Asian Journal of Medical Radiological Research <p><strong class="pull-left">Asian Journal of Medical Radiological Research (AJMRR)</strong>&nbsp;&nbsp; is an open-access; freely accessible, online and print Bi-annual peer-reviewed international journal publishes a wide spectrum of advanced research in radiology and medical imaging. <br><strong>Online ISSN: 2347-338X | Print ISSN: 2347-3371</strong></p> en-US (Dr. Rohit Varshney) Wed, 29 Apr 2020 11:14:30 +0000 OJS 60 MRI Evaluation of Central Nervous System in Childhood Developmental Delay <p><strong>Background: </strong>Developmental delay is defined as significant delay (more than two standard deviations below the mean) in one or more developmental domains. Developmental delay does not represent a diagnosis, but a term used in different clinical presentations and prognosis, which covers a wide range of etiologies including genetic, metabolic, endocrine, vascular, mal formation syndromes, traumatic, infections, toxins &amp; environmental causes. Careful evaluation and investigation can reveal a cause. Aim of our study to observe efficacy of MRI brain in children with developmental delay and to categories it’s various causes. <strong>Subjects and Methods: </strong>Record based cross sectional study was done in 200 children, who presented to department of pediatrics with developmental delay and subsequently underwent MRI study.<strong>Results:</strong>Out of 200 patients 145(72.5%) shows abnormal MRI findings. Most common MRI diagnosis of developmental delay was neurovascular insult (29.5%) followed by structural malformation (21%), infective/inflammatory disorder (17%), metabolic disorders (2.5%) and neoplastic (2.5%). Neurovascular insult was commonly found in 1-5 years of age.<strong>Conclusion: </strong>MRI is the most useful investigation in patients clinically suspicious for developmental delay and can help in diagnosing the underlying etiology. Other than no of lesions and predominant localization of lesions, encephalomalacia, gliosis, atrophy, structural malformations and neoplastic lesions, ventriculomegaly,micro or megalencephaly are useful features to diagnose underlying cause of developmental delay.</p> Abhishek. S, Bhautik Kapadia Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Lung Manifestation of Collagen Vascular Disease in HRCT <p><strong>Background: </strong>The aim of this paper was to evaluate the thoracic manifestations associated with the Connective tissue disorders, with an emphasis on interstitial and airway disease pattern on the High Resolution computed tomography (HRCT) findings. <strong>Subjects and Methods: </strong>The present study was conducted for a period of one year. A total of 50 patients with various connective tissue disorders having respiratory complaints were evaluated.<strong>Results:</strong>During the study period 50 patients (80%females and 20%males) underwent evaluation. Cough and dyspnea were the most common presenting symptoms. Variety of thoracic abnormalities weredetected in 67 (95%) cases. Most common abnormality detected on HRCT was interstitial fibrosis/interstitial lung disease present in (60%) cases. Most common parenchymal abnormalities seen were reticulations (61.4%), ground glass opacification (40%), mosaic attenuation (32.8%) and honeycombing (24.3%). Airway abnormalities seen were bronchiectasis (48.5%), emphysema (12.8%), and ground glass nodules (2.8%).<strong>Conclusion: </strong>Interstitial lung disease is the most common pulmonary manifestation among patients with connective tissue disorders, and early detection and prompt treatment is expected to improve the outcome.</p> Jagruti Kalola, Anjana Trivedi, Hiral Happani, Mohit Chauhan Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Needle Directed Pulse Spray Pharmacomechanical Thrombolysis for Acute Thrombosis of Dialysis Fistulas – Technique, Efficacy and Short Term Follow UP <p><strong>Background: </strong>The incidence of end stage renal disease is on the rise and most of these patients are undergoing dialysis either through tunnelled /non tunnelled dialysis catheters or through arteriovenous fistulas/grafts. The dialysis grafts and fistulas have limited durability of about 3 years and are more prone for thrombosis and stenosis. Catheter directed interventions are successful in establishing flow in most of the thrombosed fistulas, but require dedicated Cath lab and tertiary care centre. Needle directed thrombolysis is a novel economical, safe technique for thrombolysis of dialysis fistulas and grafts.<strong>Aim:</strong>To review the technique, safety, efficacy of needle directed pulse spray pharmacomechanical thrombolysis of dialysis fistulas and grafts with short term follow up<strong>Subjects and Methods: </strong>This was a prospective observational study done in department of Radio diagnosis, Narayana medical college, Nellore. Selectively 25 patients with thrombosed AV fistulas were referred from nephrology OPD for needle directed thrombolysis to our department from December 2018 to May 2019. The procedure was performed on OPD basis in ultrasound procedure room. Regular Doppler follow up of patients is done up to 6 months.