Publications by authors named "Shivanand Gamanagatti"

156 Publications

Successful pregnancy outcome in refractory adenomyosis treated with two sessions of uterine artery embolization: A case report and brief review.

J Gynecol Obstet Hum Reprod 2021 Mar 26;50(7):102132. Epub 2021 Mar 26.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.

Introduction: Adenomyosis associated abnormal uterine bleeding (AUB-A) often remains non-responsive to medical management. Uterine sparing treatment in young patients presenting with refractory AUB-A poses a challenge.

Case Report: A 28-years-old woman presenting with AUB-A with failed medical therapy did not improve with uterine artery embolization (UAE). She underwent a second session of UAE with smaller embolic particles to which she responded. The reported case is interesting as patient conceived spontaneously despite transiently diminished post-UAE ovarian reserves, indicating spontaneous recovery of ovarian function.

Conclusion: UAE is a promising option for young patients, though UAE for adenomyosis may require smaller embolic particles to be effective which may diminish ovarian reserves due to non-target effects, however recovery is possible in young patients..
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http://dx.doi.org/10.1016/j.jogoh.2021.102132DOI Listing
March 2021

What Is the Comparative Ability of 18F-FDG PET/CT, 99mTc-MDP Skeletal Scintigraphy, and Whole-body MRI as a Staging Investigation to Detect Skeletal Metastases in Patients with Osteosarcoma and Ewing Sarcoma?

Clin Orthop Relat Res 2021 Feb 26. Epub 2021 Feb 26.

A. Aryal, V. S. Kumar, S. A. Khan, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: Skeletal metastases of bone sarcomas are indicators of poor prognosis. Various imaging modalities are available for their identification, which include bone scan, positron emission tomography/CT scan, MRI, and bone marrow aspiration/biopsy. However, there is considerable ambiguity regarding the best imaging modality to detect skeletal metastases. To date, we are not sure which of these investigations is best for screening of skeletal metastasis.

Question/purpose: Which staging investigation-18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT), whole-body MRI, or 99mTc-MDP skeletal scintigraphy-is best in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in detecting skeletal metastases in patients with osteosarcoma and those with Ewing sarcoma?

Methods: A prospective diagnostic study was performed among 54 of a total 66 consecutive osteosarcoma and Ewing sarcoma patients who presented between March 2018 and June 2019. The institutional review board approved the use of all three imaging modalities on each patient recruited for the study. Informed consent as obtained after thoroughly explaining the study to the patient or the patient's parent/guardian. The patients were aged between 4 and 37 years, and their diagnoses were proven by histopathology. All patients underwent 99mTc-MDP skeletal scintigraphy, 18F-FDG PET/CT, and whole-body MRI for the initial staging of skeletal metastases. The number and location of bone and bone marrow lesions diagnosed with each imaging modality were determined and compared with each other. Multidisciplinary team meetings were held to reach a consensus about the total number of metastases present in each patient, and this was considered the gold standard. The sensitivity, specificity, PPV, and NPV of each imaging modality, along with their 95% confidence intervals, were generated by the software Stata SE v 15.1. Six of 24 patients in the osteosarcoma group had skeletal metastases, as did 8 of 30 patients in the Ewing sarcoma group. The median (range) follow-up for the study was 17 months (12 to 27 months). Although seven patients died before completing the minimum follow-up, no patients who survived were lost to follow-up.

Results: With the number of patients available, we found no differences in terms of sensitivity, specificity, PPV, and NPV among the three staging investigations in patients with osteosarcoma and in patients with Ewing sarcoma. Sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 67% (4 of 6 [95% CI 22% to 96%]) and specificities were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 78% (14 of 18 [95% CI 52% to 94%]), respectively, in patients with osteosarcoma. In patients with Ewing sarcoma, sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 88% (7 of 8 [95% CI 47% to 100%]), 88% (7 of 8 [95% CI 47% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and specificities were 100% (22 of 22 [95% CI 85% to 100%]), 95% (21 of 22 [95% CI 77% to 100%]), and 95% (21 of 22 [95% CI 77% to 100%]), respectively. Further, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and the NPVs were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 88% (14 of 16 [95% CI 62% to 98%]), respectively, in patients with osteosarcoma. Similarly, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (7 of 7 [95% CI 59% to 100%]), 88% (7 of 8 [95% CI 50% to 98%]), and 80% (4 of 5 [95% CI 28% to 100%]), and the NPVs were 96% (22 of 23 [95% CI 78% to 100%]), 95% (21 of 22 [95% CI 77% to 99%]), and 84% (21 of 25 [95% CI 64% to 96%]), respectively, in patients with Ewing sarcoma. The confidence intervals around these values overlapped with each other, thus indicating no difference between them.

Conclusion: Based on these results, we could not demonstrate a difference in the sensitivity, specificity, PPV, and NPV between 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy for detecting skeletal metastases in patients with osteosarcoma and Ewing sarcoma. For proper prognostication, a thorough metastatic workup is essential, which should include a highly sensitive investigation tool to detect skeletal metastases. However, our study findings suggest that there is no difference between these three imaging tools. Since this is a small group of patients in whom it is difficult to make broad recommendations, these findings may be confirmed by larger studies in the future.

Level Of Evidence: Level II, diagnostic study.
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http://dx.doi.org/10.1097/CORR.0000000000001681DOI Listing
February 2021

Prognostic and Therapeutic Potentials of OncomiRs Modulating mTOR Pathways in Virus-Associated Hepatocellular Carcinoma.

