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 26 gregorian 2017 6 26 13 3
en 27853486 10.5812/iranjradiol.20873 Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis research-article research-article Conclusion

Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.

Patients and Methods

A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology.

Results

MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%).

Background

Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer.

Objectives

The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings.

Conclusion

Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.

Patients and Methods

A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology.

Results

MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%).

Background

Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer.

Objectives

The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings.

Breast MRI;Idiopathic Granulomatous Mastitis;BI-RADS Breast MRI;Idiopathic Granulomatous Mastitis;BI-RADS http://www.Iranjradiol.com/index.php?page=article&article_id=20873 Necdet Poyraz Necdet Poyraz Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey. Tel: +90-5334931774, Fax: +90-3322237967 Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey; Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey. Tel: +90-5334931774, Fax: +90-3322237967 Ganime Dilek Emlik Ganime Dilek Emlik Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey Abdussamet Batur Abdussamet Batur Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey Ebubekir Gundes Ebubekir Gundes Department of General Surgery, Agri State Hospital, Agri, Turkey Department of General Surgery, Agri State Hospital, Agri, Turkey Suat Keskin Suat Keskin Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
en 27853487 10.5812/iranjradiol.21695 Comparative Evaluation of the Efficacy of Hand-Wrist and Cervical Vertebrae Radiography for the Determination of Skeletal Age Comparative Evaluation of the Efficacy of Hand-Wrist and Cervical Vertebrae Radiography for the Determination of Skeletal Age research-article research-article Background

Prediction of skeletal growth is necessary for growth modification and surgical orthodontic treatments and is usually done by assessing skeletal maturity indicators in hand-wrist radiographs. The use of growth stages of cervical vertebrae in lateral cephalograms has been suggested to avoid overexposure.

Objectives

This study seeks to assess the degree of agreement between hand-wrist and cervical vertebrae maturation stages for skeletal age determination and prediction of the peak growth spurt (PGS).

Conclusion

The level of agreement between the two methods was low; thus, they cannot be used alternatively to estimate patients’ skeletal age or to predict the PGS. This may be due to the effect of different maturation levels (influenced by the environment, ethnicity, and gender) on the agreement between methods for skeletal age determination.

Results

In all age groups, the skeletal maturity stages of the hand and wrist bones and the cervical vertebrae of the girls were ahead of the boys. Cohen’s kappa test revealed a low level of agreement between the two methods [Kappa (95% CI) = 0.312 (0.290 - 0.377)]; concordance was slightly higher in males (K = 0.33 for males versus 0.27 for females). Evaluation of concordance coefficients between the stages determined by the two methods indicated the highest concordance in 8- and 9-year-olds and the lowest in 12- and 14-year-olds. The level of agreement between the two methods was only acceptable in 8- and 9-year-olds of both genders and 10-year-old boys. The level of agreement between the two methods in other age groups was not acceptable.

Patients and Methods

This cross-sectional study was conducted with 67 boys and 66 girls between 8 and 18 years of age, divided into 11 age groups; 266 hand-wrist radiographs and lateral cephalograms were obtained and analyzed. Hand-wrist maturation stages were evaluated according to the Grave and Brown, Bjork system (stages 1 - 9). The cervical vertebral maturation stage (CVMS) was determined on lateral cephalograms based on a system described by Baccetti et al. (CVMS 1-5). To apply the Cohen’s kappa index, the stages of growth were reduced to 5 intervals (A - E) to relate the 5 CVMS to the 9 stages of Bjork hand-wrist analysis.

Background

Prediction of skeletal growth is necessary for growth modification and surgical orthodontic treatments and is usually done by assessing skeletal maturity indicators in hand-wrist radiographs. The use of growth stages of cervical vertebrae in lateral cephalograms has been suggested to avoid overexposure.

Objectives

This study seeks to assess the degree of agreement between hand-wrist and cervical vertebrae maturation stages for skeletal age determination and prediction of the peak growth spurt (PGS).

Conclusion

The level of agreement between the two methods was low; thus, they cannot be used alternatively to estimate patients’ skeletal age or to predict the PGS. This may be due to the effect of different maturation levels (influenced by the environment, ethnicity, and gender) on the agreement between methods for skeletal age determination.

Results

In all age groups, the skeletal maturity stages of the hand and wrist bones and the cervical vertebrae of the girls were ahead of the boys. Cohen’s kappa test revealed a low level of agreement between the two methods [Kappa (95% CI) = 0.312 (0.290 - 0.377)]; concordance was slightly higher in males (K = 0.33 for males versus 0.27 for females). Evaluation of concordance coefficients between the stages determined by the two methods indicated the highest concordance in 8- and 9-year-olds and the lowest in 12- and 14-year-olds. The level of agreement between the two methods was only acceptable in 8- and 9-year-olds of both genders and 10-year-old boys. The level of agreement between the two methods in other age groups was not acceptable.

Patients and Methods

This cross-sectional study was conducted with 67 boys and 66 girls between 8 and 18 years of age, divided into 11 age groups; 266 hand-wrist radiographs and lateral cephalograms were obtained and analyzed. Hand-wrist maturation stages were evaluated according to the Grave and Brown, Bjork system (stages 1 - 9). The cervical vertebral maturation stage (CVMS) was determined on lateral cephalograms based on a system described by Baccetti et al. (CVMS 1-5). To apply the Cohen’s kappa index, the stages of growth were reduced to 5 intervals (A - E) to relate the 5 CVMS to the 9 stages of Bjork hand-wrist analysis.

Growth;Hand;Wrist;Cervical Vertebrae;Skeletal Age Growth;Hand;Wrist;Cervical Vertebrae;Skeletal Age http://www.Iranjradiol.com/index.php?page=article&article_id=21695 Mohammadhashem Hoseini Mohammadhashem Hoseini Department of Orthodontic, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Department of Orthodontic, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Sara Zamaheni Sara Zamaheni Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hourieh Bashizadeh Fakhar Hourieh Bashizadeh Fakhar Department of Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Department of Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Forough Akbari Forough Akbari Department of Pediatrics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Pediatrics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Javad Chalipa Javad Chalipa Department of Orthodontic, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Department of Orthodontic, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Afsaneh Rahmati Afsaneh Rahmati Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122403080, Fax: +98-2122403194 Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122403080, Fax: +98-2122403194
en 27853488 10.5812/iranjradiol.24014 Changes of T2 Relaxation Time From Neoadjuvant Chemotherapy in Breast Cancer Lesions Changes of T2 Relaxation Time From Neoadjuvant Chemotherapy in Breast Cancer Lesions research-article research-article Conclusion

In breast cancer after NAC, the lesion T2 relaxation time was reduced in the responders, and this finding is potentially useful to assess the response to NAC.

