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Objective: To explore the potential of ultrasound imaging to anticipate and monitor future symptoms of patellar or Achilles’ tendinopathy. Method: The systematic review comprised prospective studies that used ultrasound imaging of Achilles’ OR patellar tendons in asymptomatic patients at baseline and measurements of pain and/or function at follow-up. The Critical Appraisal Skills Programme checklist used to assess study quality and it was done by two independent reviewers. Results: Of the 19 studies reviewed, 9(47.3%) investigated patellar tendon alone, 6(31.5%) did both patellar and Achilles’ tendon, and 4(21.2%) did Achilles tendon alone. The method of ultrasound administration was almost uniform for both the tendons. The studies showed that the use of ultrasound to predict lower limb tendinopathy was indefinite, but that a higher proportion of tendon disorganisation increased the risk of developing tendinopathy. In addition, promising results were obtained for the use of ultrasound in both Achilles’ and patellar tendinopathy in monitoring the effect of load or treatment on tendon structure. Conclusions: The included studies had participants from different sports. Tendon irregularities at baseline on ultrasound were related to increased risk and future occurrence of both patellar and Achilles’ tendinopathy. Key Words: Ultrasonography, Tendinopathy, Achilles’ tendon, Patellar tendon.

We conducted a systematic review of the literature that has examined carotid arteries using ultrasonography in order to better explain the association between diabetes, hypertension, and intima-media thickness (IMT). The goal of this study was also to get a precise evaluation of increasing intima-media thickness predictive value for clinical cardiovascular outcomes. From 2000 through 2021, we searched the Google Scholar, NCBI, PubMed, and Medscape databases. The following essential keywords were looked up: ultrasound of carotid arteries, ultrasound of common carotid arteries intima-media thickness, and carotid IMT in diabetes and hypertension. Of the 135 retained studies the percentage of detection was used to calculate the diseases that affect intima–media thickness. As a result following were the causes that alter intima–media thickness: diabetes and hypertension at 81.4 % and 80 % respectively. Coronary artery disease at 21.4%, dyslipidemia and stroke at 14.8% and 5.2% respectively. Microalbuminuria at 3%. However, non-alcoholic fatty liver disease, peripheral arterial disease (PAD) and chronic kidney disease (CKD) at an equal effect of 2.2%, MI at 1.5%. Breast arterial calcification, polycystic kidneys and glomerulonephritis at an equal effect of 0.7%. In conclusion, patients with hypertension and diabetes are most at risk of developing coronary artery disease.

Preocclusive stenosis of the common carotid artery is a rare and potentially life-threatening entity, and the early recognition of associated internal and external carotid artery patency is important for the management plan. The patient in this case report was sent for a thyroid ultrasound for complaints of neck pain, voice change, and dysphagia, and a preocclusive stenosis of the left common carotid artery was found. Multiple collateral pathways had developed to supply blood flow to the left internal carotid artery, and there was retrograde flow in the external carotid artery and antegrade flow in the internal carotid artery. Collaterals from the left thyrocervical trunk were supplying the superior thyroid artery which supplied the external carotid artery and finally the internal carotid artery through the carotid bulb. Doppler ultrasound is valuable in the identification of preocclusive common carotid artery stenosis and mapping of collateral pathways.

Obesity is a disease and acts to develop myriad of clinical condition. Along with causing other diseases it renders difficulties in some physical and imaging examination of obese patients as a challenge. Therefore, the consistency of results has a great deal of variation for sonographer. Objective: Study was aimed to evaluate the interobserver agreement in the fetal biometry among normal and obese mothers. Methods: The study includes obese and normal pregnant females with single alive without any anomaly or growth retardation fetus. Low frequency convex array transducer is used. Total 140 Patients were included and categorized according to BMI. Inter item correlation, ICC and CRC were calculated for all variables. Bland-Altman plots were constructed. T-test was applied p-value 0.05 considered significant. Results: It was observed that the variation in normal and obese pregnant ladies in third trimester is not significant and a strong agreement between the observers in both normal and obese. Conclusion: Obesity causes many problems in sonographic fetal biometry. It was observed that the variation in normal and obese pregnant ladies in third trimester is not significant and a strong agreement between the observers in both normal and obese categories.

Background: Transvaginal Sonography provides high-resolution images with high reliability and is typically used for the diagnosis of intrauterine pregnancy and ectopic conception. The extra-uterine pregnancy responsible for morbidity and mortality in First Trimester and is 80 percent accounts for maternal death. Doppler ultrasound is a safe and non-invasive technique in the evaluation of uterine artery flow patterns. It can calculate the indices like Resistivity index and Pulsatility index in numerical value. It is also observed that there are changes noted between the uterine artery indices in normal intrauterine and extrauterine pregnancies. However, it is important to compare them in normal intrauterine and extrauterine pregnancies. Objective: To compare the trans-vaginal sonographic Doppler indices of the uterine artery between normal and ectopic pregnancies confirmed by maternal serum Beta-hCG. Methodology: This case-control study was conducted at Shireen Ultrasound Clinic Peshawar, KPK Pakistan. This study enrolled a purposive sample of 80 (40 ectopic & 40 intrauterine) pregnant female patients with age 18 to 45 years. The examination was performed with Toshiba Nemio 20(Xario Prime with TVS Probe frequency range 7-14MHz). The Resistive index, Pulsatility index, mean and standard deviation were calculated for the continuous variables. Results: In normal early pregnancy, the mean RI of the right uterine artery was 0.53±0.10 and the mean RI of the left uterine artery was 0.52±0.07. In the cases of (ectopic pregnancy), the mean RI of the right uterine artery was 0.73±0.08 and the mean RI of the left uterine artery was 0.78±0.10. The p-value of the right and left uterine arteries in normal intrauterine and extrauterine ectopic pregnancies were significant at 0.05 level. Conclusion: The resistivity index of uterine arteries is significantly high in ectopic conceptions than in normal intrauterine pregnancies. But there was no significant change in PI of normal intrauterine and ectopic pregnancies. Keywords: adnexal mass, ectopic pregnancy, Transvaginal ultrasound, tubal pregnancy.

