3 research outputs found
Evaluation of solid renal masses by qualitative and quantitative parameters in four phase MDCT with histopathological correlation
No full textIntroduction: Quantitative measurement of the degree of enhancement has not been widely reported for RCC subtypes and fat-poor angiomyolipoma. Previously enhancement in either one of the corticomedullary or nephrographic phases is used for evaluation of renal masses. From the past decade renal mass enhancement is viewed in terms of differences in contrast enhancement and deenhancement patterns over multiple phases on multiphasic MDCT as well as contrast-enhanced MRI to distinguish among RCC subtypes[1]. Most recent studies by Jinzaki et al[11], sun et al and Vargas et al, Stephanie A. Lee-Felkar et al[12] advanced the concept of multiphasic renal mass attenuation profiles for individual histological subtypes. In our study we follow the current novel approach to the imaging evaluation of renal masses using qualitative and quantitative MDCT feature. Aim/purpose: To characterize the incidentally detected solid renal masses as benign or malignant and differentiating the clear cell RCC from its benign and malignant mimics based on qualitative parameters like lesion contour, calcifications, neovascularity, enhancement and quantitative parameters like mean absolute attenuation, mean relative attenuation, absolute enhancement & absolute de-enhancement in a four-phase MDCT renal mass protocol. Materials and methods: This was an Observational prospective study conducted in 42 patients in the department of Radiodiagnosis at Apollo hospitals, Jubilee hills, Hyderabad referred from the Departments of urology, surgical oncology with a clinical suspicion renal tumors or renal masses which are incidentally detected on ultrasound and referred to CT for further characterizationfor 9 months, from October 2019 to June 2020.Patients of all age groups, both sexes, who were given consent for the study taken and subsequently histopathological findings were followed.Patients with angiomyolipoma with macroscopic fat detectable, predominantly cystic renal masses on CT, Pregnant women and allergic to contrast media are excluded. 128 SLICE PHILIPS INGENUITY CT machine was used for evaluation with parameters of 3mm slice thickness, FOV of 300.00mm, voltage of 120KV, tube current of 300-350mA. Results: This was an observational prospective study was conducted among all the patients who were referred to department of radiodiagnosis for further characterisation and correlate with histopathology as gold standard.The mean age of the study population was 49.2 ± 2.9 yrs. with majority of the patients belongs to 41 – 60 yrs.78.5% of patients in the present study were male and 21.5% were female.85.7% were symptomatic at the time of presentation and the most common symptom was haematuria followed by pain in abdomen.Most common solid renal mass was renal cell carcinoma (54%). Among renal cell carcinomas clear cell RCC is most common histological variant (53%). Among the benign oncocytoma is most common (19%). Among qualitative parameters, neovascularity showed statistically significant P value with high sensitivity, specificity, PPV, NPV & accuracy. All lesions showed maximal attenuation in corticomedullary phase and decreased in subsequent phases except papillary variant of RCC. High mean absolute attenuation in CM phase + Mean relative attenuation of >0% in CM phase + absolute de enhancement >50HU has good sensitivity, specificity in differentiating clear cell RCC from others.Progressive enhancement from corticomedullary to nephrographic phase with highest mean absolute attenuation during nephrographic phase had high sensitivity, specificity & accuracy in differentiating papillary RCC from others.Delayed de enhancement more than 30HU differentiated oncocytoma from chromophobe with high sensitivity and specificity. Conclusion: Qualitative & Quantitative MDCT features enables diagnosis of malignant masses with 100% sensitivity also discriminating CcRCC from its benign and malignant mimics with high sensitivity and specificity
Correlation between MRI and arthroscopy findings inrotator cuff tears
No full textIntroduction: Rotator cuff tears are one of the most common causes of shoulder pain causing significant disability[1]. 86% of patients with shoulder pain are due to the abnormality of rotator cuff disorders[2]. MRI has revolutionized the diagnosis of shoulder pathologies. MRI is a proved sensitive, accurate, cost-effective and a non-invasive tool in investigating shoulder pathology[3]. Currently, Arthroscopy is considered as the “reference standard” for the diagnosis of shoulder pathologies. Aim/purpose: The purpose of this study attempted to assess the sensitivity and specificity of MRI with gold standard of direct visualization under arthroscope for individual rotator cuff tendons injury. Materials and methods: This is a hospital based prospective and comparative study conducted in the department of Radio diagnosis, Apollo Hospitals, Jubilee hills, Hyderabad between march 2019 to September 2020. 