فهرست مطالب

Iranian Journal of Radiology - Volume:15 Issue: 1, 2018
  • Volume:15 Issue: 1, 2018
  • تاریخ انتشار: 1397/02/24
  • تعداد عناوین: 27
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  • Yang Duan, Zhihua Xu, Hongyi Li, Xiaonan Cai, Cancan Chang, Huisheng Chen, Cheng Xia, Benqiang Yang* Page 1
    Objectives
    To explore alteration of deep medullary veins (DMVs) in transient ischemic attack (TIA) patients by using susceptibility weightedimaging (SWI).
    Patients and
    Methods
    Fifty-three TIA patients and 53 matched gender and age controls’ SWI data were studied by comparing their DMVs asymmetry/score between groups. The DMVs score based on the degree of visibility were assessed from 0 (not visible) to 3 (very prominent) for both hemispheres separately. A different score between the two hemispheres was defined as asymmetric DMVs (ADMVs), and an equal score was defined as symmetric DMVs. The higher score in the two hemispheres worked as its DMVs score for ADMVs. In ADMVs, based on whether the affected hemisphere, which was defined according to clinical symptoms by neurologists, gets a higher score or not, was defined as ipsilateral or contralateral asymmetric DMVs (iADMVs or cADMVs).
    Results
    The agreement between neuroradiologists for both asymmetry and score of DMVs on TIA patients’ SWI were excellent. There were statistically significant differences for the score of DMVs between TIA and the control group (P
    Conclusion
    The visibility of DMVs in patients with TIA were increased, with or without ADMVs, and these alterations may reflect hemodynamic information following TIA process, laying foundations for DMVs application in TIA.
    Keywords: Deep Medullary Veins, Transient Ischemic Attack, Susceptibility Weighted Imaging
  • Jaturat Kanpittaya, Patrawan Jaimook, Theerayut Thongkrau, Chaiyapon Keeratikasikorn, Kittisak Sawanyawisuth * Page 2
    Background
    Renal dysfunction is associated with significantly lower apparent diffusion coefficient (ADC) values. There are several ADC-level cutoff points that indicate renal dysfunction.
    Objectives
    This study aimed to evaluate whether or not ADC values can predict estimated glomerular filtration rate (eGFR) levels. If so, the formula to calculate eGFR level by ADC levels will be formulated.
    Patients and
    Methods
    We reviewed all adult patients who underwent upper abdomen MRI and magnetic resonance cholangiopancreatography (MRCP) protocol from January 2014 to October 2014. The ADC values and eGFR levels were recorded. The multivariate linear regression was implemented between the eGFR and studied variables. The formula to predict eGFR was produced by the final model of multivariate linear regression analysis. An online formula for eGFR prediction was also created.
    Results
    There were 261 patients who met the study criteria of which 133 patients were male (51.10). The mean age and body weight (S.D.) of all patients was 59.89 years (13.73) and 55.92 kg (11.17), respectively. The majority of patients had an eGFR of 60 - 89 mL/min (107 patients; 41.00%). The average ADC value of all patients was 1.87 × 10-3 mm2/s. There were four factors that were significantly associated with eGFR by multivariate linear regression analysis: age, sex, body weight, and ADC value. ADC value had the highest estimates at 121.94.
    Conclusion
    ADC values can predict eGFR using the following formula: estimated eGFR = -139.03 - (0.80 × age) - (4.19 × sex; [0 if female and 1 if male]) 0.57 (body weight in kg) (121.94 × ADC). This formula was also created as an online tool for both mobile and computer at http://202.28.94.20/gfr/.
    Keywords: Diffusion Weight Image, Apparent Diffusion Coefficient, Renal Function, Formula, Online
  • Kunwarpal Singh *, Kamlesh Gupta, C. L. Thukral, Priya Goyal, Vijinder Arora, Inderbir Singh Page 3
    Background
    Magnetic resonance imaging of the prostate is a major diagnostic tool in prostate cancer detection. In 2012, prostate imaging reporting and data system (PI-RADS) was published by the European society of urogenital radiology. Due to certain limitations in this version, arevised version namedProstate Imaging Reporting and Data System version 2 (PI-RADS v2) was proposed by the American College of Radiology in 2014
    Objectives
    To evaluate the role of multiparametric magnetic resonance imaging based prostate imaging reporting and data system (PI-RADS) version 2 for the assessment of peripheral zone prostate cancer and its correlation with the T staging, prostatic specific antigen (PSA) levels and apparent diffusion coefficient (ADC) values.
    Patients and
    Methods
    Eighty seven patients underwent MRI at 1.5 T units. Dynamic contrast enhanced (DCE) imaging was done in 73 patients as 14 patients had deranged renal functions. Patients with a PI-RADS v2 score of ≥ 2 underwent biopsy except in one patient with a score of 1. The histopathological report was used as gold standard. T staging was done based on MRI. The score was correlated with T staging, ADC values and serum prostate-specific antigen (S.PSA) levels by two experienced blinded radiologists. Statistical analysis was done.
