AIMS AND OBJECTIVESTo study the pattern of brain involvement in acute hepatic encephalopathy in patients with chronic liver disease and correlate the extent of involvement on magnetic resonance imaging with serum ammonia and clinical severity. MATERIALS AND METHODSThirty patients with clinical or radiological evidence of chronic liver disease who presented with acute onset neuropsychiatric symptoms with a clinical diagnosis of acute hepatic encephalopathy. A detailed history was taken. Status of chronic liver disease confirmed, serum ammonia values estimated and magnetic resonance imaging done within 7 days of admission. The anatomic pattern of involvement in FLAIR and DWI (comparison with ADC maps) noted. The initial clinical severity (assessed by West Haven grade) and serum ammonia values were recorded and correlated with extent of involvement in magnetic resonance imaging. The patients were followed up for 21 days from the day of MRI to get an idea about inpatient or outpatient status; however, no clinical or radiological end points were evaluated. OBSERVATION AND RESULTSOn FLAIR and DWI, there were abnormalities in PLIC (73.3%, 60%), thalamus (63.3%, 53.3%), PVWM (26.7%, 16.7%) and IC (36.7%, 23.3%). There was significant correlation (P<0.05) for PVWM (P=0.001, 0.002) and IC (P=0.005, 0.009) involvement with clinical severity on FLAIR and DWI. There was no significant correlation for PLIC (P=0.371, 0.162) and thalamic (P=0.252, 0.92) involvement. All the patients showed elevated serum ammonia values and a period of inpatient stay >21 days. CONCLUSIONThe constellation of anatomic involvement in the appropriate clinical setting is suggestive of acute hepatic encephalopathy. Involvement of PVWM and IC indicated a higher grade of initial clinical severity.
BACKGROUNDThough mammography remains the imaging of choice in evaluating breast lesions, it has a relatively high false positivity and false negativity. It is relevant to find a superior alternative in case of indeterminate mammographic results.The objective of the study is to compare the diagnostic yield of Magnetic Resonance Mammogram with that of a combination of x-ray mammogram and sonomammogram in differentiating benign and malignant breast lesions.
BACKGROUNDContrast-enhanced MR imaging of breast characterises the lesion more accurately than mammography or sonography. This contributes to the distinction between benign and malignant lesions. Multifocal and contralateral lesions can also be better detected by MR imaging. Aims-To differentiate benign from malignant breast lesions that have been detected on MRI by analysing qualitative lesion characteristics. To compare and correlate the radiological diagnosis with the final histopathological diagnosis. MATERIALS AND METHODSA prospective study on 41 cases was conducted in the Department of Radiodiagnosis, Govt. Medical College, Kozhikode during the period of Aug. 2009 to July 2010 who were undergoing MR imaging of breast for characterisation of lesions. Morphological parameters of the lesions were correlated with the final histopathological diagnosis. RESULTS 66.6% of benign lesions showed well-defined (Oval, round, lobulated) shape while none of the malignant lesions demonstrated this. Irregular shape was observed in all the malignancies. Smooth margin was observed in 66.7% of benign lesions while illdefined margin like irregular & spiculated constituted 70% and 25% respectively in malignancies. None of the malignant lesions showed smooth margin. CONCLUSIONWell-defined shape and smooth margin were characteristic of benign lesions. Spiculated margin was highly specific for malignancy. Both irregular and spiculated margin had a high predictive value for malignancy. Submission 23-03-2017, Peer Review 12-05-2017, Acceptance 19-05-2017, Published 25-05-2017. Corresponding Author: Juvaina Puthiyakam, Assistant Professor, Department Radiodiagnosis, Government Medical College, Kozhikode. E-mail: juvaina.faiz@gmail.com DOI: 10.14260/jemds/2017 2. To compare and correlate the radiological diagnosis with the final histopathological diagnosis. KEYWORDS MATERIALS AND METHODS Study DesignDescriptive study; Diagnostic test evaluation. Study SettingAll patients undergoing MR imaging of breast at Dept. of Radiodiagnosis, Govt. Medical College, Kozhikode for characterisation of breast lesions detected clinically, by x-ray mammography or by ultrasonography. Study Period August 2009 to July 2010Study Method 41 cases of breast lesions were evaluated with MRI. Morphologic parameters like shape and margin were studied.Final histopathological report of all the lesions were compared and correlated with MRI findings.
Cerebral leukoencephalopathy and megalencephaly with subcortical cysts (also known as van der Knaap disease) is an autosomal recessive condition. The disease was initially described in India and Netherlands independently and seems to have highest incidence in Indian Agrawal community and Turkish population. 1 The objective of this study is to document the case of two siblings with this condition, from a non-Agrawal Indian community and briefly describe the imaging features of this condition. Two siblings, born out of a third-degree consanguineous marriage, with simple focal seizures were subjected to MRI with diffusion-weighted imaging and spectrometry. The findings were compared to diseases with similar clinical presentation. Subcortical cysts initially involving anterior temporal lobes and subsequently frontal and parietal lobes, sparing of central white mater, small N acetyl aspartate peak and diffusion facilitation were the imaging findings. The imaging findings were consistent with the diagnosis of the rare genetic disorder- Cerebral leukoencephalopathy and megalencephaly with subcortical cysts.
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