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BACKGROUND: The grading of the severity of head trauma plays a vital role in acute patient management and planning a case-appropriate follow-up protocol. Few studies have been published regarding the Rotterdam scoring. In this study, we have established a correlation between the Rotterdam scores, need for sequential CTs, and the cumulative radiation dose. This correlation has helped develop a preliminary protocol that can be followed for patients hence bringing about better planned and efficient patient care. MATERIALS AND METHODS: From August 2014 to December 2020, 88 cases of traumatic head injury on whom a minimum of one sequential CT was performed, with no surgical intervention, were included and studied. Sequential head CTs of each patient were evaluated by skilled radiologists with a minimum experience of five years, all of whom were blinded to the findings of the initial and previous head CT findings. The serial head CTs were evaluated for the Rotterdam CT score (RCTS). Results: Among the patients with extradural hemorrhage (EDH), only 28.6% (8) progressed over successive CTs and 75.5% (34) of patients with subdural hemorrhage (SDH) showed significant progression over sequential CTs. Maximum number of serial CTs were obtained for cases presenting with a score of 3 (34 cases) with about three of them requiring up to a total of three CTs. However, no significant change in findings was noted on serial CTs. On the contrary, significant disease progression was noted in patients with baseline scores of 4 (76.9%) and 5 (100%), with statistical significance obtained on further analysis (P = 0.001). CONCLUSIONS: We are of the opinion that there is no additional role of sequential CT for the cases with Rotterdam score of 1 or 2 in the initial CT unless there is clinical evidence of deterioration. Rotterdam score 3 needs sequential CT after 24 hours and Rotterdam scores 4 and 5 need sequential CT after 12 hours if surgical intervention is delayed. The Rotterdam score may help predict any further need for a second CT, hence decreasing the unwanted radiation exposure.
RESUMEN
Introduction Breast masses range from inflammatory and benign to malignant lesions, varying in different age groups and clinical presentations. Breast imaging techniques leading to prompt and specific diagnosis have been a lifesaver for millions around the globe saving them undue mental stress in inflammatory lesions and preventing early death in case of neoplasms. Here, we compare mammography, ultrasonography (US) and ultrasound elastography in the screening and diagnosis of breast lesions and the usefulness of strain ratio as a non-invasive tool in diagnosing breast malignancies. Aims and objectives Determining the characteristics of breast lesions on imaging by mammogram, ultrasonography, elastography, calculating strain ratio and correlating them with histopathology. To further estimate the advantages and limitations of one modality over the other in the evaluation of breast lesions. Methods The study was done over a duration of 18 months from November 2019 to June 2021 at JSS Medical College and Hospital, Mysuru. In this prospective study, 73 female patients with palpable breast lesions were evaluated using mammography, US and sonoelastography and were co-related with histopathological findings. Results This study has proved that the use of ultrasound elastography has higher sensitivity (91.67% with strain ratio kept at 3) in detecting malignant lesions when compared with x-ray mammography and ultrasonography having a sensitivity of 87.88% and 90.91%, respectively. Our study confirmed that there is a correlation between strain ratio and histopathological findings and that the strain ratio has high sensitivity in diagnosing and differentiating malignant breast lesions. Conclusions Mammography, US and sonoelastography when combined together are helpful in characterization and management of breast lesions. This helps to avoid unnecessary invasive interventions. The specificity of the study in detecting malignant lesions was comparable with that of histopathological analysis.
