Role Of Shear Wave Elastography In Assessment Of Placental Elasticity In Normal And High-Risk Pregnancies In Third Trimester.

Objective: To assess the elasticity of placenta using shear wave elastography in normal and high-risk pregnancies in the third trimester. METHODS: The prospective, observational study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 15, 2022, to January 15, 2023, and comprised singleton pregnant women during 28-40 weeks of gestation who were referred from the obstetric department. The subjects were divided into normal pregnancy group A and high-risk pregnancy group B. Risk factors include gestational hypertension, gestational diabetes, intrauterine growth restriction, placenta previa, morbidly adherent placenta, old primigravida, teen age and morbid obesity were noted. All the patients underwent grey scale, Doppler ultrasonography and shear wave elastography. Data was analysed using SPSS 26. RESULTS: Of the 104 subjects, 78(75%) were in group A and 26(25%) were in group B. The overall mean age was 34.2±3.59 years. In group B, mean placental shear wave velocity was 2.34±1.17m/sec and elasticity was 24.41±25.51kPa compared to 1.42±0.55 m/sec and 13.6±10.23kPa in group A (p<0.05). Significant positive correlation was found between shear wave velocity and elasticity values in both groups (p<0.001). Conclusion: Shear wave elastography was found to be a useful technique in detecting placental stiffness, and can be used as an adjunct to the currently available ultrasonographic methods in high-risk pregnancies.

Effective strategy to cope the pain and discomfort among women undergoing mammography - A randomized controlled trial.

Objectives: To evaluate the role of paracetamol in reducing pain and discomfort during the mammography procedure. Methods: This randomized double-blind placebo-controlled trial was conducted at DIR, Ojha and LEJ Campus of DUHS from November 2019 to May 2021. All females aged above 40 years undergoing first time mammogram (screening or diagnostic) were enrolled. Of 639 included participants, 321 were included in paracetamol and 318 in placebo group. Patients in both the groups took medication orally which was customized by the Dow Pharmacy. The degree of pain felt during the mammography procedure was the outcome variable that was measured using Visual Analogue Scale. Results: The overall pain was found in 506 (79.19%) women. Pain was significantly higher in women who were in placebo group as compared to patients who were in paracetamol group, i.e., 280 (55.3%) and 226 (44.7%) (p-value <0.001). After adjustment of other covariates, the odds of pain was 3.64 times significantly higher in women who were in placebo group than that of women in paracetamol group (OR 3.64, 95% CI 2.31-5.74). Moreover, >25kg/m2 BMI was 2.84 times, 22.6-25 kg/m2 BMI was 2.29 times, nulligravida was 3.56 times, menopausal status was 2.23 times, pre-menopausal status was 4.51 times, and family history of breast cancer was 2.33 times significantly more likely to have pain. No post-trial complications were observed in both the groups. Conclusion: The use of paracetamol prior to the mammography procedure was found to be an effective intervention to reduce the pain among women.Clinical Trials: Identifier: NCT04381104.

Benign and malignant breast diseases during pregnancy and lactation: a diagnostic challenge.

OBJECTIVE: To determine the frequency of breast cancer associated with pregnancy and lactation, and to evaluate the lesions on ultrasound. Methods: The descriptive, observational study was conducted at the Dow Institute of Radiology, DUHS, Karachi from December 2020 to August 2021, and comprised of pregnant and lactating women with clinically palpable breast lumps and/or painful breast. The margins, orientation, echo pattern and associated features of the lesions were studied on ultrasound and were assigned a Breast Imaging Reporting and Data System grade. All the lumps were followed and ultrasound-guided core needle biopsy for histopathology was done of grades IV and V cases. Incidence and Accuracy of ultrasound for diagnosis of pregnancy-associated breast cancer was estimated. Data was analysed using SPSS 26. RESULTS: Of the 237 women, 19(8%) were pregnant and 218(92%) were lactating. The overall mean age was 28.4±5.5 years. Ultrasound findings for lactating and pregnant women were significantly different (p=0.05). Significant association of Breast Imaging Reporting and Data System grades III, IV and V lesions with heterogeneous echo texture of mass was seen (p<0.001). Biopsy was performed in 20(8.4%) cases, and 12(60%) of them had benign results on histopathology. CONCLUSIONS: A variety of benign and malignant breast diseases were found in women during pregnancy and lactation phases.

Does Structured Informational Care Reduce Anxiety In Patients Undergoing MRI? A Quasi-Experimental Study.

Objectives: To assess the anxiety level in patients undergoing magnetic resonance imaging, and to see if structured informational care reduces anxiety compared to conventional approach. METHODS: The quasi-experimental study was conducted Dow Institute of Radiology, Dow University of Health Sciences Karachi, Pakistan from January 2020 to June 2021, and comprised adult patients of either gender undergoing magnetic resonance imaging of brain / cervical spine for the first time. They were divided into S-arm group exposed to structured information with pictures, recordings and videos, and C23 arm group exposed to conventional information. The primary outcome was anxiety, measured by Beck Anxiety Inventory. Data was analysed using SPSS 11. RESULTS: Of the 280 subjects, 140(50%) were in the S-arm; 65(46.4%) males and 75(53.6%) females with mean age 41.1±15.2 years. The C-arm had 140(50%) subjects; 78(55.7%) males and 62(44.3%) females with mean age 44.2±13.9 years (p>0.05). The pre-procedure anxiety score of C-arm was 11.3±7.7 compared to 9.6±7.7 in S-arm (p=0.062. Post-procedure anxiety score in S-arm was 9.8±9.0 compared to 1.49±4.5 in C-armB (p<0.001). CONCLUSIONS: Structured informational care aimed at familiarising the patient to the magnetic resonance imagaing machine and describing the relaxing manoeuvres during examinationI was found to be a cost-effective and simple method to alleviate anxiety in patients.

