IJ Radiology

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https://repository.brieflands.com/handle/123456789/50519

In Collaboration with Imaging Center and Radiology, IKHS Hospital, TUMS

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The IJR, Journal of Radiology is the official journal of the Tehran University of Medical Sciences and the Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex. It is a scientific forum dedicated primarily to the topics relevant to radiology and allied sciences of developing countries, which have been neglected or have received little attention in the Western medical literature.

This journal particularly welcomes manuscripts that deal with radiology and imaging from geographic regions wherein problems regarding economic, social, ethnic, and cultural parameters affecting the prevalence and course of the illness are taken into consideration.

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Clinical Outcome of Infrapopliteal Angioplasty for Treatment of Chronic Lower Limb Ischemia
(Brieflands, 2019-04-30) Seyed Rasool Mirsharifi; Hossein Ghanaati; Morteza Noparast; Sara Farifteh; Madjid Shakiba; Parto Sabetrasekh
Background: Chronic lower limb arterial stenosis is a condition that impairs the quality of life and could result in amputation. One of the major treatments is angioplasty to open the stenosis. Objectives: We evaluated the midterm results of endovascular treatment of infra popliteal arterial disease as a primary intervention to reduce the level of ischemia in order to avoid major amputation. Patients and Methods: Between March 2013 and April 2015, we collected all data of patients who underwent infrapopliteal angioplasty for chronic limb ischemia (CLI), (Rutherford category 4,5, or 6). The outcome as freedom from reintervention, limb salvage, improvement of signs and symptoms, and the overall survival was analyzed. We reviewed the results of angioplasty by anatomic characteristics of the lesion, transatlantic intersociety characteristics (TASC). Results: Forty seven patients were enrolled in this study of whom 37 were male. Mean age was 67.2 years. Mean ankle brachial index (ABI) before and 6 months after percutaneous transluminal angioplasty (PTA) was 0.5 ± 0.07 and 0.68 ± 0.12, respectively (P < 0.01) and an improved ABI of at least 0.1 was detected in 78% of the patients. In 97.2%, initial technical success was obtained. Rest pain was completely resolved in 66.7% of the patients after the 3-month follow-up and 72.7% after the 6-month follow-up after the procedure. Complete or relative healing of chronic ulcer was seen in 69% and 92% of patients in the 3- and 6-month follow-up after the procedure, respectively. Restenosis occurred in four patients (8.5%), major amputation in 19.1% (9 patients) and the mortality rate was 25.1% (12 cases). Primary patency was finally estimated as 76.1%. Conclusions: PTA for infrapopliteal lesions in high-risk patients can reduce the risk of amputation with a lower mortality and morbidity.
Ultrasound Features of the First Gout Attack and the Association with Duration of Hyperuricemia
(Brieflands, 2019-07-31) Wenting Fan; Jiaan Zhu; Zheng Chen; Wenxue Li
Background: Gout is the most common form of inflammatory arthritis. Unfortunately, the burden of gout is increasing and treatment is still suboptimal. Nowadays, ultrasound is increasingly used to evaluate gout, especially in the early stage. However, little is known about the prevalence of the ultrasound signs in the first gout attack. Objectives: The aim of this study was to evaluate the prevalence of ultrasound features in the first gout attack and to correlate those features with the duration of hyperuricemia. Patients and Methods: We analyzed the ultrasound features of the knees, ankles and the first metatarsal-phalangeal joints (1st MTP) of patients with first gout attack compared to individuals with asymptomatic hyperuricemia (AHU). The findings were also compared with clinical, laboratory parameters and hyperuricemia duration. Results: Forty-eight patients with first gout attack gout were studied. The first attack affected the first MTP in 61%, the ankle in 33%, and the knee in 6% of the instances. The prevalence of snow-storm sign, double contour (DC) sign, tophi, bone erosion and abnormal blood flow was 92%, 29%, 6%, 13% and 83%, respectively. The prevalence of snow-storm sign and abnormal blood flow was significantly higher in the first attack of gout compared to AHU (P < 0.001). The hyperuricemia duration of patients with tophi and bone erosion was significantly longer than those with snow-storm sign and DC sign (7.5y and 6.5y vs 4.0y and 2y) (P = 0.004). Conclusion: Ultrasound features are associated with hyperuricemia duration. Furthermore, tophi and bone erosion can be detected in first gout attack. These data suggest that low-grade inflammation induced by uric acid may also occur in individuals with AHU.
