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Objectives: The study aimed to evaluate the relationship between maxillary sinus volume and various sinonasal anatomical variants, as detected by multi-detector computed tomography, and their associations with chronic rhinosinusitis (CRS). Material and Methods: A case–control study was conducted with 103 patients presenting with chronic sinonasal symptoms (cases) and 50 asymptomatic individuals (controls). A 128-slice computed tomography scanner was used to measure maxillary sinus volume and assess anatomical variants, such as a deviated nasal septum (DNS), concha bullosa (CB), and agger nasi cells. Exclusion criteria included previous sinonasal surgery, malignancy, craniofacial trauma, and lack of consent. Statistical analysis was performed using t -tests for continuous variables and Chi-square tests for categorical data. Receiver operating characteristic curve analysis was utilized to determine a DNS angle cutoff for predicting CRS. Results: Anatomical variants were significantly more frequent in cases than in controls. The left-sided DNS was predominant in cases, while the right-sided DNS was more common in controls. The mean DNS deviation angle was notably larger in cases (10.84° ± 7.87) than in controls (5.55° ± 5.02). Maxillary sinus volume was significantly smaller in cases (9.69 cc on the left side and 10.23 cc on the right side) compared to controls (18.57 cc and 18.46 cc, respectively), with female patients exhibiting smaller volumes than males. Agger nasi cells were detected in 51.5% of cases versus 8.0% of controls. A strong association was found between CB and contralateral DNS. The optimal DNS deviation angle cutoff for predicting CRS was identified as 12.7°. Conclusion: This study shows that CRS is linked to smaller maxillary sinus volumes, with males having larger sinus volumes than females. A DNS and larger deviation angles were associated with a higher risk of sinus inflammation, with angles over 12.7° predicting the onset of the condition. The presence of CB and agger nasi cells also contributed to the development of CRS. [ABSTRACT FROM AUTHOR]

To evaluate and measure the mean cross-sectional area of the tibial and median nerves in patients with diabetic peripheral neuropathy, and to study the association between high-resolution ultrasonographic findings in diabetic peripheral neuropathy with the duration of illness, glycosylated haemoglobin values, random blood sugar levels, and aesthesiometry (using monofilament examination).

Introduction: Neuroimaging plays an important role in the assessment of meningitis, but conventional Magnetic Resonance Imaging (MRI) is insensitive for early and specific diagnosis. Diffusion Tensor Imaging (DTI) can illustrate disturbances in white matter integrity before they become obvious on conventional MRI. Aim: To determine DTI parameters, specifically Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC), in patients with meningitis and compare them with controls. Materials and Methods: This case-control study was conducted over a period of 18 months at Teerthanker Mahaveer Medical College and Research Centre in Moradabad, Uttar Pradesh, India. The study included a total of 61 clinically diagnosed meningitis patients, aged 18 years and above, who were referred to the Department of Radiodiagnosis for an MRI Brain. Additionally, 61 controls were included. Conventional MRI images were obtained followed by DTI. FA and ADC values were calculated by placing Regions Of Interest (ROI) at different levels for both groups. DTI parameters for different causative organisms (bacterial, viral, tubercular, and fungal) were compared. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 24.0, and Analysis of Variance (ANOVA) test was used to identify significant differences. The p-value <0.05 was considered as statistically significant. Results: FA values were significantly lower in cases compared to controls at all levels in the brain (mean whole brain FA value of 0.30±0.036 in cases vs 0.43±0.030 in controls). ADC values were significantly higher in cases at the cerebellum, brainstem, and whole brain levels compared to controls (mean whole brain ADC value of 0.812±0.095 in cases vs 0.758±0.026 in controls) (p-value<0.05 considered statistically significant). These differences were evident in patients with clinically proven meningitis who had a normal appearance on conventional MRI, demonstrating the superiority of DTI over conventional MRI for the diagnosis of meningitis. Statistically significant differences were also found among different aetiological agents, highlighting the potential utility of DTI in the differential diagnosis of meningitis cases (mean whole brain FA of 0.31±0.038 in bacterial cases, 0.029±0.037 in viral cases, 0.299±0.034 in tubercular cases, and 0.27±0.00 in fungal cases vs. 0.43±0.030 in controls (p-value <0.01) and mean whole brain ADC values of 0.80±0.051 in bacterial, 0.85±0.14 in viral, 0.79±0.058 in tubercular, 1.03±0.00 in fungal cases vs. 0.758±0.026 in controls (p-value <0.01)). Conclusion: DTI is more sensitive than conventional MRI and is a useful early indicator of inflammatory process in patients with meningitis. [ABSTRACT FROM AUTHOR]

