Publications by authors named "Anju Garg"

39 Publications

CAROLI'S SYNDROME WITH AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE ON FETAL MRI: A CASE REPORT.

Congenit Anom (Kyoto) 2022 Aug 8. Epub 2022 Aug 8.

Department of Obstetrics and Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, Delhi, India.

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http://dx.doi.org/10.1111/cga.12490DOI Listing
August 2022

MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis.

Eur J Radiol 2022 Jul 6;152:110341. Epub 2022 May 6.

Department of Ophthalmology, Maulana Azad Medical College and Guru Nanak Eye Centre, New Delhi 110002, India.

In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.
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http://dx.doi.org/10.1016/j.ejrad.2022.110341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074238PMC
July 2022

Alveolar soft part sarcoma of the retroperitoneum: A case report.

J Radiol Case Rep 2021 Oct 1;15(10):20-26. Epub 2021 Oct 1.

Department of Pathology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), Jawahar Lal Nehru Marg, New Delhi-110002, India.

Alveolar soft part sarcoma is a rare soft tissue tumor with uncertain histogenesis. It is a slow growing tumor with a high rate of metastasis. The tumor is not easily identified as clinical symptoms are not pronounced. The retroperitoneum is a rare location of tumor, with a few cases published in literature. Surgical excision is the mainstay of treatment. Here we describe a rare case of a large retroperitoneal Alveolar soft part sarcoma in a young female with radiological and histopathological findings.
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http://dx.doi.org/10.3941/jrcr.v15i10.4003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9063826PMC
October 2021

CT Imaging Features in Acute Invasive Fungal Rhinosinusitis- Recalling the Oblivion in the COVID Era.

Curr Probl Diagn Radiol 2022 Sep-Oct;51(5):798-805. Epub 2022 Feb 7.

Department of Otorhinolaryngology (ENT), Maulana Azad Medical College, New Delhi, India.

Objective: Recent pandemic of COVID19 infection has witnessed a re-emergence of invasive fungal sinusitis especially of the Mucor species, which has been a rare entity in the pre covid era. Covid associated mucormycosis (CAM) is one of the dreaded and fatal complications which has surfaced up and early diagnosis is critical for management and survival .It is identified to affect both subset of patients, those with active COVID-19 infection and those who have recovered from the disease in the last 4-6 weeks. Imaging features suggestive of early invasion with supportive imaging examples and relevance of these findings in clinical decision making is presented.

Methods: This paper reviews the various imaging signs of early invasion in CAM A comprehensive checklist for clinically relevant and quick reporting is also presented.

Results: Emphysematous or ulcerative mucosal changes in the nasal cavity is an early imaging feature of CAM. Periantral soft tissue and soft tissue within the pterygopalatine fossa are important imaging signs to indicate extrasinus invasion. Disease within pterygopalatine fossa may lead to multidirectional spread and is an important check site. These findings are seen even in absence of bony erosions owing to the neurovascular spread of disease. Intra orbital and intracranial extensions were found to be fairly common and must be sought for.

Conclusion: The knowledge of early subtle signs of CAM on imaging can aid in prompt diagnosis of this fatal entity in the pertinent clinical setting. Imaging signs of spread of disease and delineation of its extent as inferred from CT imaging aids in prognosis and appropriate surgical management.
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http://dx.doi.org/10.1067/j.cpradiol.2022.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820107PMC
August 2022

Bilateral Submandibular Gland Aplasia: An Unusual Cause of Sublingual Swelling-The Role of Imaging in Patient Management.

Indian J Radiol Imaging 2021 Oct 13;31(4):1043-1046. Epub 2021 Dec 13.

Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.

There are very limited reports of aplasia of bilateral submandibular glands. We report the case of a 55-year-old male who presented with nontender palpable sublingual masses. On computed tomography and magnetic resonance imaging, bilateral submandibular gland aplasia and compensatory hypertrophy of bilateral parotid and sublingual glands were seen with herniation of hypertrophied sublingual glands through the bilateral mylohyoid muscles presenting as palpable sublingual region masses. Additional finding of bilateral accessory parotid glands was also noted. Prolapsed hypertrophied sublingual glands should be considered in patients presenting with bilateral sublingual masses to avoid unnecessary invasive procedures. We suggest radiological evaluation of such cases prior to any intervention.
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http://dx.doi.org/10.1055/s-0041-1740260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8817805PMC
October 2021

The role of "penumbra sign" and diffusion-weighted imaging in adnexal masses: do they provide a clue in differentiating tubo-ovarian abscess from ovarian malignancy?

