Alcohol use disorder (AUD) is a significant public health challenge, affecting multiple organs and organ systems, and fetal health. Additionally, AUD also significantly contributes to self-harm and road accidents. Beyond its health effects, AUD creates economic and political challenges, including escalating treatment costs and the complex alcohol regulation policies. Despite global impact, AUD remains under-addressed in countries like India due to cultural norms and limited resources. Early recognition of AUD is vital for better outcomes, relying on thorough clinical evaluation and patient history. However, denial, inebriation, or lack of awareness often delays diagnosis. Imaging techniques like ultrasound, CT, and MRI effectively depict AUD-related organ damage and aid in detecting chronic alcohol use. Radiologists play a crucial role in identifying these manifestations, contributing to its early detection and treatment. This review article highlights the imaging of alcohol use related disorders and diseases affecting different organs and organ systems at various stages. The review is presented in two parts: the first focuses on alcohol burden, alcohol metabolism and toxicity, and imaging findings of AUD-related abdominal diseases and disorders.
Purpose The aim of this study was to analyze the outcomes of percutaneous ablation in patients with renal masses. Materials and Methods We retrospectively analyzed 49 renal tumor ablations performed at our institute between 2019 and 2024. All patients underwent biopsy followed by computed tomography-guided ablation under general anesthesia. Results Of the 49 patients, 33 were male and 16 were female, with a mean age of 61 years. Biopsy revealed clear cell renal cell carcinoma (RCC) in 34 patients (69.4%) and non-clear cell RCC in 5 patients (10.2%). In 10 patients (20.4%), the biopsy results were inconclusive. The mean tumor size was 2.5 cm. Four patients (8.2%) had tumors larger than 4 cm. Microwave ablation was used in 39 patients (79.6%), radiofrequency ablation (RFA) in 9 patients (18.3%), and 1 patient underwent combined embolization with RFA. The mean follow-up duration was 25 months. Local recurrence occurred in three patients (6.1%), who were subsequently treated with stereotactic body radio-therapy, surgery, or systemic therapy. A complete response was achieved in 46 patients (93.8%). Three patients died within 1 year of follow-up due to non-oncological causes; all had shown a complete response. At the time of the last follow-up, 46 out of 49 patients were alive. Conclusion Percutaneous ablation using microwave or radiofrequency techniques is a viable alternative to surgery for the treatment of CT1 RCC, with excellent outcomes and a very low cancer-related mortality rate.
Introduction Obesity is characterized by excess adiposity. Magnetic resonance imaging (MRI) is used for quantifying and evaluating adiposity by precisely delineating soft tissues. It is widely used for assessing the visceral fat, but its use in evaluating subcutaneous fat (SCF) deposition in the lower body is scarce. This study aims to determine whether body mass index (BMI) predicts regional adiposity around the knee joint. Materials and Methods In this retrospective study, 100 patients who had an MRI of the knee were enrolled. Based on the BMI, the patients were categorized into healthy, overweight, and obese groups. Landmark-based representative coronal sections of a proton density (PD) MRI sequence were used, and two experienced musculoskeletal radiologists calculated the medial fat measurement (MFM). The one-way analysis of variance (ANOVA) method was used for statistical analysis. Results 27, 41, and 32 patients were enrolled in the healthy, overweight, and obese groups, respectively. There was a clinically significant difference between the groups (F-ratio = 7.70, p-value = 0.00079) for the MFM. There was good intra-and interobserver reliability, with kappa coefficients of 0.8 and 0.9, respectively. Conclusion BMI is a strong predictor of MFMs, indicating a direct relationship with knee regional adiposity. Landmark-based and straightforward measurements allow for reproducible and replicable assessment of SCF deposition.
Adamantinomas are a rare, low-grade, malignant mesenchymal bone tumor, accounting for fewer than 1 in 250 of all primary bone tumors across a range of ages but most commonly in the third and fourth decades. These often involve the tibia but rarely involve the fibula. We report a rare case of an isolated fibular adamantinoma in a 5-year-old boy and review the literature.
