Iranian Journal of Radiology
Volume:5 Issue: 1, Autum 2008

Background/ Approach to patients with acute right lower quadrant pain remains a clinical dilemma. Decreasing the risk of negative appendectomies is one of the major goals surgery units intend to achieve. This study has been conducted to determine the accuracy of non-contrast focused appendiceal computed tomography (CT) in preoperative diagnosis of acute appendicitis.Patients and During a period of three months, 50 consecutive adult and adolescent patients who were clinically diagnosed as acute appendicitis were included in this study. Focused non-enhanced appendiceal spiral computed tomography (CT) was performed for all patients, preoperatively. Two radiologists who were unaware of the surgical findings assessed the CT scans. After the operation and pathologic assessment, eight patients with negative appendectomy were found. The sensitivity of CT was 0.71 and 0.83 according to the interpretations of the first and second radiologists, respectively. Moreover, its specificity was 0.88 and 0.75 according to the first and second radiologists'' reports, respectively. In patients with clinically diagnosed acute appendicitis, relying on abdominal CT is not helpful.

Cardiac hydatid cyst is rare comprising 0.5-2% of all cases. A 20-year-old man was admitted for acute pulmonary embolism. Echocardiography and magnetic resonance imaging revealed hydatid cyst of pulmonary valve annulus. The cyst was drained surgically, and the patient was discharged with oral albendazole. For fatal complications of cardiac hydatid cyst, surgery is recommended in all patients.

Background/ Cartilage invasion is important in the management plan of laryngeal and hypopharyngeal neoplasms. This study was conducted to determine the diagnostic accuracy of computed tomography (CT) to detect the neoplastic invasion of the laryngeal cartilages.Patients and 37 patients with proved laryngeal or hypopharyngeal neoplasm that were candidates for total laryngectomy were included in this study. For all patients, standard contrast-enhanced laryngeal CT was performed. Two imaging findings were considered as neoplastic invasion of the laryngeal cartilage-increased density and chondrolysis. These findings were evaluated in thyroid, cricoid and arytenoid cartilages. Then, all patients underwent total laryngectomy and the cartilages were sent for histopathologic evaluation. The sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios of CT findings were evaluated for the diagnosis of neoplastic invasion of these cartilages. The mean (±SD) age of patients was 61.4±8.8 (range: 39-76) years. Thirty-four patients were male; 25 had laryngeal tumor and 12 had hypopharyngeal tumor. Totally, 139 cartilages were evaluated (37 thyroid, 37 cricoid and 65 arytenoid cartilages). Among these cartilages, 49 (16 thyroid, 11 cricoid and 22 arytenoid cartilages) had neoplastic invasion. In thyroid cartilage, the sensitivity of increased density was 0.81 and the specificity of chondrolysis was 0.91; the specificity of both findings together was 0.95. In cricoid cartilage, the sensitivity of increased density was 0.73; the specificity was 0.73; the specificity of chondrolysis was 0.96 and specificity of both findings was 1. In arytenoid cartilage, the specificity of increased density was 0.67; the specificity of chondrolysis was 0.98; and the specificity of both findings together was 1. Considering all 139 cartilages together, the sensitivity of increased density was 0.69 and the specificity of chondrolysis was 0.96. Setting all cartilages in a single group and considering both of these CT findings, the sensitivity was 0.89 and the specificity was 0.76. Chondrolysis is a specific and increased density is a relatively sensitive CT finding for the diagnosis of laryngeal cartilage neoplastic invasion; considering both findings together makes a very specific imaging finding for the diagnosis.

Background/ Since Iran is an endemic region for iodine deficiency, we conducted this study to determine the prevalence of incidental thyroid nodules in our university-affiliated hospitals. Patients and Four hundred and ten consecutive patients who attended our center for color Doppler ultrasound of carotid or other sites of the neck-other than the thyroid gland-from September 2005 to May 2006 were included in this study. All patients underwent dedicated thyroid ultrasound for detection of thyroid nodules. We found one or more nodules in 210 (51.2%) of our patients. The mean (±SD) age of patients with incidental thyroid nodules was 62.9±13.1 (range: 14-100) years. The nodules were unilateral in 56.5% and bilateral in 43.5% of the patients. Incidental thyroid nodules were detected in 46.9% of men and 58.8% of women (P=0.017). Among our patients, 61% had only one nodule. The mean (±SD) largest diameter of nodules among those with only one nodule was 10.6±7.9 mm while it was 14.2±11 mm among those with more than one nodule (P=0.03) The prevalence of thyroid incidentalomas in the population we studied was higher than many other studies. This may be due to iodine deficiency in our country.

