic esophagus presenting with respiratory distress. Trop Gastroenterol 2016; 37:147-148. [PMID: 30234950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Mishra B, Madhusudhan KS, Kilambi R, Das P, Pal S, Srivastava DN. Malignant Schwannoma of the Esophagus: A Rare Case Report. Korean J ThoracCardiovascSurg 2016; 49:63-6. [PMID: 26889451 PMCID: PMC4757402 DOI: 10.5090/kjtcs.2016.49.1.63] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/16/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022]
Abstract
Neurogenic tumors are the most prevalent tumors of the mediastinum, and schwannomas are the most common type of neurogenic tumor. Primary neurogenic neoplasm of the esophagus is uncommon and malignant schwannoma of the esophagus is extremely rare. We report a case of a 27-year-old female presenting with dysphagia and palpitations who was found to have a lobulated tumor in the mediastinum that was compressing the esophageal lumen. The tumor was successfully treated surgically without recurrence. The final diagnosis, on histopathological examination of the specimen, was malignant schwannoma.
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Affiliation(s)
- Biswajit Mishra
- Department of Radiodiagnosis, All India Institute of Medical Sciences
| | | | - Ragini Kilambi
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences
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Srivastava DN. Role of percutaneous nonvascular Interventional Radiology treatments in musculoskeletal lesions. Annals of the National Academy of Medical Sciences (India) 2016. [DOI: 10.1055/s-0040-1712603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
SUMMARYMany new, minimally invasive interventional radiology procedures are now viable alternatives to traditional invasive therapy. These interventional radiological procedures can be performed in the outpatient setting and the overall cost to the patient may be less in the long run. Radiofrequency and Laser ablation techniques are now widely used and rapidly expanding technologies in the interventional radiology used in the treatment of tumours, varicose vein and lumbar disc treatment. Similarly percutaneous vertebroplasty (PVP) is used in the treatment of spinal lesions and osteoporotic vertebral collapse. The knowledge of these procedures is vital as medicine moves into minimally invasive procedures with targeted treatments as these procedures offer less risk, less pain and less recovery time compared to various surgical procedures.In this presentation I would like to present my work related to percutaneous vertebroplasty (PVP) in spinal lesions, percutaneous Laser disc decompression (PLDD) in the treatment of chronic discogenic low back pain and percutaneous radiofrequency ablation (RFA) in musculoskeletal lesions. The technique, results and long term outcomes of these newer procedures will be discussed.
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Agrawal N, Pal S, Dash NR, Madhusudhan KS, Srivastava DN. Asymptomatic transhiatal pancreatic herniation after oesophagectomy. J Clin Diagn Res 2014; 8:ND24-5. [PMID: 25478403 PMCID: PMC4253221 DOI: 10.7860/jcdr/2014/9881.5017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022]
Abstract
Transhiatal herniation of abdominal organs after oesophageal resection and reconstruction is rare and sparsely described in the literature. The commonest organ to herniate is the colon. Pancreatic herniation has been reported twice before. We report a case of postoesophagectomy transhiatal pancreatic herniation in an asymptomatic patient.
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Affiliation(s)
- Nikhil Agrawal
- Assistant Professor, Department of HPB Surgery, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi, India
| | - Sujoy Pal
- Additional Professor, Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Additional Professor, Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - KS Madhusudhan
- Assistant Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Yadav YC, Srivastava DN. Nephroprotective and curative effects of Ficus religiosa latex extract against cisplatin-induced acute renal failure. Pharm Biol 2013; 51:1480-1485. [PMID: 23870082 DOI: 10.3109/13880209.2013.793718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT Ficus religiosa L. (Moraceae) is widely planted in the tropics. Its chemical constituents include tannin, saponin gluanol acetate, β-sitosterol, leucoanthocyanidin and leucoanthocyanin which are used for the treatment of pain, inflammation, impotence, menstrual disturbances, uterine tonic and urine related problems. OBJECTIVE To determine the possible nephroprotective and curative effects of F. religiosa latex methanol extract against cisplatin induced acute renal failure. MATERIALS AND METHODS Methanol extract was obtained by maceration process. Rats were divided in five groups. Group 1 was administered acacia (2% w/v) of 5 ml/kg throughout the experiment; group 2 was treated with single dose of cisplatin (5 mg/kg i.p.) on the 1st day; group 3 (200 mg/kg p.o.) of extract control for the 1st to 10th day, group 4 (200 mg/kg p.o.) of extract from the 1st to 10th day and a single dose of cisplatin (5 mg/kg, i.p.) on 11th day while group 5 received the same dose of cisplatin on day 1 and extract (200 mg/kg p.o.) from the 7th to 16th day. RESULTS Phytochemical screening of the extract revealed the presence of glycoside, alkaloids, tannins (phenolic compounds), flavonoids and amino acids. The half maximal inhibitory concentration (IC50) values of the extract were 31.75 ± 0.12 and 18.35 ± 0.48 µg/ml, respectively. The cisplatin-treated group 2 showed significant changes; renal functions, biochemical parameters and histopathology were significantly (**p < 0.01) recovered by 200 mg/kg curative and protective groups. DISCUSSION AND CONCLUSION These findings demonstrated that F. religiosa latex and constituents have excellent nephroprotective and curative activities and thus have great potential as a source for natural health products.
