Iranian Journal of Radiology
Volume:7 Issue: 3, Sep 2010

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma (HCC). Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma (HCC) including transcatheter arterial chemoembolization (TACE) and many tumor ablation techniques, such as percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser-induced interstitial thermotherapy (LITT), cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likelythat in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography (CT) and magnetic resonance imaging (MRI) have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated.In this review article, we discuss the imaging modalities and also tailoring of interventionalprocedures for HCC patients.

Background/ A dynamic contrast-enhanced T1 technique has been applied for calculating cerebral blood flow (CBF) with MRI. Previous studies have shown that the CBF calculated from T1 techniques was lower than the expected CBF. One cause could be the change in MRI signal intensity due to blood flowing into the measurement slice. The aims of this paper were:1. To quantify the effects of inflow on perfusion measurements using a phantom.2. To apply a simple inflow correction to perfusion measurements taken from 11 healthy subjects. Patients and A flow phantom was designed to produce different velocities covering the velocity range of small vessels and big arteries. The inflow effects were measured in the phantom. After the contrast administration for healthy subjects, CBF was calculated based on T1 technique. The inflow correction factor for the common carotid artery velocity and capillary level was calculated by the phantom as 1.23 and 1, respectively. The average value of CBF on the middle cerebral artery (MCA) grey matter territory of 11 healthy volunteers without any correction was 43.0 mL/100 g/min. For measuring the absolute CBF, the inflow correction factor for the arterial input function and tissue should be known. After applying the inflow correction factors, the absolute CBF may be calculated as 52.9 mL/100 g/min. This value is in good agreement with those in the PET literature.

Background/ High resolution ultrasound is performed in the investigation of rotator cuff pathology. However, there are various reports in the literature regarding the diagnostic accuracy of ultrasound. The purpose of our study was to compare the diagnostic accuracy of ultrasound with multislice computed tomography arthrography (CT arthrography).Patients and We prospectively studied sixty-four consecutive patients with rotator cuff pathology diagnosed by ultrasound (35 men and 29 women; age range, 35-75) who underwent preoperative multislice CT arthrography of the shoulder from February 2006 to January 2008.Full-thickness and communicating partial-thickness tears of the supraspinatus, infraspinatus,subscapularis tendons as well as the abnormalities of the long head of the biceps tendon were assessed. The right shoulder was involved in 44 patients. The supraspinatus tendon was the most frequently involved either by full-thickness (n=50) or partial-thickness (n=29) tears. Ultrasound correctly identified full-thickness rotator cuff tears in 84 % of cases with a good positive predictive value (83%). The sensitivity and specificity of ultrasound in the detection of partial-thicknss tears were 76% and 46%, respectively. These percentages significantly increased with the presence of joint effusion (77% vs 70%) and joint and subacromial/subdeltoid bursal effusion (80% vs 67%). Ultrasound allows an accurate diagnosis of full-thickness tears. The diagnostic performance of ultrasound in the assessment of partial-thickness tears increases when a joint effusion or double effusion is present.

Background/ In this study, our purpose was to evaluate the thalamic magnetic resonance (MR) spectroscopic changes in multiple sclerosis (MS) patients.Patients and Forty-three relapsing-remitting MS (RRMS) patients and 23 control subjects were included in this study. Routine brain MR and MR spectroscopy (MRS) usin single voxel technique were carried out in all the patients and the controls. The N-Acetylaspartate (NAA), choline (Cho) and creatine (Cr) peaks were calculated. The thalamic relative metabolite ratios of the RRMS patients were compared to those of the control subjects by using the statistical measures (Mann-Whitney U test). The level of statistical significance was set at 0.05. The thalamic NAA/Cr and NAA/Cho ratios were lower while the thalamic Cho/Cr ratio was higher in the MS patients than those of the control subjects. But these differences in the spectroscopic relative metabolite ratios were not statistically significant between the groups (p=0.34, p=0.22 and p=0.1, respectively). The spectroscopic relative metabolite ratios were of limited value in determining the presence of metabolic changes in the deep grey matter of MS patients. New studies about the presence of the deep grey matter damage in MS patients are necessary

Ataxia is a movement disorder that may manifest an acute, intermittent, non progressive or chronic progressive course. Ataxia alone is rare as a paraneoplastic sign, especially if it is due to neuroblastoma (abdominal or chest).We report an abdominal neuroblastoma in a two-year-old girl presenting with only acute ataxia and abnormal neuroimaging. Brain MRI showed abnormal signal finding in the medulla, pons, corticospinal tract and the periventricular space. In the abdominal CT, a mass was detected in the right adrenal gland with calcification and the histopathologic examination re-vealed neuroblastoma.We suggest in children with acute ataxia, with or without opsoclonus-myoclonus, neuroblastoma should be considered.

