role of ultrasound thesis

Role of Ultrasonics in the Diagnosis and Treatment of Diseases

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• First Online: 20 December 2023
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• Kriti 7 &
• Ravinder Agarwal 8  

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Ultrasound has been extensively used in healthcare settings for imaging various internal organs for disease diagnosis and treatment of soft tissue injuries over the past many years. Ultrasound’s usefulness in diagnosing and treating musculoskeletal disorders such as arthritis, tendinitis, shoulder and neck pain, etc., is the primary focus of the present investigation. The investigation elucidates the key differences between diagnostic and therapeutic ultrasound equipment and then summarizes and provides conclusions from the investigations done by previous researchers in the field.

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Kriti, Agarwal, R. (2024). Role of Ultrasonics in the Diagnosis and Treatment of Diseases. In: Garg, N., Gautam, C., Rab, S., Wan, M., Agarwal, R., Yadav, S. (eds) Handbook of Vibroacoustics, Noise and Harshness. Springer, Singapore. https://doi.org/10.1007/978-981-99-4638-9_39-1

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Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome

• Islam El-Hefnawi Abdel Fattah El-Shewi   ORCID: orcid.org/0000-0003-2915-433X 1 ,
• Hatem Mohamed El Azizy 1 &
• Amr Abd El Fattah Hassan Gadalla 1  

Egyptian Journal of Radiology and Nuclear Medicine volume  50 , Article number:  100 ( 2019 ) Cite this article

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Subacromial impingement is the most frequent cause of shoulder pain, accounting for up to 60% of all shoulder complaints; dynamic high-resolution ultrasonography can be used in the detection of different abnormalities causing and related to shoulder impingement. This is compared to MRI, which we considered as a standard in our cases.

Fifty patients presented with symptoms of painful shoulder with 42 patients of them having limited movements of their shoulders. All patients had a conventional B-mode ultrasound examination, and dynamic sonographic examination was also performed in all patients. The results were compared to the MRI examination results of those patients. The addition of dynamic ultrasound examination for diagnosis of the painful shoulder showed the highest sensitivity in the assessment of impingement syndrome and for detection of different abnormalities affecting the shoulder joint (e.g., 85.7% for rotator cuff partial-thickness tear, 90% for rotator cuff full-thickness tear).

Based on our results, the static US combined with dynamic study can be a helpful tool in detecting different abnormalities of the painful shoulder especially impingement syndrome and its different causes.

Injuries of shoulder joints are common. The unique structure of the shoulder joint makes it more liable for joint dislocation [ 1 ]. Different causes of the painful shoulder are encountered; shoulder impingement comes on the top with multiple factors causing it. They are divided into two major groups: structural factors (related to the Acromion, acromio-clavicular joint, rotator cuff, coracoid process, bursa, and humerus) and functional factors [ 2 ].

MRI is considered an effective technique for the evaluation of the different causes of painful shoulder, with its main disadvantage being a static evaluation of the shoulder joint [ 3 ]. Dynamic ultrasonography is a beneficial technique for the evaluation of many disorders affecting musculoskeletal organs, including painful shoulder syndrome [ 4 ].

Rotator cuff tendon disorders constitute the most common group of pathologies that affect the shoulder joints [ 5 ]. Diagnostic radiological procedures such as ultrasonography (US), MRI, and MR arthrography (MRA) provide useful information that can help clinicians to establish the proper treatment plan for each patient [ 6 ]. The role of diagnostic imaging is to help guide surgical or non-surgical management. The ideal imaging technique should have a high rate of true positive and an acceptable rate of false positive to limit unnecessary surgical intervention [ 7 ].

The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables a dynamic assessment and needle guidance [ 8 ].

The aim of this study is to assess the role of dynamic high-resolution ultrasonography in the detection of different abnormalities of the shoulder joint, to find out the value added by dynamic ultrasonography to the static examination of such cases. This is compared to MRI which we considered as a standard to our cases.

We followed the Essential Items for Reporting Diagnostic Accuracy Studies (STARD) list during the preparation of this study.

This study included 50 patients, 32 females and 18 males, with an age range from 26 to 64 years (mean age 45 years); they all complaining from painful shoulder; and 42 of them complaining from a limitation of movement.

The present study was a prospective diagnostic test accuracy study that was conducted from October 2016 and June 2017. Patients were investigated with both ultrasound (US) and magnetic resonance (MR) imaging for the painful shoulder.

Adults’ patients who presented with painful or limited movement of the shoulder were included in a consecutive manner. While patients with shoulder dislocation, neoplastic lesions, or contraindication for MRI were excluded from the study. Pregnant women were excluded as well. Eligible patients underwent a full history and clinical examination.

Ultrasonography examination

Grayscale US examination was utilized using S-6 general electric (USA) ultrasound device that is equipped with 5–12 MHz linear array transducer to characterize the etiologic factors of painful shoulder and/or causes of limitation of shoulder movements as well as any associated abnormality. While the patient is seated in a backless chair, the following were examined: biceps brachii tendon, subscapularis and biceps tendon subluxation/dislocation, supraspinatus and rotator interval, acromio-clavicular joint, subacromial-subdeltoid bursa, subacromial impingement, infraspinatus, teres minor, and posterior labrum. The detailed ultrasonographic examination of this shoulder was described elsewhere [ 2 ].

MRI examination

MRI was performed on a high field system (1.5 Tesla) magnet units (Philips Intera). The patient should be supine with the head directed towards the scanner bore. The preferred positioning of the patient’s arm is neutral to slightly externally rotated. Surface coil (flexible coils) are those that wrap around and conform to the anatomic area of interest. Preliminary scout localizers in axial, coronal, and sagittal planes were done.

Statistical analysis

The statistical analysis was carried with SPSS software (Statistical Package for the Social Sciences, version 24, SSPS Inc., Chicago, IL, USA). Frequency tables with percentages (Tables  1 , 2 , and 3 ) were used for categorical variables, and descriptive statistics (mean and standard deviation) were used for numerical variables. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPP) of US examinations of different pathologies were calculated. A p value of less than 0.05 was considered statistically significant.

All cases were examined with static and dynamic ultrasonography as well as detailed conventional MRI.

The ultrasonographic findings were compared to that obtained by MRI in all cases.

The frequency and percentage according to sex in the study population, where female patients represented 64%, while male patients represented 36%.

The frequency of pathological injuries, according to the mean age revealed that patients below 45 years showed higher incidence of intrinsic factors of impingement with high incidence of tendinopathy and partial-thickness rotator cuff tendon tears, while those above 45 years old had higher incidence of extrinsic factors, especially the acromio-clavicular osteoarthropathy, with a relatively higher incidence of full-thickness rotator cuff tendon tears .

The frequency and the percentage of affection of the right and left shoulder side were 34 patients (68%) and 16 patients (32%), respectively.

The frequency and the percentage of affection of shoulders by different pathologies by US and MRI were obtained.

According to results obtained, the U/S is superior to MRI in two conditions: dynamic evaluation of subacromial impingement and in addition to the detectable increased synovial vascularity by added color-Doppler examination.

