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Article
Role of Diffusion Weighted Imaging (DWI) of MRI Study in Differentiation Between Adenomyosis and Fibroids of the Uterus in Al-Hilla Teaching Hospital

Authors: Kassim Amir Hadi Taj-Aldean --- Shaimaa Jassim Bader
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 4 Pages: 606 -615
Publisher: Babylon University جامعة بابل

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Abstract

The uterine fibroid is most common solid uterine tumour , it is single or multiple benign neoplasm and present in 20-40% of women in productive age. There are several factors that are attributed to underlie the incidence and development of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on pelvic pressure symptoms or the woman’s menstrual cycle .Adenomyosis of the uterus is benign uterine pathology. It is thought by many to be on the spectrum of endometriosis, with ectopic endometrial glandular tissue in the myometrium. Adenomyosis may present with dysmenorrhea and menorrhagia. Ultrasound and MRI are imaging modalities that may show characteristic findings. Diffusion weighted image in MRI has been applied to evaluate the intracranial lesion ,but technical advancement make it possible to use in extra cranial sites. The aim of this study was to assess the differences, if any, in the apparent diffusion coefficient (ADC) values of adenomyosis and fibroids. Methods and Material Total patient of sample study 56 ,Patients (n= 25) diagnosed by ultrasound as uterine fibroids and (n=31) as adenomyosis, who underwent pelvic MR imaging with DWI, were included in this cross section study. DWI was achieved with using a 1.5 T scanner , different b factors of ( 0, 400, and 600 s/mm) and ADC region of interest(ROI) size were located over an area of Adenomyosis, a fibroid and unaffected normal myometrium all results are correlate with histopathological result which was considered as gold standard diagnostic methods. Results using Student’s t test to compare the ADC values of adenomyosis and fibroids. The standard deviation and the mean of the ADC values were as follows: adenomyosis 0.75 ± 0.30, fibroid 0.63 ± 0.29 and myometrium 1.39 ± 0.36. Statically, there was significant difference between the ADC values of normal myometrium and adenomyosis (p < 0.0001), normal myometrium and fibroids (p < 0.0001), and fibroids and adenomyosis (p < 0.001). Conclusion The present study display that ADC values have the possible to quantitatively and significantly differentiate between Adenomyosis and fibroids.

Keywords

Adenomyosis --- fibroid --- ADC value --- leiomyoma --- myoma --- MRI.


Article
Ultrasound and Strain Elastography in Evaluation of Suspicious Breast Masses

Authors: Zahraa Majid Abdulamir Almosawi --- Kassim Amir Hadi Taj-aldean --- Hadi Mohamed Ali Almusawi --- Ali A. Kadhim Abutiheen
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 4 Pages: 616 -626
Publisher: Babylon University جامعة بابل

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Abstract

Breast cancer is the most prevalent type of cancer in Iraq, and the commonest among females worldwide. Ultrasound is an important widely used noninvasive modality in line with mammography and other methods for the detection and characterization of breast masses in routine clinical practice. Elastography is a recent promising method used as an adjuvant to ultrasound that improves performance, increase the specificity of interpretation in differentiating benign from malignant breast masses based on imaging tissue stiffness. We aim to evaluate the accuracy of ultrasound and elastography in diagnosis of suspicious malignant breast masses. A cross sectional study was conducted in Babylon and Kerbala January 15 to August 20, 2017. A consecutive sample of women with breast mass suggestive of malignancy were evaluated with ultrasonography and strain elastography prior to histopathological study. The five point Tsukuba elasticity score were used for differentiation of breast masses. Ethical approval was taken from the Research Ethical Committee in Babylon University- College of Medicine, and verbal consent was taken from each patient prior to enrolment. A total sample of (88) females with breast mass aged 16-69 years with a mean ± SD of 41.33 ± 12.57 years. Ultrasound diagnosed correctly (58) out of the (62) malignant breast masses with a sensitivity and specificity of 93.5% and 100% respectively. By using strain elastography the sensitivity increased to 98.4% with same specificity of 100% were only one malignant mass was missed. By using the ROC analysis, the Area Under the Curve and 95% confidence interval was 0.968 (0.931-1) and 0.992 (0.974-1) for ultrasound and elastography respectively. So when elastography is used with ultrasound, it increases its sensitivity, specificity and accuracy. Efforts needed to adapt and apply its use properly in Iraq through training programs for radiologists.

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