European Journal of Molecular & Clinical Medicine

Background: The shoulder arthroscopy is the gold standard of reference in most of the shoulder pathologies including Rotator cuff tears. However, it is an invasive surgical procedure with associated risks of surgery and anaesthesia. The objective of the present study is to find out how accurately the rotator cuff pathologies can be diagnosed by these imaging tests.
Aims and Objectives: To compare the Ultrasonography, MRI findings with the Arthroscopic findings of Rotator cuff pathology of the shoulder.
Materials and Methods: All patients in whom the history and clinical examination is suggestive of Rotator cuff pathology were included in the study. Patients were evaluated using high resolution Ultrasound (HRUS) Philips HD-11, Germany and 1.5-Tesla MRI [1.5 Tesla, GE, Excite HD and USA]. Ultrasonographic and MRI examination is performed by a single radiologist experienced in musculoskeletal ultrasonography and MR Imaging. A Real time high resolution USG imaging and MRI of the shoulder was performed in a standardized fashion and subsequently with therapeutic or diagnostic arthroscopy on the symptomatic shoulder. Results were analyzed.
Results: Considering arthroscopy as the final gold standard of investigation, out of the 24 patients studied, five (20.8%) had rotator cuff tendinosis/tendinopathy, four (16.6%) had PT RCT, twelve (50%) had FT RCT while the remaining three (12.6%) had normal rotator cuff. The average delay between the MRI examination and arthroscopic surgery was 6 days (range 0-27 days) but in one case, it was as long as 117 days. A total of five (20.8%) patients were in the age group < 40 years while another five (20.8%) were between 40-50 years age group. A majority of eleven (45.8%) patients were between 50-60 years old while three (12.6%) were above 60 years.
Conclusion: It should be noted that following USG of the shoulder performed by a dedicated radiologist, MRI offers little additional value, with regard to the detection of rotator cuff tears.

Background: Ligamentous injuries to the ligaments and menisci of the knee can lead to significant morbidity and may precipitate osteoarthritis.Arthroscopic diagnosis though invasive is considered as the gold standard. Various imaging modalities like CT scan and MRI have alsobeen used in the diagnosis of these injuries and the quest for the best technique goes on.
Aim: The aim of this study is to assess the diagnostic accuracy of 1.5 T MRI in cases of ligamentous injuries of the knee joint and compare its efficacy with arthroscopy.
Materials & Methods: This is a comparative observational study which included 50 patientswho were clinically suspected to be having ligamentous injuries of the knee. MRI was done for all these patients and all of them laterunderwent arthroscopy in the Department of Orthopaedics-IMCHRC.Statistical analysis was done to derive the sensitivity, specificity, positive predictive value (PPV) and the negative predictive value (NPV) and for this the findings at arthroscopy were taken to be the true diagnosis.
Results: The patients were commonly in the age group of 21-30 years and males with RTA being the commonest mode of injury and duration of injury commonly between 6weeks to 6 months.ACL tear was the commonest injury found in 76% followed by PCL tear in 38% , MM tear in 36%, LM tear in 32%. Regarding the efficacy of 1.5T MRI for ACL tears the sensitivity was 94.6%, specificity 76.9%, PPV 92.1%, NPV 83.3% and accuracy 90%. For PCL it was 94.4%, 93.8%, 89.5%,96.8%,94% respectively. For MM it was 94.7%,100%,100%,96.9%,98% respectively and for LM 83.3%,96.9%.93.9%,91.2%,92% respectively.
Conclusion: MRI is of proven diagnostic value in the evaluation of internal ligamentous injuries of the knee joint. It has a fairly good PPV and its routine use in all clinically suspicious ligamentous injuries of the knee may be recommended. Further since MRI has a high NPV, a normal MRI scan may be used to exclude any pathology and thus avoid an expensive and invasive procedure like arthroscopy.

