Publications by authors named "Sridhar Gibikote"

52 Publications

Screening Ultrasonography in Children with Prolonged Fever Can Detect Early Takayasu Arteritis.

JMA J 2021 Oct 1;4(4):445-446. Epub 2021 Oct 1.

Departments of Pediatric Rheumatology, Radio Diagnosis and Clinical Immunology & Rheumatology, Christian Medical College Hospital, Vellore, India.

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http://dx.doi.org/10.31662/jmaj.2021-0160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580706PMC
October 2021

Radiology Reporting Errors: Learning from Report Addenda.

Indian J Radiol Imaging 2021 Apr 12;31(2):333-344. Epub 2021 Aug 12.

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India.

The addition of new information to a completed radiology report in the form of an "addendum" conveys a variety of information, ranging from less significant typographical errors to serious omissions and misinterpretations. Understanding the reasons for errors and their clinical implications will lead to better clinical governance and radiology practice. This article assesses the common reasons which lead to addenda generation to completed reports and their clinical implications. Retrospective study was conducted by reviewing addenda to computed tomography (CT), ultrasound, and magnetic resonance imaging reports between January 2018 to June 2018, to note the frequency and classification of report addenda. Rate of addenda generation was 1.1% ( = 1,076) among the 97,003 approved cross-sectional radiology reports. Errors contributed to 71.2% ( = 767) of addenda, most commonly communication (29.3%, = 316) and observational errors (20.8%, = 224), and 28.7% were nonerrors aimed at providing additional clinically relevant information. Majority of the addenda (82.3%, = 886) did not have a significant clinical impact. CT and ultrasound reports accounted for 36.9% ( = 398) and 35.2% ( = 379) share, respectively. A time gap of 1 to 7 days was noted for 46.8% ( = 504) addenda and 37.6% ( = 405) were issued in less than a day. Radiologists with more than 6-year experience created majority (1.5%, = 456) of addenda. Those which were added to reports generated during emergency hours contributed to 23.2% ( = 250) of the addenda. The study has identified the prevalence of report addenda in a radiology practice involving picture archiving and communication system in a tertiary care center in India. The etiology included both errors and non-errors. Results of this audit were used to generate a checklist and put protocols that will help decrease serious radiology misses and common errors.
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http://dx.doi.org/10.1055/s-0041-1734351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448237PMC
April 2021

Clinical Radiology Case Presentation: Do's and Don'ts.

Indian J Radiol Imaging 2021 Jan 25;31(1):24-29. Epub 2021 May 25.

Division of Clinical Radiology, Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India.

Clinical case presentation is part of daily routine for doctors to communicate with each other to facilitate learning, and ultimately patient management. Hence, the art of good clinical case presentation is a skill that needs to be mastered. Case presentations are a part of most undergraduate and postgraduate training programs aimed at nurturing oratory and presentation design skills. This article is an attempt at providing a trainee in radiology a guideline to good case presentation skills.
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http://dx.doi.org/10.1055/s-0041-1729489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299493PMC
January 2021

Musculoskeletal ultrasound in hemophilia: Results and recommendations from a global survey and consensus meeting.

Res Pract Thromb Haemost 2021 Jul 10;5(5):e12531. Epub 2021 Jul 10.

School of Rehabilitation Science Faculty of Health Science Hamilton Niagara Regional Hemophilia Program Hamilton Health Sciences McMaster University Hamilton ON Canada.

Introduction: For persons with hemophilia, optimization of joint outcomes is an important unmet need. The aim of this initiative was to determine use of ultrasound in evaluating arthropathy in persons with hemophilia, and to move toward consensus among hemophilia care providers regarding the preferred ultrasound protocols for global adaptation.

Methods: A global survey of hemophilia treatment centers was conducted that focused on understanding how and why ultrasound was being used and endeavored to move toward consensus definitions of both point-of-care musculoskeletal ultrasound (POC-MSKUS) and full diagnostic ultrasound, terminology to describe structures being assessed by ultrasound, and how these assessments should be interpreted. Next, an in-person meeting of an international group of hemophilia health care professionals and patient representatives was held, with the objective of achieving consensus regarding the acquisition and interpretation of POC-MSKUS and full diagnostic ultrasound for use in the assessment of musculoskeletal (MSK) pathologies in persons with hemophilia.

