Iranian Journal of Radiology
Volume:2 Issue: 3, Spring & Summer 2005

The imaging findings of focal splenic, presacral and paraosseous extramedullary hematopoiesis in a 35-year-old man with ß-thalassemia major are described with particular reference to ultrasonography and CT scan. A review of the radiological appearances of this rare condition is presented.

Background/ To determine the effects of estrogen and estrogen plus progesterone on mammographic density in postmenopausal women. Patients and In a descriptive cohort study, ba seline and 12-month mammograms were obtained from 97 healthy postmenopausal women, aged 45-55 years. Estrogen or combined estrogen and progesterone replacement ther apies were used for them. After one year, we classified breast density in the first and second mammograms according to Breast Imaging Reporting and Data System (BIRADS) as patterns 1 (mostly fatty) through 4 (mostly dense tissue). None of our cases had a decrease in density, while 35.1% showed an increased density.The results showed that an increase in mammographic density had no significant association with the type of prescribed hormone (P=0.77). In cases with no change in density, the parity was 3.51.86; while in the group with one-level rise, it was 4.241.84; and 5.21. 92 in the two-level rise group. Statistical analysis showed that changes in density had significant association with parity in our cases (P=0.015). HRT was associated with increases in mammographic density, suggesting that increasing mammographic density may be a marker of elevated breast cancer risk in postmenopausal women who use postmenopausal hormone replacement therapies. However, the link between changes in breast density resulting from hormone use and the change in breast cancer risk remains uncertain.

Background/ The endothelial dysfunction is associated with atherosclerosis. The dilatory reaction of atherosclerotic vessels in response to occlusion is reduced. This reduction could be of value in atherosclerosis determination. This study aimed at comparing brachial artery response to occlusion and administration of nitroglycerine in three groups: coronary artery disease patients, individuals with corona ry disease risk factors but no coronary disease,and normal subjects. Patients and The participants included 23 healthy individuals, 22 subjects with cardiovascular risk factors (diabetes mellitus, smoking, hyperte nsion or hypercholesterolemia), and 57 angiographically proven coronary pati ents. The brachial artery diameter was measured by color Doppler ultrasound at rest, 5 min utes after inflation of the cuff, and 5 minutes after sublingual administration of nitroglycerine pearl. The vessel’s diameter increased the least in the coronary artery disease and coronary risk factor groups in comparison to nor mal subjects (p=0.003 and 0.048, respectively). Vessel dilatation in response to nitroglycerine did not differ in healthy individuals from the coronary patients or the risk factor group (p=0.96 and 0.77, respectively). Doppler ultrasound may be used as a noninvasive method to identify subjects with endothelial dysfunction at high risk of coronary artery disease who need intervention or more invasive procedures.

Background/ Bronchial carcinoid tumors are neoplasms that range from typical carcinoids to the more aggressive atypical ones with similar imaging features. Considering the low prevalence of the tumor, we reviewed 21 patients. Patients and In this retrospective observational study, we reviewed the clinical, pathological and imaging findings in 21 patients diagnosed with bronchial carcinoid tumors who were admitted to National Research Insti tute of Tuberculosis and Lung Disease (NRITLD) in a 6 years period. Plain radiography and CT scan of patients were reviewed. 52.4% of the patients were male and 47.6 % female. The mean ag e of patients was 39.1 years. The most frequent clinical symptoms were cough (n= 15; 71.4%), hemoptysis (n=13; 61.9%), dyspnea (n=12; 57.1%), and pleuritic chest pain (n=7; 19%). Most of the lesions (68%) were in the right lung, 24% in the left lung, 8% in the trachea, and 19%were bilateral. Right upper lobe and right intermediate bronchus (24% an d 32%, respectively) were the most frequent sites of tumor. In radiologic examination, two cases (9.5%) had normal CXRs. Pulmonary collapse (52.4%) and mass (23.8%) were the most fr equent findings. Reviewi ng CT scans showed endobronchial lesion in three (15%) and mass in 11 (55%) patients. The mass was well defined in 8 cases (72%) and ill-defined in 3 (28%). Other findings were: mediastinal invasion (45%),atelectasis (55%), post obstructive pneumonitis (2 0%) and eccentric calcification (15%). Pathological examination revealed typical (n=18; 86%) and atypical (n=3; 14%) carcinoid tumors. Although rare, bronchial carcinoid tumors should be considered a differential diagnosis in adult patients with cough, hemoptysis, dyspnea, and pleuritic chest pain. Chest xray and CT scan can help with diagnosis. Majo r imaging findings are central, round or ovoid well-defined mass, and obstruction signs like at electasis. Diagnosis and classification should be confirmed by pathological examination on sample taken by bronchos copy or surgery.

