Iranian Journal of Radiology
Volume:10 Issue: 3, Sep 2013

Uterine artery embolization (UAE) is a minimally invasive procedure performed under fluoroscopy for the treatment of uterine fibroids and accompanied by radiation exposure.. To compare ovarian radiation doses during uterine artery embolization (UAE) in patients using conventional digital subtraction angiography (DSA) with those using digital flat-panel technology..Patients and Thirty women who were candidates for UAE were randomly enrolled for one of the two angiographic systems. Ovarian doses were calculated according to in-vitro phantom study results using entrance and exit doses and were compared between the two groups.. The mean right entrance dose was 1586±1221 mGy in the conventional and 522.3±400.1 mGy in the flat panel group (P=0.005). These figures were 1470±1170 mGy and 456±396 mGy, respectively for the left side (P=0.006). The mean right exit dose was 18.8±12.3 for the conventional and 9.4±6.4 mGy for the flat panel group (P=0.013). These figures were 16.7±11.3 and 10.2±7.2 mGy, respectively for the left side (P=0.06). The mean right ovarian dose was 139.9±92 in the conventional and 23.6±16.2 mGy in the flat panel group (P<0.0001). These figures were 101.7±77.6 and 24.6±16.9 mGy, respectively for the left side (P=0.002).. Flat panel system can significantly reduce the ovarian radiation dose during UAE compared with conventional DSA..

The incidence of breast cancer has had a four-fold increase from 1980 to 2005 in Taiwan. Limited data have been available on mobile breast screening in the Taiwanese population since 2009.. This study aims at investigating the factors influencing consensus opinion on the recall for mobile breast screening in Taiwan..Patients and The factors were categorized by individual health background, socioeconomic status and knowledge about breast screening. There were 502 questionnaires collected from Taiwanese women examined on mobile mammography screening vehicle. Data were then analyzed by SPSS 12 via analysis of variance (ANOVA), F-test, t-test or chi-square test.. Strong participation was associated with a younger age, higher educational level, higher incomes, previous history of cancer, previous family history of cancer, one or two prior mammographies, more correct recognitions of mammography, recall rate, and breast cancer risk. If the false-positive result occurred, 83.9%, 81.9% and 77.3% of the women agreed or strongly agreed to participate in noninvasive and invasive testing and screening mammography, respectively.. The policy makers should notify the importance of demographic factors affecting further examination for early detection of breast cancer in Taiwan..

BI-RADS was first developed in 1993 for mammography and in 2003 it was redesigned for ultrasonography (US). If the observer agreement is high, the method used in the classification of lesion would be reproducible.. The aim of this study is to evaluate the inter- and intraobserver agreement of sonographic BI-RADS lexicon in the categorization and feature characterization of nonpalpable breast lesions..Patients and We included 223 patients with 245 nonpalpable breast lesions who underwent ultrasound-guided wire needle localization. Two radiologists retrospectively described each lesion using sonographic BI-RADS descriptors and final assessment. The observers were blinded to mammographic images, medical history and pathologic results. Inter- and intraobserver agreement was assessed using Kappa (κ) agreement coefficient.. The interobserver agreement for sonographic descriptors changed between fair and substantial. The highest agreement was detected for mass orientation (κ=0.66). The lowest agreement was found in the margin (κ=0.33). The interobserver agreement for BI-RADS final category was found as fair (κ=0.35). The intraobserver agreement for sonographic descriptors changed between substantial and almost perfect. The intraobserver agreement of BI-RADS result category was found as substantial for observer 1 (κ=0.64) and excellent for observer 2 (κ=0.83).. Our results demonstrated that each observer was self-consistent in interpreting US BI-RADS classification, while interobserver agreement was relatively poor. Although it has been ten years since the description of sonographic BI-RADS lexicon, further training and periodic performance evaluations would probably help to achieve better agreement among radiologists..