    Results
    Highly significant correlation was observed between PI-RADS v2 score, T staging, ADC values and s PSA levels with P value
    Conclusion
    The dominant MR imaging sequence for the peripheral zone prostate cancer is diffusion weighted sequence and the corresponding ADC values, with the role of DCE sequences in doubtful cases only. PI-RADS v2 gives a scoring system on MRI for prostate cancer assessment. It should be routinely incorporated in the reporting protocol. Our study concluded that there is a highly significant correlation between lesion score on PI-RADS v2 with the T stage, corresponding ADC values and S.PSA levels, although larger study groups may be required for further evaluation and beyond doubt PI-RADS version 3 is already in its earliest stages.
    Keywords: Magnetic Resonance Imaging, Prostate, Specific Antigen, Diffusion Magnetic Resonance Imaging, Prostate
  • Ziga Snoj *, Oskar Zupanc, Vladka Salapura Page 4
    Background
    Anterior cruciate ligament reconstruction (ACL-R) technique affects graft positioning. However, how ACL graft positioning affects graft signal intensity (GSI) is yet unknown. The aim of our study was to find out if ACL-R technique affects GSI at mid-term follow-up.
    Patients and
    Methods
    A total of 50 patients were included in the study. They underwent 3.0 T MRI of the knee 4-7 years after ACL-R. Patients were divided into two groups according to ACL-R technique (transtibial technique with RIGIDfix fixation [group 1] and anteromedial portal technique with Endobutton fixation [group 2]). GSI, graft failure, graft impingement and graft position were assessed. GSI characteristics were evaluated on proton density turbo spin echo fat saturation images. Graft was divided into two portions – intraarticular portion (IAP) and intraosseous portion (IOP). Intraosseous portion was further divided into two parts – femoral (fIOP) and tibial (tIOP).
    Results
    Graft failure was identified in 12.0%. Only 9.8% showed low signal intensity of the entire graft course. Group 2 showed higher rates of increased graft signal intensity (IGSI) of the IAP and fIOP. Patients with IGSI of the IAP showed more horizontal position of the coronal tibial tunnel. Patients with IGSI of the fIOP showed more horizontal position of the coronal femoral tunnel. Patients with IGSI of the tIOP showed more horizontal position of the sagittal tibial tunnel.
    Conclusion
    IGSI can be seen in the majority of patients after ACL-R at mid-term follow-up. Our study demonstrates that graft tunnel positioning and graft fixation device may influence GSI.
    Keywords: Anterior Cruciate Ligament Reconstruction (ACL, R), MRI, Graft Signal Intensity
  • Oguzhan Ozdemir *, Yavuz Metin, Nurgul Orhan Metin, Ozlem Bilir, Ozcan Yavasi, Ali Kupeli Page 5
    Background
    Although non-enhanced CT (NECT) can be applied for the diagnosis of acute appendicitis in obligatory conditions such as impaired renal function, it is not as effective as contrast-enhanced CT.
    Objectives
    This prospective study aims to determine the added value of diffusion weighted imaging (DWI) in the diagnosis of acute appendicitis when combined with non-enhanced computed tomography (NECT).
    Patients and
    Methods
    Between June 2014 and January 2017, 94 patients (48 male, 46 female) imaged with NECT and DWI for acute appendicitis were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm2, and assessed with visual and quantitative analysis. Results of NECT and DWI, and combined imaging (NECT and DWI) were analyzed by means of sensitivity, specificity and accuracy.
    Results
    NECT and DWI provided 91.5% - 94.3% sensitivity, 82.6% - 86.9% specificity and 89.3% - 92.5% accuracy, respectively. The combined protocol (NECT and DWI) revealed 98.5% sensitivity, 95.8% specificity and 97.8% accuracy. The addition of DWI to NECT provided a 7%, 13.2% and 8.5% increase in the sensitivity, specificity and accuracy, respectively. This increase was statistically significant (P
    Conclusion
    DWI is an efficient technique for the diagnosis of acute appendicitis. This even may become more efficient if added to a NECT scan. We recommend using DWI when NECT is inevitable for different reasons. It may increase the diagnostic accuracy of NECT to avoid an additional contrast-enhanced CT scan.
    Keywords: Acute Appendicitis, Computed Tomography, Diffusion, Weighted Imaging, Emergency Department
  • Yoshifumi Noda, Satoshi Goshima *, Hiroshi Kawada, Nobuyuki Kawai, Hiromi Koyasu, Masayuki Matsuo Page 6
    Background
    Magnetic resonance (MR) imaging, have become more frequently used in the diagnosis of ovarian torsion, particularly in subacute cases.
    Objectives
    To assess the characteristic findings and diagnostic performance of preoperative MR imaging for ovarian torsion.
    Patients and
    Methods
    Twenty-three patients (age range, 10 - 58 years; mean age, 28.4 ± 12.5 years) with suspected ovarian torsion underwent preoperative MR imaging. Fifteen patients exhibited ovarian torsion, whereas the remaining eight did not. Two radiologists evaluated the MR imaging data in relation to six previously-described characteristics associated with ovarian torsion, and the sensitivity, specificity, and accuracy of this approach was determined.
    Results
    Ovarian enlargement (maximum ovarian diameter > 4.0 cm) and a twisted pedicle were significantly more common findings in patients with ovarian torsion compared with those without (regarding ovarian enlargement, P = 0.032 for both readers and considering twisted pedicle, P = 0.0094 for first reader and P = 0.0013 for second reader). The respective sensitivity, specificity, and accuracy of a twisted pedicle for the diagnosis of ovarian torsion were 73%, 88%, and 78%, respectively for reader 1 and 73%, 100%, and 83%, respectively for reader 2.
