Semiautomated MIP images created directly on 16-section multidetector CT console for evaluation of living renal donors

Institutional Review Board approval was obtained and informed consent was waived for this HIPAA-compliant study. The aim of this study was to retrospectively compare the accuracy of semiautomated maximum intensity projection (MIP) images created at a 16-section multidetector CT console with three-dimensional (3D)-workstation-generated images for the definition of renal donor anatomy, with intraoperative findings as a reference standard. In examining 40 renal donors (21 men and 19 women; age range, 24-56 years; mean age, 40.4 years), the sensitivity and accuracy for mapping donor anatomy by two readers were greater than 95%, interobserver agreement was excellent (kappa = 0.89-1.00). The 95% confidence interval for sensitivity was also calculated. Simple MIPs compared well with 3D-workstation images. MIPs from a predesigned protocol on the scanner console were generated more quickly than similar images from 3D workstations; postprocessing demands (eg, for renal donors) can be quickly fulfilled at the scanner console itself. The average time to generate simple MIPs at the console was 3.4 minutes (range, 1.7-4.4 minutes), and 22.3 minutes (range, 15-30 minutes) to create images at the 3D workstation.     

Impact of obesity on medical imaging and image-guided intervention

OBJECTIVE: The purpose of this article is to discuss the impact of obesity on medical imaging and provide some solutions that are currently available to tackle the challenges of imaging obese patients. CONCLUSION: Increasingly, radiologists are asked to image morbidly obese patients. The challenges facing radiology departments include difficulties in transporting patients to the department, inability to accommodate large patients on currently designed imaging equipment, and difficulties in acquiring desired image quality.     

Pronator Quadratus Hemangioma (PQH): A Rare Case Report and Review

The intramuscular hemangioma is a rare clinical entity in the upper extremity. Pronator quadratus hemangioma poses a considerable morbidity in the functional quality of life of an individual. MRI remains the gold standard modality in diagnosing this rare entity. Additionally, histopathological examination of the lesion corroborates for the same. PQH follows an individualized protocol in the management of the tumour. A 35-year-old female presented with pain over her right wrist from past 1 year which was dull aching, non-radiating, localised to the palmar aspect of distal 1/3rd of the right forearm. There was no history of trauma or infection over the right wrist. Swelling was present over the palmar aspect of distal 1/3rd of right forearm, which was non-pulsatile, non-fluctuant, non-transilluminant, non-compressible, non-reducible and skin over the swelling was pinchable. The movements of the right wrist were painful and restricted. There was no distal neurovascular deficit. The MRI of her right wrist and hand suggested the presence of low flow vascular malformation within pronator quadratus muscle. The patient underwent excision biopsy of pronator quadratus in toto without any neurological complications. No recurrence was noted in the follow-up period for 12 months. The pronator quadratus hemangioma is a rare clinical entity where the natural course of disease and pathophysiology remains controversial. MRI serves as the gold standard in the diagnosis of intramuscular hemangioma. The management of such tumour has to be individualized based on the functional needs of the patient. The natural course of the disease has to be elicited to decrease the morbidity and enhance the functional quality of life of the patient.     

Postmortem assessment of thalamic nuclear volumes in subjects with schizophrenia.

OBJECTIVE: The authors assessed schizophrenia-associated changes in volume and neuronal number in the mediodorsal nucleus and the pulvinar regions of the thalamus. METHOD: Right-hemisphere thalami obtained at autopsy from 14 schizophrenic and eight comparison subjects were examined. Computer-assisted morphometric techniques were used to determine volumes for the mediodorsal nucleus, pulvinar, and the anterior and centromedian nuclei as well as the parvocellular, magnocellular, and caudodorsal subdivisions of the mediodorsal nucleus. Neurons in the mediodorsal nucleus and pulvinar were counted and measured by using a stereology-based sampling strategy. RESULTS: Four schizophrenic and three comparison subjects had Alzheimer's type pathology, leaving 10 schizophrenic and five comparison subjects without other documented neuropathological changes. In analyses that included either the full cohort or only the subjects without Alzheimer's type pathology, volumes of the mediodorsal nucleus and pulvinar, but not the anterior or centromedian nuclei, were significantly smaller in the schizophrenic subjects. For the schizophrenic subjects, neuronal number in the mediodorsal nucleus, parvocellular subdivision, and pulvinar was significantly lower, and neuronal size in the mediodorsal nucleus, caudodorsal subdivision, and pulvinar was significantly smaller. CONCLUSIONS: Schizophrenia is associated with volume and neuronal changes in the mediodorsal nucleus and pulvinar, the major association nuclei of the thalamus, whereas total thalamic volume and the volumes of anterior and centromedian nuclei were not significantly altered.     