Results

In 26 cases with NAC, the mean lesion T2 relaxation time before NAC was 81.34 ± 13.68 ms, compared with 64.50 ± 8.71 ms after NAC. Significant differences in the lesion T2 relaxation times existed between the pre- and post-NAC (P < 0.001) ; based on the pathology results, the mean lesion T2 relaxation times in 23 of the 26 responders (63.18 ± 8.37 ms) was shorter than in 3 of the 26 nonresponders (74.62 ± 2.32 ms) after NAC (P = 0.029).

Objectives

To investigate the lesion T2 relaxation times change in breast cancer neoadjuvant chemotherapy (NAC).

Patients and Methods

In total, 26 patients underwent NAC. Magnetic resonance imaging (MRI) T2 mapping was performed before and after NAC. The T2 relaxation times were obtained by using Functool software on an AW 43 workstation. The treatment response was assessed according to the pathological response classification. We aimed to analyze the changes in the T2 relaxation times before and after NAC as well as to study the relationship between the response and the lesion T2 relaxation times after NAC.

Background

Neoadjuvant chemotherapy (NAC) is generally an effective method of reducing locally advanced malignant breast lesions before surgery; assessing the tumor response to NAC is crucial for patient management. T2 relaxation times can reflect biological state of lesions, may prove useful to assess the response to NAC.

Conclusion

In breast cancer after NAC, the lesion T2 relaxation time was reduced in the responders, and this finding is potentially useful to assess the response to NAC.

Results

In 26 cases with NAC, the mean lesion T2 relaxation time before NAC was 81.34 ± 13.68 ms, compared with 64.50 ± 8.71 ms after NAC. Significant differences in the lesion T2 relaxation times existed between the pre- and post-NAC (P < 0.001) ; based on the pathology results, the mean lesion T2 relaxation times in 23 of the 26 responders (63.18 ± 8.37 ms) was shorter than in 3 of the 26 nonresponders (74.62 ± 2.32 ms) after NAC (P = 0.029).

Objectives

To investigate the lesion T2 relaxation times change in breast cancer neoadjuvant chemotherapy (NAC).

Patients and Methods

In total, 26 patients underwent NAC. Magnetic resonance imaging (MRI) T2 mapping was performed before and after NAC. The T2 relaxation times were obtained by using Functool software on an AW 43 workstation. The treatment response was assessed according to the pathological response classification. We aimed to analyze the changes in the T2 relaxation times before and after NAC as well as to study the relationship between the response and the lesion T2 relaxation times after NAC.

Background

Neoadjuvant chemotherapy (NAC) is generally an effective method of reducing locally advanced malignant breast lesions before surgery; assessing the tumor response to NAC is crucial for patient management. T2 relaxation times can reflect biological state of lesions, may prove useful to assess the response to NAC.

Breast Neoplasms;MRI;T2 Relaxometry Breast Neoplasms;MRI;T2 Relaxometry http://www.Iranjradiol.com/index.php?page=article&article_id=24014 Li Liu Li Liu Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China Bo Yin Bo Yin Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Dao Ying Geng Dao Ying Geng Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Yi Ping Lu Yi Ping Lu Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China Wei Jun Peng Wei Jun Peng Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China. Tel: +86-13817515007 Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China. Tel: +86-13817515007
en 27853489 10.5812/iranjradiol.25491 Measuring the Effect of Filters on Segmentation of Developmental Dysplasia of the Hip Measuring the Effect of Filters on Segmentation of Developmental Dysplasia of the Hip research-article research-article Conclusion

Various filters are needed to improve the image quality. In this study, seven different filters were implemented and investigated on both noisy and noise-free images.

Background

Developmental dysplasia of the hip (DDH) can be detected with ultrasonography (USG) images. However, the accuracy of this method is dependent on the skill of the radiologist. Radiologists measure the hip joint angles without computer-based diagnostic systems. This causes mistakes in the diagnosis of DDH.

Objectives

In this study, we aimed to automate segmentation of DDH ultrasound images in order to make it convenient for radiologic diagnosis by this recommended system.

Materials and Methods

This experiment consisted of several steps, in which pure DDH and various noise-added images were formed. Then, seven different filters (mean, median, Gaussian, Wiener, Perona and Malik, Lee, and Frost) were applied to the images, and the output images were evaluated. The study initially evaluated the filter implementations on the pure DDH images. Then, three different noise functions, speckle, salt and pepper, and Gaussian, were applied to the images and the noisy images were filtered. In the last part, the peak signal to noise ratio (PSNR) and mean square error (MSE) values of the filtered images were evaluated. PSNR and MSE distortion measurements were applied to determine the image qualities of the original image and the output image. As a result, the differences in the results of different noise removal filters were observed.

Results

The best results of PSNR values obtained in filtering were: Wiener (43.49), Perona and Malik (27.68), median (40.60) and Lee (35.35) for the noise functions of raw images, Gaussian noise added, salt and pepper noise added and speckle noise added images, respectively. After the segmentation process, it was seen that applying filtering to DDH USG images had low influence. We correctly segmented the ilium zone with the active contour model.

Conclusion

Various filters are needed to improve the image quality. In this study, seven different filters were implemented and investigated on both noisy and noise-free images.

Background

Developmental dysplasia of the hip (DDH) can be detected with ultrasonography (USG) images. However, the accuracy of this method is dependent on the skill of the radiologist. Radiologists measure the hip joint angles without computer-based diagnostic systems. This causes mistakes in the diagnosis of DDH.

Objectives

In this study, we aimed to automate segmentation of DDH ultrasound images in order to make it convenient for radiologic diagnosis by this recommended system.

Materials and Methods

This experiment consisted of several steps, in which pure DDH and various noise-added images were formed. Then, seven different filters (mean, median, Gaussian, Wiener, Perona and Malik, Lee, and Frost) were applied to the images, and the output images were evaluated. The study initially evaluated the filter implementations on the pure DDH images. Then, three different noise functions, speckle, salt and pepper, and Gaussian, were applied to the images and the noisy images were filtered. In the last part, the peak signal to noise ratio (PSNR) and mean square error (MSE) values of the filtered images were evaluated. PSNR and MSE distortion measurements were applied to determine the image qualities of the original image and the output image. As a result, the differences in the results of different noise removal filters were observed.

