Ram Chandra Shukla

Carcinoma of the gallbladder: role of sonography in diagnosis and staging.

In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology.

Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy

AimTo evaluate the role of ultrasonography for differentiating cervical lymphadenopathy due to tuberculosis, metastasis and lymphoma.MethodsUltrasonography of the neck nodes was carried out prior to FNAC in 192 patients using a 10 mHz linear transducer. The sonographic findings were then correlated with the definitive tissue diagnosis obtained by FNAC or lymph node biopsy.ResultsThe most significant distinguishing feature was strong internal echoes seen in 84% of tubercular lymph nodes. This finding was found in only 11% of metastatic nodes and absent in lymphomatous nodes. The other findings such as L/S ratio, irregular margins, hypoechoic center, fusion tendency, peripheral halo and absent hilus were helpful in differentiating reactive from diseased nodes but showed considerable overlap in the 3 groups of tubercular, metastatic and lymphoma lymph nodes.ConclusionUltrasonography is noninvasive and can give useful clues in the diagnosis of cervical lymphadenopathy. It should be interpreted in conjunction with FNAC result. Ideally ultra-sonographic guided FNAC should be obtained from the sonographically most representative node. In FNAC indeterminate cases, sonographic features may obviate the need for an invasive lymph node biopsy.

Cholecystosonographic evaluation of the prevalence of gallbladder diseases. A university hospital experience.

Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gallbladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.

Ultrasound-Guided Fine Needle Aspiration Cytology of Malignant Gallbladder Masses

OBJECTIVE To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. STUDY DESIGN We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. RESULTS After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. CONCLUSION US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.

Intralesional bleomycin in lymphangioma: An effective and safe non-operative modality of treatment

Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management. Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG. Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients. Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.

Color Doppler ultrasonography for treatment response prediction and evaluation in breast cancer

Primary systemic therapy is a well-established modality of treatment in locally advanced breast cancer. Assessment of tumor response to chemotherapy not only helps in assessing the efficacy of the regimen used but also predicts the overall outcome of the patient. The tumor vascularity is a surrogate marker of tumor burden and this can be readily assessed by color Doppler ultrasound using various indices (resistivity index, pulsatility index and maximum flow velocity). The pre- and post-chemotherapy indices can be compared with in order assess the response to chemotherapy. Among various imaging modalities, MRI and PET have the highest sensitivity in detecting the tumor response, but they are not cost effective. Color Doppler ultrasound is a promising alternative for tumor response assessment owing to its availability, reproducibility and cost-effectiveness.

Invasive placental disorders: a prospective US and MRI comparative analysis.

Background Invasive placental disorders are potentially life-threatening. Its diagnosis and evaluation of degree of invasiveness is vital in surgical and treatment planning. Purpose To compare the role of various imaging modalities used in current practice for evaluation of invasive placental disorders, and evaluate the validity of certain imaging signs for prediction of invasive placenta. Material and Methods Twenty-two patients, which were clinically stratified as a risk group for underlying invasive placental abnormality, underwent Doppler sonography and magnetic resonance imaging (MRI). Abnormal placental invasiveness was assessed using various Doppler sonography and MRI signs described in the existing literature. We systematically evaluated the utility of each of these modalities and signs, and compared the roles played by them separately and in combination. All the cases were correlated with surgical and pathological findings. Results Nine patients had surgical and pathological confirmation of placental adhesive disorders, of which eight were predicted correctly by MRI (true positive) while one was misdiagnosed as normal placenta (false negative). All the nine cases were correctly identified by Doppler sonography. MRI was more accurate in predicting bladder invasion, identifying 5/6 cases. Conclusion Both MRI and Doppler sonography are useful for detection of invasive placental disorders. However, MRI is a better predictor of bladder invasion.

Utility of magnetic resonance imaging in the diagnosis of unsuspected cases of Parsonage-Turner syndrome: two case reports

IntroductionMRI is becoming increasingly important in the evaluation of shoulder pain, especially in the diagnosis of rotator cuff injuries and conditions that mimic them. Parsonage-Turner syndrome is a well-defined clinical entity that presents with acute-onset shoulder pain and weakness, often first recognized on magnetic resonance imaging scans.Case presentationWe studied magnetic resonance imaging features of two Asian men (ages 24 and 31 years) who presented with variable-onset shoulder pain and weakness. Magnetic resonance imaging revealed increased T2-weighted signal intensity of supraspinatus and infraspinatus muscles in both patients.ConclusionMagnetic resonance imaging findings are distinctive, although nonspecific, in cases of Parsonage-Turner syndrome, and knowledge of the imaging and clinical features of this disease enable clinicians to arrive at the correct diagnosis and guide appropriate management.

Idiopathic Hypertrophic Pachymeningitis â MRI Diagnosis and Follow up

Idiopathic hypertrophic pachymeningitis is a rare entity, posing challenge to the radiologist for a confident prospective diagnosis. The same is of prime importance as in the absence of a definitive treatment, the clinician has to initiate a presumptive therapy based on radiological diagnosis, histopathology not being the pragmatic option in most cases. We present a case which is interesting not only by virtue of the rarity of this disease but also due to the extent of cranial nerves involved and the drastic response to therapy initiated once suspected on MRI. The emphasize of this report is on being mindful of the possibility and early recognition of signs differentiating it from other close and commoner mimickers.

Antral follicle count in normal (fertility-proven) and infertile Indian women.

Background: Antral follicle count (AFC) has been labeled as the most accurate biomarker to assess female fecundity. Unfortunately, no baseline Indian data exists, and we continue using surrogate values from the Western literature (inferred from studies on women, grossly different than Indian women in morphology and genetic makeup). Aims: (1) To establish the role of AFC as a function of ovarian reserve in fertility-proven and in subfertile Indian women. (2) To establish baseline cut-off AFC values for Indian women. Settings and Design: Prospective observational case-control study. Materials and Methods: Thirty patients undergoing workup for infertility were included and compared to equal number of controls (women with proven fertility). The basal ovarian volume and AFC were measured by endovaginal. USG the relevant clinical data and hormonal assays were charted for every patient. Statistical Analysis Used: SPSS platform was used to perform the Students t-test and Mann-Whitney U-test for intergroup comparisons. Correlations were determined by Pearsons ranked correlation coefficient. Results: Regression analysis revealed the highest correlation of AFC and age in fertile and infertile patients with difference in mean AFC of both the groups. Comparison of the data recorded for cases and controls showed no significant difference in the mean ovarian volume. Conclusions: AFC has the closest association with chronological age in normal and infertile Indian women. The same is lower in infertile women than in matched controls. Baseline and cut-off values in Indian women are lower than that mentioned in the Western literature.