The results of this systematic review and meta-analysis indicate that CT angiography is an accurate tool for the diagnosis of ruptured intracranial aneurysms and can be integrated as a primary examination tool into the imaging and treatment algorithm for patients with subarachnoid hemorrhage at presentation; the chance of missing a ruptured aneurysm at CT angiography is no more than 2%.

Intracranial Aneurysms in Patients with Subarachnoid Hemorrhage: CT Angiography as a Primary Examination Tool for Diagnosis—Systematic Review and Meta-Analysis

To evaluate the clinical role of CT angiography (CTA) in patients with acute subarachnoid hemorrhage (SAH) for treatment decision-making. Consecutive patients with acute SAH had CTA using a 64-slice scanner for initial clinical decision-making. Image processing included multiplanar volume reformatted (MPVR) maximum intensity projections (MIP) and 3D volume-rendered reconstructions. CTAs were used for (1) evaluating the cause of SAH, and (2) triaging aneurysm-bearing patients to the more appropriate management, either surgical clipping or endovascular coiling. CTA findings were confirmed by neurosurgical exploration or catheter angiography (digital subtraction angiography, DSA). Successful coiling provided evidence that triaging to endovascular treatment was correct. Included in the study were 73 patients. CTA findings were confirmed by DSA or neurosurgical operation in 65 patients, and of these 65, 47 had aneurysmal SAH, 3 had vasculitis, 1 had arterial dissection and 14 had no underlying arterial abnormality. The cause of SAH was detected with CTA in 62 out of the 65 patients (95.4%, sensitivity 94%, specificity 100%). CTA revealed the aneurysm in 46 of 47 patients (98%, sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 82.3%), 1 of 3 vasculitides and 1 of 1 dissection. Of the 46 patients with aneurysm, 44 (95.7%) were referred for treatment based on CTA. In 2 patients (2 of 46, 4.4%) CTA was not informative enough to choose treatment requiring DSA. Of the 44 patients, 27 (61.4%) were referred to endovascular treatment and successful coiling was achieved in 25 (25 of 27, 92.6%). CTA using a 64-slice scanner is an accurate tool for detecting and characterizing aneurysms in acute SAH. CTA is useful in the decision process whether to coil or clip an aneurysm.

Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to "triage" patients' treatment.

Invasive peritoneal disease includes more than just peritoneal carcinomatosis. Although this is the most common aetiology, especially when a primary is found, other conditions may be responsible for peritoneal invasion. A rigorous analysis of CT features taken together with the clinical and biological context usually allows the main differential diagnoses, which entail different types of management, to be drawn out. Pseudomyxoma peritonei, peritoneal lymphomatosis, tuberculosis, peritoneal mesothelioma, diffuse peritoneal leiomyomatosis, and benign splenosis are the main differential diagnoses.

CT imaging of peritoneal carcinomatosis and its mimics.

A Review of Medical Doppler Ultrasonography of Blood Flow in General and Especially in Common Carotid Artery

Review of osteochondroma of mandibular condyle and report of a case series.

Purpose : To determine and compare the diagnostic performance of Dopler sonography of fetal middle cerebral artery (MCA), descending abdominal aorta (DAA), umbilical artery (UA), umbilical vein (UV) and inferior vea cava (IVC) for predictoin of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre-eclampsia (PET). Materials ad Methods : Fifty-eight Singleton pregnancies beyond 30 weeks of gestation complicated by intrauterine growth restriction and severe pre-eclampsia or both were prospectively examined with Doppler US of the UA, MCA, DAA, UV and IVC. Results : Thirty-six patients of the 58 included in the study population had at least one major or minor adverse outcome. Major adverse outcome criteria included perinatal deaths - includinag intrauterine and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage and necrotizing enterocolitis. Minor outcomes included cesarean delivery for fetal distress, APGAR score below 7 at 5 minutes, admission to neonatal intensive care unit (NICU) for treatment. Conclusion S/D ratio of MCA/UA is the most sensitive and specific index in predicting major perinatal adverse outcome (83% and 75%), while umbilical artery S/D ratio is the most sensitive index (66.6%) in predicting any adverse perinatal outcome i.e. including both major and minor outcome. MCA pulsatility index (P.I) is the most specific index (90.9%) for predicting in any adverse perinatal outcome. The sensitivity of the Doppler studies can be significantly increased by studying multiple vessels (91.6%). Hence we conclude that Doppler studies of multiple vessels in the fetoplacental circulation can help in the monitoring of compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of delivery in complicated pregnancies.

Doppler prediction of adverse perinatal outcome in PIH and IUGR

Osteochondroma of the mandibular condyle is fairly rare. We describe a case of this lesion in a 52-year-old woman who presented with symptoms of temporomandibular joint dysfunction. Although a panoramic radiograph demonstrated the bony exostosis, a pre-operative CT examination showed the relationship of the tumour to the condyle and also depicted soft-tissue changes secondary to the growth.

Computed tomographic features of mandibular osteochondroma

We aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity. Indubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed. Imaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications. • Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions.
 • Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis.
 • Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis.
 • Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis.
 • Histological/microbiological confirmation is often necessary to confirm the diagnosis.

/pdf/hepatic-tuberculosis-a-multimodality-imaging-review-950l78d72o.pdf

Hepatic tuberculosis: a multimodality imaging review

Peritoneal carcinomatosis is a term used to describe widespread metastases of cancerous tumors in the peritoneal cavity. It is most common in carcinomas of the gastrointestinal tract (GIT) and ovaries, and must be considered to be the main diagnosis even when the primary is not known. A wide variety of disease processes mimic peritoneal carcinomatosis. Precise diagnosis based on imaging alone is often difficult and very often the final diagnosis is only obtained after appropriate histopathology or microbiology.

CT mimics of peritoneal carcinomatosis

The term stromal tumor was coined in 1983 by Clark and Mazur for smooth muscle neoplasm of the gastrointestinal tract (GIT). Gastrointestinal stromal tumors (GIST) are nonepithelial tumors arising from the interstitial cells of Cajal, which express KIT protein-CD117 on immunohistochemistry. GIST can arise anywhere in the GIT, including the mesentery, omentum, and retroperitoneum.

KV Rajagopal

Papers

Doppler prediction of adverse perinatal outcome in PIH and IUGR

Computed tomographic features of mandibular osteochondroma

Hepatic tuberculosis: a multimodality imaging review

CT mimics of peritoneal carcinomatosis

CT features, mimics and atypical presentations of gastrointestinal stromal tumor (GIST)