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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 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
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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 her
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 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
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"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
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Elbow ossification centers
order of ossification: "CRITOE"
Capitellum
Radius
Internal (medial) epicondyle
Trochlea
Olecranom
External (lateral) epicondyle
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 Wishing all our readers of this blog a very happy and prosperous new year 2008. The concept of this blog is to provide and discuss radiology related information and has been doing so for last four years (since 2004). I welcome all our readers to actively participate by commenting on the cases and submitting their own radiology related experiences.
Our sister concern- Teleradiology Providers
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Just came across a new site radRounds which seems like a Facebook counterpart for a Radiologist with a aim of linking radiologists to each other and new opportunities in radiology. Seems like a great idea. Must check.
For Radiology Outsourcing--
Teleradiology Providers
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Here is a case of Glomus Jugulare for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.
Glomus tumours
Synonyms are paragangliomas and chemodectomas
Location is usually jugular bulb, middle ear, carotid body, vagus nerve, periaortic, larynx, ciliary ganglion, mandible, nose and fallopian canal
Origin is embryonic neuroepithelium in close association with autonomic nervous system
4% are functional
4% are metastatic
Mostly benign and hypervascular
Imaging
CT findings-destruction, expansion, involvement of sites as mentioned above no soft tissue component, intense enhancement with salt and pepper appearance.
MRI shows better delineation of characteristics, extent across CV junction, encasement of vessels, involvement of cranial nerves and IAM as well as intracranial extent
Treatment is controversial
For a small lesion may be only radiosurgery
For a bigger lesion combination of surgery with radiation
The Glasscock-Jackson and Fisch classifications of glomus tumors are widely used. The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to mortality and morbidity.
Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)
Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement
Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the pterous apex
Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canal
Type C2 tumor - Tumor invading the vertical portion of the carotid canal
Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal
Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter
Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter
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
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According to Saremi F et al in Radiographics. 2007 Nov-Dec;27(6):1539-65,
"Given its capacity to provide relevant anatomic information in exquisite detail, multidetector computed tomography (CT) has the potential to allow faster and more accurate placement of intracardiac ablation catheters and pacemaker leads relative to the anatomy of interest. High-resolution reformatted images from 64-detector CT data provide accurate anatomic information for locating important landmarks relative to the cardiac conduction system or to current electrophysiologic interventions and cardiac resynchronization therapy."
Seems like yet another upcoming application of Cardiac MDCT.
Teleradiology Providers
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