Context:Spinal dysraphisms are congenital abnormalities of the spine due to imperfect fusion of midline mesenchymal, bony and neural structures. Imaging plays a vital role in their evaluation as significant portion of patients may present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries.Aims:The aims of the study were to evaluate Spinal dysraphisms using USG and MRI and to correlate imaging findings with operative findings in patients undergoing surgery.Settings and Design:Hospital based observational study conducted over a period of year.Materials and Methods:38 cases of both sexes and below 12 years of age with spinal dysraphism were studied. USG was performed in 29 cases where acoustic window was available for proper evaluation. MRI was performed in all cases. USG findings were compared with MRI findings and operative follow up was taken in 23 cases who underwent operative management.Statistical Analysis Used:Results were analysed using percentage and arithmetic mean.Results:39.47 % cases were male and 60.53 % cases were female. Neonatal period was the most common presenting age group. Closed spinal dysraphism (63.16%) was more common than open (36.84%). 79.31% cases showed full agreement between spinal USG and MRI examinations and 6 out of 20.69% showed partial agreement. On operative correlation, USG findings were confirmatory in 91.30% cases and MRI findings were confirmatory in 100% cases.Conclusions:USG can be used as the initial modality for evaluation of spinal dysraphism as well as for screening of suspected cases. MRI is indicated to confirm abnormal USG findings, which shows all concurrent abnormalities and also provides additional anatomical details relevant to surgical planning.
Aim:Extrahepatic portal vein obstruction (EHPVO) is characterized by features of recent thrombosis or portal hypertension with portal cavernoma as a sequel of portal vein obstruction. Imaging of spleno-portal axis is the mainstay for the diagnosis of EHPVO. The aim of this study is to analyze the role of imaging in the preoperative assessment of the portal venous system in children with EHPVO.Materials and Methods:A hospital-based cross-sectional study was conducted on twenty children with EHPVO aged between 1 and 18 years over a period of 1 year. The children were evaluated clinically, followed by upper gastrointestinal endoscopy. Radiological assessment included imaging of the main portal vein, its right and left branches, splenic vein, and superior mesenteric vein using color Doppler ultrasonography (CDUSG) and magnetic resonance portovenogram (MRP). Evidence of portal biliopathy, status of collaterals, and possible sites for portosystemic shunt surgery were also examined.Results:All the patients presented in chronic stage with portal cavernoma and only one patient (5%) had bland thrombus associated with cavernoma. The CDUSG and MRPs had a sensitivity of 66.6-90% and 96.7% and specificity of 91.5% and 98.3% respectively with regard to the assessment of the extent of thrombus formation and flow in the portal venous system. Both the modalities were found to be complementary to each other in preoperative assessment of EHPVO. However, the sensitivity of MRP was slightly superior to CDUSG in detecting occlusion and identifying portosystemic collaterals and dilated intrahepatic biliary radicals.Conclusion:Results of the present study indicate that MRP is well suited and superior to CDUSG in the preoperative imaging of patients with EHPVO.
Background: MRI has not been traditionally used as an imaging modality for preoperative evaluation of ARM. It has been reserved for complicated ARM cases and Imaging in post-operative period. Aims: To study the role of MRI in preoperative evaluation of ARM patients, whether it be used as a single preoperative imaging investigation in ARM and what added advantage does it give to conventional imaging techniques. Settings and Design: Hospital based observational study was conducted over a period of 1 year which included 26 ARM patients who required preoperative imaging which was done using MRI.
I. I nt roduct io nBrain tumors are the most common solid tumor of childhood and the second most common malignancy after the leukemias. Primary central nervous system tumors (CNS) are the most common solid neoplasms in children. The incidence of CNS tumors is 2-5 new cases per 100000 per year, which is stable throughout the World. About 7% of the reported brain and CNS tumors occur in children aged 0-19 years .1, 2Although infratentorial tumors predominate in children, supratentorial tumors are more common in the first 2 to 3 years of life 2 . The clinical manifestations in childhood with brain tumors are largely those of increased intracranial pressure. Headache is a common early symptom. Most other symptoms are non-specific and include vomiting, cranial neuropathies and stupor and coma in late stages. 3 The largest percentage of childhood tumors (17%) are located within the frontal, temporal, parietal and occipital lobes of the brain. For children aged 0-14 years, pilocytic astrocytomas, embryonal tumors, and malignant glioma are the common tumors. The most common histologies in adolescent ages 15 -19 years include tumors of the pituitary and pilocytic astrocytoma. 1 Supratentorial intraaxial tumors are not very common in children but they are histologically more varied than in adults. Although there have been several neuroradiological investigations, accurate diagnosis by imaging modalities alone remains difficult in all cases, and final diagnosis in most cases requires histological examination. However, neuroradiological information is valuable in predicting tissue character and histological type or grade, and in helping establish treatment strategies. 4,5 The imaging modalities used are mainly CT and MR imaging with newer modalities like MR and CT perfusion, PET and SPECT.CT has become the primary imaging investigation in cases of suspected brain tumors, surpassing many other invasive imaging modalities. It has considerably high sensitivity, it is non-invasive having no hazards except ionizing radiations. CT can predict the pathological nature of a lesion with reasonable degree of accuracy. CT scan is more accurate indicator of brain tumor, yet it is not always 100% accurate. 6 MRI has its advantage of being a radiation free and multi-planar imaging facility. Hence a lesion can be seen in three planes and accurate localization of the lesion can be done. This modality provides better soft tissue characterization and can clearly demonstrate peritumoral edema, but has disadvantages like high cost , requires a long time for acquisition of the data and hence cannot be used for restless patient particularly neonates, infants or even uncooperative children. It cannot be done in patients having metallic implants for which CT is the modality of choice. 3 Newer multi-slice helical CT scanners are capable of providing highly collimated sub millimeter thickness sectional images in extremely short acquisition times and thus areas of hyperostosis or bone destruction, intratumoral calcification and early intratumoral or ...
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