Imaging Options Research Articles

Atrioventricular Septal Defects: Pathology, Imaging, and Treatment Options.

Atrioventricular septal defects (AVSD) represent a broad spectrum of congenital anomalies from simple to the most complex heart defects including some distinct types. Clinical presentation and timing of intervention differ by morphological subset and functional anatomy. Herein, we review morphological variations and characteristics that determine appropriate intervention and provide insights into functional anatomy based on detailed three-dimensional (3D) assessment of AVSDs. The understanding of functional morphology of AVSDs has improved significantly with detailed 3D echocardiographic evaluation of the atrioventricular junction and valve morphology. As prenatal detection of AVSDs has increased significantly, it has become the most common fetal cardiac diagnosis enabling antenatal counseling and delivery planning. Advances in diagnosis and perioperative care have resulted in optimal outcomes. The diagnosis and management of AVSDs have improved over the years with enhanced understanding of anatomy and perioperative care resulting in optimal short and long-term outcomes.

SPECT-CCTA: guiding treatment in ischaemic heart disease

Combining myocardial perfusion single photon emission computed tomography (SPECT-MPI) and coronary computed tomography angiography (CCTA) is an interesting hybrid imaging option in modern cardiovascular medicine. The integrated hybrid technique has a number of advantages compared to visual side-by-side analysis of the separate modalities. CT attenuation map can correct for attenuation artefacts and thus improve the diagnostic accuracy of SPECT-MPI. Moreover, the anatomical information of the CCTA and the perfusion map of SPECT-MPI allow for vessel-based correlation and culprit vessel identification. Combining SPECT-MPI with CCTA is an appealing tool in the work-up of complex ischaemic heart disease and might help determine the optimal treatment strategy. This case series illustrates the role of SPECT-CCTA in decision-making of revascularization strategy in complex ischaemic heart disease.

The reasons for revision surgery after reconstruction of the anterior cruciate ligament: a systematic review

Reconstruction of the anterior cruciate ligament (ACL) is a fairly successful surgical intervention that can achieve satisfactory results in 75-97 % of cases. In order to show the main categories of factors that can affect the functional outcomes of patients after ACL reconstruction and lead to unsatisfactory outcomes after surgery based on the literature data, we have run a search for English- and Russian-language publications in the electronic databases PubMed and RSCI for the period from 2000 to 2019 using the keywords: anterior cruciate ligament, ACL, revision, re-reconstruction, re-injury, re-rupture, graft failure. Out of 634 papers, 113 publications with the full text were selected. Inclusion criteria - more than 50 cases in the report; follow - up period of more than 2 years; the same groups of patients; assessment of knee joint function; application of various imaging options for the knee joint. 26 papers were included in this review. Based on the analysis of the multiple causes of failed ACL reconstruction outcomes were merged into four main groups: technical mistakes diagnosis and surgery (from 22 % to 79 %); re-injury (18 % to 79 %); biological factors (violation of the integration of the graft and its ligamental) (17 %); errors of rehabilitation and other (15 %). Thus, the review made it possible to systematize the causes of unsuccessful outcomes of ACL reconstruction and identify the most frequent.

Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States.

For two decades, pediatric contrast US has been well accepted throughout Europe and other parts of the world outside the United States because of its high diagnostic efficacy and extremely favorable safety profile. This includes intravenous (IV) administration, contrast-enhanced US (CEUS) and the intravesical application, contrast-enhanced voiding urosonography (ceVUS). However, the breakthrough for pediatric contrast US in the United States did not come until 2016, when the U.S. Food and Drug Administration (FDA) approved the first pediatric indication for a US contrast agent. This initial approval covered the use of Lumason (Bracco Diagnostics, Monroe Township, NJ) for the evaluation of focal liver lesions via IV administration in children. A second pediatric indication followed shortly thereafter, when the FDA extended the use of Lumason for assessing known or suspected vesicoureteral reflux via intravesical application in children. Both initial pediatric approvals were granted without prospective pediatric clinical trials, based instead on published literature describing favorable safety and efficacy in children. Three years later, in 2019, the FDA approved Lumason for pediatric echocardiography following a clinical trial involving a total of 12 subjects at 2 sites. The story of how we achieved these FDA approvals spans more than a decade and involves the extraordinary dedication of two professional societies, namely the International Contrast Ultrasound Society (ICUS) and the Society for Pediatric Radiology (SPR). Credit also must be given to the FDA staff for their commitment to the welfare of children and their openness to compelling evidence that contrast US is a safe, reliable, radiation-free imaging option for our pediatric patients. Understanding the history of this approval process will impact the practical application of US contrast agents, particularly when expanding off-label indications in the pediatric population. This article describes the background of the FDA's approval of pediatric contrast US applications to better illuminate the potential pathways to approvals of future indications.