<strong>Results:</strong>Out of twenty five cases about seventeen cases (68%) were successful in achieving adequate recanalization in single session. four cases (16%) required repeat sessions of thrombolysis and were successful in second attempt. In four cases (16%) there was failure in attaining adequate recanalization due to marked multisegment attenuation/flow limiting stenosis of the draining vein.<strong>Conclusion: </strong>Needle directed Pulse spray pharmacomechanical thrombolysis is a novel technique, which can be done bedside, under portable ultrasound guidance and is an economical procedure as no intervention hardware is required. Continuous monitoring allows procedure to be stopped at the earliest once there is optimal recanalization, minimizing the systemic side effects of thrombolytic agents.</p> Geda Anusha, Yugandhar Samireddypalle, Ranjith Kumar Vulchi, Sagar Dembla, Pavithira Annamalai, Sabarinath Eada, Amitha Vikrama K S Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Percutaneous Endovascular Treatment of Stenosis of Dialysis Arteriovenous Fistulas <p><strong>Background: </strong>The incidence of end stage renal disease is on the rise and most of these patients are undergoing dialysis either through tunneled/non tunneled dialysis catheters or through arteriovenous fistulas. The dialysis grafts and fistulas have limited durability of about 3 years and are more prone for thrombosis and stenosis, resulting in AVF dysfunction. As the number of access sites for dialysis is limited, percutaneous endovascular management by fistuloplasty has become the accepted first line of management to increase the lifespan of these fistulas.This article discusses a series of cases of AVF dysfunction secondary to draining vein stenosis managed by percutaneous transluminal angioplasty , their outcome and short term follow up till 3 months.<strong>Aim:</strong>To review the role of percutaneous endovascular management of stenosis of dialysis fistulas , its indications, safety, efficacy and short term patency.<strong>Subjects and Methods: </strong>This was a prospective observational study done in department of Radiodiagnosis, Narayana medical college, Nellore. About 20 cases were performed in our institution from December 2018 to August 2019. All these cases were done in angio suite after proper dialysis through temporary catheter.&nbsp; Post procedure doppler was done to evaluate the improvement in flow rate of these fistulas.<strong>Results:</strong>Seventeen cases were successful with immediate restoration of optimal flow rate during dialysis. (One case developed acute thrombosis of the fistula within 24 hours post procedure, which was successfully treated by needle directed thrombolysis with good patency at three month follow up). In two cases, there was failure of the procedure as the tight stenotic segment could not be negotiated. One case had early re-stenosis of the draining vein which required repeat session of fistuloplasty within one month with occlusion of the draining vein on three month follow up.<strong>Conclusion: </strong>Fistuloplasty is a minimally invasive percutaneous procedure with established safety and efficacy to restore the normal function of dialysis fistulae/grafts<em>. </em>The main aim of the procedure is to restore a diameter of the draining vein adequate for optimal flow rate during dialysis. Careful patient selection is required for increasing the success rate of the procedure. Repeat sessions of angioplasty is offered for re-stenosis to increase the lifespan of fistulas. Stent placement is usually avoided except for recurrent focal stenosis in precious fistulas.</p> Jagadeesh Pasupuleti, Yugandhar Samireddypalle, Saripudi S V N P Manikanta Vijay, Guntaka Srujana, Amitha Vikrama KS Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Analysis of Magnetic Resonance Imaging Findings in Patients with Migraine <p><strong>Background: </strong>Migraine is a common disabling brain disorder. Headache accounts for 4.4% of all consultations in general practice, approximately 5% of all medical admissions to hospital, and approximately 20% of neurology outpatient consultations. Hence; the present study was undertaken for assessing the MRI findings in patients with migraine.<strong>Subjects and Methods: </strong>A total of 5 patients with migraine headache were included in the present study. Complete demographic details of all the patients were obtained. Thorough clinical examination was carried out and routine haematological and other biochemical investigations were also done. Patients underwent MRI investigations. Imaging was performed using a head coil with patient in a supine position. All the MR imaging examination were performed on a Seimen'sAvento 1.5 Tesla Magnet MR system, slice thickness was 4-5mm with an inter slice gap of 0.5mm.&nbsp; MR imaging findings were compiled as per proforma and subjected to analysis using SPSS software.