Sonographic Comparison of Portal Vein Diameter in Cirrhotic and Non-Cirrhotic Patients

Background: Liver cirrhosis has become one of the major causes of morbidity and mortality. The burden of liver cirrhosis is growing in both the West and the East. In Pakistan death rate of liver cirrhosis is conspicuous because of chronic hepatitis (hepatitis B, C) and hepatocellular carcinoma. It is reported by World Health Organization that Pakistan occupies secondary place in spread of hepatitis C. Objective: To compare the portal vein diameter in cirrhotic and non-cirrhotic patients through ultrasound. Methodology: Ultrasound machine Toshiba Xario, Mindray dp 10 and G logic p5 with a curvilinear transducer of frequency 3.5 MHz was used. The study was conducted at, Hussain Diagnostic Ultrasound Centre Jampur, District Rajanpur. Data of 100 patients was collected through Cross-Sectional Analytical study. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: One hundred patients participated in this study. Among them, the minimum age was 30 and the maximum age was 70. Ratio of male patients was more than female patients, due to fact of more alcohol consumption in males. Out of 100 patients, 50 patients had cirrhosis and 50 were non cirrhotic. Liver cirrhosis patients came the severe symptoms like weakness, lethargy, hematemesis and melena. Non cirrhotic patients came with epigastric pain, nausea and vomiting. Mean of Portal vein diameter in non-cirrhotic patients was 10.5mm. Mean of  Portal vein diameter in live cirrhosis patients was 14.8mm. A statistical significance difference was found between the two means of portal vein diameter of two groups (cirrhotic and non-cirrhotic) as the p-value 0.000 less than 0.05. Conclusion: Liver cirrhosis is one of the major issues of health and a big reason for increasing mortality rate all over the world. The most common etiology of liver cirrhosis .is .alcohol. Patients come with liver cirrhosis having severe symptoms like weakness, lethargy, hematemesis and melena. Non-cirrhotic patients come with mild symptoms like epigastric pain, nausea and vomiting, having normal portal vein diameter. Mean portal vein diameter in cirrhotic patients (14.8mm) was greater than non-cirrhotic patients (10.5mm). Key words: Liver cirrhosis, Non-alcoholic steatohepatitis (NASH), Non- alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD). DOI: 10.7176/JHMN/76-12 Publication date:June 30th 202

Sonographic Incidence and Characteristics of Thyroid Nodules in Various Age Groups and Gender

Background: Thyroid nodules (TNs) are among the common diseases of the endocrine system, with 3%–7% prevalence by palpation. The prevalence by high-resolution ultrasonography among randomly selected individuals is 19%–67%, with annual increasing trends worldwide. 5% to 15% of TNs is thyroid cancer, which has become the fastest growing cancer.1 Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation.9 Objective: To characterize thyroid nodules in various age groups and gender.  Methodology: In this descriptive study, among 179 patients of thyroid nodule were selected with age and gender discrimination by convenient sampling, at Department of Radiology, Lahore General hospital and Inmol Cancer hospital Lahore. Mindray Z5 and Toshiba xario 100 with linear probe of 7.5-11MHz ultrasound machine was used. Results: Out of 179 collected, 105 were females and 74 were males who visited radiology department due to thyroid nodule. It shows 58.7% females and 41.3% males patients diagnosed. Out of 179 patients 106 patients 59.2% came with irregular margins thyroid nodules and remaining 73 patients 40.8% had thyroid nodules with regular margins. 127 patients 70.9% had hyperechoic thyroid nodules and 52 patients 29.1% had hypoechoic thyroid nodules. Out of 97 patients 54.2% developed (Multi Nodular Goiter) MNG, 66 patients 36.9% developed right thyroid nodules and 16 patients 8.9% developed left thyroid nodules. Females developed 56.2% MNG, 33.3% right thyroid nodule and 10.5% left thyroid nodule while males developed 51.4% MNG, 41.9% right thyroid nodule and 6.8% left thyroid nodule. Out of 179 patients 109 (60.9%) patients shows no perfusion of blood while remaining 70 (30.1%) shows some perfusion of blood on USG. Minimum age was 5 years and maximum were 90 years while their mean was 43. Age group between 41 to 50 years most likely develop thyroid nodules.  Conclusion: In this study we conclude that females most likely develop thyroid nodules than males.  Both males and females mostly develop multi nodular goiter and least develop left thyroid nodule. Patients in 4th decade most likely develop thyroid nodules. Key words: Thyroid nodules, Ultrasonography DOI: 10.7176/JHMN/80-15 Publication date:September 30th 202

Sonographic Association of Uterine Artery Pulsatility Index with Hypertension During Third Trimester of Pregnancy

