Iranian Journal of Radiology
Volume:9 Issue: 4, Dec 2012

The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.

The gonial angle is one of the most important measurements required for orthodontic treatment and orthognathic surgery. It is difficult to determine the accurate measurement of each gonial angle on cephalometric radiographs because of superimposition of the left and right angles.. The aim of the present study was to determine the right and left gonial angles on panoramic radiographs and to compare them with an evaluated cephalometric sample.. Patients and A total of 80 panoramic and 80 cephalometric radiographs were obtained from 6 to 12-year-old children and the gonial angle was determined by the tangent of the inferior border of the mandible and the most distal aspect of the ascending ramus and the condyleon both panoramic and cephalometric radiographs. We used Pearson’s correlation coefficient and paired t-test for comparison.. The mean gonial angle was 127. 07 ± 6. 10 and 127. 5 ± 6. 67 degrees on panoramic and cephalometric radiographs، respectively. There was no statistically significant difference between the measured gonial angles on panoramic and cephalometric radiographs and also no difference between the right and left (both Ps = 0. 18). The value of the gonial angle measured on panoramic radiography was the same as that measured on the routinely used cephalometric radiography.

In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer، sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS) -guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.. Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.. Patients and One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET) -CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7. 5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs، their dimensions were recorded. Aspiration was considered as “insufficient” if there were inadequate lymphocytes on the smears. Diagnosis of “malignancy” on cytologic examination was considered as the “final diagnosis”. If diagnosis was negative for malignancy، more invasive procedures were performed to confirm the diagnosis.. Twenty four females and 96 male patients (mean age، 57. 8 ± 9. 1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients، the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients، 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity، diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89. 1%، 91. 6% and 73. 6%، respectively. No major complications were seen.. As an alternative method to mediastinoscopy، EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

Endometrial carcinoma is a highly prevalent gynecologic malignancy. The International Federation of Gynecology and Obstetrics (FIGO) staging system underwent significant revision on 2009. Key changes in the FIGO staging system include simplification of stage I endometrial cancer and removal of cervical mucosal invasion as a separate stage. MRI is a noninvasive diagnostic method for preoperative staging of endometrial cancer. The main purpose of this study was to investigate the diagnostic efficacy of pelvic MRI in determining the depth of myometrial invasion and cervical involvement in endometrial carcinoma. The other aim was to compare the accuracy of pelvic MRI using the old and new FIGO staging systems in endometrial carcinoma.. Patients and Between November 2010 and January 2012، 54 patients underwent primary surgical staging in our department due to endometrial adenocarcinoma. Pre-operative pelvic MRI was performed and MRI staging was done according to old and new FIGO staging، separately. The sensitivity، specificity، positive and negative predictive values as well as the accuracy of MRI for deep myometrial invasion and cervical infiltration were calculated. MRI accuracy was also compared for old and new FIGO staging. Pathological staging was the standard of reference.. The mean age was 53. 31 (SD = 11. 52) and the most common histological subtype was the endometrioid type of endometrial adenocarcinoma (90. 8%). In the evaluation of deep tumoral invasion of the myometrium (> 50%)، sensitivity، specificity، diagnostic accuracy and positive and negative predictive values of MRI were 82. 35%، 94. 59%، 90. 74%، 87. 5% and 92. 1%، respectively. For cervical stromal involvement، these values were 54. 54%، 100%، 90. 74%، 100% and 89. 58%، respectively. In case of cervical mucosal involvement (in old FIGO staging)، the positive predictive value was only 50% and the accuracy decreased to 74. 07%. Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0. 62 and 0. 72، respectively (P < 0. 001).. Using 2009 FIGO classification increases the accuracy of pelvic MR imaging for preoperative staging of patients with early stages of endometrial cancer.

Although magnetic resonance spectroscopy (MRS) has been shown as an effective diagnostic tool in distinguishing inflammation from neoplasm in cystic brain lesions، the optimum approach in selecting the portions of lesions in MRS and the possible effects of different times of echoes (TEs) remains unknown.. Patients and In 16 patients with brain cystic tumors، MRS was performed at TEs of 30، 135 and 270 ms for detection of Choline (Cho)، N-Acetyl Aspartate (NAA) and Creatinine (Cr) metabolites using a 3 tesla MRI unit. The percentage of analyzed ratios greater than a cut-off point of 1. 3 for Cho/Cr and 1. 6 for Cho/NAA were calculated.. Cho/Cr and Cho/NAA ratio means at all TEs were more at the central area in comparison with the periphery، although none of the differences were statistically significant. There was no statistically significant difference among the compared TEs. The percentages of ratios above the cut-off point at all TEs were more in the rim compared to the center and in the union of both compared to the rim or center. All the patients had at least one voxel with a Cho/Cr ratio of more than 1. 3 when the voxel was chosen according to the hotspot shown in the chemical shift imaging map، regardless of their location at all examined TEs.. Selection of voxels with the guide of chemical shift imaging map yields to 100% diagnostic sensitivity. If not accessible، the use of the union of peripheral and central voxels enhances the sensitivity when compared to usage of peripheral or central voxels solely.

