Iranian Journal of Radiology
Volume:20 Issue: 1, Jan 2023

Context:

 Transarterial embolization/chemoembolization (TAE/TACE) has been shown to be effective against ruptured hepatocellular carcinoma (HCC). However, the early clinical mortality remains unpredictable.

 To conduct a comprehensive quantitative evaluation of early mortality after emergency TAE/TACE for spontaneous HCC rupture and to perform an overall analysis of risk factors to gather more representative data.

 The PubMed/Medline, Web of Science, and Embase databases were searched, and relevant studies were retrieved using the corresponding English keywords. Next, the literature was screened according to the inclusion and exclusion criteria. Finally, Stata version 15.1 and R Project 4.1.2 were used for meta-analysis.

 A total of 24 studies (n = 1,083) were included in this meta-analysis. The combined 30-day mortality following emergency TAE/TACE for spontaneous HCC rupture was 28.8% (95% confidence interval (CI): 23.4 - 34.4%). After correcting for publication bias, the combined 30-day mortality rate was estimated at 28.1% (95% CI: 22.7 - 33.6%). The results of subgroup and regression analyses also revealed that preoperative liver cirrhosis and bilobar tumor distribution were significantly associated with increased 30-day mortality following TAE/TACE (P < 0.05 for all). After re-stratification of studies by publication time, it was found that the 30-day mortality after TAE/TACE treatment for spontaneous HCC rupture has decreased significantly in the past two years (P = 0.0074); the corresponding value was 19.1% (95% CI: 14.3 - 24.3%) during 2020 - 2021 and 31.6% (95% CI: 26.4 - 36.9%) during 2001 - 2010. Three independent factors, including liver cirrhosis, bilobar tumor distribution, and period of time, may be potential factors for heterogeneity.

 In recent years, although early mortality has significantly reduced after emergency TAE/TACE for spontaneous HCC rupture, it is still not negligible. Before TAE/TACE, it is necessary for clinicians to predict the adverse outcomes, as well as the risk factors and disease-related factors, and to formulate appropriate intervention measures.

 In the past several years, emerging imaging techniques, such as computed tomography angiography (CTA), Doppler ultrasound, and magnetic resonance imaging (MRI), have been used for investigating the anatomy and perfusion of perforator complexes. Preoperative CTA can provide explicit information on perforator flaps, which not only helps surgeons to evaluate the optimal design of flaps with respect to the lateral circumflex femoral artery (LCFA) territory and the concomitant venous drainage pattern, but also reduces postoperative complications and secondary operation rates.

 This study aimed to evaluate the clinical feasibility of a low-dose CTA protocol with adaptive statistical iterative reconstruction (ASIR) for patients scheduled for anterolateral thigh perforator flap (ALTPF) surgery.

Patients and Methods:

 This prospective randomized controlled trial was conducted in a single institution from August 2016 to July 2017. A total of 60 inpatients scheduled for the ALTPF surgery were randomly allocated into three groups (n = 20 per group): group A, filtered back projection (FBP) reconstruction with a tube voltage of 120 kVp; group B, ASIR with a tube voltage of 100 kVp; and group C, ASIR with a tube voltage of 80 kVp. The vessel attenuation value, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) were compared between the three groups. Additionally, a four-point Likert scale was used to evaluate the subjective quality of images. The scan length, dose-length product (DLP), CT dose index (CTDI), and effective dose (ED) were also recorded and compared.

 The age, sex, and body mass index (BMI) were not significantly different between the three groups (P > 0.05 for all). The FOM of images in the three segments was significantly higher in group C compared to the other two groups (P < 0.001 for all). The results of subjective evaluation revealed no poor-quality images, and the Likert score did not significantly differ between the groups. Compared to group A and group B, significant reductions were observed in CTDI, DLP, and ED in group C.

 The 80-kVp protocol with ASIR not only reduced the radiation dose, but also exhibited lower performance compared to the 120-kVp protocol with FBP and the 80-kVp protocol with ASIR; it also yielded relatively satisfactory image quality.

 Biolaser is an emerging technology, which has attracted the attention of many surgeons and specialists in different medical fields.