Front Oncol 2020 4;10:604540. Epub 2021 Feb 4.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Background: Dysregulated oncomiRs are attributed to hepatocellular carcinoma (HCC) through targeting mTOR signaling pathway responsible for cell growth and proliferation. The potential of these oncomiRs as biomarker for tumor response or as target for therapy needs to be evaluated.

Aim: Tumor response assessment by OncomiR changes following locoregional therapy (LRT) and targeting of these oncomiRs modulating pathway.

Methods: All consecutive viral-HCC patients of BCLC stage-A/B undergoing LRT were included. OncomiRs (miR-21, -221, and -16) change in circulation and AFP-ratio at 1-month post-LRT to baseline was estimated to differentiate various categories of response as per mRECIST criteria. OncomiR modulating mTOR pathway was studied by generating miR-21 and miR-221 overexpressing Huh7 stable cell lines.

Results: Post-LRT tumor response was assessed in 90 viral-HCC patients (CR, 40%; PR, 31%, and PD, 29%). Significant increase of miRNA-21 and -221 expression was observed in PD (p = 0.040, 0.047) and PR patients (miR-21, p = 0.045). Fold changes of miR-21 can differentiate response in group (CR from PR+PD) at AUROC 0.718 (95% CI, 0.572-0.799) and CR from PD at AUROC 0.734 (95% CI, 0.595-0.873). Overexpression of miR-21 in hepatoma cell line had shown increased phosphorylation p70S6K, the downstream regulator of cell proliferation in mTOR pathway. Upregulation of AKT, mTOR, and RPS6KB1 genes were found significant (P < 0.005) and anti-miR-21 specifically reduced mTOR gene (P = 0.02) expression.

Conclusions: The miR-21 fold change correlates well with imaging in predicting tumor response. Overexpression of miR-21 has a role in HCC through mTOR pathway activation and can be targeted.
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http://dx.doi.org/10.3389/fonc.2020.604540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890014PMC
February 2021

Budd Chiari Syndrome and Intrahepatic Cholangiocarcinoma, An Unusual Combination: Case Report and Review of the Literature.

Perm J 2020 11;24:1-3

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Intrahepatic cholangiocarcinoma arising in the setting of Budd Chiari syndrome is uncommon and its prognostic and management implications differ from hepatocellular carcinoma.

Case Presentation: We report a case of intrahepatic cholangiocarcinoma in a patient with primary Budd Chiari syndrome. Hepatocellular carcinoma is known to occur with Budd Chiari syndrome. It was difficult to differentiate from hepatocellular carcinoma in the presence of increased alfa-fetoprotein levels. The contrast imaging showed features of progressive enhancement in the arterial, portal, and venous phases. A targeted liver biopsy showed histological features typical for cholangiocarcinoma. Immunostaining for cytokeratin 7 and cytokeratin 20 were positive, whereas that for arginase was negative, suggesting an intrahepatic cholangiocarcinoma. The patient was planned for inferior vena cava angioplasty followed by resection for intrahepatic cholangiocarcinoma.

Conclusion: Previously, only secondary Budd Chiari syndrome developing in the background of primary liver tumor has been described; no report exists of intrahepatic cholangiocarcinoma arising in background of primary Budd Chiari syndrome.
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http://dx.doi.org/10.7812/TPP/19.204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849281PMC
November 2020

Percutaneous Management of Persistent Urine Leak After Partial Nephrectomy: Sealing the Leak Site with Glue.

J Endourol Case Rep 2020 29;6(4):472-475. Epub 2020 Dec 29.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Localized urinary extravasation is a known complication after partial nephrectomy; however, rarely it forms a nephrocutaneous fistula. Nephrocutaneous fistula after partial nephrectomy is a management challenge for the treating surgeon. It is typically managed with indwelling ureteral stent placement. Persistent fistula after indwelling ureteral stent can be managed with percutaneous nephrostomy drainage. However, persistence after all these measures is a real therapeutic dilemma. Few reports are available on effective management of persistent urine leak by percutaneous obliteration of leak site using glue. We report one such rare case of persistent nephrocutaneous fistula in a 41-year-old man of Indo-Aryan ethnicity. He was managed effectively with percutaneous cyanoacrylate glue application, when all the conservative methods failed. At 6 months follow-up he is doing well clinically and radiologically. Persistent nephrocutaneous fistula after partial nephrectomy is a rare and highly morbid condition, which leads to multiple intervention and prolonged hospital stay. Percutaneous glue application is a potential therapeutic approach to tackle such cases with good results.
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http://dx.doi.org/10.1089/cren.2020.0151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803278PMC
December 2020

Utility of admission perfusion CT for the prediction of suboptimal outcome following uncomplicated minor traumatic brain injury.

Emerg Radiol 2021 Jan 9. Epub 2021 Jan 9.

Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no. 81b, 110029, New Delhi, India.

Purpose: To compare the perfusion parameters of patients with uncomplicated mild traumatic brain injury (mTBI) with healthy controls and to assess whether admission perfusion CT parameters can be used to predict outcome at 6 months post-injury in patients with uncomplicated mTBI.

Methods: Institute ethical committee approval was obtained for this prospective cohort study and informed written consent obtained from all subjects. Patients who sustained mTBI and had no abnormalities on non-contrast CT from June 2010 to January 2012 (20 months) and 10 healthy controls were included and underwent perfusion CT at admission. Outcome was determined at 6 months follow-up using the extended Glasgow Coma Outcome Scale score.

Results: Forty-nine patients were included, of which 16 (32.7%) had symptoms at 6 months post-injury (suboptimal outcome). The mean cerebral blood flow and volume were lower in both the gray and white matter of all three arterial territories in the study group than in the control group (p value < 0.05). In the study group, these values were lower in those with suboptimal outcome than in those with optimal outcome (no symptoms). Cerebral blood flow showed higher area under the curve for predicting the outcome.

