Iranian Journal of Radiology
Volume:19 Issue: 1, Jan 2022

Activation of monocytes and lower high-density lipoprotein (HDL) levels accelerate atherosclerosis. The monocyte-to-HDL ratio (MHR) and the coronary artery disease-reporting and data system (CAD-RADS) score are recognized as proper indicators of the atherosclerotic process.

This study aimed to investigate the relationship between the CAD-RADS score and the left ventricular mass (LVM) and MHR and to evaluate the role of MHR as a predictive marker for the CAD-RADS score.

In this study, the data of 160 patients, who underwent coronary computed tomography angiography (CCTA) for cardiac assessment in our radiology unit between January 2019 and January 2021, were collected and evaluated retrospectively. The CAD-RADS score, LVM, and MHR were calculated for the patients.

The multivariate analysis showed independent relationships between CAD-RADS scores and high-sensitive C-reactive protein (hs-CRP) (β = 407, P < 0.001), MHR (β = 351, P < 0.001), age (β = 0.254, P < 0.001), male sex (β = 0.179, P < 0.001), and diabetes mellitus (β = 0.122, P = 0.008). The cutoff values of MHR (9.4 for CAD-RADS-1, 11.5 for CAD-RADS-2, 12.8 for CAD-RADS-3, and 14.0 for CAD-RADS-4) showed high sensitivity and specificity for the CAD-RADS scores.

Based on the results, MHR may be associated with the CAD-RADS score and increased LVM. As an inexpensive and reliable test, MHR may be useful for the early diagnosis and follow-up of atherosclerotic heart diseases.

Thyroid nodules are common clinical findings. Although there are various accepted treatments for benign thyroid nodules, such as surgery and thermal treatment, there are some alternative methods for the management of these patients at lower costs with minimal complications.

This study aimed to compare volume reduction in radiofrequency (RF) ablation and single-session ethanol ablation (EA) and to investigate the effects of levothyroxine therapy (LT4) on benign thyroid nodules.

In this clinical trial, 91 patients with benign thyroid nodules, presenting to different medical centers in Tehran, Iran, from December 6, 2018, to December 6, 2019, were included. Patients who met the inclusion criteria were selected and randomly allocated into three groups: group 1, a single session of RF ablation (n = 31); group 2, a single session of ethanol injection (n = 30); and group 3, a six-month LT4 treatment (n = 30). Thyroid tests, including thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), anti-thyroid peroxidase (anti-TPO), T3 resin uptake (T3RU), and serum calcitonin level, were recorded at baseline and within one-, three-, and six-month intervals. The nodule volume was also assessed using sonography at baseline and in the follow-ups.

The mean volume reduction was 73.6%, 80.1%, and 8.7% at six months after the intervention in the ethanol injection, RF ablation, and LT4 treatment groups, respectively (P < 0.001). There was a significant relationship between the mean volume reduction and the follow-up period (one, three, and six months) (P < 0.001).

The RF ablation therapy was found to be the optimal modality for the management of benign thyroid nodules, as it was associated with the greatest mean volume reduction. Conversely, the lowest mean volume reduction was observed in the LT4 treatment group during six months of follow-up.

Endovascular therapy is one of the standard treatment options for patients with peripheral arterial disease. Paclitaxel-eluting stents (PES) have shown promising results in the treatment of obstructive femoropopliteal lesions. Two types of PES, namely, Zilver PTX (Cook Medical, USA) and Eluvia (Boston Scientific, USA), are available worldwide. However, no study has yet compared the outcomes of applying both PES types in the real world.

This study aimed to assess the one-year outcomes of two different types of PES for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D obstructive femoropopliteal lesions following suboptimal angioplasty.

This single-center, retrospective, observational study examined 37 limbs of 34 patients (30 males and four females) with the mean age of 71.9 ± 9.1 years (range, 53-90 years), who were included consecutively from February 2017 to May 2018. In all patients, either a Zilver PTX (Cook Medical) or an Eluvia (Boston Scientific) PES was used for TASC C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Moreover, the patients’ one-year primary patency rate, freedom from clinically driven target lesion revascularization (TLR), and event-free survival rates were determined.