Background: There is a debate around the existence, anatomy, and role of the so called
―anterolateral ligament (ALL). This study was conducted with a primary aim of finding out
and comparing the prevalence of the presence of anterolateral ligament and it’s three portions
(femoral, meniscal and tibial) in knees with and without ACL tear.
Methodology: This is a cross sectional study conducted in which A total of 96 patients
undergoing MRI knee for clinically evident ACL injury or history of chronic knee pain were
included in the study. Out of 96 patients included in the study, 48 patients had ACL tear
(Group A) and 48 patients did not have an ACL tear (Group B). Demographic data and
clinical information were noted for all patients. Descriptive variables were expressed as mean
and standard deviation for quantitative variables and frequency and percentages for
qualitative variables. The data was analyzed using SPSS® version 21.0. Categorical variables
were analyzed using Chi square test and for normally distributed data - t test was used. p
value <0.05 was considered as statistically significant.
Results: ALL was visualized in 65% of the patients included in the study. Its femoral
component was visualized in 56%, tibial component in 63% and meniscal component in 57%
of the patients. The three components were viewed together in 30% of the patients. We found
a significant association between ACL tear and the presence of ALL (p <0.001), with ALL
visualized in around 81%of knees with an ACL tear and only 48% of knees without an ACL
tear. Meniscal tears were significantly associated with the presence of ALL as out of the 62
patients in which ALL was visualized, 24 had an associated medial meniscal tear, 7 had
lateral and 3 had tear in both the menisci.
Conclusion: Our study demonstrated radiological evidence of the existence of the ALL.
Furthermore, we found presence of ALL to be significantly associated with ACL injury and
meniscal tear. Age, gender, or affected side was not found to be associated with the presence
of ALL.

Aim: To measure the tibial and femoral footprint of ACL in Indian patients (with and
without ACL injury) using MRI of normal patients, during (ACLR) and during TKR.
Materials and Methods: The present prospective study was conducted at PD HINDUJA
hospital and medical research center, Mumbai from March 2015 to November 2015
among 100 patients of Indian origin undergoing arthroscopy, TKR and MRI in our
hospital. We have taken three separate patients group undergoing different procedure
related to knee i.e. Group 1 (Arthroscopic ACL reconstruction), Group 2 (Total knee
replacement) and Group 3 (Diagnostic MRI). As MRI are done in extension of knee,
femoral footprint was in vertically oval plane, so calculating length of maximum
Supero-inferior measurement on MRI sequence of femoral footprint was giving us
length of femoral footprint. All above-mentioned readings were added in tabular form
in excel sheet master chart and was statistically analyzed using SPSS software version
24.

Introduction: Prevalence of morbidity and mortality is keep rising in poorly managed stroke
cases. Early detection and proper diagnosis have great potential in management of stroke. The
development of brain imaging modalities (CT/MRI) have led to a milestone that provides a
living autopsy of the brain.
Objective: The goal of this prospective study is to determine the clinical efficacy of CT/MRI
and its benefits over traditional techniques of clinical diagnosis in stroke patients.
Methods: 50 patients in whom clinical signs of stroke i.e., slurring of speech, weakness on
one side of the body, deviation of angle of mouth, and neurological deficits observed were
recruited in the study. CT/MRI was used to diagnosed the stroke.
Results:The NCCT finding have revealed Diffused cerebral atrophy in 14 (28%) patients,
Chronic Infarct in 11 (22%) patients, Subacute Infarct in 7 (14%) patients, Acute Infarct in 6
(12%) patients and Encephalomalacia in 2 (4%) patients whereas 10 (20%) patients
underwent MRI brain.The MRI brain finding have revealed Diffused cerebral atrophy in 6
(6%) patients, Chronic Infarct in 1 (2%) patient, Subacute Infarct in 4 (8%) patients, Acute
Infarct in 3 (6%) patients and Encephalomalacia in 2 (4%) patients whereas 37 (74%) patients
underwent NCCT head.
Conclusion: In both NCCT head and MRI brain finding have revealed diffuse cerebral
atrophy as the most common finding among recruited patients followed by the chronic infarct
(22%), subacute infarct (14%), acute infarct (12%) and encephalomalacia (4%).

Background&Method: This is a prospective study conducted in the Department of Radio
Diagnosis, Index medical college hospital and research centre. 50 patients suspicion of prostatic
pathologies were included in the study. A sample size of 50 was selected using purposive
sampling technique.All the 50 patients were subjected for the multi-parametric MRI sequences
including T1 and T2 weighted anatomical imaging, functional imaging using diffusion weighted
MRI with ADC value calculation.The machine used in this study is GE SIGNA
EXPLORER 1.5 Tesla MRI with phased array body coil.
Result:Majority of lesions 37 (74%) on diffusion weighted imaging were hyperintense
while 13 (26%) were hypointense. Out of 37 hyperintense lesions 24 (92.31%) were
malignant on histopathology and 13 (54.16%) were benign on histopathology. 13 (26%)
lesions appeared hypointense on diffusion weighted imaging 2 (7.69%) were malignant on
histopathology while 11 (45.83%) lesions were benign on histopathology.
This indicated benign lesions tends to both hyperintense and hypointense on diffusion
weighted imaging, benign lesions those appeared hyperintense on diffusion weighted
imaging had inflammatory properties ,that was confirmed on histopathology. Malignant
lesions tends to be hyperintense on diffusion weighted imaging.