Pol J Radiol 2021 15;86:e661-e671. Epub 2021 Dec 15.

Department of Pathology, Maulana Azad Medical College, New Delhi, India.

Purpose: To evaluate the role of "penumbra sign", diffusion-weighted imaging (DWI), and the apparent diffusion coefficient (ADC) value in differentiating tubo-ovarian abscess (TOA) from ovarian malignancy.

Material And Methods: Thirty-six patients with 50 adnexal masses (tubo-ovarian abscess, = 24; ovarian malignancy, = 26), who underwent magnetic resonance imaging (MRI) with DWI, were retrospectively evaluated. "Penumbra sign" (hyperintense rim on T1W images), diffusion restriction, and mean apparent diffusion coefficient (ADC) values from cystic (c-ADC) and solid (s-ADC) components were evaluated for all the masses.

Results: "Penumbra sign" on T1W images was significantly more common in the TOA group ( = 21, 87.5%) than in the ovarian malignancy group ( = 2, 7.7%) ( < 0.001). Similarly, diffusion restriction in the cystic component was more frequent in the TOA group ( = 24, 100% vs. = 2, 10.5%; < 0.001). In contrast, diffusion restriction in the solid component was more common in the ovarian malignancy group ( = 5, 20.8% vs. = 26, 100%; < 0.001). The mean c-ADC value was significantly lower in TOAs ( < 0.001). A c-ADC value of 1.31 × 10 mm/s may be an optimal cut-off in distinguishing TOAs from ovarian malignancies. Conversely, the mean s-ADC value was significantly lower in the ovarian malignancy group ( < 0.001). An s-ADC value of 0.869 × 10 mm/s may be an optimal cut-off in differentiating ovarian malignancies from TOAs ( < 0.001). ROC curve analysis showed that c-ADC values had a higher diagnostic accuracy than s-ADC values.

Conclusions: "Penumbra sign" on T1W images, diffusion characteristics, and ADC values provide important clues in addition to conventional MR imaging features in differentiating TOA from ovarian malignancy.
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http://dx.doi.org/10.5114/pjr.2021.111986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757038PMC
December 2021

Clinico-Radiological-Pathological Correlation of Visual Loss in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis.

Ophthalmic Plast Reconstr Surg 2022 May-Jun 01;38(3):242-249. Epub 2022 May 11.

Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.

Purpose: To correlate the clinical, radiological, and histopathological features in Covid-associated Rhino-orbito-cerebral mucormycosis cases presenting with acute visual loss.

Design: Cross-sectional study.

Methods: Covid-associated Rhino-orbito-cerebral mucormycosis cases with unilateral visual loss, planned for exenteration, underwent orbital and ophthalmological ocular examination. The available radiological sequences, doppler ultrasonography and histopathology findings were correlated with clinical manifestations.

Results: The median age was 51 years and the male: female ratio was 3:1. All except one presented with unilateral ophthalmoplegia. The ocular media were hazy in 2 eyes. In 8 eyes, retinal changes were suggestive of occlusion of CRA (6), combined occlusion of CRA and central retinal vein (1), and myopic degeneration with hypertensive retinopathy (1). The contralateral eye showed retinal ischemic changes in one patient. Radiological imaging showed orbital apex involvement in the 10 affected eyes and one contralateral eye. Ipsilateral cavernous sinus thrombosis, diffusion restriction on MRI of optic nerve, internal carotid artery narrowing/thrombosis, and cortical watershed infarcts were seen in 8, 4, 4, and 2 cases, respectively. The blood flow in CRA and ophthalmic artery was absent or reduced in all the 10 affected eyes and in 1 contralateral eye. On histopathology, orbital fat necrosis, fungal hyphae, acute inflammation, granuloma formation, ischemic thrombosis of ophthalmic artery was observed in 10 specimens. CRA was patent in 9 and thrombosed in 1 eye. Optic nerve was ischemic in 8 and viable in 2 eyes.

