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BACKGROUND The advent of Multidetector Computed Tomography (MDCT) has created several important advances in the detection and characterization of renal masses due to its high accuracy, low cost, and easy availability. There is a growing need to separate benign lesions from malignant ones so as to provide an appropriate timely treatment. It can be used with contrast agents and helps in providing data during multiple phases along with the possibility of multiplanar image reconstruction anytime in the future. We wanted to study the role of CT imaging as a diagnostic modality for the evaluation of renal masses. METHODS This is a prospective study conducted among 50 cases, with clinically or radiologically diagnosed renal mass who were referred to our department . A detailed clinical history, thorough clinical examination, ultrasonography and multiphase - CECT using a Philips 128 - slice multi detector scanner (Ingenuity), were performed using the set - protocol followed by multiplanar reconstruction and detailed evaluation. Findings of CT scan were correlated with clinical / biopsy / surgical findings. RESULTS Renal cell carcinoma (RCC) was the most common renal mass in our study group (48 %) followed by renal cyst (30 %). The most common presenting symptom of RCC was haematuria (91.6 %) followed by flank pain (58.3 %). Renal cyst was a fairly common lesion with majority (93.3 %) being BOSNIAK - I category. RCC most commonly showed malignant extension via lymph nodes (83.3 %) while transitional cell cancer (TCC) most commonly spread via ureteric extension (75 %). Inferior vena cava (IVC) extension, even though seen only in a small fraction of cases (4 %), was only associated with RCC. On correlation with histopathological findings, a sensitivity of 95.8 %, specificity of 96.15 % and a diagnostic accuracy of 96 % was found, for diagnosing RCC in our study. CONCLUSIONS MDCT is a robust technique for detection and characterisation of renal mases. It is rapid and easily available with excellent patient compliance. MDCT has excellent sensitivity and specificity for characterisation of renal masses. KEY WORDS MDCT, Renal Mass, Renal Cell Carcinoma, Cyst, Attenuation, Enhancement

Post-traumatic portal venous thrombosis is a rare event, and is usually seen in association with penetrating injuries. Portal venous thrombosis following blunt abdominal trauma is extremely rare with only few reports in the literature, some associated with underlying coagulation disorders. We report multidetector computed tomography findings in a case of blunt abdominal trauma with otherwise normal coagulation profile, which showed shattered spleen and MDCT evidence of acute thrombosis in the right branch of the portal vein. To the best of our knowledge, this is the first documented report of acute portal venous thrombosis in association with shattered spleen.

Introduction: Magnetic resonance imaging (MRI) is the modality of the first choice for evaluation of vertebral compression/collapse. Many MRI qualitative features help to differentiate benign from malignant collapse. We conducted this study to look for a quantitative difference in chemical shift values in benign and malignant collapse using dual-echo gradient echo in-phase/out-phase imaging. Materials and Methods: MRI examinations of a total of 38 patients were retrospectively included in the study who had vertebral compression/collapse with marrow edema in which final diagnosis was available at the time of imaging/follow-up. Signal intensity value in the region of abnormal marrow signal and adjacent normal vertebra was measured on in phase/out phase images. Signal intensity ratio (SIR) was measured by dividing signal intensity value on opposite phase images to that on in phase images. SIR was compared in normal vertebrae and benign and malignant vertebral collapse. Results: There were 21 males and 17 females with mean age of 52.4 years (range 28–76 years). Out of total 38 patients, 18 were of benign vertebral collapse and 20 of malignant vertebral collapse. SIR in normal vertebrae was 0.30 ± 0.14, 0.67 ± 0.18 in benign vertebral collapse, and 1.20 ± 0.27 in malignant vertebral collapse with significant difference in SIR of normal vertebrae versus benign collapse (P < 0.01) and in benign collapse versus malignant collapse (P < 0.01). Assuming a cutoff of

Summary Background Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation. Case Report We present imaging findings in a case of portal annular pancreas in a 45-year-old male patient. Conclusions Portal annular pancreas is a rare and often neglected pancreatic anomaly due to a lack of awareness of this entity. With the advent of MDCT and MRI, accurate preoperative diagnosis of this condition is possible.

