Diffusion Tensor Imaging in Obsessive-Compulsive Disorder

Yukiko Saito et al in Radiology 2008;246:536-542 have examined the examine microstructural white matter abnormalities in the corpus callosum (CC) of patients with obsessive-compulsive disorder (OCD). A significant reduction in FA was observed in the rostrum of the CC in patients with OCD compared with the rostral FA in the control subjects. (FA-Fractional anisotropy). Study results support the widely held view that the orbital prefrontal region is involved in the pathophysiology of OCD and indicate that the orbitofrontal circuit influences symptom severity in patients with OCD.

Radiology Grand Rounds XX

Here is a case of Tendoachilles Tear for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

In Greek mythology, Achilles was a Greek hero of the Trojan War, the central character and greatest warrior of Homer's Iliad which takes for its theme the Wrath of Achilles.Later legends state that Achilles was invulnerable on all of his body except for his heel. These legends state that Achilles was killed in battle by an arrow to the heel, and so an "Achilles' heel" or Achilles' tendon has come to mean a person's principal weakness.

Axial and saggital MRI of the ankle show an abnormal contour and altered signal intensity involving the tendoachilles, On the T2 and fat suppressed image is an area of high signal in the tendon suggesting tear. Clinical signs for complete tear are Thomson's test and inability to tiptoe.

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy
Teleradiology Providers

Google to get medical imaging information fast

"According to Diagnostic Imaging By Fishman at 2007 RSNA meeting. Radiologists seeking a specific piece of medical information online should consider initiating searches with Google, which provides a list of medical resources likely to contain the information needed. Number of links needed to get to the answer in google was found to be 1.5, yahoo-1.9, and pubmed-4.25."

Radiology Updates

Radiology Blogosphere sees yet another radiology Blog this time by Dr V David, MSK radiologist who has started a MSK MRI blog

Workshop in interventional oncology with in Tata Memorial Hospital, Details here-

6th Conference on Evidence based Management of Cancers in India

Radiology Search a peer reviewed and user tailored radiology search engine specifically for radiology related contents is now available on my blog.

Your faithfully Dr Sumer Sethi is now Radiology Expert on Medhelp. Check out My Medhelp Profile and Diagnostic Radiology Forum for the patients around the world.

Diffusion Weighted Imaging in Malignacy- A Review

Seems like diffusion imaging will soon be useful for all body malignancies and follow up post therapy. Newer applications for DWI are on the way.

Diffusion-weighed MR imaging of pancreatic carcinoma.. Abdom Imaging. 2007 Jul-Aug;32(4):481-3. By Matsuki M et al

Diffusion-weighted (DW) images can be helpful in detecting the pancreatic carcinoma and accessing the extent of the tumor. On the DW images, carcinomas were shown as high signal intensity relative to the surrounding tissue. The ADC valuein the carcinoma was significantly lower compared to that of normal pancreas and tumor-associated chronic pancreatitis

Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol. 2007 Jan;17(1):201-4. Epub 2006 Jul 25. Matsuki M et al

They concluded, DW images under free breathing enabled the clear detection of theurinary bladder carcinoma, whose ADC values were lower compared with those of the surrounding structure. The DW images may be useful in evaluating tumors invading to the surrounding structures.

Lung carcinoma: diffusion-weighted mr imaging—preliminary evaluation withapparent diffusion coefficient. Radiology. 2007 May;243(2):570-7. Epub 2007 Mar 30.Matoba M et al.

With the Spearman rank test, ADCs of lung carcinomas correlated well with tumor cellularities ADCs of lung carcinomas overlap, but ADCs of well-differentiated adenocarcinoma appear to be higher than those of other histologic lung carcinoma types.

Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging—initial experience. Radiology. 2006 Apr;239(1):223-31. Epub 2006 Feb 1. Pierallini A et al

Findings in this study suggest that DW MR images with ADC maps can provide information about the consistency of macroadenomas

Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol. 2004 Oct;77(922):851-7. Cova M et al

They concluded diffusion-weighted MR imaging of the kidney seems to be a reliable way to differentiate normal renal parenchyma and different renal diseases. Clinical experience with this method is still preliminary and further studies are required.

Diffusion-weighted MR imaging of metastatic disease of the spine: assessment ofresponse to therapy. AJNR Am J Neuroradiol. 2002 Jun-Jul;23(6):906-12. Byun WM et al.

In cases of metastatic disease of the spine, monitoring the response to medical therapy with plain radiography, bone scanning, and conventional spin-echo sequence MR imaging is unsatisfactory because of the insensitivity or nonspecific findings of these imaging modalities. Diffusion-weighted MR imaging shows that, with successful therapy, there is decreased signal intensity ofmetastatic disease of the vertebral bone marrow.

Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology. 2006 Apr;239(1):122-30. Epub 2006 Feb 21. Nasu K et al

They concluded combined reading of DW SENSE images and T2-weighted fast SE and dual-echo T1-weighted FFE MR images showed higher accuracy in the detection of hepatic metastases than did reading of SPIO-enhanced MR images

Teleradiology Providers

Sumer's Radiology Site gets nominated as one of the finalist in Best Clinical Sciences Blog Category

Dear friends

It gives me great pleasure to share with you that my website- Sumer's Radiology Site has been nominated into the finalists for the best clinical sciences blog on Medgadget Journal. Now to win we need votes

If you like my blog--

Vote here

Ryles Tube Misplaced Into Cranial Cavity

Here are some images of a polytrauma patient referred to us for a CT scan interpretation. One look at the images make you feel scared, just look at the way Ryles tube is coiling in the cranial cavity. probably he had a cribiform plate fracure through which the tube got accidentally pushed into the cranial cavity. We present the Scout film and CT sections. 35 cases of intracranial nasogastric tube insertion have been reported in the international literature. A complex craniofacial fracture is the most common predisposing factor.

Similar Case on Radswiki

Case by Dr Sumer Sethi-MD, Dr Jaya Shanker,MD

Teleradiology Providers

Tomosynthesis

"Digital x-ray tomosynthesis is a technique for producing slice images using conventional x-ray systems. Tomosynthesis improves upon conventional geometric tomography in that it allows an arbitrary number of in-focus planes to be generated retrospectively from a sequence of projection radiographs that are acquired during a single motion of the x-ray tube. By shifting and adding these projection radiographs, specific planes may be reconstructed. Applications of tomosynthesis includes angiography, chest imaging, mammography, dental imaging and orthopaedic imaging."

Further reading

Digital x-ray tomosynthesis: current state of the art and clinical potential
James T Dobbins III et al 2003 Phys. Med. Biol. 48 R65-R106

doi:10.1088/0031-9155/48/19/R01

Teleradiology Providers

Bone Age-Useful Tip

Elbow ossification centers

order of ossification: "CRITOE"
Capitellum
Radius
Internal (medial) epicondyle
Trochlea
Olecranom
External (lateral) epicondyle