Background: All disturbed pattern of bleeding which arises due to different reasons such as anovulation, pregnancy, uterine abnormalities and coagulopathies is termed as abnormal uterine bleeding (AUB). Abnormal uterine bleeding is present in many forms such as heavy bleeding, short menstrual cycle, excessive and heavy menstruation, uterine bleeding at irregular period, excessive and prolonged uterine bleeding. Abnormal uterine bleeding is mostly caused by benign findings such as endometrial hyperplasia or atrophy or benign polyps. Around 5–12% of Abnormal uterine bleeding results from Endometrial Cancer. Objective: Uterine artery Doppler indices in various causes of abnormal uterine bleeding confirmed with histopathology. Methodology: A Cross-sectional Analytical study was conducted at Shireen Ultrasound Clinic Peshawar, Pakistan. This study enrolled a purposive sample of 162 patients presenting with abnormal uterine bleeding with the age between 18 to 80 years. The examination was performed with Toshiba Nemio 20(Xario Prime with TVS Probe frequency range 7-14MHz) .The Resistive index(RI), Pulsatility index(PI), mean and standard deviation were calculated for the continuous variables. Results: A total of 162 patients were enrolled in our study. The mean age of patients was recorded 38±5 years. In this study, the histopathological findings were as follow, 8.6% adenomyosis,12.3% endometrial hyperplasia, 43.3% leiomyoma’s, 17.3% polyp, 2.5% endometrial carcinoma and 16% non-specific findings so the most common cause of abnormal uterine bleeding was leiomyoma’s with mean of Right Uterine artery (U-A) PI and RI was 3.33±1.23 and 0.83±0.03 respectively and left U-A PI and RI was 2.95±1.17 and 0.84±0.03 respectively while the least common cause was endometrial carcinoma with mean of Right U-A PI and RI was 2.54±1.08 and 0.52±0.01 respectively and of Left U-A PI and RI was 1.62±0.00 and 0.52±0.00 respectively. Conclusion: From our study we concluded that the uterine artery RI in endometrial carcinoma causing abnormal uterine bleeding is low and in benign condition like polyp, hyperplasia and fibroids is high. Keywords: Uterine bleeding, Carcinoma, Fibroids, Hyperplasia, Trans-vaginal ultrasound

Ovarian biophysical profile refers to assessment of ovaries to produce a successful conception and implantation environment. The ovarian scoring system for reproduction comprises the following parameters, taken in mid-cycle: ovarian volume, follicular size, and ovarian artery Doppler flow Resistive index and pulsatility index. Objective: To determine the diagnostic accuracy of sonographic transvaginal ovarian biophysical profile as a predictor of infertility taking transvaginal ultrasound as gold standard. Material and methods: The study comprised women visiting the department with diagnosed infertility for treatment during the period of two years. A total of 550 cycles were inducted primarily referred for ovarian assessment by ultrasound with patent tubes and normal utero-ovarian morphology. All those women having no conception with normal semen analysis of their husbands. Male factor infertility was also excluded. Baseline transvaginal sonography (TVS) was performed at proliferative phase, of the cycle. Mature follicles were studied by TVS. On an individual basis, the following parameters, that is, follicle size, ovarian volume and ovarian artery Doppler Pulsatility index, Resistive index were studied. Follicle size and ovarian artery Doppler flow were highly significant for a pregnancy. Results: The Ovarian biophysical profile was determined by applying the ovarian scoring system for reproduction (OSSR). In this research we compare infertile females with fertile. Out of 550 patients 243 (44.18%) patients were infertile and 307 (55.82%) were normal were discussed, as for as the primary infertile females were 99 (18.00%) and secondary infertile females were 144 (26.18%) and normal were 307 (55.82%). Out of five hundred and fifty cycles 331 woman had a perfect ovarian biophysical profile score of 10. The mean score of fertile was 9.39 ±1.56 and in infertile female was 7.05±2.55. The p- values

Shoulder impingement is the painful entrapment of the soft tissues in the shoulder outlet. Currently, dynamic sonography of the shoulder is the modality of choice for the evaluation of shoulder impingement syndrome. However, the current sonographic criteria for the evaluation of shoulder impingement is more subjective (operator dependent). And it is rather difficult for a novice observer to diagnose it. The measurable distance between acromion and greater tuberosity is during shoulder abduction is considered for shoulder impingement syndrome. Objective: To estimate the accuracy of the acromion to greater tuberosity distance in shoulder abduction as a sonographic diagnostic parameter for the shoulder impingement syndrome. Methods: Seven hundred and seventy-two shoulders were observed in this study. All the shoulders were evaluated with Toshiba Xario Prime ultrasound Unit with linear transducer 7-14MHz. Acromion to greater tuberosity distance was measured during the abducted arm. All the shoulders with measurable distance during abduction were declared as positive for impingement while unmeasurable distance due to disappearance of the greater tuberosity underneath the acromion was normal. Results: At 95% confidence interval, the sensitivity, and specificity with lower and upper limits, of the acromion to greater tuberosity distance during abduction for the diagnosis of shoulder impingement syndrome were 0.9731% (95.25 to 98.49%) and 100% (98.49 to 100%) respectively. While the positive-predictive and negative-predictive value were 100% (98.22% to 100%) and 97.12% (94.96% to 98.37%) respectively. However, the overall Accuracy at 95% confidence interval was 98.45% (97.30% to 99.20%). There was a high-grade interobserver (novice and expert) agreement in the diagnosis of shoulder impingement through this criteria with a Kappa value of 0.96. Conclusion: Sonographically measurable acromion to greater tuberosity distance in abduction is a more accurate, reliable, and objective technique for the diagnosis of shoulder impingement syndrome.

Objective: Comparison of Placental Elasticity and different spectral Doppler indices in normal and intrauterine growth restricted fetuses to establish efficacy of shear wave elastography in early detection of Intrauterine Growth Restricted (IUGR). Design: Cross sectional comparative. 290 pregnant women previously diagnosed by ultrasound as normal and intrauterine growth restriction fetuses which were included in this study, placental elasicity in both groups was evalauted by SWE (shearwave elastography) and compared. Methods: Primarily both groups were scanned for grayscale and Color Doppler ultrasonography in which we took the measurements of resistivity and pulsatility indices of umbilical artery (UA), uterine artery and MCA (middle cerebral artery). In these groups placental elasticity was evaluated by SWE .The ratios of strain were compared between both groups. Statistical study was carried out by using Mann-Whitney test. Cut-off values for elasticity were analyzed by plotting receiver operative characteristic curve (ROC), sensitivity. Specificity and DA (diagnostic accuracy) for IUGR were designed established on Shear wave elastography measurements. Results: The mean placental elasticity in intrauterine growth restriction (IUGR) and in normal groups was 28.71+7.28 and 5.64+1.53, respectively while in the IUGR group median placental elasticity was 27+7 and 5.50+2 with statistically elevated median among patients in the IUGR group (P

Background: Pain in knee joint is prime cause of disability particularly among postmenopausal women. Ultrasound is a non-invasive and safe imaging modality for the evaluation of knee joint pathologies. Objective: To prove multiparity as a potential cause of femoral cartilage thinning inside knee joint causing pain in postmenopausal women. Methodology: Two hundred knee of 100 postmenopausal women of various parity were conveniently selected. Patients with all other risk factors of the knee joint pain which acts as effect modifying factors were excluded. Femoral articular cartilage was measured at the lateral, central and medial aspect of the knee joint and their average was calculated. Results: 51.12 ±4.46 years was the mean age of patients (ranging from 46 to 60 years). A strong negative relation was found between the parity of the patient and the femoral articular cartilage thickness at the lateral, central and medial aspect of the knee joint of all the patients with a p-value less than 0.1. Significant variation was observed in the femoral articular cartilage thickness in various parties. Conclusion: The femoral articular cartilage decreases in size significantly with an increase in the number of deliveries (parity). So, multiparity is one of the potential causes of femoral cartilage degradation in knees joint.

Objective: To determine the reliability of knee joint sonography in the evaluation of gouty arthritis. Methodology: A search of Google Scholar, PubMed, NCBI, MEDLINE, and Medscape databases, from 1988 up to 2020. The key search terms used were knee joint; knee joint ultrasound; gout; gouty arthritis, knee joint pain; sensitivity; specificity. The reviewer independently screened the titles and abstracts of the relevant articles and full text downloads to determine whether the inclusion or exclusion criteria were met. Results: In total, 103 articles were identified through the database search. In addition, 11 articles were identified through other sources. Then, screening was performed, and 9 articles were removed due to duplication. Further screening was done for 105 articles, and 27 articles were excluded due to insufficient information. Seventy-eight full-text articles were assessed for eligibility. A total of 13 full-text articles were excluded due to research performed on animals, as the study had been designed as a review of only human studies. Sixty-three studies were included that had a qualitative synthesis. Conclusion: The knee is a weight bearing joint and may be affected by a myriad of different pathological conditions, therefore a proper diagnosis is of prime importance for a proper management plan. Ultrasound is a non-invasive, radiation-free, and readily available modality that has high sensitivity and specificity in the evaluation of gouty arthritis.

Objective: Female infertility may be a commonly encountered problem that presently accounts for a great percentage of women seeking gynecologic services. A systematic review was preformed to evaluate the most common cause of infertility, using sonography. Materials and Methods: A search was executed with Google Scholar, PubMed, NCBI, and Medscape databases, from 2001 to 2020. Two investigators independently reviewed and assessed those studies for eligibility. The data were tabulated in a Microsoft Excel sheet. The Statistical Package for the Social Sciences (SPSS), version 24 software was used to evaluate the data. Results: Out of 70 studies, the contributing factors, detected with sonography, for infertility were as follows: polycystic ovarian syndrome (PCOS), 44.9%; fibroids, 43.6%; endometriosis, 33.3%; polyps, 29.5%; adhesions, 29.5%; pelvic inflammatory disease, 23.1%; ovarian cysts, 23.1%; congenital anomalies, 20.5%; and adenomyosis, 11.5%. Conclusion: The most common cause of infertility, detected with sonography, was PCOS, and the least contributor to infertility was adenomyosis.

Objective: The objective of this study was to determine the hemodynamic changes in the umbilical artery (UA) and middle cerebral artery (MCA) with oligohydramnios, during third trimester of pregnancy. Materials and Methods: A cross-sectional descriptive study was done in a perinatal ultrasound center, over a 9-month period. The participant sample size was 64, and all of the women were conveniently consented and selected for the study. All individuals were referred for obstetrical sonography in the third trimester, with oligohydramnios. All fetal anomalies, such as a neural tube defect, dwarfism, an abdominal wall defect, were excluded from the study. Results: The mean systolic to diastolic (S/D) ratio for the UA was 3.01, within a range of 1.49 to 5.60 (± 0.79 SD). The mean pulsatility index (PI), of the UA, was 1.11, within a range of 0.41 to 5.51 cm (± 0.64 SD). The mean resistive index (RI) of the UA was 0.66, within a range of 0.33 to 1.25 cm (± 0.13 SD). The mean S/D ratio of the MCA was 5.68, within a range of 2.05 to 26.10 (± 3.10 SD). The mean PI of the MCA was 1.67 within a range of 0.75 to 2.55 cm (± 0.45 SD). The mean resistive index (RI), of the UA, was 0.82 within a range of 0.51 to 1.77 cm (± 0.82 SD). Conclusion: The Doppler indices may rise as pregnancy advances, especially in fetuses with oligohydramnios. In these types of patients, the flow within the MCA may decrease, with an increase in the gestational age. Consequently, it appears that oligohydramnios may lead to vascular remodeling of the UA and MCA.

Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.

Objective: Focused assessment with sonography for trauma (FAST) is a widely used imaging technique for the diagnosis of blunt abdominal trauma and has its limitations and advantages. A meta-analysis was completed to evaluate the reliability of FAST, in the diagnosis of blunt torso trauma. Materials and Methods: A search was completed with Google Scholar, PubMed, National Center for Biotechnology Information (NCBI), MEDLINE, and Medscape databases, from 1993 up to 2020. Eligible studies were included for information about FAST examination of abdominal trauma. The animal research was excluded from this review process. The eligible studies were first categorized and then data analysis was performed, according to specific pathologic conditions. This literature review retrieved studies’ sample size, application, sensitivity, and a specificity of diagnosis using FAST for abdominal trauma. Results: In total, 100 articles were identified through the database search. Besides, five articles were identified through other sources. Then, screening was performed, and as such, 46 published studies were included that had a qualitative synthesis. Conclusion: FAST has a high sensitivity and specificity in the diagnosis of blunt abdominal trauma. However, a large range of sensitivity and specificity of FAST in the evaluation of torso trauma reveal that sonography is operator, technique, and equipment dependent.

Aim: To see the predictability of the shear wave elastography assessment of placental elasticity (kpa) for early detection of hypotrophic fetuses Design: Cross sectional comparative.300 single tone pregnancies previously diagnosed as normal and hypotrophic fetuses were included, the placental elasicity assessed by shear wave elastography of both groups and compared. Methods: We took biometric measurements and Doppler indicis of the uterine, umbilical, and middle cerebral arteries in both groups and screened them for grayscale and colour doppler ultrasonography. The placental elasticity was measured by Shear wave elastography in these groups .The comparison of strain ratios between these groups were done. Statistical analysis was carried out using the Mann-Whitney test. By plotting ROC curves, cut-off values for elasticity were analysed. On Shear wave elastography measurements, the sensitivity and specificity and diagnostic accuracy of hypotrophic fetuses were planned and developed. Results: The mean placental elasticity in hypotrophic fetuses and normal group was 28.71 ± 7.28 and 5.64 ± 1.53 respectively while the median placental elasticity in IUGR group was 27 ± 7 and 5.50 ± 2 with statistically higher median in hypotrophic groups, p-value < 0.001. Conclusion: In hypotrophic fetuses, as placental stiffness values are much higher, therefore for early detection of compromised hypotrophic fetuses , as a non-invasive, supplementary tool to gray-scale and Doppler, the Shear-wave elastography can be used. Keywords: Hypotrophic fetuses, Shear-wave elastography, Placental Elasticity (kpa), IUGR, Uterine artery, Umbilical artery, Middle cerebral artery, resistive index, pulsatility index

Background: Pyelonephritis is a renal inflammatory condition diagnosed with patient’s history, physical examination and imaging studies. Although laboratory finding, clinical sign and symptoms are considered for the diagnosis and treatment. Aim: To compare the sonographic findings of pyelonephritis with urine complete examination Methodology: A Cross sectional analytical study was conduct at Gilani Ultrasound Center, Ferozepur Road, Lahore and routine urine examination was performed in the Sanabil Health Services Hospital, Khayaban-e-Quaid, Lahore. Entirely comprised patients were queried concerning variables such as gender, age, clinical history, grey scale ultrasound findings, Doppler ultrasound findings and lab findings. Patients were enquired to lie down as well as depiction Abdomen. Results: Out of 138 patients, 77 were males and 61 were females, maximum age of patients was 77 years and minimum was 18 years, 75 (54.3%) patients with clinical history of pyelonephritis, 67 patients were with lab findings that support pyelonephritis and 71 patients had no lab findings. Out of 138 patients, 67(48.6%) patients had right kidney acute pyelonephritis and 65(47.1%) had left kidney acute pyelonephritis. Conclusion: The study concluded that there was an important association among the Urine complete examination as well as sonographic findings in the evaluation of acute pyelonephritis. However, the clinical and ultrasound findings in acute Pyelonephritis do not play a significant role but these findings can be helpful in chronic cases of Pyelonephritis. Key words: Acute pyelonephritis, Ultrasonography, Urine complete analysis, Routine urine examination

Background: The Presence of palpable breast mass may be an indication of breast cancer. Early and accurate diagnosis for the breast masses is important for therapeutic purpose. Purpose: To assess the diagnostic accuracy of mammographic and sonographic findings in the differentiation of palpable breast masses taking histopathology as a gold standard. Materials and Methods: 134 females were involved in the study. Sonographic and mammographic findings of palpable breast masses were obtained with the help of which diagnostic accuracy of ultrasound and mammography was calculated while taking histopathology as a gold standard. Results: Mean age in 134 females was found to be 44.2±4.7 years. Sn, Sp, PPV, NPV, disease prevalence and accuracy of ultrasound in diagnosis of palpable breast lumps were 99.09%, 79.17%, 95.61%, 95.00%, 82.09% and 95.52% respectively. Sn, Sp, PPV, NPV and accuracy of mammography in diagnosis of palpable breast lumps were 95.45%, 62.50%, 92.11%, 75.00% and 89.55% while disease prevalence was same as that of ultrasound i.e. 82.09% respectively. Conclusion: Ultrasound showed higher diagnostic accuracy in the evaluation of palpable breast masses than mammography while taking histopathology as a gold standard. It is noteworthy in differentiating breast masses.

Objective: Diabetes can lead to diabetic retinopathy, which damages the retina due to blood flow remodeling of occular vessels. Early stages of diabetic retinopathy may not present with patient symptoms. Doppler indices, of the ophthalmic arteries, could help in determining the effect of diabetic vascular remodeling. This research was designed to compare the Doppler indices, in the ophthalmic artery and central retinal artery, in both diabetic and nondiabetic patients. Materials and Methods: This was a cross-sectional observational study of 72 total patients. Sonography was performed on the ophthalmic arteries of 36 diabetics and 36 nondiabetics, to compare Doppler indices. All patients were voluntarily consented to this research that was approved by the university’s Institutional Review Board (IRB). Doppler parameters recorded were peak systolic velocity, end dystopic velocity, resistive index, and pulsatility index, which were taken in both patient groups and compared. Results: A significant difference was noted in the ophthalmic artery peak systolic velocity, end-diastolic velocity, pulsatility index, and resistive index for diabetic and nondiabetic individuals, with a statistically significant set at .01. Conclusions: There was a significant difference between diabetic and nondiabetic ophthalmic Doppler indices in this cohort of patients. This cohort demonstrated vascular remodeling of the ophthalmic arteries, caused by diabetes; therefore, blood flow resistance was increased due to diabetes.

Objective: The purpose of this literature search was to review the benefits of high-intensity focused ultrasound (HIFU) and its application for different pathologies. Methods: This review summarizes the implementation of HIFU for different pathologic conditions. An National Center for Biotechnology Information, PubMed, MEDLINE, Medscape, and Google Scholar database search (1992–2016) was done with the following keywords: high-intensity focused ultrasound; uses of HIFU; and applications of HIFU in the liver, bones, uterine fibroids, prostate, breast, thyroid, pancreas, kidneys, brain, urinary bladder, and so on. Tables and graphs were created for all the variables included in the study, and descriptive statistics were applied. Results: In total, 110 records were identified, through database search. In addition, 20 articles were identified through other sources. Screening of the articles was performed, and 20 were removed due to duplication; further screening was performed for 110 articles, and 30 records were further excluded. Full-text articles were assessed for eligibility and 30 were retained. Full-text articles were excluded (N = 36) on the basis that research was performed on animals, and this review article was performed solely for human application. There were 42 qualitative syntheses that researches added to the review. In addition, 42 quantitative synthesis (meta-analysis) were added to the review. Conclusion: The conclusion of this narrative review indicates that HIFU is noninvasive, nonharmful, and effective in treating diseases and tumors of the brain, breast, bone, hepatic, renal, pancreas, and prostate; uterine fibroids; and many other solid tumors. Recent technological development suggests that HIFU is likely to play a significant role in future surgical practices. Further research works should be conducted on a large sample size to obtain more accurate results in the application of HIFU.

Objective: To determine the use of sonography and test-feeding in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS). Methodology: A total of 79 infants from 2 weeks up to 12 weeks presenting with clinical signs (projectile vomiting) of IHPS were included in the study while sent to sonography. The study duration was February 2014 to December 2019. Results: The mean age of patients was 5.18 ± 2.69 weeks ranging from 1 to 12 weeks. Male gender was predominant with 62 (78.5%) cases. Of the total 79 cases, 36 (54.6%) were suggested as positive cases of IHPS and 43 (54.4%) were as normal with sonography. Most of the cases of IHPS (23; 29.1%) were observed in firstborn babies. Mean pyloric length in normal and IHPS was 12.69 ± 0.87 and 20.78 ± 2.28 mm, respectively, and mean pyloric muscle thickness in the normal and IHPS was 2.24 ± 0.36 and 5.27 ± 0.82 mm, respectively, while mean pyloric diameter in normal and IHPS was 12.69 ±0.87 and 15.01± 2.52 mm, respectively. Conclusion: The reliability of sonographic findings was better than test-feeding in the diagnosis of IHPS. Male infants, in this cohort, were five times more susceptible to develop IHPS, compared with females.

Objectives: To sonographically assess uterine leiomyoma among pregnant women. Study Design: Cross-sectional Descriptive study. Setting: Gilani Ultrasound Center, Ferozepur Road Lahore. Period: Sep to Dec 2019. Material & Methods: The sample size was all the pregnant women with fibroid. Ultrasound machine Honda 2000 HS and Toshiba xerio x4 were used. Results: Out of 73 patients, 47(64.4%) had fibroid at the anterior wall of the uterus, 14(19.2%) patients had fibroid at the posterior wall of the uterus, 5(6.8%) patients had submucosal fibroid, 2(2.7%) patients had fibroid in the lateral wall of the uterus, 2(2.7%) patients had fibroid at fundal region of the uterus and 1(1.4%) of each had fibroid in cervix, lower uterine segment and subserosal. Conclusion: The findings of this study concluded that the anterior wall of the uterus is more favorable for leiomyoma in pregnant women.

Prune belly syndrome is a rare disorder characterized by the absence of anterior abdominal wall muscles, bilateral cryptorchidism, and urinary tract malformations. The aim of this case study was to illustrate the developmental sequelae of prune belly syndrome, acquired through a series of antenatal sonography. A 20-year-old woman visited a diagnostic medical sonography center for an obstetrical sonogram. Her fetus was diagnosed with megacystis at 15 weeks’ gestation. The mother returned for repeated appointment and to observe fetal changes during the development of prune belly syndrome. First, the megacystis, hydroureter, and hydronephrosis were noted followed by hazy ascitic and amniotic fluid. The hemodynamics were altered in the umbilical artery, middle cerebral artery, and ductus venosus. Subsequently, the pressure was neutralized, but it was observed after birth that the newborn had cryptorchidism, a distended abdomen with wrinkled wall, and absent right kidney. In conclusion, prune belly syndrome could be caused by megacystis due to bladder outlet obstruction in otherwise normal karyotype fetuses. Megacystis leads to hydroureter, hydronephrosis, and abdominal distention. The persistent abdominal distention gives rise to the underdevelopment of anterior abdominal wall muscles and cryptorchidism.

Infertility is a worldwide social, economic, and psychological problem. It can be caused by various factors including age, mental health, polycystic ovarian syndrome, ovarian failure, and defective endometrial receptivity. Endometrial receptivity is the preparation and thickening of the endometrium. Objective: To correlate the uterine artery resistive index with endometrial thickness among the females of primary infertility. Methods: A cross-sectional analytical study was conducted at Gilani ultrasound center from December 2017 to May 2018. A total number of 104 women including, 52 fertile and 52 infertile, aged between 18-50 years were selected. Statistical analysis was performed through SPSS version 25.0. Results: Among 52 fertile women, mean endometrial thickness was 8.29±0.63mm while the mean resistive index of the uterine artery was 0.78±0.070. Among 52 infertile women, mean endometrial thickness was 7.42±2.65mm while the mean RI of uterine artery was 0.78±0.047. A non-significant association was found between RI of uterine artery and endometrial thickness of infertile participants (p=0.100). Conclusions: Hence, the study concluded that there was nonsignificant correlation found between endometrial thickness and resistive index of the uterine artery among infertile participants

Low fetal weight (LFW) is an important symbol in public health, as it can help predict health outcomes in later life. At international level, LFW is considered as weight under 2500 grams or 5 pounds 8 ounces. Objective: To determine the association of advanced maternal age with low sonographic fetal weight. Methods: This was an observational descriptive study with a sample size of 104 advanced age pregnant women, conducted in Mansura Teaching Hospital Lahore. The present study was conducted in 6 months duration. All the primigravida and multigravida pregnant women's aged ≥35years were included, pregnant women aged

Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation. Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation.

Objectives: To determine sonographic association of uterine fibroids with infertility among women of childbearing age. Study Design: Cross-sectional study. Setting: Gilani Ultrasound Clinic opposite Lahore General Hospital, University of Lahore. Ahsan Diagnostic Centre, Sialkot. Period: From 10th July to 10th October 2018. Materials & Methods: The study was started after the approval of ethical committee of the University of Lahore. All the patients were enrolled in this study after signing the informed consent form. Toshiba Xario and Medison Accuvix V20 with convex transducer frequency ranging from 2 to 6 MHz were used. Fibroids were evaluated through trans-abdominal scan and sonographic data was stored in the ultrasound machine. A convenient sampling technique was used and data was further analyzed with the help of Statistical Package for the Social Sciences version 24 (SPSS 24, IBM, Armonk, NY, United States of America). Results: Among 113 subjects, the incidence of uterine fibroid was 32.7%. A significant association (p-value=0.010) was seen between existence of fibroid and the type of Infertility. The mean size of the fibroids was found to be 32.3568mm, 26(23.0%) of participants had single while 11(9.7%) of them had multiple fibroids. The location was most commonly seen in anterior and posterior wall, whereas the most common type was found to Sub-Mucosal and Sub-Serosal. Conclusion: Uterine Fibroids were commonly associated with Secondary infertility as compared to primary infertility.

Objective To determine the correlation between portal vein diameter and spleen size (craniocaudal). Methodology The study was conducted at the University Ultrasound Clinic, The University of Lahore, Lahore Pakistan from 1st January to 1st July 2013. All the individuals who referred for abdominal sonographic examination, including male, female, older and younger were conveniently included in the study, voluntarily, irrespective of the disease state. Ultrasonographic measurements of the caudocranial length of the spleen and portal vein were carried out on all of the one thousand subjects. The subject position for spleen was supine or right posterior oblique during suspended inspiration and right anterior oblique position for portal vein diameter with quiet respiration. The correlation between the splenic length and portal vein diameter was evaluated. Result A total of 1000 subjects; 36.9% females and 63.1% males aged from 4 to 79 years. The mean splenic length was 10.29 ± 1.89 cm. The mean portal vein diameter was 10.27 ± 1.78 mm. A statistically significant correlation was found between the spleen size and portal vein diameter; the Pearson correlation was significant at the 0.01 level. Conclusion Portal vein diameter is directly correlated to splenic caudocranial length. A regression formula was developed to measure the splenic length from the calculation of portal vein diameter.

Background: The incidence of Cholelithiasis is definitely recognized through propelling ages, as gallbladder stones are unordinary in individuals more young then 30 years for the most part with the recurrence running from 10 to 20% of the aggregate population. It represents a major burden for healthiness global and are one of the most widely recognized issue presenting to emergency room. Ultrasound is perceived as the highest quality level for diagnosing gallstones.Objectives: The present study was aims to establish the sonographic incidence of Cholelithiasis in the individual with positive family history.Material and Method: The Cross sectional study was included 130 patients. This study was conducted at the Department of Radiology in Khyber Teaching Hospital Peshawar, Pakistan. The duration of study was from 15 July to 15 October 2019. Data was analysis by Statistical Software for Social Sciences “SPSS version 24”. Results: Overall 130 patients included in this study. Out of 130, female individuals was 85(65.4%) and male 45(34.6%). Epigastric pain was in all individuals 130(100%). Out of 130 patients, gallstones found in 76(58.4%) patients, in which males are 21(16.2%), females 55(42.3%) and the remaining 54(41.5%) patients had no stone. In 130 patients, 37(28.5%) had positive family history and 93(71.5%) negative family history.Conclusion: It is suggested that all individuals who have epigastric pain should go through process of ultrasonography. The overall prevalence of gallstone disease was 28.5%. The occurrences of gallbladder stones were revealed several folds elevated in female while contrast with male.

The fetal Kidney length can be used in estimation of gestational age. In late 2nd and 3rd trimester both kidneys can be visualized easily and can be measured accurately. In late 2nd and 3rd trimester the fetal kidney length can be used as an investigational tool alone or may be in addition of other parameter in estimation of gestational age. The most commonly used parameters used by sonologist can predict gestational age in 1st and 2nd trimester. But as pregnancy advances, the accuracy of these parameters decreased. The length of fetal kidneys in mm collaborates very nicely with gestational age in weeks Objective: To evaluate that fetal kidney length is a reliable parameter for gestational age estimation in 2nd and in 3rd trimester of pregnancy. Methods: 371 healthy, pregnant females with a normal fetus were included in this study. A standard 2nd and 3rd trimester ultrasound examination was done. In addition to the standard biometric parameters, both fetal kidneys length were also measured. The collected data was subjected to statistical analysis. Results: This study finding confirmed that fetal kidney length can be used as standard parameters alone or in addition with other routine parameters for estimation of gestational age in late 2nd and 3rd trimester. The Pearson correlation coefficient r=0.988 which showed a strong correlation with kidney length and gestational age and p value is (0.00) Conclusion: Fetal kidney length estimates gestational age as accurate as other standard traditional parameters. It is more accurate in late 2nd & 3rd trimesters of pregnancy when other parameters are not much reliable. It is easy to detect and measure. Int. J. Appl. Sci. Biotechnol. Vol 7(1): 108-113

Prediction of gestational age based on sonographic fetal parameters is perhaps the cornerstone in modern obstetrics. The transverse cerebellar diameter serves as a reliable predictor of GA in the fetus and is a standard against which abnormalities in other fetal parameters can be compared. A variety of sonographic fetal biometric parameters can be used to assess gestational age in the second and third trimesters of pregnancy. The TCD is an additional biometric parameter against which aberrations in other fetal parameters can be compared. Objective: To assess the predictability of GA calculated by fetal TCD measured in 2nd & 3rd trimester of pregnancy on ultrasound. Methods: This was an cross-sectional study with a sample size 371 healthy, pregnant females with a normal fetus included aged 18 to 40 years, conducted in Gilani ultrasound center ferozpur road lahore. A standard 2nd and 3rd trimester ultrasound examination was done. In addition to the standard biometric parameters, the transcerebellar diameter was also measured. The collected data was subjected to statistical analysis. Results: Pearson product-moment correlation coefficient method was applied at a significance level of 1% (α = 0.01).using statistical software SPSS version 23.0. It was observed that BPD and TCD had a statistically significant, strong, linear correlation (r=0.976), GA of FL (r=0.978), LMP (r=0.976) P value (0.000) were considered significant. Conclusion: The TCD is a reliable parameter for the determination of GA in the 2nd & 3rd trimesters of pregnancy. Int. J. Appl. Sci. Biotechnol. Vol 6(4): 379-385

Background: Nephrolithiasis is a widespread disease with an incidence of 17-13 in North American, 5-9% in Europe, and 1-5% in the Asian continent. Plain abdominal radiography is used to visualize renal stones, but the cysteine stones are often poorly visible, uric acid and mixed stones are not visible at all. The second diagnostic tool for the diagnosis of renal calculus is computed tomography. The CT scout film is often overlooked and did not use for the diagnostic purpose. Objective: To compare Kidney-ureter-bladder radiography with computed tomography scout film for the diagnosis of renal calculi taking axial computed tomography as a gold standard. Materials and Methods: It was a cross-sectional analytical study design conducted on 57 patients presenting with acute flank pain in Faisal Hospital Faisalabad. Patients having ages between 18-60 were included in the study. Pregnant patients and patients with lndinavir therapy were excluded from the study. Results: The sensitivity recorded for CT scout film was 66.7% and for the plain abdominal radiography was 80.7%. The calculus carrying Hounse field unit less than 200 HU were not visualized on both the modalities x-ray and plain abdominal radiography. However, the calculus greater than 5mm in size has a sensitivity of 73% on CT scout film. Conclusion: The sensitivity recorded for CT scout film was 66.7% and for the plain abdominal radiography was 80.7%. The calculus carrying Hounse field unit less than 200 HU were not visualized on both the modalities x-ray and plain abdominal radiography. However, the calculus greater than 5mm in size has a sensitivity of 73% on CT scout film.

Background: Pregnancy has great influence on maternal thyroid gland. It induces significant physiological as well as hormonal changes that alters the maternal thyroid function. Our goal was to determine this pregnancy associated changes in thyroid gland. Objective: To correlate the sonographic findings of maternal thyroid gland with thyroid function tests during pregnancy. Material and methods: 135 pregnant women were recruited in this study, data of TSH, T3 and T4 was obtained and correlated it with the sonographic findings of maternal thyroid gland in each trimester of pregnancy. Results: In the 135 sampled pregnant women, mean thyroid gland volume was 4.08±1.19 cm3. The mean levels of T3, T4 and TSH were v3.37±.44 pmol/L, 14.96±2.49 pmol/L and 1.21±.92 mIU/L respectively. A remarkable correlation between thyroid hormones and thyroid volume was observed. Conclusion: It is concluded that the ultra-sonographic findings is correlated with the thyroid function tests during pregnancy.

Introduction: Fibromyomas are the most prevalent cancers in the female genital tract. Fibroids have benign development in the structural lining of the uterus, consisting mainly of smooth muscles. Fibroids are classified by common names, such as carcinoma, leiomyomata, myoma and fibromyoma. It may be found in various areas of a uterus, thus called due to their position in the uterus. Fibroids range in size from as little as a pea to as wide as ten inches. The association between fibroids and infertility is problematic in discovering the effect of uterine fibroids on infertility. Ultrasonography is a High Standard procedure for the diagnosis of uterine fibroids. The aim of this Observational Analysis is to explore fibroids and their various forms and their effect on infertility. Fibroids affect women in all age categories and whose treatment is important to improve fertility outputs. Purpose: The holistic review is carried out with the aid of numerous empirical studies conducted between 2005 and 2020 on the role on ultrasound Sonographic for the evaluation of uterine fibromyomas and their effects on infertility. Method: Related uterine fibroid partnership and infertility effect via ultrasonographic databases were obtained from MEDLINE, PubMed, Cochrane Library from 2005 to 2020. Randomized control experiments, prospective cohort tests, observational paired trials from well-defined registry data are performed. Multiple systematci analyses are carried out via contextual analysis. Result: A maximum of 2451 research papers and 480 full-text publications are researched and downloaded. There was a substantial risk of bias and low-quality data, but high-quality evidence suggests that using ulrasound modalities is a reliable tool for identifying the effect of uterine fibromyomas on fertility is still contentious. A lot of research have been done, and most of these research offer contentious findings. fibromyomas have an effect on fertility, but it appears that not all leiomyomas induce infertility and a number of treatments, such as myomectomy, uterine fibroids ablation. Conclusion: Ultrasonography is a better choice for initial evaluation and identification in patient with uterine fibromyomas and infertility, becouse it is widely available, relatively cheaper than other imaging ivestigation modalities and is noninvasive as compared with other modalities. Keywords: Ultrasonography, fibromyomas, Transabdominal, Transvaginal, infertility

Background: Now a day’s breast cancer is one of the most common causes of deaths and the most malignant condition among women. Objective: To determine diagnostic accuracy of ultrasound in detection of malignant focal solid breast lesions taking biopsy as a gold standard. Material and methods: This Cross-sectional analytical study was conducted at the department of radiology and pathology of Life Line Hospital. Duration of the study was 9 months after the aproval of synopsis. Ultrasound system (Toshiba Xario) with linear transducer, frequency ranging 7 to 14 MHZ. All 78 participants were scanned while observing international standards of American institute of ultrasound in medicine (AIUM) guidelines for breast sonography. Results: Total 78 females with solid breast lesions were included in this study, out of them 28 (35.90%) were found in right while 50(64.10%) in left side. The distribution of breast lesions in Upper outer quadrant, Lower outer quadrant, Upper inner quadrant, and Lower inner quadrant were 50 (64.10%), 45 (57.49%), 13 (16.67%), 16 (20.51%) and 4 (51.13%) respectively. Mean of the depth to width D/W ration in malignant was 0.78±0.098 (0.42-0.93), while in benign was 0.52±0.141(0.35-0.85). there was a significant difference between the D/W ratio of benign and malignant solid breast lesion. The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy of ultrasound while taking histopathology as gold standard were 94.74%, 95.24%, 98.18%, 86.96%, and 94.87% respectively. Conclusion: Ultrasound can differentiate benign and malignant solid breast lesion to a great extent. With the application of this sonographic criteria in the cases of solid breast lesion before biopsy for histologic examination the number of unwanted biopsies will be reduced to a great extent.

Background: Renal pelvis dilation (RPD) during pregnancy is a common physiologic process and should be differentiated from pathological dilation. Ultrasound can be used as an initial imaging modality in the evaluation of renal pelvis measurement. Objective: To find the ultrasonographic measurement of maternal renal pelvis at 20th to 40th week of pregnancy in asymptomatic women. Methodology: A descriptive study was conducted among 262 individuals. All were pregnant within the gestational age of 20th -40th weeks. Sonotech 2019 was used to perform this research to determine the measurement of maternal renal pelvis. Renal pelvis dilation was evaluated trans-abdominally by using convex array multi-frequency probe 5 MHz Results: Dilation was more prominent in right renal pelvis than left renal pelvis. The maximum renal pelvis measurements were 29 mm on the right side in the 2nd trimester and 32 mm in the 3rd trimester. Similarly, the maximum renal pelvis measurements were 9 mm on the left side in the 2nd trimester and 7.3 mm in the 3rd trimester. Renal pelvis dilation increases with gestational age. Fetus who had cephalic presentation and anterior placenta implantation were seen with more maternal RPD. Conclusion: The current research concluded that renal pelvis dilation is common in pregnancy and it is more prominent on right side than the left side. Cephalic presentation of fetus could be a factor of RPD. Key words: Ultrasound (US), Renal Pelvis Dilation (RPD), Maternal, Gestational Age(GA)