Introduction: Back pain is a common clinical problem and is the frequent complaint for referral of lumbar spine magnetic resonance imaging (MRI). Coronal short tau inversion recovery sequence (STIR) can provide diagnostically significant information in small percentage of patients. Materials and Methods: MRI examinations of a total of 350 patients were retrospectively included in the study. MR sequences were evaluated in two settings. One radiologist evaluated sagittal and axial images only, while another radiologist evaluated all sequences, including coronal STIR sequence. After recording the diagnoses, we compared the MRI findings in two subsets of patients to evaluate additional merit of coronal STIR imaging. Results: With addition of coronal STIR imaging, significant findings were observed in 24 subjects (6.8%). Twenty-one of these subjects were considered to be normal on other sequences and in three subjects diagnosis was changed with the addition of coronal STIR. Additional diagnoses on STIR included sacroiliitis, sacroiliac joint degenerative disease, sacral stress/insufficiency fracture/Looser's zones, muscular sprain and atypical appendicitis. Conclusion: Coronal STIR imaging can provide additional diagnoses in a small percentage of patients presenting for lumbar spine MRI for back pain. Therefore, it should be included in the routine protocol for MR imaging of lumbar spine.

Summary Background Robert’s uterus is a very rare müllerian duct anomaly which is characterised by septate uterus with obstruction of a one-sided cavity and formation of hematometra. Therefore, patients present with cyclical abdominal pain during menstruation along with normal menstrual flow. Case Report We present magnetic resonance imaging (MRI) findings in a case of Robert’s uterus in a young woman. Conclusions Robert’s uterus is a very rare anomaly which can be very well characterized by magnetic resonance imaging (MRI). MRI can also show any associated hematometra and endometriomas complicating this condition and aid in the institution of appropriate management in such cases.

Introduction: Elastography is a new technique that aim to assess tissue hardness non-invasively. Recently, it has been used for differentiating benign from malignant lymphadenopathy. Aim: To evaluate the sensitivity and specificity of elastography for differentiating benign from malignant cervical lymphadenopathy and to compare its findings with B-mode and color doppler findings. Materials and Methods: The present study was conducted on 50 patients with cervical lymphadenopathy. In each patient, even if multiple enlarged lymph nodes were found, only one lymph node was sampled which was most suspicious for malignancy. This selection was based on size of the lymph node and other B-mode sonography characteristics. B-mode and color doppler findings were recorded. In addition to this, strain elastography was done and five elastography patterns were defined: high elasticity (soft): pattern I represented no or very small hard area while spectrum pattern V presented where almost whole of lymph node showed hard pattern on strain elastography. Patterns II and III represented hard areas 45% respectively while pattern IV represented peripheral hard area with central soft area (due to central necrosis). Patterns I and II were considered benign. Patterns III, IV and V were considered to represent malignant lymph nodes. Additionally, a cine loop of elastography was acquired for calculation of strain ratio using adjacent muscle as reference. A cut-off value of less then two (

Introduction: Multidetector Computed Tomography (MDCT) provides clinically and surgically important information in bowel obstruction. It can depict the severity, level and cause of obstruction. Aim: To depict the spectrum of MDCT findings in cases of small and large bowel obstruction. Materials and Methods: Contrast enhanced MDCT examination of 50 patients were retrospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Ingenuity CT (128 slice MDCT, Philips Medical Systems). The axial sections were reconstructed in coronal and sagital planes to determine site and cause of bowel obstruction. Results: There were 34 males and 16 females patients in this study with mean age of 28.4 years. The level of obstruction was in small bowel in 39 patients (76.67%) and large bowel in 11 patients (23.33%). Adhesive bands were the cause of Small Bowel Obstruction (SBO) in 17 patients (43.5% of SBO patients). The most common CT signs in adhesive band SBO were beak sign (seen in 70.6% patients) and fat notch sign (52.9% patients). Five cases of SBO were secondary to benign stricture. Matted adhesions were the cause of obstruction in 3 patients. All these patients showed transition zone in pelvis with positive small bowel faeces sign. Two patients with SBO due to adhesive band had evidence of closed loop obstruction with evidence of gangrenous gut on surgery. Large Bowel Obstruction (LBO) was seen in 11 patients. Most common cause of LBO was primary colonic malignancy, accounting for 7 patients (63.6%). In one patient, the cause was direct invasion of hepatic flexure by carcinoma of gall bladder. Other causes of LBO were pelvic adhesions, faecal impaction and ischaemic stricture. Conclusion: SBO is more common than LBO with adhesive bands being the most common cause of SBO. MDCT is very useful for depicting site and cause of obstruction and any associated complications.

Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein.

A 55-year-old male patient presented with backache for 1 month. There was no history of trauma. Haematological evaluation revealed an elevated erythrocyte sedimentation rate. Radiographic examination showed partial collapse of D12 vertebra with suspicious lytic lesion. MRI showed well-defined lytic lesion in D12 vertebral body appearing mildly hypointense on T1-weighted (T1W) images and mildly hyperintense on T2-weighted (T2W) images, with associated radially arranged thickened cortical struts appearing hypointense on T1W/T2W images, mimicking cortical …

Abdominal cocoon formation is a chronic condition which usually presents with intermittent bowel obstruction and is typically described with benign conditions. In developing countries like India, where tuberculosis is endemic, abdominal cocoon in young patients without any other known chronic disease is mostly associated with abdominal tuberculosis. Abdominal cocoon secondary to malignant causes has been reported but is extremely rare, mostly in association with ovarian thecomas. Abdominal cocoon secondary to abdominal tuberculosis has been described only in few reports. We present a case of young female who presented with abdominal cocoon which was subsequently proven to be secondary to diffusely infiltrative gastric carcinoma.

