Diagnostic accuracy of gray-scale and colour doppler ultrasonography in diagnosing malignant thyroid nodules

Objective: To determine diagnostic accuracy of gray-scale and colour doppler ultrasonography in diagnosing malignant thyroid nodules

Study Design: Validation study

Place and Duration of Study: Radiology department Combined Military Hospital [CMH] and Military Hospital [MH] Rawalpindi from July 2007 to July 2008

Subjects and Methods: Fifty cases of solitary/multinodular goitre with clinical suspicion of malignancy were included in the study by non-probability purposive sampling. Gray-scale and colour doppler ultrasonography of neck/thyroid gland was done and results were compared with histo-pathological findings from Armed Forces Institute of Pathology [AFIP] and Army Medical College keeping histopathology as gold standard

Results: In 50 patients, 10 cases found to have ultrasound findings suspicious of malignancy. Out of these 10 cases, 6 cases confirmed as malignant on histopathology. In 40 patients with benign ultrasound findings, one had malignancy on histo-pathological examination. Out of these 7 patients with confirmed malignancy, four had papillary carcinoma; two had follicular carcinomas and one anaplastic carcinoma. Diagnostic parameters calculated and found to be: sensitivity 85.7%; specificity 90.6%; PPV 60%; NPP 97.5% and accuracy of 90%

Conclusion: Gray-scale and colour doppler ultrasonography is a good technique in diagnosing malignant thyroid nodules. Entirely solid nodule with no cystic element having spiculated margins, micro-calcifications and central flow are helpful sonographic findings pointing towards malignancy. Associated cervical lymphadenopathy with calcification or degeneration is a significant finding favouring malignancy

Factors associated with breast arterial calcification on mammography

To determine the frequency of breast arterial calcifications [BAC] as seen on mammographic examination and to determine the association between BAC and hypertension, age, parity and weight of the person. Cross-sectional analytic study. Department of Diagnostic Radiology, Military Hospital, Rawalpindi, from January 2006 to January 2007. Two hundred patients undergoing mammography were studied to evaluate the association of BAC with raised blood pressure, age and parity. Previous history of lactation and the patients' weight were also recorded. Proportions of classes were compared using chi-square test. 13.5% of the subjects [n = 200] were positive for BAC on mammograms. Mean age of the BAC positive subjects was higher than their counterparts found negative for BAC. Women bearing 5 - 6 children showed the highest frequency of BAC. Seventy seven [10.38%] of the BAC positive cases had previous history of lactation, whereas 15.44% [n = 123] had not breast fed their children and showed BAC. No significant association of presence of BAC was noted with the weight of the subjects. The frequency of presence of BAC on mammography was associated with systemic hypertension and higher age. It also increased with the reproductive parameters of a woman

Comparison of renal venous blood flow between normal pregnant women and non-pregnant women by colour and duplex doppler sonography

To investigate whether normal pregnancy has a significant effect on intrarenal venous blood flow and to assess whether the physiological maternal pyelocaliectasis causes a measurable change in venous impedance indices in pregnant women. Cross sectional comparative study. Radiology Departments, KRL Hospital Islamabad and Combined Military Hospital Lahore from Jan 2010 to Jul 2010. A total of 50 normal pregnant women in their second and third trimester and 50 controls, i.e. normal non-pregnant married healthy women of childbearing age were included in the study. Confounding variables were controlled by excluding subjects having recent or previous renal calculi, pathological renal conditions or congenital renal anomalies or generalized disorders affecting haemodynamics ruled out by history, clinical examination and ultrasound examination in both pregnant and non-pregnant women. After grading the degree of hydronephrosis, venous impedance index was obtained from the interlobar veins. Overall the collecting system dilatation was present in 60% of 50 right kidneys and 42% of 50 left kidneys in the pregnant women. The venous impedance indices were significantly lower in 50 pregnant women than the values in non-pregnant subjects [p< 0.001 for the right and the left kidney]. The overall difference in venous impedance indices between right and left kidneys was not significant in pregnant women [p = 0.11]. There was an inverse correlation between the grade of pelvicalyceal dilatation and the venous impedance indices in both kidneys in 50 pregnant women. Normal pregnancy causes dilatation of the pelvicalyceal system and significant reduction in renal venous impedance index values in second and third trimesters. Therefore one should be careful in interpretation of an abnormally reduced venous impedance index and hydronephrosis as a sign of pathological ureteral obstruction in pregnant women

