BACKGROUND 1. To evaluate the incidence and coexistence of multiple knee joint pathologies causing painful knee and their correlation to age and sex. 2. To evaluate the Magnetic Resonance Imaging (MRI) features in various knee pathologies and to identify the common lesions. MATERIALS AND METHODS A retrospective study was performed using the clinical data of patients presenting with painful knee joint which were evaluated with MRI. Data from 200 patients examined between September 2015 and August 2016 were included into this study. The data was analysed statistically to evaluate the correlation between the MR pathological findings to age and sex of the patients. RESULTS The patient's age ranged between 8 and 75 years (mean: 36 years). Anterior cruciate ligament (ACL) tear was the commonest finding (60%) followed by bursitis (55%), meniscal degeneration (54.6%) and meniscal tear (52%). Primary signs of ACL tear were hyperintensity, discontinuity and nonvisualisation. Secondary signs like Posterior cruciate ligament (PCL) buckling, PCL index of greater than 0.5, uncovered Lateral meniscus (LM) and bone contusion assisted in diagnosis in indeterminate cases. Mid substance was the commonest site of ACL tear (64%). PCL tear accounted for only a small percentage (7%). Medial Meniscus (MM) tear (35%) was commoner than LM tear (17%). The posterior horn of meniscus was the commonest site of injury (86.5%). Age was significantly correlated with meniscal degeneration and tear, Medial collateral ligament (MCL) degeneration, parameniscal cyst, and chondromalacia patellae. A significant correlation between male gender and ACL injury was noted. Meniscal injury was significantly correlated with bursitis, as well with MCL injury. Bone bruise was significantly correlated with ACL injury, MCL injury and Lateral collateral ligament (LCL) injury. CONCLUSIONS MRI findings of certain pathologies in a painful knee can coexist and significantly correlate with each other, age and sex of the patient.

Background Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae with anal sphincters, fistula extensions, secondary ramifications and associated complications. Aim To evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Settings and Design A hospital-based cross-sectional study. Materials and Methods The study group composed of 47 patients of perianal fistula. MRI with diffusion-weighted imaging (DWI) was performed with Philips 0.5 T Ingenia scanner. DWI with different b-values (b = 50, b = 400, and b = 800 smm2) were obtained. The MRI findings were correlated with local clinical examination and or surgical findings. Statistical Analysis Used Chi-square test, independent samples t-test, and receiver operating characteristic curve analysis. Result Fifty-nine perianal fistulas in 47 patients were included in the study sample. The visibility of perianal fistula on DWI was less than T2-weighted (T2W) and combined DWI-T2W images. Distinctly visualized (visibility score 2) perianal fistulas were observed in 47 fistulas (79.6%) on DWI, 54 (91.5%) on T2W, and 58 (98.3%) on DWI-T2W images. The mean of apparent diffusion coefficient (ADC) values of active fistula was 0.972 ± 0.127 [SD] 10−3 mm2/s and inactive was 1.232 ± 0.185 [SD] 10−3 mm2/s with a significant difference (p-value < 0.0005). A cut-off mean ADC value of 1.105 × 10−3 mm2/s was used to differentiate active from the inactive fistula with a sensitivity of 87.5% and specificity of 73.3%. Conclusion Combined DWI-T2W evaluation had a better performance in the detection of fistula than DWI or T2W alone. DWI with mean ADC calculation had a good performance in differentiating active from the inactive fistulas.

Background Isolated posterior spinal (element) tuberculosis (TB) is uncommon compared to classical anterior spinal or para-discal TB. Here, we report magnetic resonance imaging (MRI) findings of posterior spinal TB in 19 patients without involvement of the vertebral body and intervertebral disc. Purpose To evaluate the MRI findings in isolated posterior spinal (element) TB. Material and Methods Clinical and MRI data of 19 patients of isolated posterior spinal TB were retrospectively evaluated. Results Of the 19 patients, group A comprised 4 (21%) patients with rapid onset lower limb weakness and pyramidal signs while group B comprised 15 (79%) patients without any neurological deficit. Lumbar vertebrae commonly affected 9 (47.4%) patients followed by dorsal vertebrae in 8 (42.1%) patients and cervical vertebrae in 2 (10.5%) patients. The pedicle was most commonly involved in 12 (63.2%) patients followed by the lamina in 11 (58%) patients, and spinous process and facet joint in 6 (31.6%) patients each. Extra-spinal inflammation/pyomyositis/paraspinal abscess was found in 13 (68.4%) patients followed by epidural abscess 3 (15.8%) patients and both extra spinal inflammation and epidural abscess in 3 (15.8%) patients (15.8%). Compressive cord myelopathy was observed in 4 (21%) patients, where three patients underwent emergency decompression laminectomy and the remaining 16 patients were treated conservatively with anti-tubercular therapy. Conclusion Initial diagnosis of isolated posterior element TB is challenging and requires a high index of suspicion. Early diagnosis of isolated posterior spinal TB is important as early treatment may be beneficial and decreases patient morbidity.

Purpose: The people of Northeast India comprise mostly of Mongoloid descent with characteristic craniofacial features. The purpose of this study was to evaluate the normal orbital structures with MRI and determine normative data in the Northeast Indian pediatric population. Methods: MRI images of the 302 orbits of 151 pediatric patients below 16 years of age were retrospectively evaluated to measure the various orbital structures. Both axial and coronal MRI images were utilized for various orbital measurements. An independent sample t -test was done to compare various orbital data according to the sex and side. Linear regression was also done. Results: The mean age of the pediatric population was 9.64 ± 1.47 years with a male: Female ratio of 1.13:1. The mean interzygomatic line was 88.4 ± 9.09 mm and the interorbital line was 22.18 ± 3.62 mm. The mean thicknesses of medial, lateral, superior, and inferior recti muscles were 2.58 ± 0.46, 2.34 ± 0.42, 2.16 ± 0.40, and 2.53 ± 0.49 mm in males and 2.41 ± 0.41, 2.08 ± 0.34, 2.08 ± 0.46, and 2.46 ± 0.49 mm in females. The mean horizontal orbital, vertical orbital diameters, orbital index, mean volume of eyeball, and orbital cavity were 30.27 ± 2.97,3 7.06 ± 3.57, 122.58 ± 7.39, 4.63 ± 0.84, and 15.29 ± 3.52 in males, while 29.16 ± 3.23, 34.96 ± 3.99,119.96 ± 7.31, 4.49 ± 0.87, and 14.65 ± 3.47 in females, respectively. With an increase in age, the interzygomatic line ( r = 0.883, r 2 = 0.780; P < 0.0005), anterior medial interorbital line ( r = 0.808, r 2 = 0.652; P < 0.0005), mean volume of eyeball ( r = 0.915, r 2 = 0.838; P < 0.0005), orbital cavity ( r = 0.924, r 2 = 0.854; P < 0.0005), and distance between the optic nerve entry site ( r = 0.829, r 2 = 0.687; P < 0.0005) were increased. Conclusion: This study provides normative data of various orbital structures in a pediatric population and these data likely to be useful for diagnosing various pediatric orbital disorders and helps in the planning of various surgical procedures of orbits.