<strong>Results:</strong>Out of 5 migraine patients, significant abnormal MRI findings were present in 40 percent of the patients. One patient showed T2and T2 FLAIR Hyperintensities in subcortical white matter in frontal region. In the second patient with migraine, MRI finding revealed an area of diffusion restriction in left basal ganglia region which was hypointense on T1, T2 FLAIR and Hyperintense on T2 consistent with chronic infarct.<strong>Conclusion: </strong>Migraine headache patient occasionally have abnormal MRI findings to explain their headaches. Neuroimaging of headache sufferers in the general population yields few findings of clinical importance.</p> Amarjit Kaur, Simmi Bhatnagar, Navkiran Kaur, Dimple Mittal, Ishita Gupta Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Evaluation of Parenchymal Thyroid Diseases Using Ultrasonography <p><strong>Background: </strong>Thyroid diseases are among the most common endocrine disorders seen in all age groups. The present study was conducted to determine parenchymal thyroid diseases using Ultrasonography (USG) in adult patients.<strong>Subjects and Methods: </strong>This study was conducted on 140 adult patients. Patients were divided into five groups such as group I (normal); group II had first detected, early untreated Hashimoto disease (EH); group III comprised of chronic Hashimoto patients that are under treatment and/or follow up (H); group IV had multinodular parenchymal hyperplasia (M); and group V had nodular hyperplasia with Hashimoto (HM). They underwent spectral Doppler ultrasound and acoustic radiation force impulse using Siemens ACUSON S2000 machine.<strong>Results:</strong>The mean RI in group I was 0.54, in group II was 0.56, in group III was 0.42, in group IV was 0.48 and in group V was 0.49, mean AT in group I was 26.2, in group II was 25.3, in group III was 71.3, in group IV was 46.2 and in group V was 45.1, mean SWV in group I was 1.54, in group II was 1.72, in group III was 1.20, in group IV was 1.46 and in group V was 1.65. The difference was significant (P&lt; 0.05).<strong>Conclusion: </strong>Authors found that resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.</p> Naveen BS Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 29 Apr 2020 00:00:00 +0000 Von Hippel-Lindau Disease (VHL): A Rare Radiological Case Report <p>Von Hippel-Lindau disease (VHL) is a rare autosomal dominant syndrome caused by mutation in the VHL tumor suppression gene located on chromosome 3. The presented case was a 13 years male patient who initially presented to our hospital with chief complaints of Weakness in b/l lower limbs, Low backache, Right-sided flank pain. On Physical examination there was a lump in right lumbar region– which was firm on palpation. On imaging and histopathology examination the patient was found to have multiple simple pancreatic cysts, malignant renal lesion, retialangioma and spinal hemangioblastoma. So a diagnosis of VHL was made. Regular follow-up with imaging (ultrasound, CT, MRI) are necessary to follow the previous lesions and detect any newly-developed VHL-associate tumors. The Importance of screening is emphasized because the lesions in VHL disease are treatable.</p> Smrutismita Hota, Abdul Faisal Copyright (c) 2020 Asian Journal of Medical Radiological Research Sat, 30 May 2020 00:00:00 +0000 Role of Computed Tomography Scan in the Assessment of Subacute Intestinal Obstruction at Bhuj, Kutch: A Prospective Study <p><strong>Background &amp; Aim: </strong>Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. Obstruction can be functional or due to a mechanical obstruction. Now a day’s CT is considered to be the most efficacious imaging technique for determining the cause of intestinal obstruction. However, the indications for the use of CT in patients with Sub-Acute Intestinal Obstruction (SAIO) have not been fully defined. Objectives of the present study are to study the role of CT in Diagnosis of patients with suspected subacute intestinal obstruction (SAIO),to find out site &amp; cause of obstruction and&nbsp; to diagnose complications of obstruction. <strong>Subjects and Methods: </strong>This study was conducted at Department of Radiodiagnosis, Gujarat Adani institute of Medcial Science, Bhuj, Kutch, Gujarat. Total number of 22 patients with SAIO having equivocal findings on USG was included in this study. Detailed clinical evaluation of the patients was done. Plain x-ray of abdomen in erect posture &amp;abdominopelvic ultrasound were performed before CT scan. CT scans were performed on a GE lightspeed VCT 64 slice scanner and acquired in precontrast &amp; portovenous phase at 60sec after i.v. contrast administration. <strong>Results: </strong>Age of the patients in the study range between 14 to 76 years. Out of 22 were 12 male &amp; 10 female patients. On CT scan all 22 patients were found to have obstruction with 19 patients having mechanical obstruction &amp; 3 patients having pseudo obstruction secondary to appendicitis, jejunal perforation. Most common cause of SAIO was ileal stricture 38% followed by intussusceptions 23%. <strong>Conclusion: </strong>CT is not only useful in distinguishing mechanical obstruction from paralytic ileus but also it often establishes the cause of obstruction &amp; presence of complications like strangulation &amp; perforation.</p> Ashvin Pansuriya Copyright (c) 2020 Asian Journal of Medical Radiological Research Sat, 30 May 2020 00:00:00 +0000 Unique Case Series of Occipital Sinus and Its Thrombosis- A Radiological Marvel <p><strong>Background: </strong>Variations of the dural venous sinuses may result in inaccurate imaging interpretation or complications during surgical approaches. One of these variations reported infrequently is the occipital sinus with an overall incidence of under 10%.When present, it may get thrombosed or become source of intracranial bleeds or pose difficulty during occipital craniotomies.Our review suggests that the thrombosis of this unique venous sinus variant is a rare condition as there are very few case reports of the same. Herein, we present a case series of persistent occipital sinus and the unusual combination of a persistent occipital sinus and its thrombosis. <strong>Subjects and Methods: </strong>The study included 4paediatric cases that presented with neonatal seizuressecondary to different underlying aetiologies and in retrospect had either persistent andpatent occipital sinus or a thrombosed occipital sinus. A descriptive study of the aforementioned cases was carried out. MRI scanner PHILIPS Achieva 1.5 Tesla was used for diagnosis. <strong>Results: </strong>One case had thrombosis of bilateral persistent occipital sinuses and superficial cortical veins with minimal intraventricular haemorrhage in bilateral lateral ventricles.Second case had persistent and thrombosed right occipital sinus; while two other cases had persistent but patent occipital sinuses. <strong>Conclusion: </strong>A comprehensive knowledge of cerebral venous anatomy and meticulous recognition of venous variations essentially helps when dealing with a pathology, which presents along with a particular venous variation, no matter how rare this combination is.</p> R. Harikiran Reddy, Pooja Subramanya, Joish Upendra Kumar, B. Gurumurthy, Punya. J, Sahana. C. M Copyright (c) 2020 Asian Journal of Medical Radiological Research Sat, 30 May 2020 00:00:00 +0000 Efficacy of Routine Magnetic Resonance Imaging (MRI) in Evaluation of Knee Joint Pathologies <p><strong>Background: </strong>Imaging modalities like ultrasonography (USG), magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRAr) provide different form of information about the joint space and tendons related to the knee joint. Knee is the most frequently examined joint by MRI / MRAr as it is relatively non-invasive and highly accurate in assessing joint structures, saving majority of patients from non-therapeutic arthroscopy procedures. The main objective of this study is to understand the comparative role of routine MRI and MRAr in our hospital settings. <strong>Subjectsand Methods: </strong>Twenty-five patients included in the study underwent both MRI and MRAr on the same day. Results were interpreted by radiologists and data was tabulated with the final diagnosis established on MRA<strong>r.Results:</strong>Efficacy of MRI was inferior in evaluation of Anterior Cruciate ligament, meniscal and capsular tears. In patients, where MRI was normal, MR Arthrography revealed significant findings.<strong>Conclusion: </strong>Routine MRI misses significant outcome information when compared to MRAr in evaluation of knee joint. Hence, MR Arthrography should be done for optimal evaluation of knee joints in all patients especially those with clinicoradiological discordance.</p> Adil Ali Khan, Rajul Rastogi, Vijai Pratap, Satish Pathak, Ajay Pant, Yuktika Gupta, Vishakha Mittal, Sarika Goel Copyright (c) 2020 Asian Journal of Medical Radiological Research Sat, 30 May 2020 00:00:00 +0000 CT-Scan vs MRI in Diagnosing Laryngeal Carcinoma <p><strong>Background: </strong>MRI imaging offers more sensitivity than CT to cartilage invasion but results in a high rate of false-positive studies which decreases their overall accuracy. Objective: To compare accuracy of CT scan vs MRI in the laryngeal carcinoma. <strong>Subjects and Methods: </strong>All patients have been diagnosed, with and without contrast, including neck MRI and CT. In order to prevent invalidation, before laryngeal biopsy, MRI and CT scanning have been done such that the images are not altered by peri tumorous inflammation. <strong>Results: </strong>The MRI classification was right for 20 out of 25 patients (80 percent) and 5 outsized cases: three cT1b lesions were pT1a and two cT1a lesions were squamous cell papilloma’s during pathological examination. CT was accurately identified in 17 out of 25 patients (68%), with 8 understated cases: 3 cT1a lesions by CT were pT1b, 3 cT1a lesions were pT3, and 2 tumours had not been found in the CT scan. <strong>Conclusion: </strong>Our research showed that MRI in preoperative stage early glottic cancer is more sensitive than CT to accurately select eligible patients for conservatory larynx surgery like super cricoid laryngectomy and cordectomy.