Tuberous sclerosis (TS) is a developmental neuroectodermal disorder, affecting multiple organ systems. Most patients are diagnosed at the age of five years or later. Only recently, mutation analysis of TS Complex genes has enabled us make an early or even an antenatal diagnosis of the disease. Early onset with infantile seizures is mainly an ominous sign for an unfavorable outcome.MRI findings in older children and adults are well-known; however, only limited publications illustrate brain MRI findings in newborns. We present a female neonate with a positive family history, categorized as "definite TS." On MRI of the brain, white matter lesions were depicted. MRI findings were correlated with published data on neonatal TS.

Background/ The objective of this study was to determine the normal values of amniotic fluid index (AFI) at different gestational ages among a group of Iranian women.Patients and The four-quadrant sum of amniotic fluid pockets, AFI, was studied in 489 normal pregnant women with 20-42 weeks of gestational age. Those with diabetes mellitus, hypertension, ultrasonographically detectable anomalies, premature rupture of membranes, intra-uterine growth retardation, and any known fetal abnormalities were excluded from the study. The mean 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of AFI for each gestational age were calculated. The mean±(±SD) gestational age of the pregnant women studied was 31.46±6.1 (range: 20-41) weeks. The mean±(±SD) AFI was 13.26±4.59 (range: 5.1-26.1) cm. The mean (±SD) AFI was 12.1±1.6 cm (Confidence Interval 95%: 8.9-15.3) at the 20th week, increased to 14.6±1.2 cm (CI95%: 12.2-17) at the 27th week, which then declined to 10.9±1.2 (CI95%: 8.5-13.3) at the 41st week. Our study determined the curve of normal values of AFI for each gestational age and the upper and lower normal limits in a group of Iranian women.

Ovarian Burkitt''s lymphoma is rare in adulthood. Metastatic spread from ovarian malignancies occurs most commonly to the peritoneum, with nodular thickening of the peritoneum and serosal surface of the bowel, omental thickening (omental cake) and ascites. Metastasis to the para-aortic lymph nodes and liver has also been reported. Nonetheless, to the best of our knowledge, metastasis to the retroperitoneum has not still been reported.Herein, we reported an ovarian Burkitt''s lymphoma in a 20-year-old woman who presented with ascites, large bilateral ovarian masses, peritoneal and retroperitoneal metastasis.In evaluating any ovarian neoplasm with retroperitoneal metastasis in a young woman, Burkitt''s lymphoma should be considered as a possibility.

Background/ To determine the success rate of computed tomographic (CT) fluoroscopic CT (FCT) and conventional CT (CCT) for needle navigation in biopsies from mediastinum, bone, abdomen, liver and pelvis. Patients and Data from 122 consecutive percutaneous interventional biopsies performed with use of FCT guidance (mean age of 50.5; range: 1-79 years) and 84 consecutive biopsies with CCT guidance (mean age: 50.7; range, 12-83 years) were gathered from the interventional radiologist and general practitioner. The success rate of procedure was increased in the FCT group as compared with that of CCT group in some organs such as bone, abdomen, liver and pelvis. A statistically significant difference was noted when we compared FCT group with CCT in liver biopsies (P=0.019). The mean procedure time was lower in FCT group. The overall mean (±SD) FCT time was 200±90 (range: 20-400) sec; in CCT group, it was 420±260 (range: 605-800) second. FCT facilitates CT-guided biopsy procedures and reduces the procedure time by allowing visualization of the needle tip from skin entrance to the target point.

The popliteal artery entrapment syndrome (PAES) is an uncommon developmental abnormality, which comprises various anatomic variants causing compression of the popliteal artery. Strenuous athletic activity can cause repetitive compression or microtrauma to the popli-teal artery and may result in foot or calf claudication. Popliteal artery aneurysm, thrombosis, or thromboembolism may rarely occur which may mask the underlying pathology. The first diagnostic technique of choice in patients with possible PAES should be duplex color Doppler ultrasonography with high-frequency transducers. Use of stress views-active plantar flexion and passive dorsiflexion of the ankle-increases the diagnostic accuracy. Classically, arteriography with the foot in the neutral position demonstrates abrupt medial deviation of the popliteal artery. In this article, we describe imaging findings in a young wrestler with complicated PAES.As far as we know, this is the first reported case from Iran with PAES.