Conclusion: Acute visual loss in ROCM cases is associated with orbital apex involvement and thrombotic ischemia of ophthalmic artery. Cessation of flow in CRA possibly occurs secondary to ophthalmic artery thrombosis.
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http://dx.doi.org/10.1097/IOP.0000000000002112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9093237PMC
May 2022

Ectopic uterine scar pregnancy: A case report.

Ultrasound 2021 Feb 8;29(1):57-63. Epub 2020 Jul 8.

Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi.

Introduction: Implantation of a gestational sac in a previous Caesarean section scar of the lower uterine segment is a rare form of ectopic pregnancy.

Case Report: We report a case of Caesarean scar ectopic pregnancy in a 25-year-old female, diagnosed by ultrasonography and confirmed by magnetic resonance imaging. We present the clinical details, imaging findings, and management of the patient.

Discussion: Imaging plays an important role in the diagnosis of ectopic pregnancy and ultrasonography is the modality of choice. Ultrasonography features of scar ectopic pregnancy include empty uterus and cervix with normal endometrium and endocervical canal, gestational sac (with embryo and/or yolk sac) in the anterior part of the lower uterine segment in the region of the Caesarean scar with a thin myometrial layer between the bladder wall and gestational sac. Magnetic resonance imaging may be used as an adjunct imaging modality in cases with inconclusive or equivocal sonographic findings. Termination of pregnancy in the first trimester should be considered and treatment options should be individualized as there is no universal agreement on the best or most preferred treatment modality.

Conclusion: Awareness of specific ultrasound features of scar ectopic pregnancy is crucial for early recognition, correct diagnosis, and initiating prompt management to prevent complications.
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http://dx.doi.org/10.1177/1742271X20933918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844474PMC
February 2021

Phakomatoses: A pictorial review.

Indian J Radiol Imaging 2020 Apr-Jun;30(2):195-205. Epub 2020 Jul 13.

Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Phakomatoses or Neurocutaneous syndromes are a heterogeneous group of disorders and have variable inheritance pattern. Currently, more than 30 entities are included in this group. These disorders primarily affect the central nervous system; however, skin, viscera, and other connective tissues can also be involved with variable clinical presentation. We will describe and illustrate the various radiological findings of the common entities through the iconography of the cases presented to our department.
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http://dx.doi.org/10.4103/ijri.IJRI_497_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546286PMC
July 2020

Imaging in congenital inner ear malformations-An algorithmic approach.

Indian J Radiol Imaging 2020 Apr-Jun;30(2):139-148. Epub 2020 Jul 13.

Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Malformations of the inner ear are an important cause of congenital deaf-mutism. Arrest in embryologic development of inner ear during various stages gives rise to the variety of malformations encountered. Current treatment options include hearing aids, cochlear implants, and auditory brainstem implants (ABI). With the advent of cochlear implant surgery and ABI, decent functional outcomes can be obtained provided such cases are diagnosed correctly and timely. To that end, high-resolution computed tomography (HRCT) has a fundamental role in the assessment of these conditions, ably supplemented by magnetic resonance imaging (MRI). The purpose of this pictorial essay is to illustrate the imaging features of inner ear anomalies in children with congenital deaf-mutism as per the latest terminology and classification and provide an algorithmic approach for their diagnosis.
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http://dx.doi.org/10.4103/ijri.IJRI_58_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546298PMC
July 2020

Torsion of Wandering Spleen and its adherence to the right ovary - An unusual cause of recurrent pain abdomen.

J Radiol Case Rep 2020 Jul 31;14(7):10-18. Epub 2020 Jul 31.

Department of Radiology, Maulana Azad Medical College, New Delhi, India.

Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.
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http://dx.doi.org/10.3941/jrcr.v14i7.3752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536009PMC
July 2020

Meandering pulmonary vein: A case report.

J Radiol Case Rep 2020 Mar 31;14(3):7-13. Epub 2020 Mar 31.

Department of Radiology, Maulana Azad Medical College & LNJP Hospital, New Delhi, India.