The mean lesion length was measured to be 24.6 ± 6.6 cm (range, 9 - 46 cm). Based on the results, 78% of the lesions (29 limbs) showed occlusion, and 46% (17 limbs) showed more than moderate calcification. According to the TASC classification, type D lesions were detected in 25 (68%) limbs, while type C lesions were detected in 12 (32%) limbs. The mean number of stents used was 2.5 ± 0.7 per limb (range, 1 - 3) to cover a mean length of 24.3 ± 7.9 cm (range, 6-35 cm). Overall, 56 Zilver PTX stents for 23 limbs and 36 Eluvia stents for 14 limbs were used. The Kaplan-Meier estimates of one-year primary patency and freedom from TLR were 78% and 88%, respectively (Zilver PTX stent, 76.3% and 81.2%, respectively; Eluvia stent, 91.7% and 100%, respectively). Major adverse events were reported in two patients (2/37, 5.4%), including acute thrombotic occlusion of the treated lesions.

Both types of PES showed promising one-year outcomes for TASC C/D lesions regarding safety and efficacy, without any significant differences; therefore, they can be considered as an alternative therapeutic approach for surgery.

Early prediction of disease progression in COVID-19 patients can be helpful for personalized therapy, as well as the optimal allocation of public health resources.

This study aimed to present predictive models for identifying potential high-risk COVID-19 patients upon hospital admission, based on the examination of clinical and radiological features by radiologists and artificial intelligence (AI).

A total of 786 initially non-severe COVID-19 patients were retrospectively enrolled in this study between January 2 and May 28, 2020. The patients were randomly divided into training (n = 628, 80%) and test (n = 158, 20%) groups. Clinical factors, laboratory indicators, and radiologist- and AI-extracted radiological features of pneumonia lesions were determined using a convolution neural network. The features were selected based on the Boruta algorithm with five-fold cross-validation. Four models, including a model based on clinical findings (model C), a model based on the physician’s examination of radiological features (R-Doc model), a model based on AI-derived radiological features (R-AI model), and an AI-based model mimicking the physician’s examinations (AI-Mimic-Doc model), were constructed for predicting COVID-19 progression upon admission, using a logistic regression analysis. The predictive performance of the four models was evaluated by calculating the area under the receiver operating characteristic (AUC) curve with a 95% confidence interval (95% CI) and then compared using the DeLong test.

Overall, 238 out of 786 patients (30.3%) progressed into severe or critical pneumonia during the 14-day follow-up. Nine clinical findings, 17 laboratory indicators, 48 physician-extracted radiological features of pneumonia lesions, and 126 AI-driven radiological features were collected. The urea, albumin level, and lesion size in the basal segment of the right lower lobe of the lung or the proportion of CT values in the range of -200 - 60 in the left lung were the representative features for constructing the R-Doc and R-AI models, respectively. Comparison of the R-Doc model (AUC: 0.840, 95% CI: 0.747 - 0.933 for the training set and 0.731, 95% CI: 0.606 - 0.857 for the test set) with the R-AI model (AUC: 0.803, 95% CI: 0.701 - 0.906 for the training set and AUC: 0.731, 95% CI: 0.606 - 0.857 for the validation set) indicated a marginal difference in identifying patients at risk of progression to pneumonia upon admission (P < 0.1). The R-AI model was superior to model C, with an AUC of 0.770 for the training set (95% CI: 0.657 - 0.882) and 0.666 for the validation set to identify high-risk non-severe cases upon admission.

By using radiological features along with blood tests, early identification of COVID-19 patients, who are at risk of disease progression, can be achieved on admission (rapidly by using AI); therefore, the use of these features can contribute to the clinical management of COVID-19.

Dementia and its most common cause, Alzheimer's disease (AD), are growing health problems worldwide. In the pathological process, before the emergence of symptoms, magnetic resonance imaging (MRI) may be used as a non-invasive method for measuring brain perfusion.

This study aimed to investigate the feasibility and variability of brain perfusion maps derived from pulsed arterial spin labeling (PASL) MRI in a heterogeneous group of patients with cognitive disorders.

In this cross-sectional study, 85 out of 134 patients with cognitive disorders, including 23 cases of AD, 24 cases of mild cognitive impairment (MCI), 31 cases of depression, and seven cases of subjective memory impairment (SMI), were considered eligible for the study. All patients were evaluated qualitatively with 3D PASL sequences, using inline cerebral blood flow (CBF) maps. Mental examinations and neuropsychological tests were also performed beforehand.

