Iranian Journal of Radiology Iranian Journal of Radiology Iran J Radiol http://www.Iranjradiol.com 1735-1065 2008-2711 10.5812/iranjradiol en jalali 2017 6 29 gregorian 2017 6 29 10 3
en 10.5812/iranjradiol.6326 Acute Appendicitis Presenting as Unusual Left Upper Quadrant Pain Acute Appendicitis Presenting as Unusual Left Upper Quadrant Pain ABDOMINAL IMAGING case-report case-report

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.

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.

Appendicitis;Intestinal Malrotation, Familial;Abdomen, Acute;Abdominal Pain Appendicitis;Intestinal Malrotation, Familial;Abdomen, Acute;Abdominal Pain 156 159 http://www.Iranjradiol.com/index.php?page=article&article_id=6326 Tsung-Ju Chuang Tsung-Ju Chuang Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan Chun-Wen Chen Chun-Wen Chen Department of Radiology, Armed Forces Taichung General Hospital, Taichung, Taiwan; Department of Radiology, Armed Forces Taichung General Hospital, No.348, Sec. 2, Zhongshan Rd., Taiping Dist., Taichung City 411, Taiwan. , +886-423934191#7525341 Department of Radiology, Armed Forces Taichung General Hospital, Taichung, Taiwan; Department of Radiology, Armed Forces Taichung General Hospital, No.348, Sec. 2, Zhongshan Rd., Taiping Dist., Taichung City 411, Taiwan. , +886-423934191#7525341 Hsin-Yuan Lin Hsin-Yuan Lin Department of Surgery, Armed Forces Taichung General Hospital, Taichung, Taiwan Department of Surgery, Armed Forces Taichung General Hospital, Taichung, Taiwan Wen-Hsiu Hsu Wen-Hsiu Hsu Department of Gastroenterology & Hepatology, Armed Forces Taichung General Hospital, Taichung, Taiwan Department of Gastroenterology & Hepatology, Armed Forces Taichung General Hospital, Taichung, Taiwan Shou-Cheng Wang Shou-Cheng Wang Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan Chuan-Chou Tu Chuan-Chou Tu Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung, Taiwan
en Boards and Committees Boards and Committees issue-information issue-information http://www.Iranjradiol.com/index.php?page=article&article_id=14928
en Table of Contents Table of Contents issue-information issue-information http://www.Iranjradiol.com/index.php?page=article&article_id=14927
en 10.5812/iranjradiol.13264 Comparing Ovarian Radiation Doses in Flat-Panel and Conventional Angiography During Uterine Artery Embolization: A Randomized Clinical Trial Comparing Ovarian Radiation Doses in Flat-Panel and Conventional Angiography During Uterine Artery Embolization: A Randomized Clinical Trial VASCULAR & INTERVENTIONAL RADIOLOGY research-article research-article Background

Uterine artery embolization (UAE) is a minimally invasive procedure performed under fluoroscopy for the treatment of uterine fibroids and accompanied by radiation exposure.

Objectives

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 Methods

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.

Results

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).

Conclusion

Flat panel system can significantly reduce the ovarian radiation dose during UAE compared with conventional DSA.

Background

Uterine artery embolization (UAE) is a minimally invasive procedure performed under fluoroscopy for the treatment of uterine fibroids and accompanied by radiation exposure.

Objectives

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 Methods

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.

Results

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).

Conclusion

Flat panel system can significantly reduce the ovarian radiation dose during UAE compared with conventional DSA.

