فهرست مطالب

Iranian Journal of Radiology - Volume:13 Issue: 2, 2016
  • Volume:13 Issue: 2, 2016
  • تاریخ انتشار: 1395/03/11
  • تعداد عناوین: 22
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  • Michele Scialpi *, Luisa Pierotti, Sabrina Gravante, Alberto Rebonato, Irene Piscioli, Alfredo Dandrea, Raffaele Schiavone, Barbara Palumbo Page 1
    Background
    In oncologic patients, the liver is the most common target for metastases. An accurate detection and characterization of focal liver lesions in patients with known primary extrahepatic malignancy are essential to define management and prognosis..
    Objectives
    To assess the diagnostic accuracy of the split-bolus multidetector-row computed tomography (MDCT) protocol in the characterization of focal liver lesions in oncologic patients..
    Patients and
    Methods
    We retrospectively analyzed the follow-up split-bolus 64-detector row CT protocol in 36 oncologic patients to characterize focal liver lesions. The split-bolus MDCT protocol by intravenous injection of two boluses of contrast medium combines the hepatic arterial phase (HAP) and hepatic enhancement during the portal venous phase (PVP) in a single-pass..
    Results
    The split-bolus MDCT protocol detected 208 lesions and characterized 186 (89.4%) of them: typical hemangiomas (n = 9), atypical hemangiomas (n = 3), cysts (n = 78), hypovascular (n = 93) and hypervascular (n = 3) metastases. Twenty two (10.6%) hypodense lesions were categorized as indeterminate (≤5 mm). The mean radiation dose was 24.5±6.5 millisieverts (mSv)..
    Conclusion
    The designed split-bolus MDCT technique can be proposed alternatively to triphasic MDCT and in a single-pass to PVP in the initial staging and in the follow-up respectively in oncologic patients..
    Keywords: Helical Computed Tomography, Liver, Multidetector, Row CT, Neoplasm, Oncology, Split, Bolus Technique, Triphasic Technique
  • Zhi Hong Shao, Guo Liang Wang, Xiang Hua Yi, Pei Jun Wang* Page 2
    Intracranial gliosis has no typical clinical signals or imaging characteristics. Therefore, it can be easily misdiagnosed as neoplasm. Hereby, we report a unique case of gliosis that grew outward from the surface of the brain. MRI depicted its signal and enhancement pattern similar to the cerebral gray matter. The diagnosis was confirmed by pathology and immunohistochemistry. Although it was difficult to reach a diagnosis, correlating its origin, growing pattern and MR features and knowing that gliosis can present this way may help in differentiating it from other diseases..
    Keywords: Gliosis, Pathology, Magnetic Resonance Imaging (MRI), Neoplasm
  • Reza Hanifehpour *, Marzieh Motevalli, Hossein Ghanaati, Mona Shahriari, Mounes Aliyari Ghasabeh Page 3
    Background
    Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events..
    Objectives
    In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis..
    Patients and
    Methods
    A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method..
    Results
    At the cutoff point of 100 for coronary calcium scoring, there was high specificity (87%), high sensitivity (79%), high efficiency (84%), high PPV (79%), and high NPV (87%) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59% in normal or nonsignificant stenosis and 7.6% in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values
    Conclusion
    We conclude that coronary calcium scoring provided useful information in the management of patients. In CACS less than 100, it has a NPV of 87% in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients..
    Keywords: Coronary Artery Disease, Multidetector Computed Tomography, Calcium Score, Diagnostic Efficacy
  • Payam Azadeh, Babak Hassanzadeh Rad, Ali Yaghobi Joybari * Page 5
  • Maryam Niknejadi, Firoozeh Ahmadi *, Farnaz Akhbari Page 6
    Placental site trophoblastic tumor (PSTT) is a very rare variant of gestational trophoblastic tumor. It can occur after normal termination of pregnancy or spontaneous abortion and ectopic or molar pregnancy. There is a wide range of clinical manifestations from a benign condition to an aggressive disease with fatal outcome. One of the most important characteristics of PSTT, unlike other forms of gestational trophoblastic diseases (GTD) is the presence of low beta-subunit of human chorionic gonadotropin (β-hCG) levels because it is a neoplastic proliferation of intermediate trophoblastic cells. However, human placental lactogen (hPL) is increased on histologic section and in the serum of patients too. We present a case of PSTT and discuss the differential diagnosis in order to further familiarize physicians with the diagnosis and treatment of this disease. It has a varied clinical spectrum and usually presents with irregular vaginal bleeding or amenorrhea. Diagnosis is confirmed by dilatation and curettage (D and C) and hysterectomy. Because chemotherapy is not effective, surgery is the cornerstone of treatment. This case is presented because it is a rare neoplasm with different treatments and it should be differentiated from molar pregnancy.
