Diagnostic utility of gray scale ultrasound and elastography in solitary thyroid nodules

Background: A firm and hard thyroid nodule on palpation is associated with an increased risk of malignancy .Palpation is subjective. Elastography has been introduced to evaluate the tissue hardness objectively and to augment the diagnostic accuracy of gray-scale ultrasonography (US). Aim and objectives: To evaluate the diagnostic utility of gray-scale ultrasonography (US) and elastography in differentiating benign and malignant thyroid nodules. Materials and methods: A retrospective analysis of Gray scale US and Elastography of 70 solid thyroid nodules in 50 patients was done in our Dhiraj General Hospital over a 6 month period. Diagnostic performances of gray scale US, Elastography with Rago and Asteria criteria, and Odd’s ratios (ORs) with 95% confidence intervals for predicting thyroid malignancy were compared with gold standard FNAC using generalized estimating equation. Results: 70 solid thyroid nodules in 50 patients were evaluated. 21 were malignant and 49 were benign. Sensitivity, negative predictive value (NPV), and Odd’s ratio(OR) of gray-scale US for the 70 nodules were 91.6%, 94.5% and 22.2 respectively, and these values were higher than the 15.6% and 65.3% sensitivity, 71.6% and 79.2% NPV and 3.6 and 2.7 ORs found for elastography with Rago and Asteria criteria, respectively. Conclusion: Elastography alone as well as the combination of elastography and gray-scale US showed inferior performance in the differentiation of malignant and benign thyroid nodules compared with gray-scale US features. Hence elastography is not a useful tool in recommending FNAC.

Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation

Background: Thyroid gland is afflicted by various pathologies ranging from diffuse enlargement (goitre) to nodular lesions, thyroiditis, and malignancy. Presently high resolution ultrasound with color Doppler is the primary imaging modality of choice in morphological evaluation of thyroid gland. It is used to define the nature of the lesion, whether solid or cystic, to differentiate thyroid from extra thyroidal masses, to assess the size of nodule in patients who are under observation or therapy, to monitor patient who are at increased risk of thyroid malignancy especially those with radiation exposure or having a family history, to detect recurrence of thyroid malignancy after surgery and in interventional procedure like guiding in FNAC. Materials and methods: Study was carried out using standard 5-12 MHz frequency probe with grey scale and color Doppler spectrum to evaluate and analysis of different thyroid nodules and taking Ultrasound guided fine needle aspiration cytology and correlate histopathologically. Results: Majority of patients belonged to middle age group between 21-60 years with mean age of 38.2 years. Colloid goitre was most common presentation on ultrasound and it showed wide spectrum of appearance, majority being nodular with anechoic echotexture. Malignant lesions of thyroid were usually hypoechoic, though all hypoechoic lesions were not malignant. (Sensitivity of 75%, specificity of 81.48%, PPV of 37.5% and NPV 95.65%). The most sensitive sign for picking up malignancy on USG were Intralesional vascularity; absent halo sign and regional lymph node Siddharth Zala, C. Raychaudhuri. Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation. IAIM, 2019; 6(4): 86-91. Page 87 involvement (sensitivity of 100%) the most specific signs were invasion of adjacent tissue (specificity of 92.59%), Lymphadenopathy (85.18%) and hypoechotexture (81.48%). A combination of signs aid in prediction of malignancy and in guidance for site of FNAC. The most useful combination of sign proved to be Invasion to adjacent tissue, Lymphadenopathy, absent halo, hypoechogenicity, microcalcification and Intralesional vascularity on color flow imaging. Conclusion: The ultrasonographic findings in thyroiditis were usually hetroechogenicity and coarse calcification with diffuse vascularity on color flow imaging. The addition of color flow imaging to gray scale ultrasound had increased the overall sensitivity for diagnosis of thyroiditis (96.87%) and was also highly specific (89.70%)

Pulmonary Sarcoidosis – Radiological Evaluation

Background: Sarcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes. Sarcoidosis is manifested by the presence of noncaseating granulomas (NCGs) in affected organ tissues. It is characterized by a seemingly exaggerated immune response against a difficult–to-discern antigen. Materials and methods: All patients were known case of pulmonary sarcoidosis. All patients for this study had undergone X-ray and CT scan after taking informed consent. Results: In our study, we found that 17 (68%) patients with sarcoidosis have a characteristic radiologic appearance consisting of enlarged hilar and paratracheal lymph nodes, 24% of cases shows nonspecific or atypical findings, and in 4% of patients the radiograph is normal. Conclusion: Radiologists can play an essential role in the diagnosis and management of sarcoidosis. It is essential to recognize both the typical and the atypical manifestations of the disease and use information obtained from the correlation of imaging features with pathologic findings to help achieve an early diagnosis and reduce associated morbidity and mortality

Renal cell carcinoma – A spectrum of radiological findings

Background: Renal cell carcinomas (RCC) are primary malignant adenocarcinomas derived from the renal tubular epithelium and are the most common malignant renal tumor. They usually occur in 50- 70-year-old patients. Aim: Radiological evaluation of patients of renal cell carcinoma by modalities like USG, CT-Scan and MRI. Materials and methods: All the patients were cases of renal cell carcinoma that had come to Department of Radiology in Dhiraj Hospital. They were evaluated by different modalities like USG, CT-Scan and MRI after taking consent when and where needed. Results: Renal cell carcinoma followed age and sex trends which means 72% patients were males and 28% patients were females and most of the patients were above 50 years of age. Conclusion: CECT is the modality of choice for evaluation of renal cell carcinoma patients as it gives the information not only about the localization but also the distant spread of tumor. MRI can be used as an alternative and also to know about the renal vein and IVC invasion by the tumor. USG as is a cheap and easily available method can be used to screen the patients with a palpable flank mass and those with hematuria.