    Conclusion
    Identifying a twisted pedicle in a patient is therefore, suggestive of ovarian torsion.
    Keywords: Magnetic Resonance Imaging, Ovary, Ovarian Torsion, Twisted Pedicle
  • Jin Woo Kim*, Byung Hoon Lee, Yoon Joon Hwang Page 7
    Background
    Recent randomized controlled trials have recommended stentriever thrombectomy as an important modality in treating acute ischemic stroke.
    Objectives
    This study compares Solitaire-FR (ST) and Trevo-ProVue (TV) in terms of their angiographic recanalization rates and clinical outcomes in acute ischemic stroke patients with anterior circulation large artery occlusion.
    Patients and
    Methods
    Forty-seven patients who underwent stentriever thrombectomy using ST or TV were retrospectively reviewed. Successful angiographic recanalization was defined as a modified treatment in cerebral ischemia (mTICI) score of 2b-3 and a good outcome was defined as a modified Rankin scale score (mRS) of 0 - 2 at 3 months. We compared angiographic and clinical outcomes of ST- and TV-treated patients.
    Results
    Twenty-one patients (mean age ± SD: 67.7 ± 13.5 years; 14 men) were treated with ST and 26 patients (70.7 ± 9.7 years; 13 men) were treated with TV. There were no differences in baseline characteristics, initial national institute of health stroke scale score, location of occlusion, onset to puncture time, or total procedure time between groups. The rate of successful recanalization and symptomatic intracranial hemorrhage (sICH) between ST and TV groups were not different. [for ST group, mTICI 2b-3: 19 (90.55%) and sICH: 2 (9.5%); for TV group, mTICI 2b-3: 23 (88.5%) and sICH: 3 (11.5%)]. Good outcomes (mRS 0 - 2) were not significantly different between the groups [ST: 10 (47.7%) and TV: 13 (50%); P = 0.81].
    Conclusion
    The two stentriever devices showed similar recanalization rates and clinical outcomes in patients with anterior circulation large artery occlusion.
    Keywords: Ischemic Stroke, Stentriever Thrombectomy
  • Jong Woo Kim, Dong Il Gwon *, Gi-Young Ko, Hyun-Ki Yoon, Ji Hoon Shin, Jin Hyoung Kim, Heung Kyu Ko, Kyu-Bo Sung Page 8
    Background
    The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date.
    Objectives
    To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction.
    Patients and
    Methods
    A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed.
    Results
    Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean follow-up period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000).
    Conclusion
    TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.
    Keywords: Portosystemic Shunt, Transjugular Intrahepatic, Stents, Dysfunction, Risk Factors
  • Shirzad Azhari, Hossein Nayeb Aghaei, Hossein Ghanaati, Kavous Firouznia, Shokrollah Zandi * Page 9
    Background
    The existence of residual aneurysm after intracranial aneurysm clipping bears the risk of re-bleeding, which worsens with the passage of time. Digital subtraction angiography (DSA) is accepted as the gold standard for evaluation of residual aneurysm, but it is invasive, costly, and serious complications are possible.
    Objectives
    The aim of this study was to compare DSA to 64-slice CT angiography for assessing residual aneurysm.
    Patients and
    Methods
    Forty patients with 43 clipped aneurysms from which 36 were torn, were evaluated by DSA after improvement in clinical status, and after a month they were evaluated by 64-slice CT angiography. The pictures were assessed by two neuroradiologists separately, in terms of quality, artifact due to the clips, and the completion of aneurysm closing.
    Results
    In multislice computed tomographic angiography (MSCT) analysis, 36 pictures (90%) had good quality and four pictures (10%) had poor quality. In case of good quality pictures in MSCT and angiography, the 2- and 3-millimeter residual aneurysms were approved for two patients based on which, sensitivity, feature and positive/negative predictive value for diagnosis of residual aneurysm was 100 for good-quality pictures by MSCT. The level of agreement between the two neuroradiologists was 1 for diagnosing residual aneurysm and 0.86 for vasospasm. The average time for doing MSCT was 12 minutes compared to 45 minutes for DSA angiography, which was cost effective.
    Conclusion
    CT angiography is a less invasive method with high sensitivity and capabilities for diagnosing residual aneurysm. It is cheaper, quicker and can be accomplished for critical patients. Therefore, it can be taken as the first choice and a replacement for DSA in post-surgery evaluation of patients with clipped brain aneurysm.
    Keywords: Intracranial Aneurysm, CT Angiography, Digital Subtraction Angiography
  • Oguzhan Ozdemir *, Nurgul Orhan Metin, Yavuz Metin, Suleyman Kalcan, Ali Kupeli Page 10
    Background
    Several studies have shown that the majority of patients with simple appendicitis can be treated effectively and safely with antibiotics, avoiding unnecessary operation.
    Objectives
    The objective of this study was to assess the role of diffusion-weighted imaging (DWI) in the follow-up of conservative treatment of simple appendicitis.
