Iranian Journal of Radiology
Volume:19 Issue: 3, Jul 2022

Pulmonary embolism (PE) is a potentially fatal condition. Knowledge of the prognostic factors for PE may facilitate the management of these patients. Pulmonary computed tomography (CT) angiography (PCTA) can play an effective role in their management.

To evaluate the prognostic value of certain PCTA-derived indicators of right ventricular dysfunction in patients with acute PE.

A total of 61 hemodynamically stable patients with acute PE underwent PCTA and were followed-up for 60 days. The Qanadli index and 60-day mortality represented the PE severity and prognostic endpoints, respectively. The clinical significance of the following variables in predicting PE severity and mortality was examined: An abnormally positioned interventricular septum, right ventricular to left ventricular diameter ratio (RVD/LVD) on the axial plane, contrast medium reflux into the inferior vena cava (IVC), transverse diameter of the pulmonary trunk, and bolus-time curve indicators.

The 60-day mortality was estimated at 14.8% in this study. An abnormal interventricular septum morphology, RVD/LVD ratio, and contrast medium reflux into the IVC were significantly correlated with the Qanadli index. The pulmonary trunk diameter was the only predictor of 60-day mortality (optimal cutoff value, 33.5 mm; sensitivity, 66.7%; and specificity, 65.4%). The bolus-time curve indicators did not have any significant predictive value.

Some PCTA-derived indicators of right ventricular dysfunction may serve as severity/prognostic predictors in hemodynamically stable patients with acute PE.

Preeclampsia can increase the risk of cardiovascular diseases (CVDs) later in life. Also, increased intima-media thickness (IMT) of the carotid artery was introduced as an independent risk factor for CVDs.

This study aimed to evaluate and compare the IMT of carotid and femoral arteries between women with early preeclampsia and normotensive pregnant and nulligravid women.

In this study, which was conducted between May 2019 and January 2020, three groups of women were evaluated: early-onset preeclamptic pregnant women, normotensive pregnant women, and nulligravid women. The IMTs of the common femoral artery, superficial femoral artery, common carotid artery, carotid bulb, and internal carotid artery were measured using B-mode ultrasound.

A total of 100 women were enrolled in each group. The means ± SD of age in preeclamptic, normotensive and nulligravid women were 27.78 ± 3.23, 27.16 ± 3.09, and 27.11 ± 2.95, respectively. The mean gestational age of the two pregnant groups was nearly 32 weeks. Based on the results, the mean systolic blood pressure, diastolic blood pressure, and arterial pressure were significantly higher in the preeclamptic group compared to the other groups (P < 0.001). The mean IMT of both sides of the common carotid artery, carotid bulb, internal carotid artery, common femoral artery, and superficial femoral artery was significantly higher in the preeclamptic group compared to normotensive pregnant and nulligravid women (P < 0.001).

Preeclampsia was associated with the increased IMT of common and internal carotid arteries, as well as common and superficial femoral arteries. Therefore, IMT measurements in preeclamptic women can provide an opportunity to identify those who may benefit from early screening and preventive care to reduce the risk of CVDs in the future.

Accurate differentiation of angiomyolipoma (AML) from renal cell carcinoma (RCC) is important in RCC diagnosis.

This study aimed to evaluate the performance of different supervised machine learning (ML) algorithms for RCC based on computed tomography (CT) examinations.

The CT images of known cases of RCC or renal AML were collected and divided into training and testing groups. The texture features of CT images were drawn and quantified in MaZda software; a total of 352 features were drawn from each image. Top 10 features with statistical significance for differentiation of RCC from benign tumors in the training group were selected to establish diagnosis models based on 16 supervised ML algorithms. Next, the models were compared regarding accuracy and specificity. The trained models were further examined by comparison with data from the testing group.

Among 16 classifiers trained in this study, the logistic regression, linear discriminant analysis, k-nearest neighbor algorithm, support vector machines (SVMs), ridge classifier, AdaBoost classifier, gradient boosting classifier, and CatBoost classifier showed good performance in discriminating RCC from AML (accuracy, ≥ 0.7; area under the (receiver operating characteristic (ROC)) curve (AUC) ≥ 0.75) in both training and testing datasets.

Based on the ML algorithms for big data, diagnostic classifiers can be valuable tools for an accurate diagnosis of RCC. By comparing different algorithms, the present results indicated potential algorithms for the development of RCC diagnostic classifiers.

The application of multislice spiral computed tomography (MSCT) scan has improved the diagnosis of small bowel diseases (SBDs).

This study aimed to develop a structured report (SR) template for SBDs based on MSCT scans and to compare its value with free-text reports (FTRs) by radiologists with different levels of seniority in radiology.

A total of 120 SBD cases were confirmed based on the clinical manifestations, surgery, colonoscopy, and pathology. An SR template for small bowel imaging was developed, and six radiologists were divided into inexperienced and experienced groups. Sixty cases with small intestinal MSCT data were available for FTRs and another 60 cases for SRs after training. The report accuracy, satisfaction, and completion time were compared between the two reporting methods.