Anomalies of the pulmonary venous circulation are extremely uncommon. We report a case of an anomalous unilateral single pulmonary vein also referred to as a meandering pulmonary vein. A single large tortuous pulmonary vein was seen on the right side draining into the left atrium with associated ipsilateral absence of the middle lobe bronchus and interlobar fissures. This is considered a variant of the classical scimitar syndrome. The venous anatomy was depicted with considerable accuracy using multidetector computed tomography (MDCT) non-invasively.
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http://dx.doi.org/10.3941/jrcr.v14i3.3799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535996PMC
March 2020

Encephalocraniocutaneous lipomatosis: A rare congenital neurocutaneous syndrome.

Radiol Case Rep 2020 May 19;15(5):576-579. Epub 2020 Mar 19.

Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Road, New Delhi 110002, India.

Encephalocraniocutaneous lipomatosis (ECCL) is a rare sporadic congenital neurocutaneous disorder with quite specific clinical features and neuroimaging pattern that is well seen on MR imaging.
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http://dx.doi.org/10.1016/j.radcr.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083788PMC
May 2020

Tingling hand: magnetic resonance imaging of median nerve pathologies within the carpal tunnel.

Pol J Radiol 2019 22;84:e484-e490. Epub 2019 Nov 22.

Maulana Azad Medical College, New Delhi, India.

Compressive neuropathy of the median nerve at the level of the carpal tunnel, known as carpal tunnel syndrome, is the most common entrapment neuropathy, affecting about 0.1-1% of the general population. Magnetic resonance reliably imaged the flexor retinaculum and carpal bones and thus defined the borders of the carpal tunnel. In all cases the median nerve was seen as an ovoid structure of moderate signal intensity and was easily distinguished from the flexor tendons of the hands running in the carpal tunnel. Magnetic resonance imaging (MRI) serves as an extremely useful tool for evaluation of primary nerve pathologies and for the assessment of space-occupying lesions leading to its compression. We present a pictorial review of the MRI findings in the multitude of pathologies implicated in the causation of carpal tunnel syndrome. All the images were obtained from the Department of Radiodiagnosis in our own institution.
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http://dx.doi.org/10.5114/pjr.2019.90354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016503PMC
November 2019

Investigating Overlap in Signals from EVDAS, FAERS, and VigiBase.

Drug Saf 2020 04;43(4):351-362

Safety Surveillance Data and Analytics, Patient Safety Centre of Excellence, Chief Medical Officer Organisation, AstraZeneca, Cambridge, UK.

Introduction: The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and VigiBase are two established databases for safety monitoring of medicinal products, recently complemented with the EudraVigilance Data Analysis System (EVDAS).

Objective: Signals of disproportionate reporting (SDRs) can characterize the reporting profile of a drug, accounting for the distribution of all drugs and all events in the database. This study aims to quantify the redundancy among the three databases when characterized by two disproportionality-based analyses (DPA).

Methods: SDRs for 100 selected products were identified with two sets of thresholds (standard EudraVigilance SDR criteria for all vs Bayesian approach for FAERS and VigiBase). Per product and database, the presence or absence of SDRs was determined and compared. Adverse events were considered at three levels: MedDRA Preferred Term (PT), High Level Term (HLT), and HLT combined with Standardized MedDRA Query (SMQ). Redundancy was measured in terms of recall (SDRs in EVDAS divided by SDRs from any database) and overlap (SDRs in EVDAS and at least one other database, divided by SDRs in EVDAS). Covariates with potential impact on results were explored with linear regression models.

Results: The median overlap between EVDAS and FAERS or VigiBase was 85.0% at the PT level, 94.5% at the HLT level, and 97.7% at the HLT or SMQ level. The corresponding median recall of signals in EVDAS as a percentage of all signals generated in all three databases was 59.4%, 74.1%, and 87.9% at the PT, HLT, and HLT or SMQ levels, respectively. The overlap difference is partially explained by the relative number of EU cases in EudraVigilance and the ratio of EVDAS cases and FAERS cases, presumably due to differences in marketing authorizations, or market penetration in different regions. Products with few cases in EVDAS (< 1500) also display limited recall of signals relative to FAERs/VigiBase. Time-on-market does not predict signal redundancy between the three databases. The choice of the DPA has an expected but somewhat small effect on redundancy.