Results: The recommendations were that clear definitions of the types of ultrasound examinations should be adopted and that a standardized ultrasound scoring/measurement system should be developed, tested, and implemented. The scoring/measurement system should be tiered to allow for a range of complexity yet maintain the ability for comparison across levels.

Conclusion: Ultrasound is an evolving technology increasingly used for the assessment of MSK outcomes in persons with hemophilia. As adoption increases globally for clinical care and research, it will become increasingly important to establish clear guidelines for image acquisition, interpretation, and reporting to ensure accuracy, consistency, and comparability across groups.
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http://dx.doi.org/10.1002/rth2.12531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271584PMC
July 2021

Ultrasound and magnetic resonance imaging for the detection of blood: An ex-vivo study.

Haemophilia 2021 May 29;27(3):488-493. Epub 2021 Mar 29.

Department of Hematology, Christian Medical College, Vellore, India.

Objectives: Early detection of bleeding into a joint is crucial in patients with haemophilia. This study was designed to evaluate the sensitivity of ultrasonography (USG) and magnetic resonance imaging (MRI) to detect the presence of blood in small concentrations in a simulated model to mimic joint bleeding.

Materials And Methods: Different concentrations of blood in plasma, varying from 0.1% to 45%, were collected in 10-ml plastic syringes and imaged using 12 and 18 MHz USG transducers and with 1.5T and 3T MRI scanners, at different intervals of time following dilution. The images were scored for the presence of blood by four experienced radiologists who were blinded to the concentration of blood.

Results: Within the first 2 h, the 18 MHz transducer was able to detect blood consistently up to 0.5%, whereas the 12 MHz transducer could consistently identify blood up to 1.4%. After the first 12 h, both transducers were able to detect blood up to 0.5% concentration. However, at concentrations below 0.5%, there was discordance in the ability to detect blood, with both transducers. There was no correlation between the signal intensities of MRI images and concentration of blood, at different time intervals, irrespective of the magnetic field strength.

Conclusions: Detection of blood using the USG is dependent on variables such as the concentration of blood, frequency of the transducer used and timing of the imaging. As the concentration of blood decreases below 0.5%, the discordance between the observers increases, implying that the detection limit of USG affects its reliability at lower concentrations of blood. Caution is urged while interpreting USG imaging studies for the detection of blood in symptomatic joints.
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http://dx.doi.org/10.1111/hae.14303DOI Listing
May 2021

Ghosal hematodiaphyseal dysplasia and response to corticosteroid therapy.

Am J Med Genet A 2021 02 13;185(2):596-599. Epub 2020 Nov 13.

Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1002/ajmg.a.61961DOI Listing
February 2021

Critical appraisal of the International Prophylaxis Study Group magnetic resonance image scale for evaluating haemophilic arthropathy.

Haemophilia 2020 Jul 4;26(4):565-574. Epub 2020 Jun 4.

Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

A goal of the International Prophylaxis Study Group (IPSG) is to provide an accurate instrument to measure MRI-based disease severity of haemophilic arthropathy at various time points, so that longitudinal changes in disease severity can be identified to support decisions on treatment management. We review and discuss in this paper the evaluative purpose of the IPSG MRI scale in relation to its development and validation processes so far. We also critically appraise the validity, reliability and responsiveness of using the IPSG MRI scale in different clinical and research settings, and whenever applicable, compare these clinimetric properties of the IPSG MRI scale with those of its precursors, the compatible additive and progressive MRI scales.
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http://dx.doi.org/10.1111/hae.14032DOI Listing
July 2020

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey.

Haemophilia 2020 Jul 22;26(4):685-693. Epub 2020 May 22.

Department of Medical Imaging, University of Saskatchewan and Saskatchewan Health Authority Saskatoon City Hospital, Saskatoon, SK, Canada.

Aim: The objective of this survey was to understand the global trends of imaging assessments in persons with haemophilia, focusing on point-of-care ultrasound (POCUS). Insights into the barriers impeding its widespread proliferation as a frontline imaging modality were obtained.

Methods: The survey opened in September of 2017 and closed in May of 2018. Haemophilia Treatment Centres (HTCs) treating both paediatric/adult patients were the population of interest. A REDCap survey of 25 questions was disseminated to 232 clinical staff in 26 countries.