Background: Pain in the shoulder is the third-most prevalent musculoskeletal pain type. Most frequently involved in tendinopathy/tendon tears is the supraspinatus tendon, followed by a combination of the supraspinatus and infraspinatus tendon. At present, gray-scale ultrasound and MRI are used to determine the tear size, gross morphology, and postsurgical tendon repair. However, they are unable to determine the material characteristics of the muscle or tendon. Aims and Objectives: The aim of this study is to assess the role of ultrasound elastography in the evaluation of the rotator cuff tendon and to compare gray scale ultrasound and shear wave elastography (SWE) findings of the supraspinatus tendon with MRI in patients with shoulder pain. Materials and Methods: This prospective observational study included 50 patients. They were examined using a 1.5-T MRI machine and the ACUSON S3000 (Siemens Medical Solution) machine. The radiologist performing the ultrasound was blinded by the results of the MRI. Results: Age varied from 19 to 75 years. The majority (34%) were in the range of 31-40 years. Males were predominately affected. In MRI, the most common type of injury was mild tendinosis (34%), followed by moderate/severe tendinosis (26%). About 30% were diagnosed with moderate/severe tendinosis, 24% with mild tendinosis, 22% with partial tears, and 18% with full-thickness tears in gray-scale ultrasound. When SWE was combined, 32% were diagnosed with moderate/severe tendinosis, 28% with mild tendinosis, 20% with a partial tear, and 14% with a full-thickness tear. Conclusion: SWE showed better diagnostic performance than gray-scale ultrasound in the detection of supraspinatus tendinopathy. [ABSTRACT FROM AUTHOR]

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner. [ABSTRACT FROM AUTHOR]

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine whether high-resolution ultrasonography (HRUS) can provide information, on signs of inflammation and destruction, due to rheumatoid arthritis (RA). The focus was on the wrist joint, during early and late disease and compared the findings to those with magnetic resonance imaging (MRI). Materials and Methods: The study was based on 31 RA patients, with joint involvements, who were selected from those attending the outpatient rheumatology clinic. The patients completed both HRUS and MRI examinations, and their results were compared. Results: The HRUS and MRI images had near-perfect agreement, for detecting joint anomalies, in those RA patients. While comparing the overall performance of the HRUS and MRI studies, it was observed that HRUS was equal or nearly equal, demonstrating 90.83%, 100.0% and 94.93%, diagnostic sensitivity, specificity, and accuracy, respectively, for diagnosing RA pathologies. Conclusion: The early diagnosis of RA with HRUS and MRI examinations is very important, in the early treatment of RA. The HRUS examinations demonstrated a sensitive and reliable diagnostic method for assessing inflammatory activity and destructive changes in the joints of these RA patients, with HRUS findings comparable to those of MRI. [ABSTRACT FROM AUTHOR]

Byline: Mritunjay. Kumar, Gaurav. Batra, Madhukar. Maletha, Ankur. Malhotra Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a [...]

Background: Pregnancy-induced hypertension (PIH) is associated with significant maternal as well as fetal morbidity and untreated cases may be associated with poor pregnancy outcomes. It brings about various histological and morphological changes in the placenta such as infarcts, fibrosis, and calcification thereby affecting the well-being of fetus. Detection of it at an early stage is important from the point of view of management as early intervention is associated with improved maternal and fetal outcome. Shear wave elastography (SWE) of placenta is a non-invasive investigation that can detect changes in placental elasticity during the pregnancy. Aims and Objectives: The aim of the study was to assess and compare the difference in values of placental elasticity in normal pregnancy and in clinically diagnosed cases of PIH and to study its association with uterine artery-pulsatility index (UtA-PI) and fetal outcome. Materials and Methods: This was a prospective and observational study in which pregnant females with gestational age of 20–34 weeks who were referred to radiology department for routine sonography including the clinically diagnosed pregnancies with PIH were included on the basis of a predefined inclusion and exclusion criteria. A total of 106 individuals were included in the study, B-mode sonography, uterine artery Doppler, and placental SWE were performed in all these patients. All these pregnancies were followed up for the fetal outcome. Results: The mean gestational age of the studied cases was found to be 26.51±4.415 weeks. Higher SWE values were found, as compared to the normal pregnancies, in pregnancies complicated by PIH and the difference was found to be statistically highly significant (P<0.001). Placental SWE showed a strong association with UtA-PI and fetal outcome. Incidence of adverse fetal outcome such as preterm deliveries, intrauterine death, stillbirths, and small for gestational age babies was more commonly seen in PIH group and the difference was statistically significant (P<0.005). Incidence of birth asphyxia (as determined by low APGAR score) and neonatal intensive care unit admissions was more in neonates born to patients with PIH as compared to those in healthy women and the difference was statistically significant (P<0.005). Conclusion: SWE has the potency to detect the changes in placental morphology and can help with diagnosis of pregnancies complicated with PIH. It does have a synergistic role to play alongside the uterine artery Doppler and clinical parameters to predict the pregnancies with PIH. [ABSTRACT FROM AUTHOR]