A radiological perspective of assessing neonatal respiratory distress syndrome

Background: The causes of respiratory distress in the neonatal period can be classified into abnormalities primarily affecting aeration, circulation or development of the thorax. Conditions of the lungs and cardiovascular system account for the majority but abnormalities of the tracheobronchial tree, chest wall, diaphragm, and a variety of neuromuscular diseases must also be considered in the differential diagnosis. Chest radiography is the most valuable imaging modality in the investigation of neonatal respiratory disorders. Within 48 – 72 hours, the most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X-ray. Materials and methods: This was a prospective observational study that was conducted in rural tertiary care center. Anteroposterior chest radiograph in supine position of (59) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, in my study 32.20% diagnosed with transient tachyponea; 20.3% diagnosed with hyaline membrane disease; 16.94% diagnosed with congenital neonatal pneumonia; 11.86% diagnosed with meconium aspiration syndrome; 1.96% diagnosed with aspiration syndrome; 5.08% diagnosed with cardiac causes; 3.38 % diagnosed with tracheaoesophageal fistula; 3.38% diagnosed with congenital diaphragmatic hernia; 1.69% diagnosed with idiopathic persistent pulmonary hypertension; 1.69% diagnosed with eventeration of diapghram; 1.69% diagnosed with pneumoperitoneum, presented to radiology department with respiratory distress. Jayesh Shah, Nikhil Parvatkar, C. Raychaudhuri. A radiological perspective of assessing neonatal respiratory distress syndrome. IAIM, 2017; 4(12): 10-15. Page 11 Conclusion: Chest radiography is essential in neonates with acute respiratory distress to exclude structural abnormalities such as congenital diaphragmatic hernia or congenital lobar emphysema. One should remember that any sign of post–natal respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible. Finally chest radiograph should be read by an expert radiologist.

Radiological evaluation of Ovarian Dermoid

Background: Ovarian dermoid cyst is the most common ovarian neoplasm. It accounts for ~15% of all ovarian neoplasms. They tend to be identified in young women, typically around the age of 30 years. These slow-growing tumor contain elements from multiple germ cell layers and are easily detected with ultrasound and much better by CT scan and MRI. Materials and methods: Patients presented to Radiology department with known case of dermoid cysts of ovary or in whom accidental diagnosis of ovarian dermoid cyst was made eventually. Evaluation of ovarian dermoid with Ultrasound machine (Logiq P9 GE), CT scan Siemens (16 slice) and MRI Philips (1.5 Tim + dot system). Results: In our study we found that 25 (100%) patients had ovarian dermoid, 20 (80%) patients were of age group 21years to 40 years, 4 (16%) patients were of 41-60 years and 1 (4%) patients were of 0- 20 year age group. In diagnosis of ovarian dermoid our results showed that CT scan was more sensitive (96%) than USG (92% sensitivity). Conclusion: Detection and morphological characterization of ovarian dermoid can be easily done on ultrasound. MRI and CT scan are useful adjunct to USG in its characterization and detection of associated pathology. In USG, when ovary shows heterogeneously hyperechoic lesion with fat fluid level without any vascularity highly suggestive of ovarian dermoid.

Role of MRI in acute disseminated encephalomyelitis

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

Role of MRI spine in evaluation of cases of neurotrophic arthropathy

Introduction: A neurotrophic joint (also known as a Charcot joint) refers to a progressive degenerative/ destructive joint disorder in patients with abnormal pain sensation and proprioception. A substantial number of neurotrophic joints are caused secondary to lesions of the spine. Many a times the patient does not give any history indicating a spine lesion. Hence MRI scan of Spine should be made a part of the investigations in every case of neurotrophic joint. Aims and objectives: To study the incidence of Spinal lesions as a primary causative factor behind a neurotrophic joint and to study the efficacy of MRI spine exam in correctly diagnosing Spinal lesions in patients presenting with a neurotrophic joint. Materials and methods: This study was conducted in the Radiology department of Dhiraj general Hospital. 20 patients presenting with neurotrophic joint/joints but giving no history suggestive of an underlying spinal pathology were evaluated by MRI spine. Results: Out of 20 patients presenting with neurotrophic joint who were evaluated by MRI spine, only 12 scans revealed a spinal pathology secondary to which the patient had developed neuropathic change of the affected joint. Conclusion: Onset of joint neuropathy is usually insidious. If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or super infection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity and for that early diagnosis of any underlying pathology is important. MRI spine is a sensitive tool to detect any lesion of the spine. It helps to accurately diagnose a variety of spinal lesions and tells about its exact size, extent and severity and thereby contributes immensely in the management of a neurotrophic joint.

