Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women.Materials and Methods: Fifty postmenopausal women, who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (normal, osteopenia, and osteoporosis) based on T-score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD.Results: Vertebral marrow fat content was significantly increased in the osteoporotic group when compared with that of the osteopenic group and the normal bone density group. ADC values in the osteoporotic, osteopenic, and normal bone density groups were 338, 408 and 464, respectively, with statistically significant differences (P < 0.001). A statistically significant positive correlation between T-scores and ADC existed (r=0.694, p value <0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=–0.455, p< 0.001) and to marrow ADC (r= -0.302, p < 0.05).Conclusion: The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.
Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease. Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities. Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease. Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction.
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