Iranian Journal of Radiology
Volume:5 Issue: 3, Spring 2008

Background/ Distinguishing cavernous hemangioma from malignant neoplasmsrepresents a diagnostic challenge. Knowledge of the entire spectrum of gray-scaleultrasonography (US) and color Doppler appearances of these tumors is important. The objective of this study was to determine the diagnostic accuracy of gray-scale US and color Doppler appearances of liver tumors. Patients and 88 patients with 93 focal hepatic lesions were prospectivelystudied with gray-scale and color Doppler US. The final diagnoses of the liver lesions as confirmed by pathology or 99mTc-red blood cell scintigraphy were 41 hemangiomas, 15 hepatocellular carcinomas (HCCs) and 37 metastases. 87.8% of hemangiomas and 66.7% of HCCs were hyperechoic, while 54.1% of metastases were hypoechoic. In lesions < 3 cm in diameter, the sensitivity and specificity of the hyperechoic pattern for differentiation of hemangioma from metastasis and HCC were 94.1% and 80.0%, respectively. They were higher than the lesions with a diameter ≥3 cm (83.3% and 45.9%, respectively, both P=0.001). Posterior acoustic enhancement was seen in 78% of hemangiomas (P<0.001), as compared to 24.4% in metastases and 13.3% in HCCs. 10 hemangiomas had an echogenic rim. The peripheral hypoechoic rim, named as the target sign, was seen in 37.8% of metastases, 26.7% of HCCs and 2.4% of hemangiomas (P<0.001). Most hemangiomas (85.4%) showed no lesional blood flow, while most HCCs (80%) had both intraand peri-lesional vascularity (P<0.001). There was intratumoral blood flow in 86.7% of HCCs.Lesional flow, whether intratumoral or peritumoral or both, was seen in all 14 patients with HCC while absence of the lesional flow was not noted in any of the HCCs. Most hemangiomas had no detectable blood flow in color Doppler US. Almostall HCCs had intra- and/or peri-tumoral vascularity in color Doppler sonography, so the probability of hepatocellular carcinoma is low in a hepatic mass without intra- or peri-lesional vascular blood flow. So these findings together with morphological criteria may help narrow down the differential diagnosis in certain clinical conditions.

Background/ Patients in unstable clinical conditions with blunt abdominaltrauma require rapid evaluation of the abdominal organ injury to assess the need for laparatomy.This prospective study was conducted to determine the use of emergency sonographyfor evaluating patients with blunt abdominal trauma and to compare the accuracy of sonography with the results of diagnostic peritoneal lavage (DPL), exploratory laparatomy and CT scan.Patients and Emergency sonography was performed prior to any of thediagnostic methods, peritoneal lavage, exploratory laparatomy and CT, on 204 patients with blunt abdominal trauma. Sonography was performed with the “focused abdominal sonography for trauma” (FAST) technique and six areas of the abdomen were examined to detect free peritoneal fluid. Sonography showed a sensitivity of 95.4%, specificity of 78.4% and an overallaccuracy of 89% in the diagnosis of free peritoneal fluid. The positive and negative predictive values of sonography were 89.2% and 90.6%, respectively. Sonography is a reliable and accurate method for the emergency evaluationof blunt abdominal trauma.

Ectopic spleen is a rare entity. It is more common in children than in adults and it is about 15 times more common in females. Here we report a patient with an ectopic spleen who was referred for sonographic evaluation of an asymptomatic pelvic mass by a gynecologist. At sonography, a big homogenous mass located at the RLQ of the abdomen and the right pelvic cavity was detected. Further investigation by color Doppler sonography showed that the mass is an ectopic spleen and the main spleen could not be detected at its normal location.In the abdominopelvic CT scan, the spleen was located at the RLQ, no splenic tissue wasfound in the left hypochondrium, and this region was occupied by the left colon and stomach.Ectopic spleen, though very rare, should be considered in the differential diagnosis of asymptomatic pelvic masses.

Background/ This study was conducted to find out the association betweenthe clinical symptoms of chronic rhinosinusitis (CRS) and CT findings.Patients and 50 patients with CRS were studied. Their clinical symptomswere recorded according to the sinonasal outcome questionnaire (SNOT-20) and their CTfindings were graded by the Lund-Mackay grading system. The Pearson correlation coefficient was assessed between these two scores. Also we used multiple regression models for adjusted association among variables. The mean±SD of SNOT-20 and the Lund-Mackay score were 45±8.7 (range: 29–67) and 18.5±5 (range: 8–24), respectively. The mean±SD SNOT-20 score was higher for postnasal drip (PND) and facial pain; the lowest mean scores were for dizziness and ear pain.Pearson’s correlation coefficient of SNOT-20 and the Lund-Mackay grading system was 0.74 (p=0.0001). In simple regression analysis considering the Lund-Mackay score as dependent variable and SNOT symptom domains (nasal, oropharyngeal, sleep, facial, and systemic) as independent variables, the best associated clinical symptom domain was the nasal symptom domain (model r2=0.76; p<0.0001). In the multivariate linear regression model, considering the five symptom domains as independent variables, the model r2 was 0.8 (p<0.0001) and the only significant variable in the model was the nasal symptom domain (p<0.0001). Patients with higher symptom scores are more likely to have CT imagingevidence of rhinosinusitis.

