Iranian Journal of Radiology
Volume:4 Issue: 2, Winter 2007

This review gives an overview about pathophysiology, pathology and imaging findings in patients with intracranial hemorrhage and illustrates typical and common findings.

Background/ The contrast medium has to be selected with regard to safety and efficacy. Iohexol is produced in Iran as the brand name Iopaque. Currently, there are some concerns about using this brand instead of its traditional more expensive brand—Omnipaque. This study was conducted to compare the safety and radiographic efficacy of 300 mg I/mL of Iopaque and Omnipaque in peripheral angiography. Patients and 84 patients were randomly received 300 mg I/mL of one of the two brands of contrast mediums iohexol: Iopaque (Daroopakhsh, Tehran, Iran) or Omnipaque (Nycomed Imaging AS, Oslo, Norway). The radiological efficacy of the drugs was compared according to the distribution of the vascular enhancement and the amount of radiodensity in arterial, capillary, and venous phases of angiography, using visual analogue score (VAS). The adverse events were recorded by a close follow-up by the investigator at baseline, after 1 and 4 hours, and 3 days after angiography. Baseline characteristics including gender, age, and type of angiography were not statistically different between the two study groups. Both contrast agents produced acceptable visualization of the vascular structures [VAS: 8.2±1.4 in Omnipaque and 8.1±1.5 in Iopaque groups; p>0.05]. 23 patients in each group showed early and delayed adverse reactions related to contrast media. Changes in biochemistry parameters were not of clinical importance. The safety and efficacy of Iopaque and Omnipaque in peripheral angiography are the same.

Background/ To evaluate the prevalence of abdominal aortic aneurysm (AAA) in Iranian candidates of coronary artery bypass graft and its associated factors. Patients and 1,647 consecutive candidates of coronary artery bypass graft underwent abdominal aorta sonography. The relation of AAA with gender, age, smoking, dyslipidemia, hypertension, diabetes mellitus, carotid and coronary stenosis was evaluated. The prevalence of AAA was 3.7% in men and 1% in women. The prevalence was 5.2% in men older than 65 years. The largest diameter f AAA was 51 mm. Gender, age, smoking and carotid stenosis were associated factors of AAA. The prevalence of AAA is lower in Iran comparing with western studies (p<0.0001). The mean diameter of aneurysm was lesser in our study too (p<0.0001). The associated factors of AAA in our study were similar with previous reports. Screening of AAA is not recommended in Iranian candidates of coronary artery bypass graft.

Fibrolamellar hepatocellular carcinoma is a relatively rare condition that occurs in noncirrhotic livers, most frequently in adolescents or young adults with no gender predominance. The prognosis is more favorable than that of the usual hepatocellular carcinoma. Here is the case of an eighteen-year-old male patient with history of right upper quadrant abdominal pain, and no hepatomegaly. Liver function tests and serological markers for viral B and C hepatitis and tumor markers were normal. CT scan demonstrated a large hypervascular lesion in the liver and the histological examination was reported as a typical fibrolamellar hepatocellular carcinoma. Intra-arterial chemotherapy and embolization have been done for the patient. In his recent imaging the mass seems to become smaller and is considered operable. After 2.5 years he does not have any complaint and has gained some weight.

