Showing papers in "Iranian Journal of Radiology in 2007"

Hepatic doppler ultrasound in assessment of the severity of esophageal varices in cirrhotic patients

Abstract: Patients tive: Endoscopy is the gold-standard technique for the assessment of acutely hemorrhagic esophageal varices in patients with hepatic cirrhosis. The objective of this study is to determine the value of different hepatic vasculature Doppler ultrasonography and their flow characteristics for non-invasive assessment of esophageal varices. Patients and Methods: Fifty-five (31 male, 24 female) consecutive patients with a mean±SD age of 55±16 (range: 20–88) years, with biopsy-proven hepatic cirrhosis were prospectively studied using Doppler ultrasonography. All of these patients were also examined endoscopically and by echocardiography. None of patients had clinical or echocardiographic signs of right heart failure, tricuspid valve regurgitation or previous history of therapeutic interventions on varices. An ordinal logistic regression (OLR) model was used for determining the adjusted associations between sizes of esophageal varices and hepatic hemodynamic determinants. Results: There was a significant correlation between the size of esophageal varices and maximum portal vein velocity, which was lower in patients with varices (p = 0.04). Other parameters though not statistically significant, were of clinical importance. Those included portal vein mean velocity (p = 0.08), hepatic artery volume flow (p = 0.06) and hepatic venous waveform pattern (p = 0.15). OLR model did not show any significant adjusted associations between these parameters and the size of esophageal varices. Conclusion: The maximum portal vein velocity and to a lesser extent, hepatic artery volume flow were superior to Doppler ultrasonographic spectral waveform pattern of hepatic vein in differentiating patients with esophageal varices from those with no varices. None of hepatic vasculature Doppler measurements had a significant role in predicting the size of esophageal varices, nonetheless.

Accuracy of Ultrasound in Detection of Gross Prenatal Central Nervous System Anomalies after the Eighteenth Week of Gestation

Abstract: Background/Objective: Ultrasound (US) detection of prenatal central nervous system (CNS) anatomic anomalies is very important in making decision about therapeutic termination. In the present study, the accuracy of US in detection of gross prenatal CNS anatomic anomalies has been investigated. Patients and Methods: 3012 pregnant women were scanned after 18 weeks of gestation by an expert operator in a referring center. All delivered fetuses were followed after birth through clinical examination and sonography. Results: In this study, the accuracy of US in detection of gross CNS anatomic anomalies of fetuses after 18 weeks gestation was found to be 100%. The sensitivity, specificity, positive and negative predictive values of US were 100%. In sonographic examination of these 3012 pregnant women, 36 fetuses were detected with CNS anomalies, some of whom had more than one anomaly. Gross CNS anomalies observed included microcephaly, hydrocephaly, anencephaly, holoprosencephaly, ventriculomegaly, meningocele, encephalocele, lissencephaly, agenesis of corpus callosum, bilateral choroid plexus cysts and hypoplastic cerebellum. Conclusion: US is highly operator dependent and operator experience may be the most determinant affecting the results. Sonographic scanning after 18 weeks of gestation is associated with the best results.

The Diagnostic Accuracy of Abdominal Ultrasound Imaging for Detection of Ovarian Masses

Abstract: Background/Objective: Detection of the tissue diagnosis of ovarian space occupying lesions (OSOL) has remained a challenging task for sonographers since many adnexal masses have nonspecific sonographic appearances. Our objective was to evaluate the accuracy of the abdominal sonographic diagnosis of adnexal masses in 79 women with a known OSOL undergoing laparotomy for ovarian masses in Tabriz Alzahra's Haspital, northwestern Iran. Patients and Methods: From March 2004 to February 2005, sonographic reports of each patient were compared with postoperative findings. Results: Comparison of the preoperative sonographic and final pathologic diagnoses revealed a correct sonographic diagnosis in 77% of patients. The identification of ovarian cystic teratoma was correct in 17/24 cases (sensitivity of 71% and specificity of 98%). The identification of ovarian malignancy was correct in 7/10 patients (sensitivity of 70% and specificity of 98.5%). Sonograms were frankly misread in 14/79 cases, and were missed in 4/79 cases. Conclusion: In conclusion, our results show high resolution abdominal ultrasonography is an effective method in diagnosis of ovarian tumors and on 70% of patients can differentiate malignant tumors from benign tumors.

