Iranian Journal of Radiology
Volume:6 Issue: 3, Summer 2009

Background/ Breast cancer is the most common cancer among Iranian women. The mean age of these cancer patients is one decade younger than that of other developing countries. The aim of this study was frequency determination of Breast Imaging Reporting and Data System (BIRADS) subcategories, especially, higher categories and analysis of its related factors in the patients referred to the radiology department of Valie-Asr Hospital, Birjand.Patients and The study was performed on 437 female patients from June 2006 to May 2007. Patients were divided into two groups; namely, those who underwent screening mammography and those who underwent diagnostic mammography. An expert radiologist reported the mammograms according to BIRADS classification. SPSS ver 12 software and Chi-square test were used for statistical analysis and P-value was significant under 0.05. The mean age was 43.8±9 years. Eighty-one percent of the mammograms were diagnostic and only 19% of them were screening mammographies. Unilateral breast pain was the most common symptom (29%) of which 68% were premenopausal. Fify-five percent of them had a history of OCP consumption. The overall BIRADS classification frequencies were: category 0: 9 (3%), category 1: 85 (19%), category 2: 268 (61%), category 3: 37 (8%), category 4: 22 (5%), category 5: 16 (4%). A positive test result (BIRADS categories 4 and 5) in our study was 10.7% in the diagnostic group and 1.2% in the screening group (p=0.007). Five percent of all patients had a familial history of breast cancer. Screening mammography is recommended for early evaluation and early diagnosis of breast cancer.

Background/ The aim of this study was to assess the frequency of significant carotid artery stenosis and its association with the cardiovascular risk factors in a group of Iranian candidates for CABG.Patients and Three hundred and one patients with critical coronary artery disease, who were candidates for coronary artery bypass graft (CABG) were evaluated by internal carotid Doppler study. The relations between age, gender, hypertension, diabetes mellitus, smoking, lipid profile, left main coronary stenosis greater than 50% by diameter and coronary artery disease with carotid stenosis were assessed. Significant carotid stenosis greater than 70% was detected in 13 patients (4.3%). According to the meaningful relationship between significant carotid stenosis and low HDL serum level (lower than 45 in women and lower than 35 in men, p=0.028), hypertension (p=0.021), history of smoking (p=0.026) and left main coronary artery stenosis greater than 50% (p=0.035), they were identified as risk factors valuable enough to guide for selective screening. Among all cardiovascular risk factors, it seems that serum HDL, smoking, left main coronary stenosis and hypertension could be associated with significant carotid artery stenosis in CABG candidates.

Background/ Tuberculosis (TB) is one of the most common worldwide infections, especially in developing countries. Early diagnosis is very important for prevention of the chronic form of the disease and sequel formation. Chest x-ray (CXR) is an easy, feasible, non-expensive and quick tool for the diagnosis of pulmonary tuberculosis.Patients and We retrospectively evaluated 200 chest x-rays of secondary pulmonary TB cases in university-affiliated hospitals. These cases were all proved by a positive sputum smear or culture for mycobacterium tuberculosis. In this study, we correlated CXR findings of 100 male and 100 female patients. The peak age of involvement in both groups was 61-80 years. None of the chest x-rays were normal. The main radiographic findings were consolidation-infiltration, fibrosis, pleural effusion, cavitation, pleural thickening and bronchiectasis. Mediastinal lymphadenopathy was detected in 9% of the cases. Pulmonary infiltration with consolidation was the most common finding (55%). Miliary shadowing, atelectasis and pneumomediastinum were the least common presentations. Lymphadenopathy was more common in 40 to 60-year-old women. Right lung involvement was more common than the left side and the upper zones were involved in most cases. The most common underlying diseases were hypertension and diabetes mellitus. Infiltration in diabetic patients and fibrotic appearances in hypertensive patients were common findings. There was no significant difference between our data and the other studies carried out in Iran. The patients were younger in the studies from other countries. However, cavitary lesions were more common in other studies than this study, which seems to be due to the higher prevalence of underlying diseases such as HIV or diabetes.

We report a 4-year-old girl complaining of diplopia and a small lump in the medial side of the left orbit. CT scan showed a mass at the anterior thmoid sinus with erosion and expansion. The mass was excised and the diagnosis was solitary infantile myofibroma (IM).

Osteopetrosis is a rare skeletal disorder that results from a defect in the differentiation and function of osteoclasts. The lack of normally functioning osteoclasts results in abnormal formation of the primary skeleton and a generalized increase in the bone mass. This disorder is inherited as an autosomal recessive (osteopetrosis congenita) and an autosomal dominant trait (osteopetrosis tarda). In this article, we report four cases of malignant osteopetrosis and describe the clinical and dental radiographic findings associated with this rare disease.