Background/ Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in impotent men. We introduce CT cavernosography as a novel method for demonstrating leaking veins.Patients and Sixty-seven patients diagnosed as venous incompetence by Doppler study, and eight normal subjects were enrolled into the study. After intracavernosal injection of papaverine, normal saline was injected into the corpora cavernosa and the injection rate was gradually increased and the penis was observed to obtain the injection rate causing erection. Then contrast media was injected into the corpus cavernosum with obtained injection rate followed by CT scan of the penis and pelvis. In the first group, 63 patients (94%) had venous leakage by CT cavernosography. In this group, full erection was observed at the rate of 36 ml/min of saline injection in three patients and 24 ml/min in one patient. In 46 patients (73%), erection was induced with saline injection at the rates of 48-120 ml/min, and in 17 patients (27%) no full erection was demonstrated even at the injection rate of 120 ml/min. In the 2nd group we observed full erection after saline injection at the rates of 36 ml/min and 24 ml/min in five and three patients, respectively. Beside the capability of CT source images in precise visualization of all leaking veins without superimposition of bony structures, different techniques of two- or three- dimensional reformation enable us to demonstrate the anatomy of the penis and the leaking veins elegantly for further surgical planning.

Localized cystic disease (LCD) is the accumulation of multiple simple cysts, partially involvingthe kidney which are usually detected incidentally. Imaging findings of LCD are important to differentiate it from other renal cystic diseases and to avoid unnecessary surgery. Although it is known as a non-progressive condition, we present here the imaging findings of a case with LCD showing progression in long-term period.

Background/ Comparing anatomicopathologic findings in complicated and uncomplicated lower-limb varicose veins by ultrasonography.Patients and Totally, 231 consecutive patients [148 (64%) men; mean age, 46.8± 14.3 years (range: 16-88 years)]; 155 (54%) left and 132 (46%) right variceal legs were evaluated by Doppler ultrasonography with color-flow imaging using a 7.5-10 MHZ linear probe. The lower extremity venous system (including perforators and valves) were evaluated in the supine and standing position, at rest and during Valsalva's maneuver. Chi square and Fischer's exact tests were used for statistical analysis. We also performed a logistic regression analysis considering presence of any type of complication as the dependent variable and anatomic pathologies as independent variables. Of the 287 limbs with varicose veins, 124 (43%) had at least one complication (ulceration, pigmentation or infection). The highest complication rate was seen simultaneously with chronic deep vein thrombosis (DVT) with segmental obstruction (76.9) and the lowest complication rate in the incompetent valves was seen in patients with perforan vein reflux (50.4%).Mostly, the complication rate was higher in patients with the pathology in comparison to patients without it (p values<0.005). In a multivariate logistic regression model, presence of DVT and saphenofemoral incompetency were statistically significant in the model in comparison to other pathologies (OR=10.6 and 7, respectively, p values<0.02).In 175 patients (75.8%) one of the legs were involved Presence of ulcer, pigmentation and infection are significantly associated with a higher incidence of DVT, deep vein, saphenofemoral and saphenopopliteal incompetency in patients with lower limb varices.

Florid cemento-osseous dysplasia (FLCOD) is a fibroosseous lesion that affects the jaw ofmiddle-aged women. This lesion occurs more frequently in Black and Asians. A familial trend has been reported for some cases. This lesion may be completely asymptomatic and in such cases the lesion is detected in the radiographs incidentally. Radiographic features include multiple radiopaque masses, usually located in three or four quadrants or can be extensive throughout one jaw. However, when they are present in only one jaw, the mandible is the more common location. In this paper we report three cases of FLCOD that had evidences of infection as the first presentation.