</p> Mohammed Nizamuddin, Mohammed Naseeruddin, Anand Abkari Copyright (c) 2020 Asian Journal of Medical Radiological Research Wed, 24 Jun 2020 00:00:00 +0000 Role of Cross-Sectional Imaging in Tongue Lesions <p><strong>Background: </strong>The purpose of this study was to determine the role of CT and MR imaging in demonstrating lesions of the tongue. Imaging can help to decide the further management of the patient, and when resection is considered, the precise extent of the lesion can be delineated, and also if organ conservation therapy can be suggested. Hence, knowing the differentiating characteristics of these lesions is essential for a Radiologist to narrow the differential diagnosis. <strong>Aims &amp; Objectives:</strong> In the present study, we describe the imaging findings of various tongue lesions, give radio-pathological correlation, and discuss the role of CT and MRI in planning further appropriate treatment, the extent of involvement of adjacent structures, resectability, postoperative reconstruction &amp; prognosis. <strong>Subjects and Methods: </strong>Twenty patients with tongue masses were prospectively evaluated with CT &amp; MRI for eighteen months from June 2018 - Nov 2019. Contrast-enhanced CT axial images with reconstruction were acquired. MRI plain &amp; contrast study done. Imaging findings &amp; diagnoses were later correlated with surgical and histopathological results in all possible cases. <strong>Results: </strong>Among twenty patients, three patients revealed no abnormality; seventeen patients with findings on imaging include twelve squamous cell carcinoma, two venous malformations, two thyroglossal cysts, one hemangioma &amp; one fatty lipoma. <strong>Conclusion: </strong>Few specific lesion characteristics can aid in narrowing the differential diagnosis. Solid high-density lesions in the midline mostly represent lingual thyroids. Calcifications likely indicate goitrous transformation. Phleboliths are highly suggestive of venous malformations. Multinodular, thin-rim enhancing cystic lesions are indicative of lymphatic malformations, primarily when fluid-fluid levels are found. Fat/calcium content within a complex cystic lesion is specific for a dermoid cyst, whereas diffusion restriction within a pure cystic lesion is suggestive of an epidermoid cyst. Finally, when an injury is Trans spatial, three differentials to be considered are highly aggressive malignancies, congenital masses &amp; aggressive infections.</p> Deepthi BT, Gautham M, Jefrin Roy Mathew Copyright (c) 2020 Asian Journal of Medical Radiological Research Thu, 25 Jun 2020 00:00:00 +0000 Utility of CT in Head Injury- A Prospective Study <p><strong>Background: </strong>Head injury is defined as an impairment in brain function as a result of mechanical force. The dysfunction can be temporary or permanent, and may or may not result in underlying structural changes in the brain. Head injuries are a major public health problem worldwide. A limited amount of neurological damage occurs at the time of impact (primary injury). <strong>Subjects and Methods: </strong>The study was a prospective observational study took place in the Department of Neurosurgery, over a 12-month period which involves all type of head injuries. Informed consent was obtained by the subjects who participated in the study. All head injury patients attending the emergency department were included, while those with no clear history of trauma as the primary event and neurologic deficit that could not be explained by head trauma were excluded. <strong>Results: </strong>A total of 1800 patients underwent CT for a head injury. Table 1 shows baseline characteristics as age, gender, referred cases, type of injury, mode of injury and clinical features where we observed 48.2% cases were in the age group between 21-40 years with 80% of male subjects. While observing for the mode of injury, we found most of the cases falls in the category of road traffic accidents(77%) with external injury(83.5%) and loss of consciousness(63.4%) as highly observed clinical features. <strong>Conclusion: </strong>This study showed a significant association of overall CT positivity with patients sociodemographic and clinical factors such as: male gender, elderly age group (&gt;60 years), history of alcohol consumption, LOC &gt;5 min, history of vomiting, history of seizures, evidence of ear bleed, evidence of nosebleed, and GCS ≤12 (moderate and Severe head injury). From the results of this study, we recommend the following indications for doing CT in head injury patients: (1) CT is indicated in all patients with moderate and severe head injury (GCS ≤12).</p> Anil Kumar Bansal, Anil Kumar Gupta Copyright (c) 2020 Asian Journal of Medical Radiological Research Thu, 25 Jun 2020 00:00:00 +0000