Iranian Journal of Radiology
Volume:19 Issue: 2, Apr 2022

In conventional ultrasonography, the ultrasound image is not labeled with information on the location or orientation of the transducer. There is also no information on the parts of the body under examination.

This study aimed to investigate the efficacy of body navigation-loaded ultrasonography, including the real-time transducer location and the inspection site, compared to conventional ultrasound.

After obtaining approval from the institutional review board, 29 healthy adult volunteers were prospectively enrolled in this study. One gastrointestinal radiologist performed an abdominal ultrasound, using an ultrasound navigation image convergence system, developed by the authors. Subsequently, an equivalent conventional ultrasound image set was prepared. Three radiologists independently evaluated the two ultrasound image sets for identifying the target organ (two points), transducer location (two points), and transducer orientation (one point). In a two-week interval, conventional ultrasound images were first analyzed, and then, body navigation-loaded images were examined. The score differences between the first and second evaluations were compared using Wilcoxon signed-rank test. The inter-rater agreement of the three reviewers was determined by measuring the Fleiss’ kappa value.

A total of 1,402 navigation-loaded ultrasound images were acquired in this study. The ultrasound operator carefully selected 203 images for analysis. The interpretation score of all three reviewers significantly increased for each examination in the second analysis using the body navigation-loaded ultrasound images (reviewer A, from 4.07 ± 1.56 to 4.79 ± 0.69; reviewer B, from 3.83 ± 1.59 to 4.49 ± 0.88; and reviewer C, from 3.43 ± 1.60 to 4.19 ± 1.01) (P < 0.0001). The inter-rater agreement of each examination also increased significantly in the second analysis using the body navigation-loaded ultrasound images (P < 0.0001).

According to the results of this pilot study, the body navigation-loaded ultrasound technology can assist with a simple and objective interpretation of ultrasound images from organs.

Similar to most imaging procedures, the high quality of images is a key factor in ensuring that mammography delivers its full potential benefits. Radiographers play a central role in the acquisition of high-quality images, as they are responsible for not only breast positioning and compression, but also quality control and patient care.

To identify the challenges and difficulties of radiographers in daily practice and to determine the main components of mammography that require further training and education.

An online survey was conducted to collect data regarding the radiographers’ demographic data, institution profile, image assessment tools, mammography challenges, quality control, and continuing professional development.

A total of 73 radiographers participated in this study, the majority of whom were full-time radiographers with a bachelor’s degree in radiography. Less than half of the participants had been a mammographer for more than five years. The American College of Radiology (ACR) criteria were the most familiar image quality assessment tool (52%). The most frequently used scale to evaluate image quality was posterior breast tissue visualization on both craniocaudal (CC) and mediolateral oblique (MLO) views, followed by the pectoral muscle volume determined on the MLO view. Overall, positioning, artifacts, and compression were the main reasons for repeat mammography. Also, wheelchair-bound patients, overweight patients, and breast compression were the greatest challenges of patient positioning.

This pilot study highlighted the importance of developing in-house training courses for radiographers, which focus on patient positioning, image quality assessment, and patient-centered needs to improve practice standards. However, further studies on a larger sample size are needed to validate the present results.

Melanoma is one of the most serious types of skin cancer and one of the leading causes of cancer-related mortality worldwide.

This study aimed to investigate the association between 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan findings and the pathological characteristics of primary tumors in patients with malignant melanoma.

In this cross-sectional study, the baseline data of 103 patients with cutaneous or mucosal melanoma (stage III or IV) were recorded, and tumor characteristics and PET/CT scan findings were analyzed. The association between each pathological finding and PET/CT results was also investigated.

Patients without a free margin had a significantly higher mean standardized uptake value (SUVmax) of lung metastasis compared to patients with a free margin (3.12 vs. 1.69; P = 0.047). Also, patients with ulceration had a significantly higher mean SUVmax of lung metastasis compared to patients without ulceration (3.28 vs. 1.81; P = 0.041). Based on the results, increased primary tumor thickness was associated with a higher SUVmax of lung metastasis. However, there was no significant association between the metastasis type (single vs. multiple) and free margin, ulceration, or Ki-67 protein. The mean SUVmax of lung metastasis was significantly higher in mucosal melanoma compared to cutaneous melanoma. However, the mean SUVmax values of other metastases (bone, liver, and lymph nodes), even the primary lesion itself, were not significantly different between cutaneous melanoma and mucosal melanoma.