Uterine Artery;Embolization, Therapeutic;Radiation;Angiography Uterine Artery;Embolization, Therapeutic;Radiation;Angiography 111 115 http://www.Iranjradiol.com/index.php?page=article&article_id=13264 Kavous Firouznia Kavous Firouznia Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Hossein Ghanaati Hossein Ghanaati Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Aliakbar Sharafi Aliakbar Sharafi Medical Physics Department, Iran University of Medical Sciences, Tehran, Iran Medical Physics Department, Iran University of Medical Sciences, Tehran, Iran Firouze Abahashemi Firouze Abahashemi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Hassan Hashemi Hassan Hashemi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Amir Hossein Jalali Amir Hossein Jalali Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. , +98-21-66581579 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. , +98-21-66581579 Madjid Shakiba Madjid Shakiba Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
en 10.5812/iranjradiol.6952 Demographic Factors Influencing Consensus Opinion on the Recall for Women Screened by Mobile Mammography Unit in Taiwan Demographic Factors Influencing Consensus Opinion on the Recall for Women Screened by Mobile Mammography Unit in Taiwan WOMEN’S IMAGING research-article research-article Results

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.

Objectives

This study aims at investigating the factors influencing consensus opinion on the recall for mobile breast screening in Taiwan.

Patients and Methods

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.

Background

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.

Conclusion

The policy makers should notify the importance of demographic factors affecting further examination for early detection of breast cancer in Taiwan.

Results

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.

Objectives

This study aims at investigating the factors influencing consensus opinion on the recall for mobile breast screening in Taiwan.

Patients and Methods

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.

Background

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.

Conclusion

The policy makers should notify the importance of demographic factors affecting further examination for early detection of breast cancer in Taiwan.

Breast Neoplasms;Mammography;Breast Breast Neoplasms;Mammography;Breast 116 121 http://www.Iranjradiol.com/index.php?page=article&article_id=6952 Lee Yu-Mei Lee Yu-Mei Health and Management Center, Cardinal Tien Hospital, Xindian District, New Taipei City, Taiwan, Republic of China Health and Management Center, Cardinal Tien Hospital, Xindian District, New Taipei City, Taiwan, Republic of China Yao Hsueh-Hua Yao Hsueh-Hua Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu City, Taiwan, Republic of China; Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu City, Taiwan, Republic of China. Tel: +88-636102305 Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu City, Taiwan, Republic of China; Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu City, Taiwan, Republic of China. Tel: +88-636102305
en 10.5812/iranjradiol.10708 Interobserver and Intraobserver Agreement of Sonographic BIRADS Lexicon in the Assessment of Breast Masses Interobserver and Intraobserver Agreement of Sonographic BIRADS Lexicon in the Assessment of Breast Masses WOMEN'S IMAGING research-article research-article Results

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).

Objectives

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 Methods

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.

Background

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.

Conclusion

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.

Results

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).

Objectives

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 Methods

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.

Background

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.

Conclusion

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.

Mammography;Breast;Ultrasonography Mammography;Breast;Ultrasonography 122 127 http://www.Iranjradiol.com/index.php?page=article&article_id=10708 Eda Elverici Eda Elverici Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey Betul Zengin Betul Zengin Department of Radiology, Yozgat State Hospital, Yozgat, Turkey; Department of Radiology, Yozgat State Hospital, Yozgat, Turkey , +90-5058442078 Department of Radiology, Yozgat State Hospital, Yozgat, Turkey; Department of Radiology, Yozgat State Hospital, Yozgat, Turkey , +90-5058442078 Ayse Nurdan Barca Ayse Nurdan Barca Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey Pinar Didem Yilmaz Pinar Didem Yilmaz Department of Radiology, Artvin State Hospital, Artvin, Turkey Department of Radiology, Artvin State Hospital, Artvin, Turkey Aysegul Alimli Aysegul Alimli Department of Radiology, Yozgat State Hospital, Yozgat, Turkey Department of Radiology, Yozgat State Hospital, Yozgat, Turkey Levent Araz Levent Araz Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
en 10.5812/iranjradiol.11336 Magnetic Resonance Spectroscopic Findings of Chronic Lesions in Two Subtypes of Multiple Sclerosis: Primary Progressive Versus Relapsing Remitting Magnetic Resonance Spectroscopic Findings of Chronic Lesions in Two Subtypes of Multiple Sclerosis: Primary Progressive Versus Relapsing Remitting research-article research-article Results

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.