Conclusion: Perfusion parameters are altered even in patients with uncomplicated mTBI. A single ROI (region of interest) evaluation of the gray matter in the posterior cerebral artery territory on admission perfusion CT could provide a quick and efficient way to predict patients who would have a suboptimal outcome at 6 months post-injury.
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http://dx.doi.org/10.1007/s10140-020-01876-0DOI Listing
January 2021

Bilateral Symmetric Sporadic Osteofibrous Dysplasia: an Unusual Case.

Indian J Surg Oncol 2020 Sep 8;11(Suppl 2):307-310. Epub 2020 Oct 8.

Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India.

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http://dx.doi.org/10.1007/s13193-020-01236-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732948PMC
September 2020

Control of Traumatic Superior Mesenteric Vein Pseudoaneurysm With a Covered Endovascular Stent Using Transhepatic Approach.

Am Surg 2020 Dec 19:3134820972089. Epub 2020 Dec 19.

Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPNATC, 28730AIIMS, New Delhi, India.

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http://dx.doi.org/10.1177/0003134820972089DOI Listing
December 2020

Long-Term Outcomes of Endovascular Interventions in More than 500 patients with Budd-Chiari Syndrome.

J Vasc Interv Radiol 2021 01 17;32(1):61-69.e1. Epub 2020 Nov 17.

Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no. 81b, Ansari Nagar, New Delhi 110029, India. Electronic address:

Purpose: To assess and compare the long-term outcomes of various endovascular interventions in patients with Budd-Chiari syndrome (BCS).

Materials And Methods: In this single-center retrospective study, 510 consecutive patients with BCS who had undergone a total of 618 endovascular procedures from January 2001 to December 2019 were included. Details of the type of endovascular intervention, technical success, clinical success, patency rate, complications, and survival outcomes were analyzed.

Results: The overall technical success rate was 96% (593 of 618 procedures; 500 in treatment-naïve patients and 93 repeat interventions for recurrent disease). Endovascular procedures included recanalization procedures (angioplasty and stent placement) in 355 patients (71%) and transjugular intrahepatic portosystemic shunt (TIPS) creation in 145 (29%). Major postprocedure complications occurred in 14 patients (2.8%). Vascular/stent restenosis occurred in 95 patients (19%), and successful repeat intervention was performed in 82 of those 95 (86.3%). An additional 11 of these 82 (13.4%) underwent a third intervention for restenosis. In the recanalization and TIPS groups, the 1- and 5-y cumulative patency rates were 87% and 74% and 95% and 68%, respectively. The 1- and 5-y survival rates were 96% and 89% and 90% and 76%, respectively.

Conclusions: Endovascular interventions for BCS are feasible and safe in the majority of patients, with excellent short- and long-term patency and survival rates.
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http://dx.doi.org/10.1016/j.jvir.2020.08.035DOI Listing
January 2021

Unusual Primary Neoplasms of the Adult Liver: Review of Imaging Appearances and Differential Diagnosis.

Curr Probl Diagn Radiol 2020 Nov 2. Epub 2020 Nov 2.

Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India.

The radiological appearance of common primary hepatic tumors such as hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) is widely recognized. Hepatic masses with unusual histology are occasionally encountered, but seldom suspected on imaging. However, many possess characteristic imaging findings, which when assessed along with the clinical and demographic background and serum tumor markers, may enable a prospective diagnosis. This review attempts to familiarize the reader with the clinicopathological characteristics, imaging manifestations, and differential diagnosis of these unusual liver tumors in adults. Biphenotypic primary liver carcinoma is suspected in masses showing distinct areas of HCC and CCA-type enhancement pattern in cirrhotic livers. Fibrolamellar carcinoma occurs in young individuals without underlying chronic liver disease and shows a characteristic T2-hypointense scar frequently showing calcification. Perivascular epithelioid cell tumors are differentials for any arterial hyperenhancing mass in the noncirrhotic liver, particularly in patients with tuberous sclerosis. Multifocal subcapsular tumors showing target-like morphology, capsular retraction and "lollipop" sign are suspicious for epithelioid hemangioendothelioma. On the other hand, multiple hemorrhagic lesions showing patchy areas of bizarre-shaped arterial phase hyperenhancement are suspicious for angiosarcoma. Primary hepatic lymphoma (PHL) is suspected when patients with immunosuppression present with solitary or multifocal masses that insinuate around vessels and bile ducts without causing luminal narrowing. Intense diffusion restriction and low-level homogeneous or target-like enhancement are also ancillary features of PHL. Primary hepatic neuroendocrine tumor shows uptake on Ga-68 DOTANOC PET/CT. Although a straightforward diagnosis may be difficult in these cases, awareness of the characteristic imaging appearances is helpful in suspecting the diagnosis.
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http://dx.doi.org/10.1067/j.cpradiol.2020.10.001DOI Listing
November 2020

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach.

J Clin Orthop Trauma 2020 Nov-Dec;11(6):1121-1127. Epub 2020 Oct 10.

Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India.

Background: As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures.

Methods: Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months.

Results: The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively.

Conclusions: Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.
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http://dx.doi.org/10.1016/j.jcot.2020.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656521PMC
October 2020

Revised AAST scale for splenic injury (2018): does addition of arterial phase on CT have an impact on the grade?

Emerg Radiol 2021 Feb 23;28(1):47-54. Epub 2020 Jul 23.

All India Institute of Medical Sciences, New Delhi, India.

Purpose: To determine whether an additional arterial phase (AP) leads to a change in the grade of splenic injury according to the 2018 revision of the AAST Organ Injury Scale, which has incorporated vascular injuries into the grading system and also to study its impact on management.

