Iranian Journal of Radiology
Volume:21 Issue: 2, Apr 2024

 The diameter of the appendix is a key parameter in diagnosing appendicitis. The diagnostic threshold for this parameter is 6 mm, originally established through graded compression sonography of the right lower quadrant (RLQ) of the abdomen. However, without corroborative findings from computed tomography (CT), this threshold may not be a reliable indicator of appendicitis. To ensure accurate diagnosis, clinicians should perform a comprehensive, multiparameter imaging assessment of the appendix, rather than relying solely on appendix diameter.

 This study aimed to identify key factors for predicting appendicitis using contrast-enhanced coronal and sagittal CT images obtained through multiplanar reconstruction.
Patients and

 This single-center, retrospective, cross-sectional study included patients who presented to our emergency department (ED) with RLQ abdominal pain and subsequently underwent contrast-enhanced CT between July 2019 and September 2020. The primary study outcome was pathologically confirmed appendicitis. Two experienced radiologists assessed parameters such as appendix diameter, wall thickness, abnormal appendix enhancement, abnormal appendix content, appendix erection, and periappendiceal fat stranding. Multivariate logistic regression was performed to identify significant predictive factors for appendicitis.

 The study included 173 patients (median age: 37 years; women: 86). They were divided into appendicitis (n = 102) and alternative diagnosis (n = 71) groups. Significant differences were observed between the groups in terms of appendix diameter, wall thickness, wall enhancement, luminal content, appendix erection, and periappendiceal fat stranding (P < 0.001). The diagnostic sensitivity and specificity values for an appendix diameter threshold of 7.7 mm were 91% and 82%, respectively. An appendix diameter of > 7.7 mm (OR: 15.3; P < 0.001), abnormal appendix enhancement (OR: 12.5; P < 0.001), and appendix erection (OR: 6.1; P = 0.004) emerged as significant independent predictors of appendicitis.

 An appendix diameter of 7.7 mm appears to be the optimal threshold for diagnosing appendicitis. Additionally, the detection of abnormal appendix enhancement and appendix erection on contrast-enhanced CT images holds considerable diagnostic value.

The primary causes of short stature (SS) are idiopathic short stature (ISS) and growth hormone deficiency (GHD). The diagnosis of GHD relies on growth hormone stimulation tests (GHSTs), while the diagnosis of ISS is achieved through exclusion.

Growth hormone (GH) and insulin-like growth factor-I are the best therapeutic drugs for treating GHD, but their suitability for ISS remains controversial. Therefore, distinguishing between these two causes of SS is crucial. Currently, the diagnosis of GHD depends on GHSTs, whereas the diagnosis of ISS is achieved through exclusion, which is an invasive process. Thus, developing a noninvasive and convenient method to differentiate between GHD and ISS would be of great importance. Patients and

We enrolled patients aged 3 - 14 years who presented with SS and underwent GHSTs and pituitary gland (PG) magnetic resonance imaging (MRI) at our hospital from January 2020 to October 2022 for a cross-sectional study. A total of 205 patients were included, comprising 83 with ISS and 122 with GHD. The GHD patients were further divided into two groups based on the peak GH level in GHSTs. All patients underwent routine physical examinations, GHSTs, PG MRI, and X-rays of the left wrist. Two authors independently recorded the PG features (height, length, width, volume, pituitary stalk diameter, pituitary stalk length, and morphology). The PG morphology was categorized into three types: Convex, flat, and concave. Bone age was estimated from X-rays of the left wrist, which were reviewed by an experienced radiologist. Comparisons between the two groups were conducted using two independent samples t-tests or chi-square (χ²) tests.

