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Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread

World Journal of Clinical Cases 2015年第3期3卷 231-244页

作者： amit nandan dhar dwivedi Shivi Jain Ruhi Dixit Department of Radiodiagnosis and Imaging Institute of Medical Sciences Banaras Hindu University Department of General Surgery Institute of Medical Sciences Banaras Hindu University

The most common malignancy of biliary tract is gallbladder cancer(GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a verypoor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer(GC) is locoregional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography(CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.

关键词： Gallbladder cancer Loco-regional and distant spread Cholelithiasis Imaging Adenocarcinoma

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Role of Multidetector CT in Evaluation of Polytrauma Patients

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Open Journal of Emergency Medicine 2014年第3期2卷 49-52页

作者： amit nandan dhar dwivedi Department of Radiodiagnosis and Imaging Institute of Medical Sciences Banaras Hindu University Banaras India

Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.

关键词： Polytrauma Whole Body Multidetector CT Major Vascular Injuries Major Visceral Injuries

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Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Pathology in Women with Secondary Infertility Taking Laparoscopy as Gold Standard

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Surgical Science 2012年第8期3卷 414-417页

作者： amit nandan dhar dwivedi Madhu Jain Suchi Tripathi Sunny Garg Shivi Jain Institute of Medical Sciences: BHU Varanasi. India

Context: Secondary infertility is a major public health issue with growing urbanisation and increasing age of marriage among women. Disease limited to low socioeconomic strata is commonly seen in general population. Judicious and accurate assessment of underlying pathology targeting tubes should be undertaken. Aims: The aim of this observational study was to assess the diagnostic accuracy of sonosalpingography taking laparoscopy as gold standard in patients of secondary infertility. Main aim was to assess tubal factors as an underlying cause and to assess feasibility of a radiation free protocol in patients of reproductive age group. Settings and Design: The study was carried out in a hospital setting. A total of 123 patients were selected. Patients of primary infertility were excluded. Sonosalpingography was performed by a single experienced radiologist. This was confirmed by laparoscopy conducted by an experienced gynaecologist. Methods and Material: A detailed clinical and physical examination including internal examination was done. This was followed by sonosalpingography using high frequency TVS probe (Philips IU 22). All patients were subjected to laparoscopic evaluation on the same day. Statistical analysis: Sensitivity, specificity, diagnostic accuracy and predictive values. Results: Sonosalpingography was 72.91% sensitive, 81.33% specific with diagnostic accuracy of 78.05% and positive predictive value of 71.42% for tubal pathologies. Conclusions: Sonosalpingography is a very useful complementary diagnostic modality in assessment of tubal pathology. This should precede direct laparoscopic evaluation. Patients of secondary infertility can be assessed with a combination of sonosalpingography and laparoscopy. This saves the patient of radiation exposure as well as pain of contrast

关键词： Sonosalpingography Secondary Infertility Laparoscopy Chromopertubation

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MRI is a state of art imaging modality in characterization of indeterminate adnexal masses

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Journal of Biomedical Science and Engineering 2013年第3期6卷 309-313页

作者： amit nandan dhar dwivedi Shivi Jain Ram Chandra Shukla Madhu Jain Arvind Srivastava Ashish Verma Department of Obstetrics and Gynecology Institute of Medical Science Varanasi India Department of Radiodiagnosis and Imaging Institute of Medical Science Varanasi India

Aims and Objectives: The aim of this diagnostic observational study was to find an association of final diagnosis of adnexal masses suggested by MRI and compare it as an imaging modality in determining the origin, nature (benign/malignant) & characteristics of adnexal masses by calculating sensitivity, specificity, and diagnostic accuracy. Materials and Methods: The present study was carried out in 90 patients in the department of radio diagnosis and imaging, institute of medical sciences, Banaras Hindu University (BHU). The patients were referred from department of obstetrics & gynecology, institute of medical sciences. Majority of the referred cases were those who had clinical features of abdominal pain, abdominal lump, menstrual irregularity, ascites, and anorexia or weight loss & in whom adnexal mass was suspected clinically. Magnetic resonance imaging was performed using 1.5 Tesla MR Scanner, Magnetom Avanto (Siemens Healthcare). Results: Out of 114 masses, 17 (14.9%) were malignant. The benign adnexal masses were maximum in the age group 20 - 39 years (56/97, 57.7%), while malignant masses were mainly found in women ≥60 years of age (11/17, 64.7%). CA-125 level was grossly elevated in association with 35.3% of the malignant masses. On MRI, the sensitivity for the mass of ovarian origin was (97.7%) and specificity was (73.1%). The diagnostic accuracy was (92.1%). The mass of uterine origin had a sensitivity of (73.1%) and diagnostic accuracy (99.1%). Conclusion: MRI, because of its accuracy in identifying the origin of adnexal mass and characterizing the solid, hemorrhagic, fatty and fibrous content, may obviate surgery or significantly contribute to preoperative planning for a sonographically indeterminate mass. MRI is the state of the art imaging modality for evaluation of adnexal masses with an overall high diagnostic accuracy.

关键词： MRI Adnexal Masses Diagnostic Accuracy

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Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Pathology in Women with Secondary Infertility Taking Laparoscopy as Gold Standard

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Surgical Science 2012年第8期

作者： amit nandan dhar dwivedi Madhu Jain Suchi Tripathi Sunny Garg Shivi Jain

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