Ultrasonography in obstructive jaundice

To evaluate the validity of ultrasonography in patients who have obstructive jaundice. Descriptive study. The study was carried out from September 2006 to May 2008 in department of Radiology Combined Military Hospital Quetta. A total of 30 patients; 14 male and 16 female underwent operation for obstructive jaundice. All of them had preoperative ultrasonography. The site and nature of biliary obstruction were noted and the accuracy was determined with pre-operative findings/ histological diagnosis as gold standard. The cause of obstructive jaundice identified by ultrasonography with reasonable sensitivity of 90% and specificity of 90% for choledocholithiasis and sensitivity of 95.2% for pancreatic head tumors. Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and shows reasonable sensitivity and specificity to identify causes of obstruction jaundice

Role of colour doppler ultrasonography in differentiating benign and malignant thyroid nodules

To determine the validity of Colour Doppler Ultrasonography in differentiating benign from malignant thyroid nodules in patients attending outpatient department of Radiology of Combined Military Hospital, Rawalpindi, keeping fine needle aspiration as reference. Validation study. The Department of Radiology, Combined Military Hospital [CMH], Rawalpindi from June to December 2009. All patients with thyroid nodules were included for diagnostic workup. Colour Doppler study was carried out recording the size and consistency of the thyroid nodule with special emphasis to vascularity pattern. US findings were noted. Ultrasound was followed by fine needle aspiration from Armed Forces institute of Pathology [AFIP], Rawalpindi. Findings on CDUS were analyzed in light of AFIP report. Among the 107 thyroid nodules studied, 6 nodules were proven to be malignant on FNA. Of these 6 malignant nodules, only 3 were picked up by Colour Doppler ultrasound. Four were wrongly labeled as malignant by the vascularity pattern shown on Colour Doppler Ultrasound. Colour Doppler ultrasound showed a sensitivity of 50%, specificity of 96%, NPV of 97%, and PPV of 42.9%. The Colour Doppler characteristics of a thyroid nodule cannot be used to predict or exclude malignancy confidently. Although the future of duplex Ultrasonography is changing, FNAB is still needed to determine the nature of the nodule

High resolution computed tomographic patterns in adults with pulmonary tuberculosis

To determine the High Resolution Computed Tomographic [HRCT] patterns in adults with Acid Fast Bacillus [AFB] positive new cases of Pulmonary Tuberculosis [PTB]. The study was carried out at the Department of Pulmonology and Department of Radiology, Military Hospital, Rawalpindi, from June 2006 to August 2007. Fifty adults with AFB positive new pulmonary tuberculosis were included in the study, while PTB cases in the retreatment category, Multi Drug Resistant [MDR] tuberculosis, PTB with Chronic Obstructive Airways Disease [COPD], pneumoconiosis, Diffuse Parenchymal Lung Diseases [DPLDs] etc. were excluded. All cases underwent HRCT chest with 2 mm collimations at 10 mm intervals. Relevant data was collected on a pre-designed patient proforma. The mean age was 40.18 +/- 14.55 years with 88% males; 46% and 30% samples were sputum and endobronchial washings smear positive for AFB respectively, while the rest were culture positive. HRCT findings included centrilobular nodules in 92% cases, lobular consolidation in 84%, cavitation in 76%, 'tree-in-bud' appearance in 68%, lymphadenopathy in 8% and miliary nodules in 4% cases. HRCT patterns included centrilobular nodules and lobular consolidation in 80% cases, while centrilobular nodules with cavitation and centrilobular nodules with 'tree-in-bud' appearance were noted in 72% and 68% patients respectively. Thirty two [64%] cases had centrilobular nodules, cavitation and lobular consolidations and about half cases had centrilobular nodules, 'tree-in-bud' appearance and lobular consolidation. Centrilobular nodules and lobular consolidations [80%], centrilobular nodules with cavitation [72%] and centrilobular nodules with 'tree-in-bud' appearance [68%] were the most common HRCT patterns in adults newly diagnosed with pulmonary tuberculosis

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease