Purpose of the Study: Renal mass lesions in majority of the cases are due to malignant etiology and about one-third of them are reported with metastatic lesions at the time of presentation. Thus proper investigational workup is needed for staging and thereby treatment planning. The current fluorine18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F18-FDG PET/CT) study was designed to characterize renal mass lesions metabolically and identifying other metabolically active lesions in the body suggesting metastatic disease. Materials and Methods: A total of 24 patients (males – 18 and females – 6) with a mean age of 53.8 ± 12.3 years were recruited in this study for dual time-point PET/CT scan. All patients with renal mass lesions underwent contrast-enhanced CT prior to PET/CT. Metabolic parameters such as maximum standardized uptake value (max.SUV) with a cut off ≥2.5 and retention index (RI) of ≥10% were used to label the lesion as malignant and remaining less than cutoff as benign. The final diagnosis of lesion on imaging was confirmed with a histopathological examination (HPE). Results: Using max.SUV cut off value, 17/24 renal mass lesions were characterized as malignant and remaining 7/24 renal lesions of benign etiology. PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80%, 75%, 94.1%, 42.8%, and 79.1%, respectively, by considering HPE as a gold standard. Nine patients were diagnosed with distant site involvement suggestive of metastases. Conclusion: F18-FDG PET/CT can efficiently characterize solid renal mass lesion as benign and malignant using metabolic parameters such as max.SUV and RI. In addition, whole-body survey identified distant site involvement in 25% of the patients, thus contributing change in management.

Background: Lumbar interbody fusion has gained popularity for the treatment of spondylolisthesis in recent years. Both procedures have their own advantages and disadvantages. Objective: The aim of this study was to compare the clinical and radiological outcomes of MIS TLIF and OLIF in terms of visual analog score, Oswestry Disability Index, Intraoperative blood loss, and various other parameters. Material and Methods: This is a retrospective matched-pair comparative analysis between two groups who underwent Single level either OLIF or MISTLIF for spondylolisthesis operated from January 2017 to January 2020 at a Single institute by a Single surgeon. Results: Statistically there is no difference in various preoperative parameters between the two groups. The intraoperative blood loss is 112.5 mL in OLIF, and 144.6 mL is MISTLIF. The duration of surgery in OLIF is 4.41 h and 3.16 h in MISTLIF. The mean duration of the requirement of postoperative analgesia is 3 months after OLIF and 5 months after MISTLIF. The time taken for returning to regular activities is less in OLIF than MISTLIF. Conclusions: Although both OLIF and MISTLIF have almost equivalent outcomes, OLIF is better than MISTLIF in having lesser intraoperative blood loss and achieving better lordotic correction.

Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality in young individuals. Goal of management in TBI patients is mainly focused on the secondary injury. Since the cisterns and the brain communicate, it would be possible to decrease the pressure in both these compartments by opening the cisterns to the atmospheric pressure. Objective To study the outcomes and predictors of outcome with cisternostomy in the management of TBI. Methods A single tertiary care center's prospective observational study of outcomes with cisternostomy with intraoperative intracranial pressure (ICP) monitoring. Patients were evaluated clinically and radiologically with Marshall CT score. They were categorized into mild, moderate, and severe head injury groups based on Glasgow coma scale (GCS) score. Outcomes were evaluated with Glasgow outcome scale (GOS) score. Results A total of 25 patients with TBI were enrolled in this study. They underwent cisternostomy with intraoperative ICP monitoring. They were categorized into 4 groups based on the age. In our study, mortality rate was 32%. As much as 48% had good recovery at 3 months follow-up with GOS 4 and 5. Mean ICP after cisternostomy was 6.36 +/-- 1.91 mm Hg. In our study, there was decrease in ICP after cisternostomy. Conclusion Age, time interval from trauma to surgery, and ICP showed prognostic importance on outcomes. Cisternostomy can efficiently decrease the ICP in the TBI patients and reduce postoperative complications.

Chordoma is a rare bone malignancy that influences the spine and cranium base. Once in a while, it includes bone and when it does, cranial bones are the favored location. Chordomas emerge from embryonic remnants of the primitive notochord and chondrosarcomas from primitive mesenchymal cells, otherwise from the embryonic rest of the cranial cartilaginous matrix. Chondrosarcomas constitute a heterogeneous group of essential bone malignancy characterized by hyaline cartilaginous neoplastic tissue. Both are characterized by invasion and pulverization of the neighboring bone and delicate tissue with higher locoregional reappearance frequency. Chordoma and chondrosarcoma, especially myxoid variation of chondrosarcoma of the cranium base, are as often as possible amalgamated because of similar anatomic location, clinical presentation, and radiologic sightings, and mixed up histopathological highlights. Chordoma and chondrosarcoma vary with respect to their origin, management strategy, and contrast particularly with respect to outcome. Ultimately, developing indication supports aberrant growth factor signaling as possible pathogenic mechanisms in chordoma. Here, we have shown such a location-based symptomatic predicament, understood effectively with ancillary immunohistochemistry. In this review, we summarize the most recent research findings and focus primarily on the pathophysiology and diagnostic aspects.

