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Introduction: Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of gastrointestinal tract. A high postsurgical recurrence and metastatic rate have created a need for a presurgical risk profile identification system. Aim: To assess the association between morphological Computed Tomography (CT) parameters with the pathological risk profile and analyse which CT features can predict the risk grading of GISTs. Materials and Methods: This was a retrospective cohort study based on imaging and histopathological data of 26 patients with pathologically proven GISTs presenting to the Department of Radiodiagnosis of a tertiary hospital in the northern Indian Himalayan foothills over a period of five years from July 2018 to June 2023. CT imaging features including size, growth pattern, margins, enhancement, calcifications, necrosis, intralesional haemorrhage, enlarged feeding vessels, direct organ invasion, and associations such as ascites and lymphadenopathy were studied. All lesions were classified as per Miettinen risk classification into no risk, very low-risk, low, moderate, and high-risk lesions. Analysis was done by the Chi-square test. Predictive analysis was carried out by computing the odds ratio and performing regression analysis on significantly associated imaging features. Results: Out of 26 patients, the study group comprised 16 males (61.54%) and 10 females (38.46%). The most common decade of presentation was the 6th decade with the mean age of presentation being 55.81±4.23 years. Twelve patients were grouped under intermediate to high-risk grading. Lesion size >5 cm (p-value=0.0171, OR=19.12), ill-defined margins (p-value=0.0048, OR=18.33), intralesional necrosis (p-value=0.0053, OR=19.8), and enlarged feeding vessels (p-value=0.012, OR=21.27) were identified as imaging features with significant association and predictive ability for high-risk lesions. The strongest predictive ability for a high-risk profile was shown by ill-defined margins (R2=0.381) and intralesional necrosis (R2=0.3287). Conclusion: A preoperative Contrast Enhanced Computed Tomography (CECT) assessment provides a comprehensive imaging profile for GISTs as well as a fair accuracy of risk profile prediction via various singular and clustered morphological parameters.

Objective Aim of this study is to evaluate the effect of craniospinal interventions on cerebrospinal fluid (CSF) flow hydrodynamics and study the correlation of postoperative changes in flow alteration with clinical outcome. Materials and Methods Fifty patients who underwent various craniospinal procedures were studied using conventional and phase-contrast magnetic resonance imaging (PCMRI) protocol. CSF flow quantification was performed at cerebral aqueduct, foramen magnum, C2–3, and D12–L1 vertebral levels with site showing maximal alteration of CSF flow dynamics considered as the region of interest. Velocity encoding was kept at 20 cm/s. Patients with pathology atcraniovertebral junction were considered separately (group I) from others (group II) due to different flow dynamics. Follow-up scans were performed after an interval of 1 month for temporal evaluation of changes in CSF flow dynamics. Results Patients in both groups showed a significant change in peak CSF velocity postoperatively (mean change of 1.34 cm/s in group I and 0.28 cm/s in group II) with bidirectional improvement in flow on cine-phase-contrast qualitative images. Regional pain (82%) and headache (46%) were seen in most of the patients preoperatively. Postoperatively clinical symptoms improved in 59.5%, static in 26.2%, and worsened in 14.3%. In both the groups, an improvement in clinical symptomatology had significant correlation with mean changes in peak CSF velocity postoperatively (p = 0.04 in both groups). Conclusion PCMRI can effectively evaluate changes in CSF flow noninvasively both pre- and postoperatively. This may have potential role in determining clinical outcome and prognosis of patients undergoing procedures in craniospinal axis.

Introduction: The popliteal artery branching pattern has multiple variations which have implications in the outcomes of various surgical procedures. Amongst cadaveric, Computed Tomography (CT) angiographic and Digital Subtraction Angiographic (DSA) studies, Multidetector Computed Tomography (MDCT) Angiography provides a comprehensive, quick and efficient evaluation of the popliteal arterial anatomy along with surrounding structures and related pathologies of the vascular and non-vascular structures. Aim: To evaluate the patterns of popliteal artery division on MDCT angiography of lower limb in patients presenting to a tertiary medical institute in Northern India. Materials and Methods: This retrospective descriptive study was conducted in the Department of Radiodiagnosis at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India (tertiary care medical institute of Northern India). Patients presenting for a period of one year from April 2021 to March 2022 were included in the study. The MDCT angiographic findings of 152 patients who were evaluated for various illnesses, including peripheral vascular disease, popliteal arterial aneurysms, and trauma were analysed. The branching pattern of popliteal artery was evaluated according to the classification system provided by Kim DU et al. Morphometric analysis of popliteal artery, including diameter was also done. The imaging based data was collected and analysed by two radiologists. Chi-square test was used for statistical analysis. Results: The mean age of the patients was 54.18 years with male predominance of 110 (72.37%). Amongst the 304 limbs available for evaluation, the data from six limbs could not be assessed due to atherosclerotic blockage in four patients, extensive calcification in one patient and amputation in one patient. Hence, 298 limbs were evaluated on MDCT angiography for the pattern of branching of popliteal artery. Type IA was the most common pattern of division seen in 268 limbs (89.93%). Out of 298, 30 limbs showed variant anatomy, with unilateral variation in 18 patients and bilateral variation in six patients. Type III pattern (n=12, 4.03%) was more common than Type II pattern (n=11, 3.6%) in the study group. Conclusion: The knowledge of variations of popliteal arterial division and meticulous evaluation is essential to provide a successful roadmap for therapeutic measures.