What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review.

ObjectivesClinicians have minimal guidance regarding the clinical consequences of each radiologic imaging option for suspected renal colic in the emergency department (ED), particularly in relation to patient‐centered outcomes. In this scoping review, we sought to identify studies addressing the impact of imaging options on patient‐centered aspects of ED renal colic care to help clinicians engage in informed shared decision making. Specifically, we sought to answer questions regarding the effect of obtaining computed tomography (CT; compared with an ultrasound or delayed imaging) on safety outcomes, accuracy, prognosis, and cost (financial and length of stay [LOS]).MethodsWe conducted a comprehensive search using Pubmed, EMBASE, Web of Science conference proceedings index, and Google Scholar, identifying studies pertaining to renal colic, urolithiasis, and ureterolithiasis. In a prior qualitative study, stakeholders identified 14 key questions regarding renal colic care in the domains of safety, accuracy, prognosis, and cost. We systematically screened studies and reviewed the full text of articles based on their ability to address the 14 key questions.ResultsOur search yielded 2570 titles, and 68 met the inclusion criteria. Substantial evidence informed questions regarding test accuracy and radiation exposure, but less evidence was available regarding the effect of imaging modality on patient‐oriented outcomes such as cost and prognosis (admissions, ED revisits, and procedures). Reviewed studies demonstrated that both standard renal protocol CT and low‐dose CT are highly accurate, with ultrasound having lower accuracy. Several studies found that ureterolithiasis diagnosed by ultrasound was associated with overall reduced radiation exposure. Existing studies did not suggest choice of imaging influences prognosis. Several studies found no substantial differences in monetary cost, but LOS was found to be shorter if a diagnosis was made with point‐of‐care ultrasound.ConclusionThere is a plethora of data related to imaging accuracy. However, there is minimal data regarding the effect of CT on many patient‐centered outcomes. Further research could improve the patient‐centeredness of ED care.

Comparison of Panoramic, Lateral Skull Projection and CBCT Images in Detection of Mandibular Condyle Fractures

Objectives: Condyle fractures constitute 17.5–52% of all mandibular fractures. Our first aim was to investigate whether panoramic radiography or LSP images with lower radiation dose can be used instead of CBCT in the diagnosis of vertical condylar fractures. The second aim of the study was to compare observers' capabilities in diagnosing these fractures.
 Materials and Methods: A sample consisting of 15 fresh cadaver mandibles with 30 condyles frozen within 24 hours post-mortem was randomly selected. Vertical fractures from the lateral 2/3 of the condyle head with 0.5 (10 condyles) and 1mm (10 condyles) thickness were created using a fret saw. After creating condyle fractures, digital panoramic, LSP, and CBCT images were acquired. Two dentomaxillofacial radiologists with 15 years of experience, two dentomaxillofacial radiologists with five and seven years of experience, and two newly graduated dentists have evaluated the images. The success of the observers in diagnosing the vertical condyle fracture in each imaging method, intra-observer and inter-observer agreement was evaluated. 
 Results: The success of all dentists in determining the condyle fractures using LSP images was higher than the success they achieved using panoramic images, but it was not sufficient. Using different imaging options with CBCT, all diagnoses made by new graduates and dentomaxillofacial radiologists with five and 15 years’ experience were 100% compatible with the gold standard (AC1: 1 (1–1)).
 Conclusions: For the diagnosis of vertical condyle fractures, conventional techniques (panoramic and lateral jaw imaging methods) were found to be insufficient.

Hepatobiliary Excretion PET/CT With 68Ga-TAoS-DAZA to Evaluate Bile Duct Patency.

Tri-alkoxysalicyl-1,4-diazepan-6-amine (TAoS-DAZA) ligands, radiolabelled with 68Ga, have been proposed as PET/CT agents for depiction and quantification of hepatobiliary function and evaluation of bile excretion. In the presented case, a patient with hepatocellulary carcinoma underwent PET/CT with the TAoS-derivate 68Ga-tri-methoxysalicyl-(TMoS)-DAZA to determine the patency of intrahepatic and extrahepatic bile ducts, in particular of a stent in the common bile duct. The PET/CT was performed without complications. Evaluation of bile excretion over time was possible. 68Ga-TAoS-DAZA PET/CT may be an option for dynamic imaging of the excretory hepatic function to visualize the biliary tree and to rule out cholestasis.

Tutorial: practical considerations for tissue clearing and imaging.

Tissue clearing has become a powerful technique for studying anatomy and morphology at scales ranging from entire organisms to subcellular features. With the recent proliferation of tissue-clearing methods and imaging options, it can be challenging to determine the best clearing protocol for a particular tissue and experimental question. The fact that so many clearing protocols exist suggests there is no one-size-fits-all approach to tissue clearing and imaging. Even in cases where a basic level of clearing has been achieved, there are many factors to consider, including signal retention, staining (labeling), uniformity of transparency, image acquisition and analysis. Despite reviews citing features of clearing protocols, it is often unknown a priori whether a protocol will work for a given experiment, and thus some optimization is required by the end user. In addition, the capabilities of available imaging setups often dictate how the sample needs to be prepared. After imaging, careful evaluation of volumetric image data is required for each combination of clearing protocol, tissue type, biological marker, imaging modality and biological question. Rather than providing a direct comparison of the many clearing methods and applications available, in this tutorial we address common pitfalls and provide guidelines for designing, optimizing and imaging in a successful tissue-clearing experiment with a focus on light-sheet fluorescence microscopy (LSFM).

Secondary lymphedema from cancer therapy.

This manuscript is a summary of findings focusing on various aspects of secondary lymphedema specifically as a sequelae of treatment for cancer. The topic was addressed at a session held during the 8th International Congress on Cancer Metastasis that was unique a for the inclusion of patients with lymphedema and therapists joining physicians, healthcare professionals, and researchers in an effort to give an overview of secondary lymphedema following cancer therapy as well as highlighting the unknowns in the field. Lymphedema is defined and both diagnosis and incidence of cancer-related lymphedema are explored. Further, exploration of imaging options for lymphedema and information on the genetic research for patients with cancer-related secondary lymphedema are presented. Patient education and early detection methods are then explored followed by conservative treatment. Finally, an examination of surgical treatment methods available for patients with lymphedema is covered. Overall, this manuscript presents valuable information and updates for those not familiar with incidence, diagnosis, early detection, and rehabilitation of patients with cancer-related secondary lymphedema.

The Importance of Intraoperative Plain Radiographs during Cochlear Implant Surgery in Patients with Normal Anatomy

Although malpositioning of the cochlear implant (CI) electrode array is rare in patients with normal anatomy, when occurring it may result in reduced hearing outcome. In addition to intraoperative electrophysiologic tests, imaging is an important modality to assess correct electrode array placement. The purpose of this report was to assess the incidence and describe cases in which intraoperative plain radiographs detected a malpositioned array. Intraoperative anti-Stenver’s view plain X-rays are conducted routinely in all CI surgeries in our tertiary center before awakening the patient and breaking the sterile field. Data of patients undergoing 399 CI surgeries were retrospectively analyzed. A total of 355 had normal inner ear and temporal bone anatomy. Patients with intra or extracochlear malpositioned electrode arrays demonstrated in the intraoperative X-ray were described. There were four cases of electrode array malposition out of 355 implantations with normal anatomy (1.1%): two tip fold-overs, one extracochlear placement and one partial insertion. All electrodes were reinserted immediately; repeated radiographs were normal and the patients achieved good hearing function. Intraoperative plain anti-Stenver’s view X-rays are valuable to confirm electrode array location, allowing correction before the conclusion of surgery. These radiographs are cheaper, faster, and emit much less radiation than other imaging options, making them a viable cost-effective tool in patients with normal anatomy.

