فهرست مطالب

Iranian Journal of Radiology - Volume:14 Issue: 1, 2017
  • Volume:14 Issue: 1, 2017
  • Special issue
  • تاریخ انتشار: 1396/02/12
  • تعداد عناوین: 115
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  • Comparison Radiation Dose in Interventional Cardiology Between Iran and Other Countries: Evaluation Influencing Factors
    Ayoub Momivand * Page 1
    Background
    Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA), diagnostic electrophysiology studies and radiofrequency catheter ablation (RFA). When complex procedures are performed or procedures are repeated for the same patient, high-radiation dose levels can occur because procedures often require long fluoroscopy times and require high-quality images.
    Objectives
    The objective of the study is to review patient radiation doses from interventional cardiology procedures in the Iran and the world and comparison between them.
    Methods
    In this article we checked the derived data from 20 relevant studies published during the last 20 years in international scientific literature at other country except Iran and 10 studies from Iran. The variables dose-area product (DAP), fluoroscopy time, number of sequences and frames per sequence were collected for each CA, PTCA, RFA and diagnostic electrophysiology and then the obtained mean values, were compared.
    Results
    Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. By comparing the mean values of DAP and the fluoroscopy time obtained in the studies carried out in Iran with other studies in this field in other counties, it is revealed that these values in Iran were lower than the outcomes of other studies in the world.
    Conclusions
    This difference was due to the high knowledge and experience of the cardiologist in Iran and type of justify patient.
    Keywords: Patient Dosimetry, Interventional Cardiology
  • A Survey of Knowledge and Attitude of Staff and Hospital Administrators in the Implementation of Archiving and Transmission of Medical Images (PACS) in Hospitals in Ahwaz
    Fateme Panahi *, Mehrdad Gholami, Sera Mayahi Page 2
    Background
    Medical image archiving and transmission system (PACS) are systems used to capture, store, transmit and display medical images and archive medical images used. Information is exchanged through an internal network in the health center or the Internet platform.
    Objectives
    The aim of this study was to analyze the degree of knowledge and attitude of staff and hospital administrators in the implementation of archiving and transmission of medical images (PACS) in hospitals in Ahwaz.
    Methods
    This study is cross-sectional study. The population under study were the staff and hospital administrators at the medical schools in Ahwaz. A total of 176 questionnaires were distributed. Data collection tool was a questionnaire with two parts: the first part of the questionnaire consisted of demographic information which had 10 multi choice questions about the knowledge and attitude of staff and hospital administrators in the implementation of archiving and transmission of medical images (PACS). And the second Data collection tool was a check list about assessing the technical and other potential obstacles.
    Results
    The average score of the knowledge of the users and administrators with PACS and related systems were65/30 and 5/27 respectively. The attitudes of users and administrators in implementing PACS system were2/76 and 5/59 respectively. According to the managers, the major obstacles for the implementation of PACS system were a lack of awareness of the benefits of PACS for both the users and administrators and cost.
    Conclusions
    According to the present study, the potential barriers to the implementation of PACS in hospitals is the lack of knowledge of the managers and employees of the benefits of PACS system (80%). Before the implementation of PACS systems in hospitals it must be considered necessary background to increase knowledge of the workers and managers in this regard, short-term in-service training courses and providing educational pamphlets can be useful also.
    Keywords: PACS, Awareness, Barriers to Implementation, Staff, Administrators
  • Gallbladder Fundus: A Spectrum of Abnormalities
    Maryam Tavakoli *, Bijan Bijan Page 3
    Fundal gallbladder abnormalities result from broad spectrum of pathologic that most of them have no pathological significance and normally causes no symptoms. Conversely, early incidental detection of malignant lesions is important because symptomatic lesions are often incurable. So use proper imaging to differentiate between them is important. Although ultrasound has been the choice screen method of gallbladder diseases, making an accurate diagnosis may be impossible. Now day, multiphase MRI and CT scan have become the imaging technique that are widely used to detect and to characterized gallbladder abnormalities. In cross-sectional imaging analysis of finding included evaluation of thickness, contour, intralesional cystic areas, enhancement pattern, presence of stone, etc. may help to differentiated fundal gallbladder abnormalities. The porpoise of this educational exhibit is to describe gross anatomy and pathologic appearance of each abnormalities and demonstrate features of them in ultrasound, CT scan and MRI with emphasis on the specific characteristics and will review the role of imaging in the differentiation of these. Abnormalities included: Phrygian cap: Most common congenital anatomic variant of gallbladder that is asymptomatic and characterized by folding of the fundus on the body. Although ultrasound isn’t always conclusive but usually clearly identify in CT scan and MRI. Fundal septation: It is rare and usually asymptomatic and result of incomplete cavitation of gallbladder bud. In ultrasound demonstrated as an echogenic band crossing the lumen and in CT scan and MRI usually clearly identify. Localized chronic cholecystitis: Most common form of clinically symptomatic gallbladder diseases that there is evidence of chronic inflammation in pathology and may have a history of biliary colic. Ultrasound demonstrate gallbladder wall thickening and usually with cholelithiasis, without any pericholecystic inflammation. In CT scan, focal fundal thickening with flat contour and adjacent gallbladder thickening is seen. The most common finding in MRI is cholelithiasis and wall thickening without any pericholecystic inflammation. Adenomyomatosis: Has been reported in 2-8% of cholecystectomy specimens and have a predilection for the middle and elderly aged women and is usually asymptomatic or paucisymptomatic. It is widely accepted to be a degenerative disease and is characterized by Rokitansky- Aschoff sinuses that are responsible for the imaging finding. Specific ultrasound signs are anechoic intramural diverticulum with or without comet tail artifacts. Optimal CT scan evaluation of gallbladder require IV contrast and Rosary sign is highly suggestive. MRI finding are focal mass, mural thickening and pearl necklace sign. Fundal gallbladder cancer: uncommon but most common primary biliary carcinoma and predominantly affects elderly women that often present when extend to liver or adjacent structures. Over 90% are adenocarcinoma. Cross-sectional appearance is that of a mass replacing the gallbladder (40% - 65%), focal wall thickening (20% - 30%) or an intraluminal polypoid mass (15% - 25%). Ultrasound isn’t usually useful if there isn’t any invasion but there are several features that may be useful, polipoid lesions greater than 1 cm, focal wall thickening > 1 cm, heterogeneous mass or asymmetric thickening. CT scan with contrast is extremely helpful (dual phase) and finding suggesting cancer are hypo or iso attenuating heterogeneous mass, adjacent invasion, pronounced wall thickening(> 1 cm), thickness with mural irregularity or marked asymmetry. Caner in MRI is typically T1 hypo intense and T2 hyper compare with liver parenchyma, typically shows early irregular contrast enhancement which persists into delayed images. Stones are common.
    Conclusions
    All of gallbladder fundal abnormalities should be kept in the mind during imaging and knowledge of the characteristic imaging finding of each abnormalities are essential in order to manage patients.
    This is an abstract presented in the 33rd Iranian congress of radiology (ICR) and the 15th congress of Iranian radiographic science association (IRSA).
  • Periventricular Leucomalacia and Seizure in Preterm Infants
    Mahtab Amirheidari *, Reza Nafisi Moghadam, Mona Kharraji Page 4
    Background
    Prematurity neuropathology can be categorized as: periventricular leukomalacia (PVL), white matter changes, and basal ganglion, cortex and thalamus disorders. These abnormalities may induce seizure in preterm neonate. The aim of this study was to evaluate the association between white matter abnormalities and seizure in 18 months preterm infants with delay Neurodevelopment (ND).
    Methods
    This is an analytical cross-sectional study on 18 months preterm infants with ND delay who were referred to MRI department of Shaheed Sadoughi hospital of Yazd, 2015 - 2016. The information of birth age (weeks), gender, seizure, and PVL on MRI were collected. All statistical analysis was done by SPSS19.
    Results
    Totally 45 infants were studied. About 55.6% were male and 44.6% female. The mean of pregnancy duration was 32.72 - 2.78 weeks. Seizure frequency was 42.2%. The PVL grading was: 28.9% mild, 20% moderate and 4.4% sever. There was a statistically significance between PVL and birth age (week), Also between seizure and PVL.
    Conclusions
    The high light finding of our study was the higher frequency of seizure in infants without PVL. These findings can be explained by the inclusion criteria of our study.
    Keywords: Periventricular Leukomalacia, Seizure, Preterm Infant
  • Spontaneous Intracranial Hypotension (SIH) and Idiopathic Intracranial Hypertension (IIH): Imaging Presentations
    G. Reza Bakhshandehpour *, Mohammad Reza Movahhedi Page 5
    Background
    Any change in Intracranial pressure (ICP), either elevation or reduction, could be with clinical and Neuroimaging presentations which depend to the severity of the pressure changes. The principal symptom in both of these syndromes, that is, Intracranial Hyper and Hypotension, is headache which in SIH , is mainly orthostatic or postural (positional) type which occurs when the patient is in upright position, and gradually disappears when the patient is lying down. In most cases, the headaches gradually increase from the moment the patient wakes up in the morning. However, in other cases the headaches are quick and severe. The acuteness of the headaches varies in each case, which affects how quickly the condition is diagnosed. Some of the other related symptoms in in intracranial hypotension state are loss of hearing, dizziness, tinnitus, vertigo, stiffness of the neck, nausea, Loss of consciousness, Coma and even vomiting. In Intracranial Hypertension situation transient visual obscuration or blurring ,double vision, visual loss and less likely joint pain ,low back pain and even intermittent ataxia. In neurological examinations cranial nerve palsies (mainly VI) may be found. In neuroimaging studies especially on MR imaging several nonspecific and heterogeneous presentations such as dural enhancement, vertical displacement of the brain (an appearance like Arnold-Chiari type I malformation ), subdural effusion or subdural hematomas mainly in chronic cases in Idiopathic intracranial hypotension and flattening of the posterior sclera, distension of perioptic subarachnoid space, tortuosity of optic nerve and an empty sella in Idiopathic intracranial Hypertension might be seen which the presence of 3 or more of the MRI features is 95% specific in predicting idiopathic intracranial hypertension. CSF leak is a recognized cause of intracranial hypotension. This condition may be spontaneous or secondary to spinal puncture; neurosurgical procedures (iatrogenically); dehydration; uremia and spinal trauma. In intracranial hypertension situation the etiology is unknown. However, two hypothesis are reduced CSF absorption at the level of the arachnoid villi and increased brain intraparenchymal water (Vasogenic brain edema).
    Objectives
    Upon completion of this presentation, participants will be able to: 1) Recognize MRI appearance of the spontaneous intracranial hypotension and idiopathic intracranial hypertension (Pseudotumor cerebri). 2) Review their various clinical and imaging presentations.
    Conclusions
    In this presentation we will review Imaging presentations of our several proved cases. As mentioned, there are heterogeneous groups of signs and symptoms and MRI presentation in these disorders which may cause misdiagnosis with other neurologic disorders and awareness, understanding, and recognition of these presentations may permit the radiologist to play a significant role in the prevention of misdiagnosis, unwanted surgical interventions or extensive diagnostic evaluation procedures.
    Keywords: Spontaneous Intracranial Hypotension (SIH), Idiopathic Intracranial Hypertension (IIH), Magnetic Resonance Imaging (MRI)
  • Accuracy of Ultrasound and Magnetic Resonance Imaging (MRI) in Penile Fracture Mapping for Modified Surgical Repair
    Mohammad Zare Mehrjardi *, Mohsen Darabi, Seyed Morteza Bagheri, Shaghayegh Sadat Khabbaz Page 6
    Background
    Penile fracture is a relatively rare urologic emergency. It is defined as traumatic rupture in tunica albuginea of corpus cavernosum. Traditionally, surgeon explores the penis in full-length by complete degloving of its skin and repairs any defect in the tunica. Imaging modalities such as ultrasound and MRI may be of help to reveal the exact site of tunica defect preoperatively for tailoring the surgical repair by making a direct incision over the defect. Tunica albuginea is a hyperechoic layer in ultrasound covering corpora cavernosa, and its tear appears as a hypoechoic defect in this band. In MRI, tunica is seen as a low-signal intensity layer in all conventional pulse sequences around the corpora cavernosa, and its tear is evident as a discontinuity in this layer. In addition, imaging modalities may demonstrate associated injuries such as hematoma, urethral rupture, and corpus spongiosum injury.
    Objectives
    To investigate accuracy of ultrasound and magnetic resonance imaging (MRI) in penile fracture diagnosis and preoperative mapping.
    Methods
    18 consecutive patients included in the study during two years prospectively. Ultrasound and MRI were performed in all patients and interpreted by two expert radiologists independently. The defect site was mapped on a designed platform preoperatively using each modality blinded to the result of other modality. All patients were explored surgically by an expert surgeon using complete degloving of the penis technique, which was the routine procedure in our tertiary referral center. The surgeon was blinded to the radiologic mapping, and the surgical results were considered as the gold-standard. Detection rate, and agreement between preoperative imaging mapping and surgical result were determined for each modality.
    Results
    Mean age of patients was 28.2 ± 7.3 years-old. Most penile fractures were occurred during sexual intercourse (89%). Most common location of tunica rupture was mid-shaft of penis (67%), and mean length of tunica defect was 14.8 ± 3.2 mm. All patients had associated hematoma, but no one revealed urethral injury. Detection rate of ultrasound and MRI was 89% and 100%, respectively. Ultrasound was unable to detect tunica rupture in 2 patients (11%), all of which revealed tears at the penile base in MRI and during surgical exploration. Ultrasound mapped tear location correctly in 13 patients (kappa, 0.26; P = 0.045), while MRI mapped it precisely in 17 cases (kappa, 0.89; P = 1.00).
    Conclusions
    Both imaging modalities may be used for detecting tunica tear especially in atypical cases that physical examination is equivocal. However, MRI is more accurate in preoperative mapping of rupture location for performing a modified less invasive surgery.
  • The Comparison of Multi-Slice CT-Scan and Laparotomy Findings in Blunt Splenic and Hepatic Trauma
    Hamidreza Haghighatkhah, Hesameddin Hoseini Tavassol*, Reyhane Kazemi, Shaghayegh Sadat Khabbaz Page 7
    Background
    Liver and spleen are the most common injured organs in abdominal blunt trauma which can lead to life threatening bleeding. Fast and reliable evaluation of these injuries is important to manage them immediately. In this study, the level of agreement between multidetector CT-Scan and surgical findings is evaluated.
    Methods
    Multidetector CT-scan and explorative laparotomy of the patients with blunt abdominal trauma were assessed retrospectively. Characteristics of the injuries were categorized on the basis of the American Association for the Surgery of Trauma (AAST) grading system and the findings were analyzed using kappa test.
    Results
    The findings of 35 patients were analyzed. According to the kappa test, there were “Moderate” agreement between CT-Scan and surgery in evaluation of lacerations, location and AAST grade of splenic injuries, and disagreement in evaluation of splenic hematoma. In assessment of lacerations and AAST grading of hepatic injuries, there was only “Fair” agreement between CT-Scan and surgery.
    Conclusions
    Multidetector CT-Scan is an appropriate method for evaluating splenic and hepatic blunt trauma, even more accurate than surgery in some limited cases. However, only “Moderate” and “Fair” agreements, indicate that initial measures such as history taking and abdominal physical examination, specifically for unstable patients that they not have enough time to do CT-Scan, should be properly considered before using this method. Furthermore, in case of other organ injuries, CT-Scan can be an appropriate method for prioritizing other damages to splenic and hepatic injuries or vice versa, on the basis of intensity, characteristics and the grade of injury.
    This is an abstract presented in the 33rd Iranian congress of radiology (ICR) and the 15th congress of Iranian radiographic science association (IRSA)
  • Importance of Evaluation of Extra Cardiac Findings in Patients Undergoing MDCT Coronary Angiography
    Mohammad Momeni *, Maryam Farghadani, Fatemeh Momeni Page 8
    Background
    Although the aim of cardiac computed tomographic angiography (CTA) is to visualize the cardiac, coronary, and great vessels, portions of noncardiac structures such as lung, mediastinum, bones and abdomen are visible on the scan. some have suggested that the scans should be evaluated in all field of view. Some other believe that reporting accidental findings can lead to unnecessary follow up and anxiety. prevalence and seriously of the findings can guided the need for reporting the accidental findings or not. The aim of our study was to evaluate the prevalence and seriously of accidental extracardiac findings on MDCT angiography of coronary arteries.
    Methods
    A total of 411 patients with suspected coronary artery disease were evaluated with MDCT during injection of contrast material. Images were reviewed for extracardiac findings which were classified as therapy needed, further work up needed, follow up needed and no further action needed.
    Results
    Extracardiac findings were detected in 24.33% patients. findings were classified as needed therapy (1.94%), needed work up (8.02%), needed follow up (10.94%), no further action needed (3.40%). Among the findings, which needed treatment, were lung infiltration and pulmonary emboli and one case of malignancy. hiatal hernia was the most common finding, followed by pulmonary nodules which were seen in (2.9%) of patient.
    Conclusions
    Coronary artery MDCT can reveal important findings and disease in extracardiac structures. On other hand the prevalence of noncardiac findings on cardiac MDCT was significant. To avoid missing clinically important findings, all the field of cardiac MDCT should be evaluated carefully.
    Keywords: Coronary CT Angiography, Extra, Cardiac Findings, Lung Diseases, Chest
  • Assessment of Functionality and Diagnosis Precision of Digital Breast Tomosynthesis in Comparison with Breast Ultrasound Among Women in Risk of Breast Cancer
    Ali Ghafari *, Ammar Nabiloo Page 9
    Background
    Tomosynthesis is a new technology of digital mammography that enables the acquisition of a three - dimensional image and allows visualization of cancers not apparent by conventional mammography. Ultrasound (US) is also used for tumor monitoring, which is highly operator dependent and has some problems with reproducibility. US is also an easily available and noninvasive modality. Our goal is to have a comparison between breast ultrasound and tomosynthesis to determine which modality is better.
    Methods
    In a prospective study of 200 consecutive women using the DBT and MRI added to digital mammography (DM) and ultrasound (US) imaging techniques. Accuracy measurements were estimated using a lesion-by-lesion analysis for unifocal, multifocal/multicentric, bilateral and all carcinomas. They also calculated sensitivity according to breast density.
    Results
    DBT had a higher sensitivity than digital mammography alone and also had higher sensitivity in non-dense breast compared to dense breasts. Ultrasound had higher sensitivity in dense breasts. Ultrasound may result in false-negative findings, especially in the absence of a discrete mass. Digital breast tomosynthesis enables the production of images that eliminate the problem of superimposition of breast tissue, particularly in women with dense breast parenchyma.
    Conclusions
    Ultrasound had better detection functionality in dense breasts while it was unable to discriminate between lesion types due to tissue overlap requiring biopsy for further examinations. DBT is designed for the purpose of resolving tissue overlap especially when ultrasound modality was unable to determine lesion types. Further examinations and studies should be hold to determine which modality has better overall economical and detection efficiency.
    Keywords: Tomosynthesis, Ultrasound, Breast Cancer, Mammography
  • Comparing the Diagnostic Performance of Integrated 18F-FDG PET-MRI and MRI for the Identification of Local Recurrences of Soft Tissue Sarcomas
    Youssef Erfanian *, Johannes Gruneisen, Lars Podleska, Torsten Poeppe, Lale Umutlu Page 10
    Objectives
    To assess the diagnostic accuracy of PET-MRI and MRI alone for the detection of local recurrences of soft tissue sarcomas (STS) after initial surgical resection of the primary tumors.
    Methods
    A total of 41 patients with a clinically suspected tumor relapse of STS underwent an 18F-FDG- PET-MRI examination for assessment of local recurrence. Two experienced physicians interpreted the MRI data and subsequently the PET-MRI datasets in two separate reading sessions and were instructed to identify potential local tumor recurrences. Additionally, the diagnostic confidence in each reading for the identification of malignant lesions was determined. A McNemar test was applied to test for differences of both ratings and a Wilcoxon signed-rank test was used to identify differences of the confidence levels. Histopathological verification as well as follow-up imaging was applied as the standard of reference.
    Results
    A tumor relapse was present in 27 / 41 patients. Calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accurary for the detection of local tumor recurrence was 81%, 85%, 91%, 70%, 82% for MRI and 96%, 75%, 89%, 91%, 90% for PET-MRI (P > 0.05). Furthermore, PET/MRI showed significantly higher confidence levels (P
    Conclusions
    Our results demonstrate 18F-FDG PET-MRI to be an excellent imaging method in the evaluation of recurrent STS after surgical excision, as it displays superior detection accuracy as compared to routine MRI follow-up examinations.
  • The Importance of Diffusion Weighted Imaging in Breast MRI
    Maryam Noori *, Bahareh Siahlou, Hamidreza Salighehrad, Anahita Fathi, Mohammad Fathi Page 11
    Objectives
    The aim of this study was to evaluate the value of diffusion weighted imaging in Diffusion weighted imaging in distinguishing between in benign and malignant breast lesion
    Methods
    There were 37 female patients with 47 lesions. Sixty seven female subjectd (40 mean age ) ,age ranges 17-69 , with histopathologically proven breast lesions underwent DWI of breasts with a single shot echo planar imaging (EPI )sequence .the computed mean apparent diffusion cofficients (ADCs) of the breasts lesion and cell density were then correlated.