Radiological Significance of Symmetric Central Tegmental Tract Hyperintensity in Pediatric Patients
(Brieflands, 2021-01-31) Ugur Kesimal; Kamil Karaali; Utku Senol
Background: The central tegmental tract (CTT) is an extrapyramidal tract between the red nucleus and the inferior olivary nucleus which is part of the Guillain-Mollaret triangle (dentato-rubro-olivary system). Symmetric central tegmental tract hyperintensity (CTTH) is a pediatric brain magnetic resonance imaging (MRI) finding with an unclear clinical and radiological significance. Objectives: The aim of this retrospective study is to determine the radiological significance of CTTH on magnetic resonance imaging (MRI) in children. Patients and Methods: Pediatric patient’s MRI from January 2015 to January 2017 were retrospectively reviewed in this case series study. Patient records with presence of CTTH in their MRI were evaluated. Results: There were 39 out of 2981 brain MRIs with CTTH with a prevalence of 1.3%. Some CTTH lesions disappeared on follow-up. In two patients, the disappearance of CTTH temporally corresponded to clinical improvement. Also we had patients with hemolytic uremic syndrome, autoimmune hemolytic anemia, Wilson’s disease, combined immunodeficiency, Bartter syndrome, and autism. Conclusion: CTTH could be caused by a physiological maturation process or a physiological response of the cells in the central tegmental tract to a more widespread toxic/metabolic or ischemic insult in the brain. CTTH also appears to have a transient nature in some cases. Further research elucidating the pathophysiology of CTTH is needed.
Differential Diagnosis of Sinonasal Extramedullary Plasmacytoma, Non-Hodgkin’s Lymphoma, and Squamous Cell Carcinoma Using CT Scan and MRI
(Brieflands, 2021-04-30) Dong-Joo Lee; Sang Duk Hong; Myeong Sang Yu; Sung Jae Heo; Joo-Yeon Kim; Tae Young Jung; Sung-Dong Kim; Sue-Jean Mun; Hak-Jin Kim; Kyu-Sup Cho
Background: The imaging features of sinonasal extramedullary plasmacytoma (EMP) are non-specific and similar to those of other lesions, such as sinonasal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC). Objectives: To analyze the computed tomography (CT) and magnetic resonance (MR) images of patients with EMP, NHL, and SCC to identify the radiological characteristics differentiating sinonasal EMP from NHL and SCC. Patients and Methods: In this cross-sectional study, the CT and MR imaging features of 37 patients with sinonasal EMP, 46 patients with NHL, and 44 patients with SCC were analyzed. Sinonasal NHL was categorized into two distinct types, namely, natural killer/T-cell lymphoma (n = 32) and diffuse large B-cell lymphoma (n = 14). The tumor volume was determined by measuring the region of interest (ROI) in the picture archiving and communication system (PACS) program. Besides, homogeneity, apparent diffusion coefficient (ADC) in the ADC maps, degree of enhancement, adjacent bone destruction, and invasion to Waldeyer’s ring and cervical or retropharyngeal lymph nodes were evaluated. Results: Although the tumor volume was larger in the EMP group as compared to the NHL and SCC groups, the difference was not statistically significant. The NHL group showed the highest tumor homogeneity on both CT and MR images. EMP was more heterogenous than NHL, with moderate signal intensity on T1-weighted MR images. On the other hand, EMP and NHL showed significantly lower ADCs as compared to SCC. The majority of patients with sinonasal EMP, NHL, and SCC showed an avid enhancement. Also, destructive tumor growth involving the adjacent bone was more frequent in SCC than in EMP or NHL. However, there were no significant differences among sinonasal EMP, NHL, and SCC in terms of invasion to Waldeyer’s ring and cervical or retropharyngeal lymph node metastasis. Conclusion: Marked heterogeneity on T1-weighted images, low ADCs, and lack of adjacent bone destruction were the CT and MR imaging features that favored the diagnosis of EMP over NHL or SCC.