Objectives The recommended method of diagnosing acute cardiac allograft rejection (ACAR) is endomyocardial biopsy (EMB). The objective of this study was to assess the feasibility of rapid cardiac magnetic resonance (CMR) imaging protocol, which substantially reduces the scan times and increases the cost-effectiveness, for surveillance in heart transplant (HTx) recipients. Methods Thirty HTx recipients underwent noncontrast CMR the day prior to scheduled routine EMB. Acquisitions were done on a 1.5 Tesla scanner (Siemens Magnetom Aera) with a truncated rapid protocol consisting of a Trufi stack, cine imaging, and mapping. Thirty normal controls were also scanned. Results The average time per scan was 9.4 +/- 1.22 minutes. The average native T1 and T2 mapping values were significantly higher in HTx recipients than controls (p = 0.002 and p = 0.02, respectively). Patients with ACAR had significantly increased native T1 (1080.29 +/- 30.5 ms) and T2 (56.01 +/- 4.67 ms) compared with HTx recipients without ACAR (T1: 1016.07 +/- 38.23 ms; T2: 49.07 +/- 3.72 ms) (p = 0.001 and 0.0001, respectively). The area under the curve for T1 and T2 mapping to diagnose ACAR were 0.92 and 0.86, respectively. The sensitivity and specificity of native T1 (cutoff: 1033.655 ms) for diagnosing ACAR were 84.2 and 100 %, respectively, and that of T2 mapping (cutoff: 53.34 ms) were 77.2 and 89.5%, respectively. Conclusion We demonstrated the feasibility of a rapid truncated noncontrast CMR protocol for the surveillance of HTx recipients for the detection of ACAR.
Brunn's cyst is an extremely rare benign intravesical lesion arising from cystic dilatation of von Brunn's epithelial nests and may present with lower urinary tract symptoms due to bladder outlet obstruction. We report a case of a 21-year-old male presenting with obstructive urinary symptoms in whom ultrasonography demonstrated a thin-walled anechoic cystic lesion at the bladder neck, raising suspicion of ureterocele. Computed tomography intravenous pyelography revealed a well-defined intravesical cystic lesion measuring approximately 1.9 & times; 1.6 cm, with a thin wall (similar to 1.4 mm) and homogeneous fluid attenuation (similar to 18 HU), without internal septations or postcontrast enhancement. There was no communication with the distal ureter and no associated hydroureteronephrosis. Cystoscopy demonstrated a smooth, dome-shaped cystic lesion at the bladder neck. Histopathological examination confirmed cystic dilatation of von Brunn's nests. This case highlights the importance of cross-sectional imaging in differentiating Brunn's cyst from other cystic lesions near the bladder neck.
Background:Transarterial chemoembolization (TACE) is considered standard therapy for intermediate-stage hepatocellular carcinoma (HCC). However, conventional TACE (cTACE) and drug-eluting bead TACE (DEB-TACE) are limited by high recurrence rates. Recent studies have shown that balloon-occluded TACE (B-TACE) allows enhanced intratumoral drug deposition and may improve outcomes. This study aimed to evaluate the short-term outcome of B-TACE for HCC. Materials and Methods:This retrospective single-center study was conducted after obtaining approval from the institutional review board. Fifty patients with unresectable HCC were treated with B-TACE between October 2023 and September 2024. Tumor response was assessed using LI-RADS Treatment Response (LR-TR) and mRECIST (Modified Response Evaluation Criteria in Solid Tumors). Progression-free survival (PFS) was analyzed with Kaplan-Meier methods, and predictors of response were evaluated by logistic regression. Lipiodol deposition was classified into three types as a surrogate marker of drug distribution. Results:The overall response rate was 72.0%, with a complete response in 54.0% of patients. Subgroup analysis revealed that patients with Barcelona Clinic Liver Cancer (BCLC) stage A and B achieved a higher overall response rate of 77.3% (34/44), compared with 33.3% (2/6) in patients with BCLC stage C. At 1 year, 68.0% remained progression-free, with significantly higher PFS in those achieving early complete response/partial response compared with stable disease/progressive disease (83.3 vs. 28.6%, p < 0.001). Type I lipiodol deposition strongly correlated with complete response (93.8 vs. 37.5% for type II and 0% for type III; p < 0.001) and superior PFS. Multivariable analysis identified lipiodol deposition pattern, number of lesions, and baseline AFP as independent predictors of response. Complications were manageable (30.0%, mainly fever and transaminitis), with no treatment-related mortality. Conclusion:B-TACE demonstrated high efficacy and acceptable safety in HCC, with lipiodol deposition serving as a key predictor of outcome. These findings support B-TACE as a promising alternative to cTACE/DEB-TACE, particularly in intermediate-stage disease.