Results: The majority of respondents (88.3%, 91/103) reported that POCUS is most useful to confirm or rule out a presumed acute joint bleed. European HTCs reported the highest routine use of POCUS at 59.5% (22/37) followed by HTCs in the "Other" countries of the world at 46.7% (7/15) and North American HTCs at 43.9% (25/57). At the time of the survey, physiotherapists were identified as the clinical staff who perform POCUS 52.8% (28/53) of the time, in contrast with nurses/nurse practitioners who represent only 5.7% (3/53) of users. The greatest perceived barriers to the implementation of POCUS are the lack of trained healthcare professionals who can perform POCUS at 69.2% (74/107) and the overall time commitment required at 68.2% (73/107).

Conclusion: Despite POCUS being used in 49.5% (54/109) of sampled HTCs, it is still utilized almost 30% less globally than full diagnostic ultrasound. A list of barriers has been identified to inform HTCs which challenges they will likely need to overcome should they choose to incorporate this imaging modality into their practice.
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http://dx.doi.org/10.1111/hae.14006DOI Listing
July 2020

First Report of a Tissue-Engineered Graft for Proximal Humerus Gap Non-union After Chronic Pyogenic Osteomyelitis in a Child: A Case Report.

JBJS Case Connect 2020 Jan-Mar;10(1):e0031

Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala.

Case: An 11-year-old child who presented with a postseptic gap nonunion of 4 cm in the proximal humerus was treated with a customized hydroxyapatite-tricalcium phosphate-tricalcium silicate composite (HASi) scaffold loaded with culture-expanded autologous bone marrow-derived mesenchymal stem cells (MSCs) primed into osteogenic lineage. Union occurred at 3 months, and at 3 years, the child had improved joint mobility, with radiographic and computed tomographic imaging evidence of incorporation of the graft.

Conclusions: This case demonstrated the feasibility of MSC directed into osteogenic lineage on HASi to repair a long bone defect owing to postseptic osteomyelitis, a condition notorious for a high failure rate.
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http://dx.doi.org/10.2106/JBJS.CC.19.00031DOI Listing
January 2021

Correlation of quantitative and qualitative parameters of high-resolution computed tomography with pulmonary function test for diagnosing and assessing the severity of obstructive pulmonary disease.

Pol J Radiol 2019 3;84:e381-e388. Epub 2019 Oct 3.

Christian Medical College, Vellore, India.

Purpose: The aim of the study was to evaluate the role of high-resolution computed tomography (HRCT) in the prediction of presence and severity of chronic obstructive pulmonary disease (COPD), based on the pulmonary function test (PFT), to correlate the various quantitative and qualitative indices of COPD in HRCT with PFT values, and to derive at the threshold values for various quantitative HRCT indices of COPD.

Material And Methods: A one-year retrospective and prospective evaluation of the HRCTs of 90 cases and 38 controls was performed. Quantitative and qualitative parameters of COPD were assessed in HRCT and were correlated with PFT.

Results: Among the qualitative parameters, significant correlation with spirometry was found with the qualitative scoring for emphysema and presence and inhomogeneous attenuation. Among the quantitative indices, anterior junction line length, thoracic cage ratio at both aortic arch and inferior pulmonary vein level, thoracic cross-sectional area/[height]² at the aortic arch were found to have good correlation with spirometry. There was significant strong correlation of anterior junction line length and tracheal index with residual volume/total lung capacity (RV/TLC). The threshold values of chest X-ray and HRCT quantitative parameters were calculated and were found to be lower than those of the western population.

Conclusion: HRCT has a definite role in the diagnosis of COPD and can be used to predict the severity of emphysema.
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http://dx.doi.org/10.5114/pjr.2019.89306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964351PMC
October 2019

Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy in India (THIN study): a randomised controlled trial.

Arch Dis Child Fetal Neonatal Ed 2020 Jul 29;105(4):405-411. Epub 2019 Oct 29.

Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

Objective: To evaluate the neuroprotective effect of therapeutic hypothermia (TH) induced by phase changing material (PCM) on MRI biomarkers in infants with hypoxic-ischaemic encephalopathy (HIE) in a low-resource setting.

Design: Open-label randomised controlled trial.

Setting: One neonatal intensive care unit in a tertiary care centre in India.

Patients: 50 term/near-term infants admitted within 5 hours after birth with predefined physiological criteria and signs of moderate/severe HIE.

Interventions: Standard care (n=25) or standard care plus 72 hours of hypothermia (33.5°C±0.5°C, n=25) induced by PCM.

Main Outcome Measures: Primary outcome was fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC) on neonatal diffusion tensor imaging analysed according to intention to treat.

