Role Of Shear Wave Elastography In Assessment Of Placental Elasticity In Normal And High-Risk Pregnancies In Third Trimester

Objective

To assess the elasticity of placenta using shear wave elastography in normal and high-risk pregnancies in the third trimester.

METHODS

The prospective, observational study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 15, 2022, to January 15, 2023, and comprised singleton pregnant women during 28-40 weeks of gestation who were referred from the obstetric department. The subjects were divided into normal pregnancy group A and high-risk pregnancy group B. Risk factors include gestational hypertension, gestational diabetes, intrauterine growth restriction, placenta previa, morbidly adherent placenta, old primigravida, teen age and morbid obesity were noted. All the patients underwent grey scale, Doppler ultrasonography and shear wave elastography. Data was analysed using SPSS 26.

RESULTS

Of the 104 subjects, 78(75%) were in group A and 26(25%) were in group B. The overall mean age was 34.2±3.59 years. In group B, mean placental shear wave velocity was 2.34±1.17m/sec and elasticity was 24.41±25.51kPa compared to 1.42±0.55 m/sec and 13.6±10.23kPa in group A (p<0.05). Significant positive correlation was found between shear wave velocity and elasticity values in both groups (p<0.001).

Conclusion

Shear wave elastography was found to be a useful technique in detecting placental stiffness, and can be used as an adjunct to the currently available ultrasonographic methods in high-risk pregnancies.

Normal variations in cerebral venous anatomy and their potential pitfalls on 2D TOF MRV examination: Results from a private tertiary care hospital in Karachi

OBJECTIVE

To assess normal venous anatomy of the cranium and its anatomical variants.

METHODS

This retrospective study was conducted at Radiology Department of Dr. Ziauddin Hospital, Karachi, and comprised data of patients aged 2-75 years and having undergone magnetic resonance imaging of brain from April 2015 to April 2016. Magnetic resonance venography was reviewed to evaluate the cerebral venous system. All magnetic resonance venography examinations were performed using a contiguous two-dimensional time-of-flight venography technique, and were reviewed by two consultant radiologists..

RESULTS

Out of 204 patients, 96(47.05%) were males and 108(52.94%) were females. Overall Magnetic Resonance Venography examinations were found to be normal in 94(46.07%), patients, while 110(53.92%) had some of the normal anatomical variants. There was presence of superior sagittal sinus and straight sinus in 204(100%) cases. Inferior sagittal sinus was seen in 179(86.05%). Transverse sinus was hypoplastic in 8(3.92%) on the right and 80(39.2%) on the left side. Hypoplastic sigmoid sinus was present in 51(25%) patients and aplastic sigmoid sinus in 2(0.98%) patients. Flow gaps were also observed in 22(10.78%) patients. Occipital sinus was identified in 17(8.3%), vein of Trolard in 98(48.03%) and vein of Labbe in 105(51.47%).

CONCLUSIONS

Two-dimensional time-of-flight magnetic resonance venography examination was found to be a useful imaging tool showing great sensitivity in determining the normal cerebral venous anatomy.

Unilateral renal agenesis with subseptate uterus and sacrococcygeal teratoma: A unique triad

Unilateral renal agenesis (URA) is a rare condition with a reported incidence of 0.93–1.8 per 1000 autopsies. It is commonly diagnosed as an incidental finding on imaging.URA is frequently associated with other genitourinary anomalies. Different associations have been described in both males and females, however, to our knowledge, it has not been reported with subseptate uterus (SSU) and sacrococcygeal teratoma (SCT) in the same individual. Here, we present a unique case of URA with SSU and SCT.

Frequency of kidney diseases and clinical indications of pediatric renal biopsy: A single center experience

Kidney biopsy occupies a fundamental position in the management of kidney diseases. There are very few renal pathology studies available in the literature from developing world. This study scrutinized the frequency and clinicopathological relationship of kidney biopsies done at the kidney center from 1997 to 2013 amongst pediatric patients. Kidney allograft biopsy were excluded. The specimen was examined under light microscopy and immunofluorescence while electron microscopy was not done. The study includes 423 patients, mean age was 10.48 ± 4.58 years, males 245 (57.9%) were more than females 178 (42.1%). Nephrotic syndrome 314 (74.2%) was the most common clinical presentation followed by acute nephritic syndrome 35 (8.3%) and acute renal failure 24 (5.7%). Primary glomerulonephritis (PGN) was the most common group of diseases, seen in 360 (85.1%) followed by secondary glomerulonephritis (SGN) in 27 (6.4%) and tubulointerstitial nephritis in 21 (5.0%). Among PGN, minimal change disease (MCD) was the most dominant disease, with 128 (30.3%) cases followed by focal segmental glomerulosclerosis FSGS in 109 (25.8%) and membranous glomerulonephropathy in 27 (6.4%). Lupus nephritis (LN) was the leading cause of glomerular disease in SGN followed by hemolytic uremic syndrome. In conclusion, MCD is the most common histological finding, especially in younger children and FSGS is second to it. SGN is rare, and the most common disease in this category is LN while tubulointerstitial and vascular diseases are infrequent.

Transformation of membranous into anti-GBM nephritis

Membranous nephropathy is a common glomerular disease. We report a 50-year-old man with a history of membranous nephropathy in remission, who presented with acute kidney injury, proteinuria, hematuria, and hypertension. He also had a high anti-glomerular basement membrane (anti-GBM) antibody titer and crescent transformation of primary pathology. The kidney functions deteriorated rapidly despite aggressive therapy with cyclophosphamide, methylprednisolone, and plasmapheresis.