Based on the CBF maps, bilateral parietal hypoperfusion was significant in the AD and MCI groups (83 and 67%, respectively), compared to patients with depression or SMI (P < 0.01). However, it was significantly low in depressed patients (13%), and there was no hypoperfusion in the SMI group. There was a good interobserver agreement, based on the kappa coefficient in all groups (0.78%; 95% CI: 0.65 - 0.91).

The PASL MRI technique can be valuable for evaluating cognitive disorders, as it is non-invasive, rapid, and easily accessible. Besides, the qualitative assessment of CBF maps using this technique is reproducible and feasible in routine clinical practice.

Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis. Bilateral symmetric sclerosis of the long bones and possible multiorgan involvement are the main presentations of this disease. Histologically, lipid-laden foamy histiocytes are positive immunochemically for CD68 (occasionally for PS100) and negative for S100 and CD1a in ECD. Herein, we describe the case of a 35-year-old man diagnosed with ECD with peritoneal and retroperitoneal infiltrations and bone involvement. The diagnosis of ECD was only confirmed after two years of non-specific abdominal pain, nausea, and weight loss. Primarily, the patient’s clinical symptoms and abdominal computed tomography (CT) findings, which indicated omental caking, peritoneal thickening, and perinephric soft tissue density, suggested an intra-abdominal malignancy. Finally, a peritoneal biopsy was carried out, which demonstrated xanthogranulomatous infiltrations from ECD. Further radiographic skeletal survey based on histopathological results showed symmetric osteosclerosis of the long bones. Although ECD, associated with peritoneal and retroperitoneal infiltrations, is an uncommon finding, it should be included in the differential diagnosis of patients with non-specific gastrointestinal manifestations, along with multiorgan involvement and typical radiological findings.

Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.

Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality in solid organ transplant recipients and immunocompromised hosts. However, tissue-invasive CMV infection, causing cutaneous or subcutaneous diseases, has been rarely reported in the literature, and proper diagnosis can be easily delayed due to the rarity. Here, we report a rare case of a 45-year-old male renal transplant recipient, presenting with subcutaneous nodules. The nodules were initially suspected as a post-transplant lymphoproliferative disorder (PTLD) on computed tomography (CT) scan. However, biopsy later indicated a CMV infection. Based on the present findings, clinicians and radiologists are suggested to consider CMV infection as a differential diagnosis of subcutaneous nodular lesions in solid organ transplant recipients.

Splanchnic vein thrombosis is one of the rare complications of coronavirus disease 2019 (COVID-19). A 43-year-old woman presented with splanchnic vein thrombosis as a rare extrapulmonary complication of COVID-19. She was previously healthy without a medical history of coagulopathy before hospital admission. She complained of epigastric pain, along with nausea and vomiting. Enhanced abdominopelvic computed tomography (CT) scan demonstrated extensive acute thrombosis in the portal, superior mesenteric, and splenic veins with total occlusion. Intestinal ischemia or infarction was not clinically observed. All thrombophilia screening tests yielded negative results. Under anticoagulation therapy, she recovered dramatically and was discharged from the hospital. Imaging findings can be used to confirm splanchnic vein thrombosis when a COVID-19 patient has abdominal symptoms.

 Mammography is the most reliable and popular method in the clinical diagnosis of breast cancer. Calcifications are subtle lesions in mammograms that can be cancerous and difficult to detect for radiologists. Computer-aided detection (CAD) can help radiologists identify malignant lesions.

 This study aimed to propose a deep learning based CAD system for detecting calcifications in mammograms.

 A total of 815 in-house mammograms were collected from 204 women undergoing screening mammography. Calcifications in the mammograms were annotated by specialists. Each mammogram was divided into patches of fixed size, and then, patches containing calcifications were extracted, along with the same number of normal patches. A ResNet-50 Convolutional Neural Network (CNN) was trained for classification of patches into normal and calcification groups using training data and then the performance of the trained CNN was tested with new test data.

 The proposed patch learning approach (PLA) showed a classification accuracy of 96.7% in the binary classification of patches. Therefore, it could detect calcification regions in a given mammogram. The PLA achieved sensitivity and specificity of 96.7% and 96.7%, respectively, with an area under the curve of 98.8%.