Primary Hydatid Cyst of the Breast: A Case Report

Abstract: Cystic hydatid disease is caused by the parasite Echinococcus granulosus. The breast is a rare primary site of hydatid disease that accounts for only 0.27% of all cases. The cyst is usually asymptomatic and should be included under differential diagnosis of a breast lump, especially in endemic areas of this disease. Herein, we described the biopsy-proven case of a 46-year-old woman with primary hydatid disease of left breast.

Magnetic Resonance Imaging Abnormalities in Multiple Sclerosis: A Review

Abstract: During the last two decades, magnetic resonance imaging has been widely used in the diagnosis and treatment monitoring of multiple sclerosis. MRI, both conventional and non conventional methods, has transformed all aspects of MS research and clinical practice in recent years. Although advanced imaging methods have added much more to our knowledge about pathogenesis and natural history of the disease but their cost, availability, complexity and lack of validation have limited their use in routine clinical practice. Conventional MR techniques including proton density, T1/T2-Weighted images and fluid- attenuated inversion recovery sequences are now accepted in standard protocols for diagnosis and treatment outcome measures in clinical trials of multiple sclerosis. This review will focus on the type, morphology and evolution of MS lesions regarding conventional MRI and their use for treatment monitoring in daily clinical practice.

Fibrolamellar Hepatocellular Carcinoma: A Case Report

Abstract: Fibrolamellar hepatocellular carcinoma is a relatively rare condition that occurs in noncirrhotic livers, most frequently in adolescents or young adults with no gender predominance. The prognosis is more favorable than that of the usual hepatocellular carcinoma. Here is the case of an eighteen-year-old male patient with history of right upper quadrant abdominal pain, and no hepatomegaly. Liver function tests and serological markers for viral B and C hepatitis and tumor markers were normal. CT scan demonstrated a large hypervascular lesion in the liver and the histological examination was reported as a typical fibrolamellar hepatocellular carcinoma. Intra-arterial chemotherapy and embolization have been done for the patient. In his recent imaging the mass seems to become smaller and is considered operable. After 2.5 years he does not have any complaint and has gained some weight.

Multidetector CT Evaluation of Congenital Heart Disease: A Pictorial Essay

Abstract: Multidetector computed tomography (MDCT) with or without ECG-synchronized images can successfully evaluate cardiac morphology and congenital heart diseases which mainly involve great vessels. In this pictorial essay, we present the great capability of MDCT for the evaluation of complex congenital heart disease.

Ultrasound Monitoring of Temperature Change during Interstitial Laser Thermotherapy of Liver: An In Vitro Study

Abstract: Laser interstitial thermotherapy (LITT) is an internal ablation therapy consists of the percutaneous or intraoperative insertion of laser fibers directly into the liver tumor with maximum diameter of 5 cm. It is very important to control temperature increasing non invasively, because on high temperatures, tissue carbonization occurs and it can damage normal tissues. In this research, pixel shift changes on ultrasound B-mode images with temperature were measured. LITT in vitro was performed on 11 freshly sheep liver tissues using a Nd:YAG laser with a bare-tip optical fiber. Invasive temperature monitoring was performed during heating and cooling down by fixing micro thermocouples on tissue. At the same time, noninvasive temperature monitoring was performed with ultrasound B-mode images. The speed of sound variations with the temperature changes are create virtual shifts in scattering positions and time shifts into the received echo signals. It can locally cause pixel shifts on B-mode images. These pixel shifts were measured by echo tracking algorithm. Linear and nonlinear regression analysis between independent variable (temperature changes) and dependent variable (pixel shift on images) were performed. It was shown that with correlation coefficient of 0.892, cubic function was suitable. In this method, because of bubbles formation and tissue carbonization, monitoring of more than 100°C, was difficult. This method could be used for noninvasive temperature monitoring for a large number of patient, during LITT.

