SA Journal of Radiology - Volume 20, Issue 1, 2016
Volume 20, Issue 1, 2016
Source: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.957More Less
A 50-year-old man of otherwise excellent health presented with recent onset of left upper limb weakness and left facial nerve palsy. Figures 1-7 are selected magnetic resonance (MR) images.
We congratulate Dr Thato Sefanyetso for his submission of the correct findings and diagnosis of this quiz case.
Uterine artery embolisation as an effective choice for symptomatic fibroids : five-year outcome : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.959More Less
Background : Uterine artery embolisation for the treatment of symptomatic uterine fibroids is a relatively new but internationally recognised procedure. The present study seeks to report the results of the largest South African series of uterine artery embolisations for symptomatic fibroids to date. It is the fourth article to be published in South Africa on the outcomes of this procedure, and the largest South African series to date.
Objective : To evaluate the long-term efficacy of uterine artery embolisation in women with symptomatic fibroids in a tertiary hospital in South Africa.
Methods : Eighty-two women who presented for uterine artery embolisation at a single site in South Africa for symptomatic fibroids were retrospectively studied. Outcomes included recurrence and re-intervention rates, patient satisfaction and complication rate.
Results : Two patients required repeat embolisation, and one patient experienced fibroid recurrence without further intervention. No repeat myomectomies were performed. Eighty percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfied. No major complications were reported.
Conclusion : Uterine artery embolisation was shown to be a good choice in the treatment of symptomatic fibroids and presents favourable long-term outcomes in the South African population.
Temporal evaluation of computed tomographic scans at a Level 1 trauma department in a central South African hospital : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.836More Less
Background : Time is a precious commodity, especially in the trauma setting, which requires continuous evaluation to ensure streamlined service delivery, quality patient care and employee efficiency.
Objectives : The present study analyses the authors' institution's multi-detector computed tomography (MDCT) scan process as part of the imaging turnaround time of trauma patients. It is intended to serve as a baseline for the institution, to offer a comparison with institutions worldwide and to improve service delivery.
Method : Relevant categorical data were collected from the trauma patient register and radiological information system (RIS) from 01 February 2013 to 31 January 2014. A population of 1107 trauma patients who received a MDCT scan was included in the study. Temporal data were analysed as a continuum with reference to triage priority, time of day, type of CT scan and admission status.
Results : The median trauma arrival to MDCT scan time (TTS) and reporting turnaround time (RTAT) were 69 (39-126) and 86 (53-146) minutes respectively. TTS was subdivided into the time when the patient arrived at trauma to the radiology referral (TTRef) and submission of the radiology request, to the arrival at the MDCT (RefTS) location. TTRef was statistically significantly longer than RefTS (p < 0.0001). RTAT was subdivided into the arrival at the MDCT to the start of the radiology report (STR) and time taken to complete the report (RT). STR was statistically significantly longer than RT (p < 0.0001).
Conclusion : The time to scan (TTS) was comparable to, but unfortunately the report turnaround time (RTAT) lagged behind, the findings of some first-world institutions.
Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.829More Less
Background : Paediatric multidrug-resistant tuberculosis (MDR-TB) necessitates a prolonged duration of treatment with an intensive treatment regimen. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and therefore identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria.
Objectives : To describe the demographic characteristics and chest X-ray patterns of children with pulmonary MDR-TB and to compare the chest X-ray patterns of pulmonary MDR-TB between children who are HIV-infected and HIV-uninfected.
Method : Retrospective chart review of hospital notes and chest X-rays of children with pulmonary MDR-TB at King Dinuzulu Hospital, Durban. The chest X-rays were systematically reviewed for the presence of the following variables: hilar/mediastinal lymphadenopathy, bronchopneumonic opacification, segmental/lobar consolidation, cavities, miliary opacification and pleural effusion.