    Keywords: Placental Site Trophoblastic Tumor, Ultrasound
  • Yu Ching Cheng, Hung Chieh Chen, Chen Hao Wu*, Yi Ying Wu, Ming His Sun, Wen Hsien Chen, Jyh Wen Chai, Clayton Chi Chang Chen Page 7
    Background
    Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF)..
    Objectives
    The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA..
    Patients and
    Methods
    A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test..
    Results
    Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P
    Conclusion
    Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF..
    Keywords: 4D-TRAK MRA, 3D TOF MRA, Cerebral Arteriovenous Malformation, Cerebral Dural Arteriovenous Fistulas
  • Hassan Goodarzi, Seyed Masoud Khatami, Hammidreza Javadzadeh, Sadrollah Mahmoudi, Hojjatollah Khajehpour, Soleiman Heidari, Morteza Khodaparast, Ali Ebrahimi, Hamidreza Rasouli, Mohammadreza Ghane, Mehrdad Faraji, Kasra Hassanpour * Page 8
    Background
    Picture archiving and communication system (PACS) has allowed the medical images to be transmitted, stored, retrieved, and displayed in different locations of a hospital or health system. Using PACS in the emergency department will eventually result in improved efficiency and patient care. In spite of the abundant benefits of employing PACS, there are some challenges in implementing this technology like users’ resistance to accept the technology, which has a critical role in PACS success..
    Objectives
    In this study, we will assess and compare user acceptance of PACS in the emergency departments of three different hospitals and investigate the effect of socio-demographic factors on this acceptance..
    Materials And Methods
    A variant of technology acceptance model (TAM) has been used in order to measure the acceptance level of PACS in the emergency department of three educational hospitals in Iran. A previously used questionnaire was validated and utilized to collect the study data. A stepwise multiple regression model was used to predict factors influencing acceptance score as the dependent variable..
    Results
    Mean age of participants was 32.9 years (standard deviation [SD] = 6.08). Participants with the specialty degree got a higher acceptance score than the three other groups (Mean ± SD = 4.17 ± 0.20). Age, gender, degree of PACS usage and participant’s occupation (profession) did not influence the acceptance score. In our multiple regression model, all three variables of perceived usefulness (PU), perceived ease of use (PEU) and the effect of PACS (change) had a significant effect in the prediction of acceptance. The most influencing factor was change with the beta of 0.22 (P value
    Conclusion
    PACS is highly accepted in all three emergency departments especially among specialists. PU, PEU and change are factors influencing PACS acceptance. Our study can be used as an evidence of PACS acceptance in emergency wards..
    Keywords: Emergency Service, Hospital, Radiology Information Systems, PACS, Technology Acceptance, TAM
  • Ali Firat Sarp*, Yeliz Pekcevik Page 9
    Lipomatosis of the nerve, also known as fibrolipomatous hamartoma, is characterized by the infiltration of the nerve by fibro-fatty tissue. The affected nerve becomes thicker, and it simulates a mass lesion. Lipomatosis usually affects the median nerve and lipomatosis of the sciatic nerve is extremely rare. Magnetic resonance imaging (MRI) is the key to diagnosis, and it is usually pathognomonic. In this report, MRI and diffusion-weighted MRI findings of a case of a giant sciatic nerve lipomatosis without macrodactyly are presented. The MRI findings are unique, and awareness of the MRI features of this rare soft tissue mass may prevent unnecessary biopsies and surgeries..
    Keywords: Sciatic Nerve, Lipomatosis, Magnetic Resonance Imaging, Diffusion Magnetic Resonance Imaging
  • Jeong Min Ko, Jisoon Kim, Soo An Park, Kwang Nam Jin, Myeong Im Ahn, Seok Chan Kim, Dae Hee Han* Page 10
    Background
    In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax..
    Objectives
    To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis..
    Materials And Methods
    First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-to-large effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed..
    Results
    In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P
    Conclusion
    Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach..
    Keywords: Supine Thoracentesis, Posterolateral Approach, Posterior Approach
  • Suk Hyun Bae, Ji Young Lee* Page 11
    Dermatofibrosarcoma protuberans is an uncommon malignant mesenchymal tumor of the dermis, which most commonly appears on the body and extremities. A preoperative diagnosis of dermatofibrosarcoma protuberans is extremely difficult, because it is a very rare entity and its appearance is often similar to that of benign breast lesion. Here, we presented a case of breast dermatofibrosarcoma protuberans with associated radiological mammography, ultrasound, magnetic resonance imaging and fludeoxyglucose-positron emission tomography computerized tomography (FDG-PET CT) features. To our knowledge, our case is the first report of PET-CT findings of breast dermatofibrosarcoma protuberans. Furthermore, we reviewed characteristic radiologic features of this rare entity, which are helpful for differentiating it from other primary benign breast lesions..
    Keywords: Dermatofibrosarcoma Protuberans, Breast, Ultrasound, MRI, PET
  • Soheila Refahi, Bagher Minaei, Gholam Hassan Haddadi, Samideh Khoei, Azam Bakhtiarian, Masoud Pourissa, Abbas Takavar * Page 12
    Background
    Radiotherapy of the thorax often causes lung inflammation leading to fibrosis..
    Objectives
    The aim of this study was to investigate whether the use of glycyrrhizic acid (GLA) could improve the development of lung fibrosis in irradiated animals..
    Materials And Methods
    Wistar rats were divided into four groups. Group A rats received thoracic irradiation. Rats in group B received GLA and irradiation. Group C received GLA and no irradiation. Group D received no GLA and irradiation. GLA was administered at a dose of 4 mg/kg body weight using an intraperitoneal injection one hour before thoracic irradiation. Radiation therapy was delivered on a Cobalt-60 unit using a single fraction of 16 Gy. The animals were sacrificed at 32 weeks following thoracic irradiation. The lungs were dissected and blind histopathological evaluation was performed..
    Results
    Histopathologically, a decrease (statistically not significant) in the thickening of alveolar or bronchial wall, formation of fibrous bands, and superimposed collagen were noted in the animals in group B as compared to the animals in group A..
    Conclusion
    In this experimental study, administration of GLA one hour before thoracic irradiation may be a protective agent against radiation-induced fibrosis in animals and this model could be used in future studies..
    Keywords: Lung fibrosis, Radioprotector, Glycyrrhizic Acid, Histopathology
  • Yasmin Davoudi, Mohsen Foroughipour, Reza Torabi, Parvaneh Layegh, Nassim Matin, Ali Shoeibi * Page 13
    Background
    Multiple sclerosis (MS) is one of the most common autoimmune disorders of the central nervous system. In spite of various imaging modalities, the definitive diagnosis of MS remains challenging..
    Objectives
    This study was designed to evaluate the usefulness of diffusion weighted imaging (DWI) in the diagnosis of acute MS attack and to compare its results with contrast enhanced MRI (CE-MRI)..
    Patients and
    Methods
    In this cross sectional study, seventy patients with definite diagnosis of relapsing-remitting MS were included. CE-MRI using 0.1 mmol/kg gadolinium as well as DWI sequences were performed for all patients. The percentage of patients with positive DWI was compared with the results of CE-MRI and the consistency between the two imaging modalities was evaluated. Moreover, the relationship between the time of onset of patient’s symptoms and test results for both methods were investigated..
    Results
    CE-MRI yielded positive results for 61 (87%) patients and DWI yielded positive for 53 (76%) patients. In fifty patients (71.42%), both tests were positive and in six cases (8.57%), both were negative. The test results of three patients turned out to be positive in DWI, while they tested negative in CE-MRI. There was no significant relationship between the results of CE-MRI as well as DWI and the time of imaging from the onset of symptoms..
    Conclusion
    These data indicate that while CE-MRI will depict more positive results, there are cases in which DWI will show a positive result while CE-MRI is negative. We suggest that the combination of these two imaging modalities might yield more positive results in diagnosing acute MS attack giving rise to a more accurate diagnosis..
    Keywords: Diffusion Magnetic Resonance Imaging, Multiple Sclerosis, Magnetic Resonance Imaging
  • Nagihan Inan *, Arzu Arslan, Muhammed Donmez, Hasan Tahsin Sarisoy Page 14
    Background
    Imaging plays a critical role not only in the detection, but also in the characterization of lung masses as benign or malignant..
    Objectives
    To determine the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) in the differential diagnosis of benign and malignant lung masses..
    Patients and
    Methods
    Ninety-four masses were included in this prospective study. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, followed by a T1-weighted FFE sequence in the late phase (5th minutes). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained and the maximum relative enhancement, wash-in rate, and time-to-peak enhancement of masses in both groups were calculated..