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia.

Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. All thrombolytic treatments performed during 2001-2018 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Patients with (n = 23) and without (n = 85) DM had lower (P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI -0.22 to 0.56) and 0.71 (95% CI 0.38-0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI -0.12 to 0.40) and 0.64 (95% CI 0.48-0.80), respectively. The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

Spectroscopic photoacoustic imaging of cartilage damage

Osteoarthritis (OA) is a chronic joint disease characterized by progressive degradation of cartilage. It affects more than 10% of the people aged over 60 years-old worldwide with a rising prevalence due to the increasingly aging population. OA is a major source of pain, disability, and socioeconomic cost. Currently, the lack of effective diagnosis and affordable imaging options for early detection and monitoring of OA presents the clinic with many challenges. Spectroscopic Photoacoustic (sPA) imaging has the potential to reveal changes in cartilage composition with different degrees of damage, based on optical absorption contrast. In this study, the capabilities of sPA imaging and its potential to characterize cartilage damage were explored. To this end, 15 pieces of cartilage samples from patients undergoing a total joint replacement were collected and were imaged ex vivo with sPA imaging at a wide optical spectral range (between 500nm and 1,300nm) to investigate the photoacoustic properties of cartilage tissue. All the PA spectra of the cartilage samples were analyzed and compared to the corresponding histological results. The collagen related PA spectral changes were clearly visible in our imaging data and were related to different degrees of cartilage damage. The results are in good agreement with histology and the current gold standard, i.e., the Mankin score. This study demonstrates the potential and possible clinical application of sPA imaging in OA.

Assessment of Vocal Cord Motion Using Laryngeal Ultrasound in Children: A Systematic Review and Meta-Analysis.

Laryngeal ultrasound is a nonirradiating, noninvasive method for assessing the upper airway in children. This systematic review and meta-analysis examine available evidence for accuracy of laryngeal ultrasound in diagnosing vocal cord immobility in infants and children after surgery and trauma affecting the vocal cords. Medical subject heading terms were used to search MEDLINE, Embase, Google Scholar, Web of Science, and the Cochrane Library for relevant citations. Publications from January 1, 2000, to June 30, 2020 were included in the search strategy. Study inclusion criteria consisted of randomized control trials and nonrandomized retrospective or prospective observational studies where vocal cord motion was evaluated by laryngeal ultrasound and compared with a reference test. Studies were excluded if there was insufficient data to compute a sensitivity/specificity table. Case reports, case series less than 10, and manuscripts not published in English were also excluded. Studies which included subjects younger than or equal to 18 years were considered for full article review. No restrictions on study settings were imposed in this systematic review. The initial search returned 1,357 citations. After de-duplication, abstract, and full review, eight citations were included in the final meta-analysis. A bivariate random-effects meta-analysis was performed, which revealed a pooled sensitivity for laryngeal ultrasound in detecting vocal cord immobility of 91% (95% CI, 83-95%), specificity of 97% (95% CI, 82-100%), diagnostic odds ratio 333.56 (95% CI, 34.00-3,248.71), positive likelihood ratio 31.58 (95% CI, 4.50-222.05), and negative likelihood ratio 0.09 (95% CI, 0.05-0.19). Laryngeal ultrasound demonstrates high sensitivity and specificity for detecting vocal cord motion in children in a wide range of clinical settings. Laryngeal ultrasound offers a low-risk imaging option for assessing vocal cord function in children compared with the current gold standard of laryngoscopy.

Patient Response to Receiving a Notification of Elevated Breast Cancer Risk after Regular Screening Mammogram

