Iranian Journal of Radiology
Volume:4 Issue: 1, Autum 2006

Background/ Achalasia is a motility disorder of unknown etiology, characterized by absent esophageal peristalsis and loss of lower esophageal sphincter relaxation. Balloon dilatation is the most effective non-surgical treatment for patients with achalasia. Manometry, scintigraphy and radiology are three techniques that provide an objective measure of success after balloon dilatation. The objective of this study was to determine the best predictor of success after balloon dilatation in patients with achalasia. Patients and 17 patients with achalasia of cardia who referred to Taleghani Hospital in 2003, were evaluated, both symptomatically and objectively (esophageal manometry, timed barium esophagogram, and scintigraphic emptying index), before and after treating with pneumatic dilatation of esophagus. The degree of patient symptom improvements after treat-ment was recorded and correlated with improvement in some indices derived by the above-mentioned three methods. 12 (70.6%) of 17 patients had score improvements of ≥80%. All the pre-treatment diagnostic indices were significantly (P<0.05) different from those after therapy. There was no significant difference between the two groups in terms of improvement in symptoms according to the indices of barium swallow or scintigraphy. No association between the patient symptom scores and improvement in either the barium height or emptying index was found. In evaluation of efficacy of pneumatic dilatation of esophagus for treatment of achalasia, we should not only rely on transit or barium study.

Background/ Achalasia is a motility disorder of unknown etiology, characterized by absent esophageal peristalsis and loss of lower esophageal sphincter relaxation. Balloon dilatation is the most effective non-surgical treatment for patients with achalasia. Manometry, scintigraphy and radiology are three techniques that provide an objective measure of success after balloon dilatation. The objective of this study was to determine the best predictor of success after balloon dilatation in patients with achalasia. Patients and 17 patients with achalasia of cardia who referred to Taleghani Hospital in 2003, were evaluated, both symptomatically and objectively (esophageal manometry, timed barium esophagogram, and scintigraphic emptying index), before and after treating with pneumatic dilatation of esophagus. The degree of patient symptom improvements after treat-ment was recorded and correlated with improvement in some indices derived by the above-mentioned three methods. 12 (70.6%) of 17 patients had score improvements of ≥80%. All the pre-treatment diagnostic indices were significantly (P<0.05) different from those after therapy. There was no significant difference between the two groups in terms of improvement in symptoms according to the indices of barium swallow or scintigraphy. No association between the patient symptom scores and improvement in either the barium height or emptying index was found. In evaluation of efficacy of pneumatic dilatation of esophagus for treatment of achalasia, we should not only rely on transit or barium study.

Background/ Ultrasonography is an imaging modality which is easy to use and less expensive than other imaging methods. It is becoming more widely available in regions of the world where Fasciola hepatica infestation is prevalent. In this report, we described the sonographic findings of hepatic lesions in patients with fascioliasis. Patients and In this cross-sectional study, 248 patients with confirmed hepatic fascioliasis from Guilan province who were referred by internists or infectious disease specialists to private sonographic offices were studied. Abdominal sonography was performed in supine and left decubitus positions using an Aloka 288 scanner and a 3.5 MHz transducer. Out of 176 hepatobiliary involvement, the right lobe of liver and the periportal area with echoic or hypoechoic lesions, had the most involvement (45.2%). There were lesions in the gallbladder of 34 (13.7%) and biliary tracts of 17 (7%) patients. There was coincident in-volvement of both liver and biliary tracts in 13 (5.2%) patients. Sonography is a useful method to confirm hepatobiliary lesions in human fascio-liasis and can facilitate the diagnosis of this condition, particularly in areas where it is endemic.

Background/ Radiotherapy is the most effective treatment for Hodgkin’s disease in early stages. However, it can cause various side effects in radiated tissues, e.g., vascular structures. One of the effects of radiation on vessels is atherosclerosis. The primary objective of this study was to compare the atherosclerotic changes of carotid arteries, expressed as the mean intima-media thickness (IMT), in patients with Hodgkin’s disease after radiotherapy with a matched non-exposed group. We also tried to see whether there is a correlation between the time elapsed since the last radiotherapy session and the prevalence and severity of atherosclerosis. Moreover, we tested if radiation can augment the effect of age, as an in-dependent risk factor for atherosclerosis. Patients and In two groups of 50 patients, sonography of the common and internal carotid arteries in bifurcation of the artery was performed and the IMT was measured for both groups of patients exposed and unexposed to radiation. The mean±SD IMT was significantly higher in exposed (0.67±0.22 mm) than unex-posed (0.51±0.07 mm) group. There were early atherosclerotic changes, diagnosed based on the vessel morphology, in 18% of exposed and none of the unexposed group. Correlation of IMT with age is stronger in the exposed than in the unexposed group. (r=0.61 in the exposed vs. 0.22 in the unexposed). Atherosclerotic changes are more prevalent in post-radiotherapy patients that may indicate the necessity of regular and careful follow-up of these patients for the early diagnosis of vascular pathologies and considering suitable screening and therapeutic interventions for prevention of cerebral complications. Ultrasound could be a suitable technique for screening and early detection of atherosclerosis considering it’s relatively low cost and non-invasiveness.

