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Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra shivanand gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar Department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia Department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India Department of Liver Transplant and HPB Sir HN Reliance Foundation HospitalMumbai 400004India Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in BCS-HCC.METHODS A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were included.The prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were evaluated.RESULTS In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular obstruction.The median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver transplantation.CONCLUSION HCC is not uncommon in patients with BCS.Radiological interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

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Robotic ultrasound:An initial feasibility study

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World Journal of Methodology 2022年第4期12卷 274-284页

作者： Sheragaru Hanumanthappa Chandrashekhara Krithika Rangarajan Ayushi Agrawal Sanjay Thulkar shivanand gamanagatti Deepak Raina Subir Kumar Saha Chetan Arora Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Mechanical Engineering Indian Institute of TechnologyDelhi 110016India Department of Computer Science Indian Institute of TechnologyDelhi 110016India

BACKGROUND Performing ultrasound during the current pandemic time is quite challenging.To reduce the chances of cross-infection and keep healthcare workers safe,a robotic ultrasound system was developed,which can be controlled remotely.It will also pave way for broadening the reach of ultrasound in remote distant rural areas as well.AIM To assess the feasibility of a robotic system in performing abdominal ultrasound and compare it with the conventional ultrasound system.METHODS A total of 21 healthy volunteers were recruited.Ultrasound was performed in two settings,using the robotic arm and conventional hand-held procedure.Images acquired were analyzed by separate radiologists.RESULTS Our study showed that the robotic arm model was feasible,and the results varied based on the organ imaged.The liver images showed no significant difference.For other organs,the need for repeat imaging was higher in the robotic arm,which could be attributed to the radiologist’s learning curve and ability to control the haptic device.The doctor and volunteer surveys also showed significant comfort with acceptance of the technology and they expressed their desire to use it in the future.CONCLUSIONThis study shows that robotic ultrasound is feasible and is the need of the hour during thepandemic.

关键词： Robotic ultrasound Telemedicine Ultrasonography Haptic device Pandemic

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Imaging and interventions in hilar cholangiocarcinoma: A review

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World Journal of Radiology 2015年第2期7卷 28-44页

作者： Kumble Seetharama Madhusudhan shivanand gamanagatti Arun Kumar Gupta Department of Radiodiagnosis All India Institute of Medical Sciences

Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in theform of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions.

关键词： Cholangiocarcinoma Biliary malignancy Imaging Biliary intervention Computed tomography Magnetic resonance imaging

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Magnetic resonance imaging in glenohumeral instability

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World Journal of Radiology 2011年第9期3卷 224-232页

作者： Manisha Jana shivanand gamanagatti Department of Radiodiagnosis All India Institute of Medical SciencesAnsari Nagar110029 New DelhiIndia Department of Radiology JPNA Trauma CentreAll India Institute of Medical SciencesAnsari Nagar 110029 New DelhiIndia

The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability.Magnetic resonance (MR) imaging,and more recently,MR arthrography,have become the essential investigation modalities of glenohumeral instability,especially for pre-procedure evaluation before arthroscopic surgery.Injuries associated with glenohumeral instability are variable,and can involve the bones,the labor-ligamentous components,or the rotator cuff.Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament,in the form of Bankart lesion and its variants;whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion.Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion.This article reviews the relevant anatomy in brief,the MR imaging technique and the arthrographic technique,and describes the MR findings in each type of instability as well as common imaging pitfalls.

关键词： Shoulder joint Instability Magnetic resonance imaging Magnetic resonance arthrogram

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Imaging and interventions in Budd-Chiari syndrome

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World Journal of Radiology 2011年第7期3卷 169-177页

作者： Amar Mukund shivanand gamanagatti Department of Radiology Institute of Liver and Biliary SciencesNew Delhi 110029 India Department of Radiology JPNA Trauma Centre AIIMSNew Delhi 110029 India

Budd-Chiari syndrome(BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension.Clinically,two forms of disease(acute and chronic) are recognized.Mostly the patients present with ascites,hepatomegaly,and portal hypertension.In acute disease the liver is enlarged with thrombosed hepatic veins(HV) and ascites,whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava(IVC),or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC.Due to advances in radiological interventional techniques and hardware,there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation.The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS.