Conclusion

MRS is a potential way to differentiate PPMS and RRMS.

Objectives

We compared brain metabolite concentrations and ratios in patients with PPMS and RRMS by magnetic resonance spectroscopic imaging (MRSI).

Patients and Methods

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.

Background

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.

Results

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.

Conclusion

MRS is a potential way to differentiate PPMS and RRMS.

Objectives

We compared brain metabolite concentrations and ratios in patients with PPMS and RRMS by magnetic resonance spectroscopic imaging (MRSI).

Patients and Methods

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.

Background

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.

Multiple Sclerosis, Chronic Progressive;Multiple Sclerosis, Relapsing-Remitting;Magnetic Resonance Spectroscopy Multiple Sclerosis, Chronic Progressive;Multiple Sclerosis, Relapsing-Remitting;Magnetic Resonance Spectroscopy 128 132 http://www.Iranjradiol.com/index.php?page=article&article_id=11336 Nasrin Rahimian Nasrin Rahimian Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran Hamidreza Saligheh Rad Hamidreza Saligheh Rad Quantitative MR Imaging and Spectroscopy Group, Research Center for Cellular and Molecular Imaging, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran Quantitative MR Imaging and Spectroscopy Group, Research Center for Cellular and Molecular Imaging, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran Kavous Firouznia Kavous Firouznia Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Seyed Amir Ebrahimzadeh Seyed Amir Ebrahimzadeh Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alipasha Meysamie Alipasha Meysamie Community Medicine Department, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran Community Medicine Department, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran Hamideh Vafaiean Hamideh Vafaiean Quantitative MR Imaging and Spectroscopy Group, Research Center for Cellular and Molecular Imaging, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran Quantitative MR Imaging and Spectroscopy Group, Research Center for Cellular and Molecular Imaging, Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hossein Harirchian Mohammad Hossein Harirchian Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2166948899, Fax: +98-2166581558 Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2166948899, Fax: +98-2166581558
en 10.5812/iranjradiol.11386 Endovascular Stent Placement of Juxtaanastomotic Stenosis in Native Arteriovenous Fistula After Unsuccessful Balloon Angioplasty Endovascular Stent Placement of Juxtaanastomotic Stenosis in Native Arteriovenous Fistula After Unsuccessful Balloon Angioplasty VASCULAR & INTERVENTIONAL RADIOLOGY research-article research-article Conclusion

Metallic stent placement is a safe and effective procedure for salvage of native hemodialysis fistula after unsuccessful balloon angioplasty.

Results

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.

Background

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.

Objectives

To assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction.

Patients and Methods

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.

Conclusion

Metallic stent placement is a safe and effective procedure for salvage of native hemodialysis fistula after unsuccessful balloon angioplasty.

Results

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.

Background

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.

Objectives

To assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction.

Patients and Methods

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.

Endovascular Procedures;Vascular Fistula;Angioplasty Endovascular Procedures;Vascular Fistula;Angioplasty 133 139 http://www.Iranjradiol.com/index.php?page=article&article_id=11386 Burak Özkan Burak Özkan Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey; Department of Interventional Radiology, Baskent University School of Medicine, Turkey +90-5056384753, burakozkan79@hotmail.com Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey; Department of Interventional Radiology, Baskent University School of Medicine, Turkey +90-5056384753, burakozkan79@hotmail.com Durmus Güngör Durmus Güngör Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Utku Mahir Yıldırım Utku Mahir Yıldırım Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Ali Harman Ali Harman Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Özgur Özen Özgur Özen Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Cüneyt Aytekin Cüneyt Aytekin Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey Department of Interventional Radiology, Baskent University School Of Medicine, Ankara, Turkey
en 10.5812/iranjradiol.6353 Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability research-article research-article Conclusion

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.

Results

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.

Patients and Methods

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.

Background

There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture.

Objectives

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.

Conclusion

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.

Results

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.

Patients and Methods

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.

Background

There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture.

Objectives

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.