Objectives To determine the most preferable endoluminal contrast agent among mannitol, polyethylene glycol (PEG), iohexol, and water by comparing various qualitative (distension, fold visibility, and homogeneity) and quantitative parameters (distension) along with artifacts and patient feedback for computed tomography enterography (CTE). Methods This was a prospective study including 120 patients of age more than or equal to 18 years who were randomized equally into four groups. Group 1 was given 1500 mL of 3% mannitol solution, group 2 was given 1500 mL of PEG, group 3 was given 20 mL of iohexol dissolved in 1500 mL of water, and group 4 was given 1500 mL of plain water. CTE was done and images were evaluated in axial and coronal planes. Various quantitative and qualitative parameters were taken at the level of second part of duodenum, jejunum, ileum and ileocecal junction (ICJ). Artifacts and patient feedback were also taken into consideration. Results The quantitative distension and grading, qualitative distension, fold visibility, and homogeneity of the second part of duodenum, jejunum at the level of superior mesenteric artery, inferior mesenteric artery and renal artery on both sides of abdomen, ileum at the level of aortic bifurcation, common iliac bifurcation, and deep pelvis on both sides of abdomen and ICJ were significantly more in PEG group as compared with mannitol group, followed by iohexol and water group. The results were calculated by ANOVA test using p-value. In terms of patient feedback and artifacts, water was the best agent. Conclusions PEG is the most suitable contrast agent to carry out CTE. Distension, fold visibility, and homogeneity are the essential features for a better diagnostic out-come of CTE, which was better with PEG. [ABSTRACT FROM AUTHOR]

Byline: Shraddha. Pore, Suman. Sardesai, Vinay. Tapare, Meghana. Kulkarni, Ankur. Malhotra, Chandrashekhar. Chavan Sir, The role of surgical chemoprophylaxis in caesarean section is well established, [sup][1] but the recommendations about [...]

Introduction: Differentiating calcification from chronic microbleeds on imaging may have important clinical implications. Aim: The present study aimed to evaluate the role and relative advantages of Magnetic Resonance Imaging (MRI) in the detection and differentiation of intracranial calcifications and chronic microbleeds. Materials and Methods: The retrospective study comprised of 100 patients having either intracranial calcifications or microhaemorrhages selected on the basis of Computerized Tomography (CT) and MRI using predefined criteria. Two independent blinded observers evaluated the images qualitatively and quantitatively. Single pixel values were taken in the circular Region of Interest (ROI) on magnitude SWI, phase Susceptibility Weighted Imaging (SWI) and Diffusion Weighted Imaging (DWI) for quantitative analysis. Results: Fifty patients with 76 focal calcifications and another 50 patients with 245 chronic microbleeds formed part of the study. Overall sensitivity of SWI in detection of calcification was 93.9% with good inter observer agreeability (k= 0.7) on phase SWI. All the chronic microbleeds were seen on SWI but there was only moderate inter observer agreeability in evaluation of signal on phase component (k= 0.5). Average pixel values of calcifications and chronic microbleeds were -312.5±187 SD and 541.9±301.7 SD respectively on phase SWI, (p=0.0001, <0.05). Conclusion: SWI can play a pivotal role in the detection of intracranial calcifications and chronic microbleeds and resolving the ambiguity in their diagnosis. [ABSTRACT FROM AUTHOR]

The available evidence suggests positive health outcomes associated with early treatment intensification in Type 2 diabetes mellitus (T2DM). Our study estimated the productivity effects arising from improved health correlated with early intensified treatment in T2DM in Korea. Using a recently published methodology and model, we investigated the association between early intensified treatment and the probability of experiencing fewer diabetes-related complication events. Treatment strategies leading to better health outcomes are expected to be associated with social value through increased participation in paid and unpaid work activities. Therefore, we translated the lower incidence of complications into monetary terms related to productivity for the Korean population. We quantified productivity by considering (a) absenteeism, (b) presenteeism, (c) permanent loss of labor force, and (d) activity restriction. Deterministic and probabilistic sensitivity analyses in the base case parameter were performed. Approximately, 1.7 thousand (standard deviation [SD] ±580 events) micro- and macrovascular complication events could potentially be avoided by early treatment intensification. This led to a societal gain attributed to increased productivity of 23 million USD (SD ± $8.2 million). This article demonstrates the likelihood of achieving better health and productivity through early intensified treatment in diabetes., Competing Interests: Declaration of Conflicting InterestsThe author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F. Tsotra, P. Peristeris, I. Athanasiou, M. Müller are employees of WifOR institute. G. Bader, A. Malhotra are employees of Novartis.