75 patients of both sexes and age groups > 18years (minimum and maximum age of the patient seen in my study are 20 years and 86 years respectively) with history of shoulder pain, restricted movements, instability and injuries who underwent MRI investigation and subsequently underwent ARTHROSCOPY.Data was collected on a pre-designed proforma by detailed history, thorough radiological investigations followed by arthroscopy findings. The data was collected analysed and reported as Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Accuracy of MRI for each type of rotator cuff tendon tears. Correlation between MRI and Arthroscopy was done using Kappa statistics and p value. The whole data obtained was analyzed using Statistical Package for Social Sciences, version 23.0. Results: MRI examination showed all 75 patients had supraspinatus tears of which 43 are full thickness tears and 32 are partial thickness tears, 19 out of 75 patients had infraspinatus tears of which 14 are full thickness tears and 5 are partial thickness tears and 15 out of 75 patients had subscapularis tendon tears. There is no teres minor tendon tears reported in the present study. Supraspinatus tendon tears: In the present study arthroscopically proven supraspinatus tendon tears are 39(F) full thickness tears and 22 partial thickness tears (P 1 16 + P2 6). The sensitivity, specificity, PPV, NPV and accuracy of MRI in full thickness supraspinatus tears is 79.6%, 84.6%, 90.7, 68.8 and 81.3 respectively. Kappa value is 0.609(substantial) and p value was <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial articular surface tears is 80.0%, 83.6%, 64.0, 92 and 82.6. Kappa value is 0.589(moderate) and p value is <0.01, highly significant. The sensitivity, specificity, PPV, NPV and accuracy of MRI in supraspinatus partial bursal surface tears are 100%, 98.6%, 85.7, 100.0. and 98.6 respectively. Kappa value is 0.916(almost perfect) and p value is <0.01, highly significant. Infraspinatus tendon tears: Out of 19 (F 14 + P 5) cases arthroscopically proven infraspinatus tendon tears are 10 full thickness tears and 5 partial thickness tears (P). The sensitivity, specificity, NPV and accuracy value of MRI in full thickness infraspinatus tears are 100 % ,93.8%, 71.4,100 and 94.7. Kappa value is 0.803(almost perfect) and p value is <0.001, highly significant. The sensitivity, specificity, PPV, NPV and accuracy value of MRI in partial thickness infraspinatus tears are 55.6%, 100%, 100, 94.3. and 94.7. Kappa value is 0.687(substantial) and p value is <0.001, highly significant. Subscapularis tendon tears: Out of 15 cases in the present study arthroscopically proven subscapularis tendon tears are 11 partial thickness tears (P). The sensitivity specificity, NPV and accuracy of MRI in the detection of subscapularis tears is 100%, 93.8%, 73.3, 100 and 94.7. Kappa value is 0.815(almost perfect) and p value is <0.001, highly significant. Conclusion: In the present study accuracy in detecting full thickness and partial thickness tears in infraspinatus and subscapularis and partial tears of supraspinatus is high as compared to supraspinatus full thickness tears. On comparing results of individual tendon tears in our study suggests, that Magnetic resonance imaging has high sensitivity, specificity and accuracy in diagnosing full thickness and partial thickness tears of supraspinatus tendon tears, subscapularis tears and full thickness tears of infraspinatus tendons. Sensitivity in detecting infraspinatus tendon partial thickness tears was lower, however it has high specificity and accurac
Correlation of primary tumor FDG uptake with clinicopathologic prognostic factors in invasive ductal carcinoma of the breast
No full textIntroduction: 18F-fluoro-2-deoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has become an important tool in the evaluation of patients with invasive breast cancer by revealing the functional properties of breast tumors[1]. The maximum standardized uptake value (SUVmax) measured with FDG PET is a sensitive indicator for metabolic activity in breast cancer[2-10], which can be used to assess tumor aggressiveness and is associated with prognostic factors, such as the histological type, histological grade, immunohistochemical factors, and proliferation index[11,2-10]. PET with F-18 FDG has been widely used in clinical practice for the diagnosis, staging, treatment monitoring, and detection of disease recurrence in breast cancer patients[12]. Aim/purpose: To correlate clinicopathologic variables (tumor size, histologic grade, TNM stage, status of the hormonal receptor (ER, PR, HER2 expression) with PET-CT parameters such as maximum standardized uptake value(SUVmax). Materials and methods: This was a hospital based prospective cross sectional analytical study conducted for 19 months at Apollo Hospitals, Hyderabad. In the total of 70 participants after explanation of the procedure study and taking written informed consent who were diagnosed with invasive ductal carcinoma of the breast during the study period undergoing FDG PET CT scan, 55 participants were included for the study in accordance to inclusion and exclusion criteria. 15 participants were excluded. Patient was assessed for age, menopause status, tumor size (T), tumor grade (G), hormone receptor status (ER, PR, Herer2neu) and stage. Patient undergoes FDG PET CT for diagnostic evaluation. Measurement and assessment of FDG pSUVmax (mean + S.D.) in primary tumor of ductal carcinoma of the breast and correlation with clinicopathologic variables was done. Results: SUVmax was higher in the participants with higher tumor stage andhighertumorgrade.TheSUVmaxvaluesforT4stage, pTNMstageIVandGrade3 tumors were respectively 20.4 ± 2.0; 17.1 ± 3.5; and 13.2 ± 3.2. SUV max was also higher i nparticipants who were ER and PR negative(13.2±3.0; ±5.4), premenopausal women, patients with higher tumor stage, higher histological grade - poorly differentiated tumors, ER and PR negativity, triple negative receptor status and positive axillary lymph node status. Conclusion: The study demonstrates that SUVmax values are related to the recognized histopathologic and immuno histochemical prognostic factors in breast cancer predictability of predictive and prognostic factors before treatment is of importance in terms of deciding the therapeutic approach. In preoperative assessment of patients with breast cancer, PET/CT scanning is inadequate in examining axillary lymph nodes; however,it may prove beneficial in displaying the biologic characteristics and behavior of a tumor
