Publications by authors named "Nischal G Kundaragi"

11 Publications

  • Page 1 of 1

Can strain elastography be used in reclassification of indeterminate breast lesions in BIRADS lexicon?: A prospective study.

Indian J Radiol Imaging 2020 Oct-Dec;30(4):493-499. Epub 2021 Jan 13.

Department of Radiology, Aster CMI Hospital, Bangalore, Karnataka, India.

Purpose: To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions.

Methods: 113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC).

Results: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US: 0.98 vs 0.90 (Difference = 0.08, = 0.02). Elastography parameters were more specific as compared to US (ES-94.5 & SR-93.2% vs 63%, < 0.05) with high NPV. SE performed better in BIRADS 4 category lesions. On the basis of elastography parameters, 85% of BIRADS 4 category lesions were correctly predicted as benign with overall sensitivity, specificity and diagnostic accuracy of elastography being 97%, 84.6% and 91.9%. Among BIRADS 3 category lesions, 97% were correctly predicted as benign and 50% lesions were correctly predicted as malignant with a sensitivity of 50%, specificity of 97.8% and diagnostic accuracy of 94%.

Conclusion: Strain elastography is a useful adjunct to conventional ultrasonography for the assessment of indeterminate breast lesions and may help in avoiding unnecessary follow ups and biopsies. Elastography score is a better parameter as compared to strain ratio.
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http://dx.doi.org/10.4103/ijri.IJRI_425_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954173PMC
January 2021

Mesenteric ischemia: a radiologic perspective.

Abdom Radiol (NY) 2020 Nov 23. Epub 2020 Nov 23.

Department of Radiology, Aster CMI Hospital, Airport Road, Bangalore, 560092, India.

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.
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http://dx.doi.org/10.1007/s00261-020-02867-yDOI Listing
November 2020

Added value of strain elastography in the characterisation of breast lesions: A prospective study.

Ultrasound 2020 Aug 16;28(3):164-173. Epub 2020 Mar 16.

Department of Radio Diagnosis, Aster CMI Hospital, Bengaluru, India.

Background: Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion.

Purpose: To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US).

Methods: In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis.

Results: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%,  < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%.

Conclusion: Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.
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http://dx.doi.org/10.1177/1742271X20912762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412947PMC
August 2020

Fibrosing mediastinitis mimicking as chronic pulmonary thromboembolism.

BJR Case Rep 2020 Mar 12;6(1):20190049. Epub 2020 Feb 12.

Department of Radiology, Aster CMI Hospital, Bangalore, India.

Fibrosing mediastinitis is an uncommon, benign, progressive disorder caused by proliferation of fibrous tissue within mediastinum resulting in encasement of vital mediastinal broncho-vascular structures. Due to its rarity and variable clinical presentation, it is often misdiagnosed. We are presenting a case of fibrosing mediastinitis in an Ethiopian origin young male presenting with pulmonary hypertension due to simultaneous occlusion of pulmonary vein and arteries, clinically misdiagnosed as chronic pulmonary thromboembolism.
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http://dx.doi.org/10.1259/bjrcr.20190049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068094PMC
March 2020

Hepatic arterial communicating arcades-Case series and review of literature.

Indian J Radiol Imaging 2019 Oct-Dec;29(4):462-467. Epub 2019 Dec 31.

Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India.

This case series describes the hepatic arterial communicating arcades and their importance in the endovascular management of hepatic artery pseudoaneurysm, pediatric post liver transplant lobar arterial occlusion, and lobar arterial stenosis due to gall bladder carcinoma. We describe new types of arterial communicating arcades which have not been described earlier.
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http://dx.doi.org/10.4103/ijri.IJRI_413_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958894PMC
December 2019

Intracranially protruded bilateral posterior and superior SCCs with multiple dehiscences in a patient with positional vertigo: CT and MR imaging findings and review of literature.

Indian J Radiol Imaging 2014 Oct;24(4):406-9

Department of Radiology, SRM University Medical College and Hospital, Kancheepuram, Tamil Nadu, India.

We report a rare case of intracranially protruded posterior and superior semicircular canals beyond the margins of temporal bone with bony roof dehiscence in bilateral posterior and left superior semicircular canals in a patient with benign paroxysmal positional vertigo (BPPV).
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http://dx.doi.org/10.4103/0971-3026.143904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247510PMC
October 2014

Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature.

Indian J Radiol Imaging 2014 Apr;24(2):171-4

Department of Radiology, SRM University Medical College and Hospital, Chennai, Tamil Nadu, India.

Transomental and transmesenteric hernias are rare types of internal hernia, with a reported frequency of upto 4% and 8%, respectively. Combined transomental and transmesocolic hernia is even rare. Only in a few types of internal hernia, the dilated small bowel loops will be seen extending from the antero-superior aspect of the distal stomach and cause stretching effect over the adjacent bowel loops with increase in the size of the herniated bowel segment or intestinal obstruction. We report a rare case of idiopathic combined transomental (across the lesser omentum) and transmesocolic internal hernia with "stretched bowel sign," its diagrammatic representations, and review of literature.
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http://dx.doi.org/10.4103/0971-3026.134407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094971PMC
April 2014

Fibrochondrogenesis, an antenatal and postnatal correlation.

J Clin Imaging Sci 2012 18;2. Epub 2012 Feb 18.

Department of Radiodiagnosis, Government Medical College, Nagpur, India.

Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped) and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.
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http://dx.doi.org/10.4103/2156-7514.93037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307213PMC
October 2012

Ellis van creveld syndrome with synpolydactyly, an antenatal diagnosis with postnatal correlation.

J Clin Imaging Sci 2011 24;1:59. Epub 2011 Dec 24.

Department of Radiodiagnosis, Government Medical College, Nagpur, Maharashtra, India.

Ellis Van Creveld syndrome (EVC), also known as chondroectodermal dysplasia, presents at birth with short limbs accompanied by postaxial polydactyly, nail dysplasia, and dental anomalies. Other manifestations of EVC include atrial septum defects and other congenital heart diseases. We report a case of the EVC syndrome with postaxial polydactyly (Synpolydactyly with seven fingers on the right side and hexadactyly on the left side) and a partial atrioventricular canal defect diagnosed antenatally. This variation of EVS has not been reported in English literature till date.
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http://dx.doi.org/10.4103/2156-7514.91132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261597PMC
October 2012

Imaging features of extra cranial parapharyngeal space meningioma: case report.

Iran J Radiol 2011 Nov 25;8(3):176-81. Epub 2011 Nov 25.

Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India.

Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].
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http://dx.doi.org/10.5812/kmp.iranjradiol.17351065.3132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522327PMC
November 2011