Results

The best results of PSNR values obtained in filtering were: Wiener (43.49), Perona and Malik (27.68), median (40.60) and Lee (35.35) for the noise functions of raw images, Gaussian noise added, salt and pepper noise added and speckle noise added images, respectively. After the segmentation process, it was seen that applying filtering to DDH USG images had low influence. We correctly segmented the ilium zone with the active contour model.

Ultrasonography;Image Processing;Developmental Dysplasia of the Hip;Filtering Ultrasonography;Image Processing;Developmental Dysplasia of the Hip;Filtering http://www.Iranjradiol.com/index.php?page=article&article_id=25491 Hasan Erdinc Kocer Hasan Erdinc Kocer Department of Electronics and Computer Education, Technical Education Faculty, Selcuk University, Konya, Turkey Department of Electronics and Computer Education, Technical Education Faculty, Selcuk University, Konya, Turkey Kerim Kursat Cevik Kerim Kursat Cevik Department of Computer Programming, Bor Vocational High School, Nigde University, Nigde, Turkey; Department of Computer Programming, Bor Vocational High School, Nigde University, Nigde, Turkey. Tel: +90-3883114527, Fax: +90-3883118437 Department of Computer Programming, Bor Vocational High School, Nigde University, Nigde, Turkey; Department of Computer Programming, Bor Vocational High School, Nigde University, Nigde, Turkey. Tel: +90-3883114527, Fax: +90-3883118437 Mesut Sivri Mesut Sivri Department of Radiology, Medical Faculty, Selcuk University, Konya, Turkey Department of Radiology, Medical Faculty, Selcuk University, Konya, Turkey Mustafa Koplay Mustafa Koplay Department of Radiology, Medical Faculty, Selcuk University, Konya, Turkey Department of Radiology, Medical Faculty, Selcuk University, Konya, Turkey
en 27853492 10.5812/iranjradiol.28281 Variability in Observer Performance Between Faculty Members and Residents Using Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, Fifth Edition (2013) Variability in Observer Performance Between Faculty Members and Residents Using Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, Fifth Edition (2013) research-article research-article Conclusion

Investigative assessment of breast US by residents is inadvisable. We recommend continued professional resident training to improve the degree of agreement and performance.

Results

For the faculty members, fair-to-good agreement was obtained in all descriptors and final assessment, while for residents, poor-to-moderate agreement was obtained. The areas under the ROC curves were 0.78 for the faculty members, 0.59 for the senior residents, and 0.52 for the junior residents, respectively. Diagnostic performance was significantly higher in the faculty members than the senior and junior residents (P = 0.0001 and < 0.0001, respectively). After one education session, the agreement in the final assessment was one level higher in the faculty members and senior residents, yet in the senior residents, the degree of agreement was still only fair. Moreover, in the junior residents, there was no improvement.

Background

Ultrasonography (US) is a useful tool for breast imaging, yet is highly operator-dependent.

Objectives

We evaluated inter-observer variability and performance discrepancies between faculty members and radiology residents when describing breast lesions, by the fifth edition of breast imaging reporting and data system (BI-RADS)-US lexicon, and then attempted to identify whether inter-observer variability could be improved after one education session.

Patients and Methods

In total, 50 malignant lesions and 70 benign lesions were considered in our retrospective study. Two faculty members, two senior residents, and two junior residents separately assessed the US images. After the first assessment, the readers received one education session, and then reassessed the images in a random order. Inter-observer variability was measured using the kappa coefficient (κ). Performance discrepancy was evaluated by receiver operating characteristic (ROC) curves.

Conclusion

Investigative assessment of breast US by residents is inadvisable. We recommend continued professional resident training to improve the degree of agreement and performance.

Results

For the faculty members, fair-to-good agreement was obtained in all descriptors and final assessment, while for residents, poor-to-moderate agreement was obtained. The areas under the ROC curves were 0.78 for the faculty members, 0.59 for the senior residents, and 0.52 for the junior residents, respectively. Diagnostic performance was significantly higher in the faculty members than the senior and junior residents (P = 0.0001 and < 0.0001, respectively). After one education session, the agreement in the final assessment was one level higher in the faculty members and senior residents, yet in the senior residents, the degree of agreement was still only fair. Moreover, in the junior residents, there was no improvement.

Background

Ultrasonography (US) is a useful tool for breast imaging, yet is highly operator-dependent.

Objectives

We evaluated inter-observer variability and performance discrepancies between faculty members and radiology residents when describing breast lesions, by the fifth edition of breast imaging reporting and data system (BI-RADS)-US lexicon, and then attempted to identify whether inter-observer variability could be improved after one education session.

Patients and Methods

In total, 50 malignant lesions and 70 benign lesions were considered in our retrospective study. Two faculty members, two senior residents, and two junior residents separately assessed the US images. After the first assessment, the readers received one education session, and then reassessed the images in a random order. Inter-observer variability was measured using the kappa coefficient (κ). Performance discrepancy was evaluated by receiver operating characteristic (ROC) curves.

Breast;Ultrasonography;Neoplasms;Faculty;Residency Breast;Ultrasonography;Neoplasms;Faculty;Residency http://www.Iranjradiol.com/index.php?page=article&article_id=28281 Youn Joo Lee Youn Joo Lee Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea So Young Choi So Young Choi Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea Kyu Sun Kim Kyu Sun Kim Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea Po Song Yang Po Song Yang Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea. Tel: +82-422209700, Fax: +82-422209087 Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea. Tel: +82-422209700, Fax: +82-422209087
en 27853493 10.5812/iranjradiol.28689 Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent research-article research-article Background

The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications.

Objectives

To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success.

Patients and Methods

Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded.

Results

The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation.

Conclusion

The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study.

Background

The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications.

Objectives

To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success.

Patients and Methods

Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded.

Results

The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation.

Conclusion

The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study.

TIPSS;Self-Expandable Stent;Low-Profile Stent System TIPSS;Self-Expandable Stent;Low-Profile Stent System http://www.Iranjradiol.com/index.php?page=article&article_id=28689 Daniel Spira Daniel Spira Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. Tel: +49-6221566410, Fax: +49-6221565730 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. Tel: +49-6221566410, Fax: +49-6221565730 Jakub Wiskirchen Jakub Wiskirchen Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany Ulrich Lauer Ulrich Lauer Department of Gastroenterology and Hepatology, Eberhard-Karls-University, Tubingen, Germany Department of Gastroenterology and Hepatology, Eberhard-Karls-University, Tubingen, Germany Dominik Ketelsen Dominik Ketelsen Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany Konstantin Nikolaou Konstantin Nikolaou Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany Benjamin Wiesinger Benjamin Wiesinger Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tubingen, Germany
en 27853494 10.5812/iranjradiol.30426 Preoperative Grading of Astrocytic Supratentorial Brain Tumors with Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient Preoperative Grading of Astrocytic Supratentorial Brain Tumors with Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient research-article research-article Background

Diffusion-weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within the biological tissues and is particularly useful in tumor characterization.