Conclusions: Organizations typically consider regulatory expectations, operating performance (e.g., positive predictive value), and procedural complexity when selecting databases for signal management. As SDRs can be seen as a proxy of general reporting characteristics identifiable in a systematic screening process, our results indicate that, for most products, these characteristics are largely similar in each of the databases.
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http://dx.doi.org/10.1007/s40264-019-00899-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105447PMC
April 2020

Ectopic Cervical Thymus in an Infant with Normal Orthotopic Thymus: Role of Imaging in Diagnosis and Management.

Indian J Otolaryngol Head Neck Surg 2019 Oct 5;71(Suppl 1):614-617. Epub 2018 Jul 5.

3Department of Paediatrics and Neonatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002 India.

Ectopic cervical thymus (ECT) is a rare cause of solid cervical mass in the pediatric age group. The location of the mass along the path of thymic descent (thymopharyngeal duct), sonographic echo pattern and MR signal intensity identical to that of normal orthotopic thymus in the anterior mediastinum help us in making a confident diagnosis. To the best of our knowledge only nine cases have been reported in infants in the literature. We present a case of ECT presenting as a right upper neck mass in a 2 month old child.
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http://dx.doi.org/10.1007/s12070-018-1437-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848659PMC
October 2019

HRCT imaging of acquired cholesteatoma: a pictorial review.

Insights Imaging 2019 Oct 3;10(1):92. Epub 2019 Oct 3.

Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.

Chronically discharging ear is a common cause of morbidity in developing countries, and it is also associated with intratemporal and intracranial complications. The surgeon is often able to detect the disease. However, cholesteatoma in the "hidden areas" like anterior epitympanic recess and sinus tympani can be missed. Facial nerve involvement and cholesteatomatous erosion of the bony labyrinth are dreaded complications, the extent of which cannot be assessed completely on clinical examination. Adding to the complexity are the various variations in anatomy like high riding jugular bulb and aberrant internal carotid artery which could lead to catastrophic complications during surgery if left undetected preoperatively. HRCT temporal bone is useful to detect the extent of the disease, various complications, and guide the surgeon for pre-operative planning. In this review, we go through the various HRCT imaging features of acquired cholesteatoma, a reporting template, and a few words about imaging of the post-operative ear.
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http://dx.doi.org/10.1186/s13244-019-0782-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775179PMC
October 2019

Clinicoradiologic follow up of cherubism with aggressive characteristics: a series of 3 cases.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Nov 7;128(5):e191-e201. Epub 2019 Feb 7.

Additional Professor, Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India.

Cherubism is a rare autosomal dominant disorder characterized by replacement of bone with fibrous tissue containing multinucleated giant cells. It manifests as bilateral mandibular and/or maxillary enlargement. The 2017 World Health Organization classification lists cherubism as a giant cell lesion of the jaws, distinct from fibro-osseous disorders. We discuss 3 cases of familial cherubism having aggressive characteristics and present clinicoradiologic evaluations of the lesions over 12, 18, and 1.5 years, respectively. Follow-up was observational, without active intervention. Analysis of the lesions for change in size and functional impairments was correlated with periodic imaging. All patients are currently being monitored. The outcome in 2 cases has been excellent without intervention, but 1 case had extensive involvement of the jaws and involvement of the condyle and orbit. A secondary giant cell lesion involved the palate in one patient's mother, who had had cherubic lesions in childhood.
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http://dx.doi.org/10.1016/j.oooo.2019.01.082DOI Listing
November 2019

Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?

Indian J Otolaryngol Head Neck Surg 2018 Dec 17;70(4):597-603. Epub 2018 Mar 17.

2Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002 India.