Vascular variants can significantly influence surgical planning and diagnostic accuracy. One rare anomaly is that of the left vertebral artery arising directly as the fourth branch of the aortic arch, lateral to the left subclavian artery. We describe a 52-year-old male in whom this variation was found incidentally during evaluation for an acute right medullary infarct and a focal aneurysm of the right vertebral artery. The aberrant origin was confirmed by computed tomography angiography. Such variants are important in relation to anterior cervical spine surgery, vertebral artery dissection, carotid stenting, and other endovascular procedures. Awareness of these anomalies is crucial for the avoidance of intraoperative injury and optimization of neurovascular management.
Background The distal biceps brachii tendon (BB) and its aponeurotic extension, the lacertus fibrosus (LF), represent important anatomical structures of the elbow with functional and clinical relevance. Purpose The objective of this study is to describe the appearance, morphometry, and anatomical variations of the LF and distal biceps tendon on magnetic resonance imaging (MRI). Materials and Methods Retrospective review of the MRI elbow joints of 81 patients. The presence and morphology of the LF and BB were analyzed utilizing high-resolution MRI and referencing anatomical classifications and morphometric parameters. Results The study included 81 patients (32 females, 49 males; mean age 33.7 +/- 13.4 years). The LF was present in 87.7% and absent in 12.3% of elbows. Mean LF measurements were: thickness 0.63 +/- 0.16 mm, width 17.54 +/- 4.66 mm, and length 30.55 +/- 8.37 mm. In 77.5%, the brachial artery lay anterior to the median nerve; in 19.7%, they were equidistant from the LF, and in 2.8%, the median nerve lay anterior to the brachial artery. Type I BB tendon was most common (n = 74), with Type II (n = 5) and Type III (n = 2). Mean BB tendon length and thickness were 59.25 +/- 11.96 mm and 3.51 +/- 0.70 mm, respectively. BB tendon thickness was the strongest predictor of LF absence (area under the curve [AUC]: 0.698), while adding variables like tendon length, age, and sex did not significantly enhance discrimination (AUC: 0.714). Conclusion The LF and anatomical variations of the distal BB tendon at the elbow are often overlooked. We emphasize the relevance of understanding normal variants that could aid in accurate diagnosis and facilitate the recognition of possible entrapment syndromes.
Fluoroscopically guided S1 transforaminal epidural steroid injection (TFESI) is a treatment option for discogenic S1 radiculopathy or failed back surgery syndrome. Fluoroscopy plays an excellent role in treating S1 radiculopathy; however, it can sometimes be challenging due to complex sacral anatomy, bony flange, and bowel gas overlaps. In this technical report, we provide a simplified approach: fluoroscopic cranio-caudal angulation till we get an open fish-mouth appearance for better demonstration of the dorsal S1 neural foramina and ease of S1-TFESI.