There were no differences between the two groups regarding baseline clinical characteristics, except for the GH peak in GHSTs (P < 0.05). Pituitary stalk diameter, PG height, PG volume, and the dorsum sellae were significantly lower, while the tuberculum sellae was higher in the GHD group compared to the ISS group (all P < 0.05). The proportion of concave PG was higher, and the proportion of flat PG was lower in the GHD group (all P < 0.05). In subgroup analysis, PG height and PG volume were significantly lower in the absolute GHD (AGHD) group compared to the partial GHD (PGHD) group (all P < 0.05). Correlation analysis showed that PG height (r = 0.635, P < 0.01) and PG volume (r = 0.786, P < 0.01) were positively correlated with the GH peak level. Further analysis also demonstrated the differential diagnostic accuracy of PG height and PG volume, with high sensitivity (PG height: 66.3%; PG volume: 84.3%) and specificity (PG height: 85.2%; PG volume: 77.9%).

pituitary gland height, PG volume, and the concave type of PG morphology may be very helpful in the differential diagnosis of GHD and ISS.

The effect of microwave ablation on small hepatocellular carcinoma is not significantly different from that of surgical resection. Accurate assessment of the ablation effect is crucial for ensuring the safety and effectiveness of hyperthermia.

This study aimed to explore the feasibility and accuracy of supersonic shear wave elastography (SWE) in quantitatively evaluating the microwave ablation margin of the liver.

Three surgeons were each randomly assigned 4 Wuzhishan miniature pigs (WZSPs) to perform 12 ablation procedures at an ablation power of 40 W. Based on the ablation time, the lesions were divided into 15, 30, and 60- second groups. Immediately after ablation, SWE and modulus measurements were performed 5 times for each ablation lesion. The SWE data were expressed as mean ± standard deviation. Within-group and between-group comparisons were made using repeated measures analysis of variance.

A total of 144 effective ablations and 131 effective pathological results were obtained. Within the same ablation time, the elastic modulus increased in the surrounding normal tissue, ablation margin, and ablation center regions in a stepwise manner (P < 0.01). However, in the ablation center region, the elastic modulus decreased in a stepwise manner with the shortening of ablation time [60 s (97.16 ± 14.58 kPa) > 30 s (77.84 ± 9.64 kPa) > 15 s (38.92 ± 3.12 kPa)], with statistically significant differences (F = 2,131.832, P < 0.01). The elastic modulus of the ablation margin region at different ablation times remained between 22.68 - 23.56 kPa.

The elastic modulus range in the ablation margin region after microwave ablation is relatively fixed. Shear wave elastography aids in the quantitative evaluation of the ablation margin region of the liver and has high practical value in monitoring and evaluating ultrasound ablation.

Mammography is the most fundamental and widely used method for detecting breast abnormalities. Distinguishing malignant from benign lesions requires extracting relevant information, which can be challenging and timeconsuming for radiologists. Computer-aided diagnosis (CAD) techniques can serve as complementary diagnostic tools, assisting radiologists in the early detection and analysis of abnormalities in mammograms.

This study aimed to propose a CAD system for extracting significant features of abnormalities in breast mammograms using Curvelet transform and fractal analysis, and classifying breast tumors as malignant or benign based on the calculated features. Patients and

In this study, an efficient feature extraction method was applied, utilizing Curvelet transform and fractal analysis, on a dataset comprising 113 abnormal images from the Mammographic Image Analysis Society (MIAS) database, which included 62 benign and 51 malignant cases. The method yielded 575 features, but due to potential irrelevance or redundancy, a multi-objective optimization (MOO) approach based on a genetic algorithm (GA) for an artificial neural network (ANN), named GA-MOO-ANN, was proposed to obtain and focus on an optimal and effective feature set. As a result of this approach, a set of 17 efficient features was extracted. The proposed algorithm was implemented in MATLAB 2014a, and the performance metrics were calculated using 6-fold cross-validation.

The experimental results demonstrated exceptional performance, with an accuracy (Acc) of 98.2%, specificity (Sp) of 100%, sensitivity (Se) of 96.8%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 96.2%, and an impressive area under the curve (AUC) of 0.98, providing comparable results to other recent methods.

The current findings suggest that the proposed method could be a valuable tool for breast cancer diagnosis, potentially reducing the number of unnecessary breast biopsies. This method may lead to more efficient patient evaluation and earlier detection of breast tumors.