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Affiliation(s)
- Yogesh Chand Yadav
- Department of Pharmacy , Sumandeep Vidyapeeth, Pipariya Vadodara, Gujarat , India and
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Jana M, Srivastava DN, Sharma R, Gamanagatti S, Nag HL, Mittal R, Upadhyay AD. Magnetic resonance arthrography for assessing severity of glenohumeral labroligamentous lesions. J Orthop Surg (Hong Kong) 2012; 20:230-5. [PMID: 22933685 DOI: 10.1177/230949901202000219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To compare magnetic resonance (MR) arthrography and arthroscopy as a means of assessing the severity of labral tear in anterior glenohumeral instability. METHODS 52 patients presenting with traumatic recurrent anterior shoulder instability were evaluated using MR arthrography; 30 shoulders with a labroligamentous lesion were treated with arthroscopic Bankart repair. Their MR arthrographic images were interpreted by 3 senior musculoskeletal radiologists, and a radiological diagnosis was reached by consensus. The sensitivity and positive predictive values of MR arthrography for detecting a labral tear were determined. Agreement between MR arthrography and arthroscopy in terms of the width and depth of the labral tear was analysed. RESULTS On arthroscopy, a labroligamentous lesion (Bankart lesion and its variants) was present in all the 30 shoulders. Agreement between the MR arthrography and arthroscopy in terms of the width and depth of the labral tears was good. CONCLUSION MR arthrography is an accurate means of assessing the severity of anterior labroligamentous lesions and yields a good correlation with arthroscopy.
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Affiliation(s)
- Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Gupta M, Srivastava DN, Seith A, Sharma S, Thulkar S, Gupta R. Clinical impact of multidetector row computed tomography before bronchial artery embolization in patients with hemoptysis: a prospective study. Can Assoc Radiol J 2012; 64:61-73. [PMID: 22575595 DOI: 10.1016/j.carj.2011.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/14/2011] [Accepted: 08/05/2011] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate prospectively the role and impact of multidetector row computed tomography (MDCT) before bronchial artery embolization (BAE) in patients with hemoptysis. METHODS MDCT of the thorax was performed in 27 patients (21 men, 6 women; age range, 22-70 years; mean, 39 years) with hemoptysis who were referred for BAE. Transverse, multiplanar reconstruction, and 3-dimensional reconstruction (maximum intensity projection and volume rendered) images were analysed to identify the abnormal hypertrophied bronchial and nonbronchial systemic arteries causing hemoptysis, their origin and course were noted. Digital subtraction angiography was performed with the knowledge of findings of MDCT. Selective arteriogram of abnormal bronchial as well as nonbronchial arteries was performed. Embolization was attempted in 25 of these patients (92.6%) by using polyvinyl alcohol particles (350-500 μm), Gelfoam or Embospheres (400-700 μm). Follow-up was done for a mean period of 20.5 months. RESULTS Based on MDCT, 2 of 27 patients were found unsuitable for BAE. On computed tomography, 38 arteries (27 bronchial and 11 nonbronchial systemic arteries) were identified as abnormal hypertrophied vessels. On angiography, 34 of these arteries (25 bronchial and 9 nonbronchial systemic arteries) were found to be responsible for hemoptysis. Three of these arteries could not be evaluated during angiography, and 1 artery that was identified as abnormal on computed tomography was found normal on angiography. All 25 bronchial and 9 nonbronchial systemic arteries that cause hemoptysis were detected at MDCT. Embolization was successful in 23 of 25 patients. CONCLUSION MDCT enables detection and depiction of all bronchial and nonbronchial systemic arteries causing hemoptysis.
