Saumil Desai

Renal masses can be detected on USG and CT scan with USG is usually the initial modality which picks up any mass in the kidney while CT scan is preferred imaging modality for renal tumours and its staging and it is also helpful in diagnosis of previously undetected masses and small masses. To evaluate the diagnostic accuracy of USG and CT scan for detection of renal masses. 50 patients were selected for the study for which they underwent USG and CT scan examination after explaining the entire procedure and the risks involved. In our study of 50 patients, simple renal cyst was the most common renal mass encountered while renal cell carcinoma was the commonest malignant renal mass encountered followed by Wilm’s tumour. Renal cell carcinoma was the commonest primary renal parenchymal tumour in adults while Wilm’s tumour was the commonest primary renal parenchymal tumour in the first decade of life. ADPKD, RCC, Wilm’s tumor and renal lymphoma were common in males while renal abscess were common in females. All the cases of Wilm’s tumor and squamous cell carcinoma had solitary lesions while most of the cases of renal abscess showed multiple lesions in the kidneys. Renal angiomyolipoma showed multiple intraparenchymal lesions in both kidneys as seen in cases of renal lymphoma and ADPKD. Renal angiomyolipomas were easily diagnosed due to presence of characteristic CT value of fat in these lesions. As imaging modality both USG and CT scan are equally accurate in most of the cases except in cases of angiomyolipoma, renal cell carcinoma and squamous cell carcinoma as in angiomyolipoma and renal cell carcinoma, CT is more accurate for diagnosis and for squamous cell carcinoma, both the modalities were not effective in diagnosis. CT is more accurate for detecting various features of renal cell carcinoma needed for preoperative staging like perinephric extension, invasion of adjacent organs, renal vein and IVC thrombosis.

As malignant breast mass is common diagnostic problem in clinical practice, detection of breast cancer in its earliest possible stage can be done by Mammography and USG. Mammography is considered gold standard to evaluate clinically suspected breast masses and screening for breast cancer and USG is useful adjunctive modality and helps characterizing mammographically detected palpable masses, especially in patients with dense breasts (young women) and as second look procedure where an abnormality has been identified using MRI or scintimammography. To evaluate the diagnostic accuracy of Mammography and USG for detection of benign/ malignant lesions. 50 patients were selected for the study for which they underwent Mammography and USG examination after explaining the entire procedure and the risks involved.In our study of 50 patients, palpable breast lumps were found to be present in 30-39 years age group (23) followed by 40-49 years age group (18). Sensitivity, specificity and accuracy of only mammographic evaluation of malignant breast lumps is 60%, 84.4% and 82% respectively and of only USG evaluation of breast lumps is 80%, 88.9% and 88%. While sensitivity, specificity and accuracy of combined mammographic and USG evaluation of malignant breast lumps is 100%, 91% and 92% respectively. The role of mammography in patients with palpable breast lumps is to show a benign cause for palpable abnormality and to avoid further intervention and of USG as a useful adjunctive modality which helps to characterize a mammographically detected palpable abnormality. The sensitivity and specificity of detection of carcinoma would be increased if both mammography and sonography are combined which will lead to fewer unnecessary biopsies.

GIST is a visceral sarcoma that arises from the gastrointestinal tract. The clinical features and radiologic differential diagnosis of gastrointestinal stromal tumours are discussed. Gastrointestinal stromal tumours is a rare gastrointestinal tumour. Computed tomography (CT) is an imaging modality of choice for diagnosing GIST. The aim of this Retrospective study is to evaluate CT feature of GIST in20 cases. In this study 20 biopsy proven cases of GIST were evaluated retrospectively in our department from November 2010 to July 2012. The CT scan was performed prior to the treatment in all these patients. CT imaging feature includes, tumour location, size/diameter, degree & pattern of enhancement, intraluminal/exophytic, internal necrosis & haemorrhage, perilesional rat stranding, local spread, nodal & distant metastasis. Out of 20 patients, in 13/20 (65 %) cases tumour was found in stomach, 4/20 (20%) in small bowel (jejunum & ileum), 2/20 (10%) in omentum and mesentery; and 1 (5%) case tumour was found in transverse colon. 14/20 (70%) had exophytic tumour with communicating to lumen of gastrointestinal tract or in omentum and mesentery; rest 6/20 (30%) had polypoidal mass. Size of tumour ranges from 4 to 15 cm, with mean of 7.9 cm.15/20 (75%) cases shows heterogeneous enhancement with necrosis and/or calcification, rest 5/20 (25%) had homogenous enhancement. The CT HU ranges from 35 to 55, with mean of 40, 14/20 (75 %) cases had well defined margins of tumour, and rest 6 (30%) cases showed perilesional fat stranding and loss of fat plane with adjacent organ.2/20 (10%) cases showed regional nodal involvement and 3/20 (15%) cases shows distant metastasis to liver(2) & lungs (1). Keywords: Gastrointestinal stromal tumour, GIST, Computed tomography, sarcoma.