Results: Primary outcome was available for 22 infants (44%, 11 in each group). Diffusion tensor imaging showed significantly higher FA in the cooled than the non-cooled infants in left PLIC and several white matter tracts. After adjusting for sex, birth weight and gestational age, the mean difference in PLIC FA between groups was 0.026 (95% CI 0.004 to 0.048, p=0.023). Conventional MRI was available for 46 infants and demonstrated significantly less moderate/severe abnormalities in the cooled (n=2, 9%) than in the non-cooled (n=10, 43%) infants. There was no difference in adverse events between groups.

Conclusions: This study confirmed that TH induced by PCM reduced brain injury detected on MRI in infants with moderate HIE in a neonatal intensive care unit in India. Future research should focus on optimal supportive treatment during hypothermia rather than looking at efficacy of TH in low-resource settings.

Trial Registration Number: CTRI/2013/05/003693.
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http://dx.doi.org/10.1136/archdischild-2019-317311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363785PMC
July 2020

Revisiting magnetic resonance imaging pattern of Krabbe disease - Lessons from an Indian cohort.

J Clin Imaging Sci 2019 24;9:25. Epub 2019 May 24.

Departments of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India.

Context: Krabbe disease shows considerable heterogeneity in clinical features and disease progression. Imaging phenotypes are equally heterogeneous but show distinct age-based patterns. It is important for radiologists to be familiar with the imaging spectrum to substantially contribute toward early diagnosis, prognostication, and therapeutic decisions.

Aims: The study aims to describe different magnetic resonance imaging (MRI) patterns observed in a cohort of children with Krabbe disease and to assess correlation with age-based clinical phenotypes.

Materials And Methods: This is a retrospective descriptive study done at the Departments of Radiodiagnosis and Neurological Sciences of our institution, a tertiary care hospital in Southern India. Imaging features of children diagnosed with Krabbe disease over a 10-year period (2009-2018) were collected and analyzed.

Results: A total of 38 MRI brain studies from 27 patients were analyzed. Four distinct MRI patterns were recognizable among the different clinical subtypes. All patients from the early and late infantile group showed deep cerebral and cerebellar white matter and dentate hilum involvement. Optic nerve thickening was, however, more common in the former group. Adult-onset subtype showed isolated involvement of corticospinal tract, posterior periventricular white matter, and callosal splenium with the absence of other supra- and infra-tentorial findings. Juvenile subgroup showed heterogeneous mixed pattern with 78% showing adult subtype pattern and 22% showing patchy involvement of deep cerebral white matter with dentate hilum signal changes.

Conclusion: Krabbe disease shows distinct imaging features which correspond to different clinical age-based subtypes. This article reemphasizes these distinct imaging phenotypes, highlights a novel imaging appearance in juvenile Krabbe, and also alludes to the rare variant of saposin deficiency. Awareness of these patterns is essential in suggesting the appropriate diagnosis and guiding conclusive diagnostic workup. Large multicenter longitudinal studies are needed to further define the role of imaging in predicting the clinical course and thus to guide therapeutic options.
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http://dx.doi.org/10.25259/JCIS-18-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702867PMC
May 2019

Clinicoradiological Spectrum of L-2-Hydroxy Glutaric Aciduria: Typical and Atypical Findings in an Indian Cohort.

J Clin Imaging Sci 2019 27;9. Epub 2019 Feb 27.

Radiodiagnosis, Christian Medical College Vellore, Tamil Nadu India.

Context: Neurometabolic disorders form an important group of potentially treatable diseases. It is important to recognize the clinical phenotype and characteristic imaging patterns to make an early diagnosis and initiate appropriate treatment. L-2-hydroxy glutaric aciduria (L2HGA) is a rare organic aciduria with a consistent and highly characteristic imaging pattern, which clinches the diagnosis in most cases.

Aims: The study aims to describe the clinical profile, magnetic resonance imaging (MRI) patterns, and outcome in a cohort of children with L2HGA and to assess the clinicoradiological correlation.

Materials And Methods: This is a retrospective descriptive study done at the Department of Radiodiagnosis and Neurological Sciences of our institution. Clinical and radiological findings of children diagnosed with L2HGA over an 8-year period (2010-2017) were collected and analyzed. Descriptive statistical analysis of clinical and imaging data was performed.