Background: Hypertension (HTN) in pregnancy is the second most basic reason for maternal death and cause obstetric complications in 5-10% of all pregnancies. HTN directly affects the blood flow of uterine artery.  Doppler screening test is a valuable method to do safe and non-invasive detection and has high reliability in the detection of uterine artery blood flow characteristics. Objective: The purpose of the present study is to find association between predictive value of uterine artery pulsatility index in normal and hypertensive pregnancy during third trimester. Methods: A descriptive cross-sectional study was conducted with the sample size of 138 patients by selecting the convenient sampling from Ghurki Trust Teaching Hospital, Lahore. The pulsatility index of uterine artery of all the women with normal singleton pregnancy and hypertensive during third trimester of pregnancy were obtained using Doppler ultrasound. Data was analyzed with the help of Anova .The results were derived by mean, frequency and standard deviation . Results: The significance between groups was 0.002. The mean values of right and left uterine artery pulsatility index of 36 hypertensive patients were 1.40 and 1.41 and standard deviation 0.4 and 0.5 respectively whereas the mean values of right and left uterine artery pulsatility index of 102 normal patients were 0.739 and 0.77 and standard deviation 0.23 and 0.5 respectively Conclusion: Our study concluded that there was an association between uterine atery pulsatility index and hypertension during pregnancy. The uterine artery pulsatiltiy index has increased with hypertension in third trimester of pregnancy. Keywords: Hypertension, Pulsatility Index, Doppler Ultrasound DOI: 10.7176/JHMN/72-07 Publication date:March 31st 202

COMPARISON OF URINE JET VELOCITY IN VARIOUS GRADES OF HYDRONEPHROSIS IN THE CASE OF URETERIC OBSTRUCTION BY REAL-TIME

Introduction: Hydronephrosis is a common complication of the kidney that is caused by obstruction to kidney ureters and bladder. The renal pelvis and pelvicalyceal system of the kidney become dilated. The obstruction may either be in the upper or lower urinary tract. Upper urinary tract obstruction includes ureteropelvic junction obstruction, renal stone, tumours, and vesicoureteric junction obstruction while lower tract includes benign prostatic hyperplasia, prostate tumours posterior urethral valves. Material & Methods: This cross-sectional study was conducted at the Department of Radiology Lady Reading Hospital Peshawar, Pakistan. The study duration was 9 months (September 2020 and May 2021). A total of 120 participants were presented with a history of flank and are suspicious for renal stone causing hydronephrosis. 30 patients were taken as control with no renal disease while 90 were cases having renal disease. Grading of hydronephrosis and Urine jet velocity was recorded by using real-time and spectral doppler ultrasound. Results: A total of 120 participants were included in this study. The mean jet velocity in the normal individuals was recorded as 50.37 ± 6.4 cm/s, however, in patients with mild, moderate, and severe hydronephrosis the mean jet velocity was recorded as 14.23 ± 10.47 cm/s, 7.32± 8.14 cm/s and, 1.5 ± 3.98 cm/s respectively. Conclusion: Urine jet velocity is a good indicator of ureteric obstruction in a patient with various grades of hydronephrosis. The velocity of the urine jet reduced significantly with increasing the severity of hydronephrosis

COMPARISON OF HIGH-RESOLUTION SONOGRAPHY AND COLOUR DOPPLER FLOW IMAGING IN PATIENTS PRESENTING WITH ACUTE SCROTUM

Introduction: One of the most common urological emergency conditions is acute scrotum. Scrotal pain is commonly seen in early adults in the emergency departments with an association of different pathologies. The aim of this study was to determine the comparison of high-resolution sonography and colour Doppler flow imaging in patients presenting with acute scrotum. Material & Methods: A descriptive study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan. This study enrolled a purposive sample of emergency department patients presenting with acute scrotal pain. The pattern of blood flow, peak systolic velocity, resistive index, pulsatility index, mean and standard deviation were calculated for the continuous variables. Descriptive analyses were performed to investigate the distribution of data. Results: A total of 72 patients were enrolled in our study. The mean age of patients was recorded 36.33±11.66 years. The most common scrotal pathologies that associated with scrotal pain was hydrocele 31(38.8%), followed by varicocele 22(27.5%), testicular torsion 9(11.3%), cyst 8(10.0%), epididymo-orchitis 7(8.8%), pyocele 6(7.5%), orchitis 4(5.0%), increase scrotal wall thickness 3(3.8%), undescended testis 3(3.8%), inguinoscrotal hernia 1(1.3%), testicular atrophy 1(1.3%), rete testis 1(1.3%), hemangioma 1(1.3%), hematoma 1(1.3%), scrotal mass 1(1.3%), testicular microlithiasis 1(1.3%), and normal scrotal sonography 4(5.0%) of cases respectively. Conclusion: High-resolution ultrasonography along with colour and power Doppler should be used as 1st line imaging modality in patients presenting with acute scrotal pain

Comparison of Sonographic Quantitative Assessment of Splenomegaly in Thalassemia Patients Receiving Whole Blood and Packed Red Cell Transfusions