Methods: In this retrospective study, 527 patients who sustained blunt abdominal trauma and had underwent dual-phase CT (AP and portal venous phase (PVP)) from December 2014 to October 2016 (23 months) were included. Two experienced radiologists independently graded the splenic injury according to the revised system in 2 blinded ways (AP + PVP and PVP alone). Receiver operator characteristic (ROC) curves were generated for grade of injury on both the phases for all splenic interventions.

Results: Splenic injuries were detected in 154 patients, and splenic vascular injuries were detected in 52 of them. Of these, 22 vascular injuries were detected only on the AP, leading to a change in the grade of injury according to the new system in 18 patients. The AUC for ROC curves was generated for the grade of injury on AP + PVP vs. PVP alone for angioembolization (0.80 vs. 0.71, p value 0.002), and all splenic interventions (0.89 vs. 0.83, p value 0.003) showed higher AUC for AP + PVP.

Conclusion: Addition of AP leads to a significant change in the grading of splenic injuries according to the revised grading system due to increased detection of vascular injuries. Accurate classification of splenic injuries using additional AP would lead to better triage of patients for splenic interventions or conservative management.
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http://dx.doi.org/10.1007/s10140-020-01823-zDOI Listing
February 2021

Behcet's Disease With Budd-Chiari Syndrome and Challenges in Its Management.

ACG Case Rep J 2020 Mar 19;7(3):e00352. Epub 2020 Mar 19.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Budd-Chiari syndrome may rarely occur as a complication of Behcet's disease, and presentation with thrombosis of both inferior vena cava (IVC) and hepatic veins is rarer still. We present a young woman with Behcet's disease who presented with acute Budd-Chiari syndrome, with thrombosis of IVC and all 3 hepatic veins. An IVC stent was placed, followed by a transjugular intrahepatic portosystemic shunt through the IVC stent. On follow-up, despite oral anticoagulants and oral steroids, she developed recurrent thrombosis twice within a 1-year span. Her symptoms resolved with stent revision and increasing immunosuppression.
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http://dx.doi.org/10.14309/crj.0000000000000352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162122PMC
March 2020

Acute-on-Chronic Liver Failure in Budd-Chiari Syndrome: Profile and Predictors of Outcome.

Dig Dis Sci 2020 09 2;65(9):2719-2729. Epub 2020 Jan 2.

Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India.

Background And Aim: There is a paucity of data on the clinical presentations and outcome of Budd-Chiari syndrome (BCS) patients presenting as acute-on-chronic liver failure (BCS-ACLF). We aimed to describe the profile and outcomes of endovascular interventions in patients with BCS-ACLF.

Methods: All BCS-ACLF patients presenting between October 2007 and April 2019 satisfying the Asian Pacific Association for the Study of the Liver (APASL) definition were studied. We compared 30- , 90- and, 180-day survival among BCS-ACLF patients who underwent endovascular intervention with those who did not, and with a historical cohort of Child-C BCS patients without ACLF who underwent endovascular intervention.

Results: Twenty-eight (5%) of 553 BCS patients presented as ACLF as per APASL definition. The majority (60.7%) were males, and mean age was 29.6 ± 11.2 years. The most common site of the block was isolated involvement of hepatic veins-HV (68%), followed by combined inferior vena cava (IVC) and HV block (25%) and isolated IVC block (7%). The acute precipitants were stent thrombosis (17.9%), acute HV thrombosis (10.7%), acute viral hepatitis (7.1%), and antituberculosis drug with hepatitis B virus reactivation (3.6%). In 60.7% patients, no acute precipitant could be identified. The 30- , 90- , and 180-day survival in BCS-ACLF post-endovascular intervention (n = 15), BCS-ACLF without endovascular intervention (n = 13), and Child-C BCS without ACLF who underwent endovascular intervention (n = 25) were (93%, 87%, and 87%), (46%, 28%, and 0%) and (96%, 92%, and 88%), respectively (log-rank test, p value < 0.001). On multivariate Cox proportional analysis, endovascular intervention and the presence of hepatic encephalopathy were independent predictors of mortality.

Conclusion: Budd-Chiari syndrome can present as acute-on-chronic liver failure. Endovascular intervention is associated with an improved outcome.
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http://dx.doi.org/10.1007/s10620-019-06005-7DOI Listing
September 2020

Solid variant ABC of long tubular bones: A diagnostic conundrum for the radiologist.

Indian J Radiol Imaging 2019 Jul-Sep;29(3):271-276. Epub 2019 Oct 30.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Solid variant of aneurysmal bone cyst (sABC) is an extremely rare, reactive and non-neoplastic osseous lesion. On imaging it presents as a diaphyseal aggressive, eccentrically placed lytic and expansile lesion. However, differentiating this entity from the other possible malignant differentials is confounded by the histopathology mimicking several commoner lesions. We describe the distinctive MRI features of sABC of long bones from a series of four cases and briefly review the literature. We hope this review will educate all radiologists about this rare entity increasing their diagnostic confidence while formulating differentials for similar appearing lesions.
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http://dx.doi.org/10.4103/ijri.IJRI_160_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857266PMC
October 2019

A Randomized Control Trial of Thromboelastography-Guided Transfusion in Cirrhosis for High-Risk Invasive Liver-Related Procedures.

Dig Dis Sci 2020 07 13;65(7):2104-2111. Epub 2019 Nov 13.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Background And Aim: Hemostasis in cirrhosis is dynamic and balanced. Thromboelastography (TEG) assesses global coagulation status. We aimed to assess whether TEG-guided blood product transfusions result in lower blood product requirements in patients with cirrhosis undergoing invasive liver-related procedures as compared to the conventional standard of care (SOC).