    Results
    The ADC varied substantially between benign breast lesions ((1.52 ± 0.26) × 10 -3 mm2 / second). And malignant breast lesions ((0.94 ± 0.21) × 10 -3 mm2 / second) .The AUC with ROC analysis was 0.896 and the threshold for ADC was 1.17 ×10-3 mm2 /second with a sensitivity and specificity of 90% and 85%, respectively. The mean ADC of malignant breast lesions was statistically lower for benign lesions (P value less than 0.01)
    Conclusions
    The ADC would be a effective parameter in distinguishing between malignant and benign breast lesions.
  • Accuracy of MRI in Rectal Cancer After Preoperative Neoadjuvant Chemoradiotherapy
    Saeed Naghibi * Page 12
    Background
    About 1/4 colorectal cancers are related to the rectum. There 40.000 patients with the mean age of 50 years diagnosed with rectal cancer in USA. The symptoms are in a wide spectrum such as rectal bleeding, changing of defecation habits, pain, incontinenecy in the case of esphincter invasion. The diagnosis depends on getting a detailed history and a physical examination. For years the main treatment of rectal cancer was abdominoperineal resection with permanent clostomy. Today’s treatment plan includes less invasive surgical techniques combined with neoadjuvant chemoradiotherapy which results in less recurrent rates. MRI is a reliable modality in staging primary tumors but there has been conflicts about its accuracy for restaging after neoadjuvant chemoradiotherapy. In this study, accuracy, sensitivity and specifity of MRI will be discussed.
    Methods
    Study on 34 patients diagnosed with rectal adenocarcinoma referred to oncology clinic was conducted. The treatment plan included 4050 cGY radiotherapy and 5FU, Xeloda chemotherapy. All patients were assessed with 1/5 T MRI 6 to 8 weeks after treatment. T1 and T2 images with sagittal, cronal and axial planes with and without contrast agent were obtained and interpreted by two radiologists and compared with pathologic specimens as a gold standard.
    Results
    The demographic information was: mean age of 65/26 years, 19 men (55/9%), 15 women (44/1%). Accuracy of MRI at T and N staging were 38/2 % and 61/8% with the highest sensitivity of T3NM0 and specifity of T1N2.
    Conclusions
    MRI can be used for assessing rectal tumors and restaging after preoperative chemoradiotherapy.
    Keywords: MRI, Rectal, Cancer, Neoadjuvant, Radiochemotherapy
  • Comparison of Low Dose and Standard Dose Abdominal CT Scan in Body Stuffers
    Zahra Mahboubifooladi *, Hooman Bahramimotlagh Page 13
    Background
    Body stuffer determination is an important concern in emergency departments for referred patients with suspicion of swallowing drug packets. Because of small packet size, plain radiography is of little value in most patients. On the other hand, abdominal and pelvic CT scan is burdened by high cost and radiation dose. This study was performed to evaluate the sensitivity of low-dose CT scan in comparison with conventional one. So, the former can be used as an alternative screening and follow up tool for suspected body stuffers
    Methods
    In this prospective study, suspected body stuffers who were referred to radiology department, underwent two different protocols of abdominal and pelvic non-contrast CT scan: low-dose (equivalent dose of conventional abdominal x-ray) and standard dose. Standard dose CT scan was considered as the gold standard and low-dose protocol was compared with that for image quality and packet detection rate.
    Results
    The study consisted of 40 patients (all men, with mean age of 33.38 ± 7.4 years). CT evaluation with standard dose were positive in 22 patients (55%). Only 1 (2.5%) CT scan assigned as unacceptable by each radiologist in low-dose group. Noise average of low-dose protocol, was approximately 7 times greater than standard dose group, while DLP and ED are 9.7 times smaller. In comparison with standard dose CT scan, low-dose group had a sensitivity of 86.46%, specificity of 100%, PPV and NPV of 100% and 85.71%.
    Discussion
    Accuracy of low-dose CT scan for detection of baggies larger than 1 cm, approaches 100%. Therefore, it looks an appropriate screening method for body stuffers, especially when the packages are larger.
  • Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: Relation Between Radiology Thyrads Score and Bethesda Pathology Score System
    Reza Nafisi Moghadam, Mohammad Ghadrian *, Seyadkazem Aghili, Mohammad Sobhanardekani, Mohammadhosein Ahraryazdi, Kazem Razavi Page 14
    Background
    Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for different thyroid nodules size. Different pathology and radiological scoring may improve the accuracy of preoperative diagnosis of thyroid nudoles. The aim of this study was to evaluate the relation between radiology Thyrads score and Bethesda pathology score system size in two group size (≤ 10 mm and > 10 mm) of thyroid nodule in US-FNAB.
    Methods
    There were 183 thyroid nodules between 3 mm to 35 mm who underwent US-FNAB from January 2015 to November 2016 in Shaheed Sadoughi hospital- Yazd. They were divided in to two groups (group A, 3 - 10 mm; group B, 11- 35 mm). The patients were studied according radiology Thyrads score and Bethesda pathology score system. The relation between radiology Thyrads score and Bethesda pathology score system according groups size was analyzed by SPSS21.
    Results
    The mean age (± standard deviation) of patients was 44.5 (± 12.8 years). Most of them were female 138 (83.6%). The frequency of final pathology diagnoses were; 35(21.2%) non diagnostic, 107 (64.8%) benign, 13 (7.9%) malignant and 10 (6.1%) suspicious. no statically significance relation between thyrads score and nodule characteristics (solid/cyst (p-value: 0.555), calcification (P value: 0.558), lymph-adenopathy (P value: 0.521), ecogenicity (P value: 0.236), margin (P value:0.149)). The spearman correlation between radiology thyroids score and Bethesda pathology score system was statistically significant. (Correlation coefficient: 0.202, P value: 0.004).
    Conclusions
    There was a statistically significance correlation between Thyrads score and pathologic Bethesda scoring system. Decision making basis on the radiologic Thyrads score can improve the radiological diagnosis precision in nodular goiter patients.
    Keywords: US, Guided Fine, Needle Aspiration Biopsy, Thyroid Nodules, Cytopathology, Bethesda Score System, Thyrads Score
  • Future Outcome of Sonography BI-RADS Category 3 Lesions
    Afsaneh Alikhassi * Page 15
    Objectives
    This study aims to find the frequency and the malignancy rate of BI-RADS category 3 lesions detected on screening breast ultrasound and to evaluate whether they fullfilled the requirements of the latest American college of radiology imaging and reporting system.
    Methods
    Of 500 asymptomatic women who came to our center for screening sonography themselves or referred by their clinician, patients for whom BI-RADS category 3 lesions were seen on the ultrasound were selected. Clinical outcome of these lesions using one year follow up, biopsy or a combination of both were evaluated.
    Results
    The frequency of BI-RADS category 3 lesions detected on screening ultrasound was 18% (90/500). Of these patients, one was eventually proven to have malignancy with malignancy rate of 1.1%. This detected malignancy was early breast cancer with no lymph node metastasis.
    Conclusions
    Although the frequency of ultrasound BI-RADS category 3 lesions is considerably high (18 %), the malignancy rate is low (1.1%). Therefore careful assessment and follow up of BI-RADS category 3 can avoid unnecessary biopsy or surgery.
  • Comparison of Color Doppler Ultrasonography and Clinical Grading of Varicocele in Patients Referred to Shahid Faghihi Hospital in Shiraz
    Amin Abolhasani Foroughi *, Ehsan Iazdanpanah, Ali Ariafar Page 16
    Background
    Varicocele is one of the most common causes of infertility in men. Although physical examination is the standard method for the diagnosis of varicocele, but in some cases, diagnosis of the disease only by clinical examination is difficult and diagnosis confirmed by ultrasonography. The aim of this study was to compare color doppler ultrasonography and clinical grading of varicocele.
    Methods
    In this cross-sectional study, 66 patients suspected of varicocele referred to urology clinic of Shahid Faghihi hospital in Shiraz were assessed. After physical examination and clinical grading of varicoceles, the patients underwent color doppler ultrasonography was graded based on Sarteschi system. The collected data were analyzed using SPSS-24 statistical software.
    Results
    The mean age of patients was 23.16 ± 6.92 years. 60 cases (91%) had clinical varicocele and 6 cases (9%) were healthy and in ultrasonographic assessment, 63 cases (90%) had varicocele. Clinically, 40 testes were normal(grade0) and 36 testes (27.3%) had grade 1 of varicocele, 36 testes (27.3%) grade 2 and 20 testes (15.2%) had grade 3 and in ultrasound evaluation, 4 testes (3%) were normal (grade0) and 10 testes (7.6%) were in grade 1 of varicocele, 26 testes (19.7%) were in grade 2, 41 testes (31.1%) in grade 3, 53 testes (26.5%) in grade 4 and 16 testes (12.1%) in grade 5. There was a direct consistency between two systems of clinical and ultrasonographic grading (P
    Conclusions
    The results showed that clinical and ultrasonographic grading to diagnose varicoceles is directly consistent together and it is possible to make them equivalent together. In addition, the age factor has not a significant impact on disease grading.
  • Comparison of MRI and Arthroscopy Diagnostic Results in Patients with Suspected Meniscal Tears and Ruptures of ACL and PCL of Knee Joint
    Ahmad Soltanishirazi * Page 17
    Background
    The knee joint is the most vulnerable complicated and the largest joint in the human body.so the bulk of orthopaedic surgeries are related to the knee joint injuries ,while it is aggressive and many complications associated with it ,but the arthroscopy is the gold standard for diagnosis. Nowadays MRI has become an important tool in the diagnosis of considered health problems .so more studies are determine the diagnostic value of MRI in comparison with Arthroscopy.
    Results
    In this study 90 patients were examined .85% of them were male .MRI sensitivity for ACL ,MM LM, PCL evaluated 94.7 %, 93.5 % ,65%., and 100% respectively .also MRI specificity for these injuries measured 81% , 77%, 90.9% and 96.3% accordingly.
    Conclusions
    Although MRI diagnostic value in the evaluation of knee associated injuries is relatively high but does not eliminate the need to perform arthroscopy .therefore it is recommended that in future studies designing solutions in order to improving the diagnostic value of MRI must be considered
  • Carotid Intima Media Thickness in Leukoaraisis Patients
    Mona Kharraji, Reza Nafisi Moghadam, Kazem Razavi, Mohammad Sobhanardekani, Mohammadhosein Ahraryazdi Page 18
    Background
    Duplex ultra-sonography is a non-invasive, non-expensive screening test for carotid disease. Intima media thickness (IMT) is appropriate for atherosclerosis process diagnosis. Leukoaraisis (LA) increase the risk of cerebrovascular accident (CVA). LA patients need preventive medication for CVA. IMT is a non-invasive diagnostic and prognostic test in LA.
    Objectives
    The aim of this study was comparison of carotid IMT in LA patients and control group.
    Method
    The case-control study was done on 100 LA patients and 100 controls. They were selected by simple sampling method in Shaheed Sadoughi MRI unit. Two groups member were matched by age and sex. The patient’s information (age, sex, weight, height, past medical history, smoking history, ischemic heart disease (IHD), CVA and past medication) according the study checklist was collected. All statistical analysis were done by SPSS21.
    Results
    totally 200 patients were studied, 102 in normal group and 98 in ILA group. The mean age of patients was 64.39 (± 9.12) and 47% participants were male. There were no statistical differences between hypertension and hyperlipidemia frequency in two groups (P value > 0.05). The mean of left CIMT was 0.856 (± 0.202) in normal and 0.962 (± 171) in LA groups (P value: 0.026). The mean of right CIMT was 0.853 (± 0.215) in normal and 0.973 (± 188) in LA groups (p-value: 0.024).
    Conclusions
    LA increases the risk of CVA and dementia. The LA pathology is unknown. The epidemiological studies revealed the age, diabetes, smoking and atherosclerosis are related with LA. Our findings showed that CIMT as an atherosclerosis marker was higher in LA patients than control group.
    Keywords: Leukoaraisis, Intima Media Thickness, Duplex Ultra, Sonography
  • The Value of Coronary Artery Calcium Scoring in Early Diagnosis of Radiation-Induced Coronary Artery Disease in Breast Cancer Patients Following Radiation
    Abbas Arjmand Shabestari, Robab Anbiaee, Taraneh Faghihi Langroudi, Hooman Bakhshandeh, Maryam Heydari Sooreshjaany Page 19
    Background
    Breast cancer (BC) mortality rate has significantly decreased during the past decades by introducing adjuvant chemotherapy and/or radiotherapy (RT) in addition to surgery. However, as an emerging phenomenon, the corresponding therapeutic side effects caused non-malignant morbidity and mortality. Coronary artery disease (CAD) is the leading non-malignant cause of death in BC patients. It is established that chest RT has a role in atherosclerotic plaque formation in the coronary arteries. Newer techniques of RT like three-dimensional conformal radiotherapy (3D-CRT) use technical methods in which less radiation doses are given to the non-cancerous tissues. Non-invasive technique of coronary artery calcium score (CACS) can detect atherosclerotic plaques long before the plaques become symptomatic, helping to treat them in early stages, so improve BC patients’ outcome. The aim of this study is to assess and compare CACS in BC patients with a history of 3D-RT and non-BC women in the same age range with no history of RT.
    Methods
    CACS of fifty BC patients (age range: 34 - 70 years) with different time intervals from RT (range: 3-9 years) and CACS of fifty age-matched control group of non-BC women with no history of chest RT, using 64-slice ECG-gated CT scan were calculated and presented as the quantitative value of Agatston score (AS). The risk factors contributing to CAD (hypertension, hyperlipidemia, diabetes mellitus, smoking), and the Framingham’s 10-year risk score, as well as the age-matched CACS percentiles, were evaluated.
    Results
    No correlation between AS and history of RT, RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P
    Conclusions
    No difference between CACS was noted between BC patients with a history of 3D-CRT and the non-BC women without a history of RT. Although cardiac radiation dose reduction in 3D-CRT technique can justify the findings, as multiple studies have shown increase of CAD in BC patients with history of old RT techniques, but some studies show no difference in CACS between new and old RT techniques, other reason would be non-calcified atherosclerotic plaques after RT or myocardial microvascular disease due to reduced cardiac doses after 3D-CRT rather than calcified atherosclerotic plaques seen naturally by aging.
    Keywords: Breast Cancer, Three, Dimensional Conformal Radiotherapy, Calcium Score, Coronary Artery Disease
  • The Role of 18F FDG PET/CT in Clinical Management of Breast Cancer; Additional Value Over Conventional Imaging Modalities
    Mehrdad Bakhshayeshkaram *, Farahnaz Aghahosseini, Abtin Doroudinia, Soheyla Zahirifard, Mojtaba Ansari, Maryam Hassanzad, Hamid Reza Jamaat Page 20
    Background
    The aim of the present study was to investigate the potential improvement in detection rate of nodal and distant metastasis and the resultant impact on clinical management by PET-based diagnostic work up in comparison with conventional imaging modalities in various clinical settings in patients with breast cancer.
    Methods
    Of a total 256 patients with breast cancer who were referred to PET/CT division, MasihDaneshvari Hospital between May 2013 and Mar. 2016, 123 cases were included. Definitely-positive PET/CT findings in primary site as well as N1 (level I, II ipsilateral axillary nodes), N2 (ipsilateral internal mammary), N3 (ipsilateral internal mammary level I, II ipsilateral axillary, ipsilateral level II axillary, ipsilateral supraclavicular node) and distant metastasis (distant node and viscera) and related impact on clinical management (upstaging or downstaging) were retrospectively identified from the report archive and then compared with the results of baseline imaging modalities including CT scan, sonography, bone scan, C-X ray, MRI, MRM and mammography obtained from patient medical records. The most typical imaging pattern was considered as the reference standard. Indeterminant and equivocal PET positive lesion were not included in the study.
    Results
    Fourteen (11.38%) and 109 (88.62%) out of 123 patients were referred for staging and restaging/recurrence/surveillance, respectively. Mean age were 51.42 (34 - 62) and 52.66 (29 - 79) for staging and restaging groups, respectively. In staging group, 18 F FDG PET/CT recognized definitely positive additional nodal involvement in 21.4% of patients all of them related to the supraclavicular level and hence result in change N staging to N3. Additional metastatic lesions on a per lesion-basis and a per organ-basis were identified as 28.6% and 14.3%, repsectively. A significant change in patient management occurred in 42.9% (35.7% upstaging, 7.2% down staging). In restaging group, locoregional detection rate in biopsy proved recurrence was 100%. Additional nodal detection and the resultant change in N staging were 29.6% and 28.7%, respectively. Supraclavicular node detection contribute in 53.12% of overall change in N staging followed by axillary node and internal mammary equally (15.62%). Additional metastatic lesions on a per lesion-basis and per organ-basis were identified in 53.2% and 44%, respectively. Ultimate change in patients’ management was found in 42.9%.
    Conclusions
    18 F FDG PET/CT is a valuable imaging tool in initial and subsequent treatment strategy in patients with breast cancer by providing additional nodal and distant metastasis and may have the promising future potential to be as the imaging modality of choice for accurate assessment of disease extension in breast cancer in routine clinical practice.
    Keywords: 18F FDG PET, CT, Breast Cancer, Conventional Imaging, Clinical Management
  • MRI for Assessment of Anal Fistula
    Saeed Naghibi * Page 21
    Abstract: A fistula-in-ano is the passage between the skin around the anus and anal canal that usually caused by a previous anorectal abscess and an obvious sign of that is continuous discharge. Although it’s not the common disease in GI tract but it has caused considerable morbidity. The outbreaks have almost 11 per 111, 111, and 2 - 4 times more frequent in men and if it’s not diagnosed and treated on time, it can be a high risk of recurrence and fecal incontinence and associated risk of sepsis and abscesses.
    Objectives
    The purpose of the study was to evaluate the role of Magnetic Resonance Imaging in detection and characterization of perianal fistulae and correlating it with surgical findings.
    Methods
    In this study, 14 patients with clinical and physical examination of perianal fistulas were prospectively selected for MRI evaluation, with specific MRI sequence T1W, T2W, T1 Fat Sat or T2 Fat Sat, T1 contrast, etc,and with special coils plans axial, coronal, sagittal . MRI findings were recorded. The surgery was performed and the results were also recorded and eventually the consistency and effectiveness of MRI were compared with the results after surgery.
    Results
    Amongst the total of 14 patients,in 1 patient (7117) Transsphincteric fistula, 11 patients (78167) Intersphincteric fistula and 2 patients (14137) Suprasphincteric fistula were diagnosed and in surgery findings, 1 (7117) Transsphincteric fistula, 11 (71147) Intersphincteric fistula and 2 (14137) Suprasphincteric fistulas were detected and in one case no fistula was observed. An agreement between two detection methods was 82177 and sensitivity of MRI in the diagnosis of intersphincteric, transsphincteric and suprasphincteric fistulas were 1117 and the specificity was 757 in the detection and diagnosis of intersphincteric fistulas and 1117 for transsphincteric and suprasphincteric fistulas1
    Conclusions
    Based on the results of this study and according to the 1117 sensitivity of MRI, it’s useful to locate the perianal fistulas, reduce the chance of recurrence and postoperative complications and can contribute the healing process better than other diagnostic methods.
  • The Influence of Cancer-Related Characteristics on Brown Adipose Tissue at [18 F] DG PET/CT
    Mehrdad Bakhshayeshkaram, Soheyla Zahirifard, Farahnaz Aghahosseini *, Abtin Doroudinia, Maryam Hassanzad, Zahra Dehghani, Mojtaba Ansari, Hamid Reza Jamaati Page 22
    Background
    The present study aimed at investigating the influence of cancer related characteristics in association with environmental factors and patients demographics and on the prevalence of brown adipose tissue at 2-deoxy-2-[18F] fluoro-Dsglucose (18F-FDG) as well as the level of metabolic activity.
    Methods
    A total 3762 [18 F] DG PET/CT scans were retrospectively reviewed to identify BAT related [18 F] DG uptake. Demographics, anthropometrics, outdoor temperature, daylight exposure in addition to cancer related characteristics including type of cancer, reason for referral, history of recent treatment, the presence of malignant lesion were recorded. Anatomical distribution of FDG detectable BAT and related SUVmax were also determined. Control groups consisted of patients without FDG detectable BAT was randomly selected and matched for age, gender and mean outdoor temperature for all groups and for type of cancer, reason for referral and presence of active disease, as appropriate. Descriptive quantitative variables were expressed as either frequency or mean. Independent T test, Mann-Withney U test, Pearson correlation coefficients, one-way analysis of variance and linear regression test (SPSS ver.23) were used as appropriate (P value
    Results
    One-hundred eighteen studies were recognized to demonstrate foci of FDG BAT uptake (3.1%, mean age: 22.7 years). There were statistically significant higher rate of BAT occurrence in female, younger patients, normal/low BMI and Body Fat-based categorical weight, lower temperature and shorter daylight duration. In the context of cancer related characteristics, lymphoma and evaluation of treatment response were found as the most prevalent cancer type and reason for referral, respectively. Univariate analysis demonstrated strong correlation between the prevalence of FDG-detectable BAT and associated metabolic activity and age, gender, BMI and BF-based categorical weight, daylight as well as the nonactive underlying malignancy and recent history of treatment. Multivariate analysis revealed age, gender, daylight duration and recent history of treatment as independent influencing factors on BAT recruitment and the level of metabolic activity.