Cervical lymphadenopathy frequently poses a diagnostic challenge as neither clinical nor imaging assessment can reliably differentiate between benign and malignant lymphadenopathy. Non-invasive differentiation between the two may help to reduce the number of FNAC or biopsy. The purpose of this study was to evaluate whether the new ARFI technique (Virtual Touch Quantification), in conjunction with gray scale sonography and Doppler, can help in the characterization and differentiation of benign from malignant cervical lymphadenopathy. Fifty adult patients with cervical lymphadenopathy were included in the study and sonoelastography was done. Sonoelastographic findings were compared to the gold standard histopathology or cytopathology. ARFI measurements in benign and malignant enlarged lymph nodes were compared using the Student test and ROC curve was used to arrive at the Youden index, sensitivity, specificity, PPV, NPV and diagnostic accuracy. Sonographic patterns indicative of malignancy includes heterogenous echopattern, short axis/long axis ratio > 0.5, absent echogenic fatty hilum and mixed vascular pattern. Sensitivity, specificity, PPV, NPV and accuracy in differentiation between the benign and malignant lymph nodes using ARFI elastography was 79.17, 100, 100, 83.9 and 89.9% respectively. ROC curve analysis of SWVs for differentiation between the malignant and benign lymph nodes gave a cut-off value of 2.8 m/s with an area under curve of 0.892. ARFI imaging technique quantifies the tissue stiffness of the cervical lymph nodes non-invasively and aids in characterisation and differentiation of benign from malignant cervical lymphadenopathy in conjunction with conventional sonography.
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http://dx.doi.org/10.1007/s12070-018-1306-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224828PMC
December 2018

Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever.

Radiol Bras 2017 Sep-Oct;50(5):285-290

MD, Department of General Medicine, Maulana Azad Medical College, New Delhi, India.

Objective: To describe the spectrum of magnetic resonance imaging (MRI) findings in patients with neurological manifestations of dengue.

Materials And Methods: We included nine patients with dengue fever (three females and six males; age range, 9-30 years), all of whom presented with neurological manifestations. The MRI examinations, performed in 1.5 T or 3 T scanners, included T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences. Diffusion-weighted imaging with apparent diffusion coefficient mapping was also employed. Fast low-angle shot and susceptibility-weighted gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted scans, were also obtained in order to assess parenchymal enhancement. MRI scans were analyzed for lesion distribution and imaging features.

Results: All patients showed areas of altered signal intensity that appeared as hyperintensity on T2-weighted and FLAIR sequences. The most commonly affected site was the basal ganglia-thalamus complex. Other affected sites were the cerebellum, cerebral cortex, white matter, and brainstem. In all cases, we observed patchy areas of restricted diffusion and focal areas of hemorrhage.

Conclusion: Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum, cerebral cortex, and white matter. Therefore, MRI should be an indispensable part of the evaluation of patients with neurological complications of dengue fever.
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http://dx.doi.org/10.1590/0100-3984.2016.0048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656068PMC
November 2017

Imaging spectrum of spinal dysraphism on magnetic resonance: A pictorial review.

World J Radiol 2017 Apr;9(4):178-190

Jyoti Kumar, Muhammed Afsal, Anju Garg, Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India.

Congenital malformations of spine and spinal cord are collectively termed as spinal dysraphism. It includes a heterogeneous group of anomalies which result from faulty closure of midline structures during development. Magnetic resonance imaging (MRI) is now considered the imaging modality of choice for diagnosing these conditions. The purpose of this article is to review the normal development of spinal cord and spine and reviewing the MRI features of spinal dysraphism. Although imaging of spinal dysraphism is complicated, a systematic approach and correlation between neuro-radiological, clinical and developmental data helps in making the correct diagnosis.
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http://dx.doi.org/10.4329/wjr.v9.i4.178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415887PMC
April 2017

Diagnostic Value of Acoustic Radiation Force Impulse Quantification in the Differentiation of Benign and Malignant Thyroid Nodules.

Ultrason Imaging 2017 09 4;39(5):326-336. Epub 2017 May 4.

1 Department of Radio-Diagnosis, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India.

The objective of this study was to evaluate the role of ultrasound elastography using acoustic radiation force impulse (ARFI) quantification in characterizing and differentiating malignant versus benign thyroid nodules. A total of 40 thyroid nodules were evaluated with conventional sonography and ultrasound elastography using ARFI quantification. The final diagnosis was obtained from histologic findings. A total of 14 malignant and 26 benign nodules were diagnosed on the basis of histologic examination. Majority of the malignant thyroid nodules demonstrated presence of intranodular vascular flow, hypoechoic echotexture, absent halo, irregular margins and microcalcifications. However, a considerable overlap was noted in the sonographic features of malignant and benign thyroid nodules. On ARFI quantification, the mean shear wave speed (SWS) values ( M ± SD) of malignant and benign thyroid nodules were 3.131 ± 0.921 m/s and 1.691 ± 0.513 m/s, respectively. A significant difference was observed between the mean SWS values of malignant thyroid nodules and benign thyroid nodules ( p < 0.0001). Applying a cutoff value of 2.53 m/s, the sensitivity, specificity, and the area under the receiver operating characteristic curve for the differentiation were 85.71%, 96.15%, and 0.922, respectively. ARFI quantification is a promising elastography technique that provides quantitative information about tissue stiffness. It provides additional information and complements sonography as an effective diagnostic tool in characterizing and differentiating benign from malignant thyroid nodules.
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http://dx.doi.org/10.1177/0161734617706170DOI Listing
September 2017

Transvaginal Sonography Versus Cystoscopy for Detecting Urinary Bladder Invasion in Early Stage Cervical Cancer.

J Clin Diagn Res 2017 Feb 1;11(2):QC01-QC03. Epub 2017 Feb 1.

Head of Department, Department of Obstetrics and Gynecology, Hamdard Institute of Science and Medical Research , New Delhi, India .

Introduction: Cervical cancer is a major cause of mortality from cancer among women. In it's early stage pre operative staging with cystoscopy is a standard procedure for the detection of urinary bladder involvement.

Aim: The present study was conducted with the aim to compare the efficacy of Transvaginal Sonography (TVS) and cystoscopy in diagnosing bladder involvement in early stage cervical cancer patients by confirming it intraoperatively and further by histopathologic examination.

Materials And Methods: A prospective partially blinded study was conducted between March 2006 and September 2008 on 30 patients with early stage cervical cancer (Stage I and IIa) who were planned to undergo radical hysterectomy. Pre operatively, these patients underwent both TVS and cystoscopy to diagnose bladder involvement. Presence or absence of bladder involvement was then confirmed intra operatively and by histopathologic examination.

Results: In all the 30 patients studied, no bladder involvement was seen on cystoscopy where as TVS showed bladder involvement in three patients. Involvement of the bladder in these three patients was confirmed intra operatively and by histopathologic examination. Thus, in our study, TVS was 100% sensitive in detecting bladder involvement.

Conclusion: TVS is highly sensitive in diagnosing bladder involvement in early stage cervical cancer and could potentially detect cases missed with a cystoscopy.
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http://dx.doi.org/10.7860/JCDR/2017/21791.9343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376845PMC
February 2017

Giant Choledochal Cyst in A Neonate.

J Neonatal Surg 2017 Jan-Mar;6(1):22. Epub 2017 Jan 1.

Department of Pediaric Surgery, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.21699/jns.v6i1.408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224756PMC
January 2017

Association of Levels of Serum Inhibin B and Follicle-stimulating Hormone with Testicular Vascularity, Volume, and Echotexture in Children with Undescended Testes.

J Indian Assoc Pediatr Surg 2017 Jan-Mar;22(1):3-8

Department of Biochemistry, Maulana Azad Medical College, New Delhi, India.

Aims: The aim of our study was to assess the association between reproductive hormones (inhibin B [inh B], follicle-stimulating hormone [FSH]) with testicular volume, echogenicity, and blood flow (resistive index [RI]) in children with undescended testis (UDT).

Settings And Design: This was a prospective study of 1-year study duration.

Materials And Methods: A total of 33 patients (16 unilateral and 17 bilateral) UDTs aged 5-12 years with palpable UDT were included in the study. Morning fasting blood samples were taken for estimation of serum inh B and FSH as well as inh B/FSH ratio. Testicular ultrasound was done to compute testicular volume, testicular echogenicity, and testicular vascularity in terms of RI.

Results: The mean age of patients enrolled in the study was 8.29 years for unilateral UDT and 7.97 years in bilateral UDT and it was comparable. The study groups were further subdivided into two age-wise subgroups school goers (5-8 years) and prepubertal (9-12 years). The values of inh B, FSH, and inh B/FSH ratios as well as mean testicular volume were comparable between both groups and subgroups. Overall mean testicular volume had a positive correlation with FSH, inh B, and inh B/FSH, but statistical significance was reached only for inh B ( < 0.001) in children with both unilateral and bilateral UDT. Apart from five patients with hypoechogenicity within the testis, all remaining testes were of homogenous echotexture with no instances of irregular echogenicity or tumor. Children with RI >0.6 were separately studied. The incidence of high RI (>0.6) was also comparable in unilateral or bilateral disease. These subjects had unfavorable biochemical parameters in terms of low inh B levels and high FSH levels.

