IJ Radiology

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


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.


Recent Submissions

Now showing 1 - 20 of 1424
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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.
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    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.
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    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.
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    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.
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    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.
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    Missed Diagnosis and Treatment Dilemma: Large Patent Ductus Arteriosus Combined with Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery
    (Brieflands, 2017-04-30) Ayca Ata Korkmaz; Hakan Erkan; Aysegul Karadeniz; Cihan Orem
    An anomaly of the left coronary artery, originating from the pulmonary trunk, is called anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome. This syndrome is an infrequent congenital anomaly, mostly seen in children. Usually, because of the anomaly, myocardial perfusion failure occurs. This anomaly presents even less frequently in adults. The symptoms of ALCAPA develop in the early ages. Congestive heart failure is an important result of ALCAPA, as well as mitral insufficiency and left ventricular (LV) dysfunction. If there is a patent ductus arteriosus (PDA) or ventricular septal defect (VSD), high pulmonary artery pressures decreases and the coronary anomaly and perfusion defect can be hidden. Here we present a case of a large PDA combined with ALCAPA, as seen in one of the oldest patients ever reported. Recognizing PDA in patients with ALCAPA is very important, since closure of the PDA may cause catastrophic conditions. ALCAPA combined with PDA is very rare and has been reported mostly in infants. To the best of our knowledge, there is no such case diagnosed in adulthood.
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    Imaging Findings of a Primary Cardiac Osteosarcoma Arising From the Left Atrium and Mitral Posterior Leaflet with Multiple Metastases in A 58-Year-Old Woman
    (Brieflands, 2017-04-30) Eun Jee Song; Se Hwan Kwon; Hyo Chul Youn; Soo Cheol Kim; Jong Soo Shin; Joo Hyeong Oh
    Primary cardiac osteosarcoma is a very rare malignancy with nonspecific symptoms, making early diagnosis a challenge. We report the computed tomography and magnetic resonance imaging findings of a primary cardiac osteosarcoma arising from the left atrium and posterior mitral leaflet in a 58-year-old woman with multiple metastases to the brain, skull, clavicle, lung, ribs, liver, lymph nodes, and thyroid gland.
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    Multidetector Computed Tomography Imaging for the Diagnosis of Hyperthyroid Cardiomyopathy
    (Brieflands, 2017-04-30) Hye Rin Kim; Seung Min Yoo; Hwa Yeon Lee; Jae Youn Moon; Woo In Yang; Charles S. White
    We present two cases of hyperthyroid cardiomyopathy (CMP) caused by Graves’ disease in which multidetector computed tomography (MDCT) findings provided specific diagnostic clues, guiding the attending physician to a prompt diagnosis and allowing rapid initiation of therapy. We believe that a combination of diffuse thyroid enlargement, with decreased attenuation on non-enhanced chest CT, thymic hyperplasia and cardiomegaly (i.e. predominantly right heart failure with enlargement of the left atrium) are suspicious CT findings of hyperthyroid CMP.
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    Magnetic Resonance Imaging Findings of Ovotesticular Disorder of Sex Development with Bilateral Gonadoblastoma
    (Brieflands, 2017-04-30) Fatma Kulali; Safak Firat Kulali; Aslihan Semiz-Oysu; Muberra Segmen-Yilmaz; Yasar Bukte
    Ovotesticular disorder of sex development (DSD) is a very rare chromosomal anomaly characterized by the presence of both ovarian and testicular tissues.
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    Different CT Findings of Aortic Hemorrhage Extending to Pulmonary Artery from Stanford Type A Aortic Dissection
    (Brieflands, 2018-04-30) Kyu-Chong Lee; Jae Wook Lee; Hwan Seok Yong; Eun-Young Kang
    Hemorrhage extending to the pulmonary artery is an uncommon complication of Stanford type A aortic dissection that has a poor prognosis. Diagnosis of this complication is mainly dependent on imaging studies, especially computed tomography. High attenuation can be seen along the wall of the pulmonary artery on the non-enhanced study, while the enhanced study shows luminal narrowing and wall thickening of the pulmonary artery. We report three cases with different imaging findings of hemorrhage extending to the pulmonary artery from Stanford type A aortic dissection.
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    Reliability of a New Radiological Parameter Named the Modified Tönnis Angle for the Evaluation of Acetabular Dysplasia in Adults
    (Brieflands, 2018-04-30) Liangguo Fa; Guangrui Shao; Linlin Meng; Linlin Wang
    Objectives: To evaluate the reliability of Tönnis angle and modified Tönnis angle on pelvic radiographs in adults. Patients and Methods: Conventional anterior-posterior pelvic radiographs of patients were selected from the picture archiving communication system (PACS) in the department of medical radiology of the Second Hospital of Shandong University. Tönnis angle and modified Tönnis angle were measured. All measurements were performed by two experienced observers who worked independently of each other. These measurements were performed again after one month. They were performed digitally using tools of the PACS. Reliability of Tönnis angle and modified Tönnis angle was assessed by intraclass correlation coefficients and Bland-Altman plot. Results: A total of 142 patients (79 females and 63 males) with 284 hips were selected. Tönnis angle and modified Tönnis angle were measured on the 284 hips by two observers. Intraclass correlation coefficients (ICCs) for intraobserver agreement of measurements were 0.962 and 0.983 for Tönnis angle, and 0.971 and 0.984 for modified Tönnis angle. ICCs for interobserver agreement of measurements were 0.936 for Tönnis angle and 0.932 for modified Tönnis angle. Bland-Altman plot suggested good interobserver agreement of measurements for Tönnis angle and modified Tönnis angle. Conclusion: Reliability of Tönnis angle and modified Tönnis angle was good according to ICCs and the Bland-Altman plot.
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    High-Resolution Three Dimensional MRI Findings After Plugging Surgery for Superior Semicircular Canal Dehiscence: A Case Report
    (Brieflands, 2020-10-31) Ji Ye Lee; Ra Gyoung Yoon; Hyun Joon Shim
    Superior semicircular canal dehiscence (SSCD) is known as abnormal communication of the superior semicircular canal (SCC) to the intracranial space secondary to a bony defect in the canal. Patients who are subjected to surgical repair usually have intractable symptoms, and recently, plugging of SCC using a transmastoid approach has been widely recommended. In this report, we describe a case of incomplete plugging for SSCD in a 37-year-old woman, along with the high-resolution three dimensional magnetic resonance imaging (3D MRI) findings using Pöschl view reconstruction. Postoperative MRI of 3D T2-wieghted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) Pöschl plane demonstrated an incomplete plugging of the SCC with partially visible perilymphatic fluid in the posterior limb above the common crus. A 3D fluid-attenuated inversion recovery (FLAIR) sequence showed an enhancement involving the vestibule and SCC, suggesting labyrinthitis. Although there are few reports about incomplete plugging for SSCD, this case could demonstrate postoperative status and complication after plugging of SSCD using a high-resolution 3D MRI sequences with Pöschl view reconstruction.
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    Comparative Study of Three Preoperative Imaging Modalities for the Evaluation and Design of Superficial Circumflex Iliac Artery Perforator Flap: Color Doppler Ultrasound, Computed Tomography Angiography and Magnetic Resonance Angiography
    (Brieflands, 2020-07-31) Zhuowei Tian; Shizhe Wang; Yue He; Chunyue Ma
    Background: Superficial circumflex iliac artery perforator (SCIP) flap is a promising reconstructive candidate for head and neck, trunk and extremity reconstruction. In order to reduce intraoperative errors, preoperative planning is essential for evaluation of the possible variations in vascular anatomy of the groin region. However, the use of these modalities has not been compared. Objectives: The three commonly used imaging modalities [color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA)] were therefore compared in this study for the relative accuracy in the SCIP flap planning. Patients and Methods: This study was conducted on eight patients who underwent CDUS, CTA and MRA [3-dimensional time-of-flight magnetic resonance angiography, (3D TOF-MRA)] and received reconstructions with the SCIP flaps for head and neck defects. The perforators’ locations, courses and calibers were measured or marked for each flap. These imaging preoperative measurements were later compared with intraoperative findings. Results: CDUS, CTA and 3D TOF-MRA were able to effectively identify the courses of the perforators. 3D TOF-MRA was more accurate at measuring the pedicle calibers of SCIP flaps in comparison with CTA and CDUS. Conclusion: Three D-TOF-MRA may be a more valuable imaging modality for the preoperative assessment of the vascular anatomy of SCIP flaps.
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    Obturator Hernia with Meckel’s Diverticulum Mimicking Incarcerated Small Bowel Hernia: A Case Report
    (Brieflands, 2020-10-31) Won Jae Choi; Yoon Young Jung; Yongsang Kim; Dong Hee Kim
    An obturator hernia is a rare type of abdominal hernia that can cause acute intestinal obstruction. Meckel’s diverticulum, the most common gastrointestinal tract malformation, is an uncommon cause of intestinal obstruction. The combination of obturator hernia and Meckel’s diverticulum is extremely rare. We report a rare case of obturator hernia with Meckel’s diverticulum in a 76-year-old woman who presented at the emergency room with complaints of abdominal pain. The diagnosis was confirmed by a computed tomography (CT) scan and exploratory laparotomy. Since obturator hernia is uncommon and rarely associated with Meckel’s diverticulum, we described the imaging features in this case study.
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    Primary Yolk Sac Tumor of the Endometrium with MRI Findings: A Case Report
    (Brieflands, 2020-07-17) Dalin Zhu; Fan Feng; Meijuan Peng
    Primary yolk sac tumor (YST) of the endometrium is a very rare malignant germ cell tumor, primary YST of the endometrium with detailed magnetic resonance imaging (MRI) and contrast-enhanced MRI (CE-MRI) findings have not yet been reported in the English literature. We report a 40-year-old woman presenting with irregular lower abdominal pain and dysmenorrhea for more than 5 months. MRI showed a lesion in the right side wall of the uterus. Postoperative pathology and immunohistochemistry confirmed the diagnosis of primary YST of the endometrium with the International Federation of Gynecology and Obstetrics (FIGO) system staging of IV. The signal of the tumor was complex and lacked specific characteristic. Diffusion-weighted imaging (DWI) showed that the lesion is diffuse limited, the average apparent diffusion coefficient (ADC) value of the solid component was 0.735 × 10-3 mm2/s. CE-MRI showed that the irregular lesions presented uneven and mild enhancement in the arterial stage, and continued to strengthen in the venous phase, and strengthened close to the myometrium in the delayed phase. Primary YST of the endometrium should be considered if MRI scans show an irregular lesion in the myometrium with high level of alpha-fetoprotein (AFP).
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    A Multi-centric Evaluation of Deep Learning Models for Segmentation of COVID-19 Lung Lesions on Chest CT Scans
    (Brieflands, 2022-10-31) Saman Sotoudeh-Paima; Navid Hasanzadeh; Ali Bashirgonbadi; Amin Aref; Mehran Naghibi; Mostafa Zoorpaikar; Arvin Arian; Masoumeh Gity; Hamid Soltanian-Zadeh
    Background: Chest computed tomography (CT) scan is one of the most common tools used for the diagnosis of patients with coronavirus disease 2019 (COVID-19). While segmentation of COVID-19 lung lesions by radiologists can be time-consuming, the application of advanced deep learning techniques for automated segmentation can be a promising step toward the management of this infection and similar diseases in the future. Objectives: This study aimed to evaluate the performance and generalizability of deep learning-based models for the automated segmentation of COVID-19 lung lesions. Patients and Methods: Four datasets (2 private and 2 public) were used in this study. The first and second private datasets included 297 (147 healthy and 150 COVID-19 cases) and 82 COVID-19 subjects. The public datasets included the COVID19-P20 (20 COVID-19 cases from 2 centers) and the MosMedData datasets (50 COVID-19 patients from a single center). Model comparisons were made based on the Dice similarity coefficient (DSC), receiver operating characteristic (ROC) curve, and area under the curve (AUC). The predicted CT severity scores by the model were compared with those of radiologists by measuring the Pearson’s correlation coefficients (PCC). Also, DSC was used to compare the inter-rater agreement of the model and expert against that of 2 experts on an unseen dataset. Finally, the generalizability of the model was evaluated, and a simple calibration strategy was proposed. Results: The VGG16-UNet model showed the best performance across both private datasets, with a DSC of 84.23% ± 1.73% on the first private dataset and 56.61% ± 1.48% on the second private dataset. Similar results were obtained on public datasets, with a DSC of 60.10% ± 2.34% on the COVID19-P20 dataset and 66.28% ± 2.80% on a combined dataset of COVID19-P20 and MosMedData. The predicted CT severity scores of the model were compared against those of radiologists and were found to be 0.89 and 0.85 on the first private dataset and 0.77 and 0.74 on the second private dataset for the right and left lungs, respectively. Moreover, the model trained on the first private dataset was examined on the second private dataset and compared against the radiologist, which revealed a performance gap of 5.74% based on DSCs. A calibration strategy was employed to reduce this gap to 0.53%. Conclusion: The results demonstrated the potential of the proposed model in localizing COVID-19 lesions on CT scans across multiple datasets; its accuracy competed with the radiologists and could assist them in diagnostic and treatment procedures. The effect of model calibration on the performance of an unseen dataset was also reported, increasing the DSC by more than 5%.
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    Quantification of the Brain MS Plaque Volume: Comparison of Quantitative and Qualitative Estimation of the Brain MS Plaque Volume in Successive MRI Before and After Medication Use
    (Brieflands, 2021-10-31) Amin Abolhasani Foroughi; Banafsheh Zeinali-Rafsanjani; Masoume Nazeri; Mahdi Saeedi-Moghadam; Amir Torkaman
    Background: Multiple sclerosis (MS) is a demyelinating disease with multiple symptoms. To examine the effect of medications, magnetic resonance imaging (MRI) imaging can be performed. Objectives: This study aimed to compare the visual assessment of MRI images by physicians and the results of a MATLAB-based software developed for evaluating the MS plaque volume. Patients and Methods: TYSABRI (natalizumab)-treated patients were enrolled in this study. MRI was performed before and after treatment. A MATLAB-based software was developed to evaluate the MRI images. The images were then subjectively evaluated by three specialists and objectively assessed by the software, and the results were then compared. Results: Thirty-five patients participated in this study. According to the software, the status of 37.14% of the patients improved; however, 62.86% of cases deteriorated after a year of treatment. There was less than 50% agreement between the physicians and less than 55% agreement between the physicians and the software results. A disagreement of almost 45% was observed between the physicians and the software results, as in some cases, small changes were detected in successive images. The second cause of disagreement could be the physicians’ expectations; although the patient’s recovery was highly expected in some cases, their condition deteriorated. Conclusion: The results revealed that the objective assessment of sequential MRI images of MS patients reduced human errors and improved the evaluation of this disease.
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    Evaluation of Radiographers’ Experience in Mammography: An Explanatory Study
    (Brieflands, 2022-04-30) Salman Albeshan; Yazeed Alashban; Nasser Shubayr; Arwa Alkhudairy; Fatma Eliraqi
    Background: Similar to most imaging procedures, the high quality of images is a key factor in ensuring that mammography delivers its full potential benefits. Radiographers play a central role in the acquisition of high-quality images, as they are responsible for not only breast positioning and compression, but also quality control and patient care. Objectives: To identify the challenges and difficulties of radiographers in daily practice and to determine the main components of mammography that require further training and education. Patients and Methods: An online survey was conducted to collect data regarding the radiographers’ demographic data, institution profile, image assessment tools, mammography challenges, quality control, and continuing professional development. Results: A total of 73 radiographers participated in this study, the majority of whom were full-time radiographers with a bachelor’s degree in radiography. Less than half of the participants had been a mammographer for more than five years. The American College of Radiology (ACR) criteria were the most familiar image quality assessment tool (52%). The most frequently used scale to evaluate image quality was posterior breast tissue visualization on both craniocaudal (CC) and mediolateral oblique (MLO) views, followed by the pectoral muscle volume determined on the MLO view. Overall, positioning, artifacts, and compression were the main reasons for repeat mammography. Also, wheelchair-bound patients, overweight patients, and breast compression were the greatest challenges of patient positioning. Conclusion: This pilot study highlighted the importance of developing in-house training courses for radiographers, which focus on patient positioning, image quality assessment, and patient-centered needs to improve practice standards. However, further studies on a larger sample size are needed to validate the present results.
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    Breast Imaging Findings of Microcalcifications in Ductal Carcinoma in Situ and Their Correlations with Pathological and Biological Features
    (Brieflands, 2021-10-31) Eun Ji Lee; Yun-Woo Chang
    Background: Mammography (MMG) is the primary screening tool for breast cancer, as microcalcifications are the most common MMG finding in ductal carcinoma in situ (DCIS). The use of high-frequency transducers facilitates the visualization of calcifications on ultrasonography (USG), especially in patients with dense breasts and cancer symptoms. Although a correlation has been reported between the imaging features of DCIS and pathological features, few studies have focused on multiple imaging modalities. Objectives: To evaluate the correlation of DCIS microcalcifications in breast imaging with pathological and biological features. Patients and Methods: The MMG and USG findings of 125 lesions detected in 123 patients, diagnosed with pure DCIS, were retrospectively reviewed according to the breast imaging-reporting and data system (BI-RADS). The USG and comparable MMG findings of microcalcifications were divided into three groups: group 1 (MMG negative, USG negative), group 2 (MMG positive, USG negative), and group 3 (MMG positive, USG positive). The pathological findings (nuclear grade and comedo necrosis) and biological features [estrogen (ER) positive group, human epidermal growth factor receptor 2 (HER2) positive group, triple negative group, and Ki-67 index] were compared with the MMG and USG features using Chi-square test. Results: Microcalcifications were observed on MMG in 83 (66.4%) DCIS lesions. Positive microcalcifications on MMG were significantly associated with a high nuclear grade (P = 0.001) and comedo necrosis (P = 0.001). Positive microcalcifications on MMG were significantly associated with ER negativity (P = 0.023), HER2 positivity (P = 0.002), and increased Ki-67 index (P = 0.001). There were 62 lesions (49.6%) without microcalcifications on USG (group 1 and group 2), while there were 63 (50.4%) lesions with microcalcifications on USG (group 3). Positive microcalcifications on MMG were significantly associated with ER-negative group (P = 0.023), HER2-positive group (P = 0.002), and increased Ki 67 index (P = 0.001). Conclusion: Based on the present results, DCIS microcalcifications detected via imaging were significantly associated with poor prognostic pathological factors, such as a high nuclear grade and comedo necrosis, as well as poor prognostic biological factors, including ER negativity, HER2 positive group, and a high Ki-67 index.
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    The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation
    (Brieflands, 2017-01-31) Yaşar Taştemur; Vedat Sabanciogullari; İsmail Salk; Muhittin Sönmez; Mehmet Cimen
    Background: Tonsillar herniation is a condition that manifests as herniation of the brain parts, originating from the hindbrain and progressing through the foramen magnum into the cervical vertebral canal. Although the etiology of tonsillar herniation is unclear, it has been suggested that it may be congenital or acquired. In particular, there is speculation that primary mesodermal insufficiency may affect the size of the posterior cranial fossa. Objectives: Our main objective is to perform measurements of the cranium, cerebrum, and cerebellum in order to clarify the etiology of tonsillar herniation. Patients and Methods: Magnetic resonance images were taken for 1,052 patients (629 females and 423 males) with no disease affecting the bones. Chiari malformation type I (CMI) was detected in 63 of the patients. The remaining 989 patients were considered to be the control group. The patients’ mean age was 36.58 ± 22.34 (1 - 94 years). Measurements were performed using midsagittal and axial T1 and T2 images. Nine parameters were used to evaluate cranium morphometry, while a further nine were used to evaluate cerebrum and cerebellum morphometry. The data collected were analyzed using SPSS version 14 statistics software, in addition to the t-test and the Mann-Whitney U test. The significance level was set at 0.05. Results: In individuals with tonsillar herniation, while the front-back diameter of the foramen magnum, the cerebellum height, and the sagittal diameter of the cerebellum increased, the maximum cranial height, supraocciput length, clivus length, and height of the posterior cranial fossa decreased. Also, in the case of all age groups, there was no statistically significant difference between the healthy controls and the people with tonsillar herniation in terms of tentorial slope angle. The mean herniation value was 4.85 ± 3.09 mm in those with tonsillar herniation. Conclusion: Our results concerning cranium morphometry support the theory that hypoplastic posterior cranial fossa due to mesodermal insufficiency may play a role in the etiology of tonsillar herniation.