Results: There were six girls and four boys. A total of 14 MRI brain studies in 10 patients with the diagnosis were analyzed. MRI of all patients showed a similar pattern with extensive confluent subcortical white-matter signal changes with symmetrical involvement of dentate nuclei and basal ganglia. In two children who presented with acute decompensation, there was asymmetric cortical involvement and restricted diffusion, which are previously unreported. There was no significant correlation between the radiological pattern with the disease duration, clinical features, or course of the disease.

Conclusion: MRI findings in L2HGA are highly consistent and diagnostic, which helps in early diagnosis, particularly in resource-constraint settings, where detailed metabolic workup is not possible. The article also describes novel clinical radiological profile of acute encephalopathic clinical presentation.
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http://dx.doi.org/10.25259/JCIS-9-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702895PMC
February 2019

A Retrospective Case-Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess.

Am J Trop Med Hyg 2018 10;99(4):852-857

Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India.

Among pyogenic liver abscesses, melioid etiology is considered in endemic regions in the presence of known health or occupational risk factors. "Honeycomb sign," used to describe an abscess with multiple internal septations dividing the abscess cavity into multiple loculations of comparable sizes on imaging, is a sensitive sign for melioid liver abscess. This is a retrospective case-control study investigating incidence, sensitivity, and specificity of "honeycomb sign" in melioid liver abscess, in a cohort of patients with culture-proven melioidosis infection. Abscesses ≥ 2 cm were analyzed for the honeycomb sign. value < 0.05 was taken as statistically significant. Interobserver agreement was calculated between two radiologists for the presence of the sign, sensitivity, and specificity. A total of 40 abscesses were analyzed. Thirty-four abscesses (85%) manifested the honeycomb sign with interobserver agreement (kappa = 0.70 and 0.92). Sensitivity of the sign is 85% (95% confidence interval [CI]: 70-94%), specificity is 75% (95% CI: 59-87%), positive predictive value is 77% (95% CI: 62-88%), and negative predictive value is 83% (95% CI: 67-94%). If abscess size is ≥ 3 cm, the sensitivity is 91% (95% CI: 77-98%), specificity is 75% (95% CI: 59-87%), positive predictive value is 76% (95% CI: 61-88%), and negative predictive value is 91% (95% CI: 76-98%). Honeycomb sign is a novel imaging marker for melioid liver abscess. Increased awareness and recognition of this imaging feature has the potential to affect patient management.
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http://dx.doi.org/10.4269/ajtmh.18-0395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159605PMC
October 2018

Can Pixel Value Ratio be Used in the Assessment of Ceramic Bone Substitute Incorporation? Observations from a Pilot Study.

Pol J Radiol 2017 17;82:706-712. Epub 2017 Nov 17.

Pediatric Orthopedic Unit, Christian Medical College, Vellore, India.

Background: Assessment of bone graft substitute incorporation is critical in the clinical decision making process and requires special investigations. We examined if the pixel value ratio (PVR) obtained in routine follow-up digital radiographs could be used for such assessment.

Material/methods: Radiographic images were acquired using either computed radiography or flat panel digital radiography systems. The PVR from radiographs of thirty children with ceramic bone substitute grafting were analyzed using the software from the picture archival and communication system (PACS) workstation. Graft incorporation was also assessed using the van Hemert scale. Three independent observers (A, B, C) measured PVRs at two different time points during the first and the last follow-up visits. PVR was compared with the van Hemert scale scores and analyzed using Spearman's rank correlation.

Results: The mean intra-observer reliability was 0.8996, and inter-observer reliabilities were 0.69 (A C), 0.78 (A B), and 0.85 (B C) for the first follow-up visit and 0.74 (A C), 0.82 (A B), and 0.70 (B C) for the last follow-up measurements. Spearman's correlation showed a strong negative association between PVR values and van Hemert scale scores, as the healing process advanced on serial measurements at each follow-up (r=-0.94, n=60, z=-7.24, p≤0.0001). The reliability of the PVR measurements was assessed using an aluminum step wedge and ceramic graft.

Conclusions: PVR is potentially a reliable indicator of bone graft incorporation and can aid in clinical decision making provided standard radiographic techniques are used.
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http://dx.doi.org/10.12659/PJR.903022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894053PMC
November 2017

Teaching NeuroImages: Acute necrotizing encephalopathy of childhood: Neuroimaging findings.