    Patients and
    Methods
    Twenty-eight patients (mean age, 35 ± 14.6; age range, 18 - 72; M/F: 16/12) with simple appendicitis were enrolled in this prospective study. After the primary diagnosis by computed tomography (CT) at presentation, they underwent an initial DWI scan, and intravenous antibiotic therapy was started for all patients by the decision of the attending surgeon. A total of three control DWI scans were planned during the follow-up period for each patient. CT and DWI images were evaluated by two radiologists in consensus. B values 0, 500 and 1000 s/mm2 were used, and DWI images were analyzed both qualitatively and quantitatively. During follow-up, changes in the diameter of appendices and laboratory parameters were correlated with apparent diffusion coefficient (ADC) values.
    Results
    We found statistically significant correlation between ADC values, maximum appendix diameter and laboratory parameters. During follow-up period four surgical procedures were performed for reccurent appendicitis.
    Conclusion
    DWI may be used with a significant success for follow-up evaluation of patients with simple appendicitis. As a monitoring imaging method, DWI may also aid in determining the recurrences of appendicitis.
    Keywords: Acute Appendicitis, Computed Tomography, Diffusion, Weighted Imaging
  • Yoshifumi Noda, Satoshi Goshima *, Kimihiro Kajita, Hiroshi Kawada, Nobuyuki Kawai, Hiromi Koyasu, Masayuki Matsuo, Kyongtae T. Bae Page 11
    Background
    Apparent diffusion coefficient (ADC) value measured from diffusion-weighted magnetic resonance (MR) images are highly correlated with pathological T or N stage, tumor differentiation grade, and extramural depth of tumor in patients with rectal cancer.
    Objectives
    To assess the prognostic value of diffusion MR imaging and clinical-pathologic risk factors in patients with rectal cancer.
    Patients and
    Methods
    This retrospective study was approved by our institutional review board and written informed consent was waived. Sixty-one consecutive patients with rectal cancer (41 men and 20 women; mean age, 64.5 ± 12.1 years; range, 32 - 86 years) underwent pelvic MR imaging. Tumor ADC value and clinical-pathologic risk factors were tested as possible risk factors for postoperative local recurrence or distant metastasis (LRDM) as well as disease-free survival outcome.
    Results
    Of 62 tumors, 12 (19.4%) had postoperative LRDM (median follow-up 38.5 months). Plasmatic CA19-9 level (P = 0.0027), pathological N stage (P = 0.0018), lymphatic invasion (P
    Conclusion
    Preoperative tumor ADC and plasmatic CA19-9 were significantly associated with postoperative LRDM and disease-free survival in rectal cancer.
    Keywords: Magnetic Resonance Imaging, Diffusion Weighted Imaging, Apparent Diffusion Coefficient, Rectal Cancer, Disease, Free Survival
  • Xiao Fan, Qi Li, Tianyou Luo *, Yun Mao, Ling He, Jinhua Cai, Ye Xu Page 12
    Background
    Rathke’s cleft cysts (RCCs) were diagnosed mostly by shape, signal intensity and enhancement characteristics on MR images.
    Objectives
    To identify the diagnosis of RCC by an improved understanding about the cyst’s localization in reference to the pituitary gland.
    Patients and
    Methods
    We retrospectively evaluated 124 patients with pituitary cystic lesions, verified surgically and histologically. The patients were divided into RCC and cystic pituitary adenoma (CPA) groups. The cysts in both groups were observed and compared, focusing on the shape and size, as well as clinical and MRI features, especially localization. Receiver-operating-characteristic (ROC) curve was performed with the clinical and MRI findings between the groups.
    Results
    The RCC group included 90 patients (33 men) with a mean age of 40.9 years, while the CPA group included 34 patients (12 men) with a mean age of 43.5 years. On MRI, the RCCs were mostly located without shift of the pituitary stalk on the coronal view, with the superior margin of the cyst lying behind or across the junction point of the pituitary stalk on the sagittal view. The ROC curve was performed, and the following two variables exhibited good performances in diagnosing RCCs: the coronal localization (sensitivity, 91.1%; specificity, 79.4%; AUC = 0.853, 95% confidence interval: 0.778 - 0.910, P
    Conclusion
    Cyst localization, observed easily on MRI, can be used as an effective parameter for diagnosing RCC and distinguishing it from a CPA.
    Keywords: Rathke's Cleft Cyst, Embryology, Rathke's Pouch, Localization, Magnetic Resonance Imaging
  • Kavous Firouznia, Melina Hosseiny, Soheil Kooraki, Amirreza Samani, Mohammad Soltani, Amir Hossein Jalali, Seyed Ehsan Parhizgar, Hossein Ghanaati * Page 13
    Background
    As an advanced generation of flow diverters (FD), pipeline embolization device (PED) is introduced for endovascular aneurysm occlusion. In the present study, we aimed to present the mid-term results after endovascular treatment of unruptured intracranial aneurysms using PED.
    Patients and
    Methods
    A total of 20 patients with 20 intracranial wide neck aneurysms were treated with PED between July and October 2010. Patients were followed up 4 to 8 months after the procedure. Digital subtraction angiography (DSA) was carried out to assess stent integrity, displacement, and the presence of residual aneurysm.
    Results
    Out of 20 participants, PED deployment was successful in 19; whereas, intervention failed in one patient due to technical factors in device deployment. No severe acute complications were observed. One patient died after three months as a result of subarachnoid hemorrhage (SAH). Out of the remaining patients, DSA showed complete occlusion of aneurysms in 14 individuals (77.8%), while in four patients (22.2%), residual aneurysm was noted. Stent migration was not observed in any patients. Intra-stent stenosis (25% - 50%) was visualized in only one patient (5.5%).
