Comparison of ultrasound and magnetic resonance imaging findings in evaluation of fetal congenital anomalies: A single-institution prospective observational study

Background

This study aimed to compare the ultrasound (USG) and fetal magnetic resonance imaging (MRI) findings in the evaluation of congenital fetal anomalies and to determine whether the management is changes significantly if MRI is combined with USG.

Methods

In this prospective observational cohort study, we performed fetal MRI in 90 consecutive cases of fetuses diagnosed or suspected as having congenital anomalies on a prior level II USG scan. We then compared the USG and MRI findings of each anomaly according to the diagnostic information yielded by each modality.

Results

Of 90 fetuses examined during 1 year study period, MRI and USG findings were equivalent in 13.3% of cases. MRI provided additional information in 68.8% cases, of which pregnancy management was changed in 5.6% cases. MRI provided additional information but did not change management in 63.3% of cases. USG provided additional information but did not change pregnancy management in 17.8% of cases. The difference was statistically significant with a p value of .000.

Conclusion

Fetal MRI is a significantly better modality than USG for detecting additional findings in anomalies of specific organ systems. Because of its high diagnostic yield for central nervous system (CNS) anomalies, it can be combined with USG for this subgroup. For non-CNS anomalies of genitourinary system, thorax, or in syndromic/complex malformations/conjoint twin pregnancy, it may be used as an adjunct to USG on a case to case basis. MRI has the potential to change the pregnancy management in few cases, but benefit is small to advocate a complete integration of MRI and USG for fetal anomaly scanning at present.

The Morphology and Morphometry of the Human Interthalamic Adhesion Using Cadaveric Brains and Magnetic Resonance Images and Their Clinical Significance

AIM

An interthalamic adhesion (ITA) is a midplane rod-like neuroanatomical mass connecting two thalami over the cavity of the third ventricle. It is present in approximately 70-80% of healthy humans. The absence of an ITA has been considered as a midline defect of the brain associated with schizophrenia. The aim of the present study was to determine the prevalence, location, and dimensions of ITAs in Indian brains.

MATERIAL AND METHODS

We examined 100 brains (50 cadaveric and 50 MR images) in the midsagittal plane for the presence or absence of ITAs, their location in the lateral wall of the third ventricle, and dimensions.

RESULTS

ITA found in 87 brains (87%), four showed duplication (4%). Both its duplication and absence were more frequent among male. It was most commonly located in the anterosuperior quadrant with posterosuperior extension. The mean of horizontal diameter (7.13±4.31 mm) was longer than the vertical (5.13 ±3.17) in all the brains. Its average area (37.98±41.47 mm2) showed huge variation (ranges between 4.40 mm2 to 203 mm2) and was significantly higher in females (61.23±56.22 mm2) than males (36.44±43.21 mm2) (p = 0.026). No correlation was found between the surface area of the ITA and the length of the third ventricle.

CONCLUSION

Absence and duplication of ITA are fairly common in Indian brains with significant male predominance. Morphometric data are robust to advocate for the presence of sex differences in the ITA size, although not associated with surrounding thalamic or third ventricle anatomy.

Diversified migrational abnormalities in a child with seizure: imaging findings

Numerous migrational abnormalities can be seen in children presenting with seizures or developmental delay which depend on the time of insult and includes various anomalies including cortical malformation,schizecephaly, and heterotopia.CT has very low sensitivity in detecting these abnormalities.MRI is the investigation of choice due to its excellent soft-tissue resolution,grey-white matter differentiation, and multiplanar capability. The radiologist must prepare an algorithm for diagnosis to avoid missing these lesions and guide the clinician in the appropriate management.

Vertebral arteriovenous fistulae in neurofibromatosis type1: a systematic review and meta-analysis

INTRODUCTION

Vertebral Arterio-venous fistulas (VAVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. Among spontaneous cases, it is most commonly found to be associated with Neurofibromatosis type 1 (NF1).

EVIDENCE ACQUISITION

We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities and outcome of VAVFs associated with NF1. A literature search was performed by using databases PubMed Central, Embase, Cochrane Library, and Ovid MEDLINE. Also, the grey area search was done using the "Google Scholar" search engine. On screening of the original full-text English language articles, a total of 48 cases were considered suitable for inclusion in this review.

EVIDENCE ANALYSIS

VAVFs in NF1 commonly present between 3rd and 6th decade of life affecting females 2.4 times more than males. Left-sided fistulae were more common than the right side and most seen in the upper V2 segment of the vertebral artery. Most VAVFs in NF 1 patients were treated with constructive (occlusion of fistula only) endovascular therapy (n =26) with a high success rate. Moreover, Pooled proportion of the outcome data have shown significant difference between the endovascular constructive and destructive procedure.

CONCLUSIONS

The spontaneous VAVF, commonly associated with NF-1, often requires treatment. Awareness of the coexistence between NF1 and VAVF is crucial to avoid diagnostic delays and unnecessary surgical intervention leading to disastrous outcomes. Endovascular treatment is the preferred treatment approach while open surgical treatment is required in some complex fistulae and failure of endovascular techniques.

Superior semicircular canal dehiscence: A new perspective

Objective

To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its association with ear pathologies and to find whether it is an acquired condition and its association with increase in age.

Materials and methods

study was performed in a tertiary care institute present in a village, following approval of the institutional ethical committee. Retrospective review of temporal bone CT examinations performed between September 2016 and March 2017 was done. 1 mm interval axial images with sagittal and coronal reformatted images were reviewed for the presence of canal dehiscence and thinning by investigators. We characterised the Superior semicircular canal status as normal, frank dehiscence or thinning. Frank dehiscence was further classified anatomically as anterior limb, apex and posterior limb dehiscence.The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group.

Results

Retrospective review yielded 80 positive cases which included SSC dehiscence (N = 39) and thinning (N = 41). 80 normal scans were selected as control group retrospectively. Statistical analysis was performed to assess for differences between the groups studied. Pearson chi-square test applied. there was a significant association of SSC pathologies prevalence with increasing age (p = < 0.001). No significant relationship was found between SSCD and presence of either CSOM or Cholesteatoma (p = 0.285). Vertigo rather than Tullio phenomenon was the statistically significant complaint (p = <0.001). which brought the patient to the hospital.

Conclusions

The SSCD and thinning belong to the same spectrum and are acquired conditions. Increasing prevalence in old age suggests it to be an acquired condition rather than a congenital one. No significant association of these condition was seen with CSOM and cholesteatoma. Vertigo is the predominat symptom bringing the patient to hospital along with Tullio phenomenon.

Neglected vaginal foreign body leading to vaginolith, vesicovaginal fistula and vesical calculus formation in an adolescent girl

Vaginal foreign body insertion is not an uncommon clinical entity; however, long-standing neglected vaginal foreign body causing vaginolith, vesicovaginal fistula and vesical calculus formation is unusual. We present a case of a neglected vaginal foreign body (plastic cap of a nail colour) leading to vesicovaginal fistula, vaginolith and vesical calculus formation in a 12-year-old female child presenting with continuous dribbling of urine per vagina. Diagnosis was confirmed on ultrasonography, non-contrast CT scan and MRI of the pelvis. The MRI demonstrated the exact size and site of the urinary bladder wall defect, besides the foreign body and the vesical calculus. The foreign body along with vaginolith and the vesical calculus were removed via suprapubic approach under general anaesthesia; the fistula was repaired by suturing the urinary bladder and vagina wall defect.