Lipoblastomas are rare benign tum ors arising from fetal-embryo nal fat that almost always occur in children and about two thirds of them o ccur in the superficial or deep layers of soft tissue on extremities. To our knowledge there ar e only 6 case reports of mediastinal lipoblastomas in the English medical literature. We re port a case of mediastinal lipoblastoma in a 2.5–year-old child. A mediastinal mass was foun d on the chest x-ray, CT (Computed Tomography)scan and MR (Magnetic Resonance) imaging. We found a fatty density mass with no evidence of septation, strading and soft ti ssue density without enhancement after contrast injection. On MRI, the mass was high-signal intensity on T1 and T2. Complete surgical resection was performed and the pathological examination proved lipoblastoma.

Background/ There are normal anatomic varian ts of paranasal structures, with concha bullosa (pneumatization) of the middle tur binate and septal deviation being the most common. It is assumed that these anatomic varian ts contribute to chronic sinusitis by blocking normal sinus drainage. This study investigat ed this assumption among the chronic sinusitis patients referring to Radiology departments affiliated to Medical Sciences universities. Patients and A case-control study was carried o ut on 148 patients with a clinical diagnosis of chronic sinusitis who were referre d for a sinus CT scan by ENT specialists. The control group (n= 78) were chosen from the ENT clinic patients with diagnoses other than sinusitis. The association between the anatomic variants (concha bullosa of inferior and middle turbinate, agger nasi cell, haller cell, gian t ethmoidal bulla, septal deviation and inverted uncinate process) and existence of chronic sinusitis was shown wi th odds ratio(OR) and 95% confidence interval. Logistic regression analy sis was performed for adjusting the confounders. One hundred and eight (47.8 %) patients were male. The mean (±SD) age was 35.5 (±12) years. No difference was seen in the age and gender distribution between the cases and controls. Septal deviation and concha bullo sa of middle turbinate were the anatomic variants significantly associated with chronic sinusitis (respectively OR= 2.04, CI: 1.07-3.89; and OR= 2.19, CI: 1.12-4.30). Besides, we found that agger nasi cell (OR: 0.7, CI: 0.64-0.77) and inverted uncinate process (OR: 4.76, CI: 1.92-2 4.5) were associated with the occurrence of ethmoidal and frontal sinusitis, respectively. No confounding effect was seen on logistic regression analysis. Normal anatomic variants of paranasal sinuses may be considered as predictors for the occurrence of chronic sinusitis. The posit ive effect of any procedure for correction of these variants should be shown through other studies.

Background/ The purpose of this study was to determine CT scan findings in acute craniocerebral trauma and the relation between these findings and the level of consciousness. Patients and In this retrospective study, 800 pati ents with acute (less than 24 hours) craniocerebral trauma were studied over a period of three years. The patients’ level of consciousness (GCS) were determined and a brain CT scan without contrast agent was performed. A third generation General Electrics (GE) CT scanner was utilized and 10-mm and 5-mm sections were obtained for the supratento rial and infratentorial parts, respectively. From 800 patients studied, 641 (80.1%) were males and 159 (19.9%) were females. The peak age was 25 and the mean age was 26.80 ±18.30. The most common mechanism of head trauma was motor vehicle accidents (60.1%).80. M ild head injury was seen in 75% of patients,while 14% and 5.25% had moderate and severe head injuries, respectively. In 14.1%, the CT scan was normal. The most common lesions were as follows: epidural hematoma (EDH) 27.1%, subdural hematoma (SDH) 13.3%, subarachnoid hemorrhage (SAH) 11.4%, contusion 32.9% and pneumocephalus 12.1%. Intracranial hemorrhage, IVH and subdural hygroma were seen in less than 10 percent of patients. The presence of mixed lesions and midline shift regardless of the background lesions were related to statistically significant decreases in GCS. As one of the leading causes of mortality in Iran, craniocerebral trauma needs more considration, This is true especially for road accidents, which are the main cause of multiple traumas. In lower levels of consciousness, one should consider more complicated lesions and probable surgical inter vention. The presence of mixed lesions and midline shift regardless of the underlying le sion on CT scan were accompan ied by lower GCS, which may be due to major energy transmission and diff use brain tissue damage and compression of the brain stem.