Nasal Bone, Fractures, Bone;Radiography Nasal Bone, Fractures, Bone;Radiography 140 147 http://www.Iranjradiol.com/index.php?page=article&article_id=6353 Hye Jin Baek Hye Jin Baek Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea Dong Wook Kim Dong Wook Kim Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Corresponding author: Dong Wook Kim, Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea. Tel: +82-518906549, Fax: +82-518961085, E-mail:. Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Corresponding author: Dong Wook Kim, Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea. Tel: +82-518906549, Fax: +82-518961085, E-mail:. Ji Hwa Ryu Ji Hwa Ryu Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea Yoo Jin Lee Yoo Jin Lee Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
en 10.5812/iranjradiol.9281 Palatine Tonsillar Metastasis of Small-Cell Neuroendocrine Carcinoma from the Lung Detected by FDG-PET/CT After Tonsillectomy: A Case Report Palatine Tonsillar Metastasis of Small-Cell Neuroendocrine Carcinoma from the Lung Detected by FDG-PET/CT After Tonsillectomy: A Case Report HEAD&NECK IMAGING case-report case-report

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.

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.

Palatine Tonsil;Carcinoma, Neuroendocrine;Lung Palatine Tonsil;Carcinoma, Neuroendocrine;Lung 148 151 http://www.Iranjradiol.com/index.php?page=article&article_id=9281 Xiao-Hong Chen Xiao-Hong Chen Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Otolaryngology, the Second Hospital of Jiaxing City 314000, Zhejiang, China Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Otolaryngology, the Second Hospital of Jiaxing City 314000, Zhejiang, China Yang-Yang Bao Yang-Yang Bao Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Shui-Hong Zhou Shui-Hong Zhou Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China +86-13868060120, zhouyunzhoush@163.com Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China +86-13868060120, zhouyunzhoush@163.com Qin-Ying Wang Qin-Ying Wang Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Department of Otolaryngology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Kui Zhao Kui Zhao Center of PET, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Center of PET, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
en 10.5812/iranjradiol.7108 A Rare Case of Rib Osteoblastoma: Imaging Features and Review of Literature A Rare Case of Rib Osteoblastoma: Imaging Features and Review of Literature MUSCULOSKELETAL IMAGING case-report case-report

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.

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.

Ribs;Osteoblastoma;Bone Neoplasms;Osteoma, Osteoid Ribs;Osteoblastoma;Bone Neoplasms;Osteoma, Osteoid 152 155 http://www.Iranjradiol.com/index.php?page=article&article_id=7108 Shokouh Taghipour Zahir Shokouh Taghipour Zahir Department of Pathology,Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Pathology, Shahid Sadoughi University of Medical Sciences, Iran +98-3518113615, shokouh_zahir@yahoo.com Department of Pathology,Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Pathology, Shahid Sadoughi University of Medical Sciences, Iran +98-3518113615, shokouh_zahir@yahoo.com Naser Sefidrokh Sharahjin Naser Sefidrokh Sharahjin Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Saeed Kargar Saeed Kargar Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
en 10.5812/iranjradiol.4779 Urography and CT Features of Primary Small Cell Carcinoma of the Ureter: A Case Report Urography and CT Features of Primary Small Cell Carcinoma of the Ureter: A Case Report UROGENITAL IMAGING case-report case-report

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.

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.

Ureter;Carcinoma, Small Cell;Urography;Tomography, X-Ray Computed Ureter;Carcinoma, Small Cell;Urography;Tomography, X-Ray Computed 160 163 http://www.Iranjradiol.com/index.php?page=article&article_id=4779 Jianfeng Yang Jianfeng Yang Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Zhenhua Zhao Zhenhua Zhao Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Jiayin Ni Jiayin Ni Department of Urology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Department of Urology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Wenpin Dong Wenpin Dong Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Ning Wang Ning Wang Department of Pathology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Department of Pathology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China Boyin Wang Boyin Wang Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China; Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China , +86-057588228556 Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China; Department of Radiology, Shaoxing People\\\\\\\\\\\\\\\'s Hospital, Zhejiang University, Shaoxing, Zhejiang, China , +86-057588228556
en 10.5812/iranjradiol.4297 Paraspinal and Presacral Extramedullary Hematopoiesis: A Rare Manifestation of Polycythemia Vera Paraspinal and Presacral Extramedullary Hematopoiesis: A Rare Manifestation of Polycythemia Vera ABDOMINAL IMAGING case-report case-report

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.