 This study aimed to evaluate the clinical effectiveness of ultrasound-guided biolaser radiation versus ozone therapy in reducing chronic pain in patients with knee osteoarthritis during a three-month follow-up.
Patients and

 Sixty patients referring to pain clinic of Shohadaye-Tajrish and Akhtar hospitals in 2017, were included in this randomized single-blind clinical trial study. According to a randomized table of numbers, in Biolaser group (n = 30): 10 mL of normal saline + 5 mL of lidocaine 1% + BioLaser + Physical Therapy and in the Ozone group (n = 30), received 10 mL Ozone (30 mic/mL) plus 5 mL lidocaine 1% + BioLaser placebo + Physical Therapy received. The patients were evaluated for pain using VAS and knee function with KOOS questioner. The patients were followed up 4 & 12 weeks and reviewed at weeks 12 after the injection by an observer who was unaware of the groups (IRCT20111121008146N15).

 Comparison of the mean age (56.8 ± 8.5 years in the biolaser group vs. 51.5 ± 5.4 years in the ozone therapy group; P = 0.721) and body mass index (31.1 ± 3.4 kg/m2 in the biolaser group vs. 30.5 ± 2.6 kg/m2 in the ozone therapy group; P = 0.214) did not indicate any significant differences between the two groups. The pain severity decreased significantly at different times in the biolaser and ozone therapy groups (P = 0.018). The knee pressure sensitivity score was 1.3 ± 0.5 in the biolaser group and 1.6 ± 0.4 in the ozone therapy group at 12 weeks post-treatment (P = 0.037). The knee circumference was also 35.6 ± 3.0 cm in the biolaser group and 39.7 ± 3.9 cm in the ozone therapy group at 12 weeks post-treatment (P = 0.032). The KOOS performance score was 46.9 ± 9.4 in the biolaser group and 49.3 ± 7.9 in the ozone therapy group (P = 0.187). Besides, the KOOS quality of life score was 10 ± 1.3 in the biolaser group and 10.4 ± 1.5 in the ozone therapy group (P = 0.586).

 Biolaser therapy under ultrasound guidance was found to be a safe, non-invasive, and effective method, which could improve chronic pain in knee osteoarthritis during a three-month follow-up.

 The quality of positron emission tomography/computed tomography (PET/CT) images plays an important role in tumor detection. This imaging method often yields poor-quality images of overweight patients due to the high level of noise, originating from scattering and photon attenuation.

 The point spread function (PSF) is mostly used to enhance the spatial resolution and signal-to-noise ratio (SNR); however, it is known to increase the edge artifacts. The time-of-flight (TOF) principle can reduce edge artifacts in PSF modeling and improve lesion detection, especially in the thorax. The present study aimed to assess these two new techniques by applying different reconstruction parameters.

 An in-house phantom with an inner diameter of 35 cm was used for the simulation of overweight patients. Lesion-to-background ratios (LBRs) of 2: 1 and 8: 1, as well as background activity concentrations of 3 and 5 kBq/cc, were considered in this study. The list-mode data were reconstructed with various reconstruction protocols, numbers of subsets, and filter sizes. Quantitative analyses, including the coefficient of variation (COV), SNR, and recovery coefficient (RC), were also carried out. Moreover, box-and-whisker plots were performed.

 At LBR of 2: 1, by changing the protocol from ordered subset expectation maximization (OSEM) to OSEM + PSF + TOF, the median value of SNR for 13-mm lesions (37 mm) increased by 39.25% and 53.45% (42.22% and 56.21%), at background activity concentrations of 3 and 5 kBq/cc respectively. However, at LBR of 8: 1, the corresponding values were 33.22% and 48.94% (40.22% and 52.15%) at background activity concentrations of 3 and 5 kBq/cc respectively.

 The TOF protocols were strongly recommended for both background activity concentrations at LBR of 2: 1 and for the low background activity concentration at LBR of 8: 1, especially when using smaller filter sizes. Moreover, subset numbers of 18 and 24 were appropriate for all protocols. However, a smaller subset number was suitable when a low background activity concentration and a smaller filter size were applied, especially at a lower LBR.

 Cystic and cavitary lung cancer (CCLC) is infrequently observed on computed tomography (CT) scans; however, its diagnosis is often overlooked or delayed.

 The current study aimed to investigate the CT and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) features of CCLC.

Patients and Methods:

 A total of 809 patients who underwent lung tumor resection were examined in this study, and the presence of cystic and cavitary lesions on CT scans was investigated. Based on the CT scans, CCLC was identified in 102 consecutive patients. The diameters of the whole nodule and the airspace portion of the lesion, morphological patterns of cystic and cavitary lesions, presence of ground glass opacity (GGO), and loculation pattern (including the presence of a septum) were evaluated. The positron emission tomography (PET) scans of CCLC were also assessed visually and semi-quantitatively.