Results : Forty-five children (mean age, 6.29 years; median age, 6.00 years) with pulmonary MDR-TB met the inclusion criteria. The most common chest X-ray finding was consolidation (53.5%), followed by lymphadenopathy (35.6%), bronchopneumonic opacification (33.3%) and cavities (31.1%). Cavities were more common (OR 6.1; 95% CI 1.52-24.66) in children who had been initiated on standard anti-TB treatment for the current TB episode. There were no statistically significant differences in any of the chest X-ray patterns in HIV-uninfected (n = 22) compared with HIV-infected (n = 20) children.
Conclusion : The most common chest X-ray finding was consolidation, followed by lymphadenopathy, bronchopneumonic opacification and cavities. The finding of a significantly higher frequency of cavities in children who had received prior standard anti-TB treatment for the current TB episode could reflect poor disease containment and increased parenchymal damage, owing to a delay in the recognition of MDR-TB. The development of cavitation in chest X-rays of children with TB could raise concern for the possibility of MDR-TB, and prompt further testing.
Source: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.999More Less
A three-and-a-half-year-old male child was referred for neuroimaging under general anaesthesia for intractable seizures. A final diagnosis of probable tuberous sclerosis with associated left hippocampal sclerosis was made. Differential diagnosis of malformation of cortical development with hippocampal sclerosis (Type 3a) was considered with respect to the left temporal lobe abnormality. It is heartening to note that several good submissions were received for the paediatric quiz case. Noteworthy responses were received from Dr Samuel Mannikam, Dr Thandi Buthelezi, Dr Philip Janse van Rensburg and Dr Ian Haynes, however, the prize of R2000 was awarded to Dr Richard Busayo Ulatunji for the most inclusive answer.
Source: SA Journal of Radiology 20, pp 1 –3 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.1029More Less
A 40-year-old lady had a CT and an MRI scan of her brain for investigation of severe headache following recent recurrent bowel surgery. The post-operative course was complicated by abdominal wall haematoma, and she required multiple blood transfusions. The background history of multiple previous bowel resections and chronic anti-inflammatory therapy for inflammatory bowel disease was noted.
Author Gulraiz ChaudrySource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.940More Less
Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty.
Assessment of the impact of application of single-photon emission computed tomography and SPECT-CT on lesion categorisation in bone scintigraphy : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.990More Less
Objectives: To assess initial experience with the use of a new single-photon emission computed tomography-computed tomography (SPECT-CT) in the evaluation of lesions.
Methods: The folder number, radiopharmaceutical used and type of scan of patients examined with a new Siemens T6 SPECT-CT between 02 April 2016 and 31 December 2013 were retrieved. The number of 99mTc-MDP bone scans was sufficient for a detailed analysis. The scans were re-processed and reported by the observer before he was given any clinical information. Whole body planar, whole body planar plus SPECT and whole body planar plus SPECT-CT images were assessed successively in three separate sessions at least 2 weeks apart. At each session, the certainties of detection, localisation and categorisation of each lesion were recorded.
Results: A total of 539 lesions were seen on the whole body, SPECT and computed tomography (CT) images in 133 patients. The whole body images showed no lesions in 3 patients and 378 lesions in 130 patients. SPECT detected 122 additional lesions in 79 patients. Thirty-nine (12.2%) lesions were seen only on CT in 32 (24.1%) patients. For the 261 lesions seen on the planar images in the SPECT field of view, lesion detection was definite in 233 (89.3%), localisation definite in 151 (57.9%) and categorisation definite in 123 (47.1%) lesions. On the SPECT, definite lesion detection, localisation and categorisation were recorded, respectively, for 259 (99.2%), 228 (87.4%) and 176 (67.4%) of the 261 lesions. Lesion detection, localisation and categorisation certainties were definite for 100%, 99.1% and 94.7% of the SPECT-CT lesions, respectively.
Conclusion: SPECT markedly improves lesion detection and localisation, and CT enhances lesion categorisation.
Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.974More Less
Purpose: In this prospective study, we used 2D chemical shift imaging (CSI), a multi-voxel proton spectroscopy technique, to evaluate the brain metabolites on conventional magnetic resonance imaging (MRI) in normal-appearing white and grey matter in systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms (NPSLE); without neuropsychiatric symptoms (non-NPSLE); and healthy controls (HCs). Our objective was to find metabolites that discriminated NPSLE patients from the non-NPSLE and HC cohorts.
Materials and methods: The study included 23 NPSLE patients, 20 non-NPSLE patients, and 21 HCs. A clinical assessment including the SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics (SLICC) scores was conducted. All patients underwent conventional MRI and 2D CSI technique to acquire the following metabolic ratios: NAA/Cr, Cho/Cr, and Cho/NAA in the anterior and posterior insula, anterior frontal and parietal white and grey matter, thalamus, basal ganglia, and occipital grey matter.
Results: In terms of metabolic differences, the NPSLE patients had significant differences compared with the non-NPSLE and HC groups in the: left posterior insula (increased Cho/NAA; p = 0.008), right internal capsule (increased Cho/Cr; p < 0.05), left thalamus (increased NAA/Cr; p = 0.011), anterior grey matter (increased NAA/Cr; p = 0.004), posterior grey matter (increased Cho/NAA; p = 0.016), anterior white matter (increased NAA/Cr; p = 0.012), and left posterior white matter (increased Cho/NAA; p = 0.022). The NPSLE patients showed significantly higher SLEDAI scores (p < 0.001).
Conclusion: We found several significant distinct metabolic differences between NPSLE and non-NPSLE/HC patients in various brain locations.
Role of cranial computed tomography in human immunodeficiency virus-positive patients with generalised seizures : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.965More Less
Background: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination.
Method: We conducted a prospective descriptive observational study. Consecutive HIV-positive patients of 18 years and older, who presented to the Kimberley Hospital Complex's Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated.
Results: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm3.
Conclusion: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm3.
Histological underestimation of a 9-gauge stereotactic vacuum-assisted breast biopsy system compared with surgical excision at a tertiary hospital in South Africa : original researchSource: SA Journal of Radiology 20, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.818More Less
Background: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011.
Objectives: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits.
Method: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS) findings of 158 lesions (from 153 patients) were analysed and the histological findings compared with surgical excision histology results (54 lesions) to determine histological underestimation (upgrade rates).
Results: One out of eight cases of ductal carcinoma in situ (DCIS) was underestimated, yielding a DCIS underestimation rate of 12.5%.
Conclusion: The DCIS underestimation obtained from the present study in our institution was on a par with other authors' findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population.
Source: SA Journal of Radiology 20, pp 1 –7 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.1088More Less
A 40 year old lady had a CT and an MRI scan of her brain for investigation of severe headache following recent recurrent bowel surgery. The post-operative course was complicated by abdominal wall haematoma and she required multiple blood transfusions. Background history of multiple previous bowel resections and chronic anti-inflammatory therapy for inflammatory bowel disease was noted.
Source: SA Journal of Radiology 20, pp 1 –3 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.1053More Less
A 32-year-old lady presented with shortness of breath, (New York Heart Association [NYHA] grade 2-3), becoming progressively worse, associated with cough, chest pain and constitutional symptoms. She underwent extensive investigations shown in the series of images including chest radiograph, abdominal sonar, computed tomography of chest and abdomen as well as a cardiac magnetic resonance imaging study.
Computed tomography stroke findings and population demographics at Pelonomi Hospital, Bloemfontein : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.993More Less
Background: Stroke remains the highest cause of death in patients more than 50 years old in South Africa, and the fourth highest cause of death overall. There is a paucity of information regarding this disease in the Free State Province.
Objectives: To assess the stroke profile of patients referred for computed tomography (CT) imaging to our institution along with evaluating factors that could improve stroke management.
Method: The demographic information, stroke risk factors, stroke types and time to imaging were evaluated for all patients who presented for CT stroke imaging from July 2014 until July 2015. Information was gathered prospectively from the hospital and radiology information systems.
Results: The study included 174 patients (53.5% female, 46.5% male). Their mean age was 59 years (standard deviation (SD) 14.6). The most prevalent risk factors were hypertension (83.7%), smoking (20.5%) and diabetes (15.0%). The population group consisted of 67.8% ischaemic (n = 118) and 32.2% (n = 56) haemorrhagic strokes. The majority of patients with a known time of symptom onset (n = 102) presented after 8 hours (82.4%). The median order to report time (ORT) was 61 min (range 18 min-1361 min). The median arrival to report time (ART) was 32 min (range 4 min-893 min).
