فهرست مطالب

  • Volume:13 Issue: 1, 2015
  • تاریخ انتشار: 1394/07/20
  • تعداد عناوین: 29
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  • Leila Aghaghazvini *, Hashem Sharifian, Bahman Rasuli Page 1
    Primary hyperparathyroidism is an endocrine disorder recognized by hyperfunction of parathyroid gland, which can result in persistent bone absorption and brown tumor. Facial involvement of brown tumor is rare and usually involves the mandible. Giant cell tumor (GCT) is an expansile osteolytic bone tumor which is very similar in clinical, radiological and histological features to brown tumor. Herein, we present a 35-year-old woman with an 11-month history of gradually swelling of the right maxilla and buccal spaces began during pregnancy two years ago. No other clinical or laboratory problems were detected. Postpartum CT scan demonstrated a lytic expansile multi-septated mass lesion containing enhancing areas, which initially described as GCT of the right maxillary sinus following surgery. Four months later, gradual progressive swelling of the bed of tumor was recurred and revised pathological slices were compatible with GCT. Regarding patient recent paresthesia, repeated laboratory tests were performed. Finally, according to laboratory results (elevation of serum calcium and parathyroid hormone), ultrasonographic findings and radioisotope scan (Sestamibi), probable parathyroid mass and brown tumor of maxilla was diagnosed. Pathology confirmed hyperplasia of right inferior parathyroid gland. Our case was thought-provoking due to its interesting clinical presentation and unusual presentation of brown tumor in parathyroid hyperplasia..
    Keywords: Brown Tumor, Hyperparathyroidism, Giant Cell Tumor, Maxilla
  • Cigdem Devir, Mahmut Kebapci, Tuncer Temel *, Aysegul Ozakyol Page 2
    Background
    Colon cancer is a leading cause of morbidity and mortality in developed countries. The early detection of colorectal cancer using screening programs is important for managing early-stage colorectal cancers and polyps. Modalities that allow examination of the entire colon are conventional colonoscopy, double contrast barium enema examination and multi-detector computed tomography (MDCT) colonography..
    Objectives
    To compare CT colonography and conventional colonoscopy results and to evaluate the accuracy of CT colonography for detecting colorectal lesions..Patients and
    Methods
    In a prospective study performed at Gastroenterology and Radiology Departments of Medical Faculty of Eskisehir Osmangazi University, CT colonography and colonoscopy results of 31 patients with family history of colorectal carcinoma, personal or family history of colorectal polyps, lower gastrointestinal tract bleeding, change in bowel habits, iron deficiency anemia and abdominal pain were compared. Regardless of the size, CT colonography and conventional colonoscopy findings for all the lesions were cross - tabulated and the sensitivity, specificity, and positive and negative predictive values were calculated. To assess the agreement between CT colonography and conventional colonoscopy examinations, the Kappa coefficient of agreementt was used. Statistical analysis was performed by SPSS ver 15.0..
    Results
    Regardless of the size, MDCT colonography showed 83% sensitivity and 95% specificity, with a positive predictive value of 95% and a negative predictive value of 83% for the detection of colorectal polyps and masses. MDCT colonography displayed 92% sensitivity and 95% specificity, with a positive predictive value of 92% and a negative predictive value of 95% for polyps ≥ 10 mm. For polyps between 6mm and 9 mm, MDCT colonography displayed 75% sensitivity and 100% specificity, with a positive predictive value of 100% and a negative predictive value of 90%. For polyps ≤ 5 mm MDCT colonography displayed 88% sensitivity and 100% specificity with a positive predictive value of 100% and a negative predictive value of 95%..
    Conclusions
    CT colonography is a safe and minimally invasive technique, a valuable diagnostic tool for examining the entire colon and a good alternative compared to other colorectal cancer screening tests because of its high sensitivity values in colorectal lesions over 1 cm..
    Keywords: Colonography, Computed Tomographic, Colonoscopy, Colonic Polyps, Colorectal Neoplasms
  • Manouchehr Hekmat, Hamid Ghaderi, Hassan Tatari, Abbas Arjmand Shabestari, Seyedeh Adeleh Mirjafari * Page 3
    Pericardial cysts are rare lesions. These benign anomalies are located in the middle mediastinum. In this article, we present a 24-year-old man who was referred to the emergency department with dyspnea and persistent cough. In physical exam, no abnormality was found. His past medical history was normal. His trans-thoracic echocardiogram showed an echo-lucent space next to the right atrium at the right cardiophrenic angle. No pericardial effusion was found. The patient underwent surgery. After midsternotomy, a huge cyst measuring approximately 13 × 8 × 5 cm in diameters was found on the right side and outside the pericardium that was totally excised. After 5 days, the patient was discharged and pathologic report confirmed preoperative diagnosis of pericardial cyst. Giant pericardial cysts are not common and in this report, we will review published case reports..
    Keywords: Cardiac Surgery, Pericardial Cyst, Mediastinal Cyst
  • Ali Mohammad Haji Zeinali *, Mehrab Marzban, Mohammadreza Zafarghandi, Mahmood Shirzad, Shapour Shirani, Roshanak Mahmoodian, Mehrdad Sheikhvatan, Masoumeh Lotfi-Tokaldany Page 4
    Background
    Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain..
    Objectives
    The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran..Patients and
    Methods
    A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed..
    Results
    The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD..
    Conclusion
    The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients..
    Keywords: Endovascular Procedure, Aortic Diseases, Aortic Aneurysm, Dissecting, Iran
  • Wen Quan Ding, Jian Hui Gu, Yong Yuan, Dong Sheng Jin * Page 5
    Background
    Peripheral nerves at the elbow region are prone to entrapment neuropathies and injuries. To make accurate assessment, clinicians need stereoscopic display of the nerves to observe them at all angles..
    Objectives
    To obtain a stereoscopic display of the peripheral nerves at the elbow region based on magnetic resonance (MR) diffusion tensor imaging (DTI) data using three post-processing methods of volume rendering (VR), maximum intensity projection (MIP), and fiber tractography, and to evaluate the difference and correlation between them..Subjects and
    Methods
    Twenty-four elbows of 12 healthy young volunteers were assessed by 20 encoding diffusion direction MR DTI scans. Images belonging to a single direction (anterior-posterior direction, perpendicular to the nerve) were subjected to VR and MIP reconstruction. All raw DTI data were transferred to the Siemens MR workstation for fiber tractography post-processing. Imaging qualities of fiber tractography and VR/MIP were evaluated by two observers independently based on a custom evaluation scale..