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Affiliation(s)
- Mudit Gupta
- Department of Radiodiagnosis, The Ottawa Hospital, Ottawa, Ontario, Canada
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Jana M, Srivastava DN, Sharma R, Gamanagatti S, Nag H, Mittal R, Upadhyay AD. Spectrum of magnetic resonance imaging findings in clinical glenohumeral instability. Indian J Radiol Imaging 2011; 21:98-106. [PMID: 21799591 PMCID: PMC3137866 DOI: 10.4103/0971-3026.82284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The glenohumeral joint is the most commonly dislocated joint in the body, and anterior instability is the most common type of shoulder instability. Depending on the etiology and the age of the patient, there may be associated injuries, for example, to the anterior-inferior labro-ligamentous structures (in young individuals with traumatic instability) or to the bony components (commoner in the elderly), which are best visualized using MRI and MR arthrography. Anterior instability is associated with a Bankart lesion and its variants and abnormalities of the anterior band of the inferior glenohumeral ligament (IGHL), whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesions. Cases of multidirectional instability often have no labral pathology on imaging but show specific osseous changes including increased chondrolabral retroversion. This article reviews the relevant anatomy in brief and describes the MRI findings in each type, with the imaging features of the common abnormalities.
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Affiliation(s)
- Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Chandrashekhara SH, Thulkar S, Srivastava DN, Kumar L, Hariprasad R, Kumar S, Sharma MC. Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer. Br J Radiol 2010; 84:38-43. [PMID: 20858663 DOI: 10.1259/bjr/87415692] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In the management of epithelial ovarian cancer (EOC), the identification of peritoneal deposits is the most important prognostic factor. We conducted a prospective study to evaluate the role of multidetector CT (MDCT) in identifying peritoneal deposits pre-operatively. METHODS 38 previously untreated patients (median age 50 years; range 26-70 years) were evaluated with contrast-enhanced MDCT of the abdomen and pelvis. All CT scans were performed on a four-slice MDCT scanner with thin-slice image acquisition. Multiplanar coronal, sagittal or oblique images were constructed and all images were reviewed by at least two radiologists. The extent of disease was determined and mapped for all areas of the abdomen and pelvis. CT scans were reviewed and compared with surgical findings. Peritoneal deposits and thickening were separately noted for each of the nine segments of the abdomen and pelvis (i.e. bilateral hypochondria, bilateral lumbar, bilateral iliac fossa, epigastrium, umbilical region and hypogastrium) and were mainly used to determine the accuracy of MDCT in the depiction of peritoneal carcinomatosis. RESULTS Sensitivity, specificity, positive and negative predictive values and accuracy of CT in the detection of peritoneal deposits were similar to those reported in the literature. The most common anatomical sites to have peritoneal deposits were the pouch of Douglas (18 cases) and the right subdiaphragmatic region (18 cases). CONCLUSION Despite the improved scanning technology, image reconstruction and viewing ability of MDCT, its overall accuracy for the detection of peritoneal deposits is not significantly improved when compared with conventional CT; however, MDCT is useful in the assessment of disease at specific locations in the abdomen and pelvis.