Conclusion: Our stroke population did not differ significantly from others in South Africa and Africa overall. Pre- and in-hospital delays significantly influenced patient numbers qualifying for thrombolysis.
Adequacy of ultrasound reports in patients presenting with obstructive jaundice at a tertiary hospital radiology department : original researchSource: SA Journal of Radiology 20, pp 1 –8 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.1034More Less
Background: Patients with obstructive jaundice require a stepwise approach to investigation and management. Ultrasound (US) is the initial screening modality of choice and has been shown to be accurate in demonstrating the presence of dilated bile ducts, as well as the level and cause of obstruction. For adequate radiological communication to the clinician, degree of bile duct dilatation, level of obstruction, appearance of the transition zone and cause of obstruction must be reported. However, without a structured reporting method, much of this information may be omitted.
Objectives: The aim of the study was to investigate the adequacy of US findings in patients with obstructive jaundice, as documented, without standardised reporting.
Methods: A retrospective chart review of 130 US reports of adult patients presenting at Grey's Hospital US Department with a clinical assessment of obstructive jaundice was conducted. Data for the period January to December 2013, were analysed. US reports of patients with dilated bile ducts were assessed for report adequacy by looking at four important clinical factors, that is, the degree of bile duct dilatation, the level of obstruction, the appearance of the transition zone and the cause of the obstruction.
Results: A report adequacy score was assessed in 79 patients with dilated bile ducts; however, two reports were excluded because of obscuration by gas. There was a high level of report inadequacy (38%) without the use of a structured reporting template. The level of obstruction was the most common component missing from the reports (25%), followed by the appearance of the transition zone (18%) and cause of obstruction (12%).
Conclusion: We propose the use of an US report template for obstructive jaundice patients in order to ensure comprehensive reporting. Structured radiological reporting will improve the method of communication between clinicians and radiologists, thus improving the quality of patient care.
Defining current facial fracture patterns in a quaternary institution following high-velocity blunt trauma : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.1005More Less
Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions.
Objectives: A retrospective study to define facial bone fractures occurring subsequent to highvelocity trauma.
Method: A retrospective study comprising the review of CT scans of 52 patients with highvelocity facial fractures was performed between April 2007 and March 2013. Injuries were classified using the Le Fort classification system. Deviations from the true Le Fort types, which are often depicted in the literature as occurring bilaterally and symmetrically, were documented; these included unilaterality, occurrence of several Le Fort fractures on one side of the face, occurrence of several Le Fort fractures on different levels and on different sides of the face, and occurrence of other fractures in addition to Le Fort fractures.
Results: Of the 52 cases, 12 (23%) had Le Fort injuries, with true Le Fort fractures occurring in only 1, and 11 deviating from the classic description. Nine patients had Le Fort fractures and additional fractures. Mandibular and zygomatic bone fractures were found to be common associations with Le Fort injuries, occurring in 58% and 33% of the cases respectively.
Conclusion: Fractures occurring in modern practice often deviate from the traditional Le Fort classification. Precise recognition of these deviations and recognition of additional associated fractures is pivotal in their management, assisting the surgeon in determining the treatment plan, such as the surgical approach and the order in which to fix the various fractured components.
The role of MRI with diffusion-weighted imaging in restaging rectal cancers after neoadjuvant chemoradiotherapy : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.967More Less
Background: It is challenging to restage rectal cancer at MRI, in patients who have had neoadjuvant chemoradiotherapy.
Objective: To investigate the accuracy of MRI with diffusion-weighted imaging (DWI) in the restaging of rectal cancer.
Materials and methods: Pre- and post-neoadjuvant chemoradiotherapy MRI examinations of 35 patients diagnosed with locally advanced rectal cancer were evaluated and subsequently compared with post-operative pathology results.
