Nepalese Journal of Radiology

RADCON

Sundar Suwal — 2024-04-25

No abstract available.

Role of MRI in the diagnosis of Actinomycosis: A Case Report

Aalok Kumar Yadav — 2024-04-25

Actinomycosis is caused by non-spore-forming, anaerobic, gram-positive bacteria called actinomyces. Its wide range of manifestations and non-specific symptoms cause complications by delaying diagnosis. We here present a case of a 34-year-old female with a history of recurrent discharging sinus and skin rashes in the posterior chest wall for 1 year and 6 months. Initially, it was suspected of malignancy with secondary infection. The patient was advised for MRI which shows suspicion of actinomyces. Later on, it was confirmed with a biopsy of the posterior chest wall. Here we present a case to describe the role of MRI in the diagnosis of actinomycosis.

Balloon Assisted Transvenous Coil Embolization of Posttraumatic Direct Carotid-Cavernous Fistula with the Successful Outcome: A Case Report

Shailendra Katwal — 2024-04-25

A carotid cavernous fistula (CCF) is an abnormal connection between the internal carotid artery and the cavernous sinus. This case pertains to a 19-year-old male who presented with left periorbital swelling following a road traffic accident and was found to have direct CCF on imaging. The patient underwent balloon-assisted transvenous embolization, with access to the fistula being gained through the femoral vein and the inferior petrosal sinus. The use of coils successfully blocked the fistula, leading to the resolution of symptoms without any complications. This case underscores the significance of a multidisciplinary approach and the effectiveness of balloon-assisted embolization.

An Unusual Presentation of Giant Schwannoma of Hand: A Case Report

Sudeep KC — 2024-04-25

Peripheral nerve sheath tumors are uncommon. Peripheral nerve tumors (PNTs) constitute less than 5% of all hand tumors. Schwannomas, also known as neurolemmas, are benign tumors of the peripheral nerve sheath arising from Schwann cells. The median nerve schwannomas account for 0.1-0.3% of all cases. Here is a case of a seventeen-year-old male who presented with a painless lump on the thenar aspect of the left hand simulating lipoma clinically. The patient underwent various imaging modalities including Magnetic Resonance Imaging (MRI) which suggested a peripheral nerve sheath tumour most likely Schwannoma. The lesion was excised under the regional block and was confirmed as Schwannoma histologically.

Osteomyelitis in a Paediatric Patient with Sub-periosteal Abscess, Septic Pulmonary Emboli and Pneumothorax: A Case Report

Ongden Yonjen Tamang — 2024-04-25

Osteomyelitis is an inflammatory disorder affecting bone and adjacent tissue that primarily arises from pyogenic bacteria, often involving the metaphysis of long bones in pediatric patients through hematogenous spread with the common pathogen being Staphylococcus aureus. Complications such as pathological fractures, sinus formation, and abscesses, may occur. Septic pulmonary embolism (SPE), a rare complication, can lead to infarctions and abscesses in pulmonary vessels. Pneumothorax secondary to SPE can also occur, emphasizing the importance of considering these complications in patients with features of sepsis.

Diffusion Tensor Tractography in Patient with Cervical Spondylosis and Correlation with Clinical Findings

Mahesh Gautam — 2024-04-25

Introduction: Diffusion tensor imaging is a non-invasive advanced method that provides information on white matter microstructural integrity. Fractional anisotropy and apparent diffusion coefficient have been used to quantify the degree of axonal damage and demyelination. The study aims to assess the role of diffusion tensor parameters in detecting early myelopathic changes and correlate them with clinical findings.

Methods: This cross-sectional prospective study including 60 patients with clinical history of cervical myelopathy was carried out at the Department of Radiology from June 2021 to July 2022. Nurick score was used to assess the severity clinically and diffusion tensor images of the cervical spine were obtained using 3 Tesla MRI. These diffusion tensor values at the level of maximum stenosis were compared with those of the non-stenotic level. A correlation between the diffusion tensor parameters and clinical Nurick score was done.

Results: The fractional anisotropy values were significantly lower (0.51 ± 0.14 vs 0.76 ± 0.47) and apparent diffusion coefficient values were significantly higher (1.20 ± 0.20 vs 1.04 ± 0.12) at the level of maximum stenosis compared with non-stenotic levels. There was a moderate positive and strong negative correlation between the apparent diffusion coefficient and fractional anisotropy values with the Nurick score.