Objectives

The purpose of this study was to evaluate the diagnostic value of DW MRI and the apparent diffusion coefficient (ADC) for preoperative grading of astrocytic supratentorial brain tumors.

Patients and Methods

Twenty-three patients (14 females, 9 males, mean age 43 years) with astrocytic supratentorial brain tumors underwent preoperative conventional MR imaging and DW MRI. The minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities of each tumor were taken by placing several regions of interest in the tumor on DWI images and ADC maps. To assess the relationship between these values and the tumor grade, we used the Mann-Whitney U test and the Spearman correlation. Receiver operating characteristic (ROC) analysis was used to determine the cutoff value of the minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities that had the best composition of sensitivity and specificity for differentiating low-grade and high-grade astrocytic brain tumors.

Results

According to the pathology reports, 10 patients had low-grade astrocytomas (grades I, II) and 13 patients had high-grade astrocytomas (grades III, IV). The minimum ADC value showed a significantly inverse correlation with astrocytic tumor grade (P = 0.006). The correlation between the maximum ADC value and the maximum DWI signal intensity with tumor grade was direct (P = 0.013, P = 0.035). According to the ROC analysis, the cutoff values of 0.843 × 10-3 mm2/s, 2.117 × 10-3 mm2/s and 165.2 for the minimum ADC, maximum ADC and maximum DWI respectively, obtained the best combination of sensitivity and specificity for distinguishing low-grade and high-grade astrocytomas.

Conclusion

Measuring minimum ADC, maximum ADC and maximum DWI signal intensity can provide valuable information for grading of astrocytic supratentorial brain tumors before surgery.

Background

Diffusion-weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within the biological tissues and is particularly useful in tumor characterization.

Objectives

The purpose of this study was to evaluate the diagnostic value of DW MRI and the apparent diffusion coefficient (ADC) for preoperative grading of astrocytic supratentorial brain tumors.

Patients and Methods

Twenty-three patients (14 females, 9 males, mean age 43 years) with astrocytic supratentorial brain tumors underwent preoperative conventional MR imaging and DW MRI. The minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities of each tumor were taken by placing several regions of interest in the tumor on DWI images and ADC maps. To assess the relationship between these values and the tumor grade, we used the Mann-Whitney U test and the Spearman correlation. Receiver operating characteristic (ROC) analysis was used to determine the cutoff value of the minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities that had the best composition of sensitivity and specificity for differentiating low-grade and high-grade astrocytic brain tumors.

Results

According to the pathology reports, 10 patients had low-grade astrocytomas (grades I, II) and 13 patients had high-grade astrocytomas (grades III, IV). The minimum ADC value showed a significantly inverse correlation with astrocytic tumor grade (P = 0.006). The correlation between the maximum ADC value and the maximum DWI signal intensity with tumor grade was direct (P = 0.013, P = 0.035). According to the ROC analysis, the cutoff values of 0.843 × 10-3 mm2/s, 2.117 × 10-3 mm2/s and 165.2 for the minimum ADC, maximum ADC and maximum DWI respectively, obtained the best combination of sensitivity and specificity for distinguishing low-grade and high-grade astrocytomas.

Conclusion

Measuring minimum ADC, maximum ADC and maximum DWI signal intensity can provide valuable information for grading of astrocytic supratentorial brain tumors before surgery.

Diffusion Magnetic Resonance Imaging;Diffusion Weighted MRI;Cerebral Astrocytoma;Neoplasm Grading;Tumor Grading Diffusion Magnetic Resonance Imaging;Diffusion Weighted MRI;Cerebral Astrocytoma;Neoplasm Grading;Tumor Grading http://www.Iranjradiol.com/index.php?page=article&article_id=30426 Mahsa Raisi-Nafchi Mahsa Raisi-Nafchi Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fariborz Faeghi Fariborz Faeghi Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Zali Alireza Zali Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamidreza Haghighatkhah Hamidreza Haghighatkhah Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Jalal Jalal-Shokouhi Jalal Jalal-Shokouhi Jam-e-Jam Medical Imaging Center, Tehran, Iran Jam-e-Jam Medical Imaging Center, Tehran, Iran
en 27853497 10.5812/iranjradiol.33900 Imaging Findings in Patients with Granulomatous Mastitis Imaging Findings in Patients with Granulomatous Mastitis research-article research-article Conclusion

GM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation.

Objectives

The aim of this study was to review the radiological findings and diagnostic value of the imaging in GM.

Patients and Methods

This retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis.

Results

Among 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy.

Background

Granulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary.

Conclusion

GM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation.

Objectives

The aim of this study was to review the radiological findings and diagnostic value of the imaging in GM.

Patients and Methods

This retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis.

Results

Among 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy.

Background

Granulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary.

Granulomatous Mastitis;Breast;Mammography;Ultrasonography Granulomatous Mastitis;Breast;Mammography;Ultrasonography http://www.Iranjradiol.com/index.php?page=article&article_id=33900 Pelin Seher Oztekin Pelin Seher Oztekin Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey; Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey; Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Gamze Durhan Gamze Durhan Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Pinar Nercis Kosar Pinar Nercis Kosar Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey Serap Erel Serap Erel 4th Surgery Department, Ankara Training and Research Hospital, Ankara, Turkey 4th Surgery Department, Ankara Training and Research Hospital, Ankara, Turkey Sema Hucumenoglu Sema Hucumenoglu Pathology Department, Ankara Training and Research Hospital, Ankara, Turkey Pathology Department, Ankara Training and Research Hospital, Ankara, Turkey
en 27853498 10.5812/iranjradiol.34220 Dosimetry of Three Cone Beam Computerized Tomography Scanners at Different Fields of View in Terms of Various Head and Neck Organs Dosimetry of Three Cone Beam Computerized Tomography Scanners at Different Fields of View in Terms of Various Head and Neck Organs research-article research-article Background

Marketing new radiography devices necessitates documenting their absorbed X-ray doses. Since the current literature lacks studies on new devices, we assessed the doses of two new devices that had not previously been assessed.

Objectives

The new devices were compared to the Promax three dimensional (3D) scanner at two fields of view (FOV) in nine critical head and neck tissues and organs.

Conclusion

The absorbed doses pertaining to the devices and the FOVs were not significantly different, although the organs/tissues absorbed considerably different doses.