关键词： Budd-Chiari syndrome Hepatic vein angioplasty/stenting Inferior vena cava angioplasty Transjugular intrahepatic portosystemic shunt

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Preoperative transarterial Embolisation in bone tumors

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World Journal of Radiology 2012年第5期4卷 186-192页

作者： Pankaj Gupta shivanand gamanagatti Department of Radiodiagnosis All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India

Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.

关键词： Blood loss Surgical Bone tumors Embolisation Radiology Interventional

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Imaging in renal trauma

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World Journal of Radiology 2013年第8期5卷 275-284页

作者： Madhukar Dayal shivanand gamanagatti Atin Kumar Department of Radiology All India Institute of Medical Sciences

Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.

关键词： Trauma Renal injury Imaging Focused abdominal sonography for trauma Multidetector computed tomography Contrast-enhanced computed tomography Grading American Association for the Surgery of Trauma classification Vascular injury Revision of American Association for the Surgery of Trauma

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Blunt pancreatic trauma: A persistent diagnostic conundrum?

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World Journal of Radiology 2016年第2期8卷 159-173页

作者： Atin Kumar Ananya Panda shivanand gamanagatti Department of Radiology All India Institute of Medical Sciences

Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography(CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging(MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful nonoperative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.

关键词： Computed tomography Magnetic resonance imaging Pancreatic trauma Complications Magnetic resonance cholangiopancreatography Management Pancreatic injury Review

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Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias

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World Journal of Radiology 2014年第10期6卷 808-825页

作者： Ananya Panda shivanand gamanagatti Manisha Jana Arun Kumar Gupta Department of Radiodiagnosis All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India

Skeletal dysplasias are not uncommon entities and a radiologist is likely to encounter a suspected case of dysplasia in his practice. The correct and early diagnosis of dysplasia is important for management of complications and for future genetic counselling. While there is an exhaustive classification system on dysplasias, it is important to be familiar with the radiological features of common dysplasias. In this article, we enumerate a radiographic approach to skeletal dysplasias, describe the essential as well as differentiating features of common non-lethal skeletal dysplasias and conclude by presenting working algorithms to either definitively diagnose a particular dysplasia or suggest the most likely differential diagnoses to the referring clinician and thus direct further workup of the patient.

关键词： Skeletal dysplasia Short limb dwarfism Rhizomelia Radiograph Skeletal survey Review Spondylopepiphyseal dysplasia Multiple epiphyseal dysplasia Achondroplasia Algorithm Approach

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Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms:Case series

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World Journal of Gastrointestinal Endoscopy 2015年第13期7卷 1107-1113页

作者： shivanand gamanagatti Usha Thingujam Pramod Garg Surajkumar Nongthombam Nihar Ranjan Dash Department of Radiodiagnosis India Institute of Radiodiagnosis Department of Gastroenterology India Institute of Radiodiagnosis Department of Gastrointestinal Surgery and Transplantation India Institute of Radiodiagnosis

Pseudoaneurysm is a known complication of pancreatitis associated with significant mortality and morbidity. Imaging plays an important role in the diagnosis and management. Computed tomography(CT) helps localize the lesion and the severity of the background pancreatitis but digital subtraction angiography with coil embolization is recommended to avoid bleeding and inadvertent surgery. However, in cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via CT or ultrasound guidance remains a viable option and often described in literature. In this series, effort has been made to highlight the role of endoscopic ultrasound guided thrombin instillation especially in patients with poorly visualized pseudoaneurysm on ultrasound thereby avoiding surgery and the associated mortality and morbidity.

关键词： Pseudoaneurysm Angiography Endoscopic ultrasound T

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