Iranian Journal of Radiology
Volume:3 Issue: 2, Winter 2006

CT and MR imaging are often the primary examination considered in the evaluation of patients with a variety of abdominal and pelvic conditions. These exams can be encountered with either incidental irrelevant findings or normal anatomic variants both of which can mimic pathology. In addition, the quality of imaging studies has a direct impact on their proper interpretation and depends on numerous factors. Therefore, optimal protocol and the familiarity of the radiologist with the normal variants and pseudo tumors are essential in the interpretation of such studies. In addition, lack of clinical information such as prior abdominal surgery can be major contributors to misdiagnoses, which can lead to an erroneous management. For CT, these subjects are discussed in the following three categories.

Angiosarcoma of the breast is a rare tumor that accounts for 0.04 % of all breast neoplasms at the third and fourth decades of life; in contrast with carcinoma, which generally arises later. Angiosarcoma of the breast usually manifests as a painless, palpable mass without tenderness, with or without bluish-red discoloration of the overlying skin. Angiosarcoma has a high mortality rate and a very poor prognosis. Mastectomy and chemotherapy are the most likely choices of treatment for a primary angiosarcoma of the breast. Immunotherapy may also play a part in treating this rare type of breast cancer. This paper presents a case of angiosarcoma of the breast, and relevant data in the literature is also reviewed to discuss the questions on its origin, symptoms, diagnosis and treatment.

Background/ The most important lesions in coronary artery disease (CAD) are coro-nary artery plaques, many of which are calcified. Multi-slice spiral CT (MSCT) scanners can concurrently perform coronary calcium scoring (Ca-Score) as a predictor of CAD and coronary CT-angiography (CCTA) as the determining factor in therapeutic decision-making. We aimed to determine the agreement of a Ca-Score more than 100 (based on Agatston technique) with coronary artery stenosis significance on CCTA. Patients and Using ECG-gated MSCT, 65 patients who were referred for CCTA were assessed both for their Ca-Score and a significant (≥50% diameter reduction) coronary stenosis, simultaneously. Their total Ca-Score were classified in three groups (a-0, b-less than 100, and c-≥ 100). The severity of coronary stenosis was categorized to further three groups (1- lack of stenotic lesion, 2- presence of non-significant stenosis, and 3-presence of significant stenosis). Of 65 patients referred for CCTA, 42 (64.61%) had no CAD, 8 (12.3%) had non-significant lesions, and 15 (23.09%) had significant stenoses. Forty-three (66.2%) out of 65 sub-jects had a zero, 14 (21.5%) had scores <100, and 8 (12.3%) had ≥ 100 Ca-Score. In the first group (Ca-score = 0), only one had significant stenosis; while 50% of the patients in the second group (Ca-score < 100) and 87.5% from the third group (Ca-score of ≥ 100) had significant stenosis. Significant coronary stenosis has a moderate-to-good agreement with a Ca-Score of 100 or higher, compared to those with a Ca-Score of less than 100, and this was statistically significant (P < 0.0001). In patients with a calcium score of 100 or more, performing CCTA may be advis-able to assess the likelihood of significant CAD.

Background/ To evaluate the chest radiography and CT scan characteristics of pulmonary hydatid disease (PHD). Patients and One hundred patients (59 males and 41 females, age ranged from 9 to 80 years) with surgically proven pulmonary hydatid cysts were studied. We reviewed clinical and imaging findings including PA and LAT chest roentgenograms and conventional CT of the chest. Only 82 patients had CT scan in their files, but all had CXR. The radiological features (localization, diameter, architecture, density and other radiological signs and appearances) were determined. On CXR, 124 cysts were determined. In evaluation of 82 available CT scans, a total of 112 cysts were detected. No cysts was detected on 5 CT scans. No discrete cyst was detected on 10 CXRs: 4 patients, only consolidation; and 6 patients, only hydropneumothorax.. The most frequent site of involvement was RLL (29.6%). Fifteen hydatid cysts appeared as solid masses on CT. Fifty-seven cysts were ruptured cysts and 25 patients with ruptured cysts had hemop-tysis (43.9%). Thirty-eight percent of cysts had thin walls and 62% had thick walls. Sixty-four cysts were round in shape (55.7%). Single cysts were seen in 63 patients while multiple cysts were seen in 37. Median CT density of the cysts was 24 Hounsfeild Units (HU) (-18 to 84). There were 16 giant cysts (diameter  10 cm) on CT. Mean maximum and minimum dimensions of cysts were 5 cm and 4 cm on CT and 6.8 cm and 5.7 cm on CXR, respectively. On CT and CXR, "water lily sign" was seen in 18 and 22 patients, "air-fluid level" in 12 and 17 patients, and "crescent sign" in 11 and 5 of patients, respectively. Inverse crescent sign and calcification were not observed on CXRs, but each was reported on 4 CT scans. On CT, 90% of cysts were smooth, 74 cysts were uniloculated and 9 were multiloculated. Nineteen percent of cysts were infected. Other imaging findings included mediastinal shift, atelectasis, infiltration, pericystic lung reaction, chest wall involvement, and rib destruction. CXR is helpful with diagnosis of intact cysts but fails to define entire morphology of complicated cysts. CT imaging recognizes certain details not visible on radiography. In endemic regions like Iran, atypical imaging presentations of complicated pulmonary hydatid disease, such as solid masses, should be considered in differential diagnosis of pulmonary lesions

Cylindromas are benign tumors appearing as small solitary slow growing nodules on the head and neck. Multiple cylindromas may form a turban tumor. Here, we report an unusual case of multiple cylindroma with transformation to cylindrocarcinoma. The patient is a 61-year-old woman who developed a cylindrocarcinoma on a pre-existing cylindroma of head and neck, with deformity of head due to soft tissue masses, lytic lesions of scalp with invasion to brain, and destruction of orbit leading to unilateral visual loss.

