Iranian Journal of Radiology
Volume:6 Issue: 2, Spring 2009

Background/ Mammography remains the most suitable screening test in detecting microcalcifications as the earliest manifestation of breast malignancy. By means of highfrequency transducers yielding high-resolution breast imaging, some researchers have reported that ultrasonography is capable of depicting microcalcifications in the breast tissue. Therefore, this study has been designed to compare the diagnostic yield of high-resolution breast ultrasonography (HRS) versus conventional mammography.Patients and Seventy-four consecutive patients who had breast microcalcifications (hyperdense foci < 0.5mm) according to standard mammograms, without a prior history of breast disease, surgery, biopsy, chest wall radiation or systemic chemotherapy were enrolled. Considering mammograms as a reference, 46 patients without a mass, voluntarily underwent high-resolution bilateral breast ultrasonography. The mean age was 50.7±10 years (range, 35-85 years). The upper outer quadrant of the breast was the commonest place where microcalcifications were detected (36.9%). A relative frequency of 45.7% was reported for microcalcifications with breast imaging reporting and data system (BIRADS) score 3. An overall 82.6% diagnostic yield was discovered for HRS in detecting microcalcifications; it detected all microcalcifications with BIRADS score 4 and 5, but 57.1% and 90.5% of microcalcifications with BIRADS score 2 and 3, respectively. Cluster microcalcification was the most common pattern (43.5%). Considering the 82.6% diagnostic yield of HRS compared to mammography, it can be proposed as the surrogate modality in locating microcalcifications in procedures such as biopsies and hook-wiring, with the advantage of reducing radiation exposure. HRS may be the future screening modality as a result of feasibility, safety, compliance and accuracy.

Background/ Thyroid nodule is one of the most common endocrine disorders. 5%- 10% of thyroid nodules undergo malignant degeneration. The objective of this study was to determine the prevalence of thyroid incidentaloma in Bushehr, southern IranPatients and A total of 1503 consecutive 15 to 65-year-old patients who were referred to Fatemeh Zahra Hospital for any ultrasonographic examination other than the thyroid gland were included in this study. All patients underwent dedicated thyroid ultrasound by a 10 MHz linear probe for detection of thyroid nodules in the supine position The prevalence of thyroid nodules was 13.6%. The nodules were observed in 17.5% of the women and 8.5% of the men. 61.8% of the nodules were smaller than 1 cm. Thyroid nodules were more frequent in older people. Bushehr has a high prevalence of thyroid nodules. The prevalence is age dependent and is higher in women than men.

Osteochondroma, the most common benign tumor of the bone also known as exostosis, is a rarity in the spine. It occurs in solitary or multiple forms. The multiple form is often hereditary and is usually called hereditary multiple exostoses (HME). The precise diagnosis of spinal osteochondroma is performed by CT and MRI. We report a case of HME in a 17-year-old man with a positive family history. The tumor was in continuity with L4 vertebra and the spinal canal stenosis was evident. The full recovery was successful after tumor resection.

Optic nerve glioma (ONG) originating purely from the intracranial part of the optic nerve is a very rare presentation of optic pathway gliomas. We encountered a 48-year-old woman presenting with an intra-axial lesion in preoperative magnetic resonance imaging (MRI), which turned out to be a lesion originating from the intracranial segment of the optic nerve. We intend to present the case and discuss the interesting and misleading images and the different aspects of management of this rare pathology briefly.

Background/ Hypertrophic pyloric stenosis (HPS) is the commonest indication of pediatric surgery in neonatal period and early infancy. There are some clinical and radiological methods for the diagnosis of HPS. As an example, a positive "olive sign" in the abdominal examination is diagnostic; however, it seems that performing physical examination for the detection of this sign has been abandoned and that this practice has been replaced by sonography and other paraclinical tests. The aim of this study was to assess the ability of our physicians in finding the palpable olive in clinical examination and the accuracy of sonography and the true positive rate of barium study.Patients and We evaluated 84 patients admitted to our hospital during a 7-year period in which the final surgical report was HPS. Clinical examination for the right upper quadrant (RUQ) olive like mass, barium study and ultrasound findings of HPS were evaluated. Pediatric residents (junior and senior residents) examined all these cases. Twenty-one patients had a barium study and 81 had a sonography, which was performed by an attending radiologist. Data were evaluated for the diagnostic yield (DY) of all these diagnostic tools. The mean age of the patients was 36.1 days on admission and the male/female ratio was 5.4/1. All the patients had a clinical examination, in which the olive sign was detected in only 13 cases (DY= 15.5%, 95% CI: 12%-19%); 81 patients had a sonography, in 71 of whom HPS was detected (DY = 87.7%, 95% CI: 85%-92%); barium study revealed HPS in 16 of 21 patients (DY = 76.2%, 95% CI: 71.4%-82%). Sonography was more precise than clinical examination and barium study in detecting HPS. Due to the crying baby and the distended stomach, less time is spent for clinical examination. Therefore, paraclinical studies such as imaging become the first step in diagnosis and are requested earlier and even as the first diagnostic study on admission. This leads to reduction of doctors'' experience in finding the olive sign.

Hepatic tumors are rare in children. About 50%- 60% of these tumors are malignant. 65% of the liver malignancies are hepatoblastomas and most of the remainder are hepatocellular carcinomas. Yolk sac tumor (YST) is an extremely rare tumor of the liver. We report on a hepatic yolk sac tumor in a 15-month-old girl who presented with acute abdomen. She was diagnosed initially as intussusception, while ultrasonography and CT-scan indicated a liver mass. Finally, yolk sac tumor was diagnosed surgically and histopathologically.

Urinary overflow incontinence is an unusual problem in young girls. Hereby we introduce hematocolpos as one of the rare causes of overflow incontinence in a 14-year-old girl. In this case, hematocolpos simultaneously compressed the bladder and the bladder-outlet and finally caused overflow incontinence.

In this pictorial essay, we intend to review the imaging findings of a series of patients who underwent thoracolumbar instrumentation and showed any kind of complication. Imaging of complicated cases could help surgeons find the most frequent defects of these procedures. In this article, we present 18 images of 150 patients who underwent spinal instrumentation in a 15-year period.

What is your diagnosis?A 25-year-old woman presented with a low-grade fever, loss of weight and appetite of 4 months duration and intermittent vomiting of two months duration. The diagnosis was tubercular meningitis and the patient was on anti-tubercular therapy from one month. Two weeks ago, a rapidly progressive visual loss emerged in two days. In general observation, she was thin, had mild pallor and no icterus, was conscious and also irritable. In physical examination, she was febrile (100o F), there were bilateral crepitations in the chest and she had mild neck rigidity. On eye examination, there were bilateral dilated sluggishly reacting to light pupils, no projection or rays or perception of light in both eyes, the fundus showed bilateral papilloedema with features of secondary optic atrophy. Extra ocular movements were restricted in all directions suggestive of 3rd, 4th and 6th nerve paresis. Other cranial nerves were normal. There were no focal motor or sensory deficits. Blood investigations were normal except for a raised erythrocyte sedimentation rate (64 mm in the 1st hour). Three consecutive samples of sputum for acid fast bacilli were negative. The brain CT scan showed mild dilation of the third and lateral ventricles and thick basal exudates (Fig. 1.A&B). MRI of the brain showed hypertrophy of the chiasma and the cisternal segment of both optic nerves after contrast enhancement (Figs. 2&3).

We present two cases of high signal intervetebral disc in T1-weighted MRI with the differential diagnoses