    Conclusion
    This study showed promising mid-term results for the pipeline embolization device in the treatment of unruptured intracranial aneurysms. Larger studies with longer follow-up duration are warranted.
    Keywords: Embolization, Aneurysm, Intervention
  • Ho Jong Chun*, Jung Suk Oh, Hae Giu Lee, Byung Gil Choi Page 14
    Background
    Patients with hematologic diseases are frequently accompanied by coagulopathy; even a small amount of hemoptysis may worsen clinical outcomes compared to those with the similar severity of injury without coagulopathy. However, a few studies have included various hematologic conditions, and none of them were large series.
    Objectives
    To evaluate the feasibility and short-term efficacy of bronchial artery embolization (BAE) in the management of hemoptysis in patients with hematologic diseases.
    Patients and
    Methods
    This was a retrospective study of 25 patients with hematologic diseases who visited our interventional unit for the management of hemoptysis between 2009 and 2012. The clinical, laboratory, and radiographic data were retrospectively analyzed and we correlated clinical response with the amount of hemoptysis, coagulation condition, radiographic pattern, and bronchial artery hypertrophy.
    Results
    The amount of hemoptysis was trivial in 13 patients (52 %), moderate in ten patients (40%), and massive in two patients (8%). Thirteen patients (52%) had coagulopathy (platelet count 1.5). Seventeen patients (68%) showed focal pulmonary hemorrhagic patterns and eight patients (32%) showed diffuse pulmonary hemorrhagic patterns. BAE provided complete clinical response in 21 out of 25 patients (84%). Complete clinical response was not correlated with the amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy (P > 0.05). There was no significant difference in short-term survival between patients with coagulopathy and those without coagulopathy (P = 0.425), and between patients with focal hemorrhagic pattern and those with diffuse hemorrhagic pattern (P = 0.728).
    Conclusion
    BAE in hematology patients was relatively efficient in controlling hemoptysis. The amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy was not a significant factor affecting the outcome.
    Keywords: Disease, Hematologic, Embolization, Therapeutic, Hemoptysis
  • Ibrahim Ilker Oz *, Muammer Bilici, Namik Kemal Altinbas, Evrim Bozay Oz, Emrah Caglar Page 15
    Objectives
    In this study, we aimed to evaluate the one-year follow-up findings of endovascular treatment with drug-covered balloon in patients with femoropopliteal artery disease (FAD).
    Patients and
    Methods
    From June 2012 to March 2015, 43 patients were enrolled in the study. Fifteen patients, 16 limbs and 19 lesions were treated with percutaneous transluminal angioplasty (PTA). Twenty-eight patients, 31 limbs and 36 lesions were treated with drug-coated balloon (DCB). At 12 months, all patients were examined with magnetic resonance angiography.
    Results
    Primary patency was seen in 47.4% of the treated lesions in the PTA group and 80.5% in the DCB group. There was statistically significant difference in primary patency between the groups (P = 0.011). Clinical improvement was seen in 56.3% of the treated limbs in the PTA group and 83.9% in the DCB group. There was no statistically significant difference in clinical improvement between the two groups (P = 0.075).
    Conclusion
    DCB with low restenosis rate can be used safely for endovascular treatment in patients with FAD as an alternative of standard balloon and stent.
    Keywords: Femoropopliteal Artery Disease, Percutaneous Transluminal Angioplasty, Drug, Covered Balloon
  • Amin Abolhasani Foroughi, Mohammad Hossein Nowroozzadeh, Ali Khorsand *, Masoume Nazeri, Masoud Yasemi, Ruhollah Salahi Page 16
    Objectives
    The aim of this study was to determine the possible role of brain magnetic resonance imaging (MRI) in cataract detection.
    Patients and
    Methods
    This study was performed on patients who were referred to Shahid Faghihi hospital with a known disease for brain MRI. Patients were classified in two groups of case and controls. Cases were 44 eyes with abnormal signal of the lens and controls were 88 eyes with normal signal intensity of the lens. All patients underwent an ophthalmological examination and the presence of cataract and intraocular lens (IOL) was assessed in these patients. Average lens signal, average muscle signal, average fat signal, lens to muscle signal ratio, and average lens signal to average fat signal ratio were recorded.
    Results
    The mean of the average lens signal in the case group was significantly higher than controls (370 versus 161, respectively) (P value
    Conclusion
    Cataract in eyes with abnormal lens signal was significantly lower than eyes with normal lens average signal. The lens signal in eyes with cataract was similar to eyes without cataract. So, average lens signal in brain MRI does not lead to early detection of cataract.
    Keywords: Magnetic Resonance Imaging, Cataract, Lens Signal, Intraocular Lens
  • Majid Moeini, Borna Tadayon Najafabadi, Mohammadreza Zafarghandi, Javad Salimi, Morteza Taghavi, Mohammad Hassani, Morteza Noaparast * Page 17
    Background
    Endovascular treatment (ET) is a treatment option for aortoiliac occlusive disease in patients with critical symptoms. ET is the choice for the transatlantic inter-society consensus for the management of peripheral arterial disease (TASC II) type A and B lesions. However, its use for type C and D lesions is getting more popular due to its less invasive nature and feasibility for more patients than open surgery.
    Objectives
    To describe short term results of ET in the treatment of total bilateral aortoiliac occlusion and discuss its role in the treatment of such lesions.