    Results
    Stereoscopic displays of the nerves were obtained in all 24 elbows by VR, MIP, and fiber tractography post-processing methods. The VR/MIP post-processing methods were easier to perform compared to fiber tractography. There was no significant difference among the scores of fiber tracking and VR/MIP reconstruction for single direction. The imaging quality scores of fiber tractography and VR/MIP were significantly correlated based on intraclass correlation coefficient (ICC) analysis (ICC ranged 0.709 - 0.901), which suggested that the scores based on fiber tractography and VR/MIP for the same sample were consistent. Inter- and intraobserver agreements were good to excellent..
    Conclusion
    Stereoscopic displays of the peripheral nerves at the elbow region can be achieved by using VR, MIP, and fiber tracking post-processing methods based on raw DTI images. VR and MIP reconstruction could be used as preview tools before fiber tracking to determine whether the raw images are satisfactory..
    Keywords: Diffusion Tensor Imaging, Peripheral Nerves, Magnetic Resonance Imaging
  • Michele Scialpi *, Alberto Rebonato, Lucio Cagini, Luca Brunese, Irene Piscioli, Luisa Pierotti, Lucio Bellantonio, Alfredo Dandrea, Antonio Rotondo Page 6
    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..
    Keywords: Pulmonary Arteries, Pulmonary Embolisms, X-ray Computed Tomography, Contrast Material
  • Mehrdad Bakhshayesh Karam, Shirin Karimi, Leila Mosadegh *, Samira Chaibakhsh Page 7
    Background
    Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm of the pleura that typically affects individuals occupationally exposed to asbestos through a variety of industries. MPM presents with several CT features similar to more common pleural diseases such as metastatic pleural malignancy..
    Objectives
    The aim of this study is to differentiate malignant pleural mesothelioma from metastatic carcinoma of the pleura by pathological and radiological assessment in order to investigate accuracy of CT scan in this regard and to compare CT features of these two malignancies..Patients and
    Methods
    Chest CT scans of 55 pleural malignancy patients including MPM and metastatic pleural malignancy were evaluated in this retrospective study. The pathologist made the definite diagnosis based on immunohistochemistry. A chest radiologist unaware of the pathology diagnosis observed all CT scans. Several parameters including pleural thickening, pleural effusion, thickening of inter lobar fissure, contralateral extension, contraction of involved hemithorax, parenchymal involvement (infiltration, nodules, fibrosis), pleural mediastinal involvement, lymphadenopathy, extrapleural invasion (hepatic, chest wall, diaphragm, intraperitoneal), and pericardial involvement were checked. Data analysis was carried out using SPSS version 16, and the ability of CT scan to differentiate malignant pleural mesothelioma and metastatic pleural diseases was investigated..
    Results
    Totally 29 males and 26 females were assessed in this study. Based on pathology, 17 MPM and 38 metastatic pleural malignancies were diagnosed. According to CT study, about 82% of the patients with MPM and about 79% of the patients with metastatic pleural diseases were correctly diagnosed by a radiologist. The most common findings suggestive of MPM were pleural thickening (88.2%), loculated effusion (58.8%), and thickening of the interlobar fissure (47.1%). Whereas free pleural effusion (71.7%), parenchymal infiltration (65.8%) and pleural thickening (63.2%) were most prevalent parameters among metastatic cases..
    Conclusion
    CT scan is highly accurate in differentiating malignant pleural mesothelioma and metastatic pleural diseases. Pleural thickening and thickening of interlobar fissure lead us to the diagnosis of MPM and massive free pleural effusion is more commonly seen in metastatic pleural malignancy..
    Keywords: Pleural Diseases, Malignant Mesothelioma, Tomography, X-ray Computed, Neoplasm Metastasis
  • Liang-Kuang Chen *, Bi-Li Yang, Kuo-Chang Chen, Yieh-Loong Tsai Page 8
    Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy..
    Keywords: Uterus, Arteriovenous Malformation, Uterine Hemorrhage, Ultrasonography, Angiography, Embolization, Therapeutic, Enbucrilate, Pregnancy
  • Poonam Sherwani *, Shweta Singhal, Nidhi Kumar, Mahender Kaur Narula, Rama Anand, Om Prakash Pathania Page 9
    A 30-year-old woman presented with a palpable subcutaneous nodule in the areolar region of the left breast. Sonomammographic examination revealed 2 cystic lesions showing typical “filarial dance” as vigorous twirling movement of multiple curvilinear echoes with mixed red blue color Doppler signals that was non-rhythmic, nonpulsatile, and the characteristic pulse Doppler trace due to irregular worm movement. Real time sonographic demonstration of these typical features is pathognomonic for filariasis, especially in endemic areas and treatment should be initiated without delay on the basis of ultrasound..
    Keywords: Filariasis, Eosinophilia, Ultrasound, Worms
  • Ali Sarrami-Foroushani, Mohsen Nasr Esfahany *, Hamidreza Saligheh Rad, Kavous Firouznia, Madjid Shakiba, Hossein Ghanaati Page 10
    Background
    Hemodynamics is thought to play an important role in the mechanisms responsible for initiation, growth, and rupture of intracranial aneurysms. Computational fluid dynamic (CFD) analysis is used to assess intra-aneurysmal hemodynamics..
    Objectives
    This study aimed to investigate the effects of variations in heart rate and internal carotid artery (ICA) flow rate on intra-aneurysmal hemodynamics, in an ICA aneurysm, by using computational fluid dynamics..Patients and
    Methods
    Computed tomography angiography (CTA) was performed in a 55 years old female case, with a saccular ICA aneurysm, to create a patient-specific geometrical anatomic model of the aneurysm. The intra-aneurysmal hemodynamic environments for three states with different flow and heart rates were analyzed using patient-specific image-based CFD modeling..
    Results
    Results showed significant changes for the three simulated states. For a proportion of the states examined, results were counterintuitive. Systolic and time-averaged wall shear stress and pressure on the aneurysm wall showed a proportional evolution with the mainstream flow rate..
    Conclusion
    Results reinforced the pivotal role of vascular geometry, with respect to hemodynamics, together with the importance of performing patient-specific CFD analyses, through which the effect of different blood flow conditions on the aneurysm hemodynamics could be evaluated..
    Keywords: Fluid Dynamics, Internal Carotid Artery, Aneurysm, Heart Rate
  • Saeed Naghibi *, Sirous Seifirad, Mahboobeh Adami Dehkordi, Sasan Einolghozati, Nafiseh Ghaffarian Eidgahi Moghadam, Amir Akhavan Rezayat, Soroush Seifirad Page 11
    Background
    Chronic otitis media (COM) can be treated with tympanoplasty with or without mastoidectomy. In patients who have undergone middle ear surgery, three-dimensional spiral computed tomography (CT) scan plays an important role in optimizing surgical planning.