Introduction: Cerebral Microbleeds (CMBs) are increasingly recognised as an important predictor of small vessel disease and cannot be detected on routine Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) sequences. Aim: CMBs on MRI and to compare the sensitivity of Susceptibility Weighted Imaging (SWI) and T2* Gradient Recalled Echo (GRE) sequences in detection of these microbleeds. Also, to evaluate association between topography (size, number and location) of CMBs and various risk factors. Materials and Methods: This Prospective Observational analytical study comprised of 67 patients with CMBs who were evaluated with Siemens 1.5 Tesla MRI machine. T2*-weighted GRE sequence and SWI were taken in all the patients in addition to routine MRI sequences. Two observers blinded to clinical information, independently interpreted the T2*GRE and SWI sequences. Both observers recorded the topographical details of CMBs which included presence, number, size and location and their association with various risk factors (hypertension, diabetes, smoking and hyperlipidemia). Inter-rater agreement for the number of CMBs on SWI and T2*GRE was calculated using Cohen’s Kappa (κ) as measure of agreement. Intra-Class Correlation Coefficient (ICC) for reliability index in test-retest, intra-rater and inter-rater reliability was also analysed. The intrarater reliabilities of each rater were compared. The correlations between CMBs and risk factors was performed with Pearson’s correlation Coefficient (r). The p-value

Introduction: Vocal Cord Palsy (VCP) is a common clinical presentation and must be considered as a sign of underlying disease, rather than simply a diagnosis unto itself. Despite of idiopathic causes in nearly half of the cases, imaging studies are still indispensible for evaluating the varied aetiologies. Most of the signs of VCP are clearly demonstrable on axial Computed Tomography (CT) sections except one i.e., flattening of ipsilateral subglottic arch which needs specific evaluation only on coronal reformatted images. The diagnostic value of this sign is still debatable. Aim: To evaluate any additional advantage offered by coronal reformatted images in cases of unilateral VCP especially those with confusing/equivocal findings and to find out most reliable signs of unilateral VCP on axial CT sections. Materials and Methods: This retrospective study comprised of patients with clinical suspicion of VCP who were referred for CT neck and thorax in Department of Radiology at tertiary care hospital in the previous 36 months (July 2014 to June 2017). Only the cases with laryngoscopically confirmed unilateral VCP were included. The cases with laryngeal malignancy were excluded. Various imaging signs of unilateral VCP were evaluated on both axial and coronal reformatted images. Spearman’s rho (ρ) correlation coefficient was calculated to assess correlation between most frequent signs of unilateral VCP individually and also with flattening of ipsilateral subglottic arch (evaluated on coronal reformatted images). Results: Thickening and medialisation of ipsilateral aryepiglottic fold was uniformly present in all the cases of unilateral VCP. Two other most frequent signs which correlated strongly with unilateral VCP were dilatation of ipsilateral laryngeal ventricle (n=29, 93.5%) and dilatation of ipsilateral pyriform sinus (n=27, 87%). Flattening of ipsilateral subglottic arch on coronal reformatted images was seen in only 26% patients. This sign was absent in all four cases with equivocal and contralateral findings in present study. Conclusion: The coronal reformatted images failed to demonstrate any additional advantage over axial sections in diagnosing unilateral VCP even in equivocal or difficult cases. The thickening and medialisation of ipsilateral aryepiglottic fold on routine axial CT images is probably the most reliable and consistent sign for diagnosing unilateral VCP with dilatation of ipsilateral laryngeal ventricle and ipsilateral pyriform sinus as two other major supportive signs.

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,

Objective: To qualitatively and quantitatively differentiate leptomeningeal and vascular enhancement on Post-contrast Fluid Attenuated Inversion Recovery (PCFLAIR) sequence compared to post-contrast T1-weighted (PCT1W) sequence with fat suppression (FS) and evaluate its role in early detection of infectious meningitis. Materials and Methods: Thirty-one patients with diagnosis of meningitis were evaluated with pre and post-contrast FLAIR and T1-weighted sequences with fat suppression (FS). Qualitative assessment was done by two observers for presence, absence or equivocal status of leptomeningeal enhancement. Further, quantitative estimation of single pixel signal intensities (SPSI) for meningeal and vascular enhancement was undertaken. A statistical comparison was performed using Kappa coefficient and t-test. Results: The overall qualitative accuracy was 90.3% for PCFLAIR compared to 54.8% for PCT1W with FS sequence. PCFLAIR was found to be 100% accurate in the detection of tubercular and pyogenic meningitis and 70% accurate in the detection of viral meningitis while PCT1W with FS sequence showed the corresponding accuracy to be 76.2% and 0% respectively. Both observers rated PCFLAIR images better than PCT1W with FS at detecting meningitis (p