The primary tumor margin status, ulceration, tumor thickness, primary tumor location (cutaneous vs. mucosal), and the presence of lung metastasis were significantly associated with PET/CT scan findings.

Mammography (MMG) and ultrasonography (US) have been used as standard imaging modalities for the diagnosis of breast cancer. However, several drawbacks have been attributed to these modalities. Breast-specific gamma imaging (BSGI), as a nuclear medicine imaging technique, has been introduced as a supplementary tool for diagnosing breast cancer.

This study aimed to determine whether the addition of BSGI to MMG or US interpretations could improve the diagnostic accuracy and reduce the need for further examinations or unnecessary biopsies of breast lesions.

This retrospective study was conducted on 548 patients with 638 breast lesions from February 2013 to December 2018. The performance of BSGI, MMG, and US was examined for identifying breast cancer and high-risk lesions. Subgroups were classified by adding the results of BSGI for BI-RADS 0 and 4a lesions on MMG and BI-RADS 4a lesions on US. The diagnostic performance of each subgroup was then compared. The sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The diagnostic accuracy was determined by measuring the area under the receiver operating characteristic curve (AUC). Besides, factors associated with false-positive and false-negative results of BSGI were extracted.

The BSGI showed a sensitivity of 88.26% for breast cancer diagnosis, which was comparable to the sensitivity of MMG (87.95%) and lower than that of US (97.83%). The specificity and AUC of BSGI (81.62% and 0.85, respectively) were superior to those of MMG (66.83% and 0.77, respectively) and US (15.20% and 0.57, respectively). In the subgroup analysis of MMG, the sensitivity, positive predictive value, and AUC of MMG0+BSGI and MMG4a+BSGI increased significantly compared to MMG alone. In the MMG4a+BSGI group, the specificity also significantly increased. In the US subgroups, the specificity and AUC of US4a+BSGI increased significantly compared to US alone. Based on the results, a low Ki-67 index was associated with a false-negative result of BSGI.

The addition of BSGI to MMG or US could improve the diagnostic performance, especially for BI-RADS 0 and 4a lesions. Additionally, the concomitant use of BSGI with MMG or US might reduce the need for an additional examination or unnecessary biopsy.

Fibromyalgia is recognized as a chronic pain syndrome. Widespread pain is a common symptom in fibromyalgia, indicating a potential dysfunction in the processing of painful sensations in the central nervous system.

This study aimed to investigate changes in the severity of clinical symptoms in fibromyalgia patients and to evaluate the apparent diffusion coefficients and metabolites in the brain of these patients.

This cross-sectional study included 28 female outpatients with complaints of widespread pain, who were diagnosed with fibromyalgia syndrome. Magnetic resonance imaging, magnetic resonance spectroscopy, and diffusion tensor examinations were applied to evaluate patients diagnosed with fibromyalgia before treatment.

The mean age of the patients included in this study was 39.1 ± 8.6 years (range, 24 - 55 years). A statistically significant strong positive correlation was found between the scores of the visual analog scale and the fibromyalgia impact questionnaire. Besides, significant associations were found between the scores of the visual analog scale and fibromyalgia impact questionnaire and the results of fractional anisotropy, apparent diffusion coefficient, and peak values of some metabolites in spectroscopy.

The results of this study suggest that metabolites play an inhibitory or excitatory role in the central pain mechanisms of fibromyalgia as a chronic pain syndrome.

99mTc -sestamibi myocardial perfusion imaging (MIBI) washout is associated with myocardial mitochondrial damage in patients with a successful percutaneous coronary intervention (PCI) following acute myocardial infarction (AMI) and may predict the functional improvement of the left ventricle in follow-ups.

This study aimed to investigate the clinical efficacy of 99mTc-MIBI washout in patients with AMI by measuring the mean defect area based on 99mTc-MIBI myocardial perfusion-single photon emission computed tomography (MP-SPECT) rest imaging in early and delayed phases and comparing it with the defect area based on 99mTc-MIBI MP-SPECT adenosine stress imaging based on a two-day rest/stress protocol.

This study was conducted on 29 consecutive patients with AMI (23 males and 6 females; mean age, 71 ± 8.4 years), who underwent MP-SPECT using a standard two-day rest/stress protocol. The rest 99mTc-MIBI MP-SPECT images were acquired in the early phase at one hour after the injection of 99mTc-MIBI and in the delayed phase at three hours after the early phase. The total perfusion deficit (TPD) score for SPECT was measured to compare the defect area between the rest-early phase, rest-delayed phase, and post-stress imaging conditions.