    Objectives
    This study was performed to compare the findings of three-dimensional reconstructed spiral and conventional CT scan of ossicular chain study in patients with COM.

    Patients and Methods
    Fifty patients enrolled in the study underwent plane and three dimensional CT scan (PHILIPS-MX 8000). Ossicles changes, mastoid cavity, tympanic cavity, and presence of cholesteatoma were evaluated. Results of the two methods were then compared and interpreted by a radiologist, recorded in questionnaires, and analyzed. Logistic regression test and Kappa coefficient of agreement were used for statistical analyses.

    Results
    Sixty two ears with COM were found in physical examination. A significant difference was observed between the findings of the two methods in ossicle erosion (11.3% in conventional CT vs. 37.1% in spiral CT, P = 0.0001), decrease of mastoid air cells (82.3% in conventional CT vs. 93.5% in spiral CT, P = 0.001), and tympanic cavity opacity (12.9% in conventional CT vs. 40.3% in spiral CT, P=0.0001). No significant difference was observed between the findings of the two methods in ossicle destruction (6.5% conventional CT vs. 56.4% in spiral CT, P = 0.125), and presence of cholesteatoma (3.2% in conventional CT vs. 42% in spiral CT, P = 0.172). In this study, spiral CT scan demonstrated ossicle dislocation in 9.6%, decrease of mastoid air cells in 4.8%, and decrease of volume in the tympanic cavity in 1.6%; whereas, none of these findings were reported in the patients' conventional CT scans.