Multiple sclerosis (MS) is a highly prevalent cause of neurological disability and has different clinical subtypes with potentially different underlying pathologies. Differentiation of primary progressive multiple sclerosis (PPMS) from relapsing remitting multiple sclerosis (RRMS) could be difficult especially in its early phases.. We compared brain metabolite concentrations and ratios in patients with PPMS and RRMS by magnetic resonance spectroscopic imaging (MRSI)..Patients and Thirty patients with definite MS (15 with RRMS and 15 with PPMS) underwent MRSI and their non-enhancing lesion metabolites were measured. N-acetyl aspartate (NAA), Creatine (Cr), Choline (Cho), NAA/Cr and NAA/Cho were measured and compared between the two MS subtypes.. When the two MS groups were compared together, we found that Cr was significantly increased (P value=0.008) and NAA/Cr was significantly decreased (P value=0.03) in non-enhancing lesions in PPMS compared with RRMS. There was no significant difference in NAA, Cho or NAA/Cho between the two MS subtypes.. MRS is a potential way to differentiate PPMS and RRMS..

In hemodialysis patients, the most common problem in arteriovenous fistulas, as the best functional vascular access, is the juxtaanastomotic located lesions. Percutaneous transluminal angioplasty is accepted as the treatment method for juxtanastomotic lesions.. To assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction..Patients and Between July 2003 and June 2010, 20 hemodialysis patients with autogenous radiocephalic or brachiocephalic fistula dysfunction underwent stent placement for the lesion located at the juxtaanastomotic region. Indications for stent placement were insufficient balloon dilatation, early recurring stenosis, chronic organizing thrombus and vessel rupture. The Kaplan-Meier method was used to calculate the stent patency rates. All patients who had fistula dysfunction (thrombosis of hemodialysis access, difficult access cannulation, extremity pain due to thrombosis or decreased arterial access blood flow) were evaluated by color Doppler ultrasound. The stenoses were initially dilated with standard noncompliant balloons (3 to 10-mm in diameter). Dilatation was followed by high pressure (Blue Max, Boston Scientific) or cutting balloons (Boston Scientific), if the standard balloon failed to dilate the stenotic segment.. Twenty-one stents were applied. The anatomical and clinical success rate was 100%. Seventeen additional interventions were done for 11 (55%) patients due to stent thrombosis or stenosis during follow-up. Our 1- and 2-year secondary patency rates were 76.2% and 65.5%, respectively and were comparable to those after balloon angioplasty and surgical shunt revision.. Metallic stent placement is a safe and effective procedure for salvage of native hemodialysis fistula after unsuccessful balloon angioplasty..

There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture.. To compare the diagnostic accuracy between conventional radiography and computed tomography (CT) for the identification of nasal bone fractures and to evaluate the interobserver reliability between a staff radiologist and a trainee..Patients and A total of 108 patients who underwent conventional radiography and CT after acute nasal trauma were included in this retrospective study. Two readers, a staff radiologist and a second-year resident, independently assessed the results of the imaging studies.. Of the 108 patients, the presence of a nasal bone fracture was confirmed in 88 (81.5%) patients. The number of non-depressed fractures was higher than the number of depressed fractures. In nine (10.2%) patients, nasal bone fractures were only identified on conventional radiography, including three depressed and six non-depressed fractures. CT was more accurate as compared to conventional radiography for the identification of nasal bone fractures as determined by both readers (P <0.05), all diagnostic indices of an experienced radiologist were similar to or higher than those of a trainee, and κ statistics showed moderate agreement between the two diagnostic tools for both readers. There was no statistical difference in the assessment of interobserver reliability for both imaging modalities in the identification of nasal bone fractures.. For the identification of nasal bone fractures, CT was significantly superior to conventional radiography. Although a staff radiologist showed better values in the identification of nasal bone fracture and differentiation between depressed and non-depressed fractures than a trainee, there was no statistically significant difference in the interpretation of conventional radiography and CT between a radiologist and a trainee..

