Context:Diffusion Tensor Imaging (DTI) is a reliable noninvasive tool to assess renal function with medullary Fractional Anisotropy (FA) values showing the most consistent results.Aims:Evaluation of FA, Apparent Diffusion Coefficient (ADC) for detecting diabetic nephropathy (DN) using 1.5-Tesla magnetic resonance imaging (MRI). To determine FA and ADC values in chronic kidney disease (CKD) patients and controls, and comparing these with estimated glomerular filtiration rate (eGFR) and categorizing the stage of CKD.Patients and Methods:Thirty nondiabetic volunteers underwent DTI. The study included 83 diabetics, 30 frank urine proteinuric, 30 micro-albuminuric, 23 normo-albuminuric with only raised blood sugar patients. Patients were stratified by eGFR into groups: eGFR <60 and eGFR>60ml/min. ADC and FA values in cortex and medulla were compared between controls and study groups.Statistical Analysis Used:Analysis of variance and Pearson correlation using SPSS 16 were performed.Results:There was significant difference of FA medulla in controls versus albuminuric and micro-albuminuric versus frank proteinuric patients (P < 0.001). Also, there was significant difference between cortical ADC values between normal, microalbuminuric/proteinuric groups (P = 0.010, P =0.000, respectively). Significant difference between medullary FA values of patients with eGFR >60 and eGFR < 60 versus normal controls (P < 0.001) was noted. With declining renal function from normal to CKD category 5, a negative correlation between medullary FA (r= −0.785, P = 0.001) and ADC cortex values (r= −0.436, P = 0.001) was noted. A strong positive correlation between medullary FA and cortex ADC with eGFR (r = 0.598 and 0.344, respectively) was noted.Conclusion:Medullary FA of diabetics with relatively intact kidney function were significantly lower than those of controls. Hence, drop in medullary FA values can be an indicator of early nephropathy/patients at risk where eGFR is in near normal range. Cortical ADC and medullary FA demonstrated a significant correlation with eGFR with the latter showing a stronger positive correlation.

DesCripTionA 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow ( figure 1A). CT of abdomen and pelvis (figure 1B-F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the urinary bladder was also lost suggestive of adherence or infiltration. No direct endoluminal invasion into the bowel or bladder was seen. The patient further underwent MRI of the lumbosacral spine to rule out neurogenic cause for her symptoms. On MRI ( figure 1G-I), the visualised portion of the pelvic lesion was heterogeneous with peripheral enhancing solid areas and central large non-enhancing necrotic area. The solid areas were isointense on T1 sequence and hyperintense on the T2 sequence. No abnormality of the conus medullaris or nerve root compression was detected. The imaging differentials that we considered were neurogenic tumour, gastrointestinal stromal tumour (GIST) and soft-tissue sarcoma. A neurogenic tumour could explain all the imaging features. GIST and sarcomatous lesion also would have most of these imaging features except for the presence of multiple calcifications, which is a relatively uncommon feature in them.The patient was taken up for laparotomy and tumour excision under spinal anaesthesia. However, due to adhesion of the lesion to colon and the bladder, only debulking of the lesion was performed. Histopathological examination (figure 2) revealed typical whorls of meningothelial epithelioid cells, which were reactive to epithelial membranous antigen on immunohistochemistry suggestive of meningothelial meningioma (WHO grade I).The extracranial meningiomas are rare tumours most commonly occurring in the head and neck region (0.9% to 2% incidence) with their occurrence in pelvis being even more rarer. The prefix 'primary' indicates that the lesion has no connection to the central nervous system and the theories to explain their origin include misplaced extradural arachnoid cell during embryogenesis, ectopic embryonic arachnoid cells rest growth, arachnoid cells rest migration along the nerve sheaths of cranial nerve or differentiation from perineural cells.