    Patients and
    Methods
    Patients with total bilateral aortoiliac occlusion with either life disturbing claudication or critical limb ischemia symptoms, including rest pain or limb ulcer, who were unresponsive to exercise and medical treatment were chosen and underwent ET and were followed up. Their demographic data and possible risk factors were recorded. Activity level before and after the procedure was compared using paired sample T test. Satisfaction mean and standard error was calculated and three months, six months, and twelve months patency rates were calculated and 95% confidence interval (CI) was made using binomial exact test.
    Results
    Fifteen patients met the inclusion criteria and underwent ET. Technical success was achieved in all cases. There were two cases of early mortality due to concomitant coronary artery disease (CAD) and prior poor medical condition. Patients satisfaction mean was 7.9 out of 10 (SE: 0.5) and activity level after procedure was significantly higher than before (1.53 and 2.58; P
    Conclusion
    When comparing patency rates for ET and open surgery no significant difference is seen (CI [58.6, 96.4], 93.6) and since re-intervention after ET with no delay is possible, it sounds a good treatment choice for total bilateral aortoiliac occlusions. Endovascular treatment of total bilateral aortoiliac occlusions can be a valid option with promising results and fewer complications that especially can be considered in high-risk patients. Further studies are recommended.
    Keywords: Atherosclerosis, Peripheral Arterial Disease, Arterial Occlusive Diseases, Endovascular Procedures, Radiography, Interventional, Vascular Patency, Stents, Patient Satisfaction, Ischemia, Thrombosis
  • Huan Wang, Wei Yu, Hai-Yan Pan, Qing-Quan Luo, Han-Bo Le, Zhi-Jun Chen* Page 18
    Objectives
    To evaluate the differentiating roles of computed tomography (CT) for invasive adenocarcinomas (IACs) of the lung from preinvasive lesions or minimally invasive adenocarcinomas (MIAs) manifesting as part-solid ground-glass nodules (GGNs).
    Patients and
    Methods
    All 230 lesions were pathologically confirmed. Their size, CT parameters and morphological features were compared among the three groups. Optimal cut-off values were calculated for parameters with diagnostic value.
    Results
    The diameter of the GGN lesion and the maximum diameter of the solid part, as well as CT values of the ground-glass part and the solid part differed significantly among the three groups. Cut-off maximum diameter of the solid part was 2.5 and 5.5 mm to differentiate preinvasive vs. MIA and MIA vs. IAC, respectively. Cut-off mean CT value was -581 and -464 hounsfield unit (HU) to differentiate preinvasive vs. MIA and MIA vs. IAC, respectively. Cut-off CT value of the ground-glass part was -675 and -562 HU to differentiate the same three groups. Morphological characteristics such as lobulation, spiculation and air bronchograms were all more likely to occur in invasive lesions.
    Conclusion
    The mean CT value, CT value of the ground glass part and maximum solid-part diameter of a GGN can help differentiate preinvasive from invasive lung adenocarcinomas.
    Keywords: Computed Tomography, Ground, Glass Nodule, Atypical Adenomatous Hyperplasia, Minimally Invasive Adenocarcinoma, Lung Adenocarcinoma, Adenocarcinoma in situ
  • Fei Wang, Si Shen, Quan Zhou, Changzheng Shi, Guorong She, Sirun Liu * Page 19
    Objectives
    To explore the value of T2 and T1 mapping in the early detection of degenerating articular cartilage.
    Materials And Methods
    Twenty-six New Zealand rabbits were randomly divided into three groups. Groups A and B (n = 10 each) had the right knee joint injected with either collagenase type II or papain. The equivalent dilution was injected into the left knee joint as control. In addition, six rabbits served as blank group. Both knees were scanned using MRI, and T2 and T1 values of the cartilage were measured. The femurs were examined microscopically and immunohistologically. T2 and T1 values were compared within and between groups.
    Results
    In group A, immunohistochemistry found that collagen type II decreased in the treated knees. T2 and T1 values were higher in the treated knees than the controls (P
    Conclusion
    T2 and T1 mapping may be useful in the early diagnosis of cartilage degeneration. The changes in collagen content of the cartilage were related to T2 relaxation time; whereas, T1 relaxation time was affected by both collagen and proteoglycan.
    Keywords: Osteoarthritis, Magnetic Resonance Imaging, T2 Mapping, T1 Mapping, Collagenase Type II, Papain
  • Mujdat Bankaoglu *, Abdullah Soydan Mahmutoglu, Irfan Celebi, Osman Tugrul Eren, Sukru Mehmet Erturk, Evrim Kilic, Muzaffer Basak Page 20
    Objectives
    The aim of the study was to evaluate magnetic resonance imaging (MRI) findings of iliotibial band friction syndrome (ITBFS) and its association with patellar height and facet shape variations.
    Patients and
    Methods
    Forty-one knees of 32 patients (14 female, 18 male) referred from the orthopedic surgery outpatient clinics with the MRI diagnosis of ITBFS composed the study group. Thirty two knees of 29 patients (13 female, 16 male) with MRI records without any radiologic findings of knee pathology were chosen as the control group. All of the patients were evaluated by MRI, including the assessments of patellar length ratios according to Insall-Salvati method and patellar facet variations according to Wiberg’s classification.