Femoral artery pseudoaneurysm is a well-known complication after conventional angiography. Today, the treatment of choice for this condition is noninvasive repair using manual ultrasound-guided compression.

This study aimed to evaluate the efficacy of a novel compression device in improving angiography-induced pseudoaneurysm treatment compared to manual ultrasound-guided compression repair. Patients and

A double-blind, randomized clinical trial was performed on patients with femoral angiography-induced pseudoaneurysm in the Radiology Department of Ghaem Hospital, Mashhad, Iran. Based on color Doppler ultrasound exams, patients diagnosed with a pseudoaneurysm within 72 hours of angiography were included in the study. Patients were excluded if they had complete blockage, complete pseudoaneurysm thrombosis, abscess, surface tissue infection, or open wound in the area. The patients were allocated to a manual ultrasound-guided compression group or a device-assisted compression group using simple randomization with a sealed envelope method. After collecting demographic data, the patients underwent an ultrasound exam of the groin to determine and record the size of the pseudoaneurysm and the ratio of thrombosis to open lumen. The therapeutic success rate was defined as complete lumen thrombosis after conducting the compression procedure one to three times. Also, the pain score was measured during compression using the Visual Analog Scale based on a scale of 0 - 10. The duration of successful procedures was also documented. The patients were monitored for 6 hours for any side effects. The level of statistical significance was set at P < 0.05 for all tests.

The study was performed on 22 patients (13 males/9 females) with a mean age of 65.5 ± 3.5 years divided into two groups of device-assisted (n = 11) and manual ultrasound-guided (n = 11) compression repair. The two groups did not differ significantly in terms of demographic variables or initial ultrasound variables associated with the pseudoaneurysm. The device-assisted compression group was found to have lower pain intensity (5.0 ± 1.0 vs. 6.0 ± 0.8; P = 0.024) and a significantly higher success rate (100% vs. 45.5%; P = 0.004) compared to the manual compression group. None of the patients showed any side effects.

This preliminary study showed that the proposed device is completely safe and may improve the success rate while decreasing pain scores during ultrasound-guided compression procedures. Using a large multicenter study design, evaluating the efficacy of the novel device for hemostasis during sheath removal and adding new equipment to the device, such as manometers to apply controlled pressure, are suggested for future studies.

Early biliary infection (EBI) is a significant and prevalent complication following percutaneous transhepatic biliary stenting, especially in cases involving the use of 125 I particle stents for malignant biliary obstruction (MBO).

This study aims to uncover potential risk factors contributing to EBI post-implantation in this patient group. Patients and

In this retrospective study, a total of 231 patients who underwent 125 I particle stent implantation between January 2014 and December 2020 were included. Screening based on inclusion/exclusion criteria identified a total of 178 patients (115 males and 63 females, aged 32 - 83 years). Early biliary infection occurrence was monitored within the first 30 days following the stent implantation, when infectious complications are most prevalent. We analyzed baseline characteristics and perioperative parameters of patients, comparing those who developed EBI with those who did not. Multivariate logistic regression was employed to identify significant risk factors for EBI.

Out of the 178 patients, 35 (19.7%) developed EBI within 30 days post-implantation. Every EBI case was accompanied by a positive bile culture. Notably, patients with EBI more frequently had diabetes [odds ratio (OR), 3.329; 95% confidence interval (CI), 1.129 - 9.819; regression coefficient (B) = 1.203; P = 0.029], gallstones in the gallbladder or bile ducts (OR, 3.459; 95% CI, 1.060 - 11.283; B = 1.241; P = 0.040), higher level of biliary obstruction (OR, 3.008; 95% CI, 1.243 - 7.280; B = 1.101; P = 0.015), intraoperative biliary bleeding (OR, 5.416; 95% CI, 1.569 - 18.696; B = 1.689; P = 0.008), and postoperative intrahepatic pneumobilia (OR, 2.655; 95% CI, 1.108 - 6.362; B = 0.976; P = 0.029) compared to those without EBI. These factors were positively correlated with EBI development post-implantation. Conversely, the duration from percutaneous transhepatic biliary drainage (PTBD) to 125 I stent implantation was longer in patients without EBI (OR, 0.966; 95% CI, 0.940 - 0.992; B = - 0.035; P = 0.012), suggesting a negative association with EBI occurrence.