Conclusions: A significant reduction in the fractional anisotropy and an increase in apparent diffusion coefficient values at the level of stenosis was observed in individuals without a high T2 signal within the cord. Thus, these parameters might have a potential role in the early diagnosis of cervical spondylotic myelopathy

Radiographic Evaluation of Neonatal Respiratory Distress: Cross-Sectional Study on Chest X-ray Findings in the Neonatal Intensive Care Unit

Sundar Suwal — 2024-04-25

Introduction: Neonatal Respiratory distress (NRD) is a common reason for admission to the Neonatal Intensive Care Unit (NICU). While clinical diagnosis is essential, imaging evaluation can help confirm lung lesions, their extent, and associated abnormalities. However, radiation exposure from imaging modalities such as Computed Tomography (CT) and Chest X-ray (CXR) is a concern, particularly for neonates. This study aims to identify the various CXR findings in neonates with respiratory distress in the NICU.

Methods: A quantitative cross-sectional study was conducted on 59 neonates with respiratory distress in the NICU from November 2019 to November 2020. Ethical clearance was obtained, and data were collected through portable CXR. The collected data were analyzed using Microsoft Excel 2016 and Statistical Package of Social Services (SPSS) IBM version 23.

Results: CXR findings of 59 neonates with a mean age of 15.9 ± 7.4 days were evaluated. The majority were premature neonates, and the most common clinical diagnosis was respiratory distress syndrome (RDS). Hypoaeration was the most common finding in lung fields, followed by normal aeration. Parenchymal changes were observed in most cases, with reticulations/haziness being the most common, followed by consolidation. Pleural effusion was seen in a few cases, predominantly in preterm neonates with RDS.

Conclusions: The study underscores the prevalence of hypoaeration, reticulations, and consolidations in NICU patients with RDS, emphasizing the importance of early diagnosis and future research in neonatal chest imaging for respiratory distress.

Role of Sonoelastography in Differentiating Benign and Malignant Breast Lesions: A Prospective Study Comparing Elasticity Contrast Index and Tsukuba Score

Amlendu Kumar — 2024-04-25

Introduction: Breast cancer is the most common cancer occurring in women globally which is potentially curable if detected early. Ultrasound elastography is a dynamic technique that estimates tissue stiffness to differentiate between benign and malignant masses. Our study aimed to determine and compare the diagnostic accuracy of B mode Sonography, Elasticity contrast index, and Tsukuba score in differentiating malignant and benign breast masses.

Methods: This was a prospective cross-sectional study done including 110 lesions in 102 patients in the age group of 15-73 years. The solid breast lesions seen on sonography were categorized according to the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) and further evaluated with elastography using both Elasticity Contrast Index (ECI) and Tsukuba score with pathological diagnosis taken as the gold standard. The cut-off value of ECI was obtained. The diagnostic accuracy of B-mode sonography, ECI, and Tsukuba score was compared.

Results: We found that B-mode sonography had a sensitivity of 85.7%, specificity of 100%, and accuracy of 96.9 %. The accuracy of Tsukuba scores for differentiating benign and malignant lesions was 81.2%. The cut-off value of ECI obtained was 2.8 and the accuracy was 81.8%. A statistically significant correlation (p < 0.05) existed between sonographic diagnosis, ECI, and Tsukuba score.

Conclusions: B mode sonography had the highest diagnostic accuracy while ECI and Tsukuba scores were comparable. ECI can be used for breast masses using a cut-off of 2.8 to differentiate benign from malignant.

Evaluation of the Thickness of Ligamentum Flavum at the Level of Lumbosacral Spine (L4-L5, L5-S1) and its Relationship with Degenerative Disc Changes in Patients Undergoing MRI of Lumbosacral Spine

Sudeep KC — 2024-04-25

Introduction: Low back pain (LBP) is a very common cause of disability in working-age adults; with degenerative changes being the predominant cause apart from anatomical factors. Degenerative changes in the lumbar spine are associated with the alteration of the thickness of the Ligamentum Flavum (LF), which predisposes to clinical symptoms.

Methods: This was a prospective study conducted among ninety symptomatic (LBP) patients who underwent magnetic resonance imaging (MRI) and the images were evaluated to measure the thickness of the LF and evaluate the degree of disc degeneration by the Pfirrmann grading system, according to the spinal levels (L4-L5, L5-S1). An association was sought between LF hypertrophy and disc degeneration, age, sex, and disc height.

Results: The result of this study showed that with increasing age thickening of the LF could lead to degeneration of the intervertebral disc. Thickening of the LF was more at the level of L4-L5 level than at the L5-S1 level with right-sided increased thickness more than on the left and is associated with increased grade of disc degeneration. Females had slightly more thickened LF than the males at the L4-L5 level with no gender predominance at the L5-S1 level.

Conclusions: Thickening of the ligamentum flavum may be an important factor in the origin of LBP, especially in the adult population. A degenerative process in the ligamentum flavum that occurs with age and also suggests the thickening of LF due to mechanical stress at the lumbar level would ultimately result in degeneration of the disc.