Based on the results, the post-stress TPD score was significantly lower than the rest-delayed phase score (TPD: 22.2% ± 14.3% vs. 27.8% ± 14.0%; P < 0.001). Also, the rest-early phase score was significantly lower than the rest-delayed phase score (TPD: 21.5% ± 14.9% vs. 27.8% ± 14.0%; P < 0.001). However, no significant difference was observed between the post-stress score and the rest-early phase score.

The combination of rest-early phase, delayed phase, and post-stress 99mTc-MIBI imaging using a two-day protocol after AMI reperfusion was a clinically useful method, which could identify residual ischemia and predict the left ventricular function improvement in the chronic phase of disease while reducing the exposure dose.

Considering the late ossification potential of spheno-occipital synchondrosis (SOS), it can be used as a tool to estimate age in adolescents. The time of SOS fusion is known to vary in different populations.

This study aimed to assess the degree of SOS fusion in Iranian individuals, using cone-beam computed tomography (CBCT) scan.

The CBCT images of 240 patients (126 females and 114 males), aged 6 - 25 years, were assessed regarding the degree of SOS fusion, based on a four-stage scoring system. Spearman’s correlation coefficient test and regression analysis were performed to assess the correlation between age and fusion stage. Mann-Whitney test was also applied to determine differences between males and females. Besides, Kruskal-Wallis test was used to assess differences in the median values.

The SOS was completely open at the mean age of 7.63 years in females and 8.85 years in males. The mean age of partially fused SOS (stage 1) was eight years in females and 10 years in males. Besides, the mean age of completely fused SOS (stage 3) was 12 years in females and 16 years in males. The results of Spearman’s correlation coefficient test showed a significant positive relationship between age and the degree of SOS fusion in males and females (rs = 0.783, P < 0.001 in females and rs = 0.911, P < 0.001 in males).

The SOS closure degree can be applied for age estimation in the Iranian population. This study presented a method which is highly accurate for age estimation.

Breast microcalcifications are a category of lesions that can lead to malignancies. They remain a major concern in imaging of suspected cases. Vacuum-assisted biopsy (VAB) has been proposed as a safe and effective measure to evaluate microcalcifications.

The present study aimed to assess the results of VAB for breast microcalcifications.

This cross-sectional study was conducted on patients with microcalcifications detected on mammograms. Patients were recruited through simple random sampling during 2019 - 2020, based on the inclusion criteria. The inclusion criteria were microcalcifications on mammography, classified as the breast imaging-reporting and data system (BI-RADS) categories 3, 4B, 4C, and 5, and undergoing mammography-guided VAB for the microcalcifications. Patients with missing data and those who could not be followed-up for at least six months were excluded from the study. They were assessed regarding different imaging characteristics of lesions, including the breast density, BI-RADS classification, microcalcification distribution and morphology, and other demographic and clinical features before biopsy. Additionally, the results of stereotactic-guided VAB were assessed for various benign and malignant pathologies of microcalcifications. The results of descriptive and analytical tests for various radiological and pathological features of lesions were reported.

A total of 257 patients, with a mean age of 50.3 ± 8.3 yars, were included in this study. Almost half of the patients (n = 125, 48.6%) had a C-grade breast composition. Regarding the BI-RADS classification, 206 (80.2%) patients were diagnosed with 4B lesions, followed by 44 (17.1%) patients with 4C lesions. The assessment of the pattern of microcalcification distribution in imaging showed that more than half of the patients (n = 148, 57.6%) had lesions in multiple groups. The most prevalent morphology of microcalcifications was punctate amorphous (n = 109, 42.4%). The majority of patients (n = 180, 70%) had benign findings in the pathological assessment, and only 69 (26.8%) had malignant features in pathology. The distribution of malignancies differed among various BI-RADS categories. In the 4B category of lesions, there were 166 benign lesions versus 32 malignant lesions, while in the 4C category, there were 10 benign lesions versus 34 malignant lesions (P < 0.001).

This study described the findings of successful stereotactic-guided VAB for breast microcalcifications. VAB can be implemented as a promising assessment tool to evaluate suspected breast microcalcifications effectively.

Hepatocellular carcinoma (HCC) is currently the fourth most common malignant tumor and the second most fatal tumor in China, posing serious threats to the health and life of individuals.