    Conclusions
    Recent treatment, in addition to age, gender and daylight duration were proved as strong independent determinants on BAT development and the level of metabolic activity at [18 F] DG PET/CT and should be considered as an important confounding factor in future researches.
    Keywords: [18 F] DG PET, CT PET, CT, Brown Adipose Tissue, Cancer Status, SUV Max
  • Role of FDG PET/CT Scan in Head and Neck Cancer Patients
    Mehrdad Bakhshayesh Karam, Abtin Doroudinia, Farahnaz Aghahosseini, Fatemeh Kaghazchi, Payam Mehrian Page 23
    Background
    PET/CT scan has emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize on its role in head and neck oncology.
    Methods
    We reviewed our PET/CT date-base retrospectively and found 94 patients, referred with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to MasihDaneshvari hospital since 2013 to 2016.
    Results
    The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We had also 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66.2% of all cases.
    Conclusions
    Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about appropriate indications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in long term.
    Keywords: Head, Neck Cancers, PET, CT, Staging, Re, Staging
  • Comparison of Bedside Sonography with Ct Scan in Diagnosis of Pneumothorax
    Manizhe Ataei * Page 24
    Background
    Ultrasound is the choice modality in the unstable patients and after performing certain procedures, such as a thoracentesis or the placement of a central venous line, which helps to rule out an iatrogenic pneumothorax. Upright AP radiograph has less sensitivity in diagnosing pneumothorax in comparison with ultrasound. Ct scan is more sensitive in diagnosis occult pneumothoraces but Bedside ultrasound is prefferedt in unstable situations without any radiation exposure.so we aimed to compare sensitivity of sonography with ct scan in patients who are suspicious to pneumothorax after thoracentesis or the placement of a central venous line or intubatin.
    Methods
    A radiologist performed bedside sonography first and then chest chestct scan was performed for 40 patients and was interpreted without knowing ultrasound results Absence of lung sliding, loss of ''comet-tail artifacts and Lung-point sign were assumed as sonographic criteria for diagnosis pneumothorax
    Results
    The result of CT and sonography was the same in 38 case (18 case pneumothorax and 20 case without pneumothorax) 2 cases with small occult pneumothorax were not diagnosed with sonography but pneumothorax was reported at CT scan.
    Conclusions
    Sonography is valuable method in diagnosis pneumothorax in unstable patients after invasive thoracic procedures.
  • The Normal Value of Tibial Tubercle Trochlear Groove Distance in Patients with Normal Knee Examinations Using MRI
    Mohammad Sobhan Ardekani, Reza Nafisi Moghadam, Mohamadreza Sobhan, Sepehr Nabavinejad, Zoheira Arefmanesh *, Mani Habibilashgary, Mahtab Amirheidari Page 25
    Patellar instability is a multifactorial common knee pathology that has a high recurrence rate, and the symptoms continue and ultimately predispose the patient to chondromalacia and osteoarthritis. Tibial tuberosity-trochlear groove distance (TTTG) is very important in the assessment of patellofemoral joint instability. The purpose of this study was to report normal value of TTTG in males and females in different age groups and to assess the reliability of MRI in measuring TTTG. All patients presenting with knee pain and normal examinations of knee joint, with a normal MRI report, referring to ShahidSadoughi hospital of Yazd, Iran, from April 2014 to September 2014, were included into the study. MR images were studied once by two radiologists and for the second time by one radiologist. Mean value of TTTG was reported for males and females and in three age groups. Intra- and inter-observer reliability was calculated. A total of 98 patients were eligible to evaluate during 6 months (68 male and 30 female). Mean TTTG was 10.9 ± 2.5 mm in total, which was 10.8 ± 2.8 mm and 11.3 ± 2.3 mm in males and females, respectively (P > 0.05). Mean TTTG in males ≤ 30 years, 30-50 years and, ≥ 51 years old were 10.8 ± 2.6 mm, 10.8 ±2.7 mm, and 10.8 ± 2.6 mm, respectively; that was 12.1 ± 3.4 mm, 11.4 ± 1.9 mm, and 10.5 ± 1.7 mm in females ≤ 30 years, 31 - 50 years and, ≥ 51 years old, respectively (95 % CI). The coefficient of variation was
    Keywords: Knee, Anatomy, Magnetic Resonance Imaging, TTTG
  • Assessment of Correlation of Left Ventricular Diastolic Functional Indices Between Gated Myocardial Perfusion SPECT and Echocardiography
    Lida Peivandi *, Vahid Reza Dabbagh Kakhki Page 26
    Background
    Left ventricular diastolic function assumes as a major morbidity and mortality risk factor in cardio-vascular diseases especially in patients with heart failure with preserved ejection fraction. In myocardial gated perfusion SPECT, both the perfusion and the LV function, specialy systolic ones, are evaluated. Though diastolic indices, assessed by SPECT, are often overlooked in reports and they were not compared with the known methods for assessment of LV diastolic function, best of them is echocardiography (Doppler and 2D). The aim of this study was to assess the correlation of LV diastolic indices with echocardiography.
    Methods
    Forty-nine consecutive patients referred to Ghaem hospital, Nuclear medicine ward, between 2013 to 2016, were performing both SPECT and echocardiography. Diastolic LV indices in SPECT were calculated with QGS software and all DATA were recorded in SPSS for statistical analysis by performing correlation studies. P value less than 0.05 is defined as significant level.
    Results
    The population study consisted of 19 male and 30 female with the average age of 58.2 years.There is a mild negative correlation between PFR, MFR/3 and PFR/2 with LA volume, LA diameter and LA index. There is a mild negative correlation between MFR/3 and Posterior wall thickness and also a mild positive correlation between PFR/2 and systolic LV diameter. There is no significant correlation between SPECT diastolic indices with other variables in echocardiography.
    Conclusions
    In this study there is no correlation between the main LV diastolic indices derived by SPECT and echocardiography, may be due to the main changes in the last version of guidline for assessment of LV diastolic function by echocardiography.
    Keywords: Diastolic Dysfunction, Echocardiography, SPECT, Diastolic Indices, Heart Failure
  • Non-Calcified Coronary Artery Plaque Characterization by Dual Energy Computed Tomography (DECT)
    Rezvan Ravanfar Haghighi *, Sabya Sachi Chatterjee, Pratik Kumar, Vani Varadhan Chatterjee, Reza Jalli, Sepideh Sefidbakht, Fariba Zarei, Bijan Bijan Page 27
    Background
    One of the most important causes of mortality in developed and developing countries is coronary artery disease. Coronary artery disease (CAD) may develop by deposition of lipid, fibrous or calcified debris on the surface of the coronary artery lumen. Fibrous plaque and calcified plaque may cause substantial stenosis of coronary arteries leading to ischemia of heart muscle while lipid core plaque with thin fibrous cap is generally non-stenotic. Lipid core plaques have higher risk of rupture, leading to future cardiovascular events and even sudden death. Single energy, conventional CT scanners may demonstrate the calcified plaques easily but they are of limited use in properly characterizing the plaques, specifically in evaluation of fibrous components, lipid core plaque or evaluation of mixed plaques. The main aim of this study was to characterize non calcified coronary artery plaque utilizing dual-energy computed tomography (DECT) system.
    Methods
    Decomposition of non-calcified coronary artery plaque was done in terms of effective atomic number (Zeff) and electron density (ρe) by utilizing DECT. Calibration was done by CT scanning employing known chemical compounds and mixtures, at 100 and 140 kVp, by dual source dual energy CT system. The inversion algorithm was applied to the CT data of the excised coronary artery (ex-vivo) from the heart of the cadaver and the result was verified with pathological report of these ex-vivo samples.
    Results
    The results demonstrated that the HU (100) and HU (140) sets of values measured in non-calcified plaque cannot adequately characterize the nature of the plaque. Upon applying our inversion algorithm to non-calcified plaques, the collected data may be able to characterize the type of the plaque into, fibrous plaque, fibro-lipid plaque with micro-calcification, and lipid plaque containing small amounts of micro-calcification. Our results corroborated with histopathology studies in 63% of the cases.
    Conclusions
    This study (first of this kind) shows that DECT method has potential to characterize the non-calcified coronary artery plaque.
    Keywords: Dual, Energy CT, Non, Calcified Plaque, Characterization
  • Quality Improvement Project: Implementation of PACS Integrated Peer Feedback for Radiologists After an Hospital Merge
    Allard Olthof * Page 28
    Objectives
    Peer feedback among radiologists contributes to quality improvement. RadPeer is a commonly used system for peer review. Consensus-oriented group review (COGR) promotes discussion among radiologist to improve reporting quality of all team members. Thresholds to feedback can be technical and personal, that can be augmented by a hospital merge. Making use of the functionality of the picture archiving and communication system (PACS) can help to integrate peer feedback in daily workflow. A good working agreement can augment usage of the feedback system by radiologists. The purpose of this paper is to demonstrate the implementation of PACS integrated peer feedback after an hospital merge with 3 locations.
    Methods
    The workflow for peer feedback was designed and the project was approved by all radiologists. We adapted the teaching file function of the PACS to use the RadPeer feedback terminology. The radiologists were instructed how to use the system. Team meetings were scheduled to discuss cases, in line with COGR.
    Results
    Providing and receiving peer feedback was easy to do, without interruption in daily workflow. The system can be used among the three hospital locations of the healthcare group. It was easy to retrieve and demonstrate cases for group discussion and analysis. A side effect was that the feedback project helped to demonstrate to external stakeholder that the radiologists are eager to work on continuous quality improvement.
    Conclusions
    PACS integrated peer feedback is a valuable tool to improve quality in radiology and feasible to implement, especially in the setting of a hospital merge.
  • A Comparative Study Between HRCT Findings of Invasive Pulmonary Aspergillosis with Serum and Bronchoalveolar Lavage Galactomannan and Fungal Culture in Lung-Heart Transplant Recipients
    Homa Khayatzadeh *, Payam Mehrian, Payam Tabarsi Page 29
    Background
    Due to the impact of threats on the clinical outcome and survival of the lung-heart transplant recipients, such as invasive pulmonary Aspergillosis, we aimed to compare the high resolution computed tomography (HRCT) scan findings with the serum BAL galactomannan and fungal culture in these patients.
    Methods
    We reviewed the data of lung-heart transplant recipients within a 5 year period at our center. The inclusion criterion was confirmed invasive pulmonary Aspergillosis. Demographic, clinical, radiologic and laboratory characteristics of the patients were retrieved from their files and reported.
    Results
    We reviewed the data of 30 patients (mean age = 36.1 ± 13.3; Male gender = 22 (73.3%). Seventeen patients (56.7%) patients had double lung transplant, 10 933.3% had single lung transplant and 3 (10%) had heart-lung transplant. Consolidation was the most observed finding in the HRCT (n = 25) ([83.3%]) and it was more present in the left lower lobe of the lung. Ground glass opacity was observed in 19 (63.3%) of the patients and mostly in the left lower lobe. Pleural thickening and pleural effusion were present in 7 (23.3) and 19 (63.3%) of the patients, respectively. Small-size nodular infiltration ( 5 mm) was observed in only 5 (16.7%) patients. Twenty-seven (90%) patients had positive culture results, while serum and bronchoalveolar lavage galactomannan was positive in 5 (16.7) and 9 (30%) patients, respectively. Four (13.3%) patients died during the study period. However, there was no association between the HRCT and laboratory characteristics of the study population.
    Conclusions
    HRCT is helpful in the diagnosis of invasive pulmonary aspergillosis in patients with lung-heart transplant.
  • The Diagnostic Value of Current Practice of Pediatric Intravenous Urography in Afghanistan in Presence of Ultrasonography; Cross-Sectional Analytic Study at FMIC, Kabul
    Hidayatullah Hamidi *, Najibullah Rasouly Page 30
    Background
    Intravenous urography (IVU); the oldest imaging method for assessing the upper urinary tract anatomy and function; is now seldom used in the pediatric population. The important concern associated with IVU is the radiation exposure. Due to various reasons, IVU is still widely practiced in pediatrics in Afghanistan. On the other hand, Ultrasonography (USG) is universally accepted as the first-line imaging modality in pediatric uroradiology. It is inexpensive, immediate, painless, radiation-free, non-invasive and widely available.
    Objectives
    To assess the diagnostic value of current practice of pediatric IUV in presence of USG in Afghanistan. To compare the validity OF USG, plain abdominal radiograph, and their combination in with IVU in detection of urolithiasis in children.
    Methods
    A prospective cross-sectional analytic study was conducted on pediatric patients at radiology department of FMIC. First USG of urinary tract was done for all participants, followed by IVU. The statistical analysis was done using SPSS version 23. The diagnostic value of IVU was considered positive when it could provide additional information over USG and negative if it could not give any addition information over USG. Accuracy of USG, plain radiograph and their combination in detection of urolithiasis was calculated taking IVU as reference examination.
    Results
    The diagnostic value of IVU was found positive in 6.5% while it was negative in (93.5%) cases. The sensitivity and specificity of USG, Rad and their combination in detection of urolithiasis was calculated as 90.5% and 84.8%, 84.1% and 88.6%; and 98.4% and 4.8% respectively.
    Conclusions
    IVU can be largely replaced by USG in the pediatric population and if really clinically needed, its indications should always be judged according to clinical context and USG findings. In cases of urolithiasis combination of USG and plain radiograph can mostly answer the clinical question and there may be no need to perform IVU.
    Keywords: Intravenous Urography, Pediatric Uroradiology, Ultrasonography
  • Diagnosis of Solitary Pulmonary Nodules Using MRI: A Feasibility Study
    Reza Jalli, Banafsheh Zeinali Rafsanjani *, Mahdi Saeedi Moghadam Page 31
    Solitary pulmonary nodule (SPN) is explained as a separate, well-determined obscurity with the maximum size of 3cm which is enclosed by typical lung tissue and is not related to any other anomalies in the lung or adjacent lymph nodes. Among imaging modalities MRI has more benefits such as high spatial resolution and usage of nonionizing radiation, however, the efficacy of this imaging modality in lung nodules diagnosis has not been well established. Thus CT scan is considered a proper modality for the SPN diagnosis. The objective of this study was to evaluate the accuracy of MRI in the detection of SPNs which has verified by CT scan. The study was conducted as a prospective case-control study. 32 SPN patients whose disease confirmed by CT scan findings and 11 patient with normal CT scan were included in this study. Sensitivity, specificity, positive and negative predictive values of MRI were determined. The location and the size of pulmonary nodules as well as different MRI sequences were evaluated. Statistical analysis revealed that T1w sequences (27%) had the least diagnostic sensitivity, T2w images, and Fat-sat slices had 55% and 36% sensitivity respectively. Specificity of T1w, T2w, and Fat-sat images were 97%, 90% for the last two imaging sequences. According to the results, it can be concluded that although the specificity of different MRI sequences was ≥ 90%, low sensitivity and breath holding technique prevents its clinical routine usage for the suspected patients with SPN or early detection of pulmonary nodules in high-risk patients.
  • Evaluation of Bronchitis Caused by Mustard Gas Weapons in the War Combatants
    Mahdi Saeedi-Moghadam, Reza Jalli, Banafsheh Zeinali Rafsanjani * Page 32
    Sulfur mustard (SM) gas was used in the Iran-Iraq war (1981 - 1989) as a vesicant chemical warfare against the Iranian warriors. This alkylating agent with the potential of producing chemical injury in the skin, eyes, and lung, may damage both upper and lower respiratory tract, which in turn can cause different types of sequels such as asthma, bronchiectasis, chronic bronchitis and lung fibrosis. This study was performed on 274 patients with documented history of SM gas exposure. All of the participants complained of respiratory problems. Patients with a positive history of cigarette smoking, respiratory problems before the exposure to SM gas, cardiovascular problems, surgery of the lung, and exposure to occupational toxic chemicals were excluded from the study. Results of all chest HRCTs were evaluated by a radiologist. HRCT findings showed that bronchiectasis involved 53 patients (19.34%) of all cases. Varicose bronchiectasis and cystic bronchiectasis was observed in 10 (18.9%) and 6 cases (11.3%) respectively. Among patients with bronchiectasis, the involvement rate of different lobes was as follows: right upper lobe (RUL) 7.5%, right middle lobe (RML) 11.3%, left upper lobe (LUL) 15.1%, left lower lobe (LLL) 26.4% and right lower lobe (RLL) 39.6%. Findings of chest HRCT demonstrated tubular bronchiectasis was the most frequent type of this disease that involve the chemically injured patients and RLL had been the most frequently involved lobe of the lung with bronchiectasis.
  • Clinical Implication of Intra-Amniotic Sludge in Predicting of Preterm Delivery
    Narges Afzali *, Fatemeh Baghalsafa Page 33
    Background
    Preterm labor is defined as labor occurring prior to 37 weeks which .There are different factors which can lead to preterm labor including maternal causes, chorioamnionitis, cervical insufficiency and others. Because there is no satisfactory clinical method fop prediction of preterm labor, so it is important to look for some probable predicting markers by para clinical investigation.
    Objectives
    The main goal of this study is evaluation of relationship of intra-amniotic sludge in ultrasound exam and preterm delivery.
    Methods
    In a cohort study included 84 pregnant women in 18 - 32 weeks of gestational age referred to Islamic Azad university of mashhad hospitals in 2015. Cervical length measurement and intra-amniotic sludge were examined by transvaginal probe. Depending on sludge density the cases were divided to three groups: no amniotic sludge, light sludge and dense sludge. According to gestational age at delivery time the women were classified into two groups: term (delivery after 37 weeks) and preterm (delivery before 37 weeks).
    Results
    The prevalence of preterm delivery was 14/3%. The frequencies of term delivery in mothers with dense, light and no sludge were 78/6%, 82/1% and 96/4 % respectively, and for preterm delivery they were 21/4%, 17/9% and 3/6% respectively. But there was no statistically significant relationship between term and preterm delivery and type of sludge. Neonatal weight in mothers with sludge, was significantly lower than mothers without sludge.
    Conclusions
    There is no statistically significant relationship between preterm delivery and type of sludge.
    Keywords: Intra, Amniotic Sludge, Transvaginal Ultrasound, Preterm Birth, Cervical Length
  • On the Selection of Region of Interest in Measurement of Cardiac Magnetic Resonance Imaging T2* Value in Thalassemia Major Patients
    Somayeh Gholami Bardeji *, Mahdi Dodangeh, Zeinab Gholami, Reza Jalli, Mehrzad Lotfi, Mehran Karimi, Rezvan Ravanfarhaghighi, Sepideh Sefidbakht, Bijan Bijan Page 34
    Objectives
    To investigate the correlation between T2* values of different regions of interest (ROIs) in myocardium with the means of semi quantitatively estimating the myocardiac iron content in the thalassemia major patients. In the same setting we tried to design a model to predict T2* value of interventricular septum (septum) based on T2* values of other convenient ROIs in myocardium.
    Methods
    130 patients underwent ECG-gated cardiac magnetic resonance imaging (MRI), and T2* values were measured in different ROIs. Full-thickness ROIs are drawn manually in septum, entire left ventricle (LV) wall, the region of the best visual conspicuity (sharp), and LV free wall. The relation between T2* values of these four regions are investigated. Depends on the grade of siderosis, the patients are divided into four groups; Severe: T2* ≤ 10, Moderate: 10 20. The statistical analysis carried out using Matlab R2015b.
    Results
    In patients with the cardiac T2* ≤ 20, the statistical analysis confirms a significant correlation (α = 0.001) between T2* values of septum and the ROIs named above. Moreover, the statistical results become more concordant with decreasing T2* values. In addition, for patients with a T2* > 20, a weak correlation is noticed between T2* values of different ROIs. Three predictor models are provided to estimate T2* value of septum using T2* values of entire LV wall, sharp region, and LV free wall.
    Conclusions
    The T2* values of the LV free wall and the entire LV wall are reliable alternatives to estimate the T2* value of septum. The predictor model based on T2* value of entire LV wall provides the most reproducible estimation.