Methods: In this open-label, randomized controlled trial, cirrhosis patients with coagulopathy, undergoing invasive liver-related procedures, were randomized to either TEG-guided blood product transfusion or SOC. The primary outcome was difference in the amount of fresh frozen plasma (FFP) and platelet units transfused between the two groups. The secondary outcome was procedure-related bleeding complications within 5 days and any complications until 28 days.

Results: From November 2017 till June 2019, 58 patients were recruited (29: TEG and 29: SOC). Most common procedures performed were percutaneous liver biopsy (n = 48), followed by transjugular intrahepatic portosystemic shunt (n = 2), percutaneous acetic acid injection (n = 2), and transarterial chemoembolization (n = 2). There were no differences in baseline demographics, hemostatic profile, and types of procedures between the two groups. Only nine patients in TEG group received transfusions compared to all patients in SOC (31% vs 100%; P < 0.001). In TEG group, six (20.7%) received FFP (P = 0.753 vs. SOC), two (6.9%) received platelets (P < 0.001 vs. SOC), and 1(3.4%) patient received both FFP and platelet (P ≥ 0.999 vs. SOC) transfusion. None of the patients in either group developed procedure-related bleeding complications until 5 days post-procedure. The complication rates at 28-day follow-up were similar between the groups.

Conclusion: TEG-guided blood product transfusion strategy reduces blood product transfusion without increased risk of bleeding in cirrhotic patients undergoing invasive liver-related procedures (CTRI/2017/12/010822).
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http://dx.doi.org/10.1007/s10620-019-05939-2DOI Listing
July 2020

A novel single myocapsular sleeve (SMS) repair technique to reduce dislocation in posterior approach to the hip: A clinico-radiographic study.

J Clin Orthop Trauma 2019 Oct 22;10(Suppl 1):S247-S251. Epub 2019 Mar 22.

Department Orthopaedics, Saudi German Hospital, Dubai, United Arab Emirates.

Background: To assess a new modification of posterior approach to the hip and its effect on stability and functional outcome in total hip arthroplasty.

Material & Methods: A comparative retrospective study was done to assess the functional outcome and rate of dislocation among 233 hips (Group A) operated by conventional posterior approach and 567 hips (Group B) by our novel modified posterior approach. In this technique, 2-3 stay sutures are applied in external rotators, then a single conjoint-myocapsular sleeve is raised linearly over the capsule with adherent fibers of gluteus minimus to piriformis tendon, short rotators and part of quadratus for exposure of femoral head. After inserting the definite prosthesis, upper part of sleeve (capsule, piriformis tendon) is sutured at the lower part of tip of greater trochanter & lower part with lateral trochanteric bone. Fifty patients, using randomised tables, in group B underwent MRI to evaluate the efficacy of the repair at 1 and 12 weeks postoperatively.

Results: Average Harris hip score at minimum 3.9 year follow up was 83.2 in Group A & 88.7 in Group B. Group B had only one dislocation (0.176%) while Group A had 12 dislocations (5.15%). MRI showed intact repair in 47 patients (94%); fibrous continuity in 2 patients (6%) in group B patients.

Conclusion: Intermediate results shows that this technique provides enhanced stability and improved functional outcome. But more prospective and randomised controlled studies with long term followup are required to confirm its role in prevention of hip dislocations.
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http://dx.doi.org/10.1016/j.jcot.2019.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823894PMC
October 2019

Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System.

J Clin Exp Hepatol 2019 Sep-Oct;9(5):625-651. Epub 2019 Aug 6.

Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Hepatocellular carcinoma (HCC) is the 6th most common cancer and the second most common cause of cancer-related mortality worldwide. There are currently no universally accepted practice guidelines for the diagnosis of HCC on imaging owing to the regional differences in epidemiology, target population, diagnostic imaging modalities, and staging and transplant eligibility. Currently available regional and national guidelines include those from the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver, the Japan Society of Hepatology, the Korean Liver Cancer Study Group, Hong Kong, and the National Comprehensive Cancer Network in the United States. India with its large population and a diverse health infrastructure faces challenges unique to its population in diagnosing HCC. Recently, American Association have introduced a Liver Imaging Reporting and Data System (LIRADS, version 2017, 2018) as an attempt to standardize the acquisition, interpretation, and reporting of liver lesions on imaging and hence improve the coherence between radiologists and clinicians and provide guidance for the management of HCC. The aim of the present consensus was to find a common ground in reporting and interpreting liver lesions pertaining to HCC on imaging keeping LIRADSv2018 in mind.
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http://dx.doi.org/10.1016/j.jceh.2019.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823668PMC
August 2019

Prognostic role of serial alpha-fetoprotein levels in hepatocellular carcinoma treated with locoregional therapy.

Scand J Gastroenterol 2019 Sep 4;54(9):1132-1137. Epub 2019 Sep 4.

Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India.