Results

The average absorbed doses, respectively, for the large and small FOVs were 17.19 and 28.89 mGy in the Promax 3D, 19.25 and 35.46 mGy in the NewTom VGi, and 18.85 and 30.63 mGy in the NewTom 5G. The absorbed doses related to the FOVs were not significantly different (P value = 0.1930). However, the effective doses were significantly greater at the smaller FOVs / higher resolutions (P = 0.0039). The doses of the three devices were not significantly different (P = 0.8944). The difference among the nine organs/tissues was significant (Kruskal-Wallis P=0.0000).

Materials and Methods

Seventeen thermoluminescence dosimeters positioned in an average-sized male RANDO phantom were used to determine the dosimetry of the three cone beam computerized tomography devices (NewTom VGi, NewTom 5G, and Promax 3D) at two field of views (FOVs), one small and one large. The exposure by each device per FOV was performed five times (30 exposures). The absorbed and effective doses were calculated for the thyroid, parotid, submandibular gland, sublingual gland, calvarium, cervical vertebra, trunk of the mandible, and mandibular ramus. The doses pertaining to the different devices, the FOVs, and the tissues were compared using the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.

Background

Marketing new radiography devices necessitates documenting their absorbed X-ray doses. Since the current literature lacks studies on new devices, we assessed the doses of two new devices that had not previously been assessed.

Objectives

The new devices were compared to the Promax three dimensional (3D) scanner at two fields of view (FOV) in nine critical head and neck tissues and organs.

Conclusion

The absorbed doses pertaining to the devices and the FOVs were not significantly different, although the organs/tissues absorbed considerably different doses.

Results

The average absorbed doses, respectively, for the large and small FOVs were 17.19 and 28.89 mGy in the Promax 3D, 19.25 and 35.46 mGy in the NewTom VGi, and 18.85 and 30.63 mGy in the NewTom 5G. The absorbed doses related to the FOVs were not significantly different (P value = 0.1930). However, the effective doses were significantly greater at the smaller FOVs / higher resolutions (P = 0.0039). The doses of the three devices were not significantly different (P = 0.8944). The difference among the nine organs/tissues was significant (Kruskal-Wallis P=0.0000).

Materials and Methods

Seventeen thermoluminescence dosimeters positioned in an average-sized male RANDO phantom were used to determine the dosimetry of the three cone beam computerized tomography devices (NewTom VGi, NewTom 5G, and Promax 3D) at two field of views (FOVs), one small and one large. The exposure by each device per FOV was performed five times (30 exposures). The absorbed and effective doses were calculated for the thyroid, parotid, submandibular gland, sublingual gland, calvarium, cervical vertebra, trunk of the mandible, and mandibular ramus. The doses pertaining to the different devices, the FOVs, and the tissues were compared using the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.

Cone Beam Computed Tomography;Dosimetry;Field of View;Resolution;Absorbed Dose;Effective Dose Cone Beam Computed Tomography;Dosimetry;Field of View;Resolution;Absorbed Dose;Effective Dose http://www.Iranjradiol.com/index.php?page=article&article_id=34220 Sima Nikneshan Sima Nikneshan Department of Oral and Maxillofacial Radiology, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Oral and Maxillofacial Radiology, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahmood Reza Aghamiri Mahmood Reza Aghamiri Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran Ehsan Moudi Ehsan Moudi Department of Oral and Maxillofacial Radiology, Dental Faculty, Babol University of Medical Sciences, Babol, Iran Department of Oral and Maxillofacial Radiology, Dental Faculty, Babol University of Medical Sciences, Babol, Iran Nika Bahemmat Nika Bahemmat Department of Oral and Maxillofacial Radiology, Dental Faculty, Alborz University of Medical Sciences, Karaj, Iran Department of Oral and Maxillofacial Radiology, Dental Faculty, Alborz University of Medical Sciences, Karaj, Iran Hoora Hadian Hoora Hadian Department of Oral and Maxillofacial Radiology, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Department of Oral and Maxillofacial Radiology, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-1133044000 Department of Oral and Maxillofacial Radiology, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Department of Oral and Maxillofacial Radiology, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-1133044000
en 27853499 10.5812/iranjradiol.34985 Effect of Voxel Size on Detection of External Root Resorption Defects Using Cone Beam Computed Tomography Effect of Voxel Size on Detection of External Root Resorption Defects Using Cone Beam Computed Tomography research-article research-article Conclusion

Considering the similar diagnostic efficacy of all voxel sizes, 300 µm voxel size can be used with adequate efficacy for detection of external root resorption defects with minimal patient radiation dose and the shortest scanning time.

Background

Selecting a voxel size that yields minimal radiation dose with no significant compromise of the diagnostic accuracy of cone beam computed tomography (CBCT) is particularly important.

Objectives

This study aimed to assess the effect of voxel size on detection accuracy of simulated external root resorption defects using NewTom CBCT system.

Materials and Methods

In this diagnostic study, the roots of 90 extracted human central incisors were hypothetically divided into cervical, middle, and apical thirds. Variable-size defects were prepared in the buccal and lingual surfaces of the roots and CBCT scans were obtained with four different voxel sizes (150, 200, 250, and 300). Presence or absence of defects on CBCT scans was determined by three radiologists and the results were compared with the gold standard (actual size and depth of defects). Sensitivity and specificity values were calculated and reported for different groups.

Results

In the lingual surfaces, the highest specificity and sensitivity belonged to 300µm voxel size (92.9%), and 200 and 250µm voxel sizes (both 97.4%) in the cervical third, respectively. In the middle third, the highest specificity and sensitivity belonged to 250 and 200µm voxel sizes (84.6% and 100%, respectively). In the apical third, the highest specificity and sensitivity belonged to 300 µm voxel size (100% and 97.9%, respectively). In the buccal surfaces, the highest specificity and sensitivity belonged to 150 (75.0%), 300 and 250 µm voxel sizes (100%) and the minimum values belonged to 200 µm voxel size (60% and 97.3%) in the cervical third. In the apical third, the highest specificity and sensitivity were noted in 300 µm voxel size (100% and 97.6%, respectively) and the minimum values were seen in 200 and 150 µm voxel sizes (93.8%, 90.5%, respectively). In the middle third, 300, 250 and 200 µm voxel sizes yielded the highest specificity (88.9%), while 150 µm voxel size yielded the highest sensitivity (98.8%).

Conclusion

Considering the similar diagnostic efficacy of all voxel sizes, 300 µm voxel size can be used with adequate efficacy for detection of external root resorption defects with minimal patient radiation dose and the shortest scanning time.