  • Routine Versus Selective Use of Chest and Abdominopelvic CT-Scan in Blunt Trauma: A Randomized Controlled Study
    Hamidreza Talari *, Nushin Moussavi, Abdolhossein Davoodabadi, Sasan Saidfar, Fatemeh Atoof Page 35
    Background
    Whole body CT-scan (WBCT) is increasingly used in the setting of severe blunt trauma due higher sensitivity for detecting occult injuries in comparison to conventional radiography and ultrasound. But the real impact of routine CT-scan on patient outcome is still unclear. Considering the high radiation exposure due to routine CT-scan, this study was conducted to assess the effect of performing routine chest and abdominopelvic CT-scan on patient admission time and complications in blunt trauma.
    Methods
    One hundred and forty conscious and hemodynamically stable blunt trauma patients were included in this randomized controlled study. For seventy patients, routine chest and abdominopelvic CT-scan was requested in addition to conventional radiography and ultrasound. For the other 70 patients, selective CT-scan was ordered according to the clinical presentation. Patient admission times in the emergency room and surgery ward, complications and surgical procedures were assessed. “Missed injuries” defined as additional findings on CT-scan which were not evident on radiography or ultrasound were assessed.
    Results
    Admission time in the emergency ward was significantly shorter in the intervention group with 3.7 ± 0.9 hours in comparison to 4.9 ± 0.8 hours in the control group. Also mean admission time in hospital was only 5.4 ± 2.4 in the intervention group in comparison to 7 ± 3.3 days in the control group. On abdominopelvic CT-scan, 9 (7.8%) additional injuries were detected. All these 9 patients had a positive clinical examination. Chest CT-scan in the intervention group led to additional diagnoses in 17 patients (24.28%) leading to tube thoracostomy insertion in 13 patients (18.57%).
    Conclusions
    Performing routine chest and abdominopelvic CT-scan in conscious blunt trauma patients decreases the hospitalization time but has no effect on patient complications and final outcome. Using a selective approach and performing CT-scan only for symptomatic patients, would be an appropriate option to decrease radiation dose and facility overuse. Nevertheless, the concern of missing occasionally a life threatening injury still remains. Each trauma center should make the decision whether to perform CT-scan or not according to all the pros and contras of this imaging modality.
  • Fetal and Maternal Outcomes of Isolated Single Umbilical Artery
    Amirhossein Hashemi Attar *, Narges Afzali, Fatemeh Hafezi, Zahra Amini Page 36
    Background
    The umbilical cord normally consists of two arteries and one vein. Single umbilical artery (SUA) is a condition in which the cord contains only one artery. SUA may be isolated or associated with congenital anomalies. This anatomic variation can be detected by ultrasound evaluation in approximately 0.5% of pregnancies. The incidence of adverse outcomes primarily depends on whether SUA is an isolated finding or associated with fetal abnormalities and aneuploidy. The aim of this study was to investigate fetal and maternal outcomes of isolated SUA.
    Methods
    In this cohort study, 21 fetuses with isolated SUA, and 21 fetuses with normal three-vessel umbilical cord were included. All cases were examined by advanced fetal anomaly scan. In addition, cardiac, genitourinary, musculoskeletal, gastrointestinal, and neurologic anomalies were excluded. Two group were monitored during pregnancy, at delivery, and neonatal period. Perinatal and maternal outcomes were recorded.
    Results
    Among 21 fetuses with isolated SUA, the left and right arteries were absent in 12 and 9 fetuses, respectively. Interestingly, the mean head circumference at birth was significantly lower in the isolated SUA group compared to the 3-vessel group (33.35 2.06 cm vs 35.21 1.47 cm, P = 0.002). However, there was no statistically significant difference between the two groups in birth weight and length, as well as incidence of polyhydramnios, oligohydramnios, intrauterine growth retardation, intrauterine fetal death, small for gestational age, preterm delivery, cesarean delivery due to fetal distress, and neonatal intensive care unit admission.
    Conclusions
    In the absence of associated anomalies, the risk of incidence of adverse events does not appear to be increased significantly with isolated SUA. Therefore, supplementary assessment and invasive tests are not recommended in fetuses with isolated SUA, unless fetal abnormalities are detected in routine evaluations.
    Keywords: Fetus, Isolated, Single Umbilical Artery, Ultrasound
  • How Low Can We Go Dose Saving Through Low-Dose Examination for Urolithiasis Via Modern Computer Tomography with Tinfilter
    Youssef Erfanian *, Nika Guberina, Saravanabavaan Suntharalingam, Jens Theysohn, Johannes Haubold Page 37
    Objectives
    To compare radiation dose and image quality of three different CT devices using low dose abdominal protocols in patients with suspected urolithiasis. Differences in radiation dose due to usage of additional hardware (tin filter) and software (newer generation iterative reconstruction) were evaluated.
    Methods
    Low - dose examinations from two standard CT (siemens AS , siemens flash) devices with a tin - filter CT (siemens force) were compared regarding dose-length product (DLP) and computed tomography dose index volume (CTDIvol). Image quality of each CT scan was assessed using a five point Likert scale (0 = major blurring, 4 = excellent depiction). Kruskal - Wallis analysis was performed to test for significant subgroup differences in DLP, CTDIvol and image quality. An interrater agreement concerning image quality was evaluated.
    Results
    CT examinations of a total of 143 patients were assessed. DLP of Force was 56% and 55% lower in comparison to AS and flash, (74.3, 166.1 and 164.6 mGycm respectively; P 0.05). Interrater agreement regarding image quality was substantial for all CT - devices (κ = 0.75, n = 143).
    Conclusions
    Modern CTs with the innovative technology of a built-in tin filter allow for significant reduction of radiation exposure in patients with suspected urolithiasis by optimizing the X - Ray spectrum with image quality as high as in standard CT devices
  • Diagnostic Value of Doppler Sonographic Findings in Neonatal Hypoxic Ischemic Brain Damage
    Fatemeh Yarmahmoodi *, Parisa Pishdad, Seyyed Mostajab Razavinejad Page 38
    Background
    Significant improvements were done in perinatal and neonatal care in last decades. But Hypoxic Ischemic Encephalopathy (HIE) in neonates is still the important couse of neonatal mortality end adverse developmental sequelas. Neonatal HIE is defined when there is evidence of fetal distress, metabolic acidosis of neonate (PH
    Methods
    In this study we choose 32 neonate according to inclusion criteria of HIE. Doppler sonography of brain arteries was done in first 24 hours after birth.Brain MRI was done as soon as possible when clinical canditions permits doing it.
    Results
    This study showed there is significant linear correlation between severity of HIE that is defined by sonographic finding compaired with severity of HIE showed by MRI finding and clinical date. Cut off point of resistive Index (RI) for all three brain arteries (ACA.MCA and BA) WAS 0.62 , The point of optimal sensitivity and specifity for diagnosis of HIE.
    Conclusions
    Sonography is the excellent screening diagnostic modality for determination of severity and predicition of prognosis in neonatal HIE. Modern sonographic equipment can detect many brain abnormalities. Measuring cerebral Blood Flow Velocities (BFV) and RI of brain arteries with Doppler sonography is useful for predicition of severity of HIE. Use of this modality is helpful for early diagnosis and therapy of neonates with critical condition, that could decrease sequala of disease. Although MRI can detect more details and must be done when the babies clinical condition is appropriate for transport to MRI unit.
    Keywords: Neonatal Hypoxic Ischemic Encephalopathy, Brain Doppler Sonography, Brain MRI
  • Efficacy of Three-Dimensional Transvaginal Sonography in Diagnosis of Uterine Cavity Abnormalities Among Infertile Women: A Cross-Sectional Study
    Firoozeh Ahmadi *, Maryam Javam, Fatemeh Niknejad Page 39
    Objectives
    To evaluate the efficacy of three-dimensional transvaginal sonography (3D-TVS) in diagnosis of uterine cavity abnormalities among infertile women.
    Methods
    This was a cross-sectional study at Royan Institute, Tehran, from April 2012 and March 2013. All infertile women who were booked for hysteroscopy during this period of time were recruited in the study. Patients underwent preoperative 3D-TVS by an expert radiologist and hysteroscopy was performed by an expert surgeon. Patient’s history, 3D-TVS findings and hysteroscopy results were assessed to collect data. Agreement between sonography findings and hysteroscopy results, sensitivity, specificity, positive and negative predictive values, and efficacy of 3D-TVS in diagnosis of congenital and acquired uterine disorders were calculated by SPSS18 software using Cross-tabs, Kappa test, and other statistic analysis.
    Results
    Totally, 153 women were recruited in the investigation. Patients aged 30.78 ± 4.79 years in average and the duration of infertility was 4.2 ± 2.91 years among them. Uterine abnormalities were grouped as “congenital” and “acquired”. Overall efficacy of 3D TVS in diagnosis of uterine disorders was calculated 92.8% with Kappa value of 82.3, indicating a good agreement between ultrasound findings and hysteroscopy results. Efficacy of 3D TVS in diagnosis of congenital and acquired uterine lesions was calculated 92.1% and 87.6% respectively.
    Conclusions
    Our study demonstrated that 3D TVS has a good efficacy and reliable agreement with hysteroscopy in diagnosis of uterine lesions among infertile women. Therefore, it can decrease the number of diagnostic hysteroscopies.
    Keywords: 3D ultrasound, Uterus, Infertility
  • The Role of Imaging for Characterization of Incidental Splenic Lesions
    Alireza Abrishami *, Soheil Kooraki, Lars Grenacher, Hans Ulrich Kauczor Page 40
    Background
    With ever-increasing use of cross-sectional imaging, radiologists face with the challenge of characterizing incidental splenic lesions. Currently there is no guideline to manage these lesions. This study was conducted to characterize the incidental splenic lesions on cross-sectional imaging and to assess the role of various imaging factors to differentiate benign from malignant lesions.
    Methods
    This retrospective study was performed in a tertiary referral center. Data of patients with incidental spleen lesions in their cross sectional imaging were assessed. Over a course of three years, one hundred sixty one patients were included. Follow-up imaging was available in 122 individuals with mean (SD) follow-up time of 16.4 (16) months (ranged 1 - 96 months). Patients’ demographic data, morphologic features and enhancement pattern on available CT scan and MRI were carefully reviewed and compared.
    Results
    Of 161 patients with splenic lesion [54% male, mean age (SD): 59.7 (15.4). ranged: 8-88 yr], 134 (83.2%) were solitary and 89 (55.3%) were subcapsular. Benign lesions were more likely to be homogenous (59.7% vs. 29.7%, P: 0.002). Ill define and lobulated borders had significantly higher prevalence in malignant lesions (73% vs. 53.2%, P: 0.03). Malignant lesions had significantly larger size (21.7 vs. 15.5 mm, P: 0.03). None of the benign lesions showed restricted diffusion in DWI/ADC, while 50% of malignant lesions had restriction (P: 0.003). Stable lesion size in follow-up imaging was strongly associated with benign nature of the lesion (86.2% vs. 11.4 P
    Conclusions
    Small size, smooth lesion border and homogeneity favor benign nature of the incidental splenic lesions, while restricted diffusion might be a feature of malignancy. Follow-up imaging might be helpful in a subset of patients to discriminate benign and malignant incidental splenic lesions.
  • Ultrasound Technique in Evaluation of Abdominal Wall Hernia
    Hosein Rezaei *, Bita Abbasi, Farrokh Seilanian Tossie Page 41
    Background
    Some sonographic positions for detection of abdominal wall hernias needed .In this paper we described the sonographic technique of abdominal wall hernia.
    Methods
    From June 2013 to July 2016, three hundred seventy four patients referred in our department for evaluation of abdominal wall hernia (median age, 38 years; range 2 - 86 years). One hundred and ninety patients had abdominal hernia, 85 in inguinal-femoral regions, 58 in epigastria and Para-umbilical, 34 incisional and 13 Spigelian. Men most referred for inguinal regions, the women frequently referred for femoral, Para-umbilical and inscional hernia. All the patients are examined by one instrument with linear and convex multi-frequencies probes. Sononography performed first in supine position with and without valsalva manor, sitting and if possible standing view then added. Patients who operated after sonography the surgery reports compared with our findings.
    Conclusions
    Although sonography routine request for diagnosis of abdominal wall hernia, experience and various positions needed for correct diagnosis. In this paper we described our experience in sonography of abdominal wall hernia.
    Keywords: Hernia, Sonography, Abdominal Wall
  • Predictive Value of Transvaginal Ultrasound in Diagnosis of Endometriosis: A Three Year Study
    Maryam Niknejadi *, Maryam Javam, Mohammad Chehrazi Page 42
    Background
    To assess the predictive value of various transvaginal sonography findings in characterizing endometriosis.
    Methods
    This prospective investigation was conducted at Royan Institute, Tehran, Iran, from April 2010 till March 2013. All infertile women presenting with clinical symptoms of endometriosis, who were booked for laparoscopy, underwent a preoperative trasvaginal sonography by an expert radiologist. Endometriosis was diagnosed on TVS according to detecting one or more of following findings: echogenic points on serosal surface of the ovaries, ovarian endometrioma and signs of pelvic adhesion (blurred ovary margins, fixation of ovaries, deviation of ovaries or decreased distance between them). A logistic regression analysis was performed to identify prognostic factors in detection of presence of endometriosis. Each parameter was entered sequentially into the model based on hosmer-lemeshow algorithm. Values were calculated by Stata12 software regarding laparoscopy as gold standard.
    Results
    Totally, 101women were evaluated during the study. Endometriosis was present at laparoscopy in 58 patients. Mean age and the duration of infertility were calculated 30.78 ± 4.79 and 4.2 ± 2.91 years respectively. Frequencies of each sonographic finding were as follow: echogenic points (%31.68), ovarian endometrioma (%30.69), blurred ovary margin (%7.92), fixation of ovaries (%15.9), deviation of ovaries (%21.8), and decreased distance between ovaries (%8.9). As derived by logistic regression analysis, detection of “ovarian endometrioma”, “fixation of ovaries” and “ovarian deviation” strongly predicts endometriosis (odds ratio of 42.27, 46.89 and 14.78 respectively).
    Conclusions
    Our study demonstrated that TVS has a reliable predictive value in diagnosis of endometriosis. “Ovarian endometrioma”, “deviation of ovaries” and “ovarian fixation” can be used as important criteria for radiologists and gynecologists.
    Keywords: Transvaginal Sonography (TVS), Laparoscopy, Endometriosis
  • Test-Retest Reproducibility and Robustness Analysis of Recurrent Glioblastoma MRI Radiomics Texture Features
    Isaac Shiri *, Hamid Abdollahi, Sajad Shaysteh, Seied Rabi Mahdavi Page 43
    Background
    Advanced quantitative information such as radiomics features derived from magnetic resonance (MR) image may be useful for outcome prediction, prognostic models or response biomarkers in Glioblastoma (GBM), knowledge about their Reproducibility and robustness is essential. The purpose of this study was to investigate the reproducible and non-redundant radiomics texture features in oncological GBM MRI based on test-retest setup.
    Methods
    Thirteen patients with recurrent GBM who underwent repeated MR imaging approximately two day interval were subjected to this study. Lesions were segmented using competitive region-growing based algorithm. Following delineation and segmentation of lesions, 158 quantitative 3D features based on intensity histograms (IH), gray level run-length (GLRLM), gray level co-occurrence (GLCM), gray level size-zone texture matrices (GLSZM), neighborhood-difference matrices (NDM), and geometric features were extracted from the 3D-tumor volumes of each lesion. For every radiomics feature, test-retest was assessed with the intra-class correlation coefficient (ICC) and the concordance correlation coefficient (CCC) and finally the most reproducible and robust radiomics features were selected.
    Results
    Results shows that the ‘74%’ of assessed radiomics features had a high test-retest stability in terms of their ICC. There were 107 radiomics features with ‘CCC >0.95’ and 49 radiomics features were non-redundant after grouping features with ‘R2Bet ≥ 0.95’.
    Conclusions
    Test-retest and correlation analyses have identified non-redundant radiomics features and this feature are prone to errors if they employed as quantitative biomarker for GBM image analysis. However when we use robust and redundant feature, quantitative image radiomics features are informative and prognostic biomarkers for GBM Magnetic resonance imaging.
    Keywords: Radiomics, GBM, MRI, Feature
  • Apparent Diffusion Coefficient Value as a Predictive Marker to Evaluate Tumor Response in Patients with Cervical Cancer
    Fariba Allahmoradi *, Abbas Haghparast, Salman Zakariaee Page 44
    Background
    Cervical cancer is the second common cancer and the third reason of mortality among women in the world which is often occurred in third and fifth decades of their life. Cervical tumor recurrence observed in 30% of the patients and the 5-years survival rate of cervical cancer is about %50. The development of a rapid and non-invasive method for treatment response evaluation is one of the most challenges in cancer treatment management.Diffusion-weighted magnetic resonance imaging (DW-MRI) is a contrast agent free imaging technique thatis widely used for oncology studies.
    Objectives
    In this paper, thecapability of ADC valueto monitor the treatmentresponse in the cervical cancer patientswasevaluated.
    Methods
    A computerized search using the databases SID, Google Scholars, Pub med and Science Direct, covering the period from 1998 to 2015, was conducted using the following key search terms: “Treatment response”, “Diffusion-weighted magnetic resonance imaging”, “ADC”, “MRI” and “Cervical Cancer”. In total, 27 relevant papers were reviewed.
    Results
    Studies had shown thatthe mean ADC value of cervical carcinoma (1.110 ± 0.175 × 10-3 mm2/s)is significantly lower than that of normal cervical tissue (1.593 ± 0.151 × 10-3 mm2/s) (P
    Conclusions
    ADC valuecould be a prognostic factor to monitor the response to therapy for patients with cervical cancer. The addition of DW-MRI to the conventional MRI protocolsconsiderably improved the diagnostic ability of MR imaging method for tumor evaluations.
    Keywords: Treatment Response, Diffusion, Weighted Magnetic Resonance Imaging, DW, MRI, ADC, Cervical Cancer
  • Is Background Parenchymal Enhancement on Magnetic Resonance Imaging Helpful in Risk Assessment of Breast Cancer?
    Maryam Farghadani *, Ali Hekmatnia, Hoda Sharif, Mehdi Baradaran, Maryam Riahinezhad Page 45
    Objectives
    Background parenchymal enhancement (BPE) on contrast-enhanced magnetic resonance imaging (CE-MRI) corresponds to hormonally active breast fibroglandular tissue. Several studi.es have reported increased odds of breast cancer in patients with marked BPE. The purpose of the present study was to evaluate BPE in contralateral breast of biopsy proven breast cancer patients and comparison of the results with control group.
    Methods
    In a case-control study, CE-MRI of the contralateral breasts of 40 biopsy-proven breast cancer patients and 40 patients with biopsy- proven benign breast lesions, were retrospectively reviewed by an experienced radiologist and degree of BPE, and pattern of enhancement were determined, finally, BPE was compared between case and control groups using chi square test. Pearson correlation test was used to determine association between FGT amount and BPE. P value
    Results
    In the case group, 4, 17, 14, and 5 patients had minimal, mild, moderate, and marked BPE, respectively. In the control group, 12, 24, .and 4 participants had minimal, mild, and moderate BPE, respectively. BPE was significantly higher in the case group in comparison with the control group (P value
    Conclusions
    Our study revealed that patients with the diagnosis of breast cancer have greater BPE in comparison with control group. The results may be indicative for higher probability of developing breast cancer in patients with higher BPE. Therefore, CE-MRI could be a useful tool for breast cancer risk assessment.
    Keywords: Background Enhancement, MRI, High Risk Breast Cancer
  • Comparison of Gestational Age Based on BPD and FL in Standard of of HADLOCK and OSAKA with Real Gestational Age Based on LMP in Teaching Hospitals in Zahedan
    Aiob Beiknejad*, Farshid Mohebbi Page 46
    To determine the gestational age of ultrasound devices, commonly used standard tables. The aim was to determine the gestational age of pregnant women admitted to hospitals in Zahedan with HADLOCK and OSAKA table and gestational age derived from the tables to be adjusted to determine the gestational age of the actual use of tables for a more accurate determination of gestational age for the proper study population Trust
    Methods
    A total of 200 pregnant women admitted to hospitals in Zahedan were in 1393-4. Exclusion criteria were: women with a history of chronic disease and fetal anomalies and multiple pregnancy. Inclusion criteria were: pregnant women in the second trimester and third with LMP characteristics. A questionnaire was designed and pregnant women were studied by ultrasonography and femoral length and BPD were measured. Data with SPSS software, paired t-test and Pearson correlation coefficient were studied.
    Results
    In the second trimester the correlation coefficient between LMP; according to BPD in both tables were the same, but the FL values in HADLOCK and OSAKA.
    Conclusions
    In general it can be concluded that the use of OSAKA table to determine the gestational age of the study population, especially in the third trimester, is more accurate than the HADLOCK. was was varied. Also in the third trimester based on the correlation of BPD and FL were different in the above tables.
    Keywords: Ultrasonography, BPD, FL, Gestational Age
  • Is There Any Correlation Between MRI Features of Breast Lesions of BI-RADs Category 4 with Histopathologic Results?
    Ghazaleh Soofi *, Amirhossein Sarrami, Maryam Farghadani Page 47
    Objectives
    To evaluate the correlation of MRI features of breast lesions of BI-RADs category 4 with histopathologic results.