    Results
    The early phase contrast enhancement patterns were homogeneous in 78.2% of the benign masses, while heterogeneous in 74.4% of the malignant tumors. On the late phase images, 70.8% of the benign masses showed homogeneous enhancement, while most of the malignant masses showed heterogeneous enhancement (82.4%). During the first pass, the maximum relative enhancement and wash-in rate values of malignant masses were significantly higher than those of the benign masses (P = 0.03 and 0.04, respectively). The cutoff value at 15% yielded a sensitivity of 85.4%, specificity of 61.2%, and positive predictive value of 68.7% for the maximum relative enhancement..
    Conclusion
    Contrast enhancement patterns and SI-time curve analysis of MRI are helpful in the differential diagnosis of benign and malignant lung masses..
    Keywords: Lung, Neoplasm, Contrast Enhancement, Dynamic Imaging, Magnetic Resonance Imaging
  • Ihab Elaff * Page 15
    Background
    Brain segmentation from diffusion tensor imaging (DTI) into white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF) with acceptable results is subjected to many factors..
    Objectives
    The most important issue in brain segmentation from DTI images is the selection of suitable scalar indices that best describe the required tissue in the images. Specifying suitable clustering method and suitable number of clusters of the selected method are other factors which affects the segmentation process significantly..
    Materials And Methods
    The segmentation process is evaluated using four different clustering methods with different number of clusters where some DTI scalar indices for 10 human brains are processed..
    Results
    The aim was to produce results with less segmentation error and a lower computational cost while attempting to minimizing boundary overlapping and minimizing the effect of artifacts due to macroscale scanning..
    Conclusion
    The volume ratios of the best produced outputs with respect to the total brain size are 16.7% ± 3.53% for CSF, 35.05% ± 1.13% for WM, and 48.2% ± 2.88% for GM..
    Keywords: Brain Segmentation, Diffusion Tensor, Diffusion Volume, DTI, Clustering
  • Arash Mahdavi, Ali Mohammadzadeh, Golsa Joodi, Mohammad Reza Tabatabaei, Farhad Sheikholeslami, Marzieh Motevalli * Page 16
    Background
    There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated..
    Objectives
    To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice..
    Patients and
    Methods
    Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated..
    Results
    In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030..
    Conclusion
    Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting..
    Keywords: Multidetector Computed Tomography, Coronary Angiography, Cardiac Imaging Techniques, Atherosclerosis
  • Xijin Mao, Shanshan Wang, Xingyue Jiang, Lin Zhang, Wenjian Xu* Page 17
    Background
    Pulmonary embolism has become the third most common cardiovascular disease, which can seriously harm human health..
    Objectives
    To investigate the diagnostic value of dual-source computerized tomography (CT) and perfusion imaging for peripheral pulmonary embolism..
    Patients and
    Methods
    Thirty-two patients with suspected pulmonary embolism underwent dual-source CT exams. To compare the ability of pulmonary embolism detection software (PED) with CT pulmonary angiography (CTPA) in determining the presence, numbers, and locations of pulmonary emboli, the subsequent images were reviewed by two radiologists using both imaging modalities. Also, the diagnostic consistency between PED and CTPA images and dual-energy pulmonary perfusion imaging (DEPI) for segmental pulmonary embolism was compared..
    Results
    CTPA images revealed 50 (7.81%) segmental and 56 (4.38%) sub-segmental pulmonary embolisms, while the PED images showed 68 (10.63%) segmental and 94 (7.34%) sub-segmental pulmonary embolisms. Thus, the detection rate on PED images for peripheral pulmonary embolism was significantly higher than that of the CTPA images (P
    Conclusion
    PED software of dual-source CT combined with perfusion imaging can significantly improve the detection rate of peripheral pulmonary embolism..
    Keywords: Peripheral Pulmonary Embolism, Dual-Source CT, Pulmonary Embolism Detection Software, Perfusion Imaging
  • Hwa Seon Shin, Mi Jung Park*, Kyung Nyeo Jeon, Jae Min Cho, Kyung Soo Bae, Dae Seob Choi, Jae Boem Na, Ho Cheol Choi, Hye Young Choi, Ji Eun Kim, Soo Bueum Cho, Sung Eun Park Page 18
    Background
    Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD)..
    Objectives
    To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD)..
    Patients and
    Methods
    We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD..
    Results
    LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P
    Conclusion
    Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD..
    Keywords: Atherosclerosis, Coronary Artery Disease, Multidetector Computed Tomography, Peripheral Arterial Disease, Vascular Calcification
  • Chih Chen Chang, Yon Cheong Wong*, Cheng Hsien Wu, Huan Wu Chen, Li Jen Wang, Yu Hsien Lee, Patricia Wanping Wu, Wiwan Irama, Wei Yuan Chen, Chee Jen Chang Page 19
    Background
    Low-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed..
