Kartik S Jhaveri

University Health Network, Toronto, Ontario, Canada

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Publications (53)129.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE. Inflammatory hepatocellular adenoma (HCA) is a recently categorized entity of hepatocellular neoplasms. We investigated whether gadoxetic acid-enhanced MRI can distinguish inflammatory HCA from focal nodular hyperplasia (FNH). MATERIALS AND METHODS. From January 1, 2009, through January 1, 2013, gadoxetic acid-enhanced MRI examinations from two institutions were reviewed for HCA, with specific histologic features of inflammatory HCA. Biopsy and resection slides were reviewed, and immunohistochemistry for glutamine synthetase was performed in a subset to confirm the initial diagnosis. RESULTS. A total of 10 possible cases of inflammatory HCA were identified in the pathology database. On the basis of glutamine synthetase staining performed for this study, three cases were rediagnosed as FNH and thus were excluded from the study. Therefore, a total of seven patients with inflammatory HCA were identified. On gadoxetic acid-enhanced MRI, four of these patients had classic features of FNH (group A, FNH mimics), and three had imaging features suggestive of HCA (group B, typical inflammatory HCA). Imaging features that were considered diagnostic of FNH included isointense or minimal T2 hyperintensity, arterial enhancement, and diffuse hyperintensity on hepatobiliary phase. Three of the four patients with FNH mimics had slides available for pathologic rereview, and the diagnosis of inflammatory HCA was supported by glutamine synthetase immunohistochemistry findings. The pathology reports of the remaining four cases were rereviewed and were also found to have features consistent with inflammatory HCA. CONCLUSION. Inflammatory HCA can mimic FNH on MRI, including hepatobiliary phase hyperintensity. Moreover, conventional pathology using histopathology alone may lead to misclassification of inflammatory HCA.
    AJR. American journal of roentgenology. 07/2014;
  • Elizabeth Furey, Kartik S Jhaveri
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    ABSTRACT: MR imaging plays a key role in staging evaluation of rectal cancer. The cornerstone of staging MR involves high-resolution T2 imaging orthogonal to the rectal lumen. The goals of MR staging are identification of patients who will benefit from neoadjuvant therapy prior to surgery to minimize postoperative recurrence and planning of optimal surgical approach. MR provides excellent anatomic visualization of the rectum and mesorectal fascia, allowing for accurate prediction of circumferential resection margin status and tumor stage. MR has an evolving role for the evaluation of neoadjuvant treatment response, further triaging optimal patient treatment and surgical approach.
    Magnetic resonance imaging clinics of North America 05/2014; 22(2):165-190.
  • Kartik Jhaveri
    Journal of Magnetic Resonance Imaging 03/2014; · 2.57 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study was to perform a retrospective MRI-based comparative analysis of the morphologic patterns of bile duct disease in IgG4-related systemic disease (ISD, also called autoimmune pancreatitis) compared with primary sclerosing cholangitis (PSC) and the autoimmune liver diseases autoimmune hepatitis and primary biliary cirrhosis. MATERIALS AND METHODS. This study included 162 consecutively registered patients (47 with ISD, 73 with PSC, and 42 with autoimmune liver diseases). Two abdominal radiologists retrospectively reviewed MR images in consensus. Imaging findings on the bile ducts, liver, pancreas, and other organs were analyzed to establish disease patterns. RESULTS. ISD was associated with contiguous thickening of intrahepatic and extrahepatic bile ducts (p < 0.001), pancreatic parenchymal abnormalities (p < 0.001), renal abnormalities (p < 0.001), and gallbladder wall thickening (p < 0.03). The severity of common bile duct wall thickness was significantly different in ISD (p < 0.001). The mean single wall thickness in the ISD group was 3.00 (SD, 1.47) mm, in the PSC group was 1.89 (SD, 0.73) mm, and in the autoimmune liver disease group was 1.80 (SD, 0.67) mm. PSC was associated with liver parenchymal abnormalities (p < 0.001). We did not find statistical significance between the three groups in location (p = 0.220) or length (p = 0.703) of extrahepatic bile duct strictures, enhancement of bile duct stricture (p = 0.033), upper abdominal lymphadenopathy, or retroperitoneal fibrosis. Although presence of intrahepatic bile duct stricture was statistically significant when all three groups were compared, it was not useful for differentiating ISD from PSC. CONCLUSION. The presence of continuous as opposed to skip disease in the bile ducts, gallbladder involvement, and single-wall common bile duct thickness greater than 2.5 mm supports a diagnosis of ISD over PSC. ISD and PSC could not be differentiated on the basis of location and length of common bile duct stricture.
