BACKGROUND AND PURPOSE: Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS: Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS: Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P , .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P , .05). CONCLUSIONS: Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation. ABBREVIATIONS: Cart 4 Cartesian; IQ 4 image quality; NA 4 not applicable; SE 4 spin-echo; TSE 4 turbo spin-echo S tructural T1-weighted sequences are a fundamental component of routine postcontrast brain MR imaging examinations. These contrast-enhanced images are used for the diagnostic detection and evaluation of abnormal enhancement, including tumors, infections, and inflammatory diseases. Cartesian 2D T1 spin-echo (SE) is widely used as the standard-of-care, though it is relatively slow due to its single phase-encode per shot k-space coverage, and is not compatible with parallel imaging due to strong free-induction decay artifacts from the refocusing radiofrequency pulse. Two routine speed-up options include Cartesian 2D T1-SE with partial-Fourier k-space coverage, but at the cost of reduced SNR; alternatively, Cartesian 2D T1 turbo spin-echo

Jejunal Gastro-Intestinal Stromal Tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST are very rare and poses both diagnostic and therapeutic challenges in emergent conditions. MethodsA case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological ndings, surgical procedures and outcomes in these patients were studied. ResultsThree patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive.Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination con rmed Jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18 months follow up and the one patient lost to follow up after 1 year. ConclusionMultiphasic CTA is a single step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.

In the current era of minimally invasive surgeries, laparoscopic cholecystectomy being the popular surgery for the symptomatic cholelithiasis and complications pertaining to these minimally invasive surgeries, here we report a complication related to gall stone spillage after 4 months of surgery in 80-year male patient presenting as abdomen lump. The risk of stone spillage and complications related to it are more than open cholecystectomy. Careful dissection, extraction and complete retrieval of all the spilled stones can avoid these complications and hence complication related to stone spillage can be potentially avoided, and intra-operative documentation of the gall stone spillage can help to think for early diagnosis and treatment of the complications.

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