Background/ Risser''s sign, a measure of excursion in the iliac crest apophysis,has been used to evaluate the remaining skeletal growth. The objective of this studywas to evaluate the value of Risser’s sign in estimation of chronological age in a number ofuniversity-affiliated referral hospitals in Tehran, Iran.Patients and Our study group consisted of 206 patients aged between 10and 25 years with a stable hemodynamic condition who were referred due to trauma in regions other than the head and neck. All cases underwent AP spine and proximal pelvis radiographies.All radiographies were graded by Risser’s scoring system. Among our patients, 121 (58.6%) were male and 85 (41.3%) were female. Risser’s score of 0, 1, 2, 3, 4 and 5 were seen in 13 (6.3%), 7 (3.4%), 24 (11.7%), 48 (23.3%), 35 (17%), and 79 (38.3%) of the patients, respectively. Risser’s score was determined for all age groups. Allcases aged over 18 years had a Risser’s score ≥3. Risser’s score is useful for the estimation of age in adults especially for legalpurposes, though further multicenter studies are required for more comprehensive and precise data of the normal Iranian population.

Subcortical band heterotopia (SBH) or ''double cortex'' is a congenital brain abnormality that results from aberrant migration of neurons during development of the cortex. MRI shows a continuous band of heterotopic gray matter located between the cortex and ventricular walls, separated from them by a thin layer of white matter. The condition is quite rare, found predominantly in females, and is occasionally familial with an X-linked dominant inheritance. Corpus callosum agenesis is another brain abnormality, more common than SBH, diagnosed during neurological examinations for developmental delay.We report a 6-month-old boy with SBH and corpus callosum agenesis associated with uncommon clinical and radiological findings such as polymicrogyria and periventricular cystic area.

Pulmonary blastoma is a rare malignancy with various histopathological appearances in children which present as an intra-thoracic mass. In this case report we present a 4-year-old boy with pleuro-pulmonary blastoma which was unrecognized for several weeks and was managed as pleural effusion and pneumonia. We decided to present this case because of the diagnostic difficulties and radiographic appearances.

Background/ Renal cortical thickness is an important index for many renaldiseases. Ultrasonography has been introduced as an effective method to determine different renal measurements. The objective of this study was to determine the sonographic measurement of renal cortical thickness (RCT) in adults with normal renal function in Isfahan and its relation with gender, age, height, weight, body mass index (BMI), and the side of the body.Patients and 142 healthy subjects aged 20–50 years with no history ofrenal or systemic diseases were studied prospectively. These patients had normal BUN/Crtests and urine analysis. They also had a normal kidney sonography. Gray scale sonographywas used to measure the distance between the outer border of the medulla and the renal capsule, presenting as RCT. 80 men and 62 women with a mean±SD age of 38.8±7.7 years underwent sonography. The mean±SD RCT was 9.09±0.99 mm. RCT associated with gender (P=0.02) butthere was no significant difference between the right and left RCTs (P=0.15). There were significant positive correlations between RCT and renal length and the patients’ height, but such a correlation was not observed between RCT and age, BMI, and the patients’ weight. RCT varies with many variables including gender, height and length of thekidney. The results of this study can be used for evaluation of RCT to determine abnormalclinical conditions.

Cerebral venous thrombosis (CVT) may occur at any age and may be idiopathic or secondary to various causes. It has been described in patients with multiple sclerosis (MS) as well. On the other hand, because of the variations of MS per presentations, coincidence of other neurological disorders in MS patients could be ignored. Therefore, more clinical and paraclinical evaluations should be considered in MS patients with any new atypical symptom.We report a rare case with symptoms and signs of inflammatory demyelinating disease as clinically isolated syndrome (CIS) suggestive of MS onset. This case developed CVT after lumbar puncture and during high-dose methylprednisolone pulse therapy.

A middle aged man presented with rapid and progressive deterioration in the sensorium. CT scan showed an ill defined butterfly shaped lesion involving the corpus callosum