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Article ; Online: Multiple bilateral breast masses due to lymphoma metastases

Hemal Grover, MD / Shabnam Bhandari Grover, MD, DNB, MNAMS, FICR / Frimmit Leah Forman, MD / Geetika Khanna, MD / Laurie Margolies, MD

Radiology Case Reports, Vol 19, Iss 1, Pp 357-

A report of 2 cases highlighting the mammographic and sonographic features

2024 Volume 369

Abstract: Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal ...

Abstract	Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.
Keywords	Breast lymphoma ; Extramammary malignancies ; Hematogenous malignancy ; Imaging features ; Metastases within breast ; Ultrasound-guided biopsy ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	616 ; 610
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Multiple bilateral breast masses due to lymphoma metastases: A report of 2 cases highlighting the mammographic and sonographic features.

Grover, Hemal / Grover, Shabnam Bhandari / Leah Forman, Frimmit / Khanna, Geetika / Margolies, Laurie

Radiology case reports

2023 Volume 19, Issue 1, Page(s) 357–369

Abstract	Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.
Language	English
Publishing date	2023-11-10
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2023.10.026
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Physical Principles of Elastography: A Primer for Radiologists

Patra, Sayantan / Grover, Shabnam Bhandari

Indographics

2022 Volume 01, Issue 01, Page(s) 27–40

Abstract: Elastography is the noninvasive method of qualitative and quantitative evaluation of strain and elastic modulus distribution in soft tissues. In simpler terms, elastography is the science of measuring tissue stiffness, the deviation of which correlates ... ...

Abstract	Elastography is the noninvasive method of qualitative and quantitative evaluation of strain and elastic modulus distribution in soft tissues. In simpler terms, elastography is the science of measuring tissue stiffness, the deviation of which correlates with pathology of the tissue/organs being evaluated. Whereas, elasticity, refers to the property of solid matter to return to their original shape and size after removal of the deforming forces. In all forms of elastography, irrespective of the types of deforming forces or moduli, the deformation of tissue occurs in the form of shear deformation. The velocity of shear waves in the deformed tissue depends on its density and on the shear modulus. The direction of propagation of shear wave is perpendicular to the inciting mechanical or acoustic wave. The shear wave is then subsequently tracked using multiple tracking pulses, which measures tissue displacement in response to the passing shear wave. The calculated speed of the shear wave is then converted to conventional Young's modulus for the purpose of computing the tissue stiffness. The currently used elastography techniques are static or quasi-static elastography and dynamic elastography. Strain elastography (a form of static or quasi-static elastography) is based on the principle of acquisition of radio-frequency (RF) signals before and after the application of a deforming force in the form of slight compression of tissue by a transducer. RF signals are compared between the pre-compression image data set and the post-compression image data set and correlated between the two data sets. Dynamic elastography may be either ultrasound (US) based or magnetic resonance (MR) based. The types of dynamic US elastography are: acoustic radiation force impulse imaging (ARFI), transient elastography (TE), point shear wave elastography (pSWE), and shear wave elastography (SWE). ARFI uses a standard transducer to produce and propagate rapid bursts of long focused ultrasound pulses, also called as “push pulses” which cause tissue deformity, the propagation of which is tracked using radio-frequency echo tracking. In TE, a probe mounted on a vibrator is used to produce a small thump by piston like motion of transducer. The shear wave which arises from the edges of the transducer is tracked using high pulse repetition frequency tissue Doppler and computed using M-mode for display of quantitative parameters. Point shear wave, also known as quantitative ARFI, uses shear waves generated using transient tissue displacement caused by ARFI and are subsequently subjected to tracking by Doppler. Shear wave elastography is based on the principles of imaging shear wave speed. An acoustic radiation force impulse is transmitted along the acoustic axis to produce tissue displacement and deformation at points of acoustic axis. The generated shear wave is imaged using RF echo tracking over a grid of points, which is translated into a real time image. MR elastography is a dynamic technique and the basic principles of MR elastography are the same as other forms of dynamic elastography. MR elastography has limited utility in iron-overload states and in addition, due to the large amount of time required for acquisition, the technique is not suitable for unstable patients. This review presents a simplified summary of the principles of elastography along with definition of the terms and the types of elastography which are currently available to radiologists for clinical application and concludes with a brief on the newer developments for the future.
Keywords	elastography ; strain elastography ; ARFI ; transient elastography ; point Shear wave elastography ; shear wave elastography ; MR elastography
Language	English
Publishing date	2022-01-01
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2583-8229
ISSN (online)	2583-8229
DOI	10.1055/s-0042-1742575
Database	Thieme publisher's database

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Article: Imaging Approach to Pulmonary Infections in the Immunocompromised Patient.