    American Journal of Roentgenology 03/2014; 202(3):536-43. · 2.90 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study is to evaluate the interval growth, tumor recurrence, and metastatic disease occurrence of cystic renal cell carcinoma (RCC). MATERIALS AND METHODS. Pre-and posttreatment imaging of 47 histologically proven cystic RCCs, with at least 6 months of pretreatment imaging monitoring or at least 2 years of posttreatment imaging follow-up, or both, was retrospectively reviewed. Tumor morphologic features, preoperative growth, histologic typing and grading, and the incidence of tumor recurrence or metastasis were evaluated. Growth rate of tumors were compared among various histologic subtypes and Fuhrman grades. RESULTS. Of 47 tumors, 27 (57.5%) were clear cell RCCs, 12 (25.5%) were multilocular RCCs, and eight (17%) were papillary cystic RCCs. Overall, 26 (55.3%) tumors were graded as Fuhrman grade 2, 17 (36.1%) were Fuhrman grade 1, and one tumor was Fuhrman grade 3. Of the 26 tumors with a minimum of 6 months of pretreatment imaging monitoring, 19 (73%) did not show a significant increase in tumor size. The differences in mean growth among the Fuhrman grades and different subtypes were not statistically significant. The average duration of posttreatment follow-up was 51 months. There were no local recurrences among the 43 patients who underwent posttreatment imaging, except for one patient who had metastasis at preoperative clinical presentation. CONCLUSION. Cystic RCCs exhibit slow indolent growth, if any, and show no significant metastatic or recurrence potential, with excellent clinical outcomes. We raise the need for revisiting current imaging protocols that may involve frequent pre-and posttreatment imaging in cystic RCCs.
    American Journal of Roentgenology 08/2013; 201(2):W292-6. · 2.90 Impact Factor
  • Phillip V P Tran, Kartik S Jhaveri
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    ABSTRACT: PURPOSE: To assess if a high resolution respiratory triggered inversion recovery prepared GRE sequence (RT) improved image quality and detection of lesions compared with breathhold GRE T1 weighted MR sequence (BH) in the hepatobiliary uptake phase of MR of the liver using gadoxetic acid (Gd-EOB-DTPA). MATERIALS AND METHODS: Thirty-eight consecutive patients from July 2009 to September 2010 who had undergone Gd-EOB-DTPA enhanced liver exams were retrospectively identified. Qualitative assessment performed on reference lesions and background liver by two independent readers. Quantitative assessment performed by one reader. RESULTS: Liver parenchyma signal-to-noise ratio for BH was 90.3 ± 23.9 (mean ± SD) and RT, 106.1 ± 40.4 (P = 0.119). For BH, 320 lesions were detected compared with 257 for RT. Lesion to liver contrast was significantly better on RT sequences (0.26 ± 0.24; mean ± SD) compared with BH sequence (0.21 ± 0.20; P = 0.044). Fifty-seven reference lesions assessed. Both reviewers rated BH better for lesion margin and hepatic vessel sharpness. BH was rated with less artifact (P < 0.05). Lesion to liver contrast on BH was significantly better for one reviewer. CONCLUSION: BH sequence had better overall image quality than RT in several quantitative and qualitative factors including number of lesions detected and level of artifact. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 01/2013; · 2.57 Impact Factor
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    ABSTRACT: PURPOSE: To assess Blood Oxygen Level-Dependent (BOLD) Magnetic Resonance Imaging (MRI) for noninvasive preoperative prediction of Microvascular Invasion (MVI) in Hepatocellular Carcinoma (HCC). MATERIALS AND METHODS: In this prospective, institutional review board approved study, 26 patients (21 men and 5 women age range, 34-77 years with mean age of 61 years) with HCC were evaluated preoperatively with liver MRI including baseline and post oxygen (O2) breathing BOLD MRI. Post processing of MRI data was performed to obtain R2* values (1/s) and correlated with histopathological assessment of MVI. Statistical analysis was performed to assess correlation of baseline R2*, post O2 R2* and R2* ratios to presence of MVI in HCC by binary logistic regression analysis. RESULTS: MVI was present in 15/26 (58%) of HCC on histopathology. The mean R2* values ± SD at baseline and post O2 with and without MVI were 35 ± 12, 36 ± 12, 38 ± 10, 42 ± 17. The R2* values between the groups with and without MVI were not significantly different statistically. CONCLUSION: BOLD MRI is unable to accurately predict MVI in HCC. The noninvasive preoperative MRI detection of MVI in HCC remains elusive. J. Magn. Reson. Imaging 2012. © 2012 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 11/2012; · 2.57 Impact Factor
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    ABSTRACT: Advances in MR hardware and pulse sequence design over the years have improved the quality and robustness of MR imaging of the pancreas. Today, MRI is an indispensible tool for studying the pancreas and can provide useful information not attainable with other noninvasive or minimally invasive imaging techniques. In the present review, specific cases are reviewed where the strengths of MRI demonstrate the utility of this imaging modality as a problem solving tool. J. Magn. Reson. Imaging 2012;36:1037-1051. © 2012 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 11/2012; 36(5):1037-51. · 2.57 Impact Factor
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    Syed Arsalan Raza, Kartik S Jhaveri
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    ABSTRACT: This article presents a radiologic perspective of male infertility. Basic embryologic, anatomic, and physiologic concepts underpinning male reproduction are explained. Common and uncommon abnormalities related to male infertility and subfertility are described, with emphasis on imaging findings and management strategies.