Abstract Background: Population-based screening for breast cancer risk can identify unaffected women at elevated risk and inform them of risk-management options. The James Cancer Hospital recently began assessing risk for women undergoing routine screening mammography. Women found to have ≥20% lifetime risk are notified – with their mammogram results via mail and electronic medical record – that they may be at elevated risk of breast cancer and should consider consulting a high-risk provider. This initial study examined findings from a subsample who participated 2–6 weeks post-notification. Purpose: We sought to determine whether women noticed and understood the notification, and to examine their reactions to the notification of elevated risk. Methods: Of 415 women recruited, 150 (36%) completed the survey, which included items to assess memory and comprehension of the notification, and whether participants had (a) seen a healthcare provider since the notification, and (b) discussed breast cancer risk and management options during that appointment. Results: Participants (aged 40–69; mean = 50.8 years) were mostly White (86%), well-educated (77%), and with above-average income (65%). Most remembered receiving the notification (73%), perceived the information not to be complex (73%), and were confident they understood the notification (93%). Somewhat fewer (64%) remembered that the notification indicated they may be at elevated risk for breast cancer, and 44% also recalled the suggestion to meet with a healthcare provider about this risk. Of the 28 participants who had already seen any healthcare provider in the few weeks since the notification, 50% discussed breast cancer risk during that appointment and 25% said they did so because of the notification. Discussions included family cancer history, actual risk of developing breast cancer, and options for additional imaging or testing. Conclusions: These findings indicate that population-based screening associated with routine mammography can motivate women at elevated breast cancer risk to discuss their risk and management options with a healthcare provider. For some proportion of women, however, complementary communication strategies may also be needed to ensure they gain awareness of their higher-risk status.

X-ray diagnostics of fractures in childhood and adolescence-Consensus report of the scientific working group of the pediatric traumatology section of the German Society for Trauma Surgery (DGU)

Seit Jahrzehnten ist die Projektionsradiographie Standard in der Diagnostik von Frakturen und Verletzungen auch bei Patienten im Kindes- und Jugendalter. Bei jeder Untersuchung mit Röntgenstrahlen sollen aber auch individuell Nutzen und Risiko gegeneinander abgewogen werden. Die Sektion Kindertraumatologie der DGU hat zu verschiedenen Aspekten der Bildgebung zu Diagnostik und Verlaufsbeurteilung, zu Einstellungsmöglichkeiten der intraoperativen Bildgebung, zum Röntgen der Gegenseite, zu Polytrauma und CT, zu postoperativen radiologischen Kontrollen und dem Einsatz der Sonographie ein Konsenspapier erarbeitet.

Semi-automated image acquisition and automatic image quantification methods for liver Organ-Chips

Toxicant exposure can induce acute or chronic alterations in cellular numbers, morphology, and cell function. The quantification of these parameters can provide valuable information regarding a toxicant's effect and/or mechanism of action in organ-on-a-chip toxicity testing platforms. Unfortunately, manual quantification can be variable and time consuming. Additionally, the unique designs of Organ-Chips make automated imaging difficult as current microscopes were not specifically designed for Organ-Chip use. The development of semi-automated and automated imaging and quantification procedures greatly increases the quantity and quality of collected data. Using Emulate's transparent liver Organ-Chip (Liver-Chip) in combination with Keyence's bench-top BZ-X700 All-in-one fluorescence microscope we have developed semi-automated imaging and automated quantification methods for nuclei, mitochondrial viability, and apoptosis. The methods described herein provide alternative imaging options to more costly and space consuming microscopes while still providing necessary features for Organ-Chip evaluation. We were able to detect significant decreases in nuclear number and mitochondrial membrane potential, and significant increases in apoptosis with a model hepatotoxic compound, benzbromarone. These methods have greatly reduced the time and increased the quality of cell number/function data acquisition and demonstrated that these automated quantification methods can detect changes resulting from chemical exposure.

Imaging of the hand : What should be considered regarding the nerves?

Peripheral nerve disorders of the hand and wrist are most commonly caused by entrapment neuropathies, while traumatic nerve injuries and neoplasms are less common. The indication for additional imaging methods and different imaging options, especially in patients with atypical symptoms or remaining unclear etiology of symptoms after completion of standard diagnostics, are presented. The imaging methods magnetic resonance (MR) neurography and neurosonography are introduced, and typical findings as well as diagnostic pitfalls are presented. The diagnostic gold standard, which comprises apast medical history, neurologic examination and electrophysiology, can often establish the diagnosis. Imaging methods, especially MR neurography and neurosonography, are gaining increasing importance in the diagnostic workup of atypical neuropathies, as well as in the determination of the exact lesion location and spatial lesion extension, especially for surgical planning. Recent technical advances allow high-resolution depiction of small distal terminal nerve branches. MR neurography allows for the high-resolution depiction of peripheral nerves of the hand and wrist. It can confirm the diagnosis of neuropathy, identify the exact lesion location, and rule out any differential diagnoses. Neurosonography is atime- and cost-efficient alternative diagnostic method.