The Relation between Serum Creatinine and Renal Resistance Index in Parenchymal Kidney Disease

Abstract: Background/Objective: Considering the fact that gray-scale ultrasonography findings in patients with non-surgical kidney disease are highly non-specific, this study was conducted to evaluate the efficacy of color Doppler ultrasonography for determining a quick assessment of the renal function. In this study, the association between the kidney interlobar artery resistive index (RI) and serum creatinine level was investigated to identify whether this index has a significant relationship with the serum creatinine level. Patients and Methods: In a cross-sectional study, 30 patients with non-surgical parenchymal renal disease who had a serum creatinine level>1.4 mg/dL were selected during regular revisits. 30 normal individuals with serum creatinine levels<1.4 mg/dL were also selected as the comparison group. The kidneys of these subjects were investigated with gray-scale ultrasonography for bilateral symmetry, absence of stones, hydronephrosis, and any space occupying lesion. They were then evaluated with color Doppler ultrasonography and the RI was measured in 10 interlobar arteries (5 in each kidney). Results: The mean±SD serum creatinine level was 6.5±0.6 mg/dL in the case and 1.0±0.3 mg/dL in the control group. The mean RI was 78.0%±1.9% for the case and 59.3%±0.8% for the control group (p<0.001). A significant correlation was found between the serum creatinine level and the RI (r=0.68, p<0.001). Conclusion: In renal parenchymal disease, measuring RI by Doppler ultrasonography is a fair predictor of renal function.

The validity of computed tomography in complicated chronic otitis media

Abstract: Background/Objective: We assessed the validity of computed tomography (CT) in the diagnosis of complicated chronic otitis media (COM). Patients and Methods: The findings obtained from a pre-operative high resolution CT of temporal bone including coronal and axial views of 20 patients with complicated COM were compared to their intraoperative findings. Results: In our study, CT was helpful in determining the anatomy of the mastoid and could accurately predict the mastoid air cell aeration, size and status of ossicles, presence of lateral semicirculal canal (SCC) fistula and post-auricular fistula (All sensitivities equal to 100%). But it overdiagnosed the erosion of tegmen (positive predictive value of 50%). CT was unable to distinguish between cholesteatoma and fluid (abscess or effusion) and granulation tissue or polyps and was also unable to correctly reveal the facial nerve dehiscence and had a low sensitivity for showing erosion of facial canal (50%) and sigmoid sinus (60%). Conclusion: Because most complications resulting from cholesteatoma are caused by bony erosions, CT is helpful in determining the complications of COM. CT can accurately predict the extent of disease and is helpful in detection of some complications such as fistula of Lateral Semicircular Canal (LSC), erosions of dural plate and ossicular erosions. However, it is unable to distinguish between cholesteatoma, mucosal disease and fluid, and little it did contribute to detecting the facial nerve course and dehiscence. It cannot also be used for the diagnosis of the sigmoid sinus problems which could be related to no contrast administration in our study.

Vanishing of A Congenital Intracranial Aneurysm

Abstract: Intracranial aneurysms in neonatal period and early infancy may be resorbed spontaneously or due to removal of predisposing factors. Herein, we presented a rare case of vanishing of a large thrombosed intracranial aneurysm in a 25-day-old girl presented with head enlargement and vomiting. Magnetic resonance imaging (MRI) revealed a severe hydrocephalus accompanied by a 1.5-cm aneurysm at the bifurcation of the right middle cerebral artery (MCA). Doppler ultrasonography confirmed a flow with a magnitude almost similar to that of the right MCA flow, inside the mass located adjacent to it. The hydrocephalus was managed by ventriculo-peritoneal (VP) shunt. The patient underwent a conservative observation for several months. Subsequently, the aneurysm was vanished in control images.

Atypical Radiographic Manifestations of Duodenal Diverticula: A Pictorial Essay

Abstract: Duodenal diverticula are frequently encountered in daily practice of radiology centers. Dissimilar figures with different dimensions and unlikely positions of duodenal diverticula— sometimes unusual—may be found. In this pictorial essay, we present various atypical shapes, dimensions and locations of duodenal diverticula which are found during many years of experience in the field of gastrointestinal fluoroscopic contrast assessments.

