Iranian Journal of Radiology
Volume:1 Issue: 1, Autum & Winter 2003

Background/ Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapon agents (CWA) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook a retrospective analysis of the patients with documented exposure to SM during the war who subsequently developed respiratory symptoms. A review of the chest High Resolution Computed Tomography (HRCT) findings was performed to determine the features of this disease defined by this diagnostic modality. Field documents and other medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were studied. The chest HRCTs of these patients were reviewed in order to determine the delayed radiographic patterns in patients with documented exposure to SM. Fifty chest HRCTs of these patients were evaluated. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), major airway dilatation 33 (66%) and secondary lobule abnormalities 13 (26%) respectively. Exposure to SM has devastating chronic pulmonary complications potentially disabling those affected severely. Chest HRCT findings of bronchiectasis, air trapping, major airway abnormalities, and EMPA are frequently observed in patients exposed to SM. These findings are highly suggestive of constrictive bronchiolitis obliterans (BO) diagnosis.

Backgroud/ Extramedullary hematopoiesis (EMH) is a physiological response to chronic anemia and may rarely cause spinal cord compression. Herein, we describe 9 thalassemic patients presenting with signs and symptoms of cord compression either due to epidural mass or spinal canal stenosis secondary to bone widening. Since this emergency condition can be readily diagnosed by MRI and has medical rather than surgical treatment, i.e., blood transfusion and/or low dose radiation therapy, physicians should also be aware of EMH in patients with signs and symptoms of spinal cord compression, particularly in areas endemic for thalassemia. 7 patients with thalasemia intermedia are treated medically and only by oral folic acid and symptoms disappeared within 2-3 weeks. “None of the seven patients were diagnosed before from point of thalassemia.” Two patients were diagnosed as major thalassemia. About young patient in endemic areas for thalassemia who have cord compression signs and symptoms, thalassemia variants or undiagnosed minor thalassemia should be evaluated.

Background/ The purpose of this study is to evaluate the sonographic changes of the lens that present with traumatic cataract in correlation with the age of injury. Materials/ In this cross sectional study, 38 consecutively selected patients with traumatic cataract, referred to a radiology clinic were assessed by sonography. Other causes of cataract were excluded. Sonography was performed by one radiologist (M.A.K.) using ultrasound units with a 12 MHz linear transducer, and a 10-MHz mechanical sector transducer. All patients except one showed abnormal sonographic changes. Some lenses showed more than one sonographic abnormality amounting to a total of 68 abnormal findings. Setting a period of 3 months as the cut-off point, sonographic findings could be divided into the early and late onset changes. Echogenic surface, and multiple scattered fine echoes were among the early textural change seen early after traumatic cataract. Echogenic subcapsular area, echogenic cortex, and totally echogenic lens with or without structural changes were more frequent in chronic cataracts. Sonographically observed changes that occur in the lens following traumatic cataract may bear some relation to those seen in senile cataract. It remains to be determined whether and how far the physico-chemical and structural changes, and hence the sonographic features of senile cataract share similar evolutionary patterns as compared with traumatic cataract. The presence of diffuse subtle echoes could be used as an indirect sign of lens rupture when the rupture site is still obscured.

Background/ Brucellosis is an endemic zoonosis in the Middle East and despite all public health efforts it has not yet been eradicated in Iran. We aimed to highlight and categorize the imaging features of Brucella spondylitis. Twenty six cases of Brucella spondylitis were treated by the authors from 1982 up to 2003. The available imaging studies of all the cases are reviewed and include X-ray films, conventional myelography, computerized tomographic (CTscan) and magnetic resonance imaging (MRI). There were 21 male and 5 female patients with an age range of 5 to 62 years and the majority (60%) in the 4th and 5th decades of life. Wright hemagglutination tests were positive in all cases. Plain X-ray films typically showed lysis of the end plates with osteophyte formation involving affected vertebrae, followed by narrowing of the interspaces and destruction or collapse of the vertebral bodies in 7 cases. Myelography demonstrated various types of epidural filling defects and obstruction to the flow of contrast material in 10 cases. CT scan, available in 3 cases, showed erosion and cauliflower-like proliferation at the bony edges of the vertebral bodies and end plates. MRI findings varied depending upon the acute or chronic stages of the illness with hypo- or hyper-intense changs on T1 sequences, and primarily hyper-intense changes on T2 sequences in 8 cases. The findings in this series of patients suggest that imaging findings of Brucella spondylitis are scarcely specific. However when considering the medical history, place of origin of the patients, clinical presentation and laboratory findings, the early diagnosis of the illness may be possible before proceeding to surgical intervention.

Background/ To investigate the value of transabdominal sonography for evaluation of esophagitis in children. A total of 74 children with the clinical suspicion of esophagitis underwent transabdominal sonography of the gastroesophageal junction. Thicknesses of the anterior and posterior walls of the gastroesophageal junction were measured, as well as the thickness of the mucosa. This was followed by endoscopy and biopsy. In histopathologic examination 44 cases were diagnosed as having esophagitis (diseased group) and 30 were reported normal (normal group). The mean wall thickness was significantly higher in the diseased group. Sonography based on wall thickness using cut-off point of 6.9 mm had a sensitivity of 96%. Negative predictive value of 91% and accuracy of 84%. Sonography based on mucosal thickness using cut-off point of 1.8 mm had a sensitivity of 96%, negative predictive value of 81% and accuracy of 69%. Endoscopy had a sensitivity of 82%, negative predictive value 65% and accuracy of 69%. Despite the high accuracy of sonography, endoscopy due to its ability to perform biopsy cannot be superseded by sonography in evaluation of reflux esophagitis, but owing to high sensitivity and negative predictive value of sonography, it has the potential to be used as a screening test. In the clinical setting of reflux esophagitis in children, if TAS of the GEJ showed a GEJ wall thickness of 6.9 mm or less and the mucosal thickness of 1.8 mm or less, and if there is no gastroesophageal reflux noted on sonography, the patient should be considered as normal and no endoscopy is required. On the other hand, if the patient showed a thickness of the wall of the GEJ 7 mm or more, or a thickness of the mucosa of GEJ 2 mm or more on TAS, an endoscopy should be performed and a biopsy should be obtained.

Backgroud/ In recent years endoscopic sinus surgery has been established as a successful treatment of chronic sinusitis and more attention has been given to CT evaluation of the paranasal sinuses. Concha bullosa is defined as aeration of the middle turbinate. It is one of the most important anatomic variants that may cause inflammatory sinus disease by narrowing of the middle meatus. The incidence of concha bullosa has been reported from 4-80% in different studies. The goal of this study is to determine the incidence of concha bullosa and a few other significant sinonasal anatomic variants in symptomatic patients and to correlate with the presence of inflammatory sinus disease as detected on CT. Coronal CT scans of the sinuses were evaluated in 174 consecutive symptomatic patients. The symptoms included postnasal discharge and tenderness over the facial sinuses during the past two weeks prior to examination. The mean age of patients was 30.6 years (from 7 to 66 years); and there were 95 (54.6%) males and 79 (45.4%) females. Concha bullosa was present in 113 (64.9%) patients. It was bilateral in 45 (39.8%) and unilateral in 68 (60.2%) patients. In cases with unilateral concha bullosa, the left to right ratio was 1.7 to 1. Inflammatory disease of the sinuses was identified in 81 (71.7%) patients with concha bullosa and 35 (57.7%) patients without concha bullosa. The incidence of inflammatory disease of the sinuses was higher when there was coexistence of concha bullosa and deviation of the nasal septum. The most common symptom was headache (71.8%), and the least common was fever (27.9%). Tenderness over the frontal and maxillary sinuses, postnasal drip and fever were more common in patients with concha bullosa. Concha bullosa is associated with higher incidence of inflammatory sinus disease. With simultaneous concha bullosa and nasal septal deviation, the incidence of inflammatory disease increases.

Backgroud/ Ramsar in northern Iran is among the world’s well-known areas with highest levels of natural radiation. Annual exposure levels in areas with elevated levels of natural radiation in Ramsar are up to 260 mGy y-1 and average exposure rates are about 10 mGy y-1 for a population of about 2000 residents. Due to the local geological features, which includes high levels of radium in rocks, soils, and groundwater, Ramsar residents are also exposed to high levels of alpha activity in the form of ingested radium and radium decay progeny as well as very high radon levels (over 1000 MBq m-3) in their dwellings. In some cases, the inhabitants of these areas receive doses much higher than the current ICRP-60 dose limit of 20 mSv y-1 set for radiation workers. The extraordinary levels of natural radiation in Ramsar prompted us to assess the radiation susceptibility of the residents. Venous blood samples were taken from 7 healthy blood donors of both sexes who lived in some areas of Ramsar with highest levels of natural radiation (dose rates were up to 155 µSv h-1) and 5 healthy persons from a nearby control area. Standard condition for cell cultivation, irradiation and analysis of chromosome aberrations was used. The cells were exposed to the challenge dose of 1.5 Gy of Co-60 gamma ray 48 hours after PHA stimulation. Using mean chromosomal aberration per cell (MCAPC), the expected numbers of aberrations were calculated. Lymphocytes of Ramsar residents when subjected to 1.5 Gy of Gamma rays, showed fewer chromosome aberrations compared to residents in a nearby control area. These findings clearly show that high levels of natural radiation may induce radioadaptive response. Interestingly, this radioadaptation phenomenon was found in individuals who received doses as much as a few hundred times more than the inhabitants of a nearby control area. More research is needed to precisely clarify if it is possible to relax the radiation protection guidelines for inhabitants who live in such areas.

Rapidly evolving MR technology has allowed better understanding of structure and function of the human brain. Diffusion weighted MRI was developed two decades ago and it is now well established in diagnosis of acute ischaemia in patients with stroke. Diffusion tensor MRI uses the same principles but takes a step further allowing us to measure magnitude of the diffusion along different directions. This lead to the development of diffusion tensor tractography, a technique by which major neural pathways in the living brain can be visualized. There is a growing interest in exploring possible use of these techniques in clinical neurology and psychiatry. This article aims to review the principles of this technique and recent discoveries which may help us to better understand neurological and psychiatric disorders.

Adenomatous Tumors of the temporal bone are rare. Benign adenomatous neoplasms (adenoma) of the middle ear are a distinctive benign tumor based on histological and clinical observations. Papillary adenocarcinomas of the temporal bone are invasive tumors. Although, the exact site of origin of these neoplasms is not identified, owing to the local bone destruction (usually centered at posterior petromastoid plate), the general consensus favors the endolymphatic sac as being the origin of these tumors. We present the computed tomography (CT) scan and magnetic resonance (MR) imaging features of papillary adenocarcinoma of the temporal bone. This report concerns a unique case in which histology was identical to papillary adenocarcinoma of endolymphatic sac, in which the sac and duct were normal on MR images and confirmed at surgery. To the best of our knowledge, this is the first report of such tumor that preoperative MRI demonstrated non-endolymphatic sac origin of a papillary adenocarcinoma of the temporal bone. The controversy regarding the cellular origins of adenomatous tumors of the temporal bone is discussed.

[Report of a Case] I am reporting a 7-year old boy presenting with multiple non-ossifying fibromas and associated extraskeletal congenital anomalies. such as cataract–café - au- lait spots. hypogonadism, cataract and cardiovascular malformation. Review of the clinical features and correlation with pathologic and radiologic data support a diagnosis Jaffe-Campanacci syndrome; a rare malformation syndrome, possibly related to neurofibromatosis. Index Terms: skeletal anomalies, Non ossifying fibroma, (nof), fibrous cortical defect (FCD).

An eight-year-old boy presented with a history of sever neck pain radiating to the right shoulder for one week. A well circumferential intra-dural extra-medullary mass arising from the dura on the right antero-lateral side of the spinal cord was seen on magnetic resonance imaging. There was a high intensity dural tail above and below the mass associated and eccentric thickening of adjacent dura of persisting low signal in different images. Surgical exploration revealed a firm pinkish gray, hypovascular mass abutted the dura extending into the right C4 foramina. The dura was thickened not only at the origin of the mass but also a few segment above then and below the lesion. Pathological examination of the tumor revealed enterobius vermicularis inflamatory mass. This report is to our knowledge the first intradural–extramedullary presentation of oxyuriasis. Possible hematogenous mode of involvement of the CSF may further be supported by the present case.