Grover, Shabnam Bhandari / Grover, Hemal / Antil, Neha / Patra, Sayantan / Sen, Manas Kamal / Nair, Deepthi

The Indian journal of radiology & imaging

2022 Volume 32, Issue 1, Page(s) 81–112

Abstract: Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may ... ...

Abstract	Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.
Language	English
Publishing date	2022-05-27
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	605869-3
ISSN	0971-3026 ; 0970-2016
ISSN	0971-3026 ; 0970-2016
DOI	10.1055/s-0042-1743418
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Article ; Online: Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Shabnam Bhandari Grover / Hemal Grover / Neha Antil / Sayantan Patra / Manas Kamal Sen / Deepthi Nair

Indian Journal of Radiology and Imaging, Vol 32, Iss 01, Pp 081-

2022 Volume 112

Abstract	Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management ...
Keywords	immunocompromised patient ; pulmonary infection ; ct thorax ; imaging pattern ; tissue sampling ; diagnostic algorithm ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	610
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Erratum to “Imaging diagnosis of a giant choledochal cyst in an infant” [Radiology Case Reports 17 (2022) 404-411]

Shabnam Bhandari Grover, MD, DNBE, FICR, MNAMS, MRCR (UK), FICMU / Sonali Malhotra, MBBS / Saurabh Pandey, MBBS / Hemal Grover, MBBS, MD / Ravi Kale, MBBS, MS / Anshu Gupta Devra, MBBS, MD

Radiology Case Reports, Vol 18, Iss 2, Pp 735- (2023)

1480

Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Contrast enhanced ultrasound quantitative parameters for assessing neoadjuvant chemotherapy response in patients with locally advanced breast cancer.

Sharma, Anant / Grover, Shabnam Bhandari / Mani, Chinta / Ahluwalia, Charanjeet

The British journal of radiology

2021 Volume 94, Issue 1121, Page(s) 20201160

Abstract: Objectives: To evaluate the role of contrast-enhanced ultrasound (CEUS) quantitative parameters in predicting neoadjuvant chemotherapy (NACT) response in patients with locally advanced breast cancer (LABC).: Methods: 30 patients with histologically ... ...

Abstract	Objectives: To evaluate the role of contrast-enhanced ultrasound (CEUS) quantitative parameters in predicting neoadjuvant chemotherapy (NACT) response in patients with locally advanced breast cancer (LABC). Methods: 30 patients with histologically proven LABC scheduled for NACT were recruited. CEUS was performed using a contrast bolus of 4.8 ml and time intensity curves (TICs) were obtained by contrast dynamics software. CEUS quantitative parameters assessed were peak enhancement (PE), time-to-peak (TTP), area under the curve (AUC) and mean transit time (MTT). The parameters were documented on four consecutive instances: before NACT and 3 weeks after each of the three cycles. The gold-standard was pathological response using Miller Payne Score obtained pre NACT and post-surgery. Results: A decrease in mean values of PE and an increase in mean values of TTP and MTT was observed with each cycle of NACT among responders. Post each cycle of NACT (compared with baseline pre-NACT), there was a statistically significant difference in % change of mean values of PE, TTP and MTT between good responders and poor responders ( Conclusion: In responders, a decrease in the tumor vascularity was reflected in the CEUS quantitative parameters as a reduction in PE, and a prolongation in TTP, MTT. Advances in knowledge: Prediction of NACT response by CEUS has the potential to serve as a diagnostic modality for modification of chemotherapy regimens during ongoing NACT among patients with LABC, thus affecting patient prognosis.
MeSH term(s)	Adult ; Area Under Curve ; Chemotherapy, Adjuvant ; Contrast Media ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Prospective Studies ; Time Factors ; Treatment Outcome ; Ultrasonography/methods ; Unilateral Breast Neoplasms/diagnostic imaging ; Unilateral Breast Neoplasms/drug therapy ; Unilateral Breast Neoplasms/pathology ; Unilateral Breast Neoplasms/surgery
Chemical Substances	Contrast Media
Language	English
Publishing date	2021-04-16
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20201160
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Article: Contrast-enhanced voiding urosonography (CEVUS) as a novel technique for evaluation in a case of male urethral diverticulum.

Grover, Shabnam Bhandari / Patra, Sayantan / Grover, Hemal / Kumar, Anup

The Indian journal of radiology & imaging

2020 Volume 30, Issue 3, Page(s) 409–414

Abstract: Male urethral diverticulum is an uncommon entity, the abnormality being more frequently encountered in females. The pathology may be congenital or acquired and the more frequent acquired type usually occurs following trauma. Afflicted patients usually ... ...

Abstract	Male urethral diverticulum is an uncommon entity, the abnormality being more frequently encountered in females. The pathology may be congenital or acquired and the more frequent acquired type usually occurs following trauma. Afflicted patients usually lack specific symptoms, although in a few instances, symptoms of lower urinary tract obstruction, calculi, or infection may prevail. Imaging investigations utilizing a composite Retrograde urethrography (RGU)- Voiding cystourethrography (VCUG) protocol are accepted as standard approach and ultrasound is considered a secondary supplementary investigation. However, recent literature reports the utility of contrast-enhanced ultrasound (CEUS) as a novel technique in the evaluation of urinary bladder and urethra, for vesico-ureteric reflux (VUR) in children and for urethral diverticula in women. We report a case of acquired post-traumatic urethral diverticulum in an adult male patient and document a relatively unexplored novel application of contrast enhanced voiding uro-sonography (CEVUS) for the evaluation of this malady.
Language	English
Publishing date	2020-10-15
Publishing country	India
Document type	Case Reports
ZDB-ID	605869-3
ISSN	0971-3026 ; 0970-2016
ISSN	0971-3026 ; 0970-2016
DOI	10.4103/ijri.IJRI_50_20
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Article: Imaging diagnosis of a giant choledochal cyst in an infant.

Grover, Shabnam Bhandari / Malhotra, Sonali / Pandey, Saurabh / Grover, Hemal / Kale, Ravi / Devra, Anshu Gupta

Radiology case reports

2021 Volume 17, Issue 2, Page(s) 404–411

Abstract: The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary ... ...

Abstract	The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary modality for diagnosis of this entity is ultrasound, followed by MRI. The characteristic ultrasound features of a choledochal cyst are a well-defined cystic lesion which may be found to replace any segment of the biliary tree and is distinctly separate from the gallbladder. The associated anomalies are biliary atresia, gallbladder atresia, hepatic fibrosis and those of the pancreatico-biliary ductal system. MRI with MRCP has a conclusive role in confirming the ultrasound diagnosis. Choledochal cysts are currently classified as proposed by Todani et al, into five types. Herein, we report the case study of a 4-month-old male infant afflicted with a gigantic, Type1 Choledochal cyst, complicated by perforation, which was diagnosed by us at the first instance itself, using ultrasound examination and confirmed by MRI. The diagnosis was further confirmed at surgery and histopathology. The recommended treatment of cyst resection accompanied by a hepatico-jejunostomy bypass procedure, was successfully performed in the reported infant.
Language	English
Publishing date	2021-12-04
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2021.10.051
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Imaging diagnosis of plexiform neurofibroma- unravelling the confounding features: A report of two cases.

Grover, Dr Shabnam Bhandari / Kundra, Dr Rohit / Grover, Dr Hemal / Gupta, Dr Vishal / Gupta, Dr Rishab

Radiology case reports

2021 Volume 16, Issue 9, Page(s) 2824–2833

Abstract: Peripheral nerve sheath tumors such as neurofibroma, comprise 5% of all benign soft tissue tumors and usually occur due to an underlying neurofibromatosis. A plexiform neurofibroma, which is a tumor occurring exclusively in neurofibromatosis1, is a rare ... ...

Abstract	Peripheral nerve sheath tumors such as neurofibroma, comprise 5% of all benign soft tissue tumors and usually occur due to an underlying neurofibromatosis. A plexiform neurofibroma, which is a tumor occurring exclusively in neurofibromatosis1, is a rare entity and is an uncommon variant of neurofibroma. We report the clinical and imaging features of plexiform neurofibroma in two young male patients, in whom the imaging diagnosis was confirmed after biopsy. The report not only aims to highlight the characteristic imaging features of plexiform neurofibroma but we also emphasize the ultrasound appearances which are significantly characteristic and can effectively lead to the correct diagnosis at the preliminary stage of investigation. The tumors which originate from nerve sheath, are large, lobulated masses and demonstrate typical imaging features of simultaneous involvement of subcutaneous and cutaneous tissues along with infiltrative invasion of deeper structures. The tumors characteristically display fat and fluid contents and a "target sign' on evaluation by ultrasound, CT and MRI. Imaging plays an important role in confirming the diagnosis, delineating involved structures, excluding simulating conditions and forewarning a possible malignant transformation.
Language	English
Publishing date	2021-07-17
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2021.06.025
Database	MEDical Literature Analysis and Retrieval System OnLINE

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