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.

Hematopoiesis;Extramedullary;Polycythemia Vera Hematopoiesis;Extramedullary;Polycythemia Vera 164 168 http://www.Iranjradiol.com/index.php?page=article&article_id=4297 Kaleem Ahmad Kaleem Ahmad Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal; Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. , +91-9973888910 Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal; Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. , +91-9973888910 Sajid Ansari Sajid Ansari Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Roshan Koirala Roshan Koirala Department of Radiodiagnosis, Nobel Medical College, Nepal Department of Radiodiagnosis, Nobel Medical College, Nepal Meenu Agarwal Meenu Agarwal Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Shatdal Chaudhary Shatdal Chaudhary Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
en 10.5812/iranjradiol.4079 A Case of Neonatal Urosepsis with Multifocal Osteoarthritis: Could Ultrasonography Change the Clinical Course? A Case of Neonatal Urosepsis with Multifocal Osteoarthritis: Could Ultrasonography Change the Clinical Course? PEDIATRIC IMAGING case-report case-report

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.

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.

Infant, Newborn;Osteomyelitis;Pyelonephritis;Pyelectasis;Ultrasonography Infant, Newborn;Osteomyelitis;Pyelonephritis;Pyelectasis;Ultrasonography 169 171 http://www.Iranjradiol.com/index.php?page=article&article_id=4079 Giovanni Ottonello Giovanni Ottonello Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Angelica Dessì Angelica Dessì Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Maria Elisabetta Trudu Maria Elisabetta Trudu Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy Carmela Porcu Carmela Porcu Institute of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Italy Institute of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Italy Vassilios Fanos Vassilios Fanos Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy; Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy. Tel: + 39-0706093493 Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy; Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, University of Cagliari, Italy. Tel: + 39-0706093493
en 10.5812/iranjradiol.3929 Different MRI Signs in Predicting the Treatment Efficacy of Epidural Blood Patch in Spontaneous Intracranial Hypotension: A Case Report Different MRI Signs in Predicting the Treatment Efficacy of Epidural Blood Patch in Spontaneous Intracranial Hypotension: A Case Report Neuroradiology case-report case-report

Abstract

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.

Abstract

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.

Blood Patch, Epidural;Pituitary Gland, Posterior;Intracranial Hypotension;Magnetic Resonance Imaging;Cranial Sinuses Blood Patch, Epidural;Pituitary Gland, Posterior;Intracranial Hypotension;Magnetic Resonance Imaging;Cranial Sinuses 172 174 http://www.Iranjradiol.com/index.php?page=article&article_id=3929 Ching Wen Huang Ching Wen Huang Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Yuh Feng Tsai Yuh Feng Tsai Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; Neuroimaging Center, Department of Health Management, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei,Taiwan; Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C. Tel: +886-968995558, Fax: +886-223699103 Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; Neuroimaging Center, Department of Health Management, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei,Taiwan; Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C. Tel: +886-968995558, Fax: +886-223699103 Chen Yu Hsiao Chen Yu Hsiao Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
en 10.5812/iranjradiol.13172 Well-Differentiated Intraosseous Osteosarcoma in the Sacrum: A Case Report Well-Differentiated Intraosseous Osteosarcoma in the Sacrum: A Case Report MUSCULOSKELETAL IMAGING case-report case-report

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.

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.

