Synovial plicae in the knee

As mentioned in an earlier post on the infrapatellar plica, there is a pictorial essay on all the synovial plicae in the knee with their corresponding MRI and arthroscopy appearances.

This article is probably the most definitive work on this subject from the radiology perspective.

ACL ganglia and mucoid degeneration

Over the last few years, we have been increasing identifying patients with abnormal ACLs that show features suggestive of mucoid degeneration of intra-ligamentous ganglion cysts. As seen in this T2W image the ACL in mucoid degeneration is abnormally thickened and shows variable increased signal. Near the femoral insertion on this image, there is a multi-loculated cyst, which may represent a ganglion cyst.

A couple of the cases I had seen were reported by Dr. Abhay Narvekar in Arthroscopy. Five cases seemed like a big number, until this article that was published in the May issue of AJR, that deals with 74 examinations that met the criteria for either mucoid degeneration (24%)or discrete ganglia (76%). 35% had features of both.

For those reporting MRI knees on a regular basis, this article is a must to understand these two related entities.

Some things will never makes sense...PAP tests for cervical cancer when the cervix is absent.

A report in the NY Times quotes a study in this week's JAMA that found that almost 68 of all patients with a hysterectomy underwent PAP smears in the preceding 3 years. This amounted to almost 10 million women getting unnecessary PAP smears, almost half the population of women who have had a hysterectomy in the US.

The funny thing is that this is not due to a conspiracy or an attempt at mischief. The problem is attitudinal and based on socio-political issues as well as lassitude. Everyone is so used to getting a PAP smear, that they get it done anyway, irrespective of whether a hysterectomy has been done or not.

Just one of our weird medical facts.

Drug treatment of intracranial hemorrhage

Since this is something that we see day in and day out...

There is an activated recombinant coagulation factor VII that is being used in a large multi-centre trial, in patients who present within 3 hours of an intracranial hemorrhage as diagnosed on CT. This drug is called NovoSeven and has been produced by Novo Nordisk.

When given within 1 hour of diagnosis, it seems to reduce the growth of the hematoma and those on the drug have had a better outcome than those on placebo, according to a press release.

This work is also being presented at the upcoming World Stroke Congress.

STIR chest MRI for lymph node metastases

There is an interesting article published in the June issue of Radiology.

The authors have used a STIR TSE sequence in patients with bronchogenic carcinoma to try and distinguish metastatic from non-metastatic nodes. The criteria were both quantitative (using a lymph node-saline signal intensity ratio) and qualitative (based on the brightness of the node).

In small and large nodes, the sequence performed well, showing a sensitivity of 93% and a specificity of 87% on a per-patient basis for picking up mediastinal lymph node metastases. With qualitative analysis, the sensitivity was 88% and the specificity, 86%.

These results are much better than those obtained with just using the size criterion with CT or MRI. The results are also almost as good as those obtained with FDG-PET, which is where the article really starts becoming interesting.

Practically, if these results can be reproduced at other centres, MRI could become a one-stop shop for staging bronchogenic carcinoma. Instead of using CT, PET-CT or PET in various combinations, one could just do a contrast-enhanced MRI and get all the answers. A whole body STIR can also be thrown in to look for occult metastases elsewhere.

Doctors are not scientists

There is a very interesting editorial in the recent British Medical Journal. Taking a strict definition of a scientist as a person who questions, answers questions, hypothesizes, tries to prove those hypotheses, etc, Richard Smith the editor claims that most of us are not scientists. Which, if we go to see is even more true in India.

Forget scientists, the word "academic" is also used so loosely. Anyone who lectures, organizes conferences and reads articles becomes "academic". A true academic in a very broad sense would basically question, hypothesize and find answers. And the academics in Indian radiology, I am sure can be counted on the fingers of our two hands.

Women's Imaging

For those interested in this subject, there is an interesting article at Medscape based on the ARRS conference held in May.

It describes the current status of this modality in the US of A.

Women's imaging in India is available in the private hospitals and in private clinics and diagnostic centres and mostly consists of ultrasound, mammography and bone density. Ideally hysterosalpinography (HSG) should be part of the services offerred. What is missing is breast and pelvic MRI, which would need additional training and the availabilty of high-field MRI in the same centre. If we go one step further, then uterine fibroid embolization and fallopian tube recanalization can also be performed by women's radiologists.