This retrospective study aimed to investigate the treatment benefits and side effects of transarterial chemoembolization with drug-eluting bead microspheres (DEB-TACE) for HCC patients with conventional TACE (cTACE) resistance.

A total of 17 HCC patients with cTACE resistance, treated by DEB-TACE, were retrospectively analyzed from July 2017 to December 2019. According to the modified response evaluation criteria in solid tumors (mRECIST), the efficacy of treatment was classified into complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD), and the objective remission rate (ORR) and the disease control rate (DCR) were also measured at 6 and 12 weeks post-DEB-TACE treatment. Changes in liver enzymes, routine blood tests, and alpha-fetoprotein (AFP) levels were also documented. Besides, the patients’ adverse reactions were observed within one week after surgery to assess the safety of DEB-TACE therapy.

In patients with cTACE resistance, the CR, PR, SD, PD, ORR, and DCR were 0, 35.29%, 47.06%, 17.65%, 35.29%, and 82.35% at six weeks after DEB-TACE and 5.88%, 47.06%, 29.41%, 17.65%, 52.94%, and 82.35% after 12 weeks, respectively. In the first week after DEB-TACE, the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, and white blood cells elevated temporarily (P < 0.05), and side effects, such as slight pain, fever, nausea, and vomiting, occurred after surgery. Following liver protection and symptomatic treatment, the patients recovered well.

Based on the results of this study, DEB-TACE has treatment benefits and few side effects for HCC patients with cTACE resistance.

Bronchobiliary fistula (BBF) is a rare, but serious disease; therefore, early diagnosis and treatment are essential. Recently, the use of a minimally invasive procedure that directly embolizes the BBF has emerged as a useful therapeutic alternative for conventional treatments, such as drainage tube insertion or fistulectomy. Here, we report a case of a 56-year-old man, who was successfully treated with percutaneous transhepatic embolization using n-butyl cyanoacrylate and microcoils and was symptom-free for two years after the procedure. Percutaneous transhepatic embolization can be a successful alternative option for the treatment of BBF. Improved outcomes are expected in long-term follow-ups, especially when n-butyl cyanoacrylate and microcoils are used together.

Minor complications have been reported following extracorporeal shock wave lithotripsy (ESWL), including renal colic, gross hematuria, urinary obstruction, and hematoma. Some rare major complications have been also reported, such as abscess formation, acute pancreatitis with abscess, and splenic rupture. Here, we present the computed tomographic (CT) findings of a patient with necrotizing fasciitis, along with abscess formation after ESWL, which rapidly invaded the neck, chest, and abdominal wall.

A 67-year-old woman presented with persistent cough, intermittent nausea, and progressive right flank pain for one month after ESWL, which was performed for a right upper ureteral stone, measuring 1.2 × 0.3 cm, with right hydronephrosis detected on abdominal X-ray and renal ultrasound. The initial abdominal CT scan showed perirenal and pararenal hematoma of the right kidney, extending to the right posterior pararenal space, right psoas muscle, and right paraspinal region. Empiric antibiotic treatment was prescribed for the patient. After one week of treatment, the follow-up CT scan showed perirenal and pararenal abscesses with necrotizing fasciitis, invading the posterior region up to the paraspinal region and then migrating upward to the chest wall, axillary, supra-clavicular, and infra-clavicular regions, and the neck. The abscess also caused downward damage to the abdominal wall. Four weeks after a surgical intervention, the inflammatory process almost resolved.

Although the possibility of post-ESWL necrotizing fasciitis is acutely low, it is important to consider this fatal complication.

Otorrhagia is not a common manifestation of petrous internal carotid artery (ICA) aneurysm. Besides idiopathic cases, different etiologies, including trauma, infection, and radiation, have been suggested for petrous ICA aneurysms/pseudoaneurysms. However, there is limited experience in the management of this rare aneurysm/pseudoaneurysm with coil embolization.

A 58-year-old man, who was a known case of chronic otitis media, was referred from the otorhinolaryngology ward with intractable bleeding from the right ear. A pseudoaneurysmal lesion (7 mm × 5 mm) was detected in the petrous segment of the internal carotid artery. The patient underwent coil embolization with no complications.

To the best of our knowledge, this is the first case of petrous ICA pseudoaneurysm, presenting with only intractable otorrhagia. The patient was successfully treated with coil embolization, with no need for further interventions. Besides, a review of petrous ICA aneurysms or pseudoaneurysms presenting with otorrhagia was performed.