    Radiologic Clinics of North America 11/2012; 50(6):1183-200. · 1.95 Impact Factor
  • Syed Arsalan Raza, Kartik S Jhaveri
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    ABSTRACT: Detection of muscle invasion is a critical aspect in management of urinary bladder cancer. MR imaging has the potential and promise of delivering this premise noninvasively. This article reviews the current status of MR imaging in evaluation of bladder cancer. Also discussed are other important neoplastic and nonneoplastic conditions affecting the bladder.
    Radiologic Clinics of North America 11/2012; 50(6):1085-110. · 1.95 Impact Factor
  • Kartik S Jhaveri, Mukesh G Harisinghani
    Radiologic Clinics of North America 11/2012; 50(6):xi. · 1.95 Impact Factor
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    ABSTRACT: Portal biliopathy refers to biliary abnormalities secondary to extrahepatic portal vein obstruction and cavernous transformation and is caused by vascular compression from peribiliary collateral vessels, producing segmental stenoses of the common bile duct and abnormal liver function test (LFT) results. A review of imaging studies yielded 18 patients with abnormal LFT results, biliary tract dilatation, and extrahepatic portal vein obstruction with cavernous transformation. Multidetector computed tomography and magnetic resonance imaging showed biliary stenotic segments in 11 patients secondary to extrinsic compression from enlarged peribiliary collaterals. Clinical and imaging follow-up demonstrated improvement in LFT results with minimal decrease in bile duct dilatation, eliminating percutaneous or endoscopic biliary intervention.
    Clinical imaging 03/2012; 36(2):126-34. · 0.73 Impact Factor
  • Gillian Murphy, Kartik Jhaveri
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    ABSTRACT: The management of renal cell carcinoma (RCC) is evolving owing to the increasing detection of small renal masses, greater understanding of the metabolic pathways involved, new targeted medical treatments for metastatic RCC, and evolving surgical and minimally invasive image-guided treatment techniques. Consequently, the role of imaging and radiology has expanded, with new challenges encompassing all aspects of management, including diagnosis, predicting cell type, staging, preoperative vascular mapping, image-guided treatment and biopsy, detection of recurrence and the use of imaging as a biomarker to assess response to treatment. This article is a comprehensive review of RCC, outlining the etiology of the disease, RCC histological subtypes and their imaging characteristics, imaging modality techniques for evaluation of RCC, treatment strategies and the management of small renal masses.
    Expert Review of Anti-infective Therapy 12/2011; 11(12):1871-88. · 2.07 Impact Factor
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    ABSTRACT: Pancreatic adenocarcinoma is the fourth leading cause of cancer death. A prospective cohort study was undertaken between 2003 and 2011 at a tertiary care centre in Toronto, Canada. Two hundred and sixty-two subjects were enrolled based on an elevated estimated lifetime risk for pancreatic cancer due to known genetic mutations and/or cancer family history. Subjects underwent annual magnetic resonance imaging, followed by additional investigations if abnormal findings were detected. Evidence of malignancy or suspicious macroscopic abnormalities prompted referral for surgical intervention. Average length of follow-up was 4.2 years, during which 84/262 (32%) subjects demonstrated pancreatic abnormalities. Three participants developed pancreatic adenocarcinoma (one 1.5-cm tumor was resected but recurred, while the other two subjects developed metastatic cancer), and a fourth participant developed a pancreatic neuroendocrine tumor that was resected. Fifteen subjects had radiologic evidence of branch-duct intraductal papillary mucinous neoplasms, of which two underwent surgical resection. Sixty-five subjects had simple pancreatic cysts that have remained stable. Magnetic resonance imaging can detect small pancreatic tumors and cystic lesions, but further improvement in sensitivity is needed. An understanding of the natural history of pre-invasive lesions in members of high-risk families is necessary for developing a more effective screening program.