Background

Selecting a voxel size that yields minimal radiation dose with no significant compromise of the diagnostic accuracy of cone beam computed tomography (CBCT) is particularly important.

Objectives

This study aimed to assess the effect of voxel size on detection accuracy of simulated external root resorption defects using NewTom CBCT system.

Materials and Methods

In this diagnostic study, the roots of 90 extracted human central incisors were hypothetically divided into cervical, middle, and apical thirds. Variable-size defects were prepared in the buccal and lingual surfaces of the roots and CBCT scans were obtained with four different voxel sizes (150, 200, 250, and 300). Presence or absence of defects on CBCT scans was determined by three radiologists and the results were compared with the gold standard (actual size and depth of defects). Sensitivity and specificity values were calculated and reported for different groups.

Results

In the lingual surfaces, the highest specificity and sensitivity belonged to 300µm voxel size (92.9%), and 200 and 250µm voxel sizes (both 97.4%) in the cervical third, respectively. In the middle third, the highest specificity and sensitivity belonged to 250 and 200µm voxel sizes (84.6% and 100%, respectively). In the apical third, the highest specificity and sensitivity belonged to 300 µm voxel size (100% and 97.9%, respectively). In the buccal surfaces, the highest specificity and sensitivity belonged to 150 (75.0%), 300 and 250 µm voxel sizes (100%) and the minimum values belonged to 200 µm voxel size (60% and 97.3%) in the cervical third. In the apical third, the highest specificity and sensitivity were noted in 300 µm voxel size (100% and 97.6%, respectively) and the minimum values were seen in 200 and 150 µm voxel sizes (93.8%, 90.5%, respectively). In the middle third, 300, 250 and 200 µm voxel sizes yielded the highest specificity (88.9%), while 150 µm voxel size yielded the highest sensitivity (98.8%).

Accuracy;Cone-Beam Computed Tomography;Root Resorption Accuracy;Cone-Beam Computed Tomography;Root Resorption http://www.Iranjradiol.com/index.php?page=article&article_id=34985 Sima Nikneshan Sima Nikneshan Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Solmaz Valizadeh Solmaz Valizadeh Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Anahita Javanmard Anahita Javanmard Dentist, Tehran, Iran Dentist, Tehran, Iran Leila Alibakhshi Leila Alibakhshi Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122907040, Fax: +98-2188804037 Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122907040, Fax: +98-2188804037
en 27853501 10.5812/iranjradiol.36375 Evaluation of Iron Deposition in the Adrenal Glands of β Thalassemia Major Patients Using 3-Tesla MRI Evaluation of Iron Deposition in the Adrenal Glands of β Thalassemia Major Patients Using 3-Tesla MRI research-article research-article Conclusion

Adrenal iron in β-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.

Results

Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in β-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*.

Patients and Methods

Between October 2014 and March 2015, MRI was performed in 21 patients with β-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion.

Objectives

The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters.

Background

Beta-thalassemia major (β-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification.

Conclusion

Adrenal iron in β-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.

Results

Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in β-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*.

Patients and Methods

Between October 2014 and March 2015, MRI was performed in 21 patients with β-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion.

Objectives

The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters.

Background

Beta-thalassemia major (β-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification.

Adrenal Glands;Magnetic Resonance Imaging;Thalassemia;Relaxation Adrenal Glands;Magnetic Resonance Imaging;Thalassemia;Relaxation http://www.Iranjradiol.com/index.php?page=article&article_id=36375 Tevfik Guzelbey Tevfik Guzelbey Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey Bengi Gurses Bengi Gurses Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey; Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey; Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey Erman Ozturk Erman Ozturk Department of Hematology, School of Medicine, Koc University, Istanbul, Turkey Department of Hematology, School of Medicine, Koc University, Istanbul, Turkey Olcay Ozveren Olcay Ozveren Department of Cardiology, School of Medicine, Yeditepe University, Istanbul, Turkey Department of Cardiology, School of Medicine, Yeditepe University, Istanbul, Turkey Aysegul Sarsilmaz Aysegul Sarsilmaz Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey Ebru Karasu Ebru Karasu Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey
en 27853490 10.5812/iranjradiol.27812 Non-Seminomatous Germ Cell Tumor Metastasis to the Jaw: An Imaging Case Report Non-Seminomatous Germ Cell Tumor Metastasis to the Jaw: An Imaging Case Report case-report case-report

Testicular cancer typically spreads to the lymph nodes, but hematogenous dissemination to distant organs can also occur. Bone metastasis is uncommon and is thought to be a poor prognostic indicator. Jaw metastasis is exceedingly rare but is of great clinical significance, since it may be the first sign of an occult testicular cancer or the first evidence of relapse of a known tumor. Herein, we report the first case describing the imaging and clinical findings of a non-seminomatous germ cell tumor with jaw metastasis at diagnosis.

Testicular cancer typically spreads to the lymph nodes, but hematogenous dissemination to distant organs can also occur. Bone metastasis is uncommon and is thought to be a poor prognostic indicator. Jaw metastasis is exceedingly rare but is of great clinical significance, since it may be the first sign of an occult testicular cancer or the first evidence of relapse of a known tumor. Herein, we report the first case describing the imaging and clinical findings of a non-seminomatous germ cell tumor with jaw metastasis at diagnosis.

Jaw;Bone;Metastasis;Testicular Cancer;Germ Cell Tumors Jaw;Bone;Metastasis;Testicular Cancer;Germ Cell Tumors http://www.Iranjradiol.com/index.php?page=article&article_id=27812 Rita Olivia Siverino Rita Olivia Siverino Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Alessandra Uccello Alessandra Uccello Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Maria Luisa Giunta Maria Luisa Giunta Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Mario Uccello Mario Uccello Department of Oncology, ARNAS Garibaldi, Catania, Italy; Department of Oncology, ARNAS Garibaldi, Catania, Italy. Tel: +39-0957595039, Fax: +39-0957595041 Department of Oncology, ARNAS Garibaldi, Catania, Italy; Department of Oncology, ARNAS Garibaldi, Catania, Italy. Tel: +39-0957595039, Fax: +39-0957595041 Placido Amadio Placido Amadio Department of Oncology, ARNAS Garibaldi, Catania, Italy Department of Oncology, ARNAS Garibaldi, Catania, Italy Giuseppe Petrillo Giuseppe Petrillo Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy Department of Radiology, University Hospital Policlinico “G. Rodolico”, Catania, Italy
en 27853491 10.5812/iranjradiol.28209 Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion case-report case-report

Dissection of the internal carotid artery (ICA) is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT), resulting in occlusion of the ICA.