Objective: An observational cross-sectional study to assess sonographic splenomegaly quantitatively in thalassemia patients grouped with respect to transfusion given whole blood vs packed red cells. Methods: A study was conducted among 330 patients equally divided into two groups, undergoing an abdominal ultrasound examination with a transducer frequency ranging from 3-5 MHz during the period December 2021 to August 2022. An independent t-test was applied to compare the splenic volume in thalassemia patients given whole blood transfusions versus packed red cells transfusions, and Cohen's d was used to indicate the standardized difference between two ultrasound splenic volume means. Results: The mean splenic volume of the patients who received whole blood cells was 320.62 ± 219.05 cm3, which is greater than the patients who received packed red cells, whose mean was 60.72 ± 58.72 cm3, The splenomegaly was quantitatively assessed in six age groups ranging from 1 to 3 years, 4 to 6 years, 7 to 9 years, 10 to 12 years, 13 to 15 years, and 16-18 years and mean splenic volume in each age group was compared to those receiving whole blood or packed red cells transfusion. there is a statistically significant difference between both transfusion receiving groups, having a larger Cohen’s d size effect of 1.62. Conclusion: Ultrasound is a reliable imaging modality for assessing splenic volume and linear parameters of the spleen with greater splenomegaly in thalassemia patients with whole blood transfusions than those with packed red cells when quantitatively assessed according to relevant age groups. Thalassemia patients should be transfused packed red cells to delay splenomegaly, that should be assessed sonographically

Relation of color doppler twinkling artifact and scale or pulse repetition frequency

Objective: The aim of this study is to determine the effect of scale/pulse repetition frequency (PRF) on the appearance of color Doppler twinkling artifact. Materials and Methods: We commenced this cross-sectional study for 20 months from November 2014 to July 2016. During routine ultrasound examination, we observed multiple case of twinkling artifact produced by renal stones, calcifications in the thyroid nodules, bony fragments and intestinal gases, etc., We observed twinkling artifact with low- and high-PRF settings in 500 different structures. A total of 500 other structures were included wherein there was no Doppler twinkling artifact produced by them, with usual optimum PRF settings. These structures were also evaluated with low- and high-PRF to determine the effect of PRF on twinkling artifact effectively. All the patients were examined according to the AIUM guideline for appropriate examination protocol. Data were collected from the observation of twinkling artifact with low- and high-PRF/scale and evaluated with the help of IBM SPSS 24 package, the results were summarized as follow. Results: Change in scale/PRF could not affect the twinkling artifact. The twinkling artifact observed with low-PRF was the same as seen with high-PRF. There was a significant agreement between low- and high-PRF in the production of color twinkling artifact. The kappa value of agreement was estimated as 0.96, whereas the Pearson's correlation was significant with the value of 0.001. Same twinkling artifact was created with low- and high-PRF, with no significant variation. Conclusion: Twinkling artifact is independent of PRF/Scale

Diagnostic accuracy of sonoelastography in different diseases

The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body

Wartość diagnostyczna sonoelastografii w różnych jednostkach chorobowych

The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.Celem badania była ocena dokładności diagnostycznej sonoelastografii u chorych leczonych w warunkach placówek podstawowej i specjalistycznej opieki zdrowotnej. W październiku 2017 roku dokonano przeglądu baz danych Google Scholar, PubMed, MEDLINE, Medscape, Wikipedia oraz NCBI w celu pozyskania prac oryginalnych i poglądowych, które stanowiły materiał do badania. Prace wybierało dwóch badaczy niezależnie. Oceniono dokładność sonoelastografii w diagnostyce różnych chorób na podstawie tytułów i streszczeń wyszukanych prac. Główny termin stanowiła „skuteczność sonoelastografii w diagnostyce różnych chorób”, a terminy „ultrasonografia w trybie B-mode”, „obrazowanie MicroPure”, „zabieg operacyjny” i „wynik badania histopatologicznego” stosowano jako terminy referencyjne. Badane patologie dotyczyły: powierzchownych węzłów chłonnych, guzków okolicy szyi, złośliwych guzów tarczycy, łagodnych i złośliwych zmian w węzłach chłonnych szyjnych, guzków tarczycy, raka gruczołu krokowego, łagodnych i złośliwych zmian w piersiach, chorób wątroby, zmian w śliniankach przyusznych i gruczołach ślinowych, zmian w trzustce, chorób układu mięśniowo-szkieletowego oraz chorób nerek. Pozyskane przez dwóch badaczy dane dotyczące charakterystyki ocenianych prac oraz wyniki analizy przedstawiają tabele i ryciny. W sumie wyszukano 46 badań dotyczących zmian w piersiach, węzłów chłonnych, raka gruczołu krokowego, chorób wątroby, chorób gruczołów ślinowych i ślinianek przyusznych, zmian w trzustce, chorób układu mięśniowo-szkieletowego i chorób nerek, a ogólna czułość i swoistość sonoelastografii w diagnostyce tych chorób wynosiły odpowiednio 83,14% i 81,41%. Niniejszy przegląd literatury wskazuje na wysoką czułość i swoistość sonoelastografii w diagnostyce różnych chorób. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/issues/volume-18-no-7