 The present results highlighted the efficacy of the proposed PLA, especially for limited training data. Direct comparison with previous studies is not possible due to differences in datasets. Nevertheless, the PLA accuracy in detecting calcifications was higher than that of deep learning based CAD systems in previous studies. The effective performance of PLA may be attributed to the manual removal of uninformative patches, as they were not used in the training set.

The main advantage of the BI-RADS system is that when correctly applied, the ACR and BI-RADS classifications are the only necessary tools for a practical and scientific communication between radiologists and clinicians regarding the breast findings. The BI-RADS provides a common standardized language of communication by minimizing subjective interpretations. A non-specialist clinician, without an in-depth knowledge of breast imaging, should be assisted on how to manage or refer patients based on standard algorithms. Dedicated breast clinicians, despite their high level of knowledge and experience regarding breast disease and management, are not radiologists; therefore, the BI-RADS can help them organize a follow-up and perform further diagnostic examinations. Besides, radiologists who are specialized in using different modalities communicate better with each other about breast images if the BI-RADS terminology and management guidelines are applied. In this study, we present a concise and simplified description for all sections of the BI-RADS to facilitate its understanding and practical use for all practitioners, not only breast radiologists.

Orbital decompression is performed to reduce intraorbital pressure by removing the fat tissue and bone around the orbit. Access to proper equipment, experienced personnel, and adequate anatomical knowledge are essential to perform this procedure. To achieve maximum decompression, surgeons need to open the orbit up to the apex, including the optic foramen and the annulus of Zinn.

This study aimed to determine the location of the sphenoid sinus relative to the optic foramen using CT scan, which is essential for orbital decompression surgery, in the Central Anatolia Region, Turkey.
Patients and

This cross-sectional study was conducted on 64 patients from the Turkish population between March 15 and April 15, 2021 in the Central Anatolia Region. The patients were selected using the purposive sampling method. Based on the cranial CT scans, a total of 128 orbits were evaluated using the hospital’s picture archiving and communication system. Patients included in this study were admitted to the hospital with headache. However, their CT images, evaluated by an experienced radiologist, were reported to be normal. The relationship between the optic foramen and the anterior surface of the sphenoid sinus was examined, and the location of the optic foramen was determined as anterior, posterior, or equal to the sphenoid sinus. Descriptive statistics were measured for statistical analysis.

The participants of this study included 32 men and 32 women in the age range of 20 - 67 years. Based on the analyses, the optic foramen was mainly opposite to the anterior aspect of the sphenoid sinus in both females and males; this finding was more prominent in females. In the right orbit, the mean distance of the optic foramen to the anterior surface of the sphenoid sinus was +6.97 mm if the optic foramen was anterior to the anterior surface of the sphenoid sinus, while it was -4.1 mm if the optic foramen was located posteriorly to the anterior surface of the sphenoid sinus. Similarly, in the left orbit, the mean distance of the optic foramen to the anterior surface of the sphenoid sinus was +6.97 mm if the optic foramen was located anteriorly, while it was -4.15 mm if the optic foramen was located posteriorly to the anterior surface of the sphenoid sinus. The position of the optic foramen was symmetrical in 60.9% of cases in the two orbits.

Based on the results of CT scan, the optic foramen was mainly located opposite to the anterior aspect of the sphenoid sinus; this finding was more frequently observed in females (59.4%) than in males (40.6%). The present results can provide further information for surgeons to perform orbital decompression or surgeries posterior to the orbit.

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. Cases of HCC in Africa and East Asia account for 80% of all HCC cases around the world. China is one of the countries with a high incidence rate of HCC.

This case-control study aimed to explore theprognostic value of computedtomography (CT) texture features in patients with HCC following stereotactic ablative radiotherapy (SABR). Patients and

A total of 100 HCC patients, treated with SABR from January 2019 to January 2021, were divided into good prognosis (n = 57) and poor prognosis (n = 43) groups. The patients’ general data and CT texture features were then compared. Factors associated with a poor prognosis were investigated in a multivariate logistic regression analysis. A clinical feature model, a CT texture feature model, and a joint model of clinical features and CT texture features were established, and their prognostic values were evaluated by plotting the receiver operating characteristic (ROC) curves. Moreover, a nomogram prediction model was developed according to the multivariate analysis results, and its prediction efficiency was assessed.