Metastasis from a malignant tumor to the palatine tonsils is rare, accounting for only 0.8% of all tonsillar tumors, with only 100 cases reported in the English-language literature. Various malignant lung carcinomas may metastasize to the tonsils. A few cases of tonsillar metastasis from neuroendocrine lung carcinoma have been reported. A 67-year-old female underwent a right tonsillectomy because of a sore throat and an enlarged right tonsil. The postoperative pathology showed right tonsillar small cell neuroendocrine carcinoma (SCNC). Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) demonstrated metabolic activity in the lower lobe of the right lung. In addition, hypermetabolic foci were noted in the lymph nodes of the right neck and mediastinum. A needle biopsy of the pulmonary mass showed SCNC. The patient received chemotherapy and died of multiple distant metastases after 6 months. This is the first report using PET/CT to evaluate tonsillar metastasis from lung SCNC..

Osteoblastoma is a rare benign, but locally aggressive bone tumor with rare malignant transformation. It mostly affects the vertebral column and long bones. Radiographically, it is seen as an expansile, oval, sclerotic or lytic mass-like lesion with well-defined borders, although sometimes it may mimic a malignant tumor such as osteogenic sarcoma by its irregular borders. Herein, we report a case of osteoblastoma in a 22 year-old man with a long history of back and neck pain accompanied with neck stiffness. On the routine chest X-ray, the salient lesion appeared as an expansile, oval, sclerotic mass with well-defined borders and speckled calcification without any internal lucency and periosteal reaction, involving the posterolateral aspect of the first left thoracic rib, a rare anatomical site. Despite the unusual location, osteoblastoma should be considered in the differential diagnosis of a solitary rib lesion..

Appendicitis is the most common abdominal disease that requires surgery in the emergency ward. It usually presents as right lower quadrant pain, but may rarely present as left upper quadrant (LUQ) pain due to congenital anatomical abnormalities of the intestine. We report a patient who complained of persistent LUQ abdominal pain and was finally diagnosed by computed tomography (CT) as congenital intestinal malrotation complicated with acute appendicitis. It is important to include acute appendicitis in the differential diagnosis of patients who complain of LUQ abdominal pain. Abdominal CT can provide significant information that is useful in preoperative diagnosis and determination of proper treatment..

Primary small cell carcinoma of the ureter is an extremely rare disease, only several cases have been reported worldwide so far. We report a 70-year-old woman who was examined with intravenous urography and abdominal computed tomography and was diagnosed as small cell carcinoma confirmed by pathology. We describe and discuss the urography and computed tomography findings of this case..

Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside the bone marrow. Extrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. We report a case of a 38-year-old female with paraspinal and presacral extramedullary hematopoiesis with polycythemia vera. Clinical and laboratory evaluation, along with radiological and histopathological findings are described. The diagnosis of the disease was confirmed by CT-guided biopsy. Review of literature is presented..

An eleven-day boy neonate with a fetal anamnesis of grade 1 bilateral hydronephrosis according to the grading of the Society for Fetal Urology (SFU), came to our attention for an acute osteoarthritis secondary to urosepsis. In the urological follow-up, a severe bilateral vesico-ureteral reflux (VUR) was diagnosed. An early post-natal, reno-vesicle ultrasound evaluation could have changed the clinical course of our patient..

The current mainstay of treatment in spontaneous intracranial hypotension (SIH) is an epidural blood patch (EBP). Although magnetic resonance imaging (MRI) has a well-established role in the diagnosis of SIH, imaging features regarding the treatment efficacy of EBP have rarely been discussed. We therefore sought to investigate and compare the sequential brain MRI studies before and after EBP by evaluating the changes of the following intracranial structures—the contour of the transverse dural sinus (TDS), tension of the pituitary stalk (or the infundibulum), and thickness of the dura mater. We found that the progressive reversals of these structures are predictive of an effective EBP..