 A total of 104 CCLC lesions were evaluated in this study. The histological analysis indicated 85 cases of adenocarcinoma (AD) and 19 cases of squamous cell carcinoma (SCC). The morphological patterns of cystic and cavitary lesions were classified into four types. The presence of GGO, type 4 morphological pattern (a soft-tissue-density structure intermixed within clusters of a cavitary lesion), and multilocular with septum (MS) loculation pattern were significantly different according to the histological type. The maximum standardized uptake value (SUVmax) on PET scans was significantly lower in AD compared to SCC (P = 0.002). In the solid nodule part of cystic and cavitary lesions, the MS pattern was significantly more common in AD (P = 0.044).

 When cystic and cavitary lesions are observed on CT scans, the presence of GGO and the MS pattern should be considered, as it may help differentiate the histological findings.

 Temporomandibular joint disorders (TMDs) are the most common cause of non-odontogenic pain in the maxillofacial region. Internal derangement (ID) is one of the most prevalent causes of TMDs, and disc displacement is recognized as the most common ID. The masticatory muscles are among anatomical structures involved in TMDs that may be affected by ID.

 This study aimed to evaluate the correlation between the masticatory muscle dimensions and ID of temporomandibular joints using magnetic resonance imaging (MRI).

Patients and Methods:

 This cross-sectional study was conducted on the MRI images of 145 patients, retrieved from the archives of the MRI diagnostic and research center during 2020 - 2021. The patients were categorized into three main groups of normal disc position (NP) (n = 42), disc displacement with reduction (DDR) (n = 54), and disc displacement without reduction (DDWR) (n = 49). The maximum width and height of the masseter and medial pterygoid muscles and the maximum height and length of the superior and inferior heads of the lateral pterygoid muscle were measured on MRI images for each of the groups. Data were analyzed using t-test, Pearson’s correlation test, ANOVA test, and Tukey’s test (alpha < 0.05).

 Significant differences were observed between the NP, DDR, and DDWR groups regarding the height (P < 0.001) and length (P < 0.001) of the superior head of the lateral pterygoid muscle; both parameters were significantly higher in the NP group, followed by the DDR and DDWR groups (P < 0.05). The dimensions of masticatory muscles were significantly greater in males than females (P < 0.05), except for the width of the medial pterygoid muscle (P = 0.064). The height of the masseter muscle (r = 0.190, P = 0.022) and the medial pterygoid muscle (r = 0.166, P = 0.046) was significantly correlated with age.

 Significant correlations were found between the height and length of the superior head of the lateral pterygoid muscle and ID of TMJ; the corresponding values were lower in the DDWR group compared to the DDR and NP groups, respectively.

 The virtual touch quantification (VTQ) using acoustic radiation force impulse (ARFI) is a type of ARFI technology, which has been widely used against many diseases. The sensitivity and specificity of VTQ in differentiating immunoglobulin A nephropathy (IgAN) patients from healthy controls remain unestablished.

 The present study aimed to measure the VTQ values of renal parenchyma in patients with IgAN and to evaluate the efficacy of these values in distinguishing IgAN patients from healthy individuals.

Patients and Methods:

 Ultrasound examinations were performed for the experimental and control groups. All routine ultrasound data, including the renal parenchymal thickness, renal volume, resistive index (RI) of interlobar renal arteries, and peak velocity of interlobar renal arteries, were collected. The VTQ values were measured in the middle and lower renal parenchyma using the VTQ technique. A receiver operating characteristic (ROC) curve was plotted to evaluate the efficacy of VTQ in differentiating IgAN patients from healthy individuals.

 The VTQ values, RI values of interlobar arteries, and peak velocity of interlobar arteries were significantly different between patients with IgAN and the controls (2.14 ± 0.31 vs. 2.62 ± 0.24 m/s, 0.68 ± 0.05 vs. 0.63 ± 0.03 m/s, and 0.56 ± 0.59 vs. 0.60 ± 0.58 m/s; P < 0.05 for all). The VTQ values were associated with the renal parenchymal thickness, peak flow velocity of interlobular arteries, and Lee’s grade (P < 0.05 for all). The ROC curve analysis revealed that VTQ values might be used as a diagnostic method for differentiating IgAN patients (area under the curve (AUC) = 0.909) from healthy controls.

 The VTQ values significantly decreased in patients with IgAN and might play an important role in distinguishing IgAN patients from healthy individuals, with high sensitivity and specificity.