    Journal of Gastrointestinal Surgery 11/2011; 16(4):771-83. · 2.36 Impact Factor
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    ABSTRACT: American Association for the Study of Liver Diseases (AASLD) guidance recommends measurement of IgG4 in patients with sclerosing cholangitis (SC). The objective of this study was to evaluate this by analyzing our SC practice. Characteristics were collected on 168 patients with radiological or biopsy proven SC; IgG4 was measured and magnetic resonance cholangiopancreatography studies were reviewed. In all, 49% of patients were females and 55% had inflammatory bowel disease. Large duct disease was present in 63%, small duct disease in 8%, overlap with AIH in 11%, and secondary SC in 18%. Secondary etiologies included autoimmune pancreatitis (AIP) (8%), intra-hepatic cholelithiasis (3%), portal vein thrombosis (2%), and neonatal Kasai (2%). In all, 101 patients had sufficient radiology and serology for re-evaluation. IgG4 was elevated (>104 mg/dl) in 22% of patients. This was associated with male gender (73%; P=0.016), a past history of pancreatitis (27% vs. 5%; P=0.007), a higher alkaline phosphatase (ALP) value, median 338.5 U/l vs. 160 (P=0.005), and a higher primary sclerosing cholangitis (PSC) Mayo risk score, mean 0.6 vs. -0.2 (P=0.0008). Prior biliary intervention was more likely (36 vs. 13%; P=0.023), while abnormal pancreatic imaging was noted in 15%, more frequently if IgG4 was elevated (40 vs. 8%; P=0.0007). After excluding those with pancreatic disease on magnetic resonance imaging, 14 patients had elevated IgG4. This group had higher ALP 379 U/l vs. 155.5 (P=0.0006), aspartate aminotransferase (AST) 72.5 U/l vs. 34 (P=0.0005), alanine aminotransferase (ALT) 90.5 U/l vs. 36 (P=0.004), and PSC Mayo risk score values 0.4 vs. -0.2 (P=0.017). SC is a heterogeneous liver injury. IgG4 testing may be clinically important in all patients, since it appears to identify a distinct patient population, more so than just those with AIP.
    The American Journal of Gastroenterology 11/2011; 107(1):56-63. · 7.55 Impact Factor
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    ABSTRACT: The purpose of our study was to evaluate the association of hepatic hemangiomatosis with giant cavernous hemangioma (GCH) and describe the imaging appearances and clinical relevance. Forty-one patients who had undergone CT or MRI with reported GCH (> 8 cm) between 1997 and 2009 were identified retrospectively. Three readers interpreted 27 MRI studies, 36 CT studies, and 16 ultrasound studies of these patients. Prevalence, extent, and imaging appearance of coexistent hemangiomatosis in the surrounding liver parenchyma were evaluated. Forty-two GCHs were identified in 41 patients and hemangiomatosis was present in 18 of 41 patients (44%) with GCH. Twelve patients had a diffuse pattern of hemangiomatosis (67%), and six patients showed a nodular pattern consisting of multiple coalescent nodules measuring < 5 mm (33%). There was no association between the size of the GCH and presence and extent of hemangiomatosis. The common hepatic artery was enlarged (> 5 mm) in 14 patients with GCH, of whom 12 had associated hemangiomatosis. There was a statistically significant association between the size of the hepatic artery and presence of hemangiomatosis (p < 0.001). Hemangiomatosis is not rare in the liver parenchyma adjacent to a GCH. The presence and extent of hemangiomatosis must be specifically communicated to referring physicians. Surgical candidates have to be carefully selected to avoid complications, such as excessive blood loss and diminished risk of postoperative liver decompensation from apparent overestimation of functional residual volume due to oversight of involved liver areas by hemangiomatosis.