    Conclusion
    Spiral-CT scan is superior to conventional CT in the diagnosis of lesions in COM before operation. It can be used for detailed evaluation of ossicular chain in such patients.
    Keywords: Otitis Media, Cholesteatoma, Tomography, Spiral Computed
  • Biljana Markovic Vasiljkovic *, Vesna Plesinac Karapandzic, Tomislav Pejcic, Aleksandra Djuric Stefanovic, Zorica Milosevic, Snezana Plesinac Page 12
    Inflammatory myofibroblastic tumor (IMT) is an aggressive benign mass that may arise from various tissues and organs with a great variability of histological and clinical appearances. Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery. The aim of this paper is to present CT and MRI findings during four-year follow-up of complete, spontaneous regression of IMT of the uterus. The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen. At that time, the organ of origin was not specified. After analysis of the follow-up imaging findings and the mode of tumor regression, the uterus was proclaimed as the probable site of origin. IMT of the uterus is extremely rare and has been reported in ten cases up to now. The gradual, complete regression of uterine IMT documented by CT and MRI may contribute to understanding of its nature.
    Keywords: Uterus, Inflammatory Pseudotumor, Neoplasm Regression, Spontaneous
  • Mansour Moghimi, Pouria Yazdian Anari *, Marzie Vaghefi, Abbas Meidany, Heidar Salehi Page 13
    Nodular fasciitis of the breast is a rare benign pathology of soft tissue that is a consequence of fibroblastic hyperplasia within breast. It can mimic breast cancer clinically, radiologically, and histopathologically.
    A-43 year-old female with a painless mass within upper-lateral quadrant of her left breast complained of rapid and progressive growth during previous few days. No evidence of nipple discharge or sensation of pain was expressed. The mass was tender to palpation, but the size was too tiny to detect. The definitive diagnosis was established with sonography, which detected a hypoechogenic lesion, 10 mm in diameter. The excisional biopsy delivered a tissue composed of fusiform fibroblastic cells with bright ellipsoid-like nuclei and elevated nucleolus. Mitotic formations were also obvious. Low cellular and high cellular zones with hyaline fibrosis and erythrocyte accumulation existed, as well as a light lymphocytic infiltration. All of these features, in addition to adipocytic accumulation within the margins of this lesion, suggested a definitive diagnosis of Nodular fasciitis. The diagnosis of nodular fasciitis is difficult and often is indiscriminable from breast cancer, so paying close attention to this matter is critical.
    Keywords: Nodular Fasciitis, Ultrasonography, Pathology
  • Onur Tutar, Duzgun Yildirim, Cesur Samanci *, Babak Rafiee, Kaan Inan, Suleyman Dikici, Fethi Emre Ustabasioglu, Gokhan Kuyumcu Page 14
    Background
    Critical limb ischemia, a worldwide prevalent morbidity cause, is mostly secondary to vascular insufficiency due to atherosclerosis. The disease presents with intermittent claudication, which can progress to critical limb ischemia requiring amputation. Research has emphasized that the quality or existence of the pedal arch have a direct effect on wound healing and, therefore, on limb salvage, through the mechanism of collateral vascularization to the ischemic regions.

    Objectives
    This study aimed to determine the existence and, if present, grade of retrograde blood flow from plantar arch to dorsal foot artery (dorsalis pedis artery, DPA). The correlation between clinical symptoms and presence of collateral flow were also investigated.

    Patients and Methods
    Study group consisted of 34 cases, which included patient group (n = 17, all male, mean age: 68 years) and control group (n = 17, all male, mean age: 66 years). After physical examination and lower extremity Doppler examination, spectral morphology of DPA flow was recorded, before and during manual compression of posterior tibial artery (PTA), for a period of 5 seconds. At the end, findings of Doppler ultrasound, computed tomography angiography, magnetic resonance angiography and, physical examination finding and symptomatology were gathered and analyzed.

    Results
    In the patient group, 31 lower limb arteries, of total of 17 cases, were included. After compression maneuver, DPA in 11 cases (six right, five left) showed retrograde filling from plantar arch. This retrograde flow support was triphasic in three cases, biphasic in five cases, and monophasic in three cases. In other DPAs of these 20 limbs, PTA based retrograde collateral flow was not determined. In nine of these 20 limbs, with no or diminished retrograde filling, symptoms were worse than in other cases. Contrarily, only two of 11 limbs, with retrograde collaterals, have claudication during walking.

    Conclusion
    In cases with critical atherosclerotic disease of anterior tibial artery, PTA-based biphasic or triphasic retrograde collateral flow prevents ischemia, whereas monophasic support or no retrograde flow remains incapable.
    Keywords: Ultrasonography, Pulsed Doppler, Ischemia, Foot, Peripheral Arterial Disease, Atherosclerosis
  • Jung, Su Kim, Sang, Wook Yoon, Deok, Nam Seo, So, Ra Nam, Jung, Min Kim* Page 15
    Background
    Whole spine scanography (WSS) is a radiologic examination that requires whole body X-ray exposure. Consequently, the amount of patient radiation exposure is higher than the radiation dose following routine X-ray examination.

    Objectives
    Several studies have evaluated the patient effective dose (ED) following single exposure film-screen WSS. The objective of this study was to evaluate patient ED during WSS, based on the automatic image pasting method for multiple exposure digital radiography (APMDR). Further, the calculated EDs were compared with the results of previous studies involving single exposure film-screen WSS.

    Patients and Methods
    We evaluated the ED of 50 consecutive patients (M:F = 28:22) who underwent WSS using APMDR. The anterior-posterior (AP) and lateral (LAT) projection EDs were evaluated based on the Monte Carlo simulation.

    Results
    Using APMDR, the mean number of exposures was 6.1 for AP and 6.5 for LAT projections. LAT projections required more exposures (6.55%) than AP projections. The mean ED was 0.6276 mSv (AP) and 0.6716 mSv (LAT). The mean ED for LAT projections was 0.6061 mSv in automatic exposure control (AEC) and 0.7694 mSv in manual mode. The relationship between dose-area-product (DAP) and ED revealed a proportional correlation (AP, R2 = 0.943; LAT, R2 = 0.773). Compared to prior research involving single exposure screen-film WSS, the patient ED following WSS using APMDR was lower on AP than on LAT projections.

    Conclusion
    Despite multiple exposures, ED control is more effective if WSS is performed using APMDR in the AEC mode.
    Keywords: X-Rays, Radiation Dosage, Health Physics
  • Farida Abesi, Nima Nikafshar, Sina Haghanifar *, Soraya Khafri, Mahtab Hamzeh Page 16
    Background
    One of the anatomic structures in the mental interforaminal area is the mandibular incisive canal (MIC). Using various manipulation tools in the digital system may affect the visibility of MIC.

    Objectives
    The purpose of this study was to assess the effect of inversion filter (IF) on the visibility of mandibular incisive canal in panoramic radiographs.

    Patients and Methods
    In this cross-sectional study, 2580 digital panoramic images of 18 to 70-year-old patients were inspected for presence of MIC. Visibility of MIC and extension of the canal were registered separately on each side using IF and conventional mode. Data were analyzed by Kappa test using SPSS version 20 software. A probability value of P < 0.05 was considered statistically significant.

    Results
    There was no significant differences between IF and conventional mode regarding visibility of MIC (P > 0.05).

    Conclusion
    Although using IF caused improved visibility of MIC, the difference with conventional mode was not statistically different.
    Keywords: Digital, Panoramic Radiography, Software
  • Joon Ho Hur, Jun Soo Byun *, Jae Kyun Kim, Woong Jae Lee, Tae Jin Lee, Hoon Shik Yang Page 17
    Mucoceles are one of the most common benign soft tissue masses of the oral cavity. When they occur in the tongue, the ventral surface is the usual location. Mucoceles at the base of the tongue are extremely rare and must be differentiated from intralingual thyroglossal duct cysts. We present a case of a mucocele on the base of the tongue, which was incidentally found on a cervical spinal magnetic resonance image. We include a review of the literature on image findings, pathologic type, differential diagnosis, clinical symptoms, and treatment of oral mucoceles.
    Keywords: Mucocele, Tongue, Computed Tomography, Magnetic Resonance Imaging
  • Alireza Rajaei, Pooneh Dehghan *, Saideh Ariannia, Arman Ahmadzadeh, Madjid Shakiba, Kourosh Sheibani Page 18
    Background
    Using the same cutoff points for whole-body measurements as for site-specific measurements will result in underestimation of osteoporosis.

    Objectives
    We assessed the correlation between densitometry measurements for the whole body with those for the femur, lumbar spine, and forearm to evaluate the possibility of replacing site-specific values with whole-body measurements.

    Patients and Methods
    In this cross-sectional study, we evaluated all patients referred to a single rheumatology clinic for bone mineral density measurements from 2009 to 2010. All patients who had bone mineral density measurements taken from the hip, lumbar spine, forearm, and whole body were enrolled in the study. Standard bone mineral density measurements were performed using a dual energy X-ray absorptiometry device (Hologic Delphi A; Hologic, Bedford, MA, USA). Bone mineral density, Z-score, and T-score were measured for all patients and all body regions.

    Results
    The mean age of the 152 participating patients was 56.7 ± 12.6 years, and 97.4% were female. Pearson correlation coefficients of the whole-body bone mineral density values compared with site-specific values in patients over age 50 were 0.66 – 0.75. Using T-score cutoff points of -1 and -2.5 for osteopenia and osteoporosis, whole-body measurements underestimated the percentage of abnormal patients compared with the site-specific measurements (all P < 0.001). Using receiver operating characteristic (ROC) analysis, the whole-body bone mineral density showed respective areas under the curve of 0.96 and 0.84 for the diagnosis of abnormal hip bone mineral density and osteoporosis.