Sacrum;Osteosarcoma;Sarcoma, Alveolar Soft Part Sacrum;Osteosarcoma;Sarcoma, Alveolar Soft Part 175 178 http://www.Iranjradiol.com/index.php?page=article&article_id=13172 Wang Liuhong Wang Liuhong Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China Zhang Minming Zhang Minming Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China; Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China , +86-57187315255 Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China; Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China , +86-57187315255
en 10.5812/iranjradiol.6835 Assessing the Oldness and Capacity of Radiography and Ultrasound Equipment in Tehran University of Medical Sciences Assessing the Oldness and Capacity of Radiography and Ultrasound Equipment in Tehran University of Medical Sciences IMAGING INFORMATICS brief-report brief-report Conclusion

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.

Materials and Methods

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.

Results

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.

Background

Maintenance of imaging equipment is a very important part of the management of all medical imaging centers.

Objectives

To assess the oldness and capacity of radiography and ultrasound equipment in Tehran University of Medical Sciences.

Conclusion

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.

Materials and Methods

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.

Results

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.

Background

Maintenance of imaging equipment is a very important part of the management of all medical imaging centers.

Objectives

To assess the oldness and capacity of radiography and ultrasound equipment in Tehran University of Medical Sciences.

Radiography;Ultrasonography;Standards;Management Radiography;Ultrasonography;Standards;Management 179 181 http://www.Iranjradiol.com/index.php?page=article&article_id=6835 Payman Salamati Payman Salamati Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Hossein Ghanaati Hossein Ghanaati Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Shahram Ghasemzadeh Shahram Ghasemzadeh Baqiyatallah University of Medical Sciences, Tehran, Iran Baqiyatallah University of Medical Sciences, Tehran, Iran Amir Hossein Jalali Amir Hossein Jalali Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. Tel:+98-2166581579,Fax: +98-2166581578 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. Tel:+98-2166581579,Fax: +98-2166581578
en 10.5812/iranjradiol.13184 Percutaneous Liver Biopsies Guided with Ultrasonography: A Case Series Percutaneous Liver Biopsies Guided with Ultrasonography: A Case Series VASCULAR & INTERVENTIONAL RADIOLOGY brief-report brief-report Conclusion

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.

Results

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.

Patients and Methods

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.

Background

Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur.

Objectives

To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease.

Conclusion

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.

Results

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.

Patients and Methods

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.

Background

Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur.

Objectives

To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease.

Biopsy;Specimen Handling;Ultrasonography Biopsy;Specimen Handling;Ultrasonography 182 184 http://www.Iranjradiol.com/index.php?page=article&article_id=13184 Emin Cakmakci Emin Cakmakci Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey; Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey. Tel: +90-5059436888, Fax: +90-2123735014 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey; Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey. Tel: +90-5059436888, Fax: +90-2123735014 Kosti Can Caliskan Kosti Can Caliskan Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Omer Naci Tabakci Omer Naci Tabakci Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Mehmet Tahtabasi Mehmet Tahtabasi Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Zeki Karpat Zeki Karpat Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
en 10.5812/iranjradiol.13191 Association Between Obstetric Conjugate Diameter Measured by Transabdominal Ultrasonography During Pregnancy and the Type of Delivery Association Between Obstetric Conjugate Diameter Measured by Transabdominal Ultrasonography During Pregnancy and the Type of Delivery WOMEN’S IMAGING brief-report brief-report Objectives

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.

Conclusion

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.

Results

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.

Patients and Methods

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.

Background

Normal morphological features of the maternal pelvis are an important prerequisite to vaginal delivery.

Objectives

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.

Conclusion

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.

Results

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.

Patients and Methods

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.

Background

Normal morphological features of the maternal pelvis are an important prerequisite to vaginal delivery.

Ultrasonography;Pelvimetry;Cesarean Section Ultrasonography;Pelvimetry;Cesarean Section 185 187 http://www.Iranjradiol.com/index.php?page=article&article_id=13191 Mohammad Hossein Daghighi Mohammad Hossein Daghighi Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-4113346911 Fax: +984113346911 Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-4113346911 Fax: +984113346911 Masoud Poureisa Masoud Poureisa Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran Mahnaz Ranjkesh Mahnaz Ranjkesh Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Department of Radiology, Radiotherapy and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran