Fwd: Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

To:

Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis p. 476
Gaurav Gangwani, Ajit Yadav, Amit Dhamija, Arun Gupta
DOI:10.4103/ijri.IJRI_162_18  
Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging

Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging
To:

We praise your journal and authors Gonnade et al., on the excellent recent publication titled, "Ganglion impar block in patients with chronic coccydynia."[1] Their study of patients with chronic coccydynia (coccyx pain) showed that ganglion impar injections with local anesthetic block and corticosteroid significantly decreased pain and disability scores even at the maximum length of study follow-up, which was 6-month postinjection.

The authors clearly described injecting the ganglion impar via the sacrococcygeal junction. We would like to point out that other needle approaches can also be done, depending on the patient's anatomy. Specifically, interventional physicians should be aware of alternative approaches via the first[2] or second[3] intracoccygeal joint (between coccygeal vertebral bodies one and two, or between coccygeal vertebral bodies three and fourth, respectively). These approaches have been referred to as being transcoccygeal, intracoccygeal, or coccygeal transdiscal. These newer approaches have some potential advantages. First, since the sacrococcygeal joint is fused in 51% of humans,[4] these newer approaches provide access through joints that are more likely to be patent. Second, human cadaver studies have shown that the ganglion impar is usually located at the upper coccyx, rather than at the sacrococcygeal joint.[5]

We noted that the authors excluded from treatment any patients who had imaging abnormalities that would explain their tailbone pain. This surprised us since our experience is that coccydynia patients often respond extremely well to these impar injections, regardless of whether they do or do not have coccygeal imaging abnormalities. We would be very interested in the authors' thoughts on their exclusion criteria.

We hope our comments and the authors' reply will provide even more insights on relieving pain via these injections.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=482;epage=483;aulast=Foye

Fwd: Drug-induced changes in dentate nuclei of cerebellum Aswani Y, Aswani N, Sharma R - Indian J Radiol Imaging

We read with great interest the article titled "Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy" by Singh et al. in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The article is highly informative and describes signal changes in splenium and dentate nuclei following metronidazole ingestion. In this article, we describe a few drugs that cause similar signal changes in the cerebellar dentate nuclei
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=480;epage=480;aulast=Aswani

Fwd: Role of proton MR spectroscopy in spinal cord lesions: A guarded espousal Agarwal A - Indian J Radiol Imaging

I read with great interest the article titled "3T proton MR spectroscopy evaluation of spinal cord lesions" by Sathyanathan et al. published in the July–September, 2018 issue of the Indian Journal of Radiology and Imaging.[1] The manuscript is well written and informative. The authors have narrated the MR spectroscopy (MRS) protocol and patterns in various intramedullary spinal lesions in a very efficient manner. However, I would like to make the following contributions and observations pertinent to the study.

In their study cohort of 50 patients, the authors have investigated spectral pattern on intramedullary spinal cord lesions. They designated four of them as schwannoma, which is an extramedullary lesion. Literature shows very few case reports of intramedullary schwannoma, which may be found in neurofibromatosis.[2],[3] Even in the subsequent discussion, the MRS pattern of these lesions is not elaborated. So, it will be of great help if authors could clarify my doubts in this regard.

The present study[1] defines the changes in the metabolites in different spinal lesions based on the deviation in their peak values from the normal spectra. In the previous few studies,[4],[5] the results have been expressed in terms of metabolite ratios, which is an absolute quantification method. Therefore, I would like to know about the authors' experience in evaluating the metabolite ratios and their feasibility pertaining to the study.

High signal-to-noise ratio is addressed in the present study[1] by the use of high magnetic field strength (3 T). However, there are spectral reliability indices such as Cramér–Rao lower bounds of each metabolite, mean, and standard deviation of the spectral line width, the coefficient of variations of the measurements, and the group average of the spectra.[5] These quality indicators can be used in future studies for enhancing the spectral quality and dependability.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=481;epage=481;aulast=Agarwal

Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18  
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17  
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

An accurate tool to detect cardiac amyloidosis

Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18  
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y