    Objectives
    To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists..
    Patients and
    Methods
    This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test..
    Results
    Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically significant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise..
    Conclusion
    Attending radiologists could diagnose acute appendicitis accurately on NE-LDCT. Performance of senior residents on NE-LDCT is better than junior residents and comparable to attending radiologists..
    Keywords: Radiation Dose, Computed Tomography, Appendicitis, Emergencies, Education
  • Zhanguo Sun, Wenjian Xu*, Shuran Huang, Yueqin Chen, Xiang Guo, Zhitao Shi Page 20
    Background
    Despite dual-source computed tomography (DSCT) technology has been performed well on adults or infants with heart disease, specific knowledge about children with congenital pulmonary valve stenosis (PS) remained to be established..
    Objectives
    This original research aimed to establish a professional approach of DSCT performing technology on children and to assess the image quality performed by DSCT to establish a diagnostic evaluation for children with PS..
    Patients and
    Methods
    Ninety-eight children with congenital PS referred to affiliated hospital of Jining medical college were recruited from October 2013 to March 2015. Participants were divided into four groups according to different ages (0 - 1, 1 - 3, 3 - 7, 7 - 14), or three groups according to different heart rates ( 110). Image quality of pulmonary valves was assessed based on a four-point grading scale (1 - 4 points). Those cases achieving a score of ≥ 3 points were selected for further investigation, which played a critical role in our analysis. Correlation analysis was used to identify the effects of age and heart rate on image quality. Additionally, the results evaluated by DSCT were compared with those evaluated from the operation, further confirming the accuracy of DSCT..
    Results
    Seventy-two cases (73.4%) achieved a score of ≥ 3 points based on pulmonary valve imaging, which were available for further diagnosis. There was a statistically significant difference (P
    Conclusion
    Heart rate serves a pivotal role in imaging quality of DSCT. DSCT provides a functional evaluation of children with congenital PS and consequently contributes to a theoretical basis for corresponding treatment protocols..
    Keywords: Dual-source Computed Tomography, Pulmonary Valve Stenosis, Heart Defects, Congenital, Child
  • Quantitative Evaluation of the Fetal Cerebellar Vermis Using the Median View on Two-Dimensional Ultrasound
    Cenk Gezer *, Atalay Ekin, Naciye Sinem Gezer, Ulas Solmaz, Mehmet Ozeren Page 21
    Background
    Evaluation of the cerebellum and vermis is one of the integral parts of the fetal cranial anomaly screening..
    Objectives
    The aim of this study was to create a nomogram for fetal vermis measurements between 17 and 30 gestational weeks..
    Patients and
    Methods
    This prospective study was conducted on 171 volunteer pregnant women between March 2013 and December 2014. Measurements of the fetal cerebellar vermis diameters in the sagittal plane were performed by two-dimensional transabdominal ultrasonography..
    Results
    Optimal median planes were obtained in 117 of the cases. Vermian diameters as a function of gestational age were expressed by regression equations and the correlation coefficients were found to be highly statistically significant (P
    Conclusion
    This study presents the normal range of the two-dimensional fetal vermian measurements between 17 and 30 gestational weeks. In the absence of a three-dimensional ultrasonography, two-dimensional ultrasonography could also be used confidently with more time and effort..
    Keywords: Cerebellum, Fetus, Prenatal Diagnosis, Ultrasound, Vermis
  • In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma
    Atilla Suleyman Dikici, Ismail Mihmanli, Fahrettin Kilic, Ahmet Ozkok, Gokhan Kuyumcu, Pinar Sultan, Cesur Samanci, Mehmet Halit Yilmaz, Babak Rafiee, Nevbahar Tamcelik, Zehra Isik Hasiloglu*, Fatih Kantarci Page 22
    Background
    Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field..
    Objectives
    The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes..
    Patients and
    Methods
    A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov–Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test..
    Results
    There were no statistically significant differences between the glaucoma and control groups in terms of age (P > 0.05) and gender (P > 0.05). Corneal hysteresis was lower in the glaucoma group (P
    Conclusion
    The study evaluated the biomechanical properties of the ON and peripapillary structures in vivo with SWE in glaucoma. We observed stiffer ON and peripapillary tissue in glaucomatous eyes, indicating that SWE claims new perspectives in the evaluation of ON and peripapillary structures in glaucoma disease..
    Keywords: Glaucoma, Optic Nerve, Shear Wave Elastography, Peripapillary Structures