To evaluate early serial AFP changes in responders and non-responders to locoregional therapy and identify differences between significant AFP decliners and non-decliners post-treatment. Case records of hepatocellular carcinoma (HCC) patients having AFP ≥20 ng/ml and treated with locoregional therapy were examined retrospectively. Patients with complete details were included. Trends of serial AFP change (from baseline to post-treatment one month) in patients showing early tumor response (complete response (CR), partial response (PR), progressive disease (PD)) as assessed on multiphasic MRI/CT liver performed at one month following treatment. Receiver operating curves were drawn to estimate the best AFP reduction cut off for differentiating between responders (CR plus PR) from non-responders (PD). AFP decliners (those with AFP level reduction greater than 20% post-treatment) were identified and comparisons of their clinical parameters, tumor response and survival rate were made with AFP non-decliners. HCC patients ( = 126) had mean age of 52.8 years, male:female ratio (4:1), Child's A 94, BCLC stage A/B/C HCC 49/65/12, respectively. On 4-6 weeks' MRI/CT, 46 patients developed CR, 55 PR and 25 PD. Reduction in median AFP level (83% in CR, 19% in PR) occurred in responders while 16% increase occurred in PD patients (non-responders). A 30% AFP reduction could differentiate responders from non-responders with 70% sensitivity and 68% specificity, AUROC 74% (CI 0.64-0.85). AFP decliners showed better survival and tumor response than non-decliners. Serial AFP change can predict tumor response to locoregional therapy in AFP producing HCC patients. AFP decliners have better survival and tumor response than AFP non-decliners.
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http://dx.doi.org/10.1080/00365521.2019.1660403DOI Listing
September 2019

Dabigatran as an oral anticoagulant in patients with Budd-Chiari syndrome post-percutaneous endovascular intervention.

J Gastroenterol Hepatol 2020 Apr 25;35(4):654-662. Epub 2019 Nov 25.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, New Delhi, India.

Background And Aim: Anticoagulants play an important role in the management of Budd-Chiari syndrome. There is a paucity of data on the efficacy and safety of direct-acting oral anticoagulants-dabigatran, among patients with Budd-Chiari syndrome.

Methods: In a retrospective analysis of prospectively maintained data, the stent patency rates, major bleeding episode, and a composite endpoint of major bleed and/or mortality rates were compared between Budd-Chiari syndrome patients treated with dabigatran (n = 36) or vitamin K antagonists (n = 62) following endovascular intervention.

Results: The baseline characteristics, including sites of block and types of interventions, were similar between the two groups. The mean duration of follow-up in the dabigatran and vitamin K antagonist groups was 10.5 ± 6.7 and 14.1 ± 6.9 months (P = 0.006), respectively. The endovascular stent patency rates were comparable between the dabigatran and vitamin K antagonist groups at 6 months (91% vs 96.5%) and 12 months (91% vs 93%), P = 0.296 (log-rank test), respectively. Major bleeding events were comparable between the dabigatran and vitamin K antagonist groups at 6 months (3.5% vs 2%) and 12 months (3.5% vs 6.5%), P = 0.895 (log-rank test), respectively. The composite endpoint of mortality and major bleed was comparable between dabigatran and vitamin K antagonists at 6 months (4% vs 5%) and 12 months (4% vs 8%), P = 0.875 (log-rank test), respectively.

Conclusions: Dabigatran, as compared with vitamin K antagonists, is associated with similar stent patency rates and complications among patients with Budd-Chiari syndrome post-endovascular intervention.
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http://dx.doi.org/10.1111/jgh.14843DOI Listing
April 2020

Processing Techniques for Scanning Electron Microscopy Imaging of Giant Cells from Giant Cell Tumors of Bone.

Microsc Microanal 2019 12;25(6):1376-1382

Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India.

Giant cell tumor (GCT) of bone is a common benign lesion that causes significant morbidity due to the failure of modern medical and surgical treatment. Surface ultra-structures of giant cells (GCs) may help in distinguishing aggressive tumors from indolent GC lesions. This study aimed to standardize scanning electron microscopic (SEM) imaging of GC from GCT of bone. Fresh GCT collected in Dulbecco's Modified Eagle Medium was washed to remove blood, homogenized, or treated with collagenase to isolate the GCs. Mechanically homogenized and collagenase-digested GCs were imaged on SEM after commonly used drying methodologies such as air-drying, tetramethylsilane (TMS)-drying, freeze-drying, and critical point-drying (CPD) for the optimization of sample processing. The collagenase-treated samples yielded a greater number of isolated GC and showed better surface morphology in comparison to mechanical homogenization. Air-drying was associated with marked cell shrinkage, and freeze-dried samples showed severe cell damage. TMS methodology partially preserved the cell contour and surface structures, although the cell shape was distorted. GC images with optimum surface morphology including membrane folding and microvesicular structures on the surface were observed only in collagenase-treated and critical point-dried samples. Collagenase digestion and critical point/TMS-drying should be performed for optimal SEM imaging of individual GCs.
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http://dx.doi.org/10.1017/S1431927619014855DOI Listing
December 2019

Necessity of Image Guidance for Subclavian Catheterization to Improve Patient Safety.

Indian J Pediatr 2019 11 26;86(11):985-986. Epub 2019 Jul 26.

Department of Radiology, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1007/s12098-019-03039-7DOI Listing
November 2019

Percutaneous Endoscopic Step-Up Therapy Is an Effective Minimally Invasive Approach for Infected Necrotizing Pancreatitis.

Dig Dis Sci 2020 02 11;65(2):615-622. Epub 2019 Jun 11.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Background: Infected pancreatic necrosis (IPN) is a major complication of acute pancreatitis (AP), which may require necrosectomy. Minimally invasive surgical step-up therapy is preferred for IPN.

Aim: To assess the effectiveness of percutaneous endoscopic step-up therapy in patients with IPN and identify predictors of its success.

Methods: Consecutive patients with AP hospitalized to our tertiary care academic center were studied prospectively. Patients with IPN formed the study group. The treatment protocol for IPN was percutaneous endoscopic step-up approach starting with antibiotics and percutaneous catheter drainage, and if required necrosectomy. Percutaneous endoscopic necrosectomy (PEN) was performed using a flexible endoscope through the percutaneous tract under conscious sedation. Control of sepsis with resolution of collection(s) was the primary outcome measure.