Familial chondrocalcinosis: report of the case in two sisters

Abstract: Chondrocalcinosis is a chronic and progressive inflammatory joint disease with acute episodes of arthritis, which may be associated with other metabolic diseases or transmitted as a genetic disorder. We report a case of chondrocalcinosis in two sisters.

Ultrasonographic Screening for Abdominal Aortic Aneurysm in Iranian Candidates of Coronary Artery Bypass Graft

Abstract: Background/Objective: To evaluate the prevalence of abdominal aortic aneurysm (AAA) in Iranian candidates of coronary artery bypass graft and its associated factors Patients and Methods: 1,647 consecutive candidates of coronary artery bypass graft underwent abdominal aorta sonography The relation of AAA with gender, age, smoking, dyslipidemia, hypertension, diabetes mellitus, carotid and coronary stenosis was evaluated Results: The prevalence of AAA was 37% in men and 1% in women The prevalence was 52% in men older than 65 years The largest diameter f AAA was 51 mm Gender, age, smoking and carotid stenosis were associated factors of AAA Conclusion: The prevalence of AAA is lower in Iran comparing with western studies (p<00001) The mean diameter of aneurysm was lesser in our study too (p<00001) The associated factors of AAA in our study were similar with previous reports Screening of AAA is not recommended in Iranian candidates of coronary artery bypass graft

Intracranial Rhabdomyosarcoma Presented as Chronic Subdural Hematoma: A Case Report

Abstract: Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion, needle aspiration and shunting for about 2 years with partial resolution of his symptoms after each procedure. The final pathologic evaluation after extensive bilateral craniotomy revealed rhabdomyosarcoma. The role of CT and MRI in early diagnosis and management of this rare situation is discussed.

The Diagnostic Value of Computed Tomography in Determining Invasion to Carotid Arteries by Head and Neck Malignant Tumors

Abstract: Background/Objective: Awareness of invasion to the walls of the carotid arteries by malignant tumors, either tumoral mass or metastatic lymph nodes, is of great clinical importance before surgery and can change the management strategy. This study was conducted to assess the diagnostic value of computed tomography (CT) in determining invasion to carotid artery (CA) by oromaxillofacial and neck malignant tumors. Patients and Methods: CT with contrast was performed in 40 patients who has had oromaxillofacial and neck malignant tumors before surgical intervention. Abnormal CT findings in our patients were categorized into 6 types: I) tumor encasement of carotid arteries ≥270 degrees; II) tumor encasement of carotid arteries ≥180 degrees; III) compression and deformation of CA; IV) displacement of CA; V) ill-defined CA wall; and VI) the segmental deletion of fat or fascial planes between tumor and CA. The CT appearances of all tumors were prospectively compared with surgical findings. Results: Abnormal CT findings in our patients included 6 with form I; 17 with type II; 2 with type III; 8 with type IV; 7 with type V; and 33 with type VI. Surgical findings showed that the tumors invaded CA vessels in 13 of 40 patients. The sensitivity, specificity, accuracy and positive and negative likelihood ratio values with 95% confidence interval for type I were 0.31, 0.93, 0.7, 4.15 and 1.3; for type II were 0.62, 0.67, 0.65, 1.8 and 1.7; for type III were 0, 0.93, 0. 63, 0 and 0.93; for type IV were 0.07, 0.74, 0.53, 0.3 and 0.8; for type V were 0.39, 0. 93, 0.69, 5.2 and 1.6; and for type VI were 1, 0.26, 0.50 and 1.35, respectively. Conclusion: Though many CT findings are of value in determining of CA invasion by head and neck tumors, our study demonstrated that encasement ≥270 degree (type I), ill-defined wall of the artery (type V) and segmental deletion of fat or fascial planes between tumor and CA (type VI) are valuable in determining CA invasion by tumors. However, CT is not a definite way for the diagnosis of CA involvement by malignant tumoral lesions.