Radiological investigations of imperforate anus

Introduction: Imperforate anus is a defect that is present from birth (congenital) in which the opening to the anus is missing or blocked. In female infants, imperforate anus is typically characterized by the rectum, bladder and vagina sharing one large opening called a cloaca. The condition develops in utero during the 5th to 7th weeks of pregnancy. This condition often happens in conjunction with other defects of the rectum. Incidence is 1 in 5000. It is more common in males. Diagnosis is usually made shortly after birth. Aims and objectives: To study the presentation of imperforate anus using various radiological modalities. Materials and methods: 10 cases of either strong suspicion or symptoms related to imperforate anus were evaluated who came to Dhiraj hospital with different radiological modalities like plain radiograph lateral invertogram, cross table lateral radiograph, erect radiograph and contrast studies (MCUG). Results: Out of total number of 10 patients who were diagnosed and evaluated for imperforate anus 3 i.e. 33.3 % were diagnosed with plain radiograph lateral invertogram, 2 i.e. 20 % were diagnosed with prone cross table lateral radiograph, 2 i.e. 20 % were diagnosed with abdominal erect radiograph and 2 were found to have recto-vesical fistula with the help of micturating cystourethrogram. Conclusion: It was concluded that plain radiograph lateral invertogram proves to be the most important modality in diagnosing imperforate anus. It is followed by prone cross table lateral radiograph and abdominal erect radiograph. Micturating cystourethrogram proves to be important in diagnosing associated anomalies such as recto-vesical fistula.

Imaging in neurofibromatosis type 1: An original research article with focus on spinal lesions

Background: Neurocutaneous syndromes encompass a group of disorders that affect the embryonic ectodermal plate, which includes the central and peripheral nervous systems, as well as the overlying skin. Materials and methods: All patients were known case of neurofibromatosis type 1. All patients for this study had undergone MRI whole spine with brain screening. Conventional radiographs were also taken when and where needed after taking informed consent. Results: In our study we found that 15 (60%) patients having lumbar neurofibromas, 7 (28%) patients having cervical neurofibromas, 2 (8%) patients having thoracic neurofibromas and 1 (4%) patients having sacral neurofibromas. Conclusion: MRI allows non-invasive detection of spinal neurofibromas and helps determine intrdural or extradural origin and their relationship to the neural foramina, spinal canal, and thecal sac and spinal cord. The target sign (bright on T2, with dark collagen centrally) is highly suggestive of a peripheral neurofibroma on MRI.

Assessment of the rotator cuff on MRI focussed on supraspinatus tendon

Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.

Observation of various thymic lesions in pediatric age group

Background: The thymus is a central lymphoid organ that plays a vital role in the development and maturation of the immune system during childhood, the thymus appears as a bilobed triangular structure located in the anterior mediastinum. Aim and objectives: To provide radiologists a comprehensive understanding of Recognition of the variable appearance of thymic lesions and evaluation of thymic lesions on different radiological modalities like X-Rays and CT-scan for early diagnosis as well as management. Materials and methods: 10 cases of either strong suspicion or symptoms related to thymic lesion were evaluated who came to Dhiraj Hospital with different radiological modalities (X-ray, CT-scan). Results: Out of total no. of 10 patients who were diagnosed and evaluated with thymic lesion on Xrays and CT-scan are: Thymic Hyperplasia, Thymic Cyst, Thymic Lymphoma, Thymoma, Benign Teratoma, Malignant Teratoma. Conclusion: CT Imaging remains the ideal scanning modality to evaluate Radiologists play a major role in differentiating normal thymus from its variants, various thymic lesions and tumor. But common associated radiological modality used along with CT scan done is X-ray.

Evaluation of cystic lesions of liver by ultrasonography

Background: Ultrasonography is very sensitive in detecting cystic lesions of liver, which helps in detecting various lesions, along with the internal structures of the body. One gets an opportunity to evaluate additional information of other abdominal organs that can modify the course of treatment and prognosis of patient. Aim: To evaluate the demographic variables, symptomatology ultrasonographic features and the diagnostic Accuracy, with the help of ultrasonography, in evaluating cystic lesions of liver. Materials and Methods: The study comprised of 50 patients with the clinical symptoms of cystic lesions of liver. They were evaluated with ultrasonography of abdomen where cystic lesions of liver were taken, who needed follow up and interventional procedure. The study was an observational, descriptive hospital based study. Results: 50 patients were evaluated, which comprised equal number of male and female (50%), due to various harmful habits where the Patients had presented with pain and swelling in right hypochondrium. Proper diagnosis cystic lesion of liver was evaluated by ultrasonography for further management. Conclusion: Ultrasound by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is investigation of choice in liver pathology and it can easily detect solid to cystic lesions and characterize the size, shape and extent of lesion.