Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation Between Malignant and Benign Thyroid Nodules.

INTRODUCTION: High resolution ultrasound is the most sensitive imaging test available for the examination of the thyroid gland and due to increase in use of ultrasound more incidental thyroid nodules are diagnosed. In this study we try to establish the specific grayscale, color and spectral Doppler characteristics of malignant and benign thyroid nodules. AIM: To determine the specific gray scale characteristics, angioarchitecture and cut-off values of Doppler indices of malignant and benign thyroid nodules. To assess the efficacy of grayscale, Doppler and combined conventional and Doppler using defined criteria in differentiating malignant from benign nodules. MATERIALS AND METHODS: We prospectively examined 194 thyroid nodules which were confirmed on FNAC. Each nodule was described according to size, number, contents, echogenicity, margins, halo, shape, calcification, local infiltration and lymphnode enlargement. Vascularity, RI and PI values of each nodule were assessed on Doppler. Each nodule was characterized as benign, indeterminate or malignant based on grayscale and Doppler characteristics. Cut-off RI and PI values for malignant thyroid nodules were obtained by ROC. RESULTS: Out of 194 nodules, 151 nodules were benign and 43 nodules were malignant. Significant relationship was observed between malignancy and hypoechogenicity, irregular margins, taller than wide, thick incomplete halo, micro calcifications, lymphnode enlargement and local infiltration. Intranodular vascularity was a significant criterion to suggest malignancy in thyroid nodules on color Doppler. Malignant nodules had a mean RI of 0.73 and mean PI of 1.3 which were significantly higher than the benign nodules. Accuracy of detecting malignant thyroid nodules by combining gray scale and Doppler is higher than either of them alone. CONCLUSION: Using specific morphological pattern recognition features like microcalcifications, hypoechogenicity, taller than wide, irregular thick halo, lymphadenopathy and local extra thyroidal invasion has helped in differentiating malignant from benign features. Intranodular vascularity and high RI indices were the specific Doppler signs for malignant thyroid nodules. Since, Gray scale and Doppler have their own strengths and weaknesses, they were complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules.

Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis.

INTRODUCTION: Ultrasound is usually the first diagnostic investigation for the assessment of liver lesions. Apart from conventional sonography (CS), new grey-scale sonographic techniques have been developed which have increased the application of ultrasound in liver imaging. The present study was undertaken to compare image quality of CS, real-time compound sonography (RTCS), tissue harmonic sonography (THS) and tissue harmonic compound sonography (THCS) in focal liver lesions. MATERIALS AND METHODS: 100 patients with focal hepatic lesions were enroled. Lesions were divided into solid and cystic group. Solid lesions were evaluated for lesion conspicuity and elimination of artefacts. For cystic lesions, lesion conspicuity, posterior acoustic enhancement and internal echoes within the lesion were evaluated. Grading was done using 3-5-point scales. Overall image quality was assessed depending on the total points. RESULTS: 78 solid and 22 cystic liver lesions were included. THCS showed superior results for lesion conspicuity, elimination of artefacts and overall image quality in solid lesions. RTCS showed similar results as THCS for lesion conspicuity and overall image quality in solid lesions. THS gave better results in cystic lesions for all imaging parameters. Results of THCS though slightly inferior, showed no significant difference from THS, in cystic lesions. CS was found to have least diagnostic value in characterisation. CONCLUSIONS: For evaluation of focal hepatic lesions, a combination of compound and harmonic sonography, i.e. THCS, is the preferred sonographic technique.

Idiopathic subareolar breast abscess in a male patient.

We present a case of left breast abscess in a young male patient who presented with acute onset swelling left breast. Imaging studies helped in accurate diagnosis and the case was managed by subareolar incision and drainage. Subareolar breast abscess is an uncommon entity in male and should be kept as a differential diagnosis for male breast swellings.

Omental infarct mimicking acute pancreatitis.

Omental infarction is a rare condition which is being increasingly reported in the literature due to the advancement in imaging techniques and its typical computed tomography appearance. Accurate diagnosis of omental infarct can be made on computed tomography, thereby avoiding exploratory surgery. We report a case of conservatively managed primary omental infarct which was clinically thought to be acute pancreatitis.

A Case of Dermatofibrosarcoma Protuberans of the Trunk.

Dermatofibrosarcoma protuberans is a rare, usually superficial soft tissue sarcoma, which is diagnosed by its typical clinical manifestations. We report a case of histopathologically proved dermatofibrosarcoma protuberans of the left upper posterior trunk in a 35-year-old female for whom complete surgical resection was done.

A Case of Exophytic Angiomyolipoma of the Liver.

Hepatic angiomyolipoma (AML) is a benign liver tumor, composed mainly of blood vessels, smooth muscle, and fat cells in varying proportions. We report on a case of resected hepatic AML which was diagnosed preoperatively using contrast-enhanced computed tomography scan.

Unusual cause for abdominal pain in cirrhosis : thrombosed intrahepatic portal vein aneurysms.

Portal venous system aneurysm is a rare condition with very few reported cases in English literature. With the increasing availability of advanced imaging modalities like Doppler ultrasound, computed tomography and magnetic resonance imaging, portal venous system aneurysms are being increasingly reported. Here, we report a rare case of multiple intrahepatic portal venous system aneurysms complicated by thrombosis in a young patient with chronic liver disease and portal hypertension.

A Case of Intermittently Discharging Skin Lesion: Orodentocutaneous Fistula Demonstrated on CT Fistulography.

Orodentocutaneous fistula is a rare entity where periapical dental abscess communicates with both oral cavity and external skin. In few cases, patients presents initially with only cutaneous manifestation with no recollectable history of dental problem. Delay in diagnosis of odontogenic cause of skin lesion makes the disease more chronic and extensive. We hereby present a case of orodentocutaneous fistula that presented with intermittently discharging skin lesion and was evaluated by using CT fistulography.

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases.

We hereby report two cases of spontaneous emphysematous osteomyelitis of spine caused by gas forming organisms in diabetic patients, which were diagnosed using computed tomography (CT) and magnetic resonance imaging with one case managed successfully. These cases highlight the role of CT in diagnosis of gas forming spinal infections, especially in diabetic patients. Early and aggressive management is required in those cases to avoid mortality.

Doppler Sonography and 3D CT Angiography of Acquired Uterine Arteriovenous Malformations (AVMs): Report of Two Cases.

Uterine Arteriovenous Malformations (AVMs) are rare but life threatening causes of abnormal vaginal bleeding. Accurate clinical and radiological diagnosis is essential because uterine instrumentation that is often used for management of other sources of abnormal bleeding, can lead to massive hemorrhage. Timely diagnosis and early proper treatment can markedly reduce the associated disease mortality. Ultrasound with colour and spectral doppler is the initial imaging modality of choice. Three-dimensional computed tomography (CT) angiography can determine the actual extent of the vascular malformation and helps in pre-interventional planning noninvasively. Uterine AVM can be either congenital or acquired in nature with latter being more common. We hereby report two cases of acquired AVMs diagnosed by color doppler sonography and confirmed by three-dimensional CT angiography. Both the cases reported here had previous history of dilation and curettage for abortion. Clinically one patient presented with profuse uterine bleeding and another with meno-metrorrhagia and both cases underwent surgical removal of uterus.