    Conclusion
    Using the same cutoff points for whole-body measurements as for site-specific measurements will result in overestimation or especially underestimation of osteopenia and osteoporosis diagnosis. Choosing new and appropriate cutoff points for whole-body densitometric measurements when we want to substitutes this assessment instead of site specific measurements seems mandatory and will decrease the rate of false diagnoses of densitometric deficiencies in these anatomical sites.
    Keywords: Bone, Osteopenia, Osteoporosis, Diagnostic Imaging, Densitometry
  • Yeoun Joo Lee, Jae, Yeon Hwang *, Yong Hoon Cho, Yong, Woo Kim, Tae Un Kim, Dong Hoon Shin Page 19
    Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients.
    Keywords: Child, Preschool, Vascular Malformations, Intestine, Small, Gastrointestinal Hemorrhage, Radiology
  • Si Shen, Hao Wang *, Jing Zhang, Fei Wang, Si, Run Liu Page 20
    Background
    Although conventional magnetic resonance imaging (MRI) could provide excellent detection of morphological changes in the diagnosis of lumbar disc degeneration (LDD), it has some difficulties in discriminating minimal changes associated with early LDD before morphological or clinical alterations. Therefore, newer MRI techniques have emerged for investigation of early LDD.

    Objectives
    The aim of this study was to use diffusion weighted imaging (DWI), diffusion Tensor Imaging (DTI) and T2* mapping to detect lumbar discs in healthy young adults, to evaluate if they could depict the microstructural changes of early LDD.

    Patients and Methods
    Apparent diffusion coefficient (ADC), fractional anisotropy (FA), and T2* images of the lumbar discs were obtained for 40 asymptomatic young subjects (19 males and 21 females; mean age of 24.3 years), using DWI, DTI and T2* mapping with a 1.5-T MRI scanner. ADC, FA, and T2* values were measured to compare five regions of interest (ROI) selected in each nucleus pulposus (NP) of the images.

    Results
    The ADC, FA, and T2* values were different (P < 0.05) among different ROIs within the same disc or among corresponding ROIs in different level discs. While the average values of ADC increased regularly with the lowering of the anatomical location (P < 0.05), the average FA and T2* values also associated with the anatomic locations, showed an increase in L4-L5 and L5-S1 discs (P < 0.05).

    Conclusion
    ADC, FA, and T2* values may quantitatively reflect the microstructural characteristics of NP, therefore they could be used to detect the minimal changes of early LDD.
    Keywords: Magnetic Resonance Imaging, Diffusion Tensor Imaging, Diffusion Weighted Imaging, T2*, Intervertebral Disc
  • Khalil Alimohammadzadeh, Mohammadkarim Bahadori *, Fariba Hassani Page 21
    Background
    Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector.

    Objectives
    The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015.

    Materials and Methods
    This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization.

    Results
    “Management and empowerment of human resources’’ (weight = 0.465) and “requirements and facilities” (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively.

    Conclusion
    The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country’s hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step towards further efficiency and effectiveness of the health care evaluation systems.
    Keywords: Evaluation, Joint Commission International (JCI), Quality, Radiology, Iran
  • Yun Hee Cho, Kyu Ran Cho *, Eun Kyung Park, Bo Kyoung Seo, Ok Hee Woo, Sung Bum Cho, Jeoung Won Bae Page 22
    Background
    In preoperative assessment of breast cancer, MRI has been shown to identify more additional breast lesions than are detectable using conventional imaging techniques. The characterization of additional lesions is more important than detection for optimal surgical treatment. Additional breast lesions can be included in focus, mass, and non-mass enhancement (NME) on MRI. According to the fifth edition of the breast imaging reporting and data system (BI-RADS®), which includes several changes in the NME descriptors, few studies to date have evaluated NME in preoperative assessment of breast cancer.

    Objectives
    We investigated the diagnostic accuracy of BI-RADS descriptors in predicting malignancy for additional NME lesions detected on preoperative 3T dynamic contrast enhanced MRI (DCE-MRI) in patients with newly diagnosed breast cancer.

    Patients and Methods
    Between January 2008 and December 2012, 88 patients were enrolled in our study, all with NME lesions other than the index cancer on preoperative 3T DCE-MRI and all with accompanying histopathologic examination. The MRI findings were analyzed according to the BI-RADS MRI lexicon. We evaluated the size, distribution, internal enhancement pattern, and location of NME lesions relative to the index cancer (i.e., same quadrant, different quadrant, or contralateral breast).

    Results
    On histopathologic analysis of the 88 NME lesions, 73 (83%) were malignant and 15 (17%) were benign. Lesion size did not differ significantly between malignant and benign lesions (P = 0.410). Malignancy was more frequent in linear (P = 0.005) and segmental (P = 0.011) distributions, and benignancy was more frequent in focal (P = 0.004) and regional (P < 0.001) NME lesions. The highest positive predictive value (PPV) for malignancy occurred in segmental (96.8%), linear (95.1%), clustered ring (100%), and clumped (92.0%) enhancement. Asymmetry demonstrated a high positive predictive value of 85.9%. The frequency of malignancy was higher for NME lesions located in the same quadrant with the index cancer (P = 0.006), and benignancy was higher in the contralateral breast (P = 0.015). On multivariate analysis, linear (P = 0.001) and segmental (P = 0.005) distributions were significant predictors of malignancy.

    Conclusion
    The possibility of malignancy is strongly indicated when additional NME lesions show linear or segmental enhancement on preoperative 3T DCE-MRI in patients with recently diagnosed breast cancer.
    Keywords: Breast Neoplasms, Diagnosis, Non-Mass Enhancement, Preoperative Care, Magnetic Resonance Imaging
  • Hee Young Choi, Ji Hye Jang, Kyung Mi Lee, Woo Suk Choi, Sang Hoon Kim, Seung Geun Yeo, Eui Jong Kim * Page 23
    Primary nasopharyngeal tuberculosis (TB) without pulmonary involvement is rare, even in endemic areas. Herein, we present a rare complication of primary nasopharyngeal TB accompanied with tuberculous otomastoiditis (TOM) and ipsilateral facial nerve palsy, in a 24-year-old female patient, with computed tomography and magnetic resonance imagery findings.
    Keywords: Facial Nerve, Mastoiditis, Nasopharyngeal Diseases, Paralysis, Tuberculosis
  • Seung Min Lee, You Me Kim, Bong Man Kim * Page 24
    The paranasal sinuses are known to be a rare location for metastasis. Renal cell carcinoma (RCC) is the most frequent primary tumor to metastasize to the sinonasal region, followed by lung and breast cancer. In particular, clear cell type RCC, which represents approximately 85% of RCCs, is characterized by early metastasis, and it sometimes spreads to unusual sites (1, 2). Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency. Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor. The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%. The purpose of this case report is to document a rare case of silent RCC that first presented as epistaxis due to nasal cavity and ethmoid sinus metastasis.
    Keywords: Metastatic Renal Cell Carcinoma, Sinonasal Metastasis, Epistaxis
  • Eun Kyung Park, Kyu Ran Cho *, Bo Kyoung Seo, Ok Hee Woo, Sung Bum Cho, Jeoung Won Bae Page 25
    Background
    Breast cancer is a heterogeneous disease with diverse prognoses. The main prognostic determinants are lymph node status, tumor size, histological grade, and biological factors, such as hormone receptors, human epidermal growth factor receptor 2 (HER2), Ki-67 protein levels, and p53 expression. Diffusion-weighted imaging (DWI) can be used to measure the apparent diffusion coefficient (ADC) that provides information related to tumor cellularity and the integrity of the cell membranes.

    Objectives
    The goal of this study was to evaluate whether ADC measurements could provide information on the prognostic factors of breast cancer.

    Patients and Methods
    A total of 71 women with invasive breast cancer, treated consecutively, who underwent preoperative breast MRIs with DWI at 3.0 Tesla and subsequent surgery, were prospectively included in this study. Each DWI was acquired with b values of 0 and 1000 s/mm2. The mean ADC values of the lesions were measured, including the entire lesion on the three largest sections. We performed histopathological analyses for the tumor size, lymph node status, histological grade, hormone receptors, human epidermal growth factor receptor 2 (HER2), Ki-67, p53, and molecular subtypes. The associations with the ADC values and prognostic factors of breast cancer were evaluated using the independent-samples t test and the one-way analysis of variance (ANOVA).

    Results
    A low ADC value was associated with lymph node metastasis (P < 0.01) and with high Ki-67 protein levels (P = 0.03). There were no significant differences in the ADC values among the histological grade (P = 0.48), molecular subtype (P = 0.51), tumor size (P = 0.46), and p53 protein level (P = 0.62).

    Conclusion
    The pre-operative use of the 3.0 Tesla DWI could provide information about the lymph node status and tumor proliferation for breast cancer patients, and could help determine the optimal treatment plan.
    Keywords: Breast Cancer, Diffusion-Weighted Imaging, Apparent Diffusion Coefficient, Breast Magnetic Resonance
  • Gulgun Buyukdereli *, Yasemin Aktar, Ertan Kara, Aysun Uguz, Husnu Sonmez Page 26
    Background
    Thyroid nodules with indeterminate fine-needle aspiration biopsy (FNAB) results remain a diagnostic dilemma, because 70 - 85% of these nodules have been found to be benign after thyroid surgery.

    Objectives
    The purpose of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative diagnosis of cytologically indeterminate nodules.

    Patients and Methods
    Forty-six patients were included in this study. These individuals had undergone FDG PET/CTs for the preoperative evaluation of thyroid nodules with indeterminate FNAB results. The results of the preoperative PET/CT scans were compared with the postoperative pathological results and statistically analyzed.

    Results
    Of the 46 patients included in our study, the histopathology of the surgical specimens revealed thyroid cancer in 17 individuals (37%, 17/46). The PET/CT scan showed a positive result in 27 patients. Of these, 16 patients (59.3%) were found to have thyroid carcinomas. In addition, the PET/CT scan was considered to be negative in 19 patients, 18 (94.7%) of whom had benign lesions. For the detection of malignant lesions, the values for the sensitivity and specificity, and the positive predictive and negative predictive values were 94%, 62%, 59%, and 95%, respectively.

    Conclusion
    The FDG PET/CT showed a high sensitivity and a high negative predictive value for identifying malignancies in thyroid nodules with indeterminate FNAB results. Therefore, the FDG PET/CT may be a helpful tool in the clinical management of these nodules. When an FDG positive lesion is detected, further examination is recommended.
    Keywords: Thyroid Nodules, FDG PET, CT, Indeterminate, Fine Needle Aspiration Biopsy
  • Su Ho Kim, Jee Young Kim*, Woo Chan Park, Mee Kyung Kim, Tae Jung Kim Page 27
    A 29-year-old woman with systemic lupus erythematosus (SLE) presented with palpitation and neck swelling. Initial sonography showed an ill-defined hypoechoic lesion in the right thyroid gland, mentioning subacute thyroiditis. The patient received conservative care for one week. However, her neck swelling worsened and she complained of dyspnea. Follow up sonography showed marked enlargement of both thyroid glands. Irregular infiltration of hypoechoic lesions was detected along the subcapsular region of both thyroid glands. She underwent immediate intubation to secure the airway and total thyroidectomy. Histopathological staining revealed features of fungal thyroiditis with fungal hyphae characteristic of Aspergillus. There was no abnormality in the lung or paranasal sinuses. In this report, we describe the sequential sonographic findings of invasive aspergillosis in the thyroid gland presenting as progressive enlargement without other organ involvement.
    Keywords: Aspergillosis, Thyroid, Ultrasound
  • Eunyoung Kim, Sung Won Lee *, Woo Hyeon Kim, Si Hyun Bae, Nam Ik Han, Jung Suk Oh, Ho Jong Chun, Hae Giu Lee Page 28
    A 43-year-old man with liver cirrhosis received transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of recurrent variceal bleeding and F3 esophageal varices. During routine follow up liver ultrasound examination, six months after the implantation, TIPS occlusion was suspected and TIPS revision was performed. During the revision, moderate to severe stenosis at the hepatic venous segment of the tract and a total occlusion at the parenchymal segment of TIPS tract near the portal vein with biliary-TIPS fistula were identified with a clear visualization of the common bile duct. After the successful TIPS revision with the placement of an additional stent-graft, the biliary fistula and common bile duct were no more delineated. We herein report a rare case with an obvious visualization of biliary-TIPS fistula associated with obstruction of TIPS shunt on the tractogram and recanalization with an additional stent-graft.
    Keywords: Stenosis, Fistula, Portosystemic, Transjugular Intrahepatic
  • Eui_Yong Jeon_Young Kwon Cho *_Sung Bum Cho_Dae Young Yoon_Seong O Suh Page 29
    Background
    Maturation failure of autogenous arteriovenous fistula (aAVF) has been increasing after surgical procedures and the salvage percutaneous transluminal angioplasty (sPTA) for immature aAVF has been identified as an effective treatment modality.

    Objectives
    The aim of this study was to identify factors predicting successful aAVF maturation and to determine positive technical aspects of sPTA.

    Patients and Methods
    We retrospectively reviewed medical records and radiological images of 59 patients who had undergone sPTA for non-maturing aAVFs. We analysed images from pre-surgical mapping Doppler ultrasonography, angiography, and angioplasty and follow-up Doppler ultrasonography performed within two weeks after sPTA. We assessed the following factors, for their ability to predict successful aAVF maturation: 1) patient factors (age; sex; co-morbidities; and aAVF age, side and type); 2) vessel factors (cephalic vein diameter and depth, presence of accessory veins, and pre- and postoperative radial artery disease); 3) lesion factors (stenosis number, location and severity); and 4) technical factors (presence of residual stenosis and anatomic success ratio (ASR) on follow-up Doppler ultrasonography).

    Results
    The technical and clinical success rates were both 94.9% (56/59); the mean ASR was 0.84. An ASR of ≥ 0.7 and no significant residual stenosis (< 30%) (both P < 0.001) on two-week follow-up Doppler ultrasonography predicted successful aAVF maturation.

    Conclusion
    For more precise prediction of successful aAVF maturation after sPTA, short-term follow-up Doppler ultrasonography (< 2 weeks) was useful. If the ASR was < 0.7 or if residual stenosis was ≥ 30%, immediate repeat sPTA is recommended.
    Keywords: Arteriovenous Fistula, Autologous Transplantation, Doppler Ultrasonography, Angioplasty