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Affiliation(s)
- S H Chandrashekhara
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
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Madhusudhan KS, Srivastava DN, Gamanagatti S. Giant hemangioma of liver presenting as deep vein thrombosis of the lower limbs. J Postgrad Med 2010; 55:290-1. [PMID: 20083882 DOI: 10.4103/0022-3859.58939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis,All India Institute of Medical Sciences, New Delhi, India
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Madhusudhan KS, Srivastava DN, Dash NR, Gupta C, Gupta SD. Case report. Schwannoma of both intrahepatic and extrahepatic bile ducts: a rare case. Br J Radiol 2009; 82:e212-5. [PMID: 19759209 DOI: 10.1259/bjr/63746798] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Schwannoma of the biliary tree is extremely uncommon, with only a few cases having been reported so far. They commonly present with obstructive jaundice. Although involvement of the extrahepatic duct is common, occurrence in the intrahepatic ducts has not been reported. We report a case of combined intrahepatic and extrahepatic schwannoma in a 46-year-old man presenting with obstructive jaundice.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Madhusudhan KS, Sharma S, Srivastava DN, Thulkar S, Mehta SN, Prasad G, Seenu V, Agarwal S. Comparison of intra-arterial digital subtraction angiography using carbon dioxide by 'home made' delivery system and conventional iodinated contrast media in the evaluation of peripheral arterial occlusive disease of the lower limbs. J Med Imaging Radiat Oncol 2009; 53:40-9. [PMID: 19453527 DOI: 10.1111/j.1754-9485.2009.02035.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO(2)) digital subtraction angiography (DSA) using a 'home made' delivery system with iodinated contrast medium (ICM) DSA in the evaluation of peripheral arterial occlusive diseases (PAOD) of lower limbs. Twenty-one patients (27 limbs; all men; mean age, 47.6 years) who presented with PAOD of lower limbs underwent DSA using both intra-arterial CO(2) and ICM. Conventional ICM DSA was performed first and used as gold standard. Carbon dioxide was then injected by hand using a locally improvised home made plastic bag delivery system. Patient tolerance was assessed subjectively. Arteries from aortic bifurcation to the ankle were independently evaluated by two radiologists and graded for stenosis using a five-point scale. For each patient, the quality of CO(2) DSA images were compared with the corresponding images of ICM DSA and an overall grade of 'good', 'acceptable' or 'poor' was assigned. Cohen's kappa coefficient was used to determine inter-observer agreement. Carbon dioxide opacified 86.2% (188/195) of major arteries and depicted stenosis adequately in 84.5% (191/226) of arterial segments. A good or acceptable image quality of CO(2) DSA was obtained in over 95% of patients. Infrapopliteal arteries were inadequately visualized. Mild pain was seen in six (28.6%) patients with both contrast agents; one patient developed severe pain during CO(2) DSA. Inter-observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO(2) into lower limb arteries is well tolerated. Carbon dioxide DSA using the locally improvised home made delivery system is a feasible and safe alternative to ICM DSA in the evaluation of PAOD. It provides adequate imaging of arteries of lower extremities except infrapopliteal segments.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Dehli, India
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Das CJ, Goenka AH, Srivastava DN. MR-guided abdominal biopsy using a 1.5-Tesla closed system: a feasibility study. ACTA ACUST UNITED AC 2009; 35:218-23. [PMID: 19259724 DOI: 10.1007/s00261-009-9504-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND MR-guided biopsy may aid to obtain samples in cases which are not feasible with conventional US or CT guidance. PURPOSE To evaluate safety and efficacy of MRI-guided abdominal biopsy at 1.5-T closed MR system. METHODS AND MATERIALS MRI guided abdominal biopsy was performed using Siemens Avanto 1.5-T closed MR system. Eighteen samples were obtained in 10 patients under local anesthesia using a novel technique to define skin entry site. None of the cases included in the study were amenable to biopsy using the conventional ultrasound (US) or computed tomography (CT) guidance. MR compatible 18G needle (US Biopsy) was used to obtain biopsy samples. Intravenous gadolinium was used in two patients for better delineation during biopsy. Patients were followed up for 3-5 h and were discharged on the same day. RESULTS Technical success was achieved in all patients. Average number of biopsy passes were two (range 1-4). All biopsy samples were adequate for histopathological examination. Average size of the core biopsy specimen was 9 mm. CONCLUSION 1.5-T closed MR system allows adequate biopsy sampling from various abdominal organs. This technique may help to sample lesions which are not otherwise amenable for biopsy under conventional CT or US guidance.
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Affiliation(s)
- Chandan Jyoti Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Das CJ, Srivastava DN, Debnath J, Ramchandran V, Pal S, Sahni P. Endovascular management of hepatic hemorrhage and subcapsular hematoma in HELLP syndrome. Indian J Gastroenterol 2008; 26:244-5. [PMID: 18227578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous intrahepatic hemorrhage with or without subcapsular extension is a rare and grave complication of pregnancy. We present a 22-year-old lady in whom liver rupture was noted on emergency caesarian section and later confirmed on contrast-enhanced CT scan. She gradually recovered following selective hepatic angiography and embolization.
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Affiliation(s)
- Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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