Positive predictive value of Birads IV Lesions on mammogram in detection of breast carcinoma.

OBJECTIVE: To determine the positive predictive value of Breast Imaging Reporting and Data System category IV lesions, and to evaluate interobserver agreement among radiologists in interpreting the subcategories. Method: The cross-sectional study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 2018 to February 2019, and comprised adult females aged 30-60 years diagnosed with Breast Imaging Reporting and Data System IV. Already diagnosed breast carcinoma patients were excluded. The positive predictive value of Breast Imaging Reporting and Data System category IV was calculated using histopathology findings as the gold standard. Data was analysed using SPSS 22. RESULTS: There were 191 patients with a mean age of 49.01±11.79 years. Positive family history of breast cancer was found in 33(17.3%) subjects. Category IV-A was noted in 53(28.0%) subjects, IV-B in 45(23.6%) and IV-C in 93(48.7%). The overall positive predictive value of category IV was 151(79.1%), IV-A 27(50.9%), IV-B 35(77.7%) and IV-C 89(95.6%). Malignant disease was significantly associated with architectural distortion and suspicious microcalcifications (p<0.001). A good agreement was observed in the categorisation of Breast Imaging Reporting and Data System category IV between observers 1 and 2 (kappa 0.85, 95% confidence interval: 0.70-0.99), between observers 1 and 3 (kappa 0.77, 95% confidence interval: 0.61-0.94), and between observers 2 and 3 (kappa 0.63, 95% confidence interval: 0.43-0.83). CONCLUSIONS: Breast Imaging Reporting and Data System BI-RADS IV was found to have a high positive predictive value in the diagnosis of breast cancer. Besides the interobserver agreement in terms of identifying BI-RADS IV subcategories was good.

Identification of Significant Anatomical Variations in the Nose and Anterior Skull Base Using Computed Tomography: A Cross-Sectional Study.

Introduction This study is aimed at the identification of anatomic variations in the nose, paranasal sinuses (PNS), and anterior skull base, which are substantially important to ensure safe and complete endoscopic sinus and skull base surgery. Materials and methods This cross-sectional study was conducted at the Dow Institute of Radiology, Dow International Medical College, Dow University Hospital. We included adult patients (i.e., those aged 18 years or older) undergoing a non-contrast CT of the nose and PNS. Two consultant radiologists reviewed the scans on the picture archiving and communication system independently. Any conflict was resolved with consensus. Anatomical variations in the nose, PNS, and anterior skull base of both sides were evaluated. Results We reviewed the CT of the PNS of 130 patients with an age of 35.8 ± 14.48 years (mean ± standard deviation). The proportion of men (64/130; 49.2%) and women (66/130; 50.8%) was equal. All patients had one or more variations. The most common abnormality was a deviated nasal septum (DNS), observed in 115 of 130 participants (88.5%) with unilateral occurrence predominant. It was followed by inferior nasal turbinate hypertrophy and agger nasi cells in 76.2% and 67.7% patients, respectively. Optic nerve variation type I (160/260 sinuses; 61.5%) and Keros type II, for olfactory depth (162/260 sinuses; 62.3%), were most common. Conclusions Here we report anatomical variations in PNS in all patients of our study; the commonest of all anatomical variations was a DNS. A CT scan is instrumental in surgical planning and patient safety in functional endoscopic sinus surgery.

Diagnostic Accuracy of Doppler Twinkling Artifact for Identifying Urinary Tract Calculi.

Introduction Flank pain is a frequent cause of emergency department visits and is often due to renal or ureteric colic. Ultrasound is often the initial imaging study used for the detection of urinary tract calculi. Twinkling artifact is a Doppler artifact usually seen on echogenic rough surfaces such as calculi. Its presence can improve the sensitivity and specificity of ultrasound in stone detection. The objective of the current study was to determine the diagnostic accuracy of the Doppler twinkling artifact for detecting urinary calculi using non-contrast computed tomography as the gold standard. Materials and methods In this cross-sectional study, both male and female patients of any age having flank pain, burning micturition with or without hematuria were included. Ultrasound was performed and the presence or absence of Doppler twinkling artifact on calculus was noted. Following ultrasound, patients underwent plain CT scan and findings of stones were documented. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of Doppler twinkling artifact was calculated considering CT findings as the gold standard. Results Out of the total 221 patients, 146 (66.1%) were males and 75 (33.9%) were females. The mean age of the patients was 45.98 ± 16.30 years. Urinary tract calculi on ultrasound were observed in 74 (33.50%) patients, while on CT urinary tract calculi were observed in 127 (57.50%) patients. Diagnostic accuracy of Doppler twinkling artifact was found to be 71.49% with sensitivity, specificity, positive predictive value, and negative predictive value of 54.33%, 94.68%, 93.24%, and 60.54%, respectively. Conclusion Doppler twinkling artifact has low sensitivity, high specificity, and suboptimal diagnostic accuracy for the diagnosis of urinary tract calculi. Integration of this artifact has a lower sensitivity as compared to non-contrast CT scan. Multicentric studies with larger sample size and focusing on interobserver and intraobserver variability are recommended to have a consensus regarding Doppler twinkling artifact in the evaluation of renal and ureteric calculi.