Results: The accuracy of MRI with DWI to determine the T-stage status was calculated as 54.28%. Kappa statistics revealed poor concordance with pathology results, with a κ value of 0.212 ± 0.114 (p = 0.028). The apparent diffusion coefficient (ADC) values measured after the neoadjuvant chemotherapy revealed a significant increase when compared with pre-treatment ADC values (p < 0.000001). MRI accuracy rate for lymph node involvement was calculated as 57.14% with a κ value of 0.001 (p = 0.989). MRI had 80% sensitivity and 100% specificity in determining mesorectal fascia involvement, with a calculated positive predictive value of 100% and a calculated negative predictive value of 96%. The accuracy of MRI in overall staging according to the TNM staging system was 28%.
Conclusion: The accuracy of MRI in restaging rectal cancer is not yet sufficient and is not on par with the accuracy of MRI in the primary staging of the disease. This is attributed to post-treatment changes. Adding DWI to the protocol is promising, but more expanded data are required.
Investigation of the growth patterns of non-functioning pituitary macroadenomas using volumetric assessments on serial MRI investigations : original researchSource: SA Journal of Radiology 20, pp 1 –7 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.962More Less
Background: Benign non-functioning pituitary macroadenomas (NFMA) often cause mass effect on the optic chiasm necessitating transsphenoidal surgery to prevent blindness. However, surgery is complicated and there is a high tumour recurrence rate. Currently, very little is known about the natural (and residual post-surgical) growth patterns of these NFMA. Conflicting data describe decreased growth to exponential growth over various time periods. Due to lack of information on growth dynamics of these NFMA, suitable follow-up imaging protocols have not been described to date.
Objective: To determine if NFMA grow or stay quiescent over a time period using serial MRI investigations and a stereological method to determine tumour volume. In addition, to evaluate if NFMA adhere to a certain growth pattern or grow at random.
Method: Thirteen patients with NFMA had serial MRI investigations over a 73-month period at the Universitas Academic Hospital. Six of the selected patients had undergone previous surgery, while seven patients had received no medical or surgical intervention. By using a stereological method, tumour volumes were calculated and plotted over time to demonstrate growth curves. The data were then fitted to tumour growth models already described in literature in order to obtain the best fit by calculating the r2 value.
Results: Positive tumour growth was demonstrated in all cases. Tumour growth patterns of nine patients best fitted the exponential growth curve while the growth patterns of three patients best fitted the logistic growth curve. The remaining patient demonstrated a linear growth pattern.
Conclusion: A specific growth model best described tumour growth observed in non-surgical and surgical cases. If follow-up imaging confirms positive growth, future growth can be predicted by extrapolation. This information can then be used to determine the relevant follow-up-imaging interval in each individual patient.
A retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa : original researchSource: SA Journal of Radiology 20, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajr.v20i1.994More Less
Background: Histological confirmation of a breast lesion is an important step to determine the aetiology and direct further management. Evidence supports ultrasound-guided large core needle biopsy (US-LCNB) (14 gauge) as the preferred diagnostic method over traditional open surgical biopsy.
Objective: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting malignancy during the study period.
Methods: A retrospective chart review was conducted of all patients who had US-LCNBs from March 2011 - September 2012 at Addington Hospital in Durban, KwaZulu-Natal. Histopathological findings were correlated to the size of the breast lesion, rank of the radiologist performing the procedure and the number of cores obtained. The sensitivity of the technique was determined.
Results: During the study period, 147 biopsies were performed. The majority of lesions were >5 mm (85.5%). The average number of cores was 4, and 79.5% of the biopsies were performed by the senior radiologist. Of the 147 biopsies, 132 specimens were eligible for inclusion in the study. Histopathology revealed 71 malignant lesions of which 60 were confirmed histologically at excision. In 11 patients, no excision was performed. Therefore, the sensitivity of detecting malignancy was 100%.
Conclusion: Although the study did not establish a statistically significant relationship between the abovementioned technical variables and the histological outcome, the overall diagnostic yield and the sensitivity of detecting malignancy using US-LCNB is comparable to other similar international studies. A prospective study with long-term follow-up of patients would be of value.