This study identifies diabetes, gallstones in the gallbladder or bile ducts, high-level obstruction, intraoperative biliary bleeding, and postoperative intrahepatic pneumobilia as significant risk factors for EBI. Additionally, a longer interval from PTBD to 125 I stent implantation emerges as a protective factor against EBI in patients with MBO undergoing 125 I particle stent implantation. These risk factors can offer guidance to minimize post125 I particle stent implantation biliary infection, thereby shortening hospitalization for affected patients.

Idiopathic portal hypertension (IPH) is a rare clinical condition often misdiagnosed as cirrhosis. The management of IPH focuses on preventing and treating complications related to portal hypertension, such as bleeding from esophagogastric fundal varices. In contrast, the management of cirrhosis focuses on symptomatic treatment based on etiology, protecting hepatocyte function, and inhibiting hepatic inflammation and fibrosis. Therefore, it is crucial to correctly recognize both diseases and take appropriate therapeutic measures.

The aim of this study was to summarize and analyze the imaging, pathological, and serological features of idiopathic portal hypertension and cirrhosis to reduce misdiagnosis in clinical practice. Patients and

Pathological, radiological parameters [computed tomography (CT)/magnetic resonance imaging (MRI)], and serological examinations were retrospectively evaluated for 14 patients with IPH and 30 patients with cirrhosis. We analyzed and compared their imaging manifestations in terms of spleen thickness and length, liver morphology, hepatic lobe atrophy, hyperplasia, portal vein thrombosis, arteriovenous phase liver perfusion, regenerative nodules, focal nodular hyperplasia-like lesions of the liver, portal vein morphology, splenorenal shunt, and hepatorenal shunt. The aim was to investigate the correlation between the imaging manifestations and the pathological manifestations.

There were significant differences between the IPH and cirrhosis groups in individual indicators of liver function, routine blood tests, and coagulation function (P < 0.05). Significant differences in spleen thickness and length were also observed between the IPH and cirrhosis groups (P < 0.05). Atrophy and hyperplasia of the hepatic lobe differed between the two groups. Changes in liver morphology and parenchyma were observed in both the IPH and cirrhosis groups, with diffuse regenerative nodules and focal nodular hyperplasia-like lesions being significant for distinguishing between IPH and cirrhosis. Focal nodular hyperplasia-like lesions were more common in patients with idiopathic portal hypertension, whereas diffuse regenerative nodules were more common in patients with cirrhosis. All 14 IPH patients had abnormalities in the portal vein system, including main portal vein dilation, stiffness, straightening, and distal branch vein stenosis or occlusion, while 9 cirrhosis patients had portal vein abnormalities, primarily thinning of the portal vein. Pathology revealed that patients in the cirrhosis group had varying degrees of cell necrosis and edema, and pseudolobule formation was observed in all patients. Patients with IPH showed varying degrees of fibrosis in the portal and confluent areas, but lobular inflammation was not evident. Some IPH patients experienced portal vein occlusion and stenosis.

Idiopathic portal hypertension is relatively rare in clinical practice and is characterized by mostly normal liver function and hypersplenism, which may lead to a decrease in platelets, red blood cells, and white blood cells. If a giant spleen is found on imaging and the liver surface is smooth, IPH should be considered. Additionally, fibrosis, stenosis, and occlusion of the portal venous system, as well as focal nodular hyperplasia-like lesions, are suggestive of idiopathic portal hypertension. In contrast, diffuse regenerative nodules and pseudolobule formation are often indicative of cirrhosis. Furthermore, atrophy and hyperplasia of the liver are significant in differentiating the two diseases.