    Methods
    In a prospective study between December 2013 and April 2015, patients with suspicious mammographic and/or ultrasound findings referred for Breast MRI were evaluated. All the breast MRI were interpreted by a trained radiologist. Patients with lesions of BI-RADs category 4 were enrolled with written informed consent. In each patient mass lesion (ML) or non-mass lesion (NML) were determined. In patients with ML, shape (irregular or microlobulated), border (ill-defined or spiculated), contrast media distribution (inhomogenous or ring enhancement), initial and post initial contrast enhancement (strong enhancement, rapid, plateau, or continuous washout) were assessed. In patients with NML, pattern of enhancement (focal, linear, ductal, segmental or heterogeneous regional) was assessed. A Follow up program were taken with mean 3 to 12 months. The patients which underwent core needle biopsy or open biopsy were summoned.
    Results
    81 females aged 24 to 67 years (mean 43 ± 9.2) met the inclusion criteria and had adequate samples for histopathologic study. 28 (34%) patients had ML, 46 (56.8%) patients had NML and 7 (8.6%) had both ML and NML. Rate of normal result, epithelial hyperplasia, fibrocystic changes, fibroadenoma, papilloma, atypical hyperplasia, mixed fibrocystic changes and atypical hyperplasia, ductal carcinoma in situ, and invasive carcinoma were 2.5%, 12.3%, 19.8%, 8.6%, 3.7%, 19.8%, 4.9%, 14.8%, and 13.6%, respectively. In statistical analysis none of the MRI features has significant correlation with any specific histopathologic diagnosis.
    Conclusions
    This study showed that a wide spectrum of histopathologic results are seen in BI-RADs category 4. However, in this sample volume none of the MRI features in this BIRADs category has significant correlation with any specific histopathologic diagnosis.
  • MRCP Findings of Hepatobiliary Fascioliasis: A Case Report
    Shaghayegh Sadat Khabbaz * Page 48
    Background
    Fascioliasis, caused by Fasciola hepatica and Fasciola gigantica, is a parasitic infection. It merges in Iran as a serious problem in past decades. A pattern of fascioliasis transmission was defined for northern part of Iran, named «Caspian Pattern”.
    Case Presentation
    We report a 33-year-old from iran who presented with epigastric and RUQ pain. We present US and MRCP findings of hepatobiliary fascioliasis and the results of her surgery. In the sonographic study, an echogenic area with no acoustic shadowing was seen in the gallblader. CBD and CHD (common hepatic duct) was slightly dilated In the MRCP elliptical intermediate signal area in T2W and iso tense area in T1W in common hepatic duct with dilated internal biliary ducts and common bile duct was seen.
    Conclusions
    Hepatobiliary fascioliasis is a rare disease. Imaging studies can help us for diagnosis of fascioliasis with subtle symptoms and laboratory findings especially in endemic areas.
    Keywords: Fascioliasis, Magnetic Resonance Cholangiopancreatography, Ultrasonograph
  • Brain Near-Infrared Spectroscopy (NIRS)
    Soheila Refahi *, Hakimeh Saadati Page 49
    Near-infrared spectroscopy (NIRS) is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum. Typical applications include medical and physiological diagnostics. NIRS can be used for non-invasive assessment of brain function through the intact skull in human subjects by detecting changes in blood hemoglobin concentrations associated with neural activity, e.g., in branches of cognitive psychology as a partial replacement for fMRI techniques. NIRS cannot fully replace fMRI because it can only be used to scan cortical tissue, where fMRI can be used to measure activation throughout the brain. In this approach we compared NIRS with different functional brain tests.
  • Assessment of Radio-Guided Occult Lesion Localization Associated with Sonography in Nonpalpable Breast Lesions
    Ali Alamdaran *, Ramin Sadegi, Aida Sharifi, Elaheh Moododi, Naser Forghani Page 50
    Background
    Several methods are in use for localization of non-palpable breast lesions prior to excision. The most common is wire-guided localization which is fraught with difficulties and possible complications. Radio-guided localization of non-palpable lesions (ROLL) is a relatively new method which has been never used in our country before. We have for the first time investigated its diagnostic value for localization of non-palpable breast lesions in a teaching hospital in Iran.
    Methods
    In this study, 42 patients with non-palpable breast lesions, detected by ultrasonography, underwent radio-guided localization. Phytate-Tc-99m was injected into the lesion under the guidance of ultrasonography, 1-2 hours before surgery. Excision of the lesion was performed according to radioactivity signal of lesion, detected by a hand-held gamma probe during surgery. After total excision, the resection bed was explored by gamma probe to detect any residual activity. So if there was no radioactivity signal, the excision was regarded as complete. The data of ultrasonographic characteristics, localization and excision procedure, complications, margin status and tissue volume were analyzed by SPSS 16.
    Results
    Pathologic results were benign in 90.5% and malignant in 9.5% of patients. Post-operative margin of lesion was clear in 100% of patients. No margin involvement was reported. Mean duration of localization and surgical procedure was 1.80 ± 0.42 and 26.78 ± 8.10 minutes, respectively. Fault in localization took place in 4 patients (9.5%) and there was a need to secondary surgery in 1 patient (2.4%). Patients’ satisfaction level about post-operative cosmetic results was excellent in 33.3% and good in 66.6% of patients. Mean excised tissue volume was 28.59 ± 27.96 cm in all patients and 23.54 ± 23.46 cm, in patients without fault of localization.
    Conclusions
    Radio-guided localization of non-palpable breast lesions is an acceptable method because of technical facilitation, accurate localization and complete excision with limited complications. So it can be recommended as an alternative method for wire-guided localization.
  • Using A Multi-Agent System Approach for Monitoring Appropriateness Criteria in Medical Imaging
    Mahtab Karami * Page 51
    Agent technology is an emerging and promising research area in software technology, which increasingly contributes to the development of value-added information systems for large healthcare organizations due to its capability to automatically modify themselves in response to changes in their operating environment. Multi agent system (MAS) approach is the construction of a complex system as a set of entities, called agents, interacting among them in order to perform the system tasks. Patie Maes, the director of MIT media lab, deems that agent is “a computer system, which locates in dynamic and complex environment, can autonomically sense the environment and act accordingly to complete its tasks or goals”. Agent is a computing entity with four features of autonomy, reactivity, interaction and initiative. A MAS is composed of a large number of agents and other computational artifacts. These agents are goal-oriented components, that is, they are modeled as entities that pursue goals and choose for execution those actions that will potentially contribute to satisfy them. These choices depend on their information about the environment, past experiences and themselves. Agents are also social because they need to interact with other agents to achieve the satisfaction of goals, and these interactions are modeled in terms of information, requests and informs. In healthcare, medical imaging is a service-oriented, data-intensive and technology-driven environment; therefore it requires combining many computerized systems with different user environments to provide quality efficient services in less time. In such environments, MAS is well-suited to describe the interactions between agents (e.g., information exchanged, related tasks or reasons for that interaction) and the way in which the agent adapts to changes in it (e.g., new roles or goals) or its environment. Medical imaging is a science but also a discipline of action that often requires a decision. The complexity of decision-making, especially in medical imaging, comes from the uncertainty, for example the uncertainty of knowledge, uncertainty about the protocols and the uncertainty of the procedure used. A multi-agent system (MAS) for decision-aiding support uses and combines distributed and heterogeneous systems to ease the extraction of useful information in order to select appropriate protocol or procedure.
    Keywords: Medical Imaging, Agent Technology, Multi Agent System, Agent, Multi Agent System, Agent, Appropriateness Criteria
  • Assessment of Adherence to the STARD Statement for the Quality of Reports on Diagnostic Studies Published on the Iranian Journal of Radiology
    Fariba Zarei *, Banafsheh Zeinali Rafsanjani Page 52
    Background
    Standards for the Reporting of diagnostic accuracy studies (STARD) statement was developed to improve the accuracy and completeness of reporting of studies of diagnostic accuracy. It allows readers evaluate the internal and external validity and enable readers to assess the potential for bias in the study and the generalizability of the results.
    Objectives
    Up to date, few data exist about the quality of diagnostic accuracy studies in Iran. Therefore, we evaluated the extent of adherence to the STARD for the quality of reports on diagnostic accuracy studies in the Iranian journal of radiology.
    Methods
    In this cross-sectional descriptive study, we searched Iranian journal of radiology and retrieved all diagnostic accuracy studies for recent 3 years and evaluated their adherence to STARD. We used STARD checklist (version January 2003) available at www.stard-statement.org
    Results
    We identified about 14 potential diagnostic accuracy studies meeting our inclusion criteria. In this preliminary study 50% identified the article as diagnostic accuracy study in the title or abstract (MeSH heading sensitivity and specificity). 4% reported details of blinding. 3% had a flow diagram. 38% described the number, training and expertise of the persons reading the index tests and the reference standard. 25% reported definition of cutoffs and/or categories of the results of the index tests and the reference standard. Only 40% of the reports of diagnostic evaluations reported precision for the estimates of diagnostic accuracy. The occurrence of uninterpretable, indeterminate and intermediate test results were 30%. The report time interval from the index tests to the reference standard was 40%. Only 40% of articles reported on more than 50% of STARD items, while no articles reported on more than 85%. A flow chart was presented in 3 articles. Assessment of reporting on individual items of the STARD statement revealed wide variation, with some items described in 15% of articles and others in 100%. Mean STARD score (0 - 25 points available) was 14.8 (range, 5.5 ± 19.5).
    Conclusions
    These findings show non-adherence to the STARD. The authors, reviewers, and editors should pay more attention to reporting by checking STARD statement items and including a flow diagram to represent study design and patient flow.
  • The Importance of Shimming in Magnetic Resonance Spectroscopy
    Reza Faghihi, Mohammad Amin Mosleh Shirazi, Reza Jalli, Sedigheh Sina, Mahdi Haghighatafshar, Banafsheh Zeinali Rafsanjani * Page 53
    Background
    Proton magnetic resonance spectroscopy (MRS) is a well-known device for analyzing the biological fluids metabolically. Obtaining accurate and reliable information via MRS needs a homogeneous magnetic field in order to provide well-defined peaks and uniform water suppression. There are lots of reasons which can disturb the magnetic field homogeneity which can be corrected by a process known as shimming. This study is intended to recall the importance of shimming and also the significant role of quality control (QC) in achieving an accurate quantification.
    Methods
    An acrylic cylindrical quality control phantom was designed as an analog of brain MRS test phantoms in order to control the accuracy of the obtained signal of a 1.5 T Siemens MRI system which belonged to one of Shiraz hospitals. The signal of NAA, Cho, Cr, the combination of these metabolites and also the distilled water, which was used in this study, was evaluated using separate phantoms. A QC test was performed using Siemens QC phantom and a standard test phantom.
    Results
    The spectrum of our home- made phantom had a significant difference with the expected spectrum. The results of checking the spectrum of metabolites separately also confirmed that there was a systemic problem that affects all the signals originated from all metabolites and even the pure distilled water. The MRS system could not pass QC tests, and peak broadening was common in all spectra. The complex spectrum of standard test phantom was not produced successfully by the MRS system.
    Conclusions
    By a simple check of the water peak characteristics, lots of information can be obtained, one of which is the status of shimming that has a considerable effect on the accuracy of the spectrum. Thus, performing an automatic or manual shimming is not a criterion of the spectrum accuracy, and performing a periodic quality control using a test phantom by a specialist is necessary. Briefly, the quality control of MRS and all the other clinical device must be taken seriously. Sometimes QC can be the boundary of a right or a wrong decision for the patient.
  • Conjoineted Twins Sonography
    Ahmad Soltani Shirazi * Page 54
    One of the complications of Twinning of mono chorionic mono amniotic gestations is conjointed Twins. Structural congenital malformations occur in 5 % to 7 % of twin gestations versus only 3 % of singleton births. Most defects occurring in only one of the twin fetuses. Occasional anomalies such as omphalocele sincenomalia heart defect one reported in both concordance. The structural defect commonly associated with monozygotic twins included conjoined twins: extrophy of bladder, vertebral defect .trachea esophageal fistula with esophageal atresia anomalies (VATER complex) anencephaly. Congenital heart defect and holopro cencephaly. The incidence of con joined twins is approximately 1 of 50000 70 % - 75 % are female. The classification are 1) thoraco pagus: jointed at the thorax. They may share the chest and upper abdominal organs. This is the most common type (70%). 2) Xiophopagus on omphalopagus: jointed by the anterior abdominal wall down to umbilicus 3) pygopagus: jointed by the sacrum and coccyx lying back to back. 4) Ischiopagus: jointed at the ischium or sacrum lying side by side. 5) Craniopagus: jointed at the cranium lying at right angles each other. The sonographic role of management of conjointed twins is to make diagnosis and detect associated anomaly and the extent of joining of twins and map out the defect and determine the likelihood of post natal viability.
  • Denoising Effect on T2* Values in Magnetic Resonance Imaging with Application in Iron Load of Patients with Thalassaemia Major
    Mahdi Dodangeh *, Somayeh Gholami Bardeji, Zeinab Gholami, Reza Jalli, Rezvan Ravanfar Haghighi, Sepideh Sefidbakht Page 55
    Objectives
    To investigate the effect of noise and denoising on the measurement of magnetic resonance (MR) imaging T2* values at interventricular septum of the heart in thalassemia major patients. A second objective is to estimate the T2* value based on the improvement of signal to noise ratio (SNR).
    Methods
    Different levels of Rician and Gaussian noises were added to the cardiac T2* MR images of 20 thalassemia major patients. The state-of-art denoising methods were applied to the obtained noisy images. T2* values of the interventricular septum and SNR were measured in both series of images by Segment and Matlab software, respectively.
    Results
    With respect to the Gaussian noisy and denoised images in different noise levels, although SNR improved, there were no significant differences between T2* values in original, noisy and denoised images. On the other hand, after denoising images with Rician noise a relation between improvement of SNR and T2* value is noticed. A predictor model is constructed based on the level of Rician noise for each method.
    Conclusions
    In the case of existence Gaussian noise, the results confirm that denoising is not effective on the measurement of T2* value. In the case of image distortion by Rician noise, a predictor model is proposed to estimate the original T2* value. The predictor model is used to estimate the T2* value of new patients. The predicted T2* values were in good agreement with the corresponding original T2* values.
  • Imaging of Vascular Lesions in Pediatrics
    Houman Alizadeh * Page 56
    Background
    The most common soft tissue tumors during infancy and childhood are vascular lesions. Although the vast majority of these lesions have typical clinical features with no need for any further exam, but sometimes atypical superficial or deeply located lesions require complementary studies to be diagnosed and classified. In that way it is also very important to exclude very less common malignant soft tumors. Imaging studies play an essential role for categorization of vascular lesions before taking any therapeutic decision.
    Methods
    Vascular tumors such as hemangiomas and vascular malformations have their own imaging characteristics to be classified. Although MRI is the best imaging modality because of its excellent soft tissue resolution, but Ultrasound and Color Doppler studies are the first step and sometimes preferred imaging approach in most of the cases. This is a review article to describe different types of vascular lesions in childhood and infancy and explain various imaging findings of each one.
    Keywords: Imaging, Pediatrics, Vascular
  • New Varicosis Treatments and New Keynots
    Kambiz Faridmarandi *, Hossein Hemmati Page 57
    Lower extremity venous varicosis is a very prevalent disease. Approximately 15 - 25 percent of the general population suffer from some degree of this disease. In recent years many new and innovative treatments have been developed for the disease and nowadays customary treatments ( saphenous strapping and phlebotomy) are nearly obsolete. These new treatments include Laser ablation, Radio frequency ablation, Glue , sclerotherapy , foam sclerotherapy and reveloutionaized treatment of venous varicosis. These new technologies require new data that must be mentioned in duplex reports. These keynots determine which treatment is suitable for the patient and which one is not. The goal of this article is about to explain the technical aspects of the treatments and new informations that must be added to duplex reports.
  • Radiologic Evaluation of Chronic Foot Pain
    Hamid Reza Mirbagheri * Page 58
    During last ten years I have been one the guest speakers who presented the principles of foot and ankle radiology in details since 2006 - 2015 in Iranian Congress Radiology. In this presentation I am focusing on one the specific problems of the foot which is very common practice in the field of radiology and orthopaedic surgery. Chronic foot pain has a broad spectrum of potential causes and imaging studies play a key role in diagnosis and management. Chronic foot pain is a common and often disabling clinical complaint that can interfere with a patient''s routine activities. Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult. Imaging studies play a critical role in diagnosis and management. Initial assessment is typically done by plain radiography; but magnetic resonance imaging has superior soft-tissue contrast resolution and multiplanar capability, which makes it important in the early diagnosis of difficult cases when initial radiographic findings are unclear. Computed tomography displays bony detail in stress fractures, as well as in tarsal coalition. Bone scanning and ultra-sonography also are useful procedures for diagnosing specific conditions that produce chronic foot pain. Plain X-ray is an important diagnostic technique in the initial evaluation of patients with chronic foot pain. It is the most commonly used modality because of its wide availability and low cost. Radiography using the oblique view shows articulation of the Calcaneus, Talus, Navicular, and Cuboid bones, and it can be helpful in patients with foot pain who have no obvious diagnosis. Magnetic resonance imaging (MRI) can play a significant role in making a precise diagnosis, guiding treatment decisions, and determining response to therapy. Bone scanning, ultrasonography, and computed tomography (CT) also are useful procedures in the diagnosis of specific conditions.
  • Neanatal Intestinal Obstruction
    Mitra Khalili * Page 59
    Background
    Intestinal obstructions are the most common surgical emergencies in the neonatal period. Neonatal intestinal obstruction occurring during the first month of life. Early and accurate diagnosis of intestinal obstruction is important for proper patient management. This presentation is a brief review of studies in Pubmed and Google scholar. For evaluation and diagnosis, intestinal obstruction in neonates can be divided into either high or low obstruction on the basis of dilated bowel loops present on abdominal radiographs. A few dilated bowel loops are seen with high intestinal obstruction and several bowel loops are generally seen with low intestinal obstruction. High intestinal obstructions are defined as occurring proximal to the ileum with differential diagnosis and radiographic appearance as below: 1) Gastric atresia: in microgastria a distended esophagus and a small midline stomach and In gastric atresia single bubble sign« with no distal gas. 2) Duodenal atresia: double bubble sign 3) Malrotation with Ladd bands and midgut volvulus can be partial or complete
    obstruction: the abdominal radiograph in malrotation is nonspecific. It may be normal or may show a proximal bowel obstruction pattern, or show dilatation of multiple bowel loops. 4) Duodenal web partial obstruction with small amount of distal bowel gas. 5) Annular pancreas. 6) Preduodenal portal vein. 7) Jejunal atresia: triple-bubble sign with no gas in the distal bowel. Dilatation of the duodenum is a sign of chronic obstruction, therefore seen in duodenal atresia, duodenal web and annular pancreas. When obstruction occurs acutely after birth in midgut volvulus, the duodenum is not usually dilated on plain film. In complete obstruction in the high jejunum, no further roentgenographic studies are required, however, in partial obstruction (small amount of distal gas) upper GI study may be helpful to distinguish between duodenal web and malrotation with Ladd bands or midgut volvulus. The classic upper gastrointestinal appearance of malrotation with volvulus consists of an abnormal course of the duodenum that fails to cross the midline combined with a corkscrew appearance. In contrast, low intestinal obstructions involve the distal ileum or colon and typically result in diffuse dilatation of multiple small-bowel loops. If distal small bowel obstruction is suggested, a contrast enema usually is necessary. It is not possible to differentiate distal small bowel from colonic obstruction on the basis of plain abdominal roentgenograms, and consequently, contrast enema is necessary to clarify microcolon in ileal atresia and meconium ileus and differentioation from other pathology as below: 1) Meconium ileus: unused colon (i. e. , microcolon), within which are multiple small filling defects representing meconium concretions. If there is reflux of contrast material beyond the ileocecal valve, multiple small filling defects (meconium concretions) also may be seen in the terminal ileum. 2) Ileal atresia: Microcolon and blind ending ileum on contrast enema. 3) Meconium plug and small left colon syndrome: multiple filling defects (i. e. , meconium plugs) is seen in splenic flexure with left sided microcolon and with normal rectum. 4) Hirschsprung disease: abnormal rectosigmoid ratio (
    Conclusions
    Intestinal obstructions are the most common surgical emergencies in newborn infants which require early and accurate diagnosis. An understanding of the characteristic imaging appearance of various causes of neonatal bowel obstruction on abdominal X-ray can lead to correct diagnosis or leading a guide to the next appropriate step. After abdominal X-ray that shows the presence of a neonatal high intestinal obstruction, an upper gastrointestinal series is typically performed for further evaluation. However, neonates with classic radiographic findings of high intestinal obstruction, such as duodenal atresia, may undergo surgery without any additional imaging study. An enema examination is used for further investigation of low intestinal obstruction in neonates.
