ObjectivesWe aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity.MethodsIndubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed.ConclusionsImaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications.Teaching points• Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions.• Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis.• Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis.• Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis.• Histological/microbiological confirmation is often necessary to confirm the diagnosis.
Objective:To assess the performance of mannitol as a luminal contrast as compared to water and positive contrast in evaluation of bowel on multidetector computed tomography (MDCT).Materials and Methods:Three hundred patients were randomly selected for this study and were divided equally into three groups. Each subject received 1500 ml of oral contrast. Group 1 received 3% mannitol in water, group 2 received diluted iodinated positive contrast, and group 3 received plain water without additives. Qualitative and quantitative analysis for distension, fold visibility, and overall image quality were analyzed by actual diameter measurement and point scale system at different bowel levels. One-way analysis of variance (ANOVA) followed by Tukey's HSD Post-hoc test and Pearson's Chi-square (exact test) test were applied.Results:Group 1 showed better results for small bowel distension, intraluminal homogeneity, and visibility of mucosal folds on quantitative and qualitative analysis with statistically significant P value (P<0.001). The ileo-caecal junction distension and mural feature visibility was better with mannitol (P < 0.001). No significant difference in distension of stomach and duodenum was found between the three groups.Conclusion:Mannitol as endoluminal contrast increases the diagnostic accuracy of the investigative studies in comparison to water and iodine-based contrast by producing significantly better bowel distension and visibility of mural features with improved image quality without additional adverse effects.
Peripheral nerve sheath tumors are categorized into benign and malignant forms, comprising of neurofibroma and schwannoma in the benign category and malignant peripheral nerve sheath tumors in the malignant category. Magnetic resonance imaging plays an important role in the diagnosis of these lesions. The various imaging features and signs that help to identify and characterize a nerve sheath tumor are, distribution of the tumor along a major nerve, an entering or exiting nerve sign, target sign, a fascicular sign and a split-fat sign.
Purpose To evaluate the diagnostic reliability of Thyroid Imaging Reporting and Data System (TI-RADS) classifications described by American College of Radiology (ACR) and Kwak et al . by calculating the risk of malignancy, to assess the role of TI-RADS in reducing fine-needle aspiration cytology (FNAC) of benign lesions. Material and methods This was a prospective study during the period from December 2017 to August 2018. Thyroid nodules were classified using ACR TI-RADS and TI-RADS proposed by Kwak et al . The TI-RADS categorisations were compared to the final diagnosis obtained by cytopathological/histopathological analysis. The risk of malignancy for each category was calculated. Sensitivity, specificity, and positive and negative predictive values for individual suspicious ultrasound features were also assessed. Results We evaluated a total of 127 thyroid nodules. The risk of malignancy was 0% in ACR TR1, 0% in ACR TR2, 6.9% in ACR TR3, 29.2% in ACR TR4, and 80% in ACR TR5 categories. The risk of malignancy for TI-RADS according to Kwak et al . were 0%, 0%, 21.5%, 32.4%, 100% for TI-RADS 2, 3, 4A, 4B, and 4C categories, respectively. Kwak TI-RADS 2 and 3 had higher sensitivity in predicting benignity compared to ACR TR1 and 2 (35.4% vs. 25.9%). Conclusions We found TI-RADS classification to be a reliable, non-invasive, and practical method for assessing thyroid nodules in routine practice. TI-RADS can safely avert avoidable FNACs in a significant proportion of benign thyroid lesions.
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