Transferrin saturation studies in male adults showing high prevalence of iron deficiency

Estimation of serum iron, total iron binding capacity (TIBC) and transferrin saturation was performed in 62 apparently healthy male medical students. All had haemoglobin over 140 g/1. Low serum iron, elevated level of TIBC and transferrin saturation under 20% indicating iron deficiency state was found in 2 subjects. Elevated values of TIBC was found in 25 (40.32%) students as evidence of latent iron deficiency. Such high prevalence of iron deficiency in an affluent group indicates widespread iron deficiency in the general population.     

Systemic adverse effects and toxicities associated with immunotherapy: A review

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of cancers. Immunotherapeutic agents have gained immense popularity due to their tumor-specific action. Immunotherapy is slowly transforming into a separate therapeutic entity, and the fifth pillar of management for cancers alongside surgery, radiotherapy, chemotherapy, and targeted therapy. However, like any therapeutic entity it has its own adverse effects. With the increasing use of immuno-therapeutic agents, it is vital for physicians to acquaint themselves with these adverse effects. The aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic agents. We provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems, as well as an extensive discussion of the current recommendations for treatment and clinical trial data. As we continue to see increasing usage of these agents in clinical practice, it is vital for physicians to familiarize themselves with these effects.     

Bayesian algorithm using spatial priors for multiexponential T(2) relaxometry from multiecho spin echo MRI

Multiexponential T₂ relaxometry is a powerful research tool for detecting brain structural changes due to demyelinating diseases such as multiple sclerosis. However, because of unusually high signal‐to‐noise ratio requirement compared with other MR modalities and ill‐posedness of the underlying inverse problem, the T₂ distributions obtained with conventional approaches are frequently prone to noise effects. In this article, a novel multivoxel Bayesian algorithm using spatial prior information is proposed. This prior takes into account the expectation that volume fractions and T₂ relaxation times of tissue compartments change smoothly within coherent brain regions. Three‐dimensional multiecho spin echo MRI data were collected from five healthy volunteers at 1.5 T and myelin water fraction maps were obtained using the conventional and proposed algorithms. Compared with the conventional method, the proposed method provides myelin water fraction maps with improved depiction of brain structures and significantly lower coefficients of variance in white matter. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

Two in one: Double free flap from a single free fibula osteocutaneous unit

In the past two decades, the advancement in the microsurgical techniques has revolutionised the reconstruction of post-oncological head and neck defects. Free fibula osteocutaneous flap (FFOCF) has been considered as the treatment of choice by many for mandible reconstruction. The improvement in the surgical resection and adjuvant treatment has improved the survival rates even in patients with advanced cancer. Simultaneously the reconstruction is addressed towards more functional and aesthetic aspects to improve the quality of life in these patients. In this respect, a double free flap is advocated in certain cases of extensive composite oromandibular defects (COMDs). But in our institute, we have managed two such cases of extensive COMD with a single FFOCF unit – fibula bone with a skin paddle for inner lining and a perforator-based skin paddle from the proximal part of the FFOCF unit, anastomosed separately for outer cover. Compared to two separate free flaps, this method has the advantage of single donor site and reduction in reconstruction time. Though the technique of divided paddle, deepithelisation and supercharging has been mentioned for FFOCF, no such clinical cases of two free flaps from a single FFOCF unit have been mentioned in the literature.KEY WORDS: Composite oromandibular defect, double free flap, free fibula osteocutaneous flap