The writing time of SRs was significantly shorter than that of FTRs. By using FTRs, the experienced group showed higher levels of sensitivity for all diseases (i.e., intestinal wall, intestinal peripheral artery, blood vessel, bone, and other abdominal organ diseases) (P < 0.05). The experienced group showed a low misdiagnosis rate for all diseases (P < 0.05), except for bone disease (P = 0.161). By using SRs, the experienced group only showed a low misdiagnosis rate for the intestinal wall disease (P < 0.05). High sensitivity for the intestinal wall disease (P < 0.05) and intestinal peripheral artery disease (P = 0.024), along with improved sensitivity for bone lesions (P < 0.05), was reported in this group. In the inexperienced group, SRs improved sensitivity for all diseases (P < 0.05), except for intestinal wall disease (P > 0.05). The satisfaction scores for both inexperienced and experienced groups improved by using SRs (4 vs. 2.6 for the inexperienced group and 4.1 vs. 3.2 for the experienced group; P < 0.05 for both).

The SRs were superior to FTRs in terms of writing efficiency, accuracy, and satisfaction. They could improve the accuracy of inexperienced radiologists in diagnosis and help detect SBDs.

The muscle volume considerably changes with aging, pathologies, mechanical loading and exercise, and immobilization. It is recognized as an important parameter that can be measured by various methods to evaluate the effectiveness of interventions focusing on muscle strengthening and function. However, before the application of any measurement method, their reliability needs to be investigated and established.

This study aimed to evaluate the inter- and intra-rater reliability of the manual measurement method of the abductor hallucis muscle volume in feet with hallux valgus deformities using magnetic resonance imaging (MRI).

The MRI images of the feet of 15 samples with a hallux valgus deformity were selected in this study. The cross-sectional areas of the abductor hallucis muscle were measured in the cuts along the entire length of the foot and multiplied by slice thickness. Two trained raters performed the measurements. The second rater repeated the measurements after five days to eliminate the memory effect. The intra-rater reliability and inter-rater reliability were assessed based on the intraclass correlation coefficient [ICC (2, 1)] to evaluate the extent of agreement between the raters at a 95% confidence interval.

The between- and within-rater ICCs were 0.92 (0.79 - 0.97) and 0.99 (0.97 - 0.99), respectively. The standard error of measurements was also small in both inter-rater (6.2%) and intra-rater (2.1%) reliability analyses.

The manually outlined slice-by-slice volume measurement of the abductor hallucis muscle based on MRI images showed excellent inter- and intra-rater reliability. The excellent intra-rater reliability, besides the lower standard error percentage of measurements, indicates the superiority of measurements by a single person. However, further studies with a larger sample size are recommended.

The consequences of coronavirus disease (COVID-19) pandemic, especially the financial burden imposed on the healthcare systems and hospitals, have been unpredictable around the world. Radiology wards have been exposed to the highest burden during this pandemic.

This study aimed to calculate the cost of diagnostic imaging services before and during the COVID-19 pandemic, using the activity-based costing (ABC) method in an important diagnostic center of COVID-19 in Khorramabad, Iran.

In this retrospective study, data were extracted from the hospital accounting sources in the radiology ward over two years (2019 - 2021). According to the ABC method, four types of cost were defined, including wage, supporting services, Consuming materials, and overhead expenses. Therefore, based on the monthly number of services, the unit cost of each service was calculated.

The unit cost of all services during the COVID-19 pandemic was higher than before, except for CT scan (before: 6.1 USD; during: 5.6 USD) (P = 0.008). The unit cost of MRI servicewas 5.7 USD before the pandemic and 7.1 USD during the pandemic (P = 0.57); the cost per radiography service was 1.8 USD before the pandemic and 7.1 USD during the pandemic (P = 0.01); and the cost per sonography service was 1.1 USD before the pandemic and 2.8 USD during the pandemic (P = 0.04). Finally, the cost of mammography increased dramatically during the pandemic (before the pandemic: 21.3 USD; during the pandemic: 48.2 USD) (P = 0.004).

The COVID-19 pandemic has increased the radiology department expenses. The cost of CT scan services decreased due to the large number of services provided compared to the pre-pandemic period.

Although breast cancer is the most prevalent type of cancer among Iranian women, its screening is opportunistic in Iran. The available guidelines for breast cancer screening are based on mammography. A screening modality should have adequate diagnostic accuracy and be widely available at reasonable cost. Although mammography is highly accessible in Iran, its accuracy has not been investigated.

This study aimed to evaluate the accuracy of mammography in opportunistic screening regarding the current rate of patient attendance.

A total of 491 women undergoing screening mammography were followed-up based on their medical records. They were divided into positive and negative screening groups, based on the breast imaging-reporting and data system (BI-RADS) categories and approaches. To evaluate the disease status of positive cases, pathology reports were investigated, and negative cases were followed-up for stability over time.