Spondylo-epiphyseal dysplasia is a genetic disorder, resulting in the dysfunction of type II collagen (the major collagen of cartilage). We present a 17-year-old male with a history of mechanical pain predominantly in the lumbar spine and joints of the lower extremity for one year, who was previously diagnosed with and treated for spondylo-arthropathy, with normal laboratory test results but severe radiographic abnormalities in the form of generalized osteoarthritis of pelvic and knee joints. The patient was a case of late-onset spondylo-epiphyseal dysplasia.

Fetus in fetu is a rare condition in which a fetiform calcified mass is often present in the ab-domen of its host, a newborn or infant; the mass is considered as a parasitic twin originated from a diamnion-monozygotic pregnancy. Herein, we report on a new case of a 4-year-old child who was admitted for left upper quadrant abdominal mass without any symptom.

Backgrounds/ The objective of this study was to determine the mean glandular dose (MGD) resulting from mammography examinations in Yazd, southeastern Iran and to identify the factors affecting it. Patients and This survey was conducted during May to December 2005 to estimate the MGD for women undergoing mammography and to report the distribution of dose, com-pressed breast thickness, glandular tissue content, and mammography technique used. The clinical data were collected from 946 mammograms taken from 246 women who were referred to four mammography centers. The mammography instruments in these centers were four modern units with a molybdenum anode and either molybdenum or rhodium filter. The exposure conditions of each mammogram were recorded. The breast glandular content of each mammogram was estimated by a radiologist. The MGD was calculated based on measuring the normalized entrance skin dose (ESD) in air, Half Value Layer (HVL), kVp, mAs, breast thickness and glandular content. HVL, kVp and ESD were measured by a solid-state detector. The analytical method of Sobol et al. was used for calculation of MGD. The mean±SD MGD per film was 1.2±0.6 mGy for craniocaudal and 1.63±0.9 mGy for mediolateral oblique views. The mean±SD MGD per woman was 5.57±3.1 mGy. A positive correlation was found between the beam HVL with MGD (r=0.38) and the breast thickness with MGD (r=0.5). The mean±SD MGD per film of 1.42±0.8 mGy in present study was lower than most of similar reports. However, the mean MGD per woman was higher than that in other studies.

Background/ One of the causes of inevitable abortion is structural abnormalities of the uterine cavity and endometrium, which interfere with the implantation of the embryo. We performed this study to compare the efficacy of sonohysterography and hysterosalpingography with hysteroscopy in the diagnosis of these abnormalities. Patients and This cross-sectional study was conducted on 72 infertile women who were candidates for hysteroscopy, attended to the Infertility Clinics of Vali-e-Asr Reproductive Health Research Center, affiliated to Tehran University of Medical Sciences. In this study, hysterosalpingography and sonohysterography were performed prior to hysteroscopy, which was considered as the gold-standard test for the diagnosis of the structural abnormalities of the uterine cavity and endometrium. Comparing to hysteroscopy, sonohysterography had a sensitivity of 30%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 30%; hys-terosalpingography had a sensitivity of 55%, a specificity of 68%, a positive predictive value of 41% and a negative predictive value of 60%. Due to the absence of the complications associated with hysteroscopy, being an uninvasive procedure, with high sensitivity, lower cost, and higher feasibility, sonohysterography seems to be a suitable choice for diagnosing intrauterine lesions.

Renal malacoplakia is a rare benign disease. Affected patients are often the debilitated, immunosuppressed, or those with chronic disease. On CT scan, foci of malacoplakia appear less dense than the enhanced surrounding parenchyma. Radiologically, renal malacoplakia can resemble renal cell carcinoma (RCC), and thus should be considered as a differential diagnosis of RCC. We report an unusual presentation of renal malacoplakia.