Carotid Artery Intimal Medial thickness in Diabetic and Non-Diabetic Subjects in Central Kerala

Background: Increase in intimal medial thickness (IMT) of the carotid arteries is contemplated as a guide to atherosclerotic vascular disease and subclinical organ damage and foretell cardiovascular disease. The study aimed to analyse IMT in non-diabetic and diabetic subjects. Subjects and Methods: There were 105 diabetic and 95 non-diabetic subjects in this study. Common carotid artery (CCA) IMT was calculated using a linear probe of a high-resolution ultrasound medical system. Results: Diabetic subjects (0.95 mm) showed significantly higher mean intimal medial thickness (IMT) when compared non-diabetic subjects (0.85 mm) (p <0.05). Correlation of IMT was seen with age, total cholesterol, triglycerides, HDL & LDL cholesterol and systolic blood pressure (SBP) in diabetic subjects. Total cholesterol, SBP and diastolic blood pressure (DBP) showed a correlation with IMT in the non-diabetic subjects. Age, total cholesterol, SBP, and diabetes were independent risk factors for intimal medial thickness in multivariate linear regression analysis. Conclusion: Higher intimal medial thickness was seen in diabetic subjects when compared to non-diabetic subjects. We conclude that age, total cholesterol, SBP and duration of diabetes showed a significant correlation with IMT. IMT can be considered as a screening tool in diabetic patients for the early detection of atherosclerosis.

Magnetic Resonance Imaging Evaluation of Spinal Infections

Background: The advantage of Magnetic resonance imaging include multiplanar capabilities and soft-tissue contrast resolution, which is superior to that of CT. Magnetic resonance (MR) imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between an infection and other clinical conditions. Aim of the current study is to evaluate various spectrum and types of spinal infections, and discussing the role of MRI in diagnosing them and their characterization. Subjects & Methods: This Hospital-based prospective study consists 30 patients with clinically suspected spinal infections and chronic non-resolving low backache referred to the department of Radiodiagnosis in a period of 2 years. Investigations include Complete blood count, ESR, sputum analysis for acid-fast bacilli and MRI of the spine. Results: 20 cases involved the lumbar spine, of which 12 were tubercular, seven were pyogenic, and one case was actinomycosis. In total 21 tubercular cases, 12 cases involved lumbar spine (57%), 8 cases affects the thoracic spine (38%), and 1 case involves the cervical spine (P = 0.562). the incidence of spondylodiscitis is common overall in the lumbar spine. 23.8% of tubercular and 12.5 %of pyogenic cases involved more than two vertebrae. T1 hypointensity is seen in 18 cases of tuberculosis (85%), 8 cases of pyogenic (75%), and 1 case of actinomycosis (100%) (P = 0.801). 4 cases showed preservation of disc height, among which three are tubercular (75%), and 1 was actinomycosis (25%). 85 % of tubercular and 100% of pyogenic cases showed disc narrowing. 81 % of tubercular and 100 % of pyogenic cases showed disc hyperintensity. Nine cases of tuberculosis (42.9%) and 3 cases of pyogenic (37.5 %) showed epidural abscess. 26 cases showed para vertebral extension of which 18 were tubercular (69.2 %), 7 were pyogenic (26.9 %) and 1 was actinomycosis (3.8 %). 94% of tubercular and 42 % of pyogenic abscesses showed a well-defined para spinal signal in cases of paraspinal extension. 15 of the 18(83%) tuberculosis, 3 of the 7 (42%)cases of pyogenic, and 1 case of actinomycosis showed subligamentous spread along more than three vertebrae. Heterogenous enhancement was noted in 12 of the 15 (80%) tubercular cases, 1 of the 3 (33%) pyogenic cases, and 1(100%) actinomycosis case. 71% tubercular cases and 2 of 8 (25%) cases showed predominant anterior 2/3rd involvement. Grade III or more (>50%) vertebral destruction was seen in 16 tubercular (76%) and 2 pyogenic cases (25%). Six cases showed skip lesions of which 5were tubercular and 1 was pyogenic. 5 of the 21 (23.8%) tubercular and 1 of the 8 (12.5%) pyogenic cases showed skip lesions. Conclusion: Awareness of atypical MR imaging at early infectious spondylitis is important to avoid diagnostic delay and unnecessary other diagnostic procedures. Several non-infectious conditions may simulate the spinal infections. Hence It is helpful to be aware of these diseases and their MR imaging features. With these points in mind, MR imaging can be very beneficial to patients with spinal infection.

Study to Evaluate the Role of Computer aided Detection Using Full Field Digital Mammography in Breast Cancer Imaging

Background: Mammography is acknowledged as the single most effective method of screening for breast cancer and is credited with helping to reduce breast cancer mortality by approximately 30%. CAD systems are a new tool in detecting breast cancers on screening mammograms and in detecting potentially suspicious abnormalities on a mammogram. The aim & objective is to main aim of the present study to evaluate the performance of Computer Aided Detection using Full Field Digital Mammography in Breast Cancer imaging. Subjects and Methods:In the present study, Cases with lump breast with clinical suspicion of breast cancer and post op recurrence of breast cancer were imaged with FFDM and images were read on the viewing monitor without and with the aid of CAD software. The present study confirms that the diagnosis of breast cancer is made only following histopathology of respected specimen. Results: The maximum incidence was in 41-50 years and 51-60 years which was 13 cases in each group (30 %). There were 25 cases out of 40 (62.5%) in which the lesion was marked by CAD. Out of which in 20 cases (50%) only one lesion was marked by CAD and in 4 cases (10%) two lesions were marked by CAD. The total number of lesions marked by CAD was 25 (62.5%). Majority of patients had scattered fibro glandular density of breast. This was present in 19 patients (47.5%). 10 patients (20%) had heterogeneously dense breast, 07 patients (17.5%) had fatty breast and 04 patients (10%) had extremely dense breast. In majority of cases the lesion type was mass alone which was present in 26 cases (60%). While 10 cases (25%) presented as mass with microcalcifications and 4 cases (10%) presented with microcalcifications alone. In 24 cases there was no spread of cluster of micro calcification (60%). In 7 cases (17.5%) the spread of cluster of micro calcification was <10mm, in 4 cases (10%) the spread of cluster of micro calcification was 21-30 mm and in 5 cases ( 12.5%) the spread of cluster of micro calcification was > 40mm. In majority of cases the HPE revealed DCIS which was seen in 22 cases (55%), 08 cases (20%) were invasive ductal carcinoma and 02 cases was invasive lobular carcinoma. In 22 cases (55%) the BIRADS for the breast affected with cancer was BIRADS-V. While in 14 cases (35%) the score was BIRADS-IV, 04 cases (10%) the score was BIRADS-VI and in 02 case (5%) the score was BIRADS-III. The sensitivity, specificity and accuracy of CAD for detection of mass were 70%, 100% and 85% respectively and for detection of cluster of microcalcification were 100% respectively. Conclusion: CAD with FFDM is good at detection of Microcalcifications. Detection of masses is better without the aid of CAD as compared to CAD. However detection of lesion improves if reading of mammogram is done both with and without CAD.

Lung Ultrasonography and Chest Radiography in Suspected Cases of Pneumonia in Critically Ill Patients- A Comparative Study

Background: The present study compared lung ultrasound (USG) and chest radiography in suspected cases of pneumonia in critically ill patients. Subjects & Methods: 56 patients age above 20 years of age of both genders diagnosed with pneumonia were included. Patients were subjected to chest USG and X ray. Positive predictive values for both lung ultrasound and chest X-ray were calculated. Results: Age group 20-30 years had 4 patients, 30-40 years had 6, 40-50years had 10, 50-60 years had 16 and >60 years had 20 patients. The difference was significant (P< 0.05). Chest x ray reveled 40 out of 56 cases positive and 16 negative and USH showed 52 positive and 4 negative. Positive predictive value (PPV) of chest x- ray was 71.4% and USG was 92.8%. The difference was significant (P< 0.05). Conclusion: Lung ultrasound is an effective radiological tool for the assessment of suspected cases of pneumonia as compared to chest x ray.

Role of Dynamic Contrast Enhanced Magnetic Resonance Imaging and Mammogram in Evaluation of Breast Lesions with Pathological Correlation

Background: To perform mammography and dynamic contrast enhanced MRI in patients with clinically suspicious breast lumps and correlating the findings with pathology in patients of positive imaging. Subjects and Methods: total of 40 patients evaluated through MRI BI-RADS lexicon (General Electric Medical Systems) at 1.5T in combination with dynamic kinetic analysis of time and signal curves for lesion characterization. Results: The mean age was 44 years, maximum of patients (n=22) belongs to age group of 41-60 years (52.5%). Five lesions showed dark internal septations, as benign. 11 lesions (33.5%) showed heterogenous enhancement, as malignant. Early rim enhancement is observed in 3 lesions (9%). Out of which two of them were proven to be malignant and one lesion was an infective abscess. Invasive Duct Cell Carcinoma was the common histology in the malignant lesions, observed in 13 out of 18 (72.2%). Fibroadenoma was the common benign breast lesion, observed in 8 out of 19 (42.1%). In 4 post operative patients, 2 (50%) were post operative fibrosis, 1 (25%) was recurrence and 1 (25%) was post operative collection. In 18 malignant lesions, 11 patients (61.1%) had skin retraction, 10 patients (55.5%) had skin thickening, 9 patients (50%) had axillary lymphadenopathy, 2 patients (11.1%) had nipple retraction, and one patient (5.6%) had pectoralis involvement. In our study, MR imaging alone has Sensitivity of 88.8%, specificity of 86.3%, PPV of 84.2%, and NPV of 90.4% with Accuracy 87.5%. Conclusion : The dynamic contrast enhanced MRI is important tool to evaluate the postoperative breast in differentiating between benign postoperative changes. By combining kinetic analysis with morphological analysis it add benefit to categorise the breast lesions into benign and malignant with increased confidence levels. CE-MRI with both morphology and kinetic curve assessment has a Sensitivity of 94.5%, Specificity of 100% with Accuracy of 97.5%.

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects & Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.

Variable Presentations in Pulmonary Arteriovenous Malformation

Pulmonary arteriovenous malformations (PAVM) are a group of vascular anomalies of lung which present with variable clinical symptoms. Most patients with PAVM are asymptomatic but it can cause dyspnea on exertion, paradoxical emboli to brain causing various central nervous system complications like stroke and brain abscess, hemoptysis and rupture. The age at the presentation can range from 1st to 7th decade but the majority of patients present before the age of 30 years. PAVM is strongly associated with hereditary haemorrhagic telangiectasis which presents with epistaxis, mucocutaneous telangiectasias and AV malformations of various organs. In our case series, we have patients ranging from 3 yrs to 75 years with presentation ranging from asymptomatic to exertional dyspnea, hemoptysis and neurological complications.