    Results
    According to Wiberg’s classification, nine knees (21.9%) had type I, 20 (48.8%) had type II, and 12 (29.3%) had type III shape of patella in the study group. Wiberg type I and type III patella ratio in the IBFS group was higher than the control group (P
    Conclusion
    ITBFS can easily be diagnosed by MRI and it is more likely associated with patella alta and type I and III patella according to Wiberg’s classification.
    Keywords: Iliotibial Band Friction Syndrome, Wiberg I, Wiberg III, Patella Alta, MRI
  • Gabriela Grusova, Lukas Lambert *, Jan Zeman, Alena Lambertova, Jiri Benes Page 21
    Background
    A significant proportion of patients with chest discomfort suffer from esophageal pathology and other conditions unrelated to pulmonary embolism.
    Objectives
    To determine the proportion of emergency patients undergoing CT pulmonary angiography, where esophageal pathology suspected from CT and other secondary findings would contribute to the explanation of their symptoms.
    Patients and
    Methods
    CT scans of 434 patients who were referred from the emergency department for CT pulmonary angiography were evaluated for esophageal wall thickness and distention, the presence of pulmonary embolism and other findings that might explain acute symptoms. Esophageal pathology was considered when the distal esophageal wall was at least 5 mm thick, as previously reported.
    Results
    Pulmonary embolism was confirmed in 27% patients. The distal esophageal wall was thickened in 87 (20%) patients. In this group, pulmonary embolism was present in 11 patients (13%) compared to 104 (30%) in patients without esophageal wall thickening (P = 0.007). From 76 patients with excluded pulmonary embolism, in 43 (56%), a suspected esophageal pathology was consistent with their symptoms. Gastroscopy confirmed CT findings in 34 of 42 patients (P = 0.0001).
    Conclusion
    Esophageal wall thickening is common in emergency patients with excluded pulmonary embolism and this finding may help to direct the patients appropriately.
    Keywords: Chest Pain, Esophagitis, Pulmonary Embolism, Computed Tomography, Angiography
  • Mustafa Farasat, Gulgun Yilmaz Ovali, Fatih Duzgun *, Gorkem Eskiizmir, Serdar Tarhan, Ayca Tan Page 22
    Objectives
    To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios.
    Patients and
    Methods
    Twenty five patients with salivary gland mass lesions were detected through B- mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results.
    Results
    Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 ± 0.29 in the benign group and 2.02 ± 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 ± 0.94 in the benign group and mean 2.28 ± 0.38 in the malignant group. There was no statistically significant difference between the two groups (P = 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P = 0.699).
    Conclusion
    In conclusion, elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique.
    Keywords: Major Salivary Gland Tumors, Sonoelastography, Pathology
  • Bing Fan, Mei-Jiao Li, Xiao-Ying Wang*, Yu-Feng Xu, Fei-Yu Li, Lai-Yun Zhang, Jian Jiang, Yan-Yan Jiang Page 23
    Objectives
    The effect of delay in imaging on the assessment of contrast-enhanced magnetic resonance imaging (CE-MRI) has not been extensively studied. This study evaluated the effect of different delay times (3, 7, and 10 minutes) on gadobutrol (Gadovist)-enhanced MRI for diagnosis of brain metastases.
    Patients and
    Methods
    This single-center, blind-reading, post-marketing study enrolled 52 patients with suspected or known brain metastases who received gadolinium-enhanced MR examinations. All the patients received 0.1 mmol/kg dose of gadobutrol, and serial axial T1 FLAIR images were obtained at each MR examination after a delay of 3, 7, and 10 minutes. The images were evaluated by two experienced radiologists independently. The evaluation included subjective and objective evaluations of the image quality.
    Results
    Thirty-four patients were diagnosed with brain metastases. There were 295, 301, and 301 lesions detected in the 3, 7, and 10 minutes delay groups, respectively. Subjective evaluation revealed a higher mean quality score of lesion edge, lesion interior, and overall image quality in the 7 and 10 minutes groups compared to the 3 minutes group. Images in the 7- or 10-min delay groups had significantly greater CNR and CBR than the 3-min group (P
    Conclusion
    A delay time of 7 minutes was considered optimal for imaging after gadobutrol administration in patients with brain metastases.
    Keywords: Gadobutrol, Magnetic Resonance Imaging, Brain Metastases, Delay Time
  • Masaki Ogawa *, Yoshiyuki Ozawa, Masahiro Muto, Hiroyuki Katano, Kazuo Yamada, Toshiyasu Miura, Noriyuki Matsukawa, Yuta Shibamoto Page 24
    Background
    CT angiography (CTA) was routinely performed for carotid artery disease, but the plaque characterization based on measurement of density may be inaccurate, influenced by adjacent calcification and contrast agent. Remodeling ratio was one of the additional new objective indexes for plaque characterization. On coronary CTA, the utility of histogram analysis was reported in a few studies.
    Objectives
    The purpose of this study was to evaluate the diagnostic value of histogram analysis of carotid artery plaque density and positive remodeling on CTA for the diagnosis of pathologically proven complicated carotid artery plaques.
