Atul Kapoor

Real-Time Elastography in the Detection of Prostate Cancer in Patients with Raised PSA Level

The study was done to evaluate the role of real-time elastosonography (ES) in the detection of prostate cancer (PCa) in 50 consecutive patients with raised PSA level and to determine whether ES can be of use to perform a targeted biopsy. Fifty consecutive patients with raised PSA levels underwent transrectal ultrasound (TRUS) and ES examination. ES images with adequate compression and a quality factor of more than 50% were analyzed for areas of increased glandular stiffness. The ES findings were correlated with the targeted and 10-core biopsy and sensitivity, specificity calculated on per patient and per core basis. ES showed a sensitivity and specificity of 91.7% and 86.8% on per patient basis, respectively, with a false positive rate of 13%. The calculated sensitivity and specificity on per core basis of ES targeted biopsy was 72.5% and 100% compared with 100% and 81% of 10-core systematic biopsy group. The study concludes that combining ES with TRUS significantly improves the sensitivity to detect carcinoma prostate in patients with raised PSA, however, ES is unable to differentiate PCa from chronic prostatitis. The use of ES for targeted biopsy also improves the specificity over a 10-core systematic biopsy.

Neglected fractured neck of the femur: a predictive classification and treatment by osteosynthesis.

A prospective study of 236 patients with neglected femoral neck fractures was done to determine the usefulness of a preoperative classification based on the radiologic changes that occur at the site of the fracture. Thirty-four patients were observed in Group I, 125 patients were observed in Group II, and nine patients were observed in Group III. One-hundred sixty-eight patients (71.2%) were treated by closed reduction and internal fixation with cancellous screw and free fibular graft. The fracture union was achieved in all 34 patients of Group I. Union was achieved in 111 (88.8%) of 125 patients in Group II, and it was achieved in three (33.3%) of nine patients in Group III. In 143 (96.6%) of 148 successfully treated patients, the hip joint remained clinically asymptomatic with normal radiological union. One-way analysis of variance showed a good predictive value of the above classification with the results achieved by osteosynthesis. A good interobserver agreement also was seen in all three groups. We concluded that the classification is of use in the preoperative evaluation of neglected fractures of the neck of femur. For a successful osteosynthesis, the femoral head should be viable, with the size of the proximal fragment at least 2.5 cm long.

Real-Time Elastography in Differentiating Metastatic From Nonmetastatic Liver Nodules

The study was designed to evaluate the role of real-time elastography in differentiating metastatic from nonmetastatic liver nodules, which include various benign lesions, hepatocellular carcinoma (HCC) nodules and lymphoma. Out of 1000 prospective patients who underwent abdominal ultrasound (US) examination, 48 patients had liver nodules. Nodule stiffness was determined by real-time elastography (ES) using color maps and shear wave velocity (SWV) and nodules having marked stiffness or SWV of more than 2.5 m/s were diagnosed as metastatic. The final diagnosis was made on fine needle aspiration cytology. No statistically significant differences were seen on elastomaps in the stiffness of metastatic and nonmetastatic nodules (p = 0.16) while SWV showed statistically significant differences in the strain velocities of benign, metastatic and heptocellular carcinoma nodules p < 0.0001 and < 0.008, respectively. At a cutoff value of SWV 2.5 m/s, the sensitivity, specificity and false positive to detect metastatic nodules by ES were 88%, 83% and 16%, respectively. When the SWV cut off value was set at 2.0 m/s the sensitivity, specificity and false positive were 94%, 70% and 29%, respectively. The study showed that estimation of SWV by ES at a cut off value of 2.5 m/s was a better and a more useful tool in diagnosing both solid and necrotic metastatic liver nodules compared with the color stiffness maps alone.

Differentiating malignant from benign thickening of the gallbladder wall by the use of acoustic radiation force impulse elastography.

The purpose of this study was to determine whether real‐time elastography can differentiate gallbladder carcinoma from benign gallbladder wall thickening.

Real-time Elastography in Acute Appendicitis

Objective. This study was done to evaluate the role of real‐time Elastography (ES) in the diagnosis and staging the severity of acute appendicitis. Methods. Forty patients with acute pain in the right iliac fossa were evaluated using ES and sonography. All patients with a diagnosis of acute appendicitis on ES were also staged for the severity of appendicular inflammation and later underwent surgery, and the findings on imaging were confirmed and results compared. The sensitivity and specificity for ES and sonography were then calculated. Results. Elastography had sensitivity and specificity of 100% each, whereas sonography had sensitivity of 88% and specificity of 100%. Elastography also depicted the severity of inflammation, with 12 patients having mild, 8 having moderate, and 5 having severe appendicitis. Conclusions. Combining ES with sonography improves the sensitivity in detection of acute appendicitis and can also be used to triage the severity of inflammation in such patients.

Technical note: Radiofrequency ablation of hepatocellular carcinoma with contrast-enhanced ultrasound guidance: First Indian experience

Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is an established alternative treatment to surgery and intra-arterial chemotherapy, usually performed under contrast-enhanced CT scan guidance. We describe our experience with the use of contrast-enhanced ultrasound and contrast dynamics analysis for planning and monitoring RFA in a patient with HCC.