While the MRI is superior to US in bony lesions, including acromio-clavicular osteoarthritis and the description of acromial shape, that may be the basic factor for incidence of subacromial impingement as well as detecting marrow infiltrative lesions (Figs.  1 , 2 , 3 , and 4 ).

a MRI, coronal T2WIs: acromio-clavicular osteoarthritis and thickening of supraspinatous tendon with increased signal intensity yet no fiber discontinuity. b Static US image showed evidence of acromio-clavicular osteoarthritis. c Static US image showing swollen supraspinatous tendon with ill-defined hypoechogenicity yet with preserved fiber continuity. d Dynamic ultrasonography showed narrowing of the subacromial tunnel in stress position

a MRI, sagittal STIR WIs: fluid signal seen at the articular surface of the musculo-tendinous junction of supraspinatous tendon (arrow). No evidence complete fiber interruption detected. b MRI, Coronal T2WIs of the shoulder showing acromio-clavicular osteoarthritis. c Static US images show partial-thickness tear of the humeral surface of the supraspinatus tendon, seen as a hypoechoic linear defect interrupting the tendon fibers (arrow). d Dynamic ultrasonography showed narrowing of the subacromial tunnel that became accentuated in stress position

a MRI, sagittal STIR WIs: fluid signal is seen filling the gap as a result of full-thickness tear of the supraspinatous tendon (arrow), also shows acromio-clavicular osteoarthritis changes. b MRI, sagittal T2WIs of the shoulder showing focal fiber interruption of the subscapularis tendon with fluid signal noted (arrow). c MRI, axial T2 of the shoulder shows marked fluid signal along the sheath of long head of biceps tendon. d Static US images show distension of long head of biceps tendon sheath by hypoechoic fluid. e Static US shows hypoechoic linear defect interrupting the fibers of supraspinatous tendon (arrow)

a Digital radiography shows evidence of lateral downsloping of the acromion process. b MRI, sagittal STIR WIs: fluid signal seen at the articular surface of the supraspinatous tendon near its insertion (arrow). No evidence complete fiber interruption detected. Mild joint effusion is also noted. c MRI, sagittal T2WIs of the shoulder shows also partial-thickness tear of supraspinatous tendon. d Static US images show partial-thickness tear of the humeral surface of the supraspinatus tendon, seen as a small hypoechoic linear defect interrupting the tendon fibers (arrow)

In this study, we have confirmed the fact that MR examination is a valuable diagnostic modality that can give us valuable information as regards the different anatomic information and variations (e.g., the acromial shape), detecting rotator cuff abnormalities including tendinosis, partial-thickness, and full-thickness tears as well as degenerative changes of the acromio-clavicular joint. But, its main disadvantage of being a static examination that cannot reveal the exact relationship between the acromion, humeral head, and intervening soft tissues during active shoulder movement.

In this study, with dynamic evaluation for shoulder impingement is performed in all our cases through measuring the vertical dimension of the osseous subacromial tunnel in both neutral and stress positions in which the arm is semi-flexed and semi-abducted, and the hand is pronated, during stress position: the greater tuberosity of the humeral head is brought underneath the acromion, to assess if there is considerable reduction in the dimension that causes repeated shearing trauma of the rotator cuff tendon during shoulder movement (osseous impingement). It was found that the vertical dimension of the subacromial tunnel measures less than 6 mm in a neutral position and shows further reduction (about 25%) in stress position in cases of subacromial impingement.

This agreed with the study of Nathalie et al. [ 3 ] that had detected—by dynamic ultrasonography—the significant reduction of the subacromial tunnel during active shoulder movement to stress position, with the rotator cuff tendon becomes more prone to compression, eliciting shoulder pain.

In this study, 10 patients were diagnosed by MRI as having full-thickness tears of the supraspinatus tendon, 9 patients of them were detected in the US. Regarding partial-thickness tear, 14 patients were detected by MRI while in the US two of them were consistently described as degenerated tendons. This inconsistency in the evaluation of partial-thickness tears has likewise been reported by other authors. Lenza et al. [ 6 ] stated that small partial-thickness tears can be missed. In conclusion, the exact size of the partial tear should be measured to ascertain that partial-thickness tears are frequently missed due to the dimension of the injury.

In this study, US agreement to MRI for the supraspinatus tendon assessment was 90% for full-thickness tears and 85.5% for partial-thickness tears so that US can be used to rule out complete supraspinatus tears, especially in patients that are not apt to receive an MRI.

This disagreeing with studies of Melanie et al. [ 9 ] and Nathalie et al. [ 3 ] that reported the very high sensitivity (about 100%) of dynamic ultrasonography in detection of different types of partial-thickness rotator cuff tears.

In this study, we stated that ultrasonography is relatively less sensitive than MRI in the detection of rotator cuff tendinosis (83.3% sensitivity) that appears as a focal or diffuse area of decreased reflectivity, with no disruption of the fiber continuity. In the current study, 15 cases were diagnosed by ultrasonography to have rotator cuff tendinosis, such cases in addition to another three cases were detected by MRI, with ultrasonography reported normal rotator cuff tendon in such missed case.

This is agreed with the study done by Ian Beggs and reported the accepted accuracy of ultrasonography in detection of rotator cuff tendinosis, especially in cases with resultant focal or diffuse tendon thickening that could be easily compared to the adjacent normal part of the tendon or the contralateral normal one.

In this study, three cases showed evidences of calcific tendinitis detected by both ultrasonography and MRI that was seen as a tiny intra-tendinous echoic calcific focus with faint acoustic shadowing by ultrasonography and seen as a small intra-tendinous focus of signal-void in MRI. It was associated with hypertrophic acromio-clavicular osteoarthritis and subacromial bursitis (plain radiography was done for these three cases and assured the diagnosis).

Although the exact pathogenesis of calcific tendinitis condition remains unknown, it is probably multi-factorial—likely being related to degeneration, reactive change, predisposing medical conditions, and genetics [ 10 ].

This is agreed with (Chiou et al.), who reported the high accuracy of the ultrasonography in detection of calcific tendinitis.

In this study, results showed accepted accuracy (about 94.7% sensitivity) of dynamic ultrasonography in detection of acromio-clavicular joint osteoarthritic changes compared to MR.

This is agreed with the study of Melanie et al. [ 9 ] who reported the value of dynamic ultrasonography in direct visualization of the rotator cuff tendon injury by acromio-clavicular joint degenerative changes.

In this study, 28 cases showed evidences of subacromial bursitis with bursal fluid distension by ultrasonography, while MRI had detected 30 cases. It was noticed that the cases missed by U/S showed very minimal bursal effusion, which means that ultrasonography has the disadvantage in the detection of minimal amounts of fluid.

In this study, regarding joint effusion, among the cases of the study there were 35 cases having joint effusion, two of them missed by ultrasonography. But, ultrasonography had the advantage of being capable of detecting any degree of synovial thickening and differentiating the hypoechoic synovium from fluid by using the compression test.

This is agreed with almost all the reviewed studies done in the same field, like those carried out by Melanie et al. [ 9 ], Mc Nally et al. [ 11 ].

In this study, the 16 cases detected by MRI could be also detected by ultrasonography to have biceps teno-synovitis, and this ensures the fact that ultrasonography is efficient in detecting minimal fluid and subtle synovial changes.

This is agreed with the studies carried out by Nathalie et al. [ 3 ] who reported the high diagnostic value of static and dynamic ultrasonography in cases of bicep teno-synovitis.

The study has proved that dynamic ultrasonography is a highly accurate, highly sensitive diagnostic modality in different types of the painful shoulder.

Availability of data and materials

All the datasets used and analyzed in this study are available with the corresponding author on reasonable request.

Abbreviations

Acromio-clavicular joint

Acromio-humeral distance

Acromio-humeral interval

Antero-posterior

Coraco-humeral ligament

Deltoid muscle

Greater tuberosity

Calcium hydroxyapatite deposition

Humeral head

Infraspinatus muscle

Internal rotation

Long head of biceps

Longitudinal section

Lesser tuberosity

Magnetic resonance imaging

Postero-anterior

Rotator cuff

Transverse section

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Islam El-Hefnawi Abdel Fattah El-Shewi, Hatem Mohamed El Azizy & Amr Abd El Fattah Hassan Gadalla

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IEA put the idea of the study, edited the manuscript, participated in the study design, performed the US exams, and recorded the results. HME participation in the study design and gathering data. AAH patients collected and aided in statistical data. All authors read and approved the final manuscript.

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Correspondence to Islam El-Hefnawi Abdel Fattah El-Shewi .

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Written informed consent was signed by all patients before the examination. The study was approved by the research committee of the Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, 2017. No reference number provided as the committee just say yes or no according to the system in our faculty of medicine at 2017 (date of starting of this research).

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El-Shewi, I.EH.A.F., El Azizy, H.M. & Gadalla, A.A.E.F.H. Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome. Egypt J Radiol Nucl Med 50 , 100 (2019). https://doi.org/10.1186/s43055-019-0107-7

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DOI : https://doi.org/10.1186/s43055-019-0107-7

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Retrospective studies are better than prospective ones, as you already have the data you need when choosing to do a retrospective study. Prospective studies are better quality, but as a resident, you may not have time (, energy and enthusiasm) to complete these.

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Original research is challenging, especially if you do not have prior experience. I would suggest you choose a topic that answers a single or few questions. Most topics that I have listed are along those lines. Alternatively, you can choose a broad topic such as “Role of MRI in evaluation of perianal fistulas.”

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• Ultrasound evaluation of kidney length & descending colon diameter in normal and intrauterine growth-restricted fetuses
• A prospective study of hepatic vein waveform and splenoportal index in liver cirrhosis: correlation with child Pugh’s classification and presence of esophageal varices.
• CT angiography to evaluate coronary artery by-pass graft patency in symptomatic patient’s functional assessment of myocardium by cardiac MRI in patients with myocardial infarction
• MRI evaluation of HIV positive patients with central nervous system manifestations
• MDCT evaluation of mediastinal and hilar masses
• Evaluation of rotator cuff & labro-ligamentous complex lesions by MRI & MRI arthrography of shoulder joint
• Role of imaging in the evaluation of soft tissue vascular malformation
• Role of MRI and ultrasonography in the evaluation of multifidus muscle pathology in chronic low back pain patients
• Role of ultrasound elastography in the differential diagnosis of breast lesions
• Role of magnetic resonance cholangiopancreatography in evaluating dilated common bile duct in patients with symptomatic gallstone disease.
• Comparative study of CT urography & hybrid CT urography in patients with haematuria.
• Role of MRI in the evaluation of anorectal malformations
• Comparison of ultrasound-Doppler and magnetic resonance imaging findings in rheumatoid arthritis of hand and wrist
• Role of Doppler sonography in the evaluation of renal artery stenosis in hypertensive patients undergoing coronary angiography for coronary artery disease.
• Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis in ankylosing spondylitis.
• Mr evaluation of painful hip
• Role of MRI imaging in pretherapeutic assessment of oral and oropharyngeal malignancy
• Evaluation of diffuse lung diseases by high resolution computed tomography of the chest
• Mr evaluation of brain parenchyma in patients with craniosynostosis.
• Diagnostic and prognostic value of cardiovascular magnetic resonance imaging in dilated cardiomyopathy
• Role of multiparametric magnetic resonance imaging in the detection of early carcinoma prostate
• Role of magnetic resonance imaging in white matter diseases
• Role of sonoelastography in assessing the response to neoadjuvant chemotherapy in patients with locally advanced breast cancer.
• Role of ultrasonography in the evaluation of carotid and femoral intima-media thickness in predialysis patients with chronic kidney disease
• Role of H1 MRI spectroscopy in focal bone lesions of peripheral skeleton choline detection by MRI spectroscopy in breast cancer and its correlation with biomarkers and histological grade.
• Ultrasound and MRI evaluation of axillary lymph node status in breast cancer.
• Role of sonography and magnetic resonance imaging in evaluating chronic lateral epicondylitis.
• Comparative of sonography including Doppler and sonoelastography in cervical lymphadenopathy.
• Evaluation of Umbilical Coiling Index as Predictor of Pregnancy Outcome.
• Computerized Tomographic Evaluation of Azygoesophageal Recess in Adults.
• Lumbar Facet Arthropathy in Low Backache.
• “Urethral Injuries After Pelvic Trauma: Evaluation with Uretrography
• Role Of Ct In Diagnosis Of Inflammatory Renal Diseases
• Role Of Ct Virtual Laryngoscopy In Evaluation Of Laryngeal Masses
• “Ct Portography Using Mdct Versus Color Doppler In Detection Of Varices In
• Cirrhotic Patients”
• Role Of Multidetector Ct In Characterization Of Renal Masses
• Role Of Ct Virtual Cystoscopy In Diagnosis Of Urinary Bladder Neoplasia
• Role Of Multislice Ct In Diagnosis Of Small Intestine Tumors
• “Mri Flow Quantification In The Assessment Of The Commonest CSF Flow Abnormalities”
• “The Role Of Fetal Mri In Diagnosis Of Intrauterine Neurological CongenitalAnomalies”
• Role Of Transcranial Ultrasound In Diagnosis Of Neonatal Brain Insults
• “The Role Of Interventional Imaging Procedures In The Treatment Of Selected Gynecological Disorders”
• Role Of Radiological Imaging In Diagnosis Of Endometrial Carcinoma
• “Role Of High-Resolution Ct In Differentiation Between Benign And Malignant Pulmonary Nodules In Children”
• Role Of Ultrasonography In The Diagnosis Of Knee Joint Lesions
• “Role Of Diagnostic Imaging Modalities In Evaluation Of Post Liver Transplantation Recipient Complications”
• “Diffusion-Weighted Magnetic Resonance Imaging In Diagnosis And
• Characterization Of Brain Tumors In Correlation With Conventional Mri”
• The Role Of PET-CT In The Evaluation Of Hepatic Tumors
• “Role Of Computerized Tomography In Evaluation Of Mediastinal Masses In Pediatric patients”
• “Trans Vaginal Ultrasound And Magnetic Resonance Imaging In Female Urinary Incontinence”
• Role Of Multidetector Ct In Diagnosis Of Urinary Bladder Cancer
• “Role Of Transvaginal Ultrasound In Diagnosis And Treatment Of Female Infertility”
• Role Of Diffusion-Weighted Mri Imaging In Evaluation Of Cancer Prostate
• “Role Of Positron Emission Tomography With Computed Tomography In Diagnosis Of Cancer Thyroid”
• The Role Of CT Urography In Case Of Haematuria
• “Value Of Ultrasonography In Assessment Of Acute Abdominal Diseases In Pediatric Age Group”
• “Role Of Functional Magnetic Resonance Imaging In Making Brain Tumor Surgery Safer”
• The Role Of Sonoelastography In Characterization Of Breast Lesions
• “Ultrasonography, Magnetic Resonance Cholangiopancreatography (MRCP) In Assessment Of Pediatric Biliary Lesions”
• “Role Of Ultrasound And Color Doppler Imaging In Assessment Of Acute Abdomen Due To Female Genital Causes”
• “Role Of Multidetector Ct Virtual Laryngoscopy In Evaluation Of Laryngeal Mass Lesions”
• MRI Of The Postoperative Knee
• Role Of Mri In Assessment Of Valvular Heart Diseases
• The Role Of 3D & 4D Ultrasonography In Abnormalities Of Fetal Abdomen
• State Of The Art Of Mri In Diagnosis Of Hepatic Focal Lesions
• Role Of Multidetector Ct In Diagnosis Of Salivary Gland Lesions
• “Role Of Virtual Endoscopy Using Mdct In Detection & Evaluation Of Gastric Pathologies”
• The Role Of Ultrasound & Mri In Acute Pelvic Inflammatory Disease
• “Diagnosis & Staging Of Liver Fibrosis By Ultraso Und Elastography In
• Patients With Chronic Liver Diseases”
• Role Of Mri In Evaluation Of Spinal Trauma
• Validity Of Mri In Diagnosis Of Congenital Anorectal Anomalies
• Imaging Of Vascular Complication After Liver Transplantation
• “Contrast-Enhanced Digital Mammography And Digital Breast Tomosynthesis In Early Diagnosis Of Breast Lesion”
• Role Of Mammotome In Breast Lesions
• “Role Of MRI Diffusion Tensor Imaging (DTI) In Assessment Of Traumatic Spinal Cord Injuries”
• “Prediction Of Pre-eclampsia And Fetal Growth Restriction By Uterine Artery Doppler”
• “Role Of Multidetector Row Computed Tomography In Assessment Of Maxillofacial Trauma”
• “Role Of Diffusion Magnetic Resonance Imaging In Assessment Of Neoplastic And Inflammatory Brain Lesions”
• Role Of Diffusion Mri In Preoperative Evaluation Of Brain Neoplasms
• “Role Of Multidetector Ct Virtual Hysteroscopy In The Detection Of The
• Uterine & Tubal Causes Of Female Infertility”
• Role Of Advances Magnetic Resonance Imaging Sequences In Multiple Sclerosis Magnetic Resonance Spectroscopy In Multiple Sclerosis
• “Role Of Conventional Mri, And Diffusion Tensor Imaging Tractography In Evaluation Of Congenital Brain Malformations”
• Role Of MRI In Evaluation Of Spinal Trauma
• Diagnostic Role Of Diffusion-weighted MR Imaging In Neck Masses
• “The Role Of Transvaginal Ultrasound Versus Magnetic Resonance Imaging In Diagnosis & Evaluation Of Cancer Cervix”
• “Role Of 3d Magnetic Resonance Imaging Tractography In Assessment Of White Matter Tracts Compromise In Supra Tentorial Tumors”
• Role Of Proton MR Spectroscopy In The Evaluation Of Temporal Lobe Epilepsy
• Role Of Multislice Computed Tomography In Evaluation Of Crohn’s Disease
• Role Of MRI In Assessment Of Hydrocephalus In Pediatric Patients
• The Role Of MRI In Diagnosis And Staging Of Urinary Bladder Carcinoma
• USG and MRI correlation of congenital CNS anomalies
• HRCT in interstitial lung disease
• X-Ray, CT and MRI correlation of bone tumors
• “Study on the diagnostic and prognostic utility of X-Rays for cases of pulmonary tuberculosis under RNTCP”
• “Role of magnetic resonance imaging in the characterization of female adnexal  pathology”
• “CT angiography of carotid atherosclerosis and NECT brain in cerebral ischemia, a correlative analysis”
• Role of CT scan in the evaluation of paranasal sinus pathology
• USG and MRI correlation on shoulder joint pathology
• “Radiological evaluation of a patient presenting with extrapulmonary tuberculosis”
• CT and MRI correlation in focal liver lesions”
• Comparison of MDCT virtual cystoscopy with conventional cystoscopy in bladder tumors”
• “Bleeding vessels in life-threatening hemoptysis: Comparison of 64 detector row CT angiography with conventional angiography prior to endovascular management”
• “Role of transarterial chemoembolization in unresectable hepatocellular carcinoma”
• “Comparison of color flow duplex study with digital subtraction angiography in the evaluation of peripheral vascular disease”
• “A Study to assess the efficacy of magnetization transfer ratio in differentiating tuberculoma from neurocysticercosis”
• “MR evaluation of uterine mass lesions in correlation with transabdominal, transvaginal ultrasound using HPE as a gold standard”
• “The Role of power Doppler imaging with trans rectal ultrasonogram guided prostate biopsy in the detection of prostate cancer”
• “Lower limb arteries assessed with doppler angiography – A prospective comparative study with multidetector CT angiography”
• “Comparison of sildenafil with papaverine in penile doppler by assessing hemodynamic changes”
• “Evaluation of efficacy of sonosalphingogram for assessing tubal patency in infertile patients with hysterosalpingogram as the gold standard”
• Role of CT enteroclysis in the evaluation of small bowel diseases
• “MRI colonography versus conventional colonoscopy in the detection of colonic polyposis”
• “Magnetic Resonance Imaging of anteroposterior diameter of the midbrain – differentiation of progressive supranuclear palsy from Parkinson disease”
• “MRI Evaluation of anterior cruciate ligament tears with arthroscopic correlation”
• “The Clinicoradiological profile of cerebral venous sinus thrombosis with prognostic evaluation using MR sequences”
• “Role of MRI in the evaluation of pelvic floor integrity in stress incontinent patients” “Doppler ultrasound evaluation of hepatic venous waveform in portal hypertension before and after propranolol”
• “Role of transrectal sonography with colour doppler and MRI in evaluation of prostatic lesions with TRUS guided biopsy correlation”
• “Ultrasonographic evaluation of painful shoulders and correlation of rotator cuff pathologies and clinical examination”
• “Colour Doppler Evaluation of Common Adult Hepatic tumors More Than 2 Cm  with HPE and CECT Correlation”
• “Clinical Relevance of MR Urethrography in Obliterative Posterior Urethral Stricture”
• “Prediction of Adverse Perinatal Outcome in Growth Restricted Fetuses with Antenatal Doppler Study”
• Radiological evaluation of spinal dysraphism using CT and MRI
• “Evaluation of temporal bone in cholesteatoma patients by high resolution computed tomography”
• “Radiological evaluation of primary brain tumours using computed tomography and magnetic resonance imaging”
• “Three dimensional colour doppler sonographic assessment of changes in  volume and vascularity of fibroids – before and after uterine artery embolization”
• “In phase opposed phase imaging of bone marrow differentiating neoplastic lesions”
• “Role of dynamic MRI in replacing the isotope renogram in the functional evaluation of PUJ obstruction”
• Characterization of adrenal masses with contrast-enhanced CT – washout study
• A study on accuracy of magnetic resonance cholangiopancreatography
• “Evaluation of median nerve in carpal tunnel syndrome by high-frequency ultrasound & color doppler in comparison with nerve conduction studies”
• “Correlation of Agatston score in patients with obstructive and nonobstructive coronary artery disease following STEMI”
• “Doppler ultrasound assessment of tumor vascularity in locally advanced breast cancer at diagnosis and following primary systemic chemotherapy.”
• “Validation of two-dimensional perineal ultrasound and dynamic magnetic resonance imaging in pelvic floor dysfunction.”
• “Role of MR urethrography compared to conventional urethrography in the surgical management of obliterative urethral stricture.”

Search Diagnostic Imaging Research Topics

You can also search research-related resources and direct download PDFs for radiology articles on our custom radiology search engine .

Free Resources for Preparing Radiology Thesis

• Radiology thesis topics- Benha University – Free to download thesis
• Radiology thesis topics – Faculty of Medical Science Delhi
• Radiology thesis topics – IPGMER
• Fetal Radiology thesis Protocols
• Radiology thesis and dissertation topics
• Radiographics

Proofreading Your Thesis:

Make sure you use Grammarly to correct your spelling ,  grammar , and plagiarism for your thesis. Grammarly has affordable paid subscriptions, windows/macOS apps, and FREE browser extensions. It is an excellent tool to avoid inadvertent spelling mistakes in your research projects. It has an extensive built-in vocabulary, but you should make an account and add your own medical glossary to it.

Guidelines for Writing a Radiology Thesis:

These are general guidelines and not about radiology specifically. You can share these with colleagues from other departments as well. Special thanks to Dr. Sanjay Yadav sir for these. This section is best seen on a desktop. Here are a couple of handy presentations to start writing a thesis:

Read the general guidelines for writing a thesis (the page will take some time to load- more than 70 pages!

A format for thesis protocol with a sample patient information sheet, sample patient consent form, sample application letter for thesis, and sample certificate.

Resources and References:

• Guidelines for thesis writing.
• Format for thesis protocol
• Thesis protocol writing guidelines DNB
• Informed consent form for Research studies from AIIMS 
• Radiology Informed consent forms in local Indian languages.
• Sample Informed Consent form for Research in Hindi
• Guide to write a thesis by Dr. P R Sharma
• Guidelines for thesis writing by Dr. Pulin Gupta.
• Preparing MD/DNB thesis by A Indrayan
• Another good thesis reference protocol

Hopefully, this post will make the tedious task of writing a Radiology thesis a little bit easier for you. Best of luck with writing your thesis and your residency too!

More guides for residents :

• Guide for the MD/DMRD/DNB radiology exam!
• Guide for First-Year Radiology Residents
• FRCR Exam: THE Most Comprehensive Guide (2022)!

Radiology Practical Exams Questions compilation for MD/DNB/DMRD !

• Radiology Exam Resources (Oral Recalls, Instruments, etc )!
• Tips and Tricks for DNB/MD Radiology Practical Exam

FRCR 2B exam- Tips and Tricks !

• FRCR exam preparation – An alternative take!
• Why did I take up Radiology?
• Radiology Conferences – A comprehensive guide!
• ECR (European Congress Of Radiology)
• European Diploma in Radiology (EDiR) – The Complete Guide!
• Radiology NEET PG guide – How to select THE best college for post-graduation in Radiology (includes personal insights)!
• Interventional Radiology – All Your Questions Answered!
• What It Means To Be A Radiologist: A Guide For Medical Students!
• Radiology Mentors for Medical Students (Post NEET-PG)
• MD vs DNB Radiology: Which Path is Right for Your Career?
• DNB Radiology OSCE – Tips and Tricks

More radiology resources here: Radiology resources This page will be updated regularly. Kindly leave your feedback in the comments or send us a message here . Also, you can comment below regarding your department’s thesis topics.

Note: All topics have been compiled from available online resources. If anyone has an issue with any radiology thesis topics displayed here, you can message us here , and we can delete them. These are only sample guidelines. Thesis guidelines differ from institution to institution.

Image source: Thesis complete! (2018). Flickr. Retrieved 12 August 2018, from https://www.flickr.com/photos/cowlet/354911838 by Victoria Catterson

About The Author

Dr. amar udare, md, related posts ↓.

7 thoughts on “Radiology Thesis – More than 400 Research Topics (2022)!”

Amazing & The most helpful site for Radiology residents…

Thank you for your kind comments 🙂

Dr. I saw your Tips is very amazing and referable. But Dr. Can you help me with the thesis of Evaluation of Diagnostic accuracy of X-ray radiograph in knee joint lesion.

Wow! These are excellent stuff. You are indeed a teacher. God bless

Glad you liked these!

happy to see this

Glad I could help :).

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Application of ultrasonography in female infertility: a comprehensive review

• Tochukwu C. Okeke Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
• Kennedy K. Agwuna Department of Radiology, University of Nigeria Teaching Hospital, Enugu, Nigeria
• Cyril C. Ezenyeaku Department of Obstetrics & Gynecology, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria
• Lawrence C. Ikeako Department of Obstetrics & Gynecology, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria

The quest for detailed evaluation of the uterus, fallopian tubes, and ovaries that is radiation free, inexpensive, readily available, non-invasive, relatively less time consuming and easily repeatable in female infertility has resulted in further studies. However, ultrasonography (US) remains the first line indispensable tool for gynecologic workup, monitoring and treating infertility. The aim is to review the current knowledge regarding the application of ultrasonography in female infertility. This was a descriptive review of ultrasonography in female infertility. We searched several databases (Medline, Google scholar, PubMed) with keywords “ultrasonography and female infertility”, “evaluation of female infertility”, “role of ultrasonography in female infertility:, and imaging in female infertility”. Female infertility is multifactorial in origin. Ultrasonography is the most widely used imaging in gynecology and has revolutionized the management of female infertility worldwide. The recognition, evaluation and treatment of female infertility are complicated, complex, stressful and emotionally devastating for most couples. The couple’s emotional state should be supportive, informative and well tolerated. Female infertility is an immense stress to couples, families and relatives worldwide. The causes are multifactorial in origin with both congenital and acquired problems of the uterus, fallopian tubes and ovaries. Ultrasound plays an important role in female infertility workup with hysterosalpingography (HSG), sonohysterography (Sono-HSG) and magnetic resonance imaging (MRI), each playing a complimentary role in the screening, diagnosis and/or management of female infertility.

Okeke TC, Ezenyeaku CCT, Ikeako LC. A review of treatment options available to women with uterine fibroids. British Journal of Medicine and Medical Research (BJMMR). 2015;6(12):1136-48.

Balogun SK. Age as correlate of incidence of vesico-vaginal fistula (VVF): The Nigerian example. Issues Health Psychol. 1995;2:44-51.

Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21:293.

Haq IU, Mauzur S, Rehman AU, Farooq A. Role of ultrasonography in infertility management: Ovulation monitoring and assisted conception Annals. 2010;16(4):257–61.

Rastogi R. Role of imaging in female infertility (Dr. K.M Rai Memorial Oration Award). Indian J Radiol Imaging. 2010;20(3):168-73.

Padubidri VG, Daftary SN (eds). The pathology of conception. In: Howkins and Bourne Shaw’s Textbook of Gynaecology. 13th Edition. New Delhi, Elsevier. 2004;194-216.

Adekunle RA. Gynaecological Anatomy. In:Arulkumaran S, Synmonds IM, Fowlie A (eds), Oxford Handbook of Obstetrics and Gynaecology. 1st edition. New Delhi, Oxford University Press. 2004;453-58.

Donald I, MacVicar J, Brown TG. “Investigation of abdominal masses by pulsed ultrasound”. Lancet. 1958;1(7032):1188-195.

Woo Joseph. A short history of the development of ultrasound in obstetrics and Gynaecology ob-ultrasound.net retrieved, 2007.

Weissman A, Mcardle CR, Achiron R. Ultrasound in Infertility. In:Seibel MM(ed), Infertility A Comprehensive Text. 2nd edition. Connecticut, Appleton and Large. 1997;447-92.

Kratochwil A, Urban GU, Fredrick F. Ultrasonic tomography of the ovaries. Ann Chir Gynecol. 1972;61-211.

Hackeloer B, Nitschke S, Daume E, Sturm G, Buch holz R. Ultrasonics of ovarian changes under gonadotrophin stimulation. Geburtshilfe Frauenheilkd. 1977;38:185

Hacheloer BJ, Fleming R, Robinson HP, Adam AH, Coutts JRT. Correlation of ultrasonic and endocrinologic assessment of human follicular development. Am J Obstet Gynecol. 1979;135:122-29.

Kerin JF, Warnes GM, Crocker J, et al. 3-hour urinary radio immunoassay for luteinizing hormone to detect onset of preovulatory LH surge. Lancet. 1980;1:430.

O’Herlithy C, de Crespigny L, Robinson HP. Monitoring ovarian follicular development with real-time ultrasound. BJOG 1980;87:613.

Montzavinos T, Garcia JE, Jones HW Jr. Ultrasound measurement of ovarian follicles stimulated by human gonadotropins for oocyte recovery and in intro fertilization. Fertile Steril. 1983;40:461.

Seibel MM, McArdle CR, Thompson IE, Berger MJ, Taymor ML. The role of ultrasound in ovulation induction: A critical appraisal. Fertil Steril. 1981;36:573.

Gleicher N, Friberg J. fullan N, et al. Egg retrieval for in vitro fertilization sonographically controlled vaginal culdocentesis. Lancet. 1983;2:508.

Dellenbach P, Nisand I, Moreau L, et al. Transvaginal sonographically controlled ovarian follicle puncture for egg retrieval. Lancet 1984;2:1467.

Schwimer SR, Lebovic J. Transvaginal pelvic ultrasonography. J Ultrasound Med. 1984;3:381.

Frederick J, Paulson RJ, Sauer MV. Routine use of vaginal ultrasonography in the preparative evaluation of gynecologic patients. An adjunct to resident education. J. Reprod Med. 1991;36:779.

Yee B, Barnes RB, Vargyas JM, Marrs RP. Correlation of Transabdominal and transvaginal ultrasound measurements of follicle size and member with laparoscopic findings for in vitro fertilization. Fertil Steril. 1987;47:828.

Andreotti RE, Thompson GH, Janowitz W, Shapiro AG, Zusmer NR. Endovaginal and transabdominal sonography of ovarian follicles. J Ultrasound. 1989;8:555.

Timor-Tritsch IE. Is office use of vaginal ultrasonography feasible? Am J Obstet Gynecol. 1990;162:983.

Kaproth-Joslin K, Dogra V. Imaging of Female Infertility. A Pictorial Guide to the Hysterosalpingography, Ultrasonography, and Magnetic Resonance Imaging findings of the Congenital and Acquired Causes of Female Infertility. Radio Clin N Am. 2013;51:967-81.

Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. Radiographics. 2009;29(5):1353-70.

Nguyen KT. Female Infertility. In: Sauerberi EE, Nguyen KT, Nolan RL (eds). A Practical guide to Ultrasound in Obstetrics and Gynecology. 1st edition. Philadelphia, Lippincott-Raven. 1998;104-9.

Ecochard R, Boehringer H, Rabilloud M, Marret H. Chronological aspects of ultrasonic, hormonal and other indirect indices of ovulation. BJOG. 2001;108:822.

Luttjeboer F, Harada T, Hughes E, et al. Tubal flushing for Subfertility. Cochrane Database Syst Rev. 2007:CD003778.

Goldberg BB, Liu JB, Kuhlman K, Merton DA, Kurtz AB. Endoluminal Gynecologic Ultrasound: Preliminary results. J Ultrasound Med. 1991;10:583-90.

Bassil S. Changes in endometrial thickness, Width, Length and pattern in predicting pregnancy outcome during ovarian stimulation in vitro fertilization ultrasound Obstet Gynecol. 2001;18:258-63.

Fanchin R. Assessing uterine receptivity in 2001. Ultrasonographic glances at the New Millennium. An N Y Acad Sci. 2001;943:185-202.

Fleischer AC, Kepple DM, Vasquez J. Conventional and color Doppler transvaginal sonography in gynecologic infertility. Radiol Clin North Am. 1992;30:693-702.

Zhang X, Chen CH, Confino E, Barnes R, Milad M, Kazer RR. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2005;2:336-40.

Ivanovski M, Lazarevski S, Popovik M, et al. Assessment of endometrial thickness and pattern in prediction of pregnancy in an in vitro fertilization an embryo transfer cycles after ovarian stimulation. Macedonian Medical Review. 2007;4-6:117-24.

Buckett WM. A Meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80:1037-041.

Levi Setti PE, Albani E, Cavagna M, Bulletti C, Colombo GV, Negri L. The impact of embryo transfer on implantation – a review. Placenta. 2003;24(Suppl B):20-6

Woolcott R, Stanger J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod. 1997;12:963-6.

Sallam HN, Agameya AE, Rahman AF, Ezzeldin F, Sallam AN. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod. 2002;17:1767-72.

Goudas VT, Hammitt DG, Damario MA, Session DR, Singh AP, Dumesic DA. Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril. 1998;70:878-82.

Lesny P, Killick SR. Tetlow RL, Manton DJ, Robinson J, Maguiness SD. Ultrasound evaluation of the uterine zonal anatomy during in vitro fertilization and embryo transfer. Hum Reprod. 1999;14:1593-8.

Pope CS, Cook EKD, Arny M, Novak A, Grow DR. Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril. 2004;81:51-8.

Shamonki M, Schatman GL, Spandorfer SD, Rosenwaks Z. Ultrasound-guided embryo transfer may be beneficial in preparation for an IVF cycle. Hum Reprod. 2005;20(10):2844-9.

Dodson MG. Ovulation induction and transvaginal ultrasound. In:Transvaginal Ultrasound. New York: Churchill Livingstone. 1991;227-59.

Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology. 2004;233:19-34.

The American Fertility Society classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944-55.

Khati NJ, Fraizer AA, Brindle KA. The unicornuate uterus and its variants. J Ultrasound Med. 2012;31:319-31.

Taylor E, Gomel V. The uterus and fertility. Fertil Steril. 2008;89(1):1-16.

Pellerito JS, McCarthy SM, Doyle MB, Glickman MG, DeCherney AH. Diagnosis of Uterine anomalies: relative accuracy of MR Imaging, endovaginal sonography and hysterosalpingography, Radiology. 1992;183:795-800.

Homer HA, Li TC, Cokker ID. The Septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73:1-14.

Tulandi T, Arronet GH, Mclnnes RA. Arcuate and bicornuate uterine anomalies and infertility. Fertile Steril. 1980;34:362-4.

Herbst AL, Senekjian EK, Frey KW. Abortion and Pregnancy loss among diethylstilbestrol-exposed women. Semin Endocrinol. 1989;7:124-9.

Riberio SC, Tormena RA, Peterson TV, et al. Mullerian duct anomalies: review of current management Sao Paulo Med J. 2009;127(2):92-6.

Choi HK, Cho KS, Lee KW, et al. MR Imaging of intersexuality. Radiographics. 1998;18:83-96.

Griffin Y, Sudigali V, Jacques A. Radiology of benign disorders of menstruation. Semin Ultrasound CT MR. 2010;116(3):747-58.

Thurmond AS. Imaging of female infertility. Radiol Clin North Am. 2003;41:757-67.

O’Neill M.J. Sonohysterography. Radiol Clin North Am. 2003:41:781-91.

Matalliotakis IM, Katsikis IK, Panidis DK. Adenomyosis: What is the impact on fertility? Curr Opin Obstet Gynecol. 2005;17:261-4.

Valentini AL, Gul SS, Sogali BG, et al. Adenomyosis from the sign of the diagnosis, imaging, diagnostic pitfall and differential diagnosis: a pictorial review. Radiol Med. 2011;116:1267-87.

Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20:2309-316.

Deans R, Abborr J. Review of intrauterine adhesions. J Minim Invasive Gynecol. 2010;17(5):555-69.

Simpson WL, Beita LG, Mester J. Hysterosalpingography: a re-emerging study. Radiographics. 2006;26:419-31.

Valle RF, Sankpal R, Marlow JL, Cohen L. Cervical stenosis: a challenging clinical entity. J Gynecol Surg. 2002;18:129-43.

Sarto GE, Simpson JL. Abnormalities of the Mullerian and Wolffian duct systems. Birth Defects Orig Artic Ser. 1978;14:37-54.

Eng CW, Tang PH, Ong CL. Hysterosalpingography: Current applications. Singapore Med J. 2007;48(4):368-74.

Krysiewicz S. Infertility in women: diagnosis evaluation with hysterosalpingography and other imaging techniques. ARJ Am J Roentgenol. 1992;159:253-61.

Schankath AC, Fasching N, Urech-Ruh C, et al. Hysterosalpingography in the workup of female infertility: indications, technique, and diagnostic funding. Insights Imaging. 2012;3:475-83.

Kim MY, Rha SE, Oh SN. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29:495-507.

Chawla N, Kudesia S, Azad S, et al. Salpingitis isthmica nodosa. Indian J Pathol Microbiol. 2009;52:434-435.

Okeke TC, Ikeako LC, Ezenyeaku CCT. Endometriosis: a review article. Niger J Med. 2011;20(3):191-199.

Chamie LP, Blasbalg R, Pereira RM, et al. Findings of pelvic endometriosis at transvaginal US, MR imaging and laparoscopy. Radiographics. 2011;31:E77-100.

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• v.13(7); 2021 Jul

Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women

Nadia shahid.

1 Obstetrics and Gynaecology, Sindh Government Hospital Liaquatabad, Karachi, PAK

Mehar Masood

2 Obstetrics and Gynaecology, Liaquat College of Medicine and Dentistry, Karachi, PAK

3 Obstetrics and Gynaecology, Dow University of Health Sciences, Karachi, PAK

Syeda Fariha Hussain

4 Obstetrics and Gynaecology, Jinnah Medical and Dental College, Karachi, PAK

Adnan Anwar

5 Physiology, Hamdard College of Medicine and Dentistry, Karachi, PAK

Atif A Hashmi

6 Pathology, Liaquat National Hospital and Medical College, Karachi, PAK

Background and objective

Pre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women.

Methodology

This was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery’s flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria.

Twenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE.

Abnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Introduction

Pre-eclampsia (PE) is a condition involving multiple organ systems, which originates during early pregnancy and can lead to substantial maternal mortality and morbidity. However, the pathophysiology of PE is still not clear as to how it involves both the fetal/placental as well as maternal factors [ 1 ]. The primary cause of PE is attributed to relatively under-perfused/hypoxic/ischemic placenta, probably due to the abnormal development of placental vasculature early in the duration of pregnancy. The estimated rate of PE is around 10%, and it is a major cause of iatrogenic pre-term births [ 2 ].

Like any other condition, the early diagnosis of PE during pregnancy is needed to plan appropriate treatment and the monitoring of management. Complications can be effectively contained if PE is diagnosed as early as possible [ 3 ]. Hypertension in pregnancy can affect up to 10% of expectant mothers. Substantial variations have been reported between developing and developing countries, owing to the differences in socioeconomic factors and data collection [ 4 ]. PE along with its complications plays a significant role in maternal as well as perinatal morbidity and mortality globally. With effective and timely management, the outcomes in women with PE can be significantly improved. This can be achieved by developing effective methods for predicting and preventing PE and its complications so that optimal prenatal care can be provided [ 5 ].

With the use of ultrasonography (U/S) for predicting/screening PE, it was observed that PE due to defective placentation causes an incomplete transformation of spiral arteries [ 6 ]. A lesion of placental villi and vascular histopathology is four to seven times more commonly seen in PE as compared to non-PE pregnancies [ 7 ]. They are linked to an increase in resistance to the flow of the uterine artery. In measuring the impedance (resistance) to the flow of uterine arteries through Doppler U/S, assessing and quantifying incomplete spiral arteries' transformation can be performed [ 8 , 9 ].

The objective of this study was to determine the role of Doppler U/S in predicting PE among high-risk women.

Materials and methods

This was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. The risk factors for PE included a previous history or a family history of PE, diabetes mellitus, age above 30 years, history of polycystic ovarian syndrome, urinary tract infection, or a previous history of pre-term birth. Pregnant mothers having no high-risk factors for PE and those who were not willing to participate in the study were excluded. Women with uncontrolled hypertension before 20 weeks of gestation or before pregnancy were also excluded.

After obtaining informed consent from the patients, their data were collected. Based on the inclusion and exclusion criteria, a total of 75 pregnant women were included in the study. A detailed history of the mothers including age, weight, height, body mass index (BMI), and any previous medial or obstetrical history was noted. Gestational age was calculated based on the last menstrual period or from an earlier scan. Both general physical and systemic examinations were carried out in detail. Laboratory investigations included complete blood counts, blood grouping, detailed urine report, random blood sugar (RBS), and two clean catch of mid-stream urine were collected more than four hours apart on a reagent strip and those having >2 proteinuria were recorded. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation coupled with proteinuria. The machine used for Doppler U/S was a Toshiba Nemio 30 with color Doppler (Canon Medical Systems Corporation, Ōtawara, Japan). For Doppler U/S, the mothers were positioned in a semi-recumbent way with a transducer laced on the left and right lower quadrants of the maternal abdominal wall, which enabled the visualization of the external iliac artery and identification of the uterine artery’s flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. All data were recorded on a pre-designed proforma.

Data analysis

For data analysis, SPSS Statistics Version 26.0 (IBM Inc., Armonk, NY) was used. Using cross-tabulation, the sensitivity, specificity, as well as positive and negative predictive values (PPV and NPV) were reported for Doppler U/S.

Among the total 75 pregnant mothers included in the study, the mean maternal age was 27.65 ±4.77 years, while the mean gestational age was 23.88 ±1.82 weeks. Regarding risk factors of PE, a previous history of PE was the most common factor observed (52, 69.3%) among the cases, followed by a family history of PE (49, 65.3%), as shown in Table ​ Table1 1 .

SD: standard deviation

Twenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. The Doppler ultrasound findings of uterine arteries are shown in Figure ​ Figure1 1 .

RI: resistance index

Out of 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, and they were diagnosed as PE patients. Out of these 56 patients, 40 cases had abnormal uterine artery Doppler U/S. On the other hand, among 19 women who did not develop PE, abnormal uterine artery Doppler U/S was noted in five cases, as shown in Figure ​ Figure2 2 .

Based on the cutoff of Rl and notching of the uterine artery, the sensitivity, specificity, PPV, and NPV of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively (Table ​ (Table2 2 ).

RI: resistance index; PPV: positive predictive value; NPV: negative predictive value

As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE. The sensitivity of bilateral RI >0.58 was low (41%) compared to unilateral RI >0.58; however, the presence of bilateral RI >0.58 was more specific. Similarly, the presence of bilateral notching of the uterine artery was more specific in predicting PE (79%) compared to unilateral notching (Table ​ (Table3 3 ).

RI: resistance index; TP: true positive; FP: false positive; FN: false negative; TN: true negative; PPV: positive predictive value; NPV: negative predictive value

Different studies have reported varying frequencies of PE and related findings on Doppler U/S [ 10 ]. A study has observed high impedance flow in the uterine artery in about 40% of pregnant mothers, who subsequently developed PE [ 11 ]. It has also been reported that after a positive ultrasound scan on notching or impedance to flow of uterine arteries, the likelihood for PE increases by about two folds. Since PE is regarded as the most common cause of maternal mortality and morbidity, an accurate identification or prediction of PE, especially in high-risk mothers, is vital for providing timely intervention, which may prove crucial in improving maternal as well as fetal outcomes [ 12 ].

Another study has reported a PE frequency of 11.5% in which RI was >0.58 and the mothers were in-between 18-24 weeks of gestation [ 13 ]. In yet another study, 6% of mothers were found to have PE in between 20-24 weeks of gestation and an RI >0.58 [ 14 ]. However, in our study, a much higher rate of 76.7% was observed in terms of PE in between 20-26 weeks of gestation. Similar to our study, one research has reported a PE rate of 55% in mothers who had uterine artery notch bilaterally at 24 weeks of gestation, which increased to 81% at the time of delivery, with all such mothers giving birth prior to 35 weeks of gestation [ 15 ].

In this study, for the Doppler index of unilateral/bilateral RI >0.58, the sensitivity, specificity, PPV, and NPV were 71%, 26%, 74%, and 24%, respectively; for bilateral RI >0.58, those were 41%, 63%, 77%, and 27%, respectively. For unilateral/bilateral uterine artery notch, these parameters were 71%, 89%, 95%, and 52%, and for bilateral notch, these were 32%, 79%, 84%, and 28%, respectively. Compared to our study, another study has observed that the PPV in the notch of the uterine artery was 25%, with PE frequency reported in 18% while the sensitivity, specificity, PPV, and NPV in RI >0.58 were 41%, 96%, 70%, and 88%, respectively. Likewise, the values for bilateral uterine artery notching were 62%, 89%, 47%, and 94%, respectively. Various studies have reported PPV ranging from 35 to 60% and NPV ranging from 70 to 95% on the basis of PE diagnosed or predicted using Doppler U/S rather than assessing PE risk clinically [ 16 ].

One study has reported the prevalence of PE to be 58% among high-risk mothers who developed hypertension [ 17 ]. In yet another research, the abnormal Doppler ultrasound finding were reported in 11.3% of mothers with sensitivity, specificity, PPV, and NPV for PE at 36%, 90%, 11%, and 98%, respectively [ 18 ].

Similar to our study, some other studies have also observed that previous history of PE, smoking, nulliparity, first-trimester BMI >30 kg/m 2 , and a positive family history of PE are all risk factors for PE. In addition, with the introduction of Doppler U/S as a screening test for predicting PE, it has now become a test of prime importance [ 19 ].

Limitations of this study include the small sample size, retrospective study design, and the fact that data were drawn from a single institution only. Therefore, we recommend large-scale prospective studies to better understand the role of Doppler U/S in predicting PE.

Conclusions

Based on our findings, using Doppler U/S for predicting PE by determining the notching of the uterine artery and its RI was successful in terms of abnormal uterine artery notching or high RI (>0.58), and it led to predicting PE in a majority of the patients. However, as our study was retrospective in design with a limited sample size, more large-scale prospective studies are recommended to validate these observations among our population.

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The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.