To assess role of MRI in detecting female infertility.
Materials & Methods:Eighty- six women age ranged 20- 40 years were included in the
study. All underwent MRI using 1.5 Tesla unit equipped with a 32 phased-array surface
coil. Causes of female infertility was recorded.
Results: Age group 20-30 years comprised of 50 and 31-40 years had 36 patients. Various
causes of female infertility was PCOS in 12, tubal disease in 18, pelvic inflammatory
disease in 10, endometriosis in 8, leiomyoma in 6, adenomyosis in 12 and endometrial
polyps in 20 cases. A significant difference was observed (P< 0.05).
Conclusion: MRI is an excellent non-invasive, radiation-free modality for the evaluation
of female infertility; its superior soft-tissue contrast resolution and multiplanar evaluation
generate exquisite anatomical details.

Introduction: The rotator cuff disorders constitute the most common cause of shoulder
pathologies. Ultrasonography and MRI are widely used in evaluating various shoulder
pathologies. USG of shoulder is simple, cheap, fast and non-invasive imaging technology
for detection of rotator cuff and non- rotator cuff abnormalities. In this study we have
assessed the usefulness of USG in diagnosing the shoulder pathologies and have correlated
with the MRI.
Aim: Evaluation of a patient with shoulder pathology with ultrasonography as the initial
line of imaging technique as compared to MRI, assessing the accuracy of ultrasonography
in diagnosing shoulder joint pathologies, especially rotator cuff abnormalities, using MRI
as a reference standard and correlating findings wherever possible.
Materials and Methods: Hundred patients were studied prospectively over a period of two
years. Study subjects included both men and women in all age groups with suspected
shoulder pathology, suspected to have musculo-tendinous origin. All patients underwent
USG evaluation of the shoulder joint followed by MRI of the affected shoulder.
Results: USG showed a sensitivity of 85%, specificity of 100%, PPV of 100% and NPV of
97% in diagnosing full thickness tear of rotator cuff using MRI as reference. For partial
thickness tears, it showed a sensitivity of 71%, specificity of 69%, PPV of 82% and NPV of
54%. Overall accuracy of USG in detection of any tear of rotator cuff with MRI as
reference was 82%. The strength of agreement between USG and MRI for the diagnosis of
any tear of rotator cuff is considered to be ‘substantial’ in our study (Kappa=0.635).
Conclusion: USG showed comparable results to MRI in assessment of rotator cuff
abnormality and should be used as first line of investigation in patients presenting with
shoulder pathologies. It proved to have high sensitivity and specificity for full thickness
tears with relatively less sensitivity and specificity in detection of partial thickness tear.

FIESTA (FastImagingEmployingSteady-stateAcquisition) is
commonlyacceptedthatbelongstotheclass of gradient-echosequence (1). FIESTA has
provedto be useful in abdominalimagingformagneticresonansimaging (MRI) of
gastrointestinalsystem, oncologicimagings, assessingvascularpatency. However, FIESTA
MRI findings of fattyliver has not previouslybeenreported, although it
describedthesignalreductionduetofat in previousarticles.
Weobservedthatthepatientswithfattyliver had lowersignalintensity (SI) values at FIESTA
sequencescomparedto normal patientswithoutfattyliver.
Materialsandmethods:
Thirtypatientswithliverfatandthirtypatientswithoutfattyliverwerethecontrolgroup.Thirtypatie
ntswho had detectedfattyliver at T1W in-out of phase MRI (IOP-MRI)
imageswereevaluatedwithcoronalFIESTA sequence at 1.5 Teslascanner.
Allpatientswereobtained FIESTA sequenceusingthesame MRI acqusitionparameters.
LiverandspleenSI’sweremeasured as usingsame ROI on coronal FIESTA
sequencesandlivertospleen SI ratiowerecalculated. Allvalueswerecompared.
Results:
Decrease in SI of thefattyliver on FIESTA images is
negativelycorrelatedwiththefattyfraction of theliver. Patientswithfattyliver had liver / spleen
SI ratiofrom 0.15 to 0.71 (mean 0.39), and 0.41 to 0.96 in thecontrolgroup (mean 0.70).
Therewas a statisticallysignificantdifference.
Conclusion:
Webelievesuggestthatbalancedgradientechosequencesuch as FIESTA, can
detectfattyliverhoweverfurtherstudiesarerequiredforevaluatethecapability of thesequence in
evaluation of fattyfraction of theliver.