Assess the Role of Sonography and MRI in Diagnosing Ovarian Masses

Background: In order to conduct appropriate surgical treatments, the characterization of ovarian lesions is of considerable significance and can affect patient care. A multidisciplinary approach based on physical assessment, laboratory tests and imaging techniques includes adequate measurement of the adnexal masses. The aim is to assess the role of Sonography and MR in diagnosing ovarian masses, to study imaging characteristics of ovarian masses on USG and Doppler in correlating these findings with MR features. Subjects and Methods: The present study was carried out in the department of radiodiagnosis to determine the efficacy of sonography and MRI in the diagnosis of ovarian masses. The study group comprised 50 patients with clinically suspected ovarian masses and imaging was carried out on all patients with ovarian masses and imaging was carried out on all patients with ovarian masses. All the masses were evaluated on sonography based on the Sassone scoring system. Morphological analysis was performed for each mass based on wall thickness, inner wall structure, septal structure and echogenicity of mass. The color flow was carried out, subsequently; MRI was carried out for each patient. Radiological diagnosis was confirmed after surgery on histopathological examination. Results: The majority of the patients were in the age group of 31-40 years. The most common symptoms noted were pain in the abdomen. The most common clinical finding was a palpable mass. The application of Sassone sonomorphologic score >9 was identified in 8 masses, out of which 7 were malignant and 1 was a benign lesion. The colour flow was detected in 38 out of 50 masses. The presence of flow, type of flow, vessel arrangement, morphology and location were noted and on pulsed Doppler the RI and PI values were calculated. Out of 8 malignant cases, 5 were diagnosed as malignant according to the Caruso score. The overall sensitivity 100 %, specificity is 97.6% and diagnostic accuracy is 98% of MRI which is higher than that of ultrasound and CDS. Conclusion: We conclude that MRI is a superior diagnostic modality in establishing the diagnosis of ovarian masses.

3D Printed Model of Airway for Clinical Simulation

Background: The present medical curriculum aims at training the students to be proficient in performing techniques required for clinical practice. This is best achieved through clinical simulation, which has emerged as a successful method for clinical learning. Residents in respiratory medicine need to be trained in the procedure of bronchoscopy for which a functional model of the airway is required. Airway mannequins for this purpose can be produced using 3D printing technology, which involves the usage of sophisticated software. Subjects and Methods: Serial axial CT images of the chest, revealing details of the respiratory tract were selected as the base resource to recreate the bronchial tree by 3D printing. This DICOM (Digital Imaging and Communications in Medicine) images after conversion into STL (Stero lithography) format were transferred into a 3D printer and physical models were made from these data, using Vero clear and rubber. This model which had a life-like form and consistency required for practicing the skill was connected to an airway mannequin using an adaptor to practice the skill. Conclusions: Axial CT scan images provide the base data for reconstructing the airway of a patient, using 3D printing technology and appropriate software. Such reconstructions can be used to produce a functional model of the airway, which can be used for training in bronchoscopy. The training system could be connected to a monitor thereby facilitating tracking of the probe of the bronchoscope. Repeated trials make the trainees perfect their technique. Our attempt to replicating the tracheobronchial tree for such training has been a success.

Computed Tomography Angiography Evaluation of Peripheral Arterial Disease and Correlation with Colour Doppler

Background: Peripheral Arterial Disease Is a Major Problem Among the Population of Those 55 Years and Older. MDCT is a Non-Invasive Method of Visualization of Vascular System. It Affords More Widespread Vascular Screening, Allowing Diagnosis to be Made at an Early Stage. The objective is to Assess the Role of Multidetector Computed Tomography Angiography in Peripheral Arterial Disease of Lower Extremities. Subjects & Methods: A Prospective Study of 35 Patients with Signs and Symptoms of PVD, Were Subjected to Colour Doppler Ultrasonography and MDCT Examination Between a Period of 1st August 2018 to 31st May 2019. Results: Our Study Shows a Very Good Sensitivity, Specificity, PPV, NPV and Accuracy of Doppler in Assessing the Soft Plaque (82%, 100%, 100%, 97%, 97% Respectively) & in Evaluation of Stenosis Like <50% Stenosis (100%, 99%, 85%, 100% & 99% Respectively), 50-99% Stenosis (100%, 99%, 96%. 100% & 99.8% Respectively), & Occlusion (84%, 100%. 100%, 98% & 98% Respectively). The Only Parameter Which Showed Poor Result Was in Evaluation of Calcified Plaque. Conclusion: Our Study Shows that Both Colour Doppler & MDCT Can Be Complimentary in Lower Limb Arterial Disease Evaluation.