Neurology 2018 01;90(2):e177-e178

From the Departments of Radiology (A.B., M.V., A.G., S.G.) and Neurosciences (S.Y.), Christian Medical College, Tamil Nadu, India.

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http://dx.doi.org/10.1212/WNL.0000000000004800DOI Listing
January 2018

The current status of pediatric radiology in India: A conference-based survey.

Indian J Radiol Imaging 2017 Jan-Mar;27(1):73-77

Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.

Introduction: Like most other developing countries, India has a large proportion of children among its population. However, the facilities for adequate treatment of this large population is inadequate. The development of pediatric radiology as a subspecialty is still at an infant stage in India. The goal of our study was to assess the awareness about the current status of pediatric radiology in India.

Materials And Methods: A questionnaire was handed over to all attendees of a pediatric radiology conference to assess their opinion regarding the adequacy of pediatric training and practice in India. The questionnaire consisted of 10 multiple-choice and two descriptive questions. Descriptive statistical methods were used for analyzing the results.

Results: Eighty-one out of 400 delegates responded to the questionnaire. Among these 81 respondents, 50 (61.7%) felt that exposure to pediatric cases during postgraduate course was inadequate. Sixty-three out of 81 (77.7%) respondents thought that specialized training is required for practicing pediatric radiology, and 79 respondents (97%) felt that the number of such training programmes should increase. Forty-five out of 81 respondents (55.5%) were interested in pursuing pediatric radiology as a career.

Conclusion: According to the opinion of the respondents of our survey, pediatric radiology remains an underdeveloped speciality in India. Considering the proportion of the population in the pediatric age and the poor health indicators in this age group, elaborate measures, as suggested, need to be implemented to improve pediatric radiology training and the care of sick children in India.
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http://dx.doi.org/10.4103/0971-3026.202965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385782PMC
May 2017

Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours.

Pol J Radiol 2016 16;81:540-548. Epub 2016 Nov 16.

Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.

Background: It is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard - pathology.

Material/methods: In this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard - pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions.

Results: T1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between -0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement.

Conclusions: T1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size.
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http://dx.doi.org/10.12659/PJR.898108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181551PMC
November 2016

The routine pre-employment screening chest radiograph: Should it be routine?

Indian J Radiol Imaging 2016 Jul-Sep;26(3):402-404

Department of Staff Health, Christian Medical College, Vellore, Tamil Nadu, India.

Background And Objective: A routine chest radiograph is mandatory in many institutions as a part of pre-employment screening. The usefulness of this has been studied over the years keeping in mind the added time, cost, and radiation concerns. Studies conducted outside India have shown different results, some for and some against it. To our knowledge, there is no published data from India on this issue.

Materials And Methods: A retrospective review of the reports of 4113 pre-employment chest radiographs done between 2007 and 2009 was conducted.

Results: Out of 4113 radiographs, 24 (0.58%) candidates required further evaluation based on findings from the screening chest radiograph. Out of these, 7 (0.17%) candidates required appropriate further treatment.

Interpretation And Conclusions: The percentage of significant abnormalities detected which needed further medical intervention was small (0.17%). Although the individual radiation exposure is very small, the large numbers done nation-wide would significantly add to the community radiation, with added significant cost and time implications. We believe that pre-employment chest radiographs should be restricted to candidates in whom there is relevant history and/or clinical findings suggestive of cardiopulmonary disease.
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http://dx.doi.org/10.4103/0971-3026.190409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036342PMC
November 2016

Role of endovascular embolization in treatment of acute bleeding complications in haemophilia patients.

Br J Radiol 2016 Aug 21;89(1064):20151064. Epub 2016 Jun 21.

1 Department of Radiology, Christian Medical College, Vellore, India.

Objective:: Bleeding complications either spontaneously or post-operatively are very common in patients with haemophilia. Sometimes these bleeding complications remain unresponsive despite being on high dose of clotting factor replacement. The aim was to assess the role of endovascular embolization in patients with haemophilia in (a) treating haemorrhagic complications due to local causes refractory to clotting factors substitution and (b) reducing intraoperative blood loss in elective pseudotumour surgery.

Methods:: 10 patients seen between January 2000 and April 2015 with severe haemophilia A or B who had unexplained profuse persistent bleeding or required large pseudotumour excision and were taken up for digital subtraction angiography and embolization were included in the study. Data of all these patients were reviewed using the computerized hospital information system and picture archiving and communication system. Details including indications for the procedure, patient preparation for the procedure, imaging findings, details of angiography with intervention, if any, and outcome as well as follow-up data were analyzed.

