Xanthogranuloma is a rare lesion of the sellar-suprasellar region. We describe a case of suprasellar xanthogranuloma in whom serial MRI revealed features that have not been previously described--development of dural tail, vascular encasement and intra-axial lesions in posterior fossa.
Early graft dysfunction after renal transplantation manifests as acute rejection (AR) or acute tubular necrosis (ATN). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging is a noninvasive method of assessing tissue oxygenation, which may be useful for predicting acute allograft dysfunction. This was a prospective study involving 40 patients scheduled for renal transplantation from August 2012 to August 2014. In addition, 15 healthy donors were also enrolled in this study. All recipients underwent BOLD MR imaging (MRI) and R2* mapping 10–20 days after transplant, and additionally within 48 h of biopsy if there was any evidence of graft dysfunction. The healthy donors underwent BOLD MRI 1–2 days before surgery. The biopsies were grouped into AR, ATN, and no evidence of AR or ATN. The mean medullary R2*, cortical R2*, corticomedullary gradient, and medullary: cortical R2* ratio were compared between groups using one-way analysis of variance. Spearman's correlation and multinomial linear regression were applied to determine the influence factors of R2* value. Overall, nine patients had graft dysfunction. Six were reported as AR, two as ATN, and one as no evidence of ATN or rejection. The mean medullary and cortical R2* were significantly higher in ATN group compared with AR and normal group, whereas the mean medullary and cortical R2* of AR group were significantly lower than normal group. The corticomedullary gradient of AR group was significantly lower compared with ATN and normal group. Medullary R2*:cortical R2* ratio was significantly lower in AR group compared with normal group. No significant difference was noted between the 15 donors and patients with normal graft function. R2* values on BOLD MRI are significantly decreased in AR allografts and increased in an early stage of ATN allografts, suggesting that BOLD MRI can become a valuable tool for discriminating between AR and ATN.
The study was aimed at evaluating role of CT Pulmonary Angiography (CTPA) and Indirect CT venography (ICTV) in clinically suspected pulmonary embolism (PE) in oncology setup.17/31 (54.9%) patients were diagnosed with PE with or without deep vein thrombosis. DVT was diagnosed in 12(38.7%). 1 patient had DVT in absence of PE while 13/31 (41.9%) patients were diagnosed not to have PE or DVT. Clinical symptoms or pre-test probability determined by Well’s criteria and other laboratory investigations were not found predictive of PE. CTPA diagnosed PE with greater ease, shorter time required with no dependence on clinical pretest probability unlike pulmonary scintigraphy. In cases with CTPA negative for PE, CT described additional findings possibly explaining patient’s presenting symptoms unlike negative pulmonary scintigraphy. In cases where PE was excluded, CTV identified DVT (if present) in the same sitting, obviating separate venous Doppler. A single investigation with ability to deal with complete spectrum of DVT and PE makes CTPA & ICTV ‘one stop shop’ imaging modality for PE and DVT. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 40-52 DOI: http://dx.doi.org/10.3126/njr.v3i1.8795
Balloons are valuable tools in the armamentarium of a neurointerventionalist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.
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