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All Posts in Category: MRI

Prostate Cancer in India

by Dr. Anuradha Shah

Prostate cancer is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide.

The prevalence of prostate cancer in India is now similar to the Western countries due to changing life styles, increased awareness, and easy access to medical facility, hence more cases of prostate cancer are being picked up

Prostate cancer is usually a very slow growing cancer and most patients do not have significant symptoms until the cancer reaches an advanced stage. Prostate cancer that is detected early — when it’s still confined to the prostate gland has a better chance of successful treatment.

Most men with prostate cancer die of other unrelated causes, and many never know that they have the disease. But once prostate cancer begins to grow quickly or spreads outside the prostate, it is dangerous.

Risk Factors

  • Age: Risk of prostate cancer increases with age. Prostate cancer is very rare in men below 40 and the risk increases rapidly after the age of 50.
  • Family history: Prostate cancer seems to run in families which suggests a genetic or inherited factor involved in its causation.

Screening and Early Detection

  • Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood sample.
  • Another way to find prostate cancer early is the digital rectal exam (DRE).
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Iron Overload in Thalassemia – Severe

One of the severest iron overload of the myocardium seen in a thalassemic in a long time. T2* of 3.2 ms. #thalassemia #ironoverload #t2cardiac #t2* #cardiacmri #radiology #heart from Instagram: http://ift.tt/1OQWYb5
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LV Apical Hypoplasia

This is a young man who came with palpitations. An echocardiogram showed an abnormal LV and the thought was of arrhythmogenic right ventricular cardiomyopathy (ARVC) or inflammatory cardiomyopathy. A cardiac MRI was performed.

The cine images show the unusual morphology. The papillary muscles insert directly onto the “apex”. The RV wraps around the LV. There is fat infiltration of the “apex” – essentially the epicardial fat seems to invaginate into the LV. In our case, the CT scan images also show calcification of the papillary muscles.

4C and 2C delayed enhanced MRI images

4C and 2C delayed enhanced MRI images

Cardiac CT (SA)

Cardiac CT (SA)

Cardiac CT (2C)

Cardiac CT (2C)

Cardiac CT (4C) view

Cardiac CT (4C) view

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Tuberculosis of the Myocardium Masquerading as Angiosarcoma

This is a 23-years old man who presented with right sided tachycardia. A CT scan of the chest was performed that showed a mass involving the RV and RA with enlarged necrotic mediastinal and right internal mammary nodes (Fig. 1). This was interpreted as a mass of unknown etiology, but nothing much was done.

Axial CT scan shows a mass (red arrows) involving the RV and RA.

Axial CT scan shows a mass (red arrows) involving the RV and RA.

Axial CT scan shows the mass (red arrows) in the AV groove and involving the RA appendage. Note the enlarge right internal mammary node (blue arrow)

Axial CT scan shows the mass (red arrows) in the AV groove and involving the RA appendage. Note the enlarge right internal mammary node (blue arrow)

Axial CT scan shows enlarged necrotic mediastinal nodes (blue arrow)

Axial CT scan shows enlarged necrotic mediastinal nodes (blue arrow)

 

 

 

 

 

 

 

A week later, for some reason, a cardiac CT was performed that showed normal coronary arteries (Fig. 2).

CT cardiac shows normal proximal coronary arteries

CT cardiac shows normal proximal coronary arteries

 

 

 

 

 

Two weeks later, a cardiac MRI was done. This showed the mass well (Fig. 3, video 3) involving the RV and RA as well as the RA appendage and the adjacent AV groove with mediastinal and internal mammary nodes.

Delayed hyperenhanced 4C view of the heart shows an enhancing mass (red arrows) involving the RV and RA

Delayed hyperenhanced 4C view of the heart shows an enhancing mass (red arrows) involving the RV and RA

 

A provisional diagnosis of angiosarcoma was made and a PET/CT study was performed the next day to look for lesions that might help give a clue to the diagnosis or amenable for biopsy. The PET/CT showed the mass well (Fig. 4A), along with active internal mammary (Fig. 4B) and mediastinal (Fig. 4C) nodes and it was decided to perform a CT guided biopsy of the internal mammary node (Fig. 5), which was performed the next day.

PET/CT shows the RV and RA mass (red arrows).

PET/CT shows the RV and RA mass (red arrows).

PET/CT shows a necrotic enlarged right internal mammary node

PET/CT shows a necrotic enlarged right internal mammary node

PET/CT shows an active mediastinal node as well.

PET/CT shows an active mediastinal node as well.

CT guided biopsy of the internal mammary node.

CT guided biopsy of the internal mammary node.

 

 

 

 

 

The biopsy report was caseating granulomatous inflammation of possible tuberculous etiology and the GeneXpert showed absence of rifampicin resistance.

The most common entity that presents as an RV mass is angiosarcoma. TB of the heart typically simulates sarcoidosis and usually presents as a “granulomatous cardiomyopathy” with nodes and areas of enhancement within the LV. TB presenting as a mass like lesion is unusual. This case teaches us how TB is still the greatest masquerader of all.

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Root Tear Post Horn Medial Meniscus in Patient with Osteoarthritis

This 63-years old man has marked cartilage loss as seen on the sagittal image (arrows) with mild marrow edema. He has difficulty in walking, gradually progressive for the last 10 years, with acute exacerbation in the last 1 month with a history of a mild twisting injury.

On the MRI, the marrow edema is part of the acute exacerbation, but the root tear seen involving the posterior horn of the medial meniscus on the coronal image is the result of the twisting injury. This usually leads to further acceleration of degeneration because of changes in the stress response by the meniscus and signals the need to eventually go in for a total knee replacement (TKR).

The sagittal image shows cartilage loss with marrow edema and a Baker's cyst. The coronal image shows  a tear of the root of the posterior horn of the medial meniscus

The sagittal image shows cartilage loss with marrow edema and a Baker’s cyst. The coronal image shows a tear of the root of the posterior horn of the medial meniscus

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