A PILOT STUDY FOR EVALUATION OF ROLE OF B-MODE ULTRASOUND AND STRAIN ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT BREAST MASSES

Background: Early detection of malignant lesions is critical key stone for the successful management of breast cancer. Conventional B-mode ultrasound although could not replace the histopathology which is still gold standard, plays an important role in the diagnostic pathways by using the Breast Imaging Reporting and Data System (BIRADS) lexicon (standardized by American College of Radiology [ACR]). Although characterization of solid breast masses by sonography has improved greatly since the early 1990s, specificity remains low and a large number of biopsies result in benign diagnosis. Strain elastography and strain ratio (SR) are recent techniques which may help in increasing the specificity of ultrasound. Methods: The present study was a pilot study aimed to establish a correlation between B-mode ultrasound and strain elastography in differentiating benign and malignant breast masses and to compare the results of B- mode ultrasound and Strain Elastography with fine-needle aspiration cytology/ biopsy findings. It was a prospective study conducted in the Department of Radio-diagnosis of Rajindra Hospital, Patiala. A total of 40 patients who presented with the complaint of palpable breast lump were evaluated with B-Mode Ultrasonography (USG) and Strain elastography (using elastography score [ES] and SR). Results: The study group (40 patients with breast lumps) comprised 38 (95%) female patients and 2 (5%) male patients. Among the group 29 were benign and 11 were malignant. Fibroadenoma followed by fibrocystic disease was the most common benign pathologies and invasive ductal carcinoma followed by Ductal Carcinoma in situ was the most common malignant pathologies. Sensitivity, specificity, and diagnostic accuracy of B-Mode USG in diagnosing palpable breast lump are 72.7%, 86.2%, and 82.5%, respectively, while that of strain elastography in diagnosing palpable breast lump are 81.8%, 93.10%, and 90.0%, respectively. Using strain ratio (SR) only the sensitivity, specificity, and diagnostic accuracy was found to be 93.1%, 100%, and 95% better than B-Mode USG and shear elastography alone separately and combined. The mean SR for a benign mass is 2.00±0.97 and for a malignant mass is 5.40±1.55. Conclusion: Ultrasound elastography (using ES) has a higher sensitivity, specificity and diagnostic accuracy in differentiating benign and malignant breast masses then B mode USG (using BIRADS). Using SR alone has shown better sensitivity, specificity, and diagnostic accuracy but its standalone or in combination diagnostic application has to be followed up with further studies

PILOT STUDY OF LOWER UTERINE SEGMENT CESAREAN SCAR THICKNESS PREOPERATIVELY BY TRANSVAGINAL SONOGRAPHY AND ITS CORRELATION WITH INTRA-OPERATIVE FINDINGS

Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness. Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers. Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age. Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system

Looking beyond the Sella: Suprasellar Infundibular Prolactinoma

This is a case report of a 24-year-old female who presented with galactorrhoea and elevated serum prolactin levels of 150 ng/mL. The intrasellar pituitary gland demonstrated normal morphology and characteristic enhancement. The pituitary stalk was thickened and revealed a non-enhancing lesion on dynamic contrast imaging, which was interpreted as a functioning microadenoma. The patient exhibited significant clinical improvement after initiation of therapy with a dopamine agonist, Cabergoline

Lissencephaly-A Brain Flawed

We present a case report of a twelve-day old child suffering from seizures, in which magnetic resonance imaging (MRI) established the diagnosis of Lissencephaly. Although the causes of this disease entity are manifold, MRI can reveal stigmata of antenatal maternal infections in the child. In such a scenario, cytomegalovirus (CMV) is an important offender. In this article we discuss the pathogenesis of Lissencephaly in general, along with signs of transplacental CMV infection in the child. A diagnosis of CMV induced Lissencephaly obviates the need for chromosomal analysis and other genetic studies