Results: A total of 415 patients with AP were included. Of them, 272 patients had necrotizing pancreatitis and 177 (65%) developed IPN. Of these 177 patients, 27 were treated conservatively with antibiotics alone, 56 underwent percutaneous drainage alone, 53 required underwent PEN as a step-up therapy, 1 per-oral endoscopic necrosectomy, and 52 required surgery. Of the 53 patients in the PEN group, 42 (79.2%) were treated successfully-34 after PEN alone and 8 after additional surgery. Eleven of 53 patients died due to organ failure-7 after PEN and 4 after surgery. Independent predictors of mortality were > 50% necrosis and early organ failure.

Conclusion: Percutaneous endoscopic step-up therapy is an effective strategy for IPN. Organ failure and extensive pancreatic necrosis predicted a suboptimal outcome in patients with infected necrotizing pancreatitis.
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http://dx.doi.org/10.1007/s10620-019-05696-2DOI Listing
February 2020

Can ADC be used as a surrogate marker of response to therapy in intestinal tuberculosis?

Abdom Radiol (NY) 2019 09;44(9):3006-3018

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110049, India.

Purpose: To evaluate the utility of Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in assessing treatment response in patients of intestinal tuberculosis (ITB).

Method And Materials: MR Enterography (MRE) was done for patients with suspicion of ITB and 19 patients with pre- and post-treatment imaging were included in the analysis. MRE included T1W, T2W, post-contrast T1W, and DWI sequences. DWI was done using b values-0, 400 and 800 s/mm, and ADC maps were generated. The trace DW images and ADC values were compared before and after therapy. Composite gold standard (clinical, colonoscopic criteria, and biopsy) was used to assess treatment response and to classify into no response, partial response, and complete response.

Results: Thirty-one bowel segments were evaluated at baseline and after treatment in 19 patients. Prior to therapy, restricted diffusion was seen in 29/31 (93.5%) segments. After treatment, patients with either complete or partial response (27/31 segments, 15 patients) showed significant rise in mean ADC values from 1.1 ± 0.37 × 10 to 2.1 ± 0.64 × 10 mm/s (p value < 0.05), whereas no significant change was found in mean ADC values of non-responders (4/29 segments in 4 patients) which increased from 1.0 ± 0.1 × 10 mm/s on baseline scan to 1.32 ± 0.2 × 10 mm/s on post-treatment scan (p value = 0.318). An increase in ADC value was found to be a reliable and objective marker of improvement with response to therapy.

Conclusion: ADC values show good correlation with treatment response in ITB and can be used for objectively quantifying it.
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http://dx.doi.org/10.1007/s00261-019-02090-4DOI Listing
September 2019

Magnetic resonance neurography and ultrasonogram findings in upper limb peripheral neuropathies.

Neurol India 2019 Jan-Feb;67(Supplement):S125-S134

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Peripheral neuropathy is defined as any disease or damage to the peripheral nerves. Imaging modalities are emerging as a complementary tool of choice for diagnosis of peripheral neuropathies. This has been made possible by the advent of high-resolution ultrasound, higher field strength magnets, better surface array coils, and superior software. In addition, imaging plays a pivotal role in deciding the management. They help in determining the continuity and course of the nerve, thereby helping in the pre-surgical mapping of nerve. Imaging studies also help in prognosticating the recovery by determining the event to be acute or chronic. This article describes the imaging findings of various neuropathies affecting upper limb peripheral nerves, broadly categorized as traumatic and non-traumatic. The non-traumatic group is further divided as entrapment, infective, inflammatory and tumors.
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http://dx.doi.org/10.4103/0028-3886.250701DOI Listing
December 2019

Comparison of F18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging as Markers of Graft Viability in Anterior Cruciate Ligament Reconstruction.

Am J Sports Med 2019 01 27;47(1):88-95. Epub 2018 Nov 27.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) can be used to assess changes in the metabolism of an anterior cruciate ligament (ACL) graft as it is undergoing "ligamentization." Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the preferred modality for noninvasive assessment of graft structure and graft vascularity.

Purpose: To compare the use of F18-FDG PET/CT and DCE-MRI to assess ligamentization within the ACL graft and correlate the results with clinical tests.

Study Design: Case series; Level of evidence, 4.

Methods: Among 30 recruited patients, 27 patients (3 females and 24 males) completed 2 follow-up assessments at a mean of 125 ± 22 days and 259 ± 38 days after arthroscopic ACL reconstruction. At both assessments, anterior drawer test, Lachman test, and Lysholm scoring (LS) were conducted. Images from F18-FDG PET/CT and MRI were analyzed qualitatively and quantitatively (maximum standardized uptake value [SUVmax], SUVmax ratio to the contralateral side [SUVmax CL], normalized enhancement [NE]) in 3 zones: femoral, intra-articular (IA), and tibial. Of the 27 recruited patients, 1 patient had reinjury due to a fall. Therefore, 26 patients were considered for the final analysis.

Results: A significant improvement ( P = .0001) was found in median LS, from 78.5 (range, 62-90) to 94.5 (range, 84-100), at the second follow-up. All grafts were found to be viable on PET/CT and vascularized on MRI. All grafts were seen as continuous on MRI, with exception of 1 graft at the second follow-up. Dynamic MRI identified single-vessel supply to all of the grafts at the first follow-up and multiple-vessel supply in 10 patients at the second follow-up. Reduction in the median SUVmax, SUVmax CL, and NE at second follow-up was seen in all 3 zones. Only SUVmax CL in the IA zone showed a significant reduction ( P = .032); patients with excellent LS at the second follow-up showed significantly higher reduction ( P = .005) than patients with good LS. NE in the IA zone was correlated (0.39; P = .048) with LS only at the first follow-up, whereas SUVmax CL (-0.52; P = .006) and SUVmax (-0.49, P = .010) in the IA zone negatively correlated with LS at the second follow-up only. No correlation was observed between PET/CT and MRI parameters.

