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108]
Letters to the Editor
References
1. Tsutsumi  S, Ito  M, Yasumoto  Y, Tabuchi  T, Ogino  I. The
Virchow‑Robin spaces: Delineation by magnetic resonance imaging
with considerations on anatomofunctional implications. Childs
Nerv Syst 2011;27:2057‑66.
2. Kwee  RM, Kwee  TC. Virchow‑Robin spaces at MR imaging.
RadioGraphics 2007;27:1071‑86.
3. Wang Y‑XJ, King AD, Zhou H, Leung S‑F, Abrigo J, Chan Y‑L, et al.
Evolution of radiation‑induced brain injury: MR imaging‑based
study. Radiology 2010;254:210‑8.
4. Brandsma D, van Helvoirt R, Taphoorn MJ. Multiple cysts in the
cerebral white matter: A rare complication of whole brain radiation
therapy. J Neurooncol 2001;53:51‑4.
5. Tsuruda JS, Kortman KE, Bradley WG, Wheeler DC, Van Dalsem W,
Bradley  TP. Radiation effects on cerebral white matter: MR
evaluation. AJR Am J Roentgenol 1987;149:165‑71.
Impact of revised atlanta classification of
acute pancreatitis on generation of a score
employing modified CT severity index
Sir,
We read with great interest the article titled “Severity
assessment of acute pancreatitis using CT severity index
and modified CT severity index: Correlation with clinical
outcomes and severity grading as per the Revised Atlanta
Classification” by Sahu et al. published in the April–June
2017 issue of the Indian Journal of Radiology and Imaging.[1]
The manuscript is highly informative. We, however, would
like to make the following pertinent observations.
One of the principal aims of the present study[1] was to
calculate the degree of concordance between the CT scoring
indices and the clinical grading as per the Revised Atlanta
Classification for Acute Pancreatitis. The former included
CT Severity Index  (CTSI) and Modified CT Severity
Index (MCTSI), both of which generate a score based on
CECT findings, thus, stratifying acute pancreatitis (AP) as
mild, moderate, or severe. Revised Atlanta Classification for
Acute Pancreatitis revolutionized the management of AP by
simplifying clinical as well as morphological classifications
and coining newer nomenclature for radiological findings
to bring in more objectivity.[1,2] Naturally, calculation of
CT scoring indices, for e.g., MCTSI on the basis of newer
terminology may alter the final score. For example:
a. Revised Atlanta Classification for Acute Pancreatitis
considers any intrapancreatic collection straightaway
374 Indian Journal of Radiology and Imaging / Volume 28 / Issue 3 / July - September 2018
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non-commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Access this article online
Quick Response Code:
Website:
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DOI:
10.4103/ijri.IJRI_335_17
Cite this article as: Gopinath M, Nagesh C, Kesavadas C. Post radiation
evolution of giant virchow-robin spaces in a case of pituitary macroadenoma.
Indian J Radiol Imaging 2018;28:373-4.
© 2018 Indian Journal of Radiology and Imaging | Published by Wolters Kluwer - Medknow
parenchymal necrosis,[2] which is in strong disagreement
with the older terminology used to compute MCTSI.[3] The
latter grades intrapancreatic collection and parenchymal
necrosis as two separate entities.[3] Hence, MCTSI as per the
latter (the older terminology) would be 2 or 4 (depending
on the percentage of necrosis whether more than or less
than 30%), while the former would generate a score of 4
b. The nomenclature of fat islands in peripancreatic
collections is yet another point of disagreement.[3] While
older terminology used to calculate MCTSI considers
it as acute fluid collections without necrosis,[3] revised
terminology labels it to be acute necrotic collection
(in acute stage).[2]
The present study defines the CT parameters as per the
Revised Atlanta Classification for Acute Pancreatitis. [1]
However, MCTSI, if computed using the recent classification,
may yield a different score compared to when calculated as
per the older terminology. Hence, it would be of enormous
help if the authors could clarify our doubts.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Letters to the Editor
Yashant Aswani, Prashant K Singh1
Department of Radiology, Pacific Medical College and
Hospital, Udaipur, 1Jhalawar Medical College, Rajasthan, India
E‑mail: aswaniyashant@gmail.com
References
1. Sahu B, Abbey P, Anand R, Kumar A, Tomer S, Malik E. Severity
assessment ofacute pancreatitis using CT severity index and
modified CT severity index: Correlation with clinical outcomes and
severity grading as per the RevisedAtlanta Classification. Indian J
Radiol Imaging 2017;27:152‑60.
