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ABSTRACTS OF PAPERS PRESENTED AT THE 94TH RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 11TH FEBRUARY 2002, 2.30 PM SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)
1. CT of the Colon
Devang Desai, Inder Talwar, Meher Ursekar
CT is often performed for diseases of the colon. It is useful for examining the relationships between colonic lesions and adjacent structures. CT is an excellent method to evaluate the wall of the colon, and is an adjunct to barium studies in evaluation of a patient with colonic disease.
Optimal CT evaluation of the colon requires bowel preparation by cleansing and luminal distension, to evaluate the true thickness of its wall (normal < 3 mm). Iodinated contrast medium, instilled per rectally, or air insufflation, are both good methods to achieve this objective. Diagnostic evaluation is facilitated by intravenous contrast. Aside from evaluating upper abdominal solid organs, it allows evaluation of the bowel wall, and aids in differentiating causes of colonic wall thickening.
2. VERTEBROPLASTY
Ashish Jhunjhunwala, Kiran Nimje, DB Modi
Vertebroplasty is simple, minimally invasive procedure
- offers a remarkable therapeutic option for patients suffering from osteoporotic or tumour related fractures and pain.
- consists of image guided injection of a bone cement, most commonly polymethylmethacrylate (PMMA) into a fractured or disrupted vertebral body.
- advantage of both achieving pain relief and restoring bone biomechanical strength.
- Safe, effective treatment for non-infective, painful destructive vertebral lesions, whether benign or malignant, as well as osteoporotic vertebral fractures in which conservative therapy fails.
3. IMAGING FINDINGS IN THE BRAIN IN HIV POSITIVE PATIENTS
Devang Desai, Inder Talwar, Meher Ursekar
CNS complications in AIDS patients are common and often the cause of severe morbidity and mortality. Most symptomatic CNS complications in AIDS patients involve the brain, principally in the form of HIV encephalitis, various other forms of infection, or development of neoplasms. The most obvious reason for this is the reduction in capability of the immune system to fight common pathogens. The imaging findings are important to recognize because in many instances the underlying brain lesions are responsive to medical therapy.
The most common type of brain involvement in AIDS are:
1. HIV alteration of white and grey matter resulting in HIV encephalopathy and HIV dementia.
2. Opportunistic infections amongst which the most common are tuberculosis and toxoplasmosis.
3. Tumours with lymphoma as the leading type.
The imaging diagnostic accuracy of CNS symptoms in AIDS is low. Yet, CT with intravenous iodinated contrast, and MRI with gadolinium injection, can both demonstrate lesions in the brain due to HIV, though MRI has much higher sensitivity. Proton MR spectroscopy is useful for detecting neuronal damage, and correlates well with atrophy and clinical neurological signs. MRI with MRS may increase the sensitivity of detection of HIV involvement of the CNS, but this is under evaluation.
SPECT and FDG-PET also have a large role to play in the imaging of AIDS patients, and are extremely useful in differentiating lymphoma from other non-neoplastic lesions.
4. OBSTRUCTIVE UROPATHY ON RENAL SCAN NUCLEAR RENOGRAPHY
Ritu Bhanot, Vinay Goyal
It is a dynamic study performed after IV injection of a radiopharmaceutical (DTPA/EC) which is excreted by the kidneys.
The renogram obtained by the Gamma Camera is more accurate, and moreover sequential images can be obtained which offers important information for the interpresentation of the study.
Role of renal scan in investigation of obstructive uropathy is significant, as it alone can offer simultaneous quantification of renal function and dynamic analysis of individual urine flow rates - the two most important parameters in obstruction.
Diuresis Renography
To distinguish between Stasis and Obstruction, Diuresis renography is 'Gold-Standard' (for investigation of urinary tract obstruction)
Common causes : Idiopathic HDN or PUJ obstruction which may be due to:
- truly idiopathic
- neuromuscular defect at PUJ.
- secondary to previous surgery.
- calculus disease. o ureteric polyp
- aberrant lower pole vessels, kinks, adhesions, etc.,
- VUR
Advantages Over Other Studies
- No catheterisation (MCU)
- Lower radiation doses (Infant, Transplanted kidney, serial studies)
- Simultaneous assessment of renal function.
- Monitoring progress .
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