Role of FDG-PET/CT in Identification of Histological Upgrade of Ductal Carcinoma in Situ (DCIS) in Needle Biopsy
(Brieflands, 2021-07-31) Na Young Jung; Bong Joo Kang; Sung Hun Kim; Ie Ryung Yoo; Yeon Soo Lim; Won Jong Yoo
Background: Accurate preoperative detection of the invasive components of ductal carcinoma in situ (DCIS) is essential for an appropriate treatment. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan, which can indicate the metabolic activity and aggressiveness of breast cancer, may be used as one of the predictors of the invasive components of DCIS in needle biopsy. Objectives: To determine whether the FDG-PET/CT findings are associated with the histological upgrade of DCIS in biopsy. Patients and Methods: In this retrospective cohort, we reviewed 165 cases of DCIS in 162 patients, who underwent preoperative FDG-PET/CT examinations between April 2008 and September 2015. The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared. The semi-quantitative analyses were based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. The significant predictors of DCIS histological upgrade were age (P = 0.011), SUVmax (P < 0.001), visual analysis of FDG-PET/CT (P = 0.004), and pathological tumor size (P = 0.003) in the univariate analysis. In the multivariate analysis, the SUVmax (odds ratio [OR] = 3.31, P = 0.003) and tumor size (OR = 1.20, P = 0.022) were significant when the model included the SUVmax, age, and size (model 1). On the other hand, age (OR = 0.96, P = 0.032), visual analysis (OR = 4.67, P = 0.006), and tumor size (OR = 1.25, P = 0.005) were significant predictors when the model included visual analysis, age, and size (model 2). The sensitivity was significantly higher in the visual analysis, whereas the specificity, positive predictive value (PPV), and accuracy were significantly higher in the semi-quantitative analysis. Conclusion: FDG-PET/CT is a potentially useful imaging tool to predict the upgrade of DCIS to invasive cancer.
Imaging Evaluation of Clinical and Subclinical Myocarditis in Multisystem Inflammatory Syndrome of Children with COVID-19 Using Cardiac Magnetic Resonance: The Results and Prognosis
(Brieflands, 2023-10-31) Afrouz Alipour; Farhad Akhavein; Feisal Rahimpour; Mohammadreza Naghibi Sistani; Behzad Alizadeh
Background: Coronavirus disease 2019 (COVID-19) has emerged as the most significant health crisis in recent years, leading to over 6 million deaths globally due to the disease. Objectives: Given the prevalence of multisystem inflammatory syndrome in children (MISC) following the COVID-19 pandemic, this study aims to examine the imaging findings and prognoses of clinical and subclinical myocarditis in children with MISC through cardiac magnetic resonance (CMR) imaging. Patients and Methods: This prospective cohort study carried out over eighteen months from May 2021 to November 2022, included 14 patients who underwent CMR imaging. A census of all eligible patients during the study period served as the sampling method. Inclusion criteria were patients with confirmed COVID-19 infection through serological tests, polymerase chain reaction (PCR), or recent exposure to COVID-19 patients. Exclusion criteria included patients with a history of congenital heart disease (CHD) or pulmonary disease. Additional diagnostic tests performed included blood sample tests, chest X-ray (CXR), electrocardiogram (ECG), and echocardiography. CMR imaging was conducted on patients with cardiac involvement. A diagnosis of myocardial inflammation was made if a patient met at least two of the Lake Louise Criteria. The Chi-square, Fisher's exact, and Mann-Whitney tests were used to examine the relationship between quantitative variables and treatment outcomes. Additionally, the Wilcoxon signed rank, and McNemar’s tests assessed changes in echocardiography findings from admission to follow-up. A significance level of 0.05 was set. Results: Among the 14 patients studied, 8 (57.10%) were girls and 6 (42.90%) were boys. The average age was 6.03 ± 3.71 years. The median time to CMR imaging after symptom onset was 4 weeks (interquartile range (IQR): 2 - 12, range: 30). Global function assessment using left ventricular ejection fraction (LVEF) showed that 5 (35.70%), 3 (21.40%), and 6 (42.90%) patients had normal function, mild dysfunction, and significant LV dysfunction, respectively. 71.40% of patients who recovered had mild tricuspid regurgitation (TR) and no cardiomegaly. Significant differences in mean values of polymorphonuclear neutrophil (PMN) (37.71 ± 11.75 vs. 81.44 ± 13.06), lymphocytes (48.71 ± 20.08 vs. 12.51 ± 7.26), hemoglobin (Hb) (12.60 ± 1.55 vs. 10.10 ± 1.62), mean corpuscular volume (MCV) (85.90 ± 5.67 vs. 79.37 ± 5.23), erythrocyte sedimentation rate (ESR) (8.86 ± 13.60 vs. 30.29 ± 21.33), and C-reactive protein (CRP) (18.91 ± 27.25 vs. 100.57 ± 85.67) were observed between non-recovered and recovered patients, respectively (P < 0.05). However, no statistically significant association was found between other variables, including N-terminal pro–B-type natriuretic peptide (NT-proBNP), D-dimer, and Troponin I (TPI), with treatment outcomes (P > 0.05). Conclusion: Our findings indicate that a negative COVID-19 test does not exclude an established clinical COVID-19 infection in children with MISC. The results suggest that all children with MISC and a history of COVID-19 infection should undergo assessment for myocardial fibrosis, regardless of ejection fraction (EF) as determined by Echocardiography, laboratory tests, and COVID-19 test results. Strain analysis, conducted during both the acute phase and subsequent follow-ups through CMR imaging or Echocardiography, is recommended to enhance the understanding of the prognosis.
Widespread Hydatidosis of Sacroiliac Bones and Retroperitoneum A Case Report
(Brieflands, 2004-12-30) M. Zhianpour; R. Basiratnia
Metastatic Melanoma to the Pancreas Forming Portal Vein Tumor Thrombosis: A Case Report
(Brieflands, 2017-04-30) Dong Kyun Kim; Joon-Il Choi; Moon Hyung Choi; Chandana Lall; Eun Sun Jung; In Seok Lee
Pancreatic metastasis of malignant melanoma is rare and porto-splenic tumor thrombus associated with malignant melanoma is even less frequent. We report a case of metastatic malignant melanoma involving the pancreas, portal vein, splenic vein and superior mesenteric vein. A 60-year-old man showed an elevated amylase level. He had a history of sigmoid colon adenocarcinoma and malignant melanoma. Computed tomography (CT) and magnetic resonance imaging (MRI) showed extensive thrombosis involving the intra- and extrahepatic portal veins extending into the superior/inferior mesenteric vein and splenic vein. On T1 weighted images, tumor thrombi demonstrated diffusely high signal intensity, which is a characteristic finding in malignant melanoma. Also, thrombus showed prominent diffusion restriction on diffusion weighted images and intense uptake of 18F-fluorodeoxyglucose (18F-FDG) on positron emission tomography (PET). Ultrasound-guided biopsy confirmed the metastatic, malignant melanoma involving the pancreas and the veins. We report an unusual manifestation of metastatic, malignant melanoma to the pancreas with extensive tumor thrombi. Specific MR features including high signal intensity on T1 weighted images and diffusion restriction on diffusion weighted images were helpful in reaching a conclusion.
Conjoineted Twins Sonography
(Brieflands, 2017-04-12) Ahmad Soltani Shirazi
One of the complications of Twinning of mono chorionic mono amniotic gestations is conjointed Twins. Structural congenital malformations occur in 5 % to 7 % of twin gestations versus only 3 % of singleton births. Most defects occurring in only one of the twin fetuses. Occasional anomalies such as omphalocele sincenomalia heart defect one reported in both concordance. The structural defect commonly associated with monozygotic twins included conjoined twins: extrophy of bladder, vertebral defect .trachea esophageal fistula with esophageal atresia anomalies (VATER complex) anencephaly. Congenital heart defect and holopro cencephaly. The incidence of con joined twins is approximately 1 of 50000 70 % - 75 % are female. The classification are 1) thoraco pagus: jointed at the thorax. They may share the chest and upper abdominal organs. This is the most common type (70%). 2) Xiophopagus on omphalopagus: jointed by the anterior abdominal wall down to umbilicus 3) pygopagus: jointed by the sacrum and coccyx lying back to back. 4) Ischiopagus: jointed at the ischium or sacrum lying side by side. 5) Craniopagus: jointed at the cranium lying at right angles each other. The sonographic role of management of conjointed twins is to make diagnosis and detect associated anomaly and the extent of joining of twins and map out the defect and determine the likelihood of post natal viability.
Iatrogenic Superficial External Pudendal Artery Pseudoaneurysm: Treatment with Doppler US-Guided Compression
(Brieflands, 2014-05-01) Oktay Algin; Assanaly Mustafayev; Evrim Ozmen
Pseudoaneurysms rarely occur as a serious complication following incomplete hemostasis of an arterial puncture site. As a result of the increase in diagnostic and therapeutic angiography, the frequency of iatrogenic pseudoaneurysm has increased as well. Iatrogenic pseudoaneurysms associated with angiographic catheterization occur most commonly in the common femoral artery. Here we report a case of iatrogenic superficial external pudendal artery (SEPA) pseudoaneurysm following cardiac catheterization, which was diagnosed with Doppler ultrasound (US) and multidetector computed tomographic angiography (MDCTA) before Doppler US-guided compression therapy. To the best of our knowledge, iatrogenic SEPA pseudoaneurysm, which is an unusual vessel location for pseudoaneurysm occurrence, has not been reported in the literature. In patients in whom anticoagulant-thrombolytic therapy or therapeutic catheterization with larger sized sheath is planned, determination of the precise localization of arterial puncture site is important for the prevention of iatrogenic pseudoaneurysm development. Arterial puncture guided with Doppler US might reduce complications. When suspected, MDCTA is useful in the diagnosis and demonstration of iatrogenic pseudoaneurysms. Treatment of US-guided compression should be the first choice for iatrogenic pseudoaneurysms. Interventional radiologists and cardiologists should have enough experience about the catheterization complications and their treatment in order to decrease the morbidity and mortality related to the intervention.
Early Sonographic Diagnosis of Neurocutaneous Melanosis in a Newborn
(Brieflands, 2014-08-01) Zeynep Ilerisoy Yakut; Ahmet Yagmur Bas; Aynur Turan; Nihal Demirel; Tulin Hakan Demirkan
Neurocutaneous melanosis (NCM) is a rare, congenital non-hereditary syndrome, characterized by multiple pigmented nevi. We report the radiologic findings of a newborn who had extensive cutaneous melanotic nevus with satellite lesions in the brain. Ultrasound showed multiple echogenic foci in the cerebral parenchyma. Subsequent MRI confirmed these lesions as characteristic deposits of melanin. The infant was asymptomatic, but presence of risk factors such as malign transformation or neurological manifestations makes early diagnosis very important. We present this case to emphasize on the radiological findings of this syndrome in order to reach an early diagnosis.
Normative Values of Intracranial Translucency (IT) Thickness as an Ultrasonographic Marker for Neural Tube Defect (NTD) Screening in the Iranian Singleton Pregnancies
(Brieflands, 2017-04-12) Mohammad Zare Mehrjardi; Elham Keshavarz; Morteza Sanei Taheri
Background: Neural tube defects are the second most common congenital anomalies following congenital heart defects. Once NTD is detected prenatally, different options are available including pregnancy termination, and intrauterine fetal surgery. Considering these facts, prenatal screening for NTDs is becoming a part of routine fetal care. Several ultrasonographic markers have been suggested for detection of NTD during pregnancy. Intracranial translucency (IT) is a relatively new ultrasonographic marker for NTD screening during first-trimester. It actually represents the fourth cerebral ventricle, seen as an anechoic structure in the mid-sagittal plane of the fetal face posterior to the brainstem. Its absence or obliteration can be an indirect sign of open spina bifida, which is caused secondary to the caudal displacement of brain in these fetuses. In this study, we aimed to determine the normative values of this marker in the Iranian population. Objectives: To determine the normative values of intracranial translucency (IT) thickness in the Iranian singleton pregnancies. Methods: 230 consecutive singleton pregnancies between 11 weeks and 13 weeks+6 days of gestation were included in the study during 9 months (June 2015 to February 2016) prospectively in Mahdieh and Sarem womens hospital, Tehran, Iran. Crown-rump length (CRL), nuchal translucency (NT) thickness, fetal heart rate, and nasal bone status were evaluated by ultrasound as parts of the routine first-trimester screening for aneuploidies. Precise gestational age was determined by the fetal CRL as well. In addition, IT thickness was measured in the mid-sagittal view of the fetal head between two echogenic horizontal lines: posterior border of the brainstem anteriorly and anterior aspect of the fourth ventricle choroid plexus posteriorly (figure 1). All the measurements were performed by a radiologist with four years of experience in fetal imaging. Ethnicities other than Iranian, multiple gestation pregnancies, and pregnancies conceived by assisted reproductive technology (ART) were not included in the study initially. Other exclusion criteria were any obvious anatomic fetal anomaly in the ultrasound examination, abnormal genetic or maternal serum biomarker test result, increased NT, and presence of open NTD in the post-partum follow-up. Results: : Of the 230 included singleton pregnancies, all of them resulted in healthy live births, except for two pregnancies terminated at 19 and 17 weeks of gestation due to severe skeletal dysplasia and an abnormal genetic test result compatible with Down syndrome, respectively. None of born babies had open NTD on post-partum follow-up. Five pregnancies were excluded from the final analysis, including a fetus with increased NT, two pregnancies with abnormal maternal serum biomarker test result (one of which confirmed to be trisomy 21), poor visualization due to maternal severe obesity in one case, and skeletal dysplasia diagnosed at 19 weeks of gestation in one of pregnancies. The median maternal age was 29 (range, 16 - 49) years. Median gestational age was 12 weeks + 5 days (range, 11 weeks + 2 days-13 weeks + 6 days). There were 68 cases per gestational week between 11 and 11 + 6 weeks, 84 cases between 12 and 12 + 6 weeks, and 73 cases between 13 and 13 + 6 weeks. Mean IT thickness was 1.94 - 0.73 mm (95% CI, 1.84 - 2.04) in all included pregnancies. This measurement was 1.57 - 0.34 mm (95% CI, 1.49 - 1.65) for fetuses between 11 and 11 + 6 weeks, 1.86 - 0.29 mm (95% CI, 1.80 - 1.92) for fetuses between 12 and 12 + 6 weeks, and 2.12 - 0.41 mm (95% CI, 2.02 - 2.22) for fetuses between 13 and 13 + 6 weeks. Kolmogorov-Smirnov analysis demonstrated normality of IT thickness distribution in the included cases (P > 0.10). Linear regression analysis demonstrated that there was a statistically significant positive linear association between IT thickness and gestational age (rs = 0.92, P = 0.021). Conclusions: We determined the normative values of IT thickness for the Iranian fetuses in a pilot study, which may be considered for NTD screening during the first-trimester in the national and international guidelines. It is important to determine normal measurements of different ultrasonographic and biochemistry markers nationally, since there are significant differences among various ethnicities. One should expect that IT thickness increases in a linear manner during first-trimester, and in case of its obliteration or absence open NTDs should be strongly suspected.
The Diagnostic Accuracy of Abdominal Ultrasound Imaging for Detection of Ovarian Masses
(Brieflands, 2007-04-30) Masoud Poureisa; S. Refahi; F. Moghangard
Acardiac Parabiotic Twin: A Case Report
(Brieflands, 2007-12-31) Shirin Bavarian
Comparison of Allergic Adverse Effects and Contrast Enhancement Between Iodixanol and Iopromide
(Brieflands, 2012-06-30) Farideh Gharekhanloo; Saadat Torabian
Background: Iodinated X-ray contrast media are the most commonly used contrast agents in the world with an annual application of 40-50 million. New non-ionic con- trast agents are subdivided into low osmolar agents such as iopromide and iso-osmolar agents such as iodixanol. Regarding different biochemical characteristics, these agents are different in the allergic reactions and contrast enhancement and final lesion conspicuity. Objectives: This study was carried out to compare allergic adverse effects and contrast enhancement between iodixanol and iopromide. Patients and Methods: One-hundred and twenty patients who were referred for abdominal CT scan to Besat Hospital were included in this study. Patients were randomly divided into two groups (A and B). Group A received 100 cc iodixanol (300 mgI/mL) and group B received 100 cc iopromide (300 mgI/ml) by power injector. CT examination was performed using Helical CT Scanner (Somatom, Siemens, Germany). Sixty seconds after injection, images were obtained and enhancement of port, liver and aorta were determined. Allergic adverse effects were recorded one hour and up to one week after injection. Results: Iodixanol produced a significantly greater enhancement of the hepatic, aorta and portal vein than iopromide (P < 0.01). Sixty seconds after injection, associated pain and heat sensation were less frequent in iodixanol in comparison with iopromide (P = 0.03). Immediate reactions such as nausea and vomiting were less frequent in iodixanol (P = 0.01). Late skin reactions such as rash was more frequent in iodixanol (P < 0.01). Conclusions: Iodixanol is safe and is better tolerated in the early phase of injection with better contrast enhancement and lesion conspicuity. Mild late skin rash is its disadvantage.
Ultrasound-guided Core Needle Biopsy of Liver Hemangiomas: Three-Year Experience
(Brieflands, 2007-12-31) A. Alamdaran
Split-Bolus Single-Pass Multidetector-Row CT Protocol for Diagnosis of Acute Pulmonary Embolism
(Brieflands, 2016-01-01) Michele Scialpi; Alberto Rebonato; Lucio Cagini; Luca Brunese; Irene Piscioli; Luisa Pierotti; Lucio Bellantonio; Alfredo D’Andrea; Antonio Rotondo
Background: Currently computed tomography pulmonary angiography (CTPA) has become a widely accepted clinical tool in the diagnosis of acute pulmonary embolism (PE). Objectives: To report split-bolus single-pass 64-multidetector-row CT (MDCT) protocol for diagnosis of PE. Patients and Methods: MDCT split-bolus results in 40 patients suspicious of PE were analyzed in terms of image quality of target pulmonary vessels (TPVs) and occurrence and severity of flow-related artifact, flow-related artifact, false filling defect of the pulmonary veins and beam hardening streak artifacts. Dose radiation to patients was calculated. Results: MDCT split-bolus protocol allowed diagnostic images of high quality in all cases. Diagnosis of PE was obtained in 22 of 40 patients. Mean attenuation for target vessels was higher than 250 HU all cases: 361 ± 98 HU in pulmonary artery trunk (PAT); 339 ± 93 HU in right pulmonary artery (RPA); 334 ± 100 HU in left pulmonary artery (LPA). Adequate enhancement was obtained in the right atrium (RA):292 ± 83 HU; right pulmonary vein (RPV): 302 ± 91 HU, and left pulmonary vein (LPV): 291 ± 83 HU. The flow related artifacts and the beam hardening streak artifacts have been detected respectively in 4 and 25 patients. No false filling defect of the pulmonary veins was revealed. Conclusion: MDCT split-bolus technique by simultaneous opacification of pulmonary arteries and veins represents an accurate technique for diagnosis of acute PE, removes the false filling defects of the pulmonary veins, and reduces flow related artifacts.
Contrast-Enhanced Three-Dimensional Fluid-Attenuated Inversion Recovery Imaging with an Optimal Scan Interval and Angulation to Visualize Endolymphatic Hydrops
(Brieflands, 2022-07-31) Jinye Li; Lixin Sun; Linsheng Wang; Na Hu; Long Li; Gesheng Song; Han Xu; Ting Xu; Weiqiang Dou; Ruozhen Gong; Chuanting Li
Background: There is no gold standard diagnostic test for endolymphatic hydrops (EH). Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging has been reported to depict EH with administration of gadolinium-based contrast media (GBCM). However, the optimal scan interval and angulation remain unknown in 3D-FLAIR labyrinthine imaging following double-dose injections of a gadolinium-based contrast agent in patients with vertigo and sensorineural hearing loss. Objectives: This study aimed to determine the optimal parameters of 3D-FLAIR labyrinthine imaging, including the optimal scan angulation and scan interval, for patients with sensorineural hearing loss and vertigo. Patients and Methods: In this cross-sectional clinical study, following the double-dose administration of a gadolinium contrast agent, 3D-FLAIR labyrinthine images were acquired from 22 patients with unilateral vertigo and sensorineural hearing loss at different intervals after injection. The corresponding contrast-to-noise ratios (CNRs) and signal-intensity ratios (SIRs) of these images, acquired at different intervals, were measured. Moreover, separate visualization of endolymphatic and perilymphatic spaces was scored, and angulation of the anterior skull base scan was investigated in the sagittal position. Results: The 3D-FLAIR images showed the strongest image contrast in the cochlea with a double-dose gadolinium-based contrast injection at six hours post-injection. Significantly higher SIR and CNR values were reported at six hours post-injection in both unaffected and affected ears compared to other intervals (4 h vs. 6 h in the affected side, SIR: 1.65 ± 0.24 vs. 2.09 ± 0.47, CNR: 13.88 ± 5.54 vs. 19.17 ± 6.81; in the unaffected side, SIR: 1.58 ± 0.27 vs. 1.82 ± 0.34, CNR: 12.20 ± 3.88 vs. 15.42 ± 4.58, P < 0.001 for all; 6 h vs. 8 h in the affected side: SIR: 2.09 ± 0.47 vs. 1.72 ± 0.43, CNR: 19.17 ± 6.81 vs. 12.22 ± 4.96; in the unaffected side, SIR: 1.82 ± 0.34 vs. 1.57 ± 0.30, CNR: 15.42 ± 4.58 vs. 10.61 ± 3.87, P < 0.001 for all). Visualization of the endo- and perilymphatic spaces for both the cochlea and vestibule was significantly better at six hours post-injection compared to four hours post-injection in both affected sides (P < 0.05 for both). The optimal angulation ranged from 6.20° to 13.6° (P < 0.001). Conclusion: By using an optimal scan interval, together with an optimal scan angulation, 3D-FLAIR imaging can reliably visualize the endolymphatic space and sensitively indicate cochlear blood-labyrinth barrier disruptions without requiring extra image reconstruction.
Tumor Size Measurements with Breast Magnetic Resonance Imaging (MRI) in Elderly Breast Cancer Patients: A Comparison of Breast MRI with Mammography and Ultrasound
(Brieflands, 2021-07-31) Jin Kyung An; Jeong Joo Woo; Ji Ye Lee; Bora Lee
Background: With a rapid increase in the aging population around the world, there has been a surge in the number of elderly breast cancer patients. Magnetic resonance imaging (MRI) is commonly used in preoperative assessments for elderly patients. However, there has been no consensus on the accuracy of tumor size measurements by MRI. Objectives: To compare the accuracy of MRI versus conventional imaging methods, namely, mammography (MG) and ultrasound (US), in tumor size measurements in elderly patients and to determine the predictors of measurement accuracy. Patients and Methods: This study was conducted on 134 patients, aged 50 years or above (137 breasts with invasive cancer). The tumor size and T stage were assessed using MG, US, and MRI, and the results were compared with pathological findings. The tumor size differences between the imaging and pathological findings were classified as ≤ 0.5 cm or > 0.5 cm. Differences in tumor size and T stage were analyzed based on age group (≥ 60 years vs. < 60 years), using chi-square test, Fisher’s exact test, and Cohen’s kappa coefficient. The diagnostic sensitivity, specificity, and accuracy were also measured. Multivariate logistic regression analysis was performed to evaluate the predictors that influenced tumor size differences. Results: Tumor size differences ≤ 0.5 cm, T-stage agreement, and diagnostic performance for T stages ≥ 2 were higher in the elderly group compared to the younger group on MRI. The T-stage agreement with the histopathological results was higher on MRI compared to conventional imaging methods. For diagnosis of T stages ≥ 2, MRI showed the highest sensitivity, while US showed the highest specificity. The calcification type, dense breasts, and histological grade 3 were predictors of tumor size differences > 0.5 cm. Conclusion: The accuracy of tumor size measurements on MRI was higher in elderly patients aged ≥ 60 years. The diagnostic accuracy further increased in elderly patients with non-dense breasts and mass-type lesions. In T-stage analysis, MRI showed the highest sensitivity, while US showed the highest specificity.
Cost-Effectiveness of Endovascular Aneurysm Repair Versus Open Surgical Repair for Ruptured Abdominal Aortic Aneurysms: A Systematic Review
(Brieflands, 2021-07-31) Zeinab Dolatshahi; Fateme Mezginejad; Shahin Nargesi; Moslem Saliminejad
Context: If the diameter of an aneurysm increases by more than 6 cm, the risk of aortic rupture increases by 50% within 10 years. Therefore, rupture of aneurysm, which is usually asymptomatic, can lead to severe complications and increase the risk of mortality. The current study aimed to systematically review studies comparing the cost-effective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) as the primary treatment options for patients with ruptured abdominal aortic aneurysms (AAAs). Methods: An electronic search was conducted in PubMed, EMBASE, Science Direct, Scopus, and other scientific economic databases. Relevant articles were searched from 1999 to 2020 using keywords, such as “abdominal aortic aneurysm”, “endovascular”, “open surgery”, “rupture”, “economic evaluation”, and “cost-effectiveness”. The quality of articles was assessed using the Quality of Health Economic studies (QHES) checklist; finally, five articles were included in this review. Results: The results of the QHES checklist showed that most studies had a good quality. A third-party payer’s perspective was the dominant perspective in all selected studies, comparing EVAR with OSR. All studies considered the direct medical costs and did not disclose any discount rates, except for one study, reporting a 3.5% discount rate. Almost all included studies found EVAR to be a cost-effective intervention; only one study concluded that EVAR, with a cost-effectiveness ratio of €424,542, was not the best treatment option. Conclusion: In patients with ruptured AAAs, the EVAR intervention improved the quality of life, decreased the mortality rate, and shortened the hospital stay as compared to OSR.

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