Dissection of the internal carotid artery (ICA) is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT), resulting in occlusion of the ICA.

Dissection;Internal Carotid Artery;Neurointerventional Procedure;Magnetic Resonance Angiography Dissection;Internal Carotid Artery;Neurointerventional Procedure;Magnetic Resonance Angiography http://www.Iranjradiol.com/index.php?page=article&article_id=28209 Suha Akpinar Suha Akpinar Near East University Hospital, Nicosia, North Cyprus, Turkey Near East University Hospital, Nicosia, North Cyprus, Turkey Guliz Yilmaz Guliz Yilmaz Department of Radiology, Faculty of Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey; Department of Radiology, Faculty of Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey. Tel: +90-3926751000; +90-5338748687, Fax: +90-3926751090 Department of Radiology, Faculty of Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey; Department of Radiology, Faculty of Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey. Tel: +90-3926751000; +90-5338748687, Fax: +90-3926751090
en 27878064 10.5812/iranjradiol.31677 Cavernous Hemangioma of the Rib: A Case Report Cavernous Hemangioma of the Rib: A Case Report case-report case-report

Hemangioma of the rib is a rare benign vascular tumor. Herein, we report a 63-year-old man presenting with hemangioma of the left sixth rib. An osteolytic eccentric expansive mass with calcification and focal cortical disruption was detected on chest computed tomography (CT). The mass showed low 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) avidity on positron emission tomography. The patient underwent resection of the left sixth rib. Based on the histopathology findings, a diagnosis of cavernous hemangioma was made. Rib hemangiomas and malignant lesions appear similar on CT scans; therefore, most cases of rib hemangiomas reported in the literature were treated with rib resection. However, rib hemangiomas should be included in the differential diagnosis of an asymptomatic patient if an osteolytic expansive lesion containing sunburst calcifications with low 18F-FDG avidity is observed on a CT scan.

Hemangioma of the rib is a rare benign vascular tumor. Herein, we report a 63-year-old man presenting with hemangioma of the left sixth rib. An osteolytic eccentric expansive mass with calcification and focal cortical disruption was detected on chest computed tomography (CT). The mass showed low 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) avidity on positron emission tomography. The patient underwent resection of the left sixth rib. Based on the histopathology findings, a diagnosis of cavernous hemangioma was made. Rib hemangiomas and malignant lesions appear similar on CT scans; therefore, most cases of rib hemangiomas reported in the literature were treated with rib resection. However, rib hemangiomas should be included in the differential diagnosis of an asymptomatic patient if an osteolytic expansive lesion containing sunburst calcifications with low 18F-FDG avidity is observed on a CT scan.

Rib Resection;Hemangioma;Tumor Rib Resection;Hemangioma;Tumor http://www.Iranjradiol.com/index.php?page=article&article_id=31677 Joon Young Park Joon Young Park Department of Radiology, Chonnam National University Hospital, Gwangju, Korea Department of Radiology, Chonnam National University Hospital, Gwangju, Korea Jin gyoon Park Jin gyoon Park Department of Radiology, Chonnam National University Hospital, Gwangju, Korea Department of Radiology, Chonnam National University Hospital, Gwangju, Korea Seung Jin Lee Seung Jin Lee Department of Radiology, Chonnam National University Hospital, Gwangju, Korea; Department of Radiology, Chonnam National University Hospital, Gwangju, Korea. Tel: +82-622205146, Fax: +82-622264380 Department of Radiology, Chonnam National University Hospital, Gwangju, Korea; Department of Radiology, Chonnam National University Hospital, Gwangju, Korea. Tel: +82-622205146, Fax: +82-622264380
en 27853495 10.5812/iranjradiol.31943 Giant Omental Cyst (Lymphangioma) Mimicking Ascites and Tuberculosis Giant Omental Cyst (Lymphangioma) Mimicking Ascites and Tuberculosis case-report case-report

Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ascites on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ascites and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ascites. We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ascites at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination.

Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ascites on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ascites and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ascites. We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ascites at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination.

Omentum;Cyst;Lymphangioma;Ascites;Tuberculosis;Child Omentum;Cyst;Lymphangioma;Ascites;Tuberculosis;Child http://www.Iranjradiol.com/index.php?page=article&article_id=31943 Asuman Nur Karhan Asuman Nur Karhan Department of Pediatric Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey. Tel: +90-3123051993-94, Fax: +90-3123054157 Department of Pediatric Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey. Tel: +90-3123051993-94, Fax: +90-3123054157 Tutku Soyer Tutku Soyer Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey Altan Gunes Altan Gunes Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Beril Talim Beril Talim Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Ibrahim Karnak Ibrahim Karnak Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey Berna Oguz Berna Oguz Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Inci Nur Saltik Temizel Inci Nur Saltik Temizel Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
en 27853496 10.5812/iranjradiol.32190 A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions case-report case-report

Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS).

Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS).

Radiographic Image Enhancement;Triple Negative Breast Neoplasms;Contrast Media;Developing Countries;Subtraction Technique Radiographic Image Enhancement;Triple Negative Breast Neoplasms;Contrast Media;Developing Countries;Subtraction Technique http://www.Iranjradiol.com/index.php?page=article&article_id=32190 Maria Del Mar Travieso Aja Maria Del Mar Travieso Aja Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain; Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain. Tel: +34-928012600, Fax: +34-928451461 Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain; Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain. Tel: +34-928012600, Fax: +34-928451461 Purificacion Munoz Purificacion Munoz Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain Mario Rodriguez Rodriguez Mario Rodriguez Rodriguez Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain Victor Vega Benitez Victor Vega Benitez Department of Surgery, Insular and Maternal and Child Hospitals (CHUIMI), Las Palmas, Spain Department of Surgery, Insular and Maternal and Child Hospitals (CHUIMI), Las Palmas, Spain Octavio P. Luzardo Octavio P. Luzardo Research Group in Environment and Health, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain Research Group in Environment and Health, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
en 27878065 10.5812/iranjradiol.32927 Corticobulbar Tract Involvement in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report Corticobulbar Tract Involvement in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report case-report case-report

A 36-year-old woman, diagnosed with systemic lupus erythematosus (SLE), showed bulbar symptoms including impaired memory, slurred speech and swallowing difficulty 7 days before admission. Magnetic resonance imaging (MRI) showed symmetric confluent hyperintensities in the bilateral cerebral white matter on T2 weighted imaging (T2-WI), extended into the genu of the internal capsule and the crus cerebri of the midbrain. MR spectroscopy showed increased choline and decreased N-acetyl aspartate (NAA) peak and positron emission computed tomography (PET CT) showed decreased fluorodeoxyglucose (FDG) uptake on the lateral portion of the frontal lobe, suggesting demyelination of the white matter. The value of apparent diffusion coefficient, fractional anisotropy, tensor linear, tensor planar and relative anisotropy of the corticobulbar tract (CBT) were lower than those of the corticospinal tract. This is the first case report of CBT involvement in a patient with neuropsychiatric SLE (NPSLE) as far as we know. The findings of T2-WI and diffusion tensor imaging (DTI) showed precise anatomical location of neuronal damage of CBT. In addition, magnetic resonance spectroscopy (MRS), PET-CT and parameters of DTI supported the explanations of the inflammatory process and metabolic change of the white matter caused by NPSLE.