EVALUATION OF FETAL THIGH CIRCUMFERENCE AS AN ADDITIONAL MARKER FOR FOETAL BIOMETRY

Objective: Accurate determination of gestational age is the sine qua non of optimal management and hence prognostication of all pregnancies.A meticulous biometry ensures timely interventions resulting in favorable maternal and fetal outcomes. Traditionally, the parameters of Biparietal diameter (BPD), Femur length (FL), Head circumference (HC), and Abdominal circumference (AC) have been utilized for routine fetal biometry. The present study aims to assess the utility of Fetal Thigh Circumference (ThC) as an additional marker for fetal biometry. Methods: The present retrospective, observational, and cross-sectional study was done in the Departments of Radiodiagnosis and Obstetrics and Gynaecology in an ethically and socio-economically diverse group of pregnant females. All pregnant females with singleton pregnancies between 22 and 40 weeks of gestation and fulfilling the inclusion and exclusion criteria were subjected to ultrasound examination. Subsequently analysis was done for the data collected. Results: There were a total of 287 participants in present study group with mean age of 23±3.4 years. The strength of agreement almost perfect (>0.99) between the mean observed ThC to ThC values by Deter et al. taken as standard. There was a highly significant positive correlation between gestational period and standard biometry parameters and ThC. ThC model for prediction will be better than standard biometry parameters of BPD, HC and AC but not as good as FL model according to the regression analysis of the present study. Conclusions: There is concordance of fetal ThC as an accurate predictor of period of gestation only after FL. It can be combined with standard biometry parameters to give a better estimation of period of gestation

Relevance of the NR4A sub-family of nuclear orphan receptors in trophoblastic BeWo cell differentiation

Abstract Nur-77, a member of the NR4A sub-family of nuclear orphan receptors, is downregulated in the placentae of pre-eclamptic women. Here, we investigate the relevance of Nor-1, Nurr-1 and Nur-77 in trophoblastic cell differentiation. Their transcript levels were found to be significantly upregulated in BeWo cells treated with forskolin. The maximum increase was observed after 2 h, with a second peak in the expression levels after 48 h. The expression of NR4A sub-family members was also found to be upregulated in BeWo cells after treatment with hCG and GnRH. A similar significant increase was observed at the respective protein levels after 2 and 48 h of treatment with forskolin, hCG or GnRH. Silencing Nor-1, Nurr-1 or Nur-77 individually did not show any effect on forskolin-, hCG- and/or GnRH-mediated BeWo cell fusion and/or hCG secretion. After silencing any one member of the NR4A sub-family, an increase in the transcript levels of the other sub-family members was observed, indicating a compensatory effect due to their functional redundancy. Simultaneously silencing all three NR4A sub-family members significantly downregulated forskolin- and hCG-mediated BeWo cell fusion and/or hCG secretion. However, a considerable amount of cell death occurred after forskolin or hCG treatment as compared to the control siRNA-transfected cells. These results suggest that the NR4A sub-family of nuclear orphan receptors has a role in trophoblastic cell differentiation

The adventures of ‘Ascaris lumbricoides’ - An intrepid traveller

Hepatobiliary ascariasis is an underestimated & unforeseen corollary of gastrointestinal ascariasis particularly common amongst the endemic populations. A high index of suspicion coupled with the increased use of ultrasonography & endoscopic procedures have unravelled this deviant sequel of helminth infestation. Conservative measures with meticulous sonographic surveillance remain the preferred first-line treatment for worms confined to the biliary ducts; with, endoscopic and surgical interventions being reserved for the persistently symptomatic or when complications ensue. Gall bladder ascariasis however mandates aggressive endoscopic/ surgical measures in most cases due to poor inherent response to pharmacotherapy alone. We hereby present the study of a 10 years old female child with the sonographic, MRCP, per-operative & histopathological correlates of hepatobiliary ascariasis. The bizarre eventuality of the worm migrating from the gastrointestinal tract and traversing across the intrahepatic ducts to ultimately lodge within the gall bladder (as demonstrated on consecutive scans & confirmed per-operatively ) , especially across narrow calibre childhood ducts is a singular affair and hence consigns exclusivity to our case

The diagnostic accuracy of diffusion weighted magnetic resonance (MR) imaging for discrimination of malignant from benign cervical lymphadenopathy in head and neck tumours using histopathology as the reference standard

Head and neck cancers accounts for maximum number of cancer cases in Indian hospital settings. Involvement of neck nodes is a very important prognostic factor of its outcome. Differentiation between benign and metastatic lymphadenopathy often presents a diagnostic challenge with conventional imaging techniques. Diffusion-weighted imaging (DWI) has emerged as a powerful non-invasive imaging technique that is capable of characterisation of these lesions as benign or malignant with the help of apparent diffusion coefficient (ADC) maps. Aim: The aim of this cross-sectional study was to determine the diagnostic accuracy of DWI to differentiate benign from malignant cervical lymph nodes in head and neck tumours, subsequently confirming the results using histopathology as the reference standard. Materials and Methods: The cross-sectional study was conducted on 60 patients of either age or sex with enlarged neck lymph nodes over a period of 2 years, subsequently these patients underwent DW MRI imaging followed by histopathology of either neck dissection specimen or core biopsy or US guided FNAC as a part of the study. Results: Out of 60 patients, 41(68.33 percent) cases came out as malignant and 19 (31.67 percent) cases came out as benign. The results obtained were 36 true positives, 4 false positives, 15 true negatives and 5 false negatives. The overall sensitivity of DWI for differentiating malignant from benign cervical lymphadenopathy was 87.80% with specificity of 78.95%. The positive predictive value and negative predictive value were 90.00% and 75.00% respectively. The best ADC threshold value for distinguishing benign and malignant nodes was 1.005 × 10-3 mm2/sec. Conclusion: DWI is an important tool to differentiate benign vs malignant lymphadenopathy and helps in guiding the clinician to treat these nodes accordingly

ROLE OF CHEST CT IN EVALUATION OF PULMONARY MANIFESTATIONS OF COVID-19 RECOVERED CASES

ABSTRACT Objective: Pulmonary manifestations may be seen in a number of COVID-19 recovered patients and the evidence on Post COVID pulmonary sequelae is still limited. Herein, we aim to assess the role of (Computed Tomography) CT Chest in evaluation of pulmonary manifestations of COVID-19 recovered cases. Methods: We conducted a hospital based study in Department of Radiodiagnosis at Govt. Medical College & Rajindra Hospital Patiala. It included 182 RT-PCR proven COVID-19 patients after they recovered from disease with at least one negative RT-PCR test and/or Clinical recovery. Clinical data and CT findings in the recovery phase were summarized and the relationship of different clinical parameters with CT severity scores were analyzed. Results: The mean (± SD) age of patients was 50.2 ± 14.7 years and 62.6% of them were males. The mean (± SD) Symptomatic-scan interval was 33.05 ± 22.27 days. Pulmonary abnormalities were found in majority of the cases in the recovery phase i.e. 176 patients accounting for 96.7%, while 6 patients had normal scans. Bilateral involvement was seen in 169 out of 176 patients. Common CT patterns observed were Ground glass opacities (GGOs) (90.34%), reticular pattern (81.82%), interlobular septal thickening (70.45%), linear opacities (90.34% cases), fibrous stripes (78.41% cases) and consolidation (36.93%). The mean (± SD) CT severity score of our study subjects was 16.10 ± 7.95. Patients were also categorized into 4 groups according to symptomatic scan interval <1month, 1-2 month, 2-3month and > 3months. We found that residual changes were more severe in patients with shorter symptomatic scan interval. Conclusion: In conclusion, COVID-19 patients demonstrate persistent pulmonary abnormalities even after clinical recovery. Hence, follow up in patients with moderate & severe disease is strongly recommended

Ultrasound evaluation of fetal central nervous system anomalies and its correlation with postnatal outcome

Introduction: CNS anomalies are the most serious congenital abnormalities. Ultrasound is an effective and non invasive modality of prenatal diagnosis of these anomalies. The purpose of the current study was to determine the frequency of CNS anomalies and its postnatal outcome. Objectives: Present study was undertaken to find out the incidence of CNS anomalies in utero by ultrasound and to confirm them by autopsy or postnatal examination. Materials and Methods: Ultrasound scanning of 5761 pregnant women was performed. Pregnancies with ultrasound findings of CNS anomalies were followed up. Prenatal findings were compared with postnatal findings and confirmed by autopsy wherever possible. In case of live birth post natal findings were noted. Results: Ultrasound detected 50 anomalies in 42 cases. Ultrasound findings were exactly matching in 90%. 4 cases had variations 3 on autopsy & 1 on postnatal USG. Conclusion: The incidence of CNS malformations on ultrasound was 0.73%. Autopsy and postnatal findings showed high degree of correlation with prenatal ultrasound findings