FIESTA (FastImagingEmployingSteady-stateAcquisition) is commonlyacceptedthatbelongstotheclass of gradient-echosequence (1). FIESTA has provedto be useful in abdominalimagingformagneticresonansimaging (MRI) of
gastrointestinalsystem, oncologicimagings, assessingvascularpatency. However, FIESTA MRI findings of fattyliver has not previouslybeenreported, although it describedthesignalreductionduetofat in previousarticles. Weobservedthatthepatientswithfattyliver had lowersignalintensity (SI) values at FIESTA sequencescomparedto normal patientswithoutfattyliver.

In this paper, a proposed hybrid algorithm using K-means and Fuzzy logic for brain segmentation, is developed, simulated and evaluated. The system identifies the white matter, gray matter and Cerebrospinal Fluid (CSF). The proposed system was tested using Magnetic Resonance Imaging (MRI), and evaluated in terms of the misclassification rate and percentage of clustering. The misclassification rate was found to be lesser in the proposed system as compared to the existing systems using K-means and Fuzzy logic. Further, the percentage of clustering is improved by the proposed system as compared to the existing algorithms. This work paves the way for future development of Neuro Fuzzy K-means algorithm in order to reduce the misclassification rate further in clustering the white matter, gray matter and CSF.

Background: Technologists are exposed to a strong magnetic field (1.5-3.0 Tesla), higher than the earth magnetic field (≈0.5mT). In addition to that, the exposure to the radiofrequency (RF) may create currents producing skin burns. This study's objective was to assess the magnetic resonance imaging (MRI) safety practices in specific departments in Saudi Arabia in the Riyadh region, evaluate the incidence of biological effects and health implications of the electromagnetic fields present during MR scans, and to detect the occupational hazards. Methods: A survey questionnaire was designed and used to stimulate the target population's views on aspects of MRI safety and detected risks. The survey's target population includes consultants, radiologists, technologists, patients, and others who underwent MRI procedures. Results: A total of 28 technologists were responded from the five hospitals. The study results showed that 50% of the technologist reported various levels of effects, including vertigo and lack of concentration. It is well documented that exposure to MRI requires special consideration due to high magnetic field exposure. Conclusions: This study's main findings are that radiology nurses and patients in MRI units are highly exposed to the magnetic field, especially before and after MRI examination. Any department did not report projectile hazards. Staff is exposed to various degrees of radiation risks. No incident or accident was reported in all investigated hospitals. The staff is well protected in light of the current practice.

Segmenting brain tumors is a major challenge in the production of scientific pictures. To order to maximize care outcomes and increasing the hospital success rate, early detection of brain tumors plays an important part. A challenging and time-consuming job is the manual segmentation of brain tumors from large quantities of MRI images produced in clinical routine. Automatic brain tumor segmentation is possible. This article aims to analyze strategies for the segmentation of brain tumors dependent on MRI. Automatic segmentation using deep learning approaches has recently been proven common because these approaches accomplish the latest findings much better than other methods would solve this issue. Deep learning approaches may also provide for effective analysis and unbiased interpretation of vast volumes of picture evidence dependent on MRI. There are many papers on MRI based brain tumor segmentation which focus on traditional methods. Different from others, we concentrate on the recent trend in the field of deep learning. Next, the brain tumors and techniques for segmenting the brain tumor are added. Then, the new architectures are explored with a emphasis on the current development in deep learning methods. Finally, an evaluation is introduced and further improvements are discussed to standardize brain tumor segmentation procedures dependent on MRI in the day-to-day clinical practice.

Abstract: Background: Understanding the RELATION between anterior cruciate ligament
and postero lateral corner TRAUMA with antero-lateral ligament of knee with it’s clinical
diagnosis would help us better understand the pattern of injury and to take proper
treatment action .Objectives :To find the correlation between pattern of injury of
anterolateralligament , anterior cruciate ligament and posterolateral corner injury on MRI
with it’s clinical correlation and associated findings. Methodology: A cross-sectional study
will be done at Acharya Vinoba Bhave Rural Hospital, Sawangi, involving52 patients who
present with knee trauma for MRI. The sample will be selected and involvement of
Anterior cruciate ligament ,postero lateral corner injury and antero-lateral ligament with
associated findings will be evaluated using T1, T2 and PD MRI sequences. These will be
compared and there association will be calculated which can be used for better planning of
treatment. Results: After appropriate statistical analysis, we expect to find association
between anterolateral ligament and anterior cruciate ligament tear with posterolateral
corner injury and this will be considered for reconstruction. Conclusion: In this
observational study, we expect associations between injured ligaments with aid of clinical
findings . We also expect to find a positive association between anterolateral ligament with
posterolateral corner injury and anterior cruciate ligament tear.