    Keywords: Neonate, Bowel Obstruction, Radiography, Contrast Enema, Upper GI Series
  • Safety Considerations in Cardiovascular Magnetic Resonance Imaging Studies
    Maryam Moradi * Page 60
    The aim of this review is focusing on the most important safety issues in cardiovascular MRI (magnetic resonance imaging) which are categorized as: 1-safety items in patients who referred for stress cardiac MR studies. 2-Safety consideration that we must know when a patient with cardiovascular devices referred for any (cardiovascular or non-cardiovascular) MRI with focus on new protocols according to update or old devices. 3-Review safety issues in the use of MR contrast agent.
  • Assessment the Possibility of Radiation Dermatitis Incidence in the Interventionist's Leg
    Fariba Zarei *, Alireza Rasekhi, Banafsheh Zeinali Rafsanjani, Mahdi Saeedi Moghadam, Amin Abolhasani Foroughi Page 61
    Background
    Fluoroscopy guided imaging, which is going to be more routine these days require a long time of fluoroscopic observing, which can increase the radiation dose of the physician and other staff who have to stay near the patient during the procedure. In our department, one of the senior interventionists had observed the hair loss in his lower limb. Thus the objective of this study was measuring the radiation dose of the physician’s leg during common procedures in order to find out that whether the radiation dose exceeds the threshold of deterministic effects of radiation or not?.
    Methods
    Thermo luminescent-dosimeters (TLD-100) set on the leg part of the anthropomorphic whole body phantom PBU-50, was used in order to measure the radiation dose in 2 centers where our interventionist work. Meanwhile, the duration of exposure in important procedures was observed and recorded in center 1 for 2 months. During this period some data such as age, height, and weight of the patients and radiation exposure time, dose (mGy) and dose area product (dap) (Gy.cm2) was recorded
    Results
    The result of TLD dosimetry shown that the mean effective dose in center 1 and 2 was 0.20 and 0.86 mSv, and also the mean-dose (mSv)/min in these centers was 0.02 ± 0.00 and 0.20 ± 0.015 mSv/min respectively.
    Conclusions
    The effective annual dose of interventionists who work in center 1 and 2 was 143.08 and 1226.78 mSv respectively. The high radiation dose which delivers to the leg of physicians in center 2 can be an important cause of radiation dermatitis occurred on the leg of our interventionist. Patient dose during most of the procedures was less than the threshold dose for occurring erythema but unfortunately in TIPS procedure which is a time-consuming procedure the patient radiation dose exceeds the threshold. It would be useful if a plan design to reduce the dose of patients and even physicians.
  • Imaging Consideration in Subarachnoid Hemorrhage
    Maryam Moradi * Page 62
    This presentation aims to focus on different types of sub arachnoid hemorrhage (diffuse ,central and perimesencephalic) with different etiology and their important imaging considerations that are important to know when a radiologist encounter to a case of sub arachnoid hemorrhage.
  • Patient Radiation Shielding Methods in Interventional Radiology: A Literature Review
    Ayoub Momivand * Page 63
    Background
    The increasing complexity and numbers of interventional fluoroscopy procedures have led to increasing patient radiation doses. Consequently, radiation protection of the patients undergoing X-ray procedures is essential. During any medical procedure that uses radiation, the as low as reasonably achievable principle should always be followed.
    Objectives
    To investigate available shielding methods in an effort to further awareness and understanding of existing preventive measures related to patient exposure in interventional radiology.
    Methods
    Searches were conducted to locate literature discussing the effectiveness of commercially available shields. Literature containing information regarding eye and thyroid shielding was identified. The selected studies were examined using the following topics as guidelines: the effectiveness of the shield (percentage of dose reduction), the shield’s effect on image quality, arguments for or against its use (including practicality) and overall recommendation for its use in clinical practice.
    Results
    Only a limited number of studies have been performed on the use of shields for the eyes and thyroid, but the evidence shows an overall benefit to their use. This study demonstrates how thyroid shields can be used to reduce dose to the thyroid by almost half. The use of thyroid and eyes shields is not routine but has been studied in patients during interventional procedures. The effect of shielding on image quality was not remarkable in a majority of studies. Although it is noted that more studies need to be conducted regarding the impact on image quality, the currently published literature stresses the importance of shielding in reducing dose.
    Conclusions
    Available shields for the thyroid and eyes should be implemented in clinical practice. Further research is needed to demonstrate the prevalence of shielding in the clinical setting.
  • Does Myocardial Scan with Technetium Lead to Radio Adaptive Response Among Patients Who Are Undergoing Thallium Scan? (Cytogenetic Study)
    Mohammmad Mehdi Shirazi *, Ali Shabestani Monfared, Maryam Shahidi, Mehrangiz Amiri Page 64
    Background
    Low dose radiation will induce adaptation and following exposure to an adaptive dose, the cells are more resistance to following challenging doses. This phenomenon is known as radio-adaptive response. The aim of this study was to investigate the percentage of apoptotic cells in the peripheral blood samples of the patients which undergo myocardial perfusion imaging with Tc-99m prior to thallium scan to assess the induction of radio-adaptive response.
    Methods
    97 samples from 74 patients, referred to nuclear medicine center of Mazandaran heart hospital for myocardial perfusion imaging which had no history of diagnostic, therapeutic, occupational and radioactive exposures during past two years, were provided. The participants were classified into four groups including control, technetium, thallium and the last group were the patients that examined by technetium followed by thallium. Then 2 mL Peripheral blood samples were obtained, the samples were studied by neutral comet assay with one-way ANOVA.
    Results
    The mean percent of apoptotic cells in the groups 2, 3, 4 were more than the controls and the mean percent of apoptotic cells in the patients who examined with 201Tl were more than other groups but the mean percent of apoptotic cells in the group 4 (99mTc before 201Tl) was less than that group 3(just examinated by 201Tl) and this difference was significant statistically.
    Conclusions
    These findings suggest that exposure to Tc-99m could induce a radio-adaptive response against the exposure of Tl-201.
    Keywords: Myocardial Perfusion Imaging, Radio, Adaptive Response, Technetium, Thallium
  • Statistic Method for Spine Vertebral Fracture Possibility
    Ali Akbar Khadem *, Jalal Jalal Shokouhi Page 65
    Radiology and imaging data of patient is the main and the most important data of the patient. Not only it shows disease of patient, but also it is included of the body geometry such as 2D and 3D. Gathering and saving of radiology images and data for different patients can be useful for future statistic studies.
    Many questions like, how to, why, in which and etc can be answered by statistic method, if we have had enough information in our hand. In this study we are going to find possibility of fracture in vertebra using statistic method. Radioogle web site was prepared as an search engine to gather information, searching data and result. By this method, the result extracted and show which vertebra are about to harm in case of fracture. The result shows that L1 is the most and L2, L4, L5 and C2 are the next possible to fracture in impact and accident. Other disease of spine and hierarchy in vertebra will be futuristic discussion.
    Keywords: Radioogle, Statistic Method, Fracture Frequency
  • Normative Values of Intracranial Translucency (IT) Thickness as an Ultrasonographic Marker for Neural Tube Defect (NTD) Screening in the Iranian Singleton Pregnancies
    Mohammad Zare Mehrjardi *, Elham Keshavarz, Morteza Sanei Taheri Page 66
    Background
    Neural tube defects are the second most common congenital anomalies following congenital heart defects. Once NTD is detected prenatally, different options are available including pregnancy termination, and intrauterine fetal surgery. Considering these facts, prenatal screening for NTDs is becoming a part of routine fetal care. Several ultrasonographic markers have been suggested for detection of NTD during pregnancy. Intracranial translucency (IT) is a relatively new ultrasonographic marker for NTD screening during first-trimester. It actually represents the fourth cerebral ventricle, seen as an anechoic structure in the mid-sagittal plane of the fetal face posterior to the brainstem. Its absence or obliteration can be an indirect sign of open spina bifida, which is caused secondary to the caudal displacement of brain in these fetuses. In this study, we aimed to determine the normative values of this marker in the Iranian population.
    Objectives
    To determine the normative values of intracranial translucency (IT) thickness in the Iranian singleton pregnancies.
    Methods
    230 consecutive singleton pregnancies between 11 weeks and 13 weeks days of gestation were included in the study during 9 months (June 2015 to February 2016) prospectively in Mahdieh and Sarem women’s hospital, Tehran, Iran. Crown-rump length (CRL), nuchal translucency (NT) thickness, fetal heart rate, and nasal bone status were evaluated by ultrasound as parts of the routine first-trimester screening for aneuploidies. Precise gestational age was determined by the fetal CRL as well. In addition, IT thickness was measured in the mid-sagittal view of the fetal head between two echogenic horizontal lines: posterior border of the brainstem anteriorly and anterior aspect of the fourth ventricle choroid plexus posteriorly (figure 1). All the measurements were performed by a radiologist with four years of experience in fetal imaging. Ethnicities other than Iranian, multiple gestation pregnancies, and pregnancies conceived by assisted reproductive technology (ART) were not included in the study initially. Other exclusion criteria were any obvious anatomic fetal anomaly in the ultrasound examination, abnormal genetic or maternal serum biomarker test result, increased NT, and presence of open NTD in the post-partum follow-up.
    Results
    : Of the 230 included singleton pregnancies, all of them resulted in healthy live births, except for two pregnancies terminated at 19 and 17 weeks of gestation due to severe skeletal dysplasia and an abnormal genetic test result compatible with Down syndrome, respectively. None of born babies had open NTD on post-partum follow-up. Five pregnancies were excluded from the final analysis, including a fetus with increased NT, two pregnancies with abnormal maternal serum biomarker test result (one of which confirmed to be trisomy 21), poor visualization due to maternal severe obesity in one case, and skeletal dysplasia diagnosed at 19 weeks of gestation in one of pregnancies. The median maternal age was 29 (range, 16 - 49) years. Median gestational age was 12 weeks 5 days (range, 11 weeks 2 days-13 weeks 6 days). There were 68 cases per gestational week between 11 and 11 6 weeks, 84 cases between 12 and 12 6 weeks, and 73 cases between 13 and 13 6 weeks. Mean IT thickness was 1.94 - 0.73 mm (95% CI, 1.84 - 2.04) in all included pregnancies. This measurement was 1.57 - 0.34 mm (95% CI, 1.49 - 1.65) for fetuses between 11 and 11 6 weeks, 1.86 - 0.29 mm (95% CI, 1.80 - 1.92) for fetuses between 12 and 12 6 weeks, and 2.12 - 0.41 mm (95% CI, 2.02 - 2.22) for fetuses between 13 and 13 6 weeks. Kolmogorov-Smirnov analysis demonstrated normality of IT thickness distribution in the included cases (P > 0.10). Linear regression analysis demonstrated that there was a statistically significant positive linear association between IT thickness and gestational age (rs = 0.92, P = 0.021).
    Conclusions
    We determined the normative values of IT thickness for the Iranian fetuses in a pilot study, which may be considered for NTD screening during the first-trimester in the national and international guidelines. It is important to determine normal measurements of different ultrasonographic and biochemistry markers nationally, since there are significant differences among various ethnicities. One should expect that IT thickness increases in a linear manner during first-trimester, and in case of its obliteration or absence open NTDs should be strongly suspected.
  • Effect of 3D Printers in the Future of Radiology and Imaging
    Ali Akbar Khadem *, Jalal Jalal Shokouhi, Alireza Darvish Page 67
    Today Radiology and imaging are the only and main method to generate geometrical data from body. 3D model of the body will give us the best and reliable information for better understanding and diagnostic. On the other hand with development of CAD/CAM and Rapid prototyping, the 3D printers were born to build 3D models without considering the geometry. Today the 3D printers are able to makes a 3D physical model from complicated membrane in less that 2 hours in low cost. 3D physical model of hard tissues like skull, vertebra, MSK and etc. as well as soft tissue like heart can be built using 3D printers. Now, a new discussion for future of radiology will be opened: does a radiologist make the 3D physical model using 3D printer in near future? Is the 3D printer replaced with printed report of radiology? 2D images, 3D images or 3D physical models (3D printed model) are the most advantage for diagnostic?
    Keywords: 3D Printer, Stereo Lithography, Rapid Prototyping, CAD, CAM
  • Radiographic Manifestations of Tuberculosis in HIV Positive Patients: Correlation with CD4 Positive Tcell Count
    Mehrdad Bakhshayesh Karam *, Soheyla Zahirifard, Farahnaz Aghahosseini Page 68
    Background
    Observations on Tuberculosis HIV co-infection in addition to epidemiologic molecular studies have recently provided strong evidence for the state of immune system as the major determinant of the TB imaging spectrum. However, the presence of any correlation between radiographic findings and the degree of suppression in HIV positive patients still remains controversial. The present study aimed to investigate the TB radiographic manifestation in HIV positive patients and its relationship to the CD4 positive cell count.
    Methods
    Chest radiography of 15 HIV positive patients with a definite diagnosis of pulmonary Tuberculosis in Masih Daneshvari hospital, between 2013 - 2014, were retrospectively reviewed. Radiographic findings and severity were categorized as typical (upper lobe infiltration/cavity) and atypical (middle/lower lobe opacity, adenopathy, pleural effusion and normal X-ray). Demographics and CD4 positive cell count were also recorded. Data analysis was performed using SPSS version 23 (frequency and mean for descriptive quantitative variables and Logistic regression analysis for correlation, P
    Results
    Of a total 15 patients (86.7% men and 13.3% women), 78.6% had CD4 positive counts below 350 (mean ± SD; 229.15 ± 199.45). The most common radiographic findings in descending order of frequency were adenopathy (53.3%), pleural effusion (26.7%) and cavitation (6.7%) with an overall atypical presentation of 93.3%. This study failed to reveal any statistically significant correlation between CD4 positive cell count and radiographic manifestation as well as severity.
    Conclusions
    In CD4 positive cell count below 500, the dominant radiographic pattern of Tuberculosis is atypical presentation. At this level of immunity, CD 4 positive T cell dysfunction may play a deterministic role in TB radiographic manifestation.
  • Mathematical and Statistic Method to Diagnostic of Metastasis Based on Radiology Images for Breast Cancer
    Minoo Tabandegan*, Ali Akbar Khadem, Neda Mirzaie, Jalal Jalal Shokouhi Page 69
    One out of eight women face with the problem of breast cancer in her life. It is the second causes of women death in the world. Detection of breast cancer metastasis at the earliest stage is important to predict and control of breast cancer progression. It can spread to the different parts of the body, such as are the bone, liver, and lung and etc. How and where does the breast metastasis grow and migrate may open many questions to the radiologist and medical Scientifics. In this study, we discussed about the possibility of the breast metastasis to the other parts of the body and using statistic method we are able to estimate the frequency of metastasis from breast to the other parts. We have selected statistic method to this research and we studied over 200 patients (effected by breast cancer) using radiology image data. We save the history of the patient and gather all patient data in a table.
  • Mathematical and Statistic Method to Diagnostic of Metastasis based on Radiology Images for Breast Cancer
    Minoo Tabandegan *, Ali Akbar Khadem, Neda Mirzaie, Jalal Jalal Shokouhi Page 70
    One out of eight women face with the problem of breast cancer in her life. It is the second causes of women death in the world. Detection of breast cancer metastasis at the earliest stage is important to predict and control of breast cancer progression. It can spread to the different parts of the body, such as are the bone, liver, and lung and etc. How and where does the breast metastasis grow and migrate may open many questions to the radiologist and medical Scientifics. In this study, we discussed about the possibility of the breast metastasis to the other parts of the body and using statistic method we are able to estimate the frequency of metastasis from breast to the other parts. We have selected statistic method to this research and we studied over 200 patients (effected by breast cancer) using radiology image data. We save the history of the patient and gather all patient data in a table. Result and
    Discussion
    the result show that the most metastasis of breast occur in the brain and the less occur in liver. The result may help radiologist to understand better origin of metastasis and in case the possibility is high, the radiologist may ask for breast imaging. A New discussion comes to the mind that, do we need to perform breast imaging if radiologist faced with metastasis on brain?
  • Increased Renal Parenchymal Echogenicity in Children with Acute Abdominal Pain: Can It Be an Alarming Sign?
    Rahele Mehraeen *, Mehdi Maghsoudi Page 71
    Background
    Ultrasound is an important imaging modality in children whit acute abdominal pain. There are many etiologies which can cause acute abdominal illness. Both kidneys are evaluated in a routine abdominal sonography. Renal echogenicity in pediatric changes with age gradually, as in neonates and early infancy we can see increased echogenicity as normal variant. But there are several studies which have stated that increased echogenicity of the renal parenchyma are an indicator of renal disease in older children and adults. On the other hand, there are a few cases of renal hyper echogenicity in children with various abdominal diseases without any renal pathologic condition. This study aimed to investigate the relationship between renal echogenicity and the final diagnosis in children with acute abdominal pain.
    Methods
    This cross sectional study was done on 93 children referred to Amirkola Children’s hospital with complain of acute abdominal pain who were examined with sonography. Patients with a known history of renal disease or urinary tract infections were excluded. The renal parenchymal echogenicity evaluated by comparison with adjacent liver and was divided into three categories.
    Results
    Of all 93 assessed children (52 male, 41 female) with mean age 6.45 y/o, 18 cases (19.4%) had abnormal renal parenchymal echogenicity (equal or more than liver).The final diagnosis of the cause of abdominal pain in 43 cases (46.2%) was acute appendicitis, in 8 cases (8.6%) was mesenteric adenitis, in 4 cases (4.3%) was gastroenteritis and in 2 cases (2.2%) was invagination.
    Conclusions
    The results show that renal hyperechogenicity is nonspecific finding in children which presented with acute abdominal pain and does not necessarily an indicator of renal disease in these specific patients. According to this study, increased echogenicity of the kidneys should alert the radiologist to search the abdomen more thoroughly for a cause of the acute abdominal illness.
    Keywords: Renal Parenchymal Echogenicity, Acute Abdominal Pain
  • Lead Contaminated Opium as Unusual Cause of Abdominal Pain-Case Series
    Anahita Sadeghi *, Hamidreza Soleimani, Siavosh Nasseri-Moghadam, Amir Reza Radmard Page 72
    Background
    Lead is a toxic metal which is widely distributed in the environment and can be accumulated in the many organs such as gastrointestinal system. Several clinical signs suggest lead poisoning include anemia, abdominal pain, constipation and/or neurologic signs. We report a case series of patients with abdominal pain due to lead contaminated opium who underwent diagnostic work up including plain abdominal radiograph and/or CT scan.
    Methods
    We hereby describe 119 consecutive patients hospitalized in our emergency department who presented with complains of acute, severe abdominal pain due to lead contaminated opium (September 2015 - October 2016). Upon admission they were first suspected to have lead poisoning due to their abnormal imaging findings. Demographic, clinical and laboratory data, imaging and levels of lead were collected for all patients.
    Results
    Of 119 enrolled patients, 116 subjects (97.5%) were male. The mean age of our patients was 50.4 ± 13.4 (18 - 92 years). They all had a history of oral consumption of opium on a daily basis. Half of the patients had a history of several hospitalizations. One also had a history of a negative laparotomy. Several tiny metallic densities were visualized in the colon in the obtained plain abdominal radiographs that were confirmed in CT scan in some patients. Laboratory data revealed anemia in majority of them with mean hemoglobin 10.4 ± 2.4 g/dL. Mean blood lead level was 76.2 fL (range 20 - 316). Serum lead level was classified into four levels: lead level 100 (n = 25; 21.0%). All patients were referred to psychiatrist for quitting opium.
    Conclusions
    Our case series highlights the role of imaging in possibility of lead poisoning among opium users, that presented with acute abdominal pain with an unknown cause.
    Keywords: Lead Poisoning, Opium, Abdominal Pain
  • Evaluation of Usage fMRI in Alzheimer's Disease Diagnose
    Sohaila Yazdani *, Karim Khoshgard, Hasan Norouzi Page 73
    Background
    Alzheimer’s disease (AD) is a state where neurons within the brain stop functioning, lose connection with other neurons and die. It’s the most common cause of dementia, a loss of brain function that can harmfully impact memory, thinking, language, judgment and behavior. Alzheimer’s is irreversible and progressive. Although the cause of Alzheimer’s disease is unknown, scientists believe that a build-up of beta-amyloid plaques and neurofibrillary tangles in the brain are associated with the disease. Medications that slow the progression of the disease and manage symptoms are available, but there is no cure for Alzheimer’s disease. Current diagnosis of AD is through clinical, neuropsychological, and neuroimaging assessments. Functional MRI (fMRI) measures brain activity during a cognitive, sensory, or motor task or at rest by measuring changes in blood oxygen level dependent (BOLD) MR signal.
    Objectives
    In this paper, we evaluate application of fMRI to detect AD.
    Methods
    The papers were searched in PubMed, Medline and Scopus databases with the relevant key words such as fMRI, Alzheimer disease and early detection.