Background/ The concept of evaluating the musculoskeletal system with ultrasound was initially introduced in the late 1970s. For evaluating meniscal tears, which are a common injury in traumatic events of knee, linear probes with high resolution have been used. In this study, we compared the results of sonography with arthroscopy in diagnosing bucket handle tear of meniscus and MCL tear. Patients and 218 clinically symptomatic knee joints with clinical indication of arthro-scopy were examined by sonography in a referral sport medicine center. The patients eventually had arthroscopic exam. The results were compared, and statistically analyzed using Fisher’s exact. In this study, of 218 patient who had arthroscopy and sonography, the sensitivity and specificity of sonography in meniscal tear were 68.1% and 100%, respectively. 34 patients had bucket handle tear of the posterior horn of the medial meniscus on sonography; six cases (17.6%) of which had abnormally small posterior horns of medial meniscus (in favor of meniscal tear) but in 60 patients with other types of meniscal tear, sonography revealed tear in 58 (96.6%)(P<0.0001). Six patients had complete MCL tear in arthroscopy, while in sonography 4 complete MCL tears were shown. Sensitivity of ultrasound in diagnosing complete MCL tear was 66.6% and specificity of 98%. Ultrasound is easily applicable in evaluation of knee derangement: however, for bucket handle tears it has limited application. For MCL tears, sonography seems an accurate method. Ultrasonography is rapid, low-cost and non-invasive examination.

Moyamoya (a Japanese term, meaning ‘hazy things’) was first described by Takeuchi in 1963. Two forms of this disease have been distinguished: 1-Primary moyamoya, or moyamoya dis-ease, with a strong hereditary predisposition and girls are more frequently affected. 2-Secondary moyamoya, or moyamoya syndrome, which is caused by a variety of underlying dis-eases. The Japanese scientists have classified moyamoya into four types: hemorrhagic, epileptic, infarct, and transient ischemic attack. Herein, we introduce an 8-years-old girl with the chief complaint of speech disorder. In her physical examination, we detected expressive aphasia and right-sided central facial palsy. After a few days, right hemiplegia and cortical blindness appeared as well. Gradually she was totally unable to move and was transferred to the ICU because of loss of consciousness. MRI showed diffuse hyper signal lesions in the left temporoparietal and bilateral occipital area. MRA showed narrowing of the internal carotid artery and abnormal collaterals (moyamoya vessels). After indirect bypass surgery (EDAS), she is now able to sit, walk, run and speak. There are rare angiographically proven moyamoya cases. To our knowledge this was the first EDAS in Iran and a rare case of moyamoya with a dramatic response to operation.

Dual x-ray absorptiometry (DXA) is the most widely used measurement for the assessment of bone mass in osteoporosis. In clinical measurement, bone width can affect bone mineral parameters. The purpose of this study was to examine the dependence of bone mineral pa-rameters on bone width. In this study, DXA measurements were conducted on rabbit bone in vivo using clinical instruments. We have selected rabbit’s bones that have low BMD and more collagen tissue to predict structure not only measures BMD, but is also sensitive to the structure of the bone. To investigate the effect of bone width on the measured parameters, three regions of femur and tibia bones (N=132) were processed: upper (1/3 of length), middle (1/2 of length) and lower (2/3 of length) for BMC, areal BMD and volumetric BMD. The ANOVA analysis of bone mineral extracted by DXA showed significant differences (P<0.05) between BMC, BMDa and BMDv of six groups of upper, middle and lower parts of the femur and the tibia. It shows that BMC and BMD correlate well with the bone width, but BMDv inversely correlates with bone width. Linear and nonlinear regression analyses were used to examine the relationship between DXA characteristics with bone width and the regression function for each parameter is given. We concluded that BMC, areal BMD, and volumetric BMD in rabbit''s bone with collagen fibers more than bone mineral are dependent on bone width. This result may be at least in part due to large precision error measurement of the bone width, in vivo.

Implantation of high grade and invasive bladder carcinoma into the abdominal wall is not common and can occur as side effects of uninary bladder interventions and surgical procedures, including perforation of bladder wall during transurethral resection of the tumor. Herein, we present a case of implantation of bladder transitional cell carcinoma into abdominal wall into an incisional hernia of a previous small bowel operation; three years after the bladder tumor had been diagnosed and treated. In evaluating any mass lesion in the abdominal wall, it is important to consider the possibility of bladder tumor implantation.

Objective/ To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. Patients and In our center, 36 successful carotid stenting procedures (of 38 at-tempted) were performed in 37 patients (23 men; aged 667 years). Cerebral protection in-volved distal filter devices (n= 36) of which 12 were Accunet and 24 were EZ filter wires. The protection devices were positioned successfully in 36 of the 38 attempted vessels. The 30-day incidence of stroke and neurological death was three. Neurological complications included one major stroke, and one minor stroke. There was also one (sudden cardiac death on the first day). The proportion of stroke or death was two for symptomatic lesions and one for asymptomatic lesions, and two in patients aged <80 years and one in those aged 80 years. Protection device-related vascular complications included mild spasm, which occurred after three procedures (8%), none of which led to neurological symptoms. There were another four cardiogenic deaths in 30-day follow-up. In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurological complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.