Context: Acute pulmonary embolism (PE) is one of the common and potentially fatal medical emergencies. The short-term mortality of PE ranges from less than 1% in hemodynamically stable patients to over 90% in patients presenting with cardiopulmonary arrest.[1] Patients presenting with PE have a high risk of mortality in the first 30 days.[2],[3],[4],[5] Echocardiography is routinely done in cases of PE for knowing cardiac status but echo being highly operator dependent, Computed Tomography (CT) pulmonary angiography (CTPA) can provide an alternative with lesser operator dependence. The main purpose of this study is to assess the prognostic value of different parameters measured by multi-detector CT pulmonary angiography (CTPA) in evaluating the clinical outcome of acute PE patients. Aim and Objectives: To study association of left atrium (LA) volume, LA volume index, RVV/LVV ratio, IVC reflux, interventricular septal bowing with clinical outcome. Methods and Materials: The prospective study was conducted in the Department of Radio-Diagnosis, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati in the time frame of March 2018 to June 2019. A total of 46 cases that were confirmed to have acute pulmonary thromboembolism on CTPA meeting the study criteria were studied for location of emboli, LA volume, LA volume index, RVV/LVV ratio, IVC reflux, interventricular septal bowing. The parameters were compared with adverse clinical outcomes which were defined as death within 30 days or escalation of therapy, according to the MAPPET-3 ( Management Strategies and Prognosis in Pulmonary Embolism Trial-3) study criteria.[7] Statistical Analysis Used: Chi-square test was used for comparisons of categorical variables, and Student t-test was used for comparisons in the distributions of continuous variables by using IBM SPSS statistics 20. A P value <0.05 was considered significant. Results: Our study included 46 patients belonging to age range of 18 to 83 years with evidence of pulmonary thromboembolism on CTPA study. Out of these, 18 (39%) patients had adverse events, where 17 (37%) patients died within 30 days, and 1 (2%) had a cardiac arrest where he was revived after cardiopulmonary resuscitation within 30 days from diagnosis of acute PE. There was no difference in the distribution of age, sex or other comorbidities between the patients who had adverse events and those who did not. In our study, patients with centrally lodged thrombi showed higher mortality and other adverse events than patients with more peripherally lodged PE (p value = 0.022). There was no evidence of any statistically significant association between the IVC reflux, septal bowing, cardiac volume parameters with adverse events within 30 days of diagnosis of acute PE. Conclusion: In our study, we found the location of thrombus on CTPA to be a significant factor in predicting the adverse outcome. Other parameters like LA volume, LA volume index, RVV/LVV ratio, IVC reflux interventricular septal bowing did not demonstrate a significant relationship with 30-day adverse outcomes. The use of cardiac volumes in predicting the clinical outcome did not show any significant relationship, and this could be due to underlying conditions like hypertension, smoking, systemic diseases. The use of cardiac chamber volumes in predicting clinical outcome needs to be studied on a larger sample size to look for the role of other systemic factors affecting its volume.

Context: Classic prognostic markers in breast cancer are tumor size and grade, lymph node status, molecular markers, including estrogen receptor (ER), progesterone receptor (PR), Ki-67 index, human growth factor receptor 2 (HER2) protein, and angiogenic molecular markers. Purpose of present study is to assess the utility of apparent diffusion coefficient (ADC) values in the prognosis of breast cancer by correlating them with molecular biomarkers. Aim: To correlate the ADC values of DWI of Breast cancer with immunochemical prognostic factors.Settings and Design: Retrospective observational study. Materials and Methods: Ours is a retrospective study of 30 female cases of histologically proven breast carcinoma who underwent magnetic resonance imaging (MRI) of breast in Tertiary healthcare centre, Andhra Pradesh. Molecular prognostic factors data were available for 20 cases which were further analyzed.Statistical Analysis Used: Correlation between the ADC value of the breast tumour and molecular prognostic markers was analyzed using Student's t test.Results: Mean ADC of Ki-67 index positive cancers (0.755 × 10 - 3 ± 0.158 × 10 - 3mm2/s) was significantly lower than Ki-67 index negative cancers (0.929 × 10-3 ± 0.117 × 10 - 3mm2/s) suggesting statistically significant correlation between ADC value and Ki67 index. There is no significant correlation between ADC value and ER, PR, and HER2 expression status.Conclusion: Our study showed statistically significant association between ADC values and Ki-67 index. Thus ADC values may be of use in providing prognostic information about disease.

Background and Objective: Ultrasonography (??USG) and magnetic resonance cholangiopancreatography (??MRCP) are noninvasive modalities for evaluation of patients with obstructive jaundice. USG is widely available and less expensive compared to MRCP. But the value of USG is limited in obese patients and distal CBD evaluation due to poor window caused by bowel gas. With this knowledge, we planned to assess the diagnostic efficacy of USG and MRCP in detecting the level and cause of obstructive jaundice considering the gold standard being the final diagnosis made at surgery/Endoscopic retrograde cholangiopancreatography (ERCP). Settings and Design: Prospective observational study. Material and Methods: The study was conducted in the department of Radio Diagnosis, SVIMS, over a period of 18 ?months from March 2018–July 2019. This study includes thirty-seven consecutive patients who were referred to the department of Radiodiagnosis with the clinical suspicion of obstructive jaundice and elevated serum bilirubin levels. USG followed by MRCP were done in all the patients. Results: Of the thirty-seven patients with obstructive jaundice, twenty-nine patients had benign while eight patients had malignant etiology. For diagnosing the cause of obstructive jaundice, MRCP has a diagnostic accuracy of 97.2% and USG has a diagnostic accuracy of 86.4%. The sensitivity of MRCP is greater than USG in diagnosing the cause of obstructive jaundice. In diagnosing the level of obstruction, MRCP had an accuracy of 100%, while USG 81%. Conclusion: As MRCP has more diagnostic accuracy compared to ultrasound in detecting the level and cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size.