Results:: In 6 of these 10 cases, bleeding was spontaneous, in 2 cases due to trivial fall and in 2 cases due to post-operative bleeding. Angiography in these patients revealed vascular blush, abnormal hypervascularity or active extravasation. In all 10 patients, an embolization procedure was performed, with bleeding controlled in 8 patients. There were no procedure-related complications during the procedure, post-procedure bleeding or haematoma at the site of arterial access. One patient had recurrence of bleeding for whom surgical exploration was required, and one patient had significant bleeding intraoperatively which was controlled with high-dose clotting factors, blood transfusion and fresh frozen plasma intraoperatively.

Conclusion:: Endovascular embolization is a safe, effective and cost-saving procedure in arresting bleeding in selected patients with severe haemophilia who are unresponsive to adequate clotting factor replacement and where local vascular causes could be contributing to the bleeding. Pre-operative embolization is also a good procedure to reduce intraoperative blood loss in patients with large pseudotumours.

Advances In Knowledge:: Angiography and embolization in patients with haemophilia is technically challenging and should be performed by highly skilled interventional radiologists, which limits its wider use and familiarity among multidisciplinary teams managing haemophilia. By bringing the knowledge of this effective treatment to the specialist groups who care for patients with haemophilia, its wider application may be possible which can save life and/or reduce morbidity.
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http://dx.doi.org/10.1259/bjr.20151064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124877PMC
August 2016

Anonychia with absent phalanges and brachydactyly: A report of two unrelated cases.

Indian J Dermatol Venereol Leprol 2016 Nov-Dec;82(6):693-695

Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.4103/0378-6323.184198DOI Listing
May 2017

Imaging in Pediatric Demyelinating and Inflammatory Diseases of Brain- Part 2.

Indian J Pediatr 2016 Sep 30;83(9):965-82. Epub 2016 Apr 30.

Department of Pediatric Neuroimaging, Hospital for Sick Children, Toronto, Canada.

Imaging plays an important role in diagnosis, management, prognostication and follow up of pediatric demyelinating and inflammatory diseases of brain and forms an integral part of the diagnostic criteria. This article reviews the spectrum of aquaporinopathies with an in-depth discussion on present criteria and differentiation from other demyelinating diseases with clinical vignettes for illustration; the latter part of article deals with the spectrum of CNS vasculitis.
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http://dx.doi.org/10.1007/s12098-016-2052-zDOI Listing
September 2016

Role of Computed Tomography in Pediatric Abdominal Conditions.

Indian J Pediatr 2016 Jul 11;83(7):691-701. Epub 2016 Mar 11.

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.

In the pediatric patient, computed tomography (CT) scan as an imaging modality for evaluation of the abdomen is to be used judiciously. The use of correct scanning protocols, single phase scanning, scanning only when required are key factors to minimize radiation doses to the child, while providing diagnostic quality. CT is the preferred modality in the evaluation of trauma, to assess extent of solid organ or bowel injury. It is also useful in several inflammatory conditions such as inflammatory bowel diseases and acute pancreatitis. CT also has an important role in evaluating intra-abdominal tumors, although magnetic resonance imaging (MRI) can be used as an alternative to CT.
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http://dx.doi.org/10.1007/s12098-016-2030-5DOI Listing
July 2016

Role of Computed Tomography in Pediatric Chest Conditions.

Indian J Pediatr 2016 Jul 26;83(7):675-90. Epub 2016 Feb 26.

Department of Radiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.

CT is the preferred cross-sectional imaging modality for detailed evaluation of anatomy and pathology of the lung and tracheobronchial tree, and plays a complimentary role in the evaluation of certain chest wall, mediastinal, and cardiac abnormalities. The article provides an overview of indications and different types of CT chest, findings in common clinical conditions, and briefly touches upon the role of each team member in optimizing and thus reducing radiation dose.
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http://dx.doi.org/10.1007/s12098-015-1955-4DOI Listing
July 2016

Reply to "Hemosiderin Detection With Ultrasound: Reality or Myth?".

AJR Am J Roentgenol 2016 Jan;206(1):W31-5

2 Christian Medical College, Vellore, India.

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http://dx.doi.org/10.2214/AJR.15.15535DOI Listing
January 2016

Imaging in Pediatric Demyelinating and Inflammatory Diseases of the Brain- Part 1.