Age40 years, serum alpha-fetoprotein level > 9 ng/mL, gamma-glutamyl transpeptidase > 60 U/L, aspartate aminotransferase > 40 U/L, lesion size > 5 cm, unsmooth tumor margins, no tumor capsule or incomplete capsule, multiple tumors, portal phase CT value of cancer > 135%, and a relative washout ratio > -24% in the portal phase of cancer were risk factors for a poor prognosis in HCC patients after SABR. The area under the ROC curve and sensitivity and specificity of the joint model were 0.817 (95% confidence interval [CI]: 0.773 - 0.861, P < 0.001), 80.47%, and 91.05%, respectively, which significantly exceeded those of the other two models. The nomogram prediction model showed high accuracy and validity.

The texture features of CT images before SABR are of a high prognostic value for HCC patients and contribute to the selection of appropriate treatment protocols.

Ultrasound Breast Imaging-Reporting and Data System (BI-RADS) classification may underestimate ductal carcinoma in situ (DCIS). Currently, there is a lack of research on ultrasound BI-RADS underestimating DCIS.

To improve the diagnosis of DCIS, this study aimed to investigate factors associated with the underestimation of DCIS, based on ultrasound BI-RADS assessments.

In this cross-sectional study, consecutive patients with breast ultrasound BI-RADS classification and biopsy results were retrospectively examined. DCIS was found in the pathology reports of all patients. DCIS cases classified as BI-RADS 4A or lower were considered as underestimations of DCIS, while DCIS cases classified as BI-RADS 4B or higher were considered as non-underestimation of DCIS. The demographics, clinical manifestations, features of breast images, BI-RADS classification, and pathological results of the two groups were compared to explore possible associated factors. A stepwise logistic regression analysis was also carried out based on the significance of factors associated with the underestimation of DCIS according to the BI-RADS assessment.

Between January 2015 and May 2017, a total of 296 breast DCIS lesions were diagnosed in 294 female patients. Overall, 65 lesions (22.0%) were underestimated DCIS, and 231 lesions (78.0%) were non-underestimated DCIS; no significant differences were found between their clinical presentations. The univariate analysis showed that the age of the patients, presence of microinvasions, maximum lesion diameter, shape, margin, orientation, echo pattern, posterior acoustic features, ultrasound pattern, and vascularity of lesions were possibly associated factors, which could lead to the underestimation of DCIS. The logistic regression analysis showed that age above 50 years, maximum lesion diameter < 10 mm, lack of microinvasion, and circumscribed margins were associated with the underestimation of DCIS.

In this study, 22% of DCIS lesions was underestimated by the BI-RADS assessment. The patient’s age, maximum lesion diameter, microinvasion, and lesion margin were associated with the underestimation of DCIS.

The use of 68Ga-PSMA PET/CT scan has recently received particular attention in the evaluation of prostate cancer patients.

The present study aimed to evaluate the relationship between the PSA level, Gleason score, and 68Ga-PSMAPET/CT findings in prostate cancer patients.

In this cross-sectional study, 80 male patients with a definitive diagnosis of prostate cancer, who were candidates for 68Ga-PSMA PET/CT scan for both initial staging and restaging, were included. Restaging indicated biochemical recurrence, which refers to a detectable level of PSA after being documented undetectable following a definitive primary treatment. All prostate cancer patients, who were not initially treated with a definitive therapy, were excluded from the study. A cutoff value ≥ 4 was considered significant for SUVmax to differentiate benign from malignant 68Ga-PSMA-avid lesions. Any 68Ga-PSMA uptake outside the prostate bed, especially in the lymph nodes, bones, and visceral organs, was considered metastatic.

Comparison of the PSA level between two subgroups with and without metastasis demonstrated a higher PSA level in patients with metastatic abdominal lymph nodes and a slightly higher PSA level in patients with metastatic pelvic lymph nodes. No significant correlation was found between the Gleason score and the total PSA. There was also no significant association between the level of PSA and the type of Lymph node involvement (single or multiple) in different involved areas. Besides, there was no significant correlation between the SUVmax and the level of PSA and the Gleason score in different involved areas.

The SUVmax value in 68Ga PSMA PET/CT scan provides a reliable predictor for neither the grade of prostate cancer, nor the metastatic status associated with cancer progression. The measurement of total PSA may predict metastasis to the abdominal and pelvic lymph nodes caused by prostate cancer.