    American Journal of Roentgenology 04/2011; 196(4):809-15. · 2.90 Impact Factor
  • Anoop P Ayyappan, Kartik S Jhaveri, Masoom A Haider
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    ABSTRACT: The purpose of this study was to assess the potential role for chemical shift magnetic resonance imaging (MRI) in identifying lymphangiomas from other cystic mesenteric and retroperitoneal masses. A retrospective search of radiology database identified 24 consecutive patients with mesenteric and retroperitoneal cysts (nine men, 15 women; mean age, 41 years; age range, 19-75 years) who had undergone MR which included in-phase and opposed-phase chemical shift imaging. Signal intensity (SI) decrease between in-phase and opposed-phase MR images of the cyst was evaluated qualitatively by two radiologists. Ultrasound (US), computed tomography (CT), and MRI findings of the morphological appearances of all the cystic lesions that demonstrated significant signal drop on chemical shift MR were also recorded. Of mesenteric and retroperitoneal cysts, 33% (8/24) revealed qualitative decrease in intensity on opposed-phase MR images relative to that seen on in-phase images. On ultrasound, these cysts demonstrated anechoic simple fluid. Their mean CT attenuation was 13 HU (range: 5-20 HU). Signal loss on fat-suppressed T1-weighted sequences was displayed only by a single cyst. None of the lesions with qualitative SI decrease on opposed-phase MR showed suggestion of lipid on US and CT. The presence of intra cystic lipid detected by chemical shift MR may not be overt on cross-sectional imaging such as US and CT. Chemical shift MRI provides additional sensitivity and specificity as an imaging test for demonstration of lipid within mesenteric and retroperitoneal cysts enabling a higher diagnostic yield for lymphangioma leading to more appropriate patient management.
    Clinical imaging 01/2011; 35(2):127-32. · 0.73 Impact Factor
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    ABSTRACT: To compare the image quality and acceptability of a low dose with those of standard dose abdominal/pelvic multidetector CT in patients with stage 1 testicular cancer managed by surveillance. One hundred patients (median age 31 years; range 19-83 years), 79 with seminoma and 21 with non-seminoma, underwent abdominal/pelvic imaging with low and standard dose protocols on 64-slice multidetector CT. Three reviewers independently evaluated images for noise and diagnostic quality on a 5-point scale and for diagnostic acceptability. On average, each reader scored noise and diagnostic quality of standard dose images significantly better than corresponding low dose images (p < 0.0001). One reader found all CT examinations acceptable; two readers each found 1/100 (1%) low dose examinations unacceptable. Median and mean dose-length product for low and standard dose protocols were 416.0 and 452.2 (range 122.9-913.4) and 931.9 and 999.8 (range 283.8-1,987.7) mGy cm, respectively. The low dose protocol provided diagnostically acceptable images for at least 99% of patients and achieved mean dose reduction of 55% compared with the standard dose protocol.
    European Radiology 07/2010; 20(7):1624-30. · 4.34 Impact Factor
  • Anoop P Ayyappan, Kartik S Jhaveri
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    ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and one of the few malignancies with an increasing incidence in the USA. Imaging plays a crucial role in early detection, accurate staging and planning management strategies. Contrast material-enhanced MRI or computed tomography (CT) are the best imaging techniques currently available for the noninvasive diagnosis of HCC. The diagnosis of HCC is strongly dependent on hemodynamic features (arterial hypervascularity and washout in the venous phase) on dynamic imaging, and biopsy is no longer recommended for tumors with classical imaging features prior to treatment. The major challenge for radiologists in imaging cirrhosis is the characterization of hypervascular nodules smaller than 2 cm, which often have nonspecific imaging characteristics. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC. The strengths and current limitations of these imaging modalities are highlighted.
    Expert Review of Anti-infective Therapy 04/2010; 10(4):507-19. · 2.07 Impact Factor
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    ABSTRACT: Infertility is a common problem. The role of imaging in assisting clinical evaluation is discussed. Ultrasound and magnetic resonance imaging are first-line, noninvasive imaging techniques that provide accurate definition of anatomical causes of infertility. This affords an opportunity to deliver timely and appropriate treatment. This pictorial review illustrates normal imaging anatomy and various causes of male infertility, and focuses on congenital and acquired testicular abnormalities and post-testicular obstruction, such as congenital absence of the vasa deferentia, seminal vesicle cysts, prostatic utricle cysts, Mullerian cysts, ejaculatory duct cysts (Wolffian cysts), and epididymal obstruction.
    Canadian Association of Radiologists Journal 02/2010; 61(3):144-55. · 0.43 Impact Factor

Publication Stats

631 Citations
129.59 Total Impact Points

Institutions

  • 2011–2014
    • University Health Network
      Toronto, Ontario, Canada
  • 2007–2013
    • University of Toronto
      • Department of Medical Imaging
      Toronto, Ontario, Canada
  • 2012
    • Fundación Santa Fe de Bogotá
      Μπογκοτά, Bogota D.C., Colombia
  • 2010
    • Texas Tech University Health Sciences Center
      El Paso, Texas, United States
  • 2007–2010
    • Mount Sinai Hospital, Toronto
      • Department of Medical Imaging
      Toronto, Ontario, Canada
  • 2009
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2001–2004
    • Massachusetts General Hospital
      • Department of Radiology
      Boston, MA, United States
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2000
    • P.D Hinduja National Hospital & Medical Research Centre
      Mumbai, Mahārāshtra, India