Background/ Segmental colonic transit studies are important in patients with severe constipation. This study is the first Iranian preliminary survey of colonic transit scintigraphy using 67Ga-citrate as a new method in constipated patients with normal radiographic and colonoscopic evaluations. Patients and Thirteen patients with idiopathic constipation underwent colon transit scintigraphy. After oral administration of 6-7 MBq 67Ga-citrates, serial abdominal images were taken up to 72 hours. Pattern classification wa s performed visually according to the distribution of radioactivity. Scintigraphic parameters such as geometric mean center (GMC) of segmental retention of tracer, as well as mean ac tivity profiles and colo nic tracer half-clearance time were calculated Three patterns of colonic transit scintigraph y were recognized. Nine patients had the normal pattern, i.e. excellent propagation of ac tivity. Three patients had the colonic inertia pattern with marked retention of activity in th e transverse colon and splenic flexure at 48 hours. One patient had significant retention of activity in the rectosigmoid at 72 hours, defined as functional rectosigmoid obstruction (FRSO). No significant difference was seen in GMC24h between the normal pattern and colonic inertia (P=0.053), but GMC48h and GMC72h markedly differed between the two groups (P=0.0 16 and 0.025 respectively). The mean half clearance time (MCT) of the two groups was di fferent (P=0.017). Our results are well compatible with scintigraphic diagnostic criteria in different patterns of colonic transit defined by other studies with different radiotracer. Oral 67Ga-citrate colon transit scintigraphy is a feasible method to evaluate idiopathic constipation and seems to be a suitable surrogate for radio-opaque markers.

: Backgrounds/ The aim of this study was to compare abdominal sonographic features of patients with mesenteric lymphadenitis versus sonographic features of the asymptomatic children, in order to identify diagnost ic criteria for mesenteric lymphadenitis. Patients and Ultrasound data from 113 children with acute abdominal pain whose suspected sonographic diagnosis was mesenteric adenitis or ileitis was inspected in a child hospital in March 2004 to March 2005. The fina l diagnoses were established after patient management and follow-up. As for the control group, a hundred asymptomatic children were referred from health centers or kindergartens. No para-aortic lymphadenopathy was found in any of the subjects from the study and the control groups. The number of enlarge d mesenteric lymph nodes observed in symptomatic children was significantly greater than the figure in asymptomatic children (P0.0001). The highest rate of sensitivity was seen with the presence of RLQ lymphadenopathy (94.7%) and the highest rate of specifici ty was seen with the presence of lymphadenopathy in two or three areas of LUQ or mi d-abdomen together; lymphadenopathies larger than 6mm in RLQ; presence of more than 4 lymph nodes (with any size) in a sonographic image from RLQ; or thickening of terminal il eum more than 8mm (92%-100%) in the diagnosis of mesenteric lymphadenitis. In children with acute abdominal pain due to causes such as appendicitis which cannot be confirmed by ultrasound and the f indings consist of only enlarged mesenteric lymph nodes (≥4mm) and/or mural thickening of the terminal ileum (≥8mm), the probable diagnosis would be mesenteric adenitis-ileitis and surgery is not required; but close observation is recommended.

Backgrounds/ Noninvasive evaluation of elastic properties of vessel wall is hampered by the absence of methods to directly asse ss local elasticity. In order to invasively record the static pressure of carotid artery dur ing cardiac cycle in rabbit s and compare it with noninvasive technique, T–shaped tubes have been designed and constructed and calibrated. A noninvasive method to measure static pressure in arteries and finally estimate the elasticity of vessels is provided. In male white rabbits, we estimated the static pressure changes in carotid artery noninvasively by measuring blood flow velocities throughout cardiac cycle using Color Doppler Ultrasound. The blood flow ve locities were converted to static pressure changes by using energy conservation low. The st atic pressure changes of arterial wall were estimated. These parameters were compared wi th measured actual static pressure changes using a T-shaped tube, that was inserted into the carotid artery and the static pressure change was measured in the side br anch of the tube. The elastic parameters in both methods were calculated and compared by pa ired t-test statistical analysis. Statistical analysis of static pressure c hanges and elastic parameters in both methods showed that there was no significant difference between the two methods. By applying this noninvasive approach, we can estimate elastic parameters in arteries of normal people and patients with, or at risk of developing atherosclerosis for determination of disease extent. We propose this noninvasive method as an accurate and safe way suitable for screening of large popula tions of young and symptom-free individuals.