Hereby we report a case of well-differentiated intraosseous osteosarcoma in the sacrum. A 32-year-old woman was admitted to our hospital with a low echo-level mass in the pelvis searched by ultrasound in a routine physical examination. Radiographically, the mass was misdiagnosed as a benign bony tumor originating from the sacrum. The tumor was completely resected and pathological diagnosis was intraosseous well-differentiated osteosarcoma. Twelve months after operation, the patient was well and there was no evidence of recurrence and distal metastasis. This is a peculiar case of well-differentiated osteosarcoma involving an unusual site of the sacrum. The radiographic appearance and the differential diagnosis are discussed. We consider that dense trabeculated-like bone within an intraosseous solid mass might be suggestive of a well-differentiated osteosarcoma that was valuable in guiding the treatment and prediction of its prognosis. Well-differentiated osteosarcoma, although malignant, may be mistaken for a benign condition. Local excision has almost always been associated with recurrence. For this case, the patient had a wide excision and had no recurrence and metastasis. Therefore, it is very important to identify the radiological features and to distinguish this tumor from benign lesions and high-grade osteosarcomas before operation..

Maintenance of imaging equipment is a very important part of the management of all medical imaging centers.. To assess the oldness and capacity of radiography and ultrasound equipment in Tehran University of Medical Sciences.. The study was performed in 16 hospitals, 4 faculties and three healthcare centers of Tehran University of Medical Sciences. We evaluated all the X-ray equipment (including the simple plain and dental, panorex, mammography, fluoroscopy and C-arm X-Ray devices) and also simple and Doppler ultrasound machines in terms of the type and usage of the device, production year, quantity of utilization, location, brand and current condition.. Among fixed X-ray systems, 15 were currently in use, two were junk, two were damaged, and one was not utilized. The mean (SD) of the usage of these was 2151 (2230) cliché/month, and the mean (SD) of the oldness was 16.9 (13.6) years. The oldness of radiography equipment in our study was more than 20 years in 16, between 11 and 20 in 46, and less than 10 years in 76 devices. The mean (SD) usage (patients/month) of simple and color Doppler devices were 234.1 (365.2) and 597.5 (505.3), respectively. The oldness of ultrasonography equipment in our study was more than 11 years in 12 and less than 10 years in 55 devices. We found that 22 (15.9%) of the radiography systems and two (3%) of the ultrasonography systems had been used for more than 20 years.. Radiology equipment in Tehran University of Medical Sciences have potential capacity, but they need repair, and better maintenance and management and application of standards for the imaging system needs organized supervisory mechanisms..

Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur.. To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease..Patients and In our retrospective study, we evaluated ultrasound-assisted needle biopsies that were performed in outpatients from October 2006 to July 2010. The liver biopsies were performed following one-night fasting using the tru-cut biopsy gun (18-20 gauge) after marking the best seen and hypovascular part of the liver, distant enough from the adjacent organs.. A total of 1018 patients were referred to our radiology department. Most of the patients had hepatitis B (60.6%). The biopsy specimens were recorded and sent to our pathology department for histopathological examination.. According to the results of our series, percutaneous liver biopsy using the tru-cut biopsy gun guided by ultrasonography can be performed safely. We resolve that routine ultrasound of the puncture site is a quick, effective and safe procedure. The complication rate is very low. The US-assisted percutaneous liver biopsy should be used for all cases..

Normal morphological features of the maternal pelvis are an important prerequisite to vaginal delivery.. We aimed to evaluate the association between obstetric conjugate diameter (OCD) measured by ultrasonography and the type of delivery, vaginally (V) or by cesarean (C) section..Patients and Pelvimetry was performed in 200 primigravid women for fetal cephalic presentation. The OCD was measured twice by transabdominal ultrasonography during 25-30 weeks and 30-35 weeks of pregnancy.. The mean OCD of both sonographies in groups V and C was 125.51± 8.35 mm (105-144.5) and 112.99 ± 8.53 mm (96-134.5), respectively, which was significantly lower in group C (P<0.001). The values of OCD between the first and second measurements were not different significantly (P=0.065). C-section was indicated in 65 (32.5%) mothers. The optimal cut-off point for the OCD in the prediction of vaginal delivery was ≥ 119.75 mm, with a sensitivity and specificity of 80% and 78.5%, respectively.. The US measurement of OCD might be an accurate method that almost always remains constant during late pregnancy; it is easy to measure and might be confidentially employed for predicting C-section, but needs more precise studies to be used widely..