Conclusion: Glucose metabolism and vascularity in the graft tissue can be used to assess ligamentization of ACL graft. A viable and vascularized graft at first follow-up is associated with good to excellent final outcome, regardless of LS at this stage. Since no correlation was observed between PET/CT and MRI parameters, they may be assessing different domains of the same process. Higher NE in the IA zone at the first follow-up and lower SUVmax CL in the same region at second follow-up are associated with better outcome.
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http://dx.doi.org/10.1177/0363546518805092DOI Listing
January 2019

Traumatic Airway Injuries: Role of Imaging.

Curr Probl Diagn Radiol 2020 Jan - Feb;49(1):48-53. Epub 2018 Oct 29.

Department of Radiology and Department of Surgery, JPN Apex trauma Center, All India Institute of Medical Sciences, New Delhi, India.

Airway Injuries are rare but often immediately life threatening. Incidence ranges from 0.5-2 % in blunt and 1-6 % in penetrating trauma. Upper airway injuries (UAI) are often clinically apparent and get shunted during the primary survey in the emergency department. Few UAI and majority of lower airway injuries (LAI) are occult on primary survey and need a high suspicion index. Clinically, the diagnosis of tracheobronchial injury is delayed in many patients because the airway column is maintained by the peribronchial tissue. Imaging in the form of MDCT, in conjunction with endoscopy, plays a role in delineating the exact site and extent of injury and ruling out associated vascular and esophageal injuries for definitive management of UAI. Chest radiographs and ultrasonography help raise suspicion of LAI by detection of pneumomediastinum, persistent pneumothorax and/or subcutaneous emphysema and should be followed up with multidetector computed tomography (MDCT) which is the mainstay of diagnosis. However, it requires careful evaluation of the airway tract and a thorough knowledge about the mechanism of trauma for detection of subtle injuries. Reconstructions in multiple planes and use of various post-processing techniques including minimum intensity projection (MinIP) images enhance the detection rate. The specific signs of LAI on CT include discontinuity in the tracheobronchial tree, focal intimal flap projecting in the lumen, focal soft tissue attached to the tracheal/bronchial wall, complete cut off of the bronchus/trachea and the fallen lung sign. We, hereby, illustrate the imaging spectrum of traumatic airway injuries in detail and discuss their management implications.
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http://dx.doi.org/10.1067/j.cpradiol.2018.10.005DOI Listing
June 2020

Computerized Tomography-Based Morphometric Analysis of Subaxial Cervical Spine Pedicle in Asymptomatic Indian Population.

Int J Spine Surg 2018 Apr 3;12(2):112-120. Epub 2018 Aug 3.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: The purpose of this study was to analyze morphometry of the subaxial cervical spine pedicles in an Indian population based on computed tomography (CT), and thus assess the safety and feasibility of cervical pedicle screw in the subaxial cervical spine.

Methods: CT scans of 500 subaxial cervical spine vertebrae were analyzed from 100 patients presenting to our institution and undergoing cervical spine CT scan for an unrelated cause as part of ATLS protocol. Pedicle width (PW), pedicle axis length (PAL), pedicle transverse angulation (PTA), and lateral pedicle distance (LPD) were calculated on axial CT scans, and pedicle height (PH), pedicle length (PL), superior pedicle distance (SPD), and pedicle sagittal angulation (PSA) were calculated on sagittal CT scans.

Results: The mean PW ranged from 4.3 mm at C3 to 5.7 mm at C7. Mean PH ranged from 5.5 mm at C3 to 6.1 mm at C7. Mean PTA ranged from 44.5° at C3 to 37.1° at C7. PSA ranged from 16.65° at C3 to 3.29° at C7. Mean LPD ranged from 1.6 mm at C3 to 3.4 mm at C6. Mean SPD ranged from 3.5 mm at C3 to 1.15 mm at C7. Mean PAL ranged from 29.6 mm at C3 to 33.04 mm at C7. Mean PL ranged from 5.2 mm at C3 to 5.78 mm at C7.

Conclusions: Our CT-based morphometric study confirms that cervical pedicle screw placement is possible in most of the Indian population except at C3 in females. A thorough understanding of pedicle anatomy with proper CT-based preoperative planning can mitigate the risk associated with pedicle screw placement in subaxial cervical spine.
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http://dx.doi.org/10.14444/5017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159543PMC
April 2018

Imaging findings in Erdheim-Chester disease: what every radiologist needs to know.

Pol J Radiol 2018 4;83:e54-e62. Epub 2018 Feb 4.

Department of Radiology, All India Institute Of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.

Erdheim-Chester disease (ECD) is a rare sporadic non-Langerhans cell histiocytic (LCH) proliferative disorder with systemic predilection. It usually affects adults in the 5-7 decades of life and has non-specific clinical manifestations. Its suspicion is often heralded by the presence of characteristic radiological findings and subsequently confirmed by demonstration of CD68-positive xanthogranulomatous infiltrates on histopathology. Despite being a non-malignant entity, it might be fatal due to organ dysfunction. Imaging plays a key role in the diagnosis, management, and follow-up. Imaging findings are essential to establish the diagnosis, assess actual disease burden, and explore the aetiopathogenesis and therapeutic options to halt disease progression and associated morbidity.
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http://dx.doi.org/10.5114/pjr.2018.73290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047091PMC
February 2018