Prionopathies and Prionlike Protein Aberrations in Neurodegenerative Diseases

Protein misfolding has been an area of intense research and is implicated in a number of neurodegenerative diseases. Key proteins in the brain lose their native ability to fold and instead assume abnormal conformations. Misfolded proteins cluster to form pathologic aggregates, which cause cellular dysfunction, neuronal death, and neurodegeneration. The prionopathies are best known among the neurodegenerative diseases for their ability to misfold, self-propagate, and infect other organisms. There is increasing evidence of a rationale for a prionlike mechanism of spread of other neurodegenerative diseases through a similar seeding mechanism. In this review, we detail the role of a key protein aberration known to the various prion diseases, including sporadic, variant, and iatrogenic Creutzfeldt-Jakob disease; variably protease-sensitive prionopathy; Gerstmann-Straussler-Scheinker disease; fatal familial insomnia; and kuru. We also discuss the clinical presentation, the available, and emerging imaging options for these diseases. In the second part of this review, we delineate how a prionlike seeding process may be driving the progression of other neurodegenerative diseases, including Parkinson disease, Alzheimer disease, and Huntington disease. A discussion of clinical presentation and imaging features of these example diseases follows to make a case for a common approach to developing imaging biomarkers and therapies of these diseases.Learning Objective: Upon completion of this article, one should be able to describe the various types of prion diseases, recognize and identify the common the neuro-imaging findings in prion diseases, describe seeding mechanism of prion disease, list the common amyloid PET tracers used for Alzheimer’s disease, and list common imaging biomarkers in neurodegenerative diseases.

Head-to-Head Comparison of 68Ga-NOTA (68Ga-NGUL) and 68Ga-PSMA-11 in Patients with Metastatic Prostate Cancer: A Prospective Study.

68Ga-NOTA Glu-Urea-Lys (NGUL) is a novel prostate-specific membrane antigen (PSMA)-targeting tracer used for PET/CT imaging. This study aimed to compare performance in the detection of primary and metastatic lesions and to compare biodistribution between 68Ga-NGUL and 68Ga-PSMA-11 in the same patients with prostate cancer. Methods: Eleven patients with metastatic prostate cancer were prospectively recruited. The quantitative tracer uptake was determined in normal organs and in primary and metastatic lesions. Results:68Ga-NGUL showed significantly lower normal-organ uptake and rapid urinary clearance. The number and sites of detected PSMA-positive primary and metastatic lesions were identical, and no significant quantitative uptake difference was observed. 68Ga-NGUL showed a relatively lower tumor-to-background ratio than 68Ga-PSMA-11. Conclusion: In a head-to-head comparison with 68Ga-PSMA-11, 68Ga-NGUL showed lower uptake in normal organs and similar performance in detecting PSMA-avid primary and metastatic lesions. 68Ga-NGUL could be a valuable option for PSMA imaging.

Scope of sub basalt imaging using locally generated converted waves and mixed mode depth imaging: A study on real data

The seismic imaging below basaltic layer is extremely challenging. The attenuation of PP energy while penetrating through basalt section, very high absorption and scattering of PP waves and generation of multiples are some important impediments. The imaging problems are severe when basaltic layer has varying thicknesses (undulations) of multiple flows with inter layered sediments. Basalt has high velocity compared to surrounding sediment. Hence the point of critical reflection angle is reached at a smaller offset. Anomalous value of Vp/Vs generates converted waves from basalt top. Quantitative modelling has demonstrated the presence of PSSP energy up to a wide offset range (8+ Km). This has led us to explore the option of sub-basalt imaging using PSSP waves. We generated synthetic PP and PSSP gathers with one dimensional modelling. The PSSP energy is visible from an offset of 1800 m onwards from basalt top. In absence of multi component OBN or OBC data, an attempt has been made to extract PSSP waves from 2D seismic data (streamer data) for time and depth imaging of PSSP waves. In this paper, we also present mixed mode (PP + PSSP), depth imaging as an alternative option for more precise structural interpretation and mapping of sub-basalt reflectors.