Indian J Pediatr 2016 Sep 4;83(9):952-64. Epub 2015 Dec 4.

Department of Pediatric Neuroimaging, Hospital for Sick Children, Toronto, Canada.

Imaging plays an important role in the diagnosis, management, prognostication and follow up of pediatric demyelinating and inflammatory diseases of the brain and forms an integral part of the diagnostic criteria. Conventional and advanced MR imaging is the first and only reliable imaging modality. This article reviews the typical and atypical imaging features of common and some uncommon demyelinating and inflammatory diseases with emphasis on the criteria for categorization. Imaging protocols and the role of advanced imaging techniques are also covered appropriately.
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http://dx.doi.org/10.1007/s12098-015-1916-yDOI Listing
September 2016

Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites.

Indian J Gastroenterol 2015 Sep 4;34(5):395-8. Epub 2015 Nov 4.

Department of Hepatology, Christian Medical College, Vellore, 632 004, India.

Background: Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tuberculosis within 2 hours of sample collection. The present study aimed at assessing efficacy of Xpert™ MTB/Rif assay for diagnosing peritoneal tuberculosis.

Methods: Patients with exudative ascites, fluid negative for acid-fast bacilli on auramine O fluorescence staining and unyielding fluid cytology for malignant cells, were included. Ultrasound-guided omental biopsy samples were obtained in all. Xpert™ MTB/Rif assay on tissue samples was assessed against a composite "reference" standard for diagnosis of peritoneal tuberculosis, defined as presence of any of the three-culture showing M tuberculosis, granulomatous inflammation on histology or resolution of ascites with 2 months of antitubercular therapy.

Results: During January 2012-July 2013, 28 patients (age:43 ± 15 years; mean ± SD; male:20) were recruited. Serum ascitic albumin gradient was <1.1 in all except in four patients with underlying cirrhosis. Twenty-one of the 28 patients had peritoneal TB as diagnosed by composite reference standard (histology:18; culture:4; treatment response:3). Seven patients (25%) had an alternative diagnosis (metastatic carcinoma 2, adenocarcinoma 2, mesothelioma 2, and systemic lupus erythematous 1). Xpert™ MTB/Rif assay was positive in 4/21 patients with peritoneal tuberculosis and in none of the 7 patients with alternative diagnosis. Thus, sensitivity, specificity, positive, and negative predictive values for tissue Xpert™ MTB/Rif assay in diagnosing peritoneal tuberculosis were 19% (95% C.I: 6% to 42%), 100% (95% C.I: 59% to 100%), 100% (40% to 100%), and 29% (95% C.I: 13% to 51%), respectively.

Interpretation And Conclusion: Tissue Xpert™ MTB/Rif assay was of limited use in diagnosing peritoneal tuberculosis.
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http://dx.doi.org/10.1007/s12664-015-0599-7DOI Listing
September 2015

Imaging evaluation of hemophilia: musculoskeletal approach.

Semin Thromb Hemost 2015 Nov 19;41(8):880-93. Epub 2015 Oct 19.

Department of Medical Imaging, The Hospital for Sick Children, Toronto, Canada.

Imaging assessment is an important tool to evaluate clinical joint outcomes of hemophilia. Arthropathic changes have traditionally been evaluated by plain radiography and more recently by ultrasound and magnetic resonance imaging (MRI). Early arthropathic changes can be identified by modern imaging techniques such as T2 mapping MRI of cartilage even before clinical symptoms become apparent. Cross-sectional imaging modalities such as CT, ultrasonography, and MRI are useful in assessing bleeding-related musculoskeletal complications such as pseudotumors that still exist in some parts of the world. This article provides an overview of imaging of hemophilic arthropathy, and discusses the role and scope of individual imaging modalities currently in use in clinical practice, as well as of promising techniques that require further investigation in the immediate future.
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http://dx.doi.org/10.1055/s-0035-1564798DOI Listing
November 2015

Penile epidermal inclusion cyst: a rare location.

BMJ Case Rep 2015 Aug 19;2015. Epub 2015 Aug 19.

Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1136/bcr-2015-212137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550923PMC
August 2015

The Stall Grid Contest.

Indian J Radiol Imaging 2015 Jul-Sep;25(3):325-6

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India E-mail:

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http://dx.doi.org/10.4103/0971-3026.161472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531462PMC
August 2015
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