    Results
    BOLD fMRI is considered to reflect the joined synaptic activity of neurons through MRI signal changes because of alterations in blood flow, blood volume, and the blood oxyhemoglobin/deoxyhemoglobin ratio. In patients with clinically diagnosed AD, the outcomes of fMRI have been quite consistent, showing reduced hippocampal activity during the encoding of new data. Several studies have reported increased prefrontal cortical activity in AD patients, suggesting that other networks may increase activity as an attempted compensatory mechanism during hippocampal failure. In particular, the event-related fMRI studies have found that hyperactivity was observed, which suggested that hyperactivity might represent a compensatory mechanism in the setting of early AD pathology. Also, fMRI of default mode network (DMN) brain activity during resting is lately achievement attention as a potential noninvasive biomarker to diagnose initial AD.
    Conclusions
    Both task-related and resting fMRI techniques have the potential to detect early brain dysfunction related to AD. However, the use of fMRI in AD populations thus far has been limited to a relatively small number of research groups.
    Keywords: FMRI, Alzheimer Disease, Early Detection
  • A Review on Application of Nanotechnology for Early Breast Cancer Detection Based on Medical Imaging
    Minoo Tabandegan*, Jalal Jalal Shokouhi, Ali Akbar Khadem, Neda Mirzaie Page 74
    Breast cancer is characterized by a distinct metastatic pattern involving the regional lymph nodes, bone marrow, lung and liver. Tumour cell migration and metastasis share many similarities with leukocyte trafficking, which is critically regulated by chemokines and their receptors. Detection of breast cancer and its metastasis at the earliest stage is important for the management and prediction of breast cancer progression. CT scans, X-ray, ultrasound imaging and MRI for various cancer detection. These traditional diagnostic methods however are not very powerful methods when it comes to cancer detection at very early stages. In general, they are quite useful clinically, but they are not enough and perfect. So if there is very few cells that have metastasized away from the primary at a distant site, they might miss them. It might say that there is nothing there when in fact there is something there. So especially micro metastasis,as they are called, smaller amounts of tumor burden, are the hardest things for all these technologies to solve. Due to the highly engineerable nature of nanotechnology, targeted nanoparticles exhibit significant advantages including increased contrast sensitivity, binding avidity and targeting specificity. A biomarker is characteristic of a specific state and therefore can be used as a marker for a target disease, like a protein, a fragment of a protein, DNA, or RNA-based. Cancer biomarkers, are an indication of cancer and by detecting them the existence of that specific cancer can be verified. Quantum dots, gold nanoparticles, and many other materials have been developed over the years for detecting .Gold nanoparticles (GNPs) have been in the bio-imaging spotlight due to their special optical properties. GNPs with strong surface-plasmon-enhanced absorption and scattering have allowed them to emerge as powerful imaging labels and contrast agents. Quantum dots are semiconducting, light-emitting Nano crystals that have emerged as a powerful molecular imaging agent since their discovery and they are an exciting material to work with due to their unique optical properties compared to traditional organic fluorescent labels. In this study we demonstrate the possibility of new methods for breast cancer detection at a very early stage with Nano technology and their effects on treatment in near future.
  • Unilateral Enlargement of Kidney: A Rare Manifestation of Autosomal Recessive Polycystic Kidney Disease
    Elham Zarei, Razieh Shahnazari * Page 75
    Background
    Autosomal recessive polycystic disease (ARPKD) is a heritable but phenotypically variable disorder characterized by varying degrees of nonobstructive renal collecting duct ectasia, hepatic biliary duct ectasia and fibrosis of both liver and kidney. The phenotypes of the ARPKD are distinguished by the age of the diagnosis at presentation and the predominance of renal over hepatic manifestations or vice versa. Sonography is currently the imaging technique of choice in children with renal cystic disease. Classic ARPKD is evident at birth with symmetrically enlarged kidneys with increased Parenchymal echogenicity at ultrasound with using a curved array transducer. In previous reports, nephromegaly is a constant imaging finding at the time of diagnosis. Asymmetrical enlargement has only been reported in one case report and the current case report is the second observation in this regard.
    Case Presentation
    A preterm neonate with suspicious RT renal mass and oligohydramnios at prenatal ultrasound was hospitalized due to respiratory distress and hypertension. Although postnatal ultrasound showed enlarged echogenic Rt kidney and normal sized echogenic Lt Kidney, regarding to linear array transducer findings, ARPKD was considered rather than renal mass. The diagnosis was confirmed after nephrectomy and histologic examination.
    Conclusions
    Because the abnormality in ARPKD affects the renal tubules, high resolution sonographic techniques with linear array transducer are well suited to the imaging of this disease. Although, the patient showed asymmetric renal enlargement, unique findings on linear array transducer help to diagnosis of ARPKD regardless of renal size. Also, the finding of asymmetric renal enlargement in this patient adds another radiologic finding that could be associated with ARPKD.
  • Application of PET/CT in Oncologic Imaging
    Sohaila Yazdani *, Homayon Fallah, Fahimeh Rezaie Page 76
    Background
    There are many challenges in oncologic imaging including: more accurate staging, determine site with highest probability of tumor existence for biopsy, especially for brain tumors because of the sensitive anatomical position, determine the exact location of the tumor for radiotherapy treatment planning and etc. Positron emission tomography (PET) is imaging modality which provides some special functional information. The basis of the PET system is detection of tow photons which are generated by positron/electron encounter which occurs directly after positron emission by radionuclide. However, it is powerless in providing anatomical information. Computed tomography (CT) generates three dimensional reconstructions of patients anatomy based on differences in X-ray attenuation. Combination of PET and CT is able to provide anatomical and physiological information of patients synchronizes.
    Objectives
    In this paper, we evaluate application of PET/CT for improve oncologic imaging.
    Methods
    The papers were searched in PubMed and Scopus databases with the relevant key words including, PET/CT, Oncologic Imaging and Cancer staging.
    Results
    The most relevant biomarker for PET is 8F- FDG (F-18 Fluorodeoxyglucose), which is incorporated into malignant cells by glucose transporters which are over expressed by cancer cells. CT is the common imaging modality in diagnosis the cancers. It is due to its speed, high special resolution and relative cost-effectiveness. The combination of these two modalities in one system produced PET/CT system which is more accurate than these two imaging modalities separately and enhances the sensitivity and specificity of diagnosis. For example in a study which used PET/CT for differentiation between the malignant and benign disease Presacral, sensitivity, specificity, the positive predictive value and the negative predictive value are 100%, 96%, 88% and 100% respectively. In another study, which was done for preradiotherapy staging of head-and-neck SCCs, it was shown that FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively).
    Conclusions
    PET/CT can provide diagnosis and more accurate staging, location of tumor with its capability in providing the anatomical and physiological information synchronizes. Therefore PET/CT plays an important role in oncology.
    Keywords: PET, CT, Oncologic Imaging, Cancer Staging
  • Cerebral Vein and Sinus Thrombosis
    Nader Jamalzadeh * Page 77
    Although cerebral venous thrombosis is an uncommon cause of stroke among the young, it is being increasingly recognised. A prothrombotic risk factor is identified in the majority of the patients. In most instances it is seen in women in the post-partum period and those on oral contraceptives. Magnetic Resonance Imaging (MRI) has improved our ability to diagnose this condition however the variability of radiological and clinical presentation remains a challenge. MR in combination with MR venography (MRV) is the single most sensitive diagnostic technique. The MR appearance of the thrombus within the dural sinus or cortical vein is variable and is largely dependent on its age. The loss of the normal flow void on spin echo T2 images is a sensitive parameter. Thrombus on MRV is seen as loss of high flow signal from the sinus. Focal parenchymal changes occur in approximately 50% of cases and are due to oedema and infarction, with or without haemorrhage. Appearances of these lesions too are dependent on their age. Diffuse changes of raised intracranial pressure with gyral effacement may also be present.
  • The Investigation of Lorestan University of Medical Sciences Radiology Students Attitude Toward Digital Radiology
    Fateme Panahi *, Kourosh Gorji Page 78
    Background
    Considering the graduate community in the future, defining the perception of students of radiology of the benefits of digital technology is essential to improve the quality of the images is essential. The aim of this study was to investigate students of Radiology; attitude about digital radiology in Lorestan University of Medical Sciences.
    Methods
    This cross-sectional study was carried out in 1393 on 38 radiology students who were selected by convenience sampling. The instrument used was a 14-item questionnaire (both digital and conventional radiology department) to assess demographic information and attitude of students of digital radiology. The validity was confirmed by experts and its reliability by Cronbakh’s alpha test and SPSS19 software. At the end statistical data were analyzed using t-test and plenty of tables.
    Results
    The general attitude of the students was that the digital radiology, by reducing the dose can improve the density and contrast of images, enhanced details and will lead to improved radiological techniques. According to the study, 6/78 percent of students had correct information and 7.7% of them had incorrect information from digital radiology. Also the remaining respondents’ information was considered as moderate.
    Conclusions
    In this study Radiology students believed digital radiology can enhance the production efficiency and quality of the images. They also had the right information about digital radiology. However, it is recommended in order to prevent the emergence of problems caused by change of radiology equipment and efficiency of the professional in-service training the theoretical training needs to be improved.
    Keywords: Attitude, Students of Radiology, Digital Radiology
  • Benign or Malignant: A Case Report of Multifocal Epithelioid Hemangioma of Fibula
    Roshan Fahimi, Hamid Rajebi * Page 79
    Case Presentations
    A 63-year-old female with no significant prior trauma and relevant past medical history presented with a 2-month history of severe, persistent, gradually worsening, sharp and non-radiating pain over her left distal fibula. Physical examination revealed extreme tenderness to palpation over the lateral distal fibula. There was soft tissue prominence over the mid to lower third of the fibula.
    Results
    Left lower leg radiographs depicted two ill-defined osteolytic destructive lesions measuring 29 and 37 mm in length in the fibular diaphysis. A pathologic fracture was present through the distal lesion. A laboratory test, including serum protein electrophoresis, alkaline phosphatase and basic metabolic profile, was ordered to evaluate for multiple myeloma. CT scans of the chest and abdomen were obtained to evaluate for primary malignancy or any evidence of metastatic disease. The results of these tests were unremarkable. Image-guided biopsy of the lesions was performed and revealed epithelioid hemangioma (EH). The patient was initially managed with a walker boot. At the 2-month follow-up, an additional third smaller lesion was detected along with an interval increase in size of the two previously seen lesions. The patient proceed with preoperative embolization followed by surgical curettage and open reduction and internal fixation. Angiogram was done and tumor feeding artery was identified but tumor embolization was unsuccessful. The patient underwent fibular bone lesion curettage, PRO-DENSE bone grafting and open reduction and internal fixation with the left fibular diaphyseal plate. Radiographs revealed continued healing with bone graft incorporation at 1.5-, 3- and 7-month follow-ups. The patient was permitted to return to all activities without restriction 1.5 months after the surgery.
    Conclusions
    EH is an uncommon, slow-growing vascular tumor that generally presents on the skin and the subcutaneous soft tissues of the head, with osseous EHs being rare. Although osseous EHs can present as multifocal lesions, the majority of bony EHs are solitary and arise in the diaphysis or metaphysis of long tubular bones, with a predilection for the lower extremity. Radiographically, EH may present as well-defined lytic lesions with sclerotic margins or mixed lytic and sclerotic lesions. These lesions are often located eccentrically and may demonstrate a disrupted or intact cortex.
  • New Techniques in MRI Give Us the Appertunity to Have Better Detection, Better Evaluation of Brain Lesions
    Homayoun Hadizadeh Kharazi * Page 80
    One of most challenging problems in neuroradiology is differentiation lesions in brain and another challenging problems is post op. or post radiation/post chemotherapy changes vs recurrence /remnant. On this lecture I am going to show you many cases that on the basis of new technique such as SWI, PWI, MRS, cine MRI, DTI and tractography we can achieve the final diagnosis.
  • Hydrocephalus
    Amir Pejman Hashemi Taheri * Page 81
    Hydrocephalus is a common finding in patient with extensive intracranial pathology. This finding may have obvious cause or even happened by a subtle abnormality. Some of the normal looking ventricles are really hydrocephalus when compare with previous images and some are due to NPH. Communicating and non-communicating hydrocephalus should be separated to divided pathologic causes. This session is about production, circulation, absorption, technical MRI evaluation and pathology of hydrocephalus. CISS is the main MRI sequence that use to evaluation which give an excellent image for diagnosis. Ventriculostomy is also one of the main surgical procedures which could be done for treatment of many pathological conditions and will be shown by films.
  • Nerve and Tendon Ultrasound (25 min)
    Kambiz Motamedi * Page 82
    This presentation will cover, appearance of normal nerve versus tendon; anisotropy (advantage and disadvantage); special case carpal tunnel; tendinopathy; nerve impingement; special case cubital tunnel.
  • Ultrasound Guided Interventions (25 min)
    Kambiz Motamedi * Page 83
    Key features covered by this talk are, choice of transducers and needles; patient positioning; joint injections and aspirations; tendon sheath injections; cyst aspirations; Biopsies.
  • Future and New Developments in MSK Ultrasound (20 min)
    Kambiz Motamedi * Page 84
    This talk reviews the following topics, fenestration (dry needling); barbotage; PRP injection; elastography; ultrasound versus MRI.
  • Post-Operative Imaging of Shoulder (20 min)
    Kambiz Motamedi * Page 85
    This presentation features, modalities: plain radiographs, CT, MRI, and ultrasound; arthroplasty; hardware loosening; suture anchor migration; AVN, collapse, arthritis; rotator cuff repair; labral repair.
  • Workshop Musculoskeletal Ultrasound of the Upper Extremity
    Kambiz Motamedi * Page 86
    This workshop features, (Live) demonstration of sonographic technique of the upper extremity joints; patient positioning; transducer choices, operation and position on the anatomic landmarks; optimal evaluation of the anatomic structures in shoulder, elbow and wrist; hopefully on Thursday or Friday.
  • Imaging of Vascular Lesions in Pediatric
    Houman Alizadeh * Page 87
    The most common soft tissue tumors during infancy and childhood are vascular lesions. Although the vast majority of these lesions have typical clinical features and do not require any further exam, but sometimes atypical superficial or deeply located lesions need complementary studies to be diagnosed and classified. In that way it is also very important to exclude very less common malignant soft tumors. Imaging studies play an essential role for categorization of vascular lesions. Vascular tumors such as hemangiomas and vascular malformations have their own imaging characteristics to be classified. Although MRI is the best imaging modality because of its excellent soft tissue resolution, but ultrasound and color Doppler studies are the first step and sometimes preferred imaging approach in most of the cases. This is a review article to describe the various imaging findings of different types of vascular lesions in childhood and infancy.
  • Pediatric Primary Malignant Bone Tumor
    Ali Hekmatnia *, Maryam Riahinejad Page 88
    Primary bone tumors are the sixth most common neoplasm occurring in children and constitute approximately 6% of all childhood malignancies with a peak incidence in 15- to 19-year- old individuals. These lesions are the third most Common tumors in adolescents and young adults (exceeded only by leukemia and lymphoma) common complaints are intermittent to constant mild to severe pain, constitutional symptoms (fever, weight loss). Swelling, erythema in the affected extremity; fracture and lesions may be found incidentally on radiographs obtained for other reasons. Radiographic distinction are poorly circumscribed mass with cortical disruption; multiple layers of poorly organized periosteal new bone (eg, and quot; onionskin and quot; appearance of Ewing’s sarcoma); slow-growing lesions will have moth-eaten lucencies, while faster-growing lesions will have permeative destruction Osteosarcoma and small round cell tumor such as Ewing sarcoma and lymphoma are the most common malignant bone tumors in this age group. Although the overall incidence of osteosarcoma is higher than Ewing sarcoma in adolescents younger than 20 years, Ewing sarcoma is more common in children younger than 10 years of age. MRI or CT to determine extent of skeletal involvement and biopsy is necessary for definitive histologic diagnosis. LDH can be used as a marker in order to detect response to therapy as well as for recurrence in Ewing sarcoma; and elevated serum alkaline phosphatase in osteosarcoma.
  • Pediatric Musculoskeletal Imaging Guidelines, Pediatric Musculoskeletal Imaging Age Considerations
    Fatemeh Mehdipour * Page 90
    Many conditions affecting the musculoskeletal system in the pediatric population are different diagnoses than those occurring in the adult population. For those diseases which occur in both pediatric and adult populations, minor differences may exist in management due to patient age, comorbidities, and differences in disease natural history between children and adults. Patients age
  • The Role of Imaging in Childhood Osteomyelitis
    Roxana Azma * Page 91
    Osteomyelitis in childhood can be a challenging diagnosis. Imaging plays an important role in the diagnosis of osteomyelitis in children, and the imaging findings are crucial in the treatment decision. Pediatric hematogenous osteomyelitis may have variable radiological expression, which is influenced by the age and condition of the patient, the virulence of the causative agent, the stage of the disease, or the selected imaging tool. Different imaging modalities exist for imaging of osteomyelitis which include: conventional radiography, Three-phase bone scintigraphy, ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging. Conventional radiography is the initial step in evaluation of osseous changes. In most cases it will be the only imaging technique used in the diagnosis, as well as treatment. Ultrasonography, is a very useful modality. It allows correlating the physical exam with US findings and comparing the affected side with the opposite side. After conventional imaging MRI is the most important imaging modality for the evaluation of osteomyelitis. MRI excellent delineation of the osseous component as well as, soft tissue extension, joint effusion and complications of osteomyelitis such as abscess formation, especially in case of failure to respond to therapy. CT scan is more useful and superior to MR in detecting cortical destruction, air and sequesters. Bone scintigraphy using 99Tc methylene diphosphonate may help to confirm suspected osteomyelitis by showing increased uptake in all three phases of the dynamic perfusion.
  • Skull Base (Middle Cranial Fossa Lesions)
    Jalal Jalal Shokouhi * Page 92
    Anatomy: middle cranial fossa mainly floored by sphenoidal bone and located post. To innominate bone or lesser wing and ant. to temporal bone. Main foramens are located in deep part, bilateral to sellae are orbital fissures, optic canals, foramen rotundom, ovale and spinosum, foramen lacerum also meckle cave or trigeminal impression and carotid canal. This fossa is like a butterfly in shape. Lesions: related to basic anatomy optic canal (gliomas, schwannomas) chiasmal, anterior clinoidal and middle also post clinoidal tumors (meningiomas) pituitary macroadenomas, carotid aneurysms, cavernous sinus tumors, all nerve tumors in related foramens or fissures, arachnoid cysts, skull base metastasis, bone tumors like Ewing’s sarcoma and osteogenic sarcoma. Imaging: both CT and MRI with and without contrast are needed for exact diagnosis but CT is special for bone and MRI for soft tissue and vessels. They are complementary for each other. CT also is special for calcification, sclerosis and CSF leakage. Useful MR pulses are T1, T2 of spin-echo, STIR-T2, T2* (calcification, paramagnetic effect and melanin) and DWI to DDX between benign and malignant tumors. T1 images are necessary to enhance lesions. PET-CT and PET-MR for metabolic activity and metastatic evaluation could be helpful. Radiology and imaging for surgery: imaging is not only necessary for diagnosis but for a good and one and only way to find surgery approach and reducing post-op. complication even complications in surgery room. By modern operating rooms and in future real time CT and MRI could control surgery procedure.
  • Imaging of Cervical Lymph Nodes
    Yasmin Davoudi * Page 93
    The imaging assessment of nodal disease can be challenging for the radiologist because there are multiple sites to review and differing opinions about criteria for abnormal nodes. The ability to accurately detect nodal metastases is improved with knowledge of the criteria for abnormal nodes, the nodal drainage patterns, and common imaging pitfalls. In this article, we introduce these basic concepts and review the appropriate approach for evaluation of metastatic cervical lymph nodes on cross-sectional neck imaging. This presentation would cover the following topics: criteria for abnormal nodes which includes size, morphology, margin and internal content of the lymph nodes ( cystic changes , Ca, etc.), site Classification based on the system devised by American head and neck society and American academy of otolaryngology-head and neck surgery, features Important for Staging and the radiologist’s role is to describe characteristics pertinent to the N staging, important features for Management such as extra capsular spread. It would also have a brief review of advanced imaging techniques for nodal metastases and the indications for FNA in head and neck lymphadenopathies.
  • Imaging of Anterior Skull Base Pathologies
    Leila Aghaghazvini * Page 94
    Several lesions (Inflammatory, neoplastic and congenital) can involve in the skull base. The role of imaging is to detect the location and extension of lesion, determine mass and mass like lesions, differentiate benign from malignant tumors, detect invasion to adjacent structures and make decision in surgical planning. Skull base divides to anterior, middle and posterior cranial fossa and some pathologies are common in all spaces and a few are only seen in special sites. In this presentation we plan to explain the lesions in anterior skull base.