Here are the reports on evaluation and hyst erosalpingographic (HSG) findings of 6 unsuspected pregnancies. Besides, two relevant cases of importance in the authors’ 30 years of radiology practice are included. Two important radiologic features found on HSG in unsuspected pregnancies are double outlined uterine cavity (DOUC) and filling defect features. Despite the irradiation exposure of the fetuses in their early life, 4 ende d up in normal infant deliveries, one of them being a twin delivery. One case of miscarriage occured due to a intrauterine device. One case refused the follow-up sessions. It seems when performed by mistake througho ut early pregnancy, the HSG will not necessitate termination of the pregnancy.

Immunosuppressive drugs are prescribed routinely to kidney transplant recipients to prevent rejection. These medications are associated wi th an increased risk of secondary malignancies,including renal cell carcinoma in the transplanted kidney itself. We present a case of renal cell carcinoma in a transplanted kidney.

Background/ To evaluate the safety, efficacy an d complication rate of uterine artery embolization in symptomatic fibroid patients in Iran. Patients and A hundred and two patients aged 20-48 years (mean age: 35.7 ±6.4 years) with symptomatic fibroids entered th e study from September 2001 to November 2004. The most common presenting symptom was increased menstrual bleeding, which occurred in 74.5% of all patients. Urinary symptoms occurred in 43%, and bulk-related symptoms were seen in 63.7 % of our patients. We performed bilateral UAE (uterine artery em bolization) using PVA (pol yvinyl alcohol) particles (500-710 micron) and assessed the patients before UAE and at regular follow- ups at 1, 3, 6 and 12-month intervals by questionnaires / interviews and ultrasound. MRI without gadolinium (Gd-DTPA) injection was done before emboliz ation and at 6 and 12 months after the procedure. By Friedman test, sequential follow-up (up to 12 months) showed that the vaginal bleeding severity significantly decreased (p <0.0001), with menorrhagia resolving in 59.4% of patients at 1 month, and in 69% at 12 months. The mean uterus volume decreased 38.5 ±30% after 12 months. The paired t-test showed that dominant fibroid volume changed from 273.7±439.2 cm3 to 112.1±141.6 cm3 at month 6 (n=58, p=0.001) and from 246.1±314.5 cm3 to 70.1±73.5 cm3 at month 12 (n=41, p<0.0001). The initial size of the fibroids did not affect the success rate. The study showed the high efficacy of UAE in controlling fibroid related symptoms, with only few complications.

Vascular involvement in Behçet’s disease is divided into venous and arterial thrombosis and arterial aneurismal formation. Multiple arterial aneurysms rarely occur in Behçet’s disease; however, when they do occur, they cause so me complex signs and symptoms related to the location of arterial involvement. We descri be a 22-year-old male with Behçet’s disease and multiple arterial aneurysms in the main arterial branches of the neck, such as left and right subclavian aneurysms, innominate and left caro tid bifurcation arterial aneurysms, together with right vertebral and left subclavian artery occlusions. This case shows that multiple arterial involvem ents should be considered as one of the possible manifestations of Behçet’s disease.

High flow priapism is a rare entity caused by a pathologic influx from lacerated arteries to the cavernous bodies. Transcatheter embolization of feeding arteries is the treatment of choice. We reviewed a series of 5 patients who un derwent transcatheter embolization in our hospital from 2000 to 2004. The mean age of patients was 32 years; dur ation of priapism was between one week and a year. All underwent bilateral pudendal artery ca theterization with No.5 French Cobra-II catheters. We did not microcatheters in our patien ts. Embolized materials were gel-foam, coils and polyvinyl alcohol microspheres. We could follow four of them for 6 to 40 months; one of the patients dropped out from our follow-up study. All the four patients had completed detumescence after a maximum of two days from embolization;none of them experienced signific ant complications and all returned to normal sexual function and remained symptom free thereafter (6-40 months). We noted no difference in complications and duration to restore erectile function and less recurrence rate with embolization of main br anch of pudendal artery instead of superselective embolization of arteriocavernous fistul a feeder artery with a microcatheter that is the method of choice for the treatment of high flow priapism, but due to small number of cases it needs further studies to be confirmed.