Plain radiography and contrast radiologic studies are traditionally the main options in evaluating neonates presenting with bilious vomiting. While ultrasonography (US) is more available، its diagnostic accuracy is in question.. The purpose of this study is to determine the diagnostic accuracy of US in evaluating these patients with bilious vomiting.. Patients and All neonates with bilious vomiting or bilious nasogastric tube drainage presented to a children’s hospital in a 1. 5-year period were included. US were performed in all patients. The results were compared with clinical and radiological data and the final diagnosis. We used chi-square and Fisher’s exact tests for analysis.. The cause of bilious vomiting for 18 of the 23 included patients was surgical. All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%]، while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%، Confidence Interval (CI) 95%: 29%-71%]. The sensitivity and specificity of US in diagnosing intestinal atresia (n = 9) was 89% [CI 95%: (68% - 100%)] and 100%. In cases with malrotation (n = 4) and midgut volvulus (n = 2)، sonographic diagnosis was in concordance with final surgical diagnosis.. This study suggested that in cases in which US makes a certain diagnosis، its accuracy eliminates the need for further diagnostic tests، but if it is inconclusive، further radiological contrast studies should be tried to make the final diagnosis.

Malignant pleural mesothelioma (MPM) is an uncommon neoplasm. MPM occurs more frequently in patients born or living in certain villages of Turkey.. We aimed to review radiological findings of MPM.. Patients and We reviewed the CT findings in 219 biopsy-proven MPM patients admitted to our clinic between 1993 and 2008.. The most common CT findings included pleural thickening (n=197، 90%) classified as diffuse (n=138، 63%)، nodular (n=49، 22%) and mass-type (n=16، 7%). Pleural effusion was found in 173 patients (79%)، involvement of the interlobar fissures in 159 (73%)، mediastinal pleural involvement in 170 (78%)، volume contraction in 142 (65%)، mediastinal shift in102 (47%) and mediastinal lymphadenopathy in 54 (25%).. MPM may present with diverse radiological features. Pleural thickening and pleural effusion were the most frequent radiological findings. Thoracic CT scans might be assessed more cautiously in patients with environmental exposure to asbestos.

Primary neuroendocrine carcinoma of the breast is a very rare malignant tumor. There are not many cases reported in the English literature since it was first documented in 1983. Reports on the imaging features، in particular the ultrasonographic features of this rare tumor are scarce. Herein، we report a case of aggressive primary infiltrating neuroendocrine carcinoma of the breast، masquerading as an inflammatory breast condition in a 22-year-old young lady، perhaps the youngest case ever reported in the English literature. We discuss the imaging features and highlight the Doppler ultrasonographic findings of this rare breast carcinoma. This is the first documentation on Doppler ultrasonographic findings of primary neuroendocrine carcinoma of the breast in the literature.

Malignant spermatic cord tumor is rare. Spermatic cord metastasis is less common and the prognosis of these patients is poor. Here we report a case of unilateral spermatic cord metastasis from advanced gastric cancer. A 57-year-old male underwent total gastrectomy due to advanced gastric cancer. Three years later، a painless hard palpable mass in the left inguinal area developed and the pathology revealed a spermatic cord metastasis from stomach cancer.

The ribs are essential structures of the osseous thorax that provide certain significant information and aid interpretation of radiologic images in daily routine practice. Intrathoracic rib is a rare congenital anomaly that is usually discovered incidentally، but may cause in vain interventions in case of being unaware. We herein report an intrathoracic rib in a girl whose chest X-ray was strange enough to obtain a spiral computed tomography (CT) scanning for a definitive diagnosis afterwards.

A patient with a 3-month history of headache refractory to pain medication was admitted. The CT scan and MRI showed evidence of a posterior fossa mass. This was pathologically confirmed as an extra medullary plasmacytoma (EMP). He had a pathologic fracture of the left humerus 7 years ago while the radiologist was unaware at the time of diagnosis. A solitary bone plasmacytoma (SBP) was the cause of the pathologic fracture. This report includes the first description of MRI findings in a patient with a rare-incidence intracranial solitary extra medullary plasmacytoma (SEP) in Iran. There is a striking similarity between the features of intracranial SEP and meningiomas. Intracranial SEP، although rare، should be included in the differential diagnosis of brain tumors in areas where meningiomas commonly arise. The MRI findings and differential diagnosis of plasmacytoma are reviewed. Before this case report، only few cases have been reported in the literature. Nonetheless، this is the first report of posterior fossa EMP from Iran.

Meningeal melanocytoma is a primary melanocytic neoplasm with certain MR and immunohistochemical characteristics worthy to note. In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea، vomiting، diplopia، progressive visual blurring and hearing loss، magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study. Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal. Contrast-enhanced MRI revealed diffuse enhancement in the basal cisterns extending throughout the spinal canal. Immunohistochemical analysis on one of the intraspinal nodules proposed leptomeningeal melanocytoma. The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin، often suggests a diagnosis of a melanocytic leptomeningeal process. Moreover، there are unique immunohistochemical characteristics for these varied lesions. In appropriate clinical settings، certain radiologic findings، especially both T1 and T2 shortening in nodular CNS lesions should propose meningeal melanocytoma.