Background/ In thermal tissue ablation, it is very important to control the increase in the temperature for having an efficient ablation therapy. We conducted this study to determine the efficacy of measuring pixel shift of ultrasound B-mode images as a function of change in tissue temperature. By fixing some microthermocouples in liver tissues, temperature at different points was monitored invasively in vitro during laser-induced thermotherapy. According to our results, optimum power and exposure time were determined for ultrasound temperature monitoring. Simultaneously, noninvasive temperature monitoring was performed with ultrasound B-mode images. These images were saved on computer from 25ºC to 95ºC with 10 ºC steps. The speed of sound changes with each 10°C temperature change that produce virtual shifts in the scatter positions. Using an image processing method, the pixel shift due to 10 °C temperature change was extracted by motion detection. The cubic regression function between the mean pixel shifts on ultrasound B-mode images caused by the change in speed of sound, which in turn was a function of the mean change in temperature, was evaluated. When temperature increased, pixel shift occurs in ultrasound images. The maximum pixel shift was observed between 60 to 70 ºC (temperature changes (ΔT) of 35–45 ºC). After 70ºC, the local pixel shift due to change in the speed of sound in liver tissue had an irregular decreasing. Pearson correlation coefficient between invasive and non-invasive measurements for 10°C temperature changes was 0.93 and the non-linear function was suitable for monitoring of temperature. Monitoring of changes in temperature based on pixel shifts observed in ultrasound B-mode images in interstitial laser thermotherapy of liver seems a good modality.

Background/ Detection of the tissue diagnosis of ovarian space occupying lesions (OSOL) has remained a challenging task for sonographers since many adnexal masses have nonspecific sonographic appearances. Our objective was to evaluate the accuracy of the abdominal sonographic diagnosis of adnexal masses in 79 women with a known OSOL undergoing laparotomy for ovarian masses in Tabriz Alzahra''s Haspital, northwestern Iran. Patients and From March 2004 to February 2005, sonographic reports of each patient were compared with postoperative findings. Comparison of the preoperative sonographic and final pathologic diagnoses revealed a correct sonographic diagnosis in 77% of patients. The identification of ovarian cystic teratoma was correct in 17/24 cases (sensitivity of 71% and specificity of 98%). The identification of ovarian malignancy was correct in 7/10 patients (sensitivity of 70% and specificity of 98.5%). Sonograms were frankly misread in 14/79 cases, and were missed in 4/79 cases. In conclusion, our results show high resolution abdominal ultrasonography is an effective method in diagnosis of ovarian tumors and on 70% of patients can differentiate malignant tumors from benign tumors.

Background/ Considering the fact that gray-scale ultrasonography findings in patients with non-surgical kidney disease are highly non-specific, this study was conducted to evaluate the efficacy of color Doppler ultrasonography for determining a quick assessment of the renal function. In this study, the association between the kidney interlobar artery resistive index (RI) and serum creatinine level was investigated to identify whether this index has a significant relationship with the serum creatinine level. Patients and In a cross-sectional study, 30 patients with non-surgical parenchymal renal disease who had a serum creatinine level>1.4 mg/dL were selected during regular revisits. 30 normal individuals with serum creatinine levels<1.4 mg/dL were also selected as the comparison group. The kidneys of these subjects were investigated with gray-scale ultrasonography for bilateral symmetry, absence of stones, hydronephrosis, and any space occupying lesion. They were then evaluated with color Doppler ultrasonography and the RI was measured in 10 interlobar arteries (5 in each kidney). The mean±SD serum creatinine level was 6.5±0.6 mg/dL in the case and 1.0±0.3 mg/dL in the control group. The mean RI was 78.0%±1.9% for the case and 59.3%±0.8% for the control group (p<0.001). A significant correlation was found between the serum creatinine level and the RI (r=0.68, p<0.001). In renal parenchymal disease, measuring RI by Doppler ultrasonography is a fair predictor of renal function.

Chondrocalcinosis is a chronic and progressive inflammatory joint disease with acute episodes of arthritis, which may be associated with other metabolic diseases or transmitted as a genetic disorder. We report a case of chondrocalcinosis in two sisters.

Varix of the umbilical vein is a rare entity. We report a case of fetal intraabdominal umbilical vein varix (FIUV) diagnosed by color Doppler ultrasonography at 24 weeks of gestation. This case had normal ultrasound at 13–19 weeks. No other anomalies were detected in subsequent evaluations by ultrasonography and echocardiography. Eventually the fetus at 30 weeks’ gestation was affected by hydrops and Intrauterine Fetal Death occurred at 31 weeks’ gestation.