Literature outlining the role of hand positioning in percutaneous radiological procedures is sparse. However, this is a crucial consideration in musculoskeletal intervention because of the range of needles used. Specifically, the index finger helps to optimize needle stability, trajectory, and enable controlled insertion to improve patient safety and the likelihood of procedural success. This article explores the uses of the index finger in the manipulation of devices when performing percutaneous musculoskeletal procedures. The index finger may be either fully or partially extended and anchored along the shaft of the biopsy device. When fully extended, the index finger can rest against the skin to provide counterforce during needle advancement-this prevents unintended jolted advancements when passing between tissues of different densities. When partially extended, the index finger rests on a point of reference along the needle shaft and acts as a confirmatory marker for the depth of insertion once that level is flush with the skin. The suggested index finger positions should be consistently used to promote needle stability and ensure controlled advancement.
Introduction Gestational diabetes mellitus (GDM) disrupts myocardial function irrespective of evident structural cardiac anomalies. The modified myocardial performance index (Mod-MPI) is a Doppler-based parameter that incorporates both systolic and diastolic performance, acting as a sensitive measure for comprehensive ventricular function. Purpose This article assesses and compares fetal Mod-MPI values in pregnancies complicated by GDM and in healthy normoglycemic controls and also evaluates its diagnostic accuracy in detecting subclinical fetal cardiac dysfunction. Materials and Methods This prospective case-control study was conducted at a tertiary care center over 18 months. The study included 60 pregnant women (28-32 weeks' gestation) with 30 GDM patients confirmed via the American Diabetes Association oral glucose tolerance testing and 30 matched normoglycemic controls matched for key confounders. Pulsed-wave Doppler echocardiography measured Mod-MPI with sample volume at the mitral-aortic junction with isovolumic contraction time, ejection time, and isovolumic relaxation time calculated via valve click landmarks. Group comparisons, correlation analyses, and receiver operating characteristic (ROC) curve assessments were performed. Results Mean fetal Mod-MPI was significantly higher in the GDM group compared with controls (0.508 +/- 0.040 vs. 0.366 +/- 0.045; p < 0.001). The ROC curve revealed excellent diagnostic performance (area under the curve = 0.933) with high sensitivity and specificity achieving an optimal cutoff of 0.46. Conclusion Fetal Mod-MPI serves as a reliable, feasible, and reproducible index for subclinical fetal myocardial impairment in GDM and facilitates early fetal risk assessment.
Background The present study aims to evaluate the effectiveness of retrospective positron emission tomography/magnetic resonance (PET/MR) fusion, in conjunction with the Neck Imaging Reporting and Data System (NI-RADS) classification system, to improve diagnostic accuracy and facilitate the detection of recurrence in patients with oral cancer. Materials and Methods This retrospective study analyzed 106 patients with surgically treated oral cavity malignancies followed by adjuvant chemotherapy and/or radiotherapy and under surveillance for 9 to 12 months. In all patients, PET data was fused with postcontrast magnetic resonance imaging (MRI) images using automated software, and various MRI sequences were analyzed. Statistical analysis was performed using GraphPad Prism (version 10.2). Results Majority of patients were male (90.6%), aged 51 to 60 years (30.2%), with single lesions (96.2%). Histopathology confirmed 70% malignant and 30% benign lesions. MRI had high concordance with pathology in NI-RADS grade I (90.5%) but struggled with higher grades. PET showed similar trends, with increasing discordance in intermediate-risk cases. PET/MR fusion outperformed both modalities, achieving the highest concordance rates, especially in grades I (88.2%), II (93.3%), and IV (100%). PET/MR fusion demonstrated superior diagnostic performance with 96.1% sensitivity, 87.88% specificity, and 93.64% accuracy. Receiver operating characteristic analysis confirmed its superiority (area under the ROC curve: 0.948). Conclusion PET/MR fusion offers superior detection rates for recurrent tumors in oral cancer surveillance, in comparison to PET and MRI alone with NI-RADS category I and II, while MRI with diffusion-weighted imaging excels in identifying perineural spread and locoregional extension. By leveraging both modalities, it minimizes false negatives and facilitates earlier interventions, improving patient outcomes.