Aorto-esophageal fistula (AEF) is a rare and life threatening condition, which can be rapidly fatal. More than half of such cases are secondary to aortic aneurysm rupture. There are only two previous reports describing AEF caused by penetrating atherosclerotic ulcer. We present multidetector computed tomography findings in a case of AEF secondary to penetrating atherosclerotic ulcer.

We present a case of an adult male who presented with herniation of soft tissues of temporomandibular joint into the external auditory canal (EAC) through a persistent foramen tympanicum. The patient was referred for computed tomography (CT) for suspicious mass in the left EAC. Multidetector CT helped in correctly characterizing the lesion with retraction of the soft tissue mass in open mouth biopsy and thereby avoiding unnecessary biopsy.

A 65-year-old lady presented with sudden onset of palpitations, headache, perspirations and flushing. Clinical examination revealed tenderness in right lumbar region. Ultrasound abdomen revealed multiple hyperechoic hepatic lesions and a mesenteric mass. Contrast-enhanced computerized tomography (CECT) abdomen revealed multiple hypervascular hepatic lesions. Two enhancing mesenteric masses with desmoplastic reaction were seen encasing the mesenteric branches of superior mesenteric artery. Subcentimeter mesenteric nodes were also seen. A small 1.5 cm×1.35 cm enhancing submucosal lesion was noted in the distal ileum (Fig. 1). Diagnosis of ileal carcinoid with mesenteric and hepatic metastases was made. FNAC from hepatic lesions proved the diagnosis. Almost 90% of carcinoids occur in terminal ileum. Carcinoid syndrome is seen in patients with metastases from carcinoid tumors and is characterized by dry flushing, diarrhea and asthma attacks [1]. MDCT has revolutionised the diagnosis of primary ileal carcinoid, as subcentimeter masses can be diagnosed with confidence while other indirect signs like mesenteric mass with desmoplastic reaction acting as supportive evidence [2].

Annular pancreas is a well-known developmental anomaly. It usually presents in neonatal period with duodenal obstruction due to pancreatic tissue enveloping the second part of duodenum. It is associated with other anomalies such as Down's syndrome, duodenal atresia, and Hirschsprung disease. Presentation in adults can be due to pancreatitis or obstruction. While complete annular pancreas is well described in literature, imaging appearance of incomplete annular pancreas is only described recently. We present imaging findings in two cases of partial annular pancreas.

Extraosseous fat-fluid level is a rare but specific sign of hematogenous osteomyelitis. It results due to marrow necrosis due to infection with the release of fat globules and pus which extends into periosseous tissues through bony erosions. To form a fat-fluid level, the marrow necrosis has to be extensive which is not always present. However, when present and in appropriate clinical settings, it is fairly specific for hematogenous osteomyelitis. We describe radiographic, computed tomography, and magnetic resonance imaging findings in a case of osteomyelitis with extraosseous fat globules and fat-fluid level.

A 40-year-old man presented with right hypochondrial and epigastric pain and tenderness. There was no history of jaundice or vomiting. Serum alkaline phosphatase was mildly elevated (170 IU/L). His ultrasound was suggestive of gall bladder worms or stones. MRI revealed curvilinear hypointense structure in the gall bladder (Fig. 1); this suggested the diagnosis of gall bladder ascariasis. Common hepatic and bile ducts were normal. Stool examination revealed ova of Ascaris lumbricoides. The patient was given analgesics and albendazole (400 mg single dose). Three days later, he reported relief of symptoms and passage of worm in the stools. Ultrasound done 4 days later showed no worm in the gall bladder. The adult worm of ascariasis usually resides in the small bowel. It can occasionally migrate into biliary system. Involvement of gall bladder is rare because of the small size of cystic duct [1]. Ultrasound is the usual imaging modality for diagnosing gall bladder ascariasis which demonstrates it as curvilinear echogenic structure [1]. In cases which are inconclusive on sonography, MRI may show curvilinear hypointense structure in the gall bladder lumen, while gall stones typically appear as rounded objects of signal void [2]. MRI also allows simultaneous visualization of common hepatic and common bile ducts. Gall bladder ascariasis is usually treated by surgery and endoscopy. Occasionally, medical therapy may lead to spontaneous passage of worm, as happened in our case.