    Patients and
    Methods
    We retrospectively evaluated 29 patients with atherosclerotic carotid artery stenosis treated by carotid endarterectomy. On CTA, the boundaries of non-calcified plaques were manually traced at the site of the greatest stenosis. In addition to the mean plaque density, the percentage of pixels (PP) with a density of less than 30 Hounsfield units (HU) (PP
    Results
    Histologically, 13 of the 29 patients had complicated plaques. PP
    Conclusion
    Histogram analysis of the carotid artery plaque density may be more useful for the evaluation of atherosclerosis on CTA compared with the conventional analysis of plaque densities, and the combined analysis of histogram analysis and the remodeling ratio may help to predict future stroke events.
    Keywords: Atherosclerotic Carotid Artery Plaque, CT Angiography, Histogram Analysis, Positive Remodeling
  • Zeinab Oghabian, Amir Homayoun Jafari * Page 25
    Background
    Measurement of oxygen consumption can give useful information of brain functionality in health and disease. To have a better understanding of normal physiology in all conditions (rest or functional tasks), development of accurate brain oxygen mapping is essential. This mapping could also be a great help in managing pathological conditions with disturbance in oxygen supply. One of the most important hemodynamic parameters of the brain is oxygen extraction fraction (OEF). By development of blood oxygen level dependent magnetic resonance imaging (BOLD MRI) in imaging, several methods have been proposed for measuring this parameter. The latest methods are mostly based on hypercapnic and hyperoxic stimulus.
    Objectives
    Here, we presented a new method with hypercapnic and hyperoxic stimulus and using BOLD and dynamic susceptibility contrast (DSC) perfusion imaging instead of arterial spin labelling (ASL).
    Materials And Methods
    A 3T Siemens Trio Tim Scanner was used for imaging five patients (three males and two females) who were recruited for this experiment. Four set of T1 data, BOLD data and two DSC-perfusions (two injections) were applied to each subject. Gas manipulation was applied while acquiring BOLD data and one of the DSC-perfusion was done in hyperoxic condition. Gas manipulation was a combination of hypercapnic, hyperoxic and normoxic conditions in a total of 13 minutes. The DSC data was analyzed using PMA (ASIST) software to calculate cerebral blood flow (CBF) and using its results with the BOLD data, OEF was calculated by MATLAB coding. All preprocessing was done with the SPM12 (MATLAB).
    Results
    Comparable results were acquired for OEF with previous studies. The mean value of estimated OEF for gray matter (GM), white matter (WM) and whole brain is 0.46, 0.37, and 0.44, respectively which are within the expected range of normal condition.
    Conclusion
    As the proposed method for OEF measurement uses a combination of hyperoxic and hypercapnic stimulus with BOLD and DSC-perfusion imaging, it could be considered the most available one in all MRI scanners and being a voxel wise method, it could give OEF value for any requested ROI.
    Keywords: Oxygen Mapping, Oxygen Extraction Fraction, OEF, Hyperoxia, Hypercapnia, DSC, Perfusion, CBF, BOLD, MRI
  • Hussein Soleimantabar, Sofia Sabouri, Samira Salajeghe *, Sara Salajeghe Page 26
    A 4- year old boy with a history of poor feeding, dyspnea and irritability while feeding that started since infancy, was referred to our center. Long-term examination of the disorder was started by echocardiography since he was one-month old and was performed when he was 2 years old. Although in all those evaluations, right sided aortic arch (RSAA) and increased right ventricle (RV) and pulmonary artery (PA) pressures were noticed, the definite diagnosis was not reached at that occasion. The patient was referred to our radiographic center and preceeded to undergo CT angiography with multislice spiral thin section scans plus maximum intensity projection (MIP), multiplanar reconstruction (MPR) and volume rendering techniques. The computed tomography (CT) angiographic findings revealed type C aortic arch interruption with right sided aortic arch which is a very rare condition and only one similar case has been previously reported in the literature. Interestingly, almost all types of right sided aortic arch interruptions reported so far were of type B. The reason why our case is type C could be explained from an embryologic point of view. Explanation of this case could be helpful and attractive since echocardiographic and angiographic findings were not definitive enough for final diagnosis of this case. The symptoms intensified after repairing the patient’s ventricular septal defect (VSD); however, definite diagnosis was obtained by CT angiography. What makes this case report more important is that the authors believe that diagnostic methods in developed countries are able to diagnose this congenital heart disease sooner in neonatal or even in prenatal periods, resulting in a lower incidence of presentation of similar cases in childhood.
    Keywords: Cardiac Imaging, CT, Angiography, Pediatrics
  • Seung Eun Lee, Young-Seon Kim* Page 27
    Duplication of the vertebral artery (VA) is rare but clinically significant. This variant shows a dual origin of VA with fusion at variable levels in the neck. It can be misdiagnosed as a dissection of the VA, arterial hypoplasia, or narrowing on selective catheter angiography. Thorough knowledge of this variation before an endovascular procedure is helpful in preventing unintentional diagnostic or therapeutic challenges. We report a case of a 52-year-old female patient with left duplicated VA, which was incidentally detected by magnetic resonance angiography (MRA) and contrast-enhanced computed tomography angiography (CTA). We have also reviewed the literature and discussed the embryological development of duplicated VA. This report can be helpful in identifying unexpected vascular variations on CTA or MRA and differentiate this anatomical variation from other pathologic conditions in clinical practice such as dissection, arterial hypoplasia, or arterial narrowing.
    Keywords: Vertebral Artery, Duplication, Multidetector Computed Tomography, Magnetic Resonance Angiography