Primary pulmonary choriocarcinoma (PPC) is an exceptionally rare and aggressive germcell malignancy of nongonadal origin, often presenting a diagnostic challenge. We describe a 30-year-old nongravid woman who presented with haemoptysis and fever and was found to have a left-sided lung mass. Further Imaging showed many lung and splenic metastases. Histopathology and elevated serum Beta-HCG levels (99,594mIU/mL) verified Choriocarcinoma. Pelvic magnetic resonance imaging (MRI) ruled oututerine or adnexal primary, establishing PPC as the diagnosis. Beta-HCG levels returned to normal after 3 months of treatment with the EMA/CO chemotherapy regimen, which produced a notable clinical, radiological, and biochemical response. MRI brain posttreatment revealed a subcentimetric enhancing haemorrhagic cerebellarlesion, suspicious for metastasis, warranting close follow-up. Despite PPC's generally dismal prognosis, this case shows that there is hope for a positive early therapeutic response. Prolonged surveillance remains crucial due to the risk of recurrence and brain metastases.
In today's global environment, there is a significant risk of cancer due to changing eating habits. Leukemia is a cancer affecting the bone marrow and white blood cells. This type of cancer affects children and adults, so it has a high mortality rate worldwide. This type of cancer invades the blood and spreads to other organs. The existing leukemia diagnosis system is manual, cumbersome, and prone to errors. Most existing systems fail to effectively analyze feature margins and relative entity thresholds, resulting in reduced precision. This occurs because actual margins of true positive rates degrade, increasing the false-positive rates. Hence, there is a need for an automated leukemia diagnosis system based on computer-aided diagnosis and deep learning methods to detect cancer cells from microscopic images. However, automatic leukemia diagnosis from microscopic blood images is tedious and produces imprecise, unreliable results. To address these problems, this research proposes a novel Deep DenseNet Convolution Generative Neural Network (D(2)CGNN) based on Absolute Maximum Support Feature Selection (AMSFS) to predict early-stage leukemia. The proposed first step is the Adaptive Gaussian Filter technique to analyze the noise ratio and remove noise from collected microscopic blood images. The second step is the Recursively Brightness Enhancement Histogram Equalization (RBEHE) method to improve image contrast levels from preprocessed images. The third step is identifying the region of interest in leukemia cancer using Region-based Watershed Segmentation. Afterward, select the best features of leukemia cancer using the AMSFS method. Finally, based on feature-selected microscopic images, the proposed method efficiently classifies samples as either cancerous or not. The proposed method was tested using the American Society of Hematology microscopic image, a publicly available database of leukemia patients. The proposed method provides better sensitivity of 93.4%, specificity of 93.2%, f1-score of 94.7%, and classification results of up to 95.6% than other methods.
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma of cytotoxic alpha beta T cells that mimics panniculitis. This report details the case of a 23-year-old woman who presented with fever, multiple left arm and axillary subcutaneous swellings, and was empirically treated with anti-tubercular therapy (ATT). After 5 months of ATT, she developed a left breast mass and the subcutaneous nodules became refractory, for which she underwent evaluation with digital mammography, ultrasound, and positron emission tomography-computed tomography, which showed diffuse skin and subcutaneous thickening with no mass. Histopathology with immunohistochemistry demonstrated a predominantly subcutaneous lobular infiltrate of atypical lymphocytes, establishing SPTCL. She was subsequently treated with Cyclosporine and systemic corticosteroids, resulting in clinical regression. There are exceedingly few reports of SPTCL of the breast and none documented in the Indian radiology literature. Distinguishing SPTCL from septo-lobular panniculitis and inflammatory breast diseases is challenging; heightened awareness facilitates timely diagnosis and appropriate therapy.