Conclusions: Our findings hint to the fact that palpable UDT forms a homogenous group, whether unilateral or bilateral, whereas impalpable testes may form a separate category and need further studies to substantiate this hypothesis.
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http://dx.doi.org/10.4103/0971-9261.194609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217136PMC
January 2017

Ectopic goitrous submandibular thyroid with goitrous orthotopic thyroid gland.

Indian J Radiol Imaging 2016 Apr-Jun;26(2):245-8

Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

Ectopic thyroid is a rare developmental anomaly with lingual thyroid accounting for majority of the cases. The presence of ectopic thyroid tissue lateral to the midline is very rare, and very few cases located in the submandibular region have been reported. The simultaneous finding of submandibular ectopic thyroid tissue and a functional orthotopic thyroid gland is even rarer. In the differential diagnosis of an ectopic submandibular thyroid, it is fundamental to exclude a metastasis from well-differentiated thyroid cancer, even when primary thyroid carcinoma is not demonstrable.
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http://dx.doi.org/10.4103/0971-3026.184420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931786PMC
July 2016

Goldenhar syndrome with contralateral pulmonary aplasia: a rare association.

J Radiol Case Rep 2016 Jan 31;10(1):35-40. Epub 2016 Jan 31.

Department of Radiodiagnosis, Lok Nayak Hospital, New Delhi, India.

We present a case of a 13-year-old boy with clinical features of Goldenhar syndrome (hemifacial microsomia with malformed ears) and associated contralateral pulmonary aplasia. The patient did not have any associated respiratory symptoms. Pulmonary aplasia is an uncommon association of Goldenhar Syndrome. A case of contralateral pulmonary aplasia has been rarely reported in the literature to the best of our knowledge.
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http://dx.doi.org/10.3941/jrcr.v10i1.2113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861587PMC
January 2016

Multi-detector computed tomography imaging of large airway pathology: A pictorial review.

World J Radiol 2015 Dec;7(12):459-74

Tejeshwar Singh Jugpal, Anju Garg, Jyoti Kumar, Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110002, India.

The tracheobronchial tree is a musculo-cartilagenous framework which acts as a conduit to aerate the lungs and consequently the entire body. A large spectrum of pathological conditions can involve the trachea and bronchial airways. These may be congenital anomalies, infections, post-intubation airway injuries, foreign body aspiration or neoplasms involving the airway. Appropriate management of airway disease requires an early and accurate diagnosis. In this pictorial essay review, we will comprehensively describe the various airway pathologies and their imaging findings by multi-detector computed tomography.
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http://dx.doi.org/10.4329/wjr.v7.i12.459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697120PMC
December 2015

Giant Unruptured Sinus of Valsalva Aneurysm: An Unusual Cause of Right Heart Failure.

J Clin Imaging Sci 2015 30;5:64. Epub 2015 Nov 30.

Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

Aneurysm of sinus of Valsalva is a rare cardiac abnormality. Unruptured aneurysm of sinus of Valsalva is usually asymptomatic and often discovered incidentally. However, a large aneurysm can, in rare cases, cause compression of the ventricular outflow tract. We report a case of 17-year-old male with congestive right heart failure with a large, partially thrombosed unruptured aneurysm of the right sinus of Valsalva. The aneurysmal sac was compressing the right ventricular outflow tract causing marked dilatation of the right ventricle and atrium that was confirmed on contrast-enhanced computed tomography imaging. Unruptured sinus of Valsalva aneurysm causing right heart failure in adolescence has been rarely reported in literature.
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http://dx.doi.org/10.4103/2156-7514.170733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683788PMC
December 2015

A Rare Case of Low Flow Vascular Malformation of Head and Neck Region Presenting with Multiple Phleboliths.

J Clin Diagn Res 2015 Jun 1;9(6):ZJ01-2. Epub 2015 Jun 1.

Professor & Head, Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences , New Delhi, India .

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http://dx.doi.org/10.7860/JCDR/2015/11806.6034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525630PMC
June 2015
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