  • Outlines Imaging of Salivary Glands
    Maryam Mohammadzadeh * Page 95
    In this regards first of all cross sectional anatomy of salivary glands and different diagnostic modalities such as ultrasound, CAT scan, conventional MRI and nuclear studies will be discussed. Advanced MRI modality such as DCE (dynamic susceptibility enhanced) imaging will be introduced. Then various pathologies of salivary glands including infectious, benign and malignant neoplastic processes and their different imaging characteristics will be mentioned in detail along with high quality images. At the end a diagnostic algorithm for appropriate management of patients with salivary gland lesion will be presented which is very helpful for both clinicians and radiologists especially for residents.
  • Imaging of Paranasal Sinuses, Focusing on Neoplastic Lesions
    Hashem Sharifian * Page 97
    Dependency of clinicians and surgeons on imaging studies for primary evaluation of patients and also for follow up of them, significantly increased in recent years, parallel to advances in imaging methods and new imaging modalities. Regarding to these tips, it is important that we can use new concepts in conducting imaging to fulfill new requirements of clinicians and then provide sufficient data in our reports to answer their questions about the patient disease. Here I try to discuss different imaging modalities in evaluation of patients and how to design and conduct protocols to meet our needs in this era. Presentation of appropriate cases better shows the goal of this lecture.
  • New Guidelines in Management of Thyroid Nodule When to Biopsy and When to Follow
    Bijan Bijan * Page 98
    Lack of unified system in characterizing and reporting thyroid nodules is deeply felt almost in every institution and is a source of confusion among diagnostic radiologists, pathologists, thyroid surgeons, oncologists, endocrinologists and interventionalists. Elaborate systems exist but they are not easy to use. Therefore many of those systems cannot be utilized widely in general radiology practice. A simplified approach to thyroid nodule is a crucial need to prevent unnecessary work up, follow up or procedures. A combination of TIRADS and ACR guidelines probably would strike a balance between high sensitivity with acceptable specificity.
  • Review the Appropriate Approach for Evaluation of Metastatic Cervical Lymph Nodes on Cross-Sectional Neck Imaging
    Yasmin Davoudi * Page 99
    The imaging assessment of nodal disease can be challenging for the radiologist because there are multiple sites to review and differing opinions about criteria for abnormal nodes. The ability to accurately detect nodal metastases is improved with knowledge of the criteria for abnormal nodes, the nodal drainage patterns, and common imaging pitfalls. In this article, we introduce these basic concepts and review the appropriate approach for evaluation of metastatic cervical lymph nodes on cross-sectional neck imaging. This presentation would cover the following topics: criteria for abnormal nodes which includes size, morphology, margin and internal content of the lymph nodes (cystic changes, Ca, etc.), site classification based on the system devised by American head and neck society and American academy of otolaryngology-head and neck surgery, features important for Staging and the radiologist’s role is to describe characteristics pertinent to the N staging. Important features for management such as extra capsular spread. It would also have a brief review of Advanced Imaging Techniques for Nodal Metastases and the indications for FNA in head and neck lymphadenopathies.
  • Imaging of Vascular Masses of the Head and Neck
    Mohammad Davoodi * Page 100
    The classification and imaging appearances of vascular masses of the head and neck are reviewed. The radiological appearances of congenital vascular masses (infantile haemangiomas and other congenital vascular tumours, high-flow and low-flow vascular malformations), acquired vascular masses (benign and malignant tumours, non-neoplastic lesions) and other hypervascular masses are described and illustrated.
  • Womens Imaging, Us Imaging for Infertility Workup
    Firoozeh Ahmadi * Page 101
    Infertility can be defined as the inability to conceive a pregnancy after 1 year of unprotected intercourse or after 6 months in a woman over 35 years old. The use of sonography, in particular transvaginal sonography (TVS), has become an integral component of the evaluation and treatment of infertility. The TVS allows high-resolution assessment of the uterus, ovaries, and fallopian tubes. TVS plays a critical role in the diagnosis and treatment of infertile women. Initial baseline ultrasound examination is used primarily to identify structural abnormalities that might affect fertility such as uterine anomalies, endometrial polyps or submucosal leiomyomas, endometrial adhesions/synechiae, or hydrosalpinges. Sonography is also used to assess for possible underlying pathologic processes associated with infertility such as adenomyosis, endometriosis, polycystic ovary syndrome (PCOS), and low antral follicular count. If the baseline pelvic sonogram is inconclusive or noncontributory, further anatomic evaluation can be obtained by means of pelvic magnetic resonance imaging (MRI), hysterography, sonohysterography, or even hysteroscopy and laparoscopy, as indicated. CT and MRI play essential roles in evaluating gynecological disease .with the advent of multidetector CT faster scanning during optimal vascular opacification is now available which may improve accuracy in the detection and staging of gynecologic disease. However due to multiplanar capability and excellent tissue contrast, MRI is the preferred imaging modality of the female pelvis in many instances. Hysterosalpingography (HSG) is a valuable technique in evaluating the uterus and fallopian tubes. Contrast material introduced into the uterus through the cervical canal outlines the inner cavity of the uterus and tubes. A spill of contrast material into the peritoneal cavity reveals the patency of the fallopian tubes.
  • Ovarian Cancer Staging by MDCT
    Mahrooz Malek * Page 102
    Ovarian cancer is the most lethal gynecological cancer and about 70% of the patients are advanced stagein the time of diagnosis. Decision about management (surgical debulking versus neoadjuant chemotherapy) in ovarian cancer patients is dependent on initial staging by abdominopelvic MDCT or MRI, so, Radiologist expertise on ovarian cancer staging is very important. Involvement of mesenteric root, peritoneal implante larger than 2 cm, lymphadenopathy superior to renal hilum and implants near hepatic veins are criteria for nonresectability of ovarian cancer and radiologist must be familiar and expert on the imaging protocol and findings on MDCT for ovarian cancer staging.
  • Sonographic and Imaging of Grunulomatous Disease of Breast
    Ahmad Soltani Shirazi * Page 103
    Idiopathic lobular grunulomatous mastitis is a chronic inflammatory disease of Breast that can clinically mimic Brent carcinoma or pyogenic abscess. The most common clinical presentation is a fine unilateral discrete mass associated Inflammation of overlying skin. Nipple retraction and sinus formation are present. Breast TB should be considered in differential we present a few cause of our center with sonography findings and lab test data. The most common mammographic findings an asymmetric density or ill-defined mass. Ultrasound findings are variable irregular hypoecho mass and cyst with thick irregular wall. The cyst wall and septation show imageble flow on color Doppler images. Fistule formation with echogenic fluid and imageble flow of fistule ducts are seen in 60% of patient. In our cases 15% have ductal ectesia with abscess 85 % thick irregular wall multiple complex cysts and 65 % echogenic fluid collection and fistula tract.
  • Weight of Different Descriptors of Mammography
    Masoumeh Gity * Page 104
    Mammography has been recognized as the best method of screening for breast cancer, for a long time. Although the sensitivity of mammography is acceptable, it has limited specificity and a radiologist should be aware of limitations and pitfalls. There are different positive findings in mammography which are descriptors of breast disease including benign lesions or breast cancer. In this talk I will explain different descriptors of mammography. These descriptors are different in weight toward predicting malignancy. For example, a mass is classified by the shape, margin and density. It has been discussed that some forms of “margin” have a high positive predictive value for malignancy. Also microcacifications as good descriptors for early malignant process are classified by their shape (morphology) and distribution. We will discuss the comparative weight of different descriptors as predictors of breast cancer.
  • Basic and New Techniques for MRI of the Breast
    Thomas Helbich * Page 105
    MRI of the breast has evolved as a non-invasive imaging modality and is ideally suited for several indications e.g. pre-operative staging and screening in women at increased risk for breast cancer. The widespread use opens also the discussion on over-diagnosis if only 20 - 30 out of 100 MRI - guided breast biopsies lead to the diagnosis of breast cancer. Thus MRI based strategies are needed to significantly reduce the number of unnecessary biopsies by decreasing over-diagnosis. In their development cancer have acquired several functional capabilities, which are defined as the hallmarks of cancer. For a deeper understanding of the hallmarks of cancer, and, consequently, improved personalized patient care, diagnostic tests must be multilayered and complex to identify the relevant underlying processes of cancer development and progression. Contrast-enhanced MRI (CE-MRI) is the most sensitive test for breast cancer detection, with a good specificity. Recently, several functional parameters on MRI have been assessed for breast imaging and this combined application is defined as multiparametric imaging. Multiparametric imaging with different functional MRI parameters (mpMRI) visualizes and quantifies the functional processes of cancer development and progression at multiple levels, and provides specific information about the hallmarks of cancer. MpMRI of the breast improves diagnostic accuracy in breast cancer, obviates unnecessary breast biopsies, and enables an improved assessment and prediction of response to neoadjuvant therapy. This lecture will provide a comprehensive overview of the current strategies and emerging techniques for mpMRI of the breast.
  • Breast Cancer Screening with MRI
    Thomas. Helbich * Page 106
    The sensitivity and specificity of mammography are limited in highly fibroglandular breasts (ACR density C and D). Digital mammography provides increased sensitivity in young women and those with moderately dense breasts, and digital three-dimensional mammography (Tomosynthesis) promises further improvement. For women with the densest breasts, however, radiography is unlikely to be the optimum solution. MRI, although not affected by breast density, is expensive and access is often limited. Nevertheless, enthusiasm for the use of MRI as a screening modality is growing because MRI demonstrated to be the most sensitive test and cancer yield is significant higher in comparison to any other imaging technology. This has been demonstrated in women at high and average risk. In comparison to mammography the specificity is lower, but technical developments have given rise to sharper, more informative images. These improvements foster the use of MRI. Different trials have been preformed and promising results have been reported. This talk will focus on benefits, harms, and cost-effectiveness of supplemental MRI based breast cancer screening.
  • Imaging of Hepatic Metastasis
    Amir Reza Radmard * Page 107
    Metastases are the most common malignant hepatic lesions and considered to be the most frequent indication for imaging of the liver. The accurate detection and characterization of liver metastasis remains a critical issue at the initial diagnosis of primary cancer or during the course of patient treatment. In the recent years, the advent of highly efficient imaging modalities and new techniques has facilitated the early detection of hepatic metastases. This can provide a unique opportunity for applying different treatment options including resection (like colorectal metastases) or radiologic interventional therapies. Optimized MDCT and MRI protocols and application of liver MRI specific contrast agents have also been promising in this agenda. The radiologist’s knowledge from underlying histopathologic changes in different types of liver metastases can aid for accurate detection and interpretation of imaging findings. In this talk, the spectrum of imaging findings in hepatic metastasis will be reviewed and new updates in technical aspects will be discussed.
  • Imaging Presentation of Budd-Chiari Syndrome
    Atousa Adibi * Page 108
    Budd-Chiari syndrome is caused by the obstruction of the hepatic venous, with high mortality rate in nontreated cases. Because the clinical presentation of this syndrome is nonspecific, is very important. Contrast enhanced multiphase computed tomography (CT) and magnetic resonance (MR) angiography permits morphologic and functional assessment of liver changes in suspicious clinical setting. The aim of this presentation is to present the classical imaging features of this syndrome. 1- Radiographic features, 1-1- CT scan, 1-1-1- inhomogeneous mottled liver with delayed enhancement in the periphery of the liver and around the hepatic veins; 1-1-2- peripheral zones of the liver may appear hypo attenuating because of reversed portal venous blood flow; 1-1-3- caudate lobe enlargement and increased contrast enhancement compared with the remainder of the liver; 1-1-4- inability to identify hepatic veins. 1-2- Ultrasound, 1-2-1- acute; 1-2-2- hepatomegaly; 1-2-3- splenomegaly; 1-2-4- heterogeneous echotexture; 1-2-5- chronic; 1-2-6- hypertrophied caudate lobe; 1-2-7- peripheral atrophy; 1-2-8- regenerative nodules; 1-2-9- gallbladder wall thickening; 1-2-10- ascites. 1-3- Color-flow Doppler, 1-3-1- part of or the entire right hepatic vein with no flow or inappropriately directed flow; 1-3-2- discontinuity between the main hepatic vein and the IVC; 1-3-3- reversed flow in hepatic veins and intra and extrahepatic collaterals; 1-3-4- portal vein changes such as hepatopetal or hepatofugal flow; 1-3-5- thrombus or tumour within the IVC; 1-3-6- increased resistive index within the hepatic artery: > 0.75.
  • Diagnosis and Staging of Hepatocellular Carcinoma
    Amir H. Davarpanah * Page 109
    Hepatocellular carcinoma (HCC) is the fifth most common tumor in the world, and its incidence is increasing. It is second most common cause of cancer related death worldwide and fastest growing cause of cancer death in the United States. Cirrhosis is the most important clinical risk factor for HCC, with approximately 80% of cases of HCC developing in patients with a cirrhotic liver. HCC differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The prognosis of HCC depends largely on the stage at which the tumor is detected. The detection of HCC early in its development, therefore, is critical to improve the survival of affected patients. In this talk, we discuss surveillance strategies with ultrasonography (US) as the primary screening imaging test as well as current state of the art for the imaging-based diagnosis and staging of HCC.
  • The Current Diagnostic and Treatment Options for Managing Hemobilia
    Mohammad Gharib Salehi * Page 110
    hemobilia is a rare source of upper gasterointestinal bleeding. Though the incidence is increasing along with the rise in minimally invasive biliary interventions. Prompt diagnosis and treatment rests of having appropriate clinical Suspicion which should be based on the patients presenting signs and symptoms, as well as history including recent instrumentation. Endoscopy should be reservedfor cases of upper gasterointestinal bleeding with low suspicion for hemobilia. Interventional radiology may be the first line diagnostic and therapeutic option for patients with a high suspicion of hemobilia. While embolization is the mainstay of therapy, other options include thrombin injection, stent placement, and/or placement of a percutaneous biliary drain. Surgery should be reserved for failed treatment by interventional radiologist.
  • What Should We Know Before Doing Mechanical Thrombectomy in Stroke Patients
    Ramin Pourghorban * Page 111
    Mechanical thrombectomy has shown promising results in large vessel ischemic stroke, with recent large trials changing to guidelines worldwide. In this presentation, results from the five recent randomized trials will be discussed. There is an ongoing debate on the inclusion and exclusion criteria of mechanical thrombectomy. It can be done in large vessel occlusions, including up to M2 middle cerebral artery (MCA), anterior cerebral artery (ACA), basilar artery, and posterior cerebral artery (PCA). The effect of time window, age, prior intravenous thromblysis on patients’ selection will be discussed. An elaboration on the effect of national institutes of health stroke scale (NIHSS) score in the clinical setting, Alberta stroke program early computed tomography score (ASPECTS) on non-contrast CT, presence of collaterals on CT angiography (CTA), and presence of penumbra on CT perfusion or post contrast MRI will be given as well. The pros and cons of general anesthesia versus conscious sedation during mechanical thrombectomy and aspiration technique versus stent-retriever will be reviewed. The usual devices used in mechanical thrombectomy and practical tips of endovascular treatment will be discussed. Finally, modified treatment in cerebral ischemia (mTICI) score after thrombectomy will be shown.
  • Endovascular Treatment of Stroke Patients
    Joachim Berkefeld * Page 112
    Stroke patients with proximal occlusions of the main stems of cerebral arteries are no optimal candidates for i. v. thrombolysis. For many years interventional stroke treatment could not be established as alternative. This changed with the introduction of stent retrievers and flexible large lumen aspiration catheters. Randomized trials now proved a significant benefit from intervention for a wide spectrum of severely compromised stroke patients in time windows of up to 8 hrs. However, the randomized trials leave open questions concerning proper patient selection. The benefit for patients with larger infarcts with an ASPECTS between 3 and 5 or patients in time windows above 8 hrs is still uncertain. Especially for critical candidates imaging for reliable detection of the ischemic core and surrounding salvageable brain tissue plays an important role. Technically equivalence between new aspiration techniques as alternative to the use of stent-retrievers is not finally proven. Recanalization of tandem occlusions with the necessity of acute stenting demands better materials for plaque coverage and thrombus withhold. Management of cases with occlusions due to intracranial atherosclerosis is also debatable. The positive trial results provide especially new challenges to establish countrywide neurointerventional services. Even in developed countries recruitment and training of interventional radiologists as well as priority transportation of stroke patients is challenging to organize.
  • Endovascular Treatment of Intracranial Aneurysms
    Joachim Berkefeld * Page 113
    Interventional treatment of ruptured intracranial aneurysms in patients with subarachnoid hemorrhage is a standard therapy based on evidence from randomized trials. Simple coiling is still used for most of the cases. Modern coil technology provides a wide variety of complex shaped coils for faster procedures and reliable dense packing. The assistance of stents and balloons widens the indication towards wide-neck-aneurysms. A major drawback of coiling and reason for recent debates about clipping vs. coiling is the lack of long term stability due to recanalization. Especially size above 10 mm and aneurysm location with direct inflow-jet at a bifurcation may favour reperfusion and the necessity for repeated controls for a long time. However, most of the adequately coiled aneurysms remain stable and rebleeding is confined to very few single cases. Flow-divertes placed in the parent vessel across the aneurysms neck or as nitinol basket within the aneurysm sac provide new treatment options for large, wide neck and fusiform aneurysms. Successful treatment demands careful patient selection and adequate sizing of the devices to induce reliable thrombosis within the aneurysms and “healing” of the vessel wall defect by coverage of the neck by endothelium and connective tissue. Prophylactic treatment of unruptured aneurysms should be associated with low complication rates, good angiographic results and long term stability. Interdisciplinary decision making and counseling, treatment and follow-up of patients in a neurovascular center are new challenges for interventional neuroradiologists.
  • Management of Loco-Regional Interventions in HCC
    Hazhir Saberi * Page 114
    Some patients are more susceptible to HCC (like HBV, Cirrhosis and …). In these patientsscreening imaging (ultrasound) is highly recommended. In positive cases next step would be 4-phasic CT scan or dynamic MRI for confirm diagnosis and also staging. If there are typical signs of HCC (wash in, wash out), biopsy is not necessary in susceptible populations. Gold standard treatment of HCC is surgery (resection or liver transplantation). In thosecases which are not candidate for surgery, Loco-Regional treatments are key players. The mostnoticeable of these are: TACE (Trans Arterial Chemoembolization) and Local Ablations (RF, Microwave, Alcohol injections and …). Site and Size of tumors should be considered in decision forablative techniques. Limitations for RF are 1) tumors more than 3 cm or 2) subcapsular locationor 3) neighboring to large vessels, but there are less limitations in Microwave. TACE is one of thetreatment of choice in cases which are not candidate for surgery or thermal ablations (intermediate stage). There are also some limitations for TACE which the most important one is decompensated cirrhosis (child B8, 9 and C). In this technique there are two factors (ischemia and chemotherapy) attenuating the tumors with synergistic effect. Generally TACE has a palliative situation in the guidelines but could be used as a bridge for curative plan (surgery or liver transplantation) alone or in combination with ablation techniques.
  • What Should We Know in BIPPS
    Rambod Salouti * Page 115
    Cushing’s syndrome is a rare endocrine disease characterized by hypercortisolemia caused by excess ACTH secreted by the pituitary. Distinguishing pituitary sources from the ectopic sources of ACTH is challenging because of the limited accuracy of noninvasive assays. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). In patients without a suggestive pituitary lesion on MRI of greater than 1 cm in size, inferior petrosal sinus sampling provides excellent specificity and higher sensitivity than other available biochemical testing strategies .BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing’s, whereas the absence of a gradient suggests ectopic Cushing’s. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small adenomas within the sella. BIPSS has rare complications and is considered safe.
  • Radiofrequency Ablation of Benign Thyroid Nodules: Initial Clinical Experience in Iran
    Hojat Ebrahiminik*, Ali Mosaddegh Khah, Ahmadreza Soroush, Narges Fadaei, Babak Shekarchi, Noor Fattah Page 116
    Prevalence of thyroid nodules diagnosed by ultrasonography has been reported to be high (about 50%) probably due to iodine deficiency in our region. Most thyroid nodules benign but some require treatment for cosmetic reasons or subjective symptoms. The conventional method of treatment in Iran is surgery. For the first time in Iran, from February 2016, 50 patients with 63 nodules (solid or cystic) were successfully treated by radiofrequency (RF) ablation. The procedure was performed under local anesthesia with no need for hospitalization. At one and three months post-ablation follow ups 40% to 67% reduction in nodule volume was observed. No hormone imbalance or voice changes were seen in none of the patients. Indication of RF ablation includes benign confirmed nodules (at least 2 times Fine needle aspiration or biopsy) neck pain, dysphasia, foreign body sensation, discomfort, cough, cosmetic problems, or thyrotoxicosis in cases of autonomously functioning thyroid nodules (AFTNs). Compared with surgery, RF ablation as a minimally invasive approach provided significantly lower rate of complications regarding thyroid function which well-maintained after procedure also no external scar was formed. Pain and inflammation during the first 3 to 7 days after RF ablation and long term treatment results (1 to 6 months) are of disadvantages. We recommend RF ablation to be considered as possibly the first-line treatment for benign thyroid nodules. Disclosure: Nothing to disclose.
    Keywords: Thyroid Nodule, Radio Frequency, Ablation, Iran, RF