Background Artificial intelligence (AI) fundamentally involves mathematical concepts related to handling and applying data to real-world scenarios. In the current educational scenario, the academic separation between biological sciences and data sciences often begins at an early educational stage (e.g., by 10th grade in many curricula), leading to a significant understanding gap between data scientists and medical professionals. In radiology, where large volumes of reproducible numerical data are routinely stored, AI holds significant transformative potential. To harness its benefits and understand its limitations, radiologists must acquire foundational knowledge of these techniques. This workshop was therefore designed to bridge this knowledge and conceptual divide, in addition to identifying deficiencies in basic concepts. Objectives This article evaluates the effectiveness of an AI in radiology workshop by comparing participants' knowledge perception, confidence, and overall perspectives before and after the survey. Design Prospective survey-based study using pre- and post-workshop questionnaires. Setting The workshop was held on January 26, 2025 during the 77th annual Indian Radiological and Imaging Association (IRIA) and 23rd Asian Oceanian Congress of Radiology (AOCR) in Chennai, Tamil Nadu, India. Participants Radiologists, fellowship trainees, and radiology residents attending the workshop. Main Outcome Measures center dot Participant confidence in applying AI-assisted tools in radiology workflow. center dot Perceived improvement in understanding of AI in radiology. center dot Shift in participants' perspectives and perceptions regarding AI's role in future radiology practice. Results Forty-five participants completed both surveys; only 11.1% had prior formal AI training, and 20% had used AI in clinical practice. Perceived understanding improved significantly with 26.7% reporting "significant" and 44.4% "moderate" improvement. The mean postworkshop confidence in applying AI-assisted tools was 3.2 on a 5-point Likert scale, indicating a moderate level of confidence following the training. A positive shift in perception was observed in 82.2% of participants. Case studies and practical examples were most valued, alongside requests for more hands-on sessions and improved technical infrastructure. Conclusion The "AI in Radiology" workshop successfully fostered a more confident and informed perspective on AI in radiology among its participants. The findings strongly advocate for continued educational efforts that are clinically relevant, practical, and highly interactive. Future initiatives should prioritize extended hands-on sessions and advanced case-based discussions to meet the expressed needs for continued, deeper learning.
Background Free flap (FF) surgery is central to reconstructive microsurgery, relying heavily on vascular patency for flap survival. While clinical monitoring is standard, the dynamic changes in blood flow velocity following microvascular anastomosis (MVA) remain inadequately studied. This research investigates pedicle velocity trends using Doppler ultrasonography to better understand flap physiology and predict outcomes. Materials and Methods A prospective observational study was conducted at All India Institute of Medical Sciences Rishikesh between April 2023 and September 2024, including 35 patients undergoing FF reconstruction. Pedicle blood velocities were measured using high-frequency Doppler ultrasonography at four intervals: before pedicle division (V0), 20 minutes post-anastomosis (V1), and postoperative days 7 (V2) and 28 (V3). Mean velocities were analyzed using repeated-measures ANOVA (analysis of variance) with Bonferroni correction. Results Both arterial and venous velocities showed a statistically significant change over time (p < 0.001). No significant velocity change was observed immediately post-anastomosis (V0 vs. V1), both arterial and venous velocities increased significantly by POD 7 and stabilized by POD 28. The flap success rate was 97%, with venous thrombosis being the primary cause of failure. The case of venous thrombosis showed abnormal early velocity elevation. Doppler ultrasonography also facilitated preoperative planning and postoperative complication management. Conclusion Pedicle blood velocity increases progressively following MVA, likely reflecting vascular remodeling and improved perfusion. Early aberrations in velocity trends may serve as warning signs of thrombotic events. Doppler ultrasound emerges as a valuable, noninvasive tool for dynamic flap assessment and warrants broader application in microsurgical practice. Further large-scale studies incorporating waveform analysis may strengthen its role in predictive diagnostics.