Background/ Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study (NCS) in the diagnosis of carpal tunnel syndrome.Patients and 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. The mean cross-sectional area (CSA) of the median nerve at the tunnel inlet was 11.4±1.7 mm2 for the patient group and 5.78 ±0.9 mm2 for the control group (P<0.001). The mean cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the patient group and 4.7±0.7 mm2 for the control group (P<0.001). The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm2. In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS.

Background/ Healthy aging may be accompanied by some types of cognitive impairment; moreover, normal aging may cause natural atrophy in the healthy human brain. The hypothesis of the healthy aging brain is the structural changes together with the functional impairment happening. The brain struggles to over-compensate for those functional age-related impairments to continue as a healthy brain in its functions. Our goal in this study was to evaluate the effects of aging on the resting-state activation network of the brain using the multi-session probabilistic independent component analysis algorithm (PICA).Patients and We compared the resting-state brain activities between two groups of healthy aged and young subjects, so we examined 30 right-handed subjects and finally 12 healthy aging and 11 controls were enrolled in the study. Our results showed that during the resting-state, older brains benefit from larger areas of activation, while in young competent brains, higher activation occurs in terms of greater intensity. These results were obtained in prefrontal areas as regions with regard to memory function as well as the posterior cingulate cortex (PCC) as parts of the default mode network. Meanwhile, we reached the same results after normalization of activation size with total brain volume. The difference in activation patterns between the two groups shows the brain''s endeavor to compensate the functional impairment.

Meningioma particularly the intradural subtype is one of the common spinal tumors, which usually occurs as a round to oval broad based lesion. We report an unusual case of en-plaque meningioma in which the lesion completely encircled the cervical spinal cord. En-plaque meningiomas remain a surgical challenge. Although early recognition and combined strategy of surgery and radiosurgery have shown promising results, these lesions can still be associated with poorer prognosis particularly when the lesions are complex in nature and the resources are limited.

Ureterocele prolapse is a rare complication that obstructs the bladder outlet. This disease rarely presents in infant boys. In this case report, we present two 2.5 and 5-month-old infant boys with suspected posterior urethral valve diagnosis. Sonography demonstrated significant bilateral hydroureteronephrosis and unilateral interavesical ureterocele in both our patients. Voiding cystourethrography showed a filling defect in the posterior urethra associated with severe unilateral reflux. The diagnosis of prolapsing ureterocele should be considered whenever there is a ureterocele associated with bilateral uropathy.

Background/ This study was performed to construct an institution specific crown-rump length (CRL) nomogram and to compare its ability to predict gestational age with previously published nomograms.Patients and A regression model was developed for estimation of gestational age using CRL measurements of 123 singleton fetuses in the Nepalese population. Measurements were obtained by placing the calipers of the ultrasound machine from the crown to the rump. The appropriateness of previously established CRL nomograms for predicting the gestational age was assessed in the Nepalese population to determine comparability between nomograms. CRL corresponds to Robinson''s nomogram up to 9 weeks of gestational age. There is a deficiency of 2mm at 10 weeks, 5 mm at 11 weeks and 8 mm at 12 weeks. CRL measurements are used as a reliable method for estimation of the gestational age as well as a baseline for comparing gestational ages later. CRL corresponds to Robinson''s nomogram up to 9 weeks gestational age. There is a deficiency of 2-8 mm from 10-12 weeks gestational age. Difference with the established nomograms may be due to ethnic differences of the fetal development. After 12 weeks, CRL measurement is unreliable due to flexion of the fetus.

A 65-year-old man was presented with intermittent hematuria and non-specific right-sided abdominal pain.What is your diagnosis?

Dear editor:Swine flu is a new emerging atypical H1N1 influenza virus infection. Nowadays swine flu pandemic has become a global public health threat.1 As there are several epidemic foci of swine flu around the world and there are many infected cases, it is necessary for every country to prepare for management. Chest x-ray is an important investigation for the confirmed infected cases as well as highly suspicious cases. There must be specific concern for infection control in the procedure of patient preparation for chest x-ray. In routine clinical practice, separation of the patients and using specific isolated parts are suggested for general clinic; however, this might not be possible for the x-ray unit. It is routinely not possible to separate the x-ray room specifically for this group of patients. There must be a special communication system between the ward and the x-ray unit for early preparation. The process must be managed as a fast track procedure and preparation of a special room based on disinfectant principles before and after each x-ray procedure. In addition, preparation of the patients according to basic infection control process such as wearing masks and hand washing before the x-ray procedure are other precautionary measurements.

Dear editor:Wandering spleen is a rare pediatric emergency. Persistent torsion of the splenic pedicle causes splenic infarction, which results as an acute abdomen and severe pain. An abdominal mass is present in the majority of cases. We emphasize that whenever a pediatric patient comes with acute abdomen and the spleen is not in the usual position and a mass is found elsewhere in the abdomen or pelvis, the possible diagnosis of wandering spleen with acute torsion should be kept in mind. Ultrasonography (US) is the initial study of choice, but CT scan of the liver and the spleen are excellent adjuncts when the diagnosis remains in question.