 Inflammatory myofibroblastic tumors (IMTs) of the gastrointestinal (GI) tract are rare phenomena, and the computed tomography (CT) findings of GI IMTs are not well-established.

 To describe the characteristics of CT scans, pathological specimens, and histological subtypes of GI IMTs in adults.

Patients and Methods:

 The multidetector computed tomography (MDCT) scans of 11 adult patients (8 males, 3 females; age range, 19 - 76 years) with pathologically proven GI tract IMTs (stomach, small bowel, and colon) were retrospectively evaluated by two abdominal radiologists. The radiological features of IMTs were investigated. The imaging features were correlated with three microscopic IMT subtypes (myxoid vascular, spindle cell, and hypocellular fibrous). Immunohistochemistry was also performed on the specimens, including smooth muscle actin (SMA), vimentin, desmin, S-100, and anaplastic lymphoma kinase.

 The tumor size ranged from 1.4 to 15 cm (mean, 5.7 cm). Two growth patterns were classified, namely, wall-thickening (n = 3) and solitary mass-forming (n = 8) patterns; each pattern was matched with a characteristic pathological subtype. All solitary, well-circumscribed masses corresponded to the spindle cell type. Low-attenuation wall thickening with perienteric infiltration was observed in three patients with a wall-thickening pattern. All solitary, well-circumscribed masses (n = 8) showed homogeneous enhancement with variable internal low attenuation, correlated with cystic degeneration, necrosis, myxoid change (n = 6), and hemorrhagic necrosis (n = 2). No patient showed bowel obstruction, while one patient showed regional lymphadenopathy. Immunophenotypes were not correlated with any growth pattern or histological subtype.

 The GI IMTs can be classified into two patterns, including wall-thickening and well-circumscribed masses, each matched with a characteristic pathological subtype, which can help explain the tumor behavior. Concomitant CT findings may also provide diagnostic clues for IMT.

 T-cell lymphomas constitute a heterogeneous group of hematological malignancies with global poor outcomes. Computed tomography (CT)-based texture analysis (CTTA) is a promising technique to predict the survival of these patients.

 The present study aimed to investigate whether CTTA features on the pretreatment unenhanced CT scans of 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) examination can predict the survival of patients with T-cell lymphomas.

Patients and Methods:

 In this retrospective cohort study, patients with T-cell lymphomas, undergoing pretreatment 18F-FDG PET/CT scan during 2008 - 2019, were included, and their clinical and biological characteristics were collected. The mean gray value, entropy, kurtosis, skewness, and standard deviation were derived from the pixel distribution histogram before and after spatial filtration at different anatomic scales in up to five lesions per patient, indicating a high focal uptake on 18F-FDG PET scan. A Lasso-penalized Cox regression analysis was performed to identify independent predictors of overall survival (OS), progression-free survival at 24 months (PFS24), and PFS.

 A total of 23 patients (7 females and 16 males; median age, 69 years; age range, 33 - 86 years) were included in this study. The CTTA was performed for 60 lesions. The median OS and PFS were 391 days (range, 10 - 3,463 days) and 268 days (range, 10 - 2,321 days), respectively. No CT texture parameter was associated with PFS or PFS24. The standard deviation at a coarse filter scale was independently associated with a poor OS (HR = 1.009, CI: 1.0012 - 1.016, P = 0.02). A value above 143 was associated with a poor prognosis with a specificity of 81%.

 The pretreatment CTTA-derived tumor standard deviation at a coarse filter scale may be a predictive biomarker of OS in patients with T-cell lymphomas.

 Myoepithelial carcinomas are rare malignant neoplasms, which are known to arise from the salivary glands or other organs.

 Here, we present a case of myoepithelial carcinoma in a 64-year-old woman, presenting to a clinic with a painful ankle mass for the past three years. Ultrasonography showed a 1 cm, iso- to hypoechoic mass on the medial malleolus of the right ankle. Magnetic resonance imaging (MRI) revealed a well-defined mass with iso-signal intensity on T1-weighted images and high signal intensity on T2-weighted images. On the enhanced image, the mass showed homogenous enhancement. In diffusion-weighted images with a high b-value, the lesion showed restriction with a low apparent diffusion coefficient (ADC). Surgical removal was performed, and pathological analysis revealed myoepithelial carcinoma.

 Myoepithelial carcinoma of the extrasalivary glands is a very uncommon phenomenon. Despite its rarity, it should be considered as a differential diagnosis when a soft tissue mass of the ankle shows malignant potential in radiological findings.