In the study sample, sensitivity was estimated at 73.08% (95% CI: 55.21 - 88.93), specificity was estimated at 94.41% (95% CI: 91.91 - 96.32), and accuracy was 93.28% (95% CI: 90.69 - 95.33). These test accuracy indices were not significantly different between the groups regarding age, family history, breast density, and history of breast interventions.

The test’s sensitivity or ability to detect a disease was relatively low in opportunistic screening; it was found to be similar to the results of studies of first time implementation of screeninng. In both settings, a test needs to diagnose both incident and prevalent cases. The overall accuracy of mammography was acceptable, even in opportunistic screening.

46,XY pure gonadal dysgenesis (PGD) is also known as Swyer syndrome. The chromosome analysis indicates a 46,XY karyotype. As different degrees of gonadal hypoplasia or degeneration occur in the process of embryonic development due to several factors, gonadal dysplasia or gonadal tumors are probable.

The patient was a 22-year-old female with no menstruation during puberty. Her chest was funnel-shaped, the breast development was classified as Tanner III grade, the vulva was normal, the pubic hair was classified as Tanner II grade, and the vaginal long was 6 cm. The endocrine examination indicated a follicle-stimulating hormone level of 95.0 mIU/mL and an estradiol level of 34.0 pg/mL. Tumor markers, including alpha-fetoprotein (AFP), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), and carcinoembryonic antigen (CEA), were normal. Dual-energy X-ray absorptiometry revealed that the bone mineral density was lower than the normal range at this age. Ultrasonography showed a hypoechoic mass in the left adnexal area, considering gonadal tissue with calcification. Pelvic MRI indicated a gonadal malignancy, and the gonadal tissue of the right adnexal area was cord-shaped. The chromosome analysis indicated a 46,XY karyotype. Accordingly, a clinical diagnosis of PGD was established. Moreover, laparoscopic gonadectomy and pathological examination were performed, and a final diagnosis of Swyer syndrome, complicated with a left-sided gonadoblastoma and asexual cell tumor, was made.

PGD is associated with a high risk of gonadal tumors. Considering the rarity of this disease, a detailed evaluation of gonadal size and timely preventive gonadectomy are recommended for patients with gonadal dysplasia. Overall, imaging examinations can provide important information for the diagnosis of gonadal dysplasia. MRI can clearly indicate the size and shape of the gonads and the tumor, as well as the relationship between the tumor and the surrounding tissue.

The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions.

This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART.

Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated.

In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively.

In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression.

There is no gold standard diagnostic test for endolymphatic hydrops (EH). Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging has been reported to depict EH with administration of gadolinium-based contrast media (GBCM). However, the optimal scan interval and angulation remain unknown in 3D-FLAIR labyrinthine imaging following double-dose injections of a gadolinium-based contrast agent in patients with vertigo and sensorineural hearing loss.

This study aimed to determine the optimal parameters of 3D-FLAIR labyrinthine imaging, including the optimal scan angulation and scan interval, for patients with sensorineural hearing loss and vertigo.

In this cross-sectional clinical study, following the double-dose administration of a gadolinium contrast agent, 3D-FLAIR labyrinthine images were acquired from 22 patients with unilateral vertigo and sensorineural hearing loss at different intervals after injection. The corresponding contrast-to-noise ratios (CNRs) and signal-intensity ratios (SIRs) of these images, acquired at different intervals, were measured. Moreover, separate visualization of endolymphatic and perilymphatic spaces was scored, and angulation of the anterior skull base scan was investigated in the sagittal position.

The 3D-FLAIR images showed the strongest image contrast in the cochlea with a double-dose gadolinium-based contrast injection at six hours post-injection. Significantly higher SIR and CNR values were reported at six hours post-injection in both unaffected and affected ears compared to other intervals (4 h vs. 6 h in the affected side, SIR: 1.65 ± 0.24 vs. 2.09 ± 0.47, CNR: 13.88 ± 5.54 vs. 19.17 ± 6.81; in the unaffected side, SIR: 1.58 ± 0.27 vs. 1.82 ± 0.34, CNR: 12.20 ± 3.88 vs. 15.42 ± 4.58, P < 0.001 for all; 6 h vs. 8 h in the affected side: SIR: 2.09 ± 0.47 vs. 1.72 ± 0.43, CNR: 19.17 ± 6.81 vs. 12.22 ± 4.96; in the unaffected side, SIR: 1.82 ± 0.34 vs. 1.57 ± 0.30, CNR: 15.42 ± 4.58 vs. 10.61 ± 3.87, P < 0.001 for all). Visualization of the endo- and perilymphatic spaces for both the cochlea and vestibule was significantly better at six hours post-injection compared to four hours post-injection in both affected sides (P < 0.05 for both). The optimal angulation ranged from 6.20° to 13.6° (P < 0.001).

By using an optimal scan interval, together with an optimal scan angulation, 3D-FLAIR imaging can reliably visualize the endolymphatic space and sensitively indicate cochlear blood-labyrinth barrier disruptions without requiring extra image reconstruction.

There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics.

This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and

The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant.

In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 millisievert (mSv). There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017).

In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.