2. Thoeni RF. The revised Atlanta classification of acute pancreatitis:
Its importance for the radiologist and its effect on treatment.
Radiology 2012;262:751‑64.
3. Sainani N, Catalano O, Sahani D. Pancreas. In: Haaga JR, Dogra VS,
Forsting M, Gilkeson RC, Ha HK, Sundaram M, Editors. CT and
MRI of the whole body. 5thed. Philadelphia: Mosby Elsevier; 2009.
p. 1599‑674.
OHVIRA and OSVIRA syndrome
Sir,
I read with great interest the article titled,
“Herlyn–Werner–Wunderlich syndrome presenting with
infertility: Role of MRI in diagnosis” by Ahmad et al. in
Indian Journal of Radiology and Imaging.[1] The manuscript
is informative. However, I would like to make the following
contributions.
OHVIRA, also known as Herlyn–Werner–Wunderlich
syndrome, abbreviates a complex urogenital anomaly
whose embryopathogenesis is still putative. It reads
out as Obstructed HemiVagina and Ipsilateral Renal
Agenesis/Anomaly.[1] Besides, it has a didelphic uterus.[1]
Central to understanding of the pathology is embryogenesis
of vagina, a disputed topic as yet. While classically the upper
vagina is believed to have Mullerian  (paramesonephric)
roots akin to fallopian tubes, uterus and cervix with
sinovaginal bulbs forming the remainder of the lower
vagina, recent studies debunk this age‑old concept. [2]
Acien[2] proposed Wolffian (mesonephric) origin of vagina
in entirety – a notion which has been proved in experiments
on female rats by Sanchez.[3]
Using Acien’s hypothesis, all three components of
OHVIRA can be fully explained.[2] A faulty development of
mesonephric duct fails to induce the metanephric blastema,
the future kidney. Also because vagina is Wolffian in origin,
it too does not develop. Further, lack of growth factors
from the mesonephros disturbs the proper positioning and
placement of the paired paramesonephric ducts, resulting in
nonfusion (uterus didelphys). Hence, the result is OHVIRA
syndrome.[2]
Indian Journal of Radiology and Imaging / Volume 28 / Issue 3 / July - September 2018
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non-commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Access this article online
Quick Response Code:
Website:
www.ijri.org
DOI:
10.4103/ijri.IJRI_421_17
Cite this article as: Aswani Y, Singh PK. Impact of revised atlanta
classification of acute pancreatitis on generation of a score employing modified
CT severity index. Indian J Radiol Imaging 2018;28:374-5.
© 2018 Indian Journal of Radiology and Imaging | Published by Wolters Kluwer - Medknow
On a parallel track is a constellation of urogenital anomalies
in males grouped under the so‑called Zinner syndrome (ZS).
It comprises atresia of unilateral ejaculatory duct that leads
to obstruction and dilation of seminal vesicle (seminal
vesicle cyst) with ipsilateral renal agenesis.[4] Because all the
components of this syndrome are mesonephric in origin,
Aswani et al. postulated similar embryopathogenesis of
ZS in males as that of OHVIRA in females  (as per new
hypothesis of Wolffian origin of vagina).[5] This concept
thus places ZS as a male equivalent of OHVIRA, unlike
previously where ZS was thought to be a male counterpart
of Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome
in females.[6] The caveat here is that MRKH is a Mullerian
anomaly, while ZS is Wolffian in origin.[5] Finally, Aswani
et al. proposed OSVIRA as an acronym for ZS, similar to its
female equivalent OHVIRA, which expands as Obstructed
Seminal Vesicle and Ipsilateral Renal Agenesis.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Raj Bharatkumar Koticha
Department of Radiology, HBT Medical College and RN
Cooper Hospital, Vile Parle West, Mumbai, Maharashtra, India
E‑mail: rkoticha@gmail.com
References
1. A h m a d   Z , G o y a l   A , D a s   C J , D e k a   D , S h a r m a   R .
Herlyn‑Werner‑Wunderlich syndrome presenting with infertility:
Role of MRI in diagnosis. Indian J Radiol Imaging 2013;23:243‑6.
375