A 36-year-old woman, diagnosed with systemic lupus erythematosus (SLE), showed bulbar symptoms including impaired memory, slurred speech and swallowing difficulty 7 days before admission. Magnetic resonance imaging (MRI) showed symmetric confluent hyperintensities in the bilateral cerebral white matter on T2 weighted imaging (T2-WI), extended into the genu of the internal capsule and the crus cerebri of the midbrain. MR spectroscopy showed increased choline and decreased N-acetyl aspartate (NAA) peak and positron emission computed tomography (PET CT) showed decreased fluorodeoxyglucose (FDG) uptake on the lateral portion of the frontal lobe, suggesting demyelination of the white matter. The value of apparent diffusion coefficient, fractional anisotropy, tensor linear, tensor planar and relative anisotropy of the corticobulbar tract (CBT) were lower than those of the corticospinal tract. This is the first case report of CBT involvement in a patient with neuropsychiatric SLE (NPSLE) as far as we know. The findings of T2-WI and diffusion tensor imaging (DTI) showed precise anatomical location of neuronal damage of CBT. In addition, magnetic resonance spectroscopy (MRS), PET-CT and parameters of DTI supported the explanations of the inflammatory process and metabolic change of the white matter caused by NPSLE.

SLE;Corticobulbar Tract;MRI;Diffusion Tensor;MR Spectroscopy;PET CT SLE;Corticobulbar Tract;MRI;Diffusion Tensor;MR Spectroscopy;PET CT http://www.Iranjradiol.com/index.php?page=article&article_id=32927 Ho Kyun Kim Ho Kyun Kim Department of Radiology, School of Medicine, Catholic University of Daegu, Daegu, Korea Department of Radiology, School of Medicine, Catholic University of Daegu, Daegu, Korea Mun Han Mun Han Department of Medical and Biological Engineering, Kyungpook National University, Daegu, Korea Department of Medical and Biological Engineering, Kyungpook National University, Daegu, Korea Hui Joong Lee Hui Joong Lee Department of Radiology, Kyungpook National University Hospital, Daegu, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. Tel: +82-534205390; Fax: +82-53422-2677 Department of Radiology, Kyungpook National University Hospital, Daegu, Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. Tel: +82-534205390; Fax: +82-53422-2677
en 27878066 10.5812/iranjradiol.35298 A Rare Case of Invasive Apocrine Carcinoma of the Breast with Unusual Radiologic Findings A Rare Case of Invasive Apocrine Carcinoma of the Breast with Unusual Radiologic Findings case-report case-report

Invasive apocrine carcinoma (IAC) of the breast is a rare subtype of breast malignancy. Its incidence is not well known, but it is approximately less than 1% to 4%. For these reasons, there are few reports and little information on the radiologic appearance of IAC. Furthermore, most of the case reports show malignant features which are similar to invasive ductal carcinoma (IDC). We present a rare case of IAC without typical malignant feature on mammography, and ultrasonography (USG). Imaging findings on computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are also presented. The nodule in our case showed a relatively benign feature on USG and it is the first case of IAC with unusual findings. Therefore, this report may encourage radiologists to consider the malignant potential and perform pathologic correlation even if a newly developed nodule does not present with a typical malignant feature on USG.

Invasive apocrine carcinoma (IAC) of the breast is a rare subtype of breast malignancy. Its incidence is not well known, but it is approximately less than 1% to 4%. For these reasons, there are few reports and little information on the radiologic appearance of IAC. Furthermore, most of the case reports show malignant features which are similar to invasive ductal carcinoma (IDC). We present a rare case of IAC without typical malignant feature on mammography, and ultrasonography (USG). Imaging findings on computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are also presented. The nodule in our case showed a relatively benign feature on USG and it is the first case of IAC with unusual findings. Therefore, this report may encourage radiologists to consider the malignant potential and perform pathologic correlation even if a newly developed nodule does not present with a typical malignant feature on USG.

Breast;Breast Neoplasms;Apocrine Glands;Mammography;Ultrasonography Breast;Breast Neoplasms;Apocrine Glands;Mammography;Ultrasonography http://www.Iranjradiol.com/index.php?page=article&article_id=35298 Ji Min Kim Ji Min Kim Department of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Department of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Shin Young Kim Shin Young Kim Department of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea; Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Chungcheongnam-do Cheonan, Korea. Tel: +82-415703515, Fax: +82-415703516 Department of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea; Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Chungcheongnam-do Cheonan, Korea. Tel: +82-415703515, Fax: +82-415703516 Mee Hye Oh Mee Hye Oh Department of Pathology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Department of Pathology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Jong Eun Lee Jong Eun Lee Department of Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Department of Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
en 27853500 10.5812/iranjradiol.35299 Septochoanal Polyp with Metaplastic Ossification Mimicking Sinonasal Tumor: A Case Report Septochoanal Polyp with Metaplastic Ossification Mimicking Sinonasal Tumor: A Case Report case-report case-report

Choanal polyps are a form of nasal polyps that grow toward the choana with a single stalk. Septochoanal polyp is a rare entity that originates from the mucosa of the nasal septum with choanal extension. The most common site of its origin is mainly the superior aspect of the posterior portion of the nasal septum. However, metaplastic ossification is a rare event in nasal polyp and to the best of our knowledge, septochoanal polyp with metaplastic ossification has not been reported in the literature. Herein, we report a case of huge septochoanal polyp with metaplastic ossification obstructing both the nasal cavity and nasopharynx, which was successfully removed via transnasal endoscopic approach.

Choanal polyps are a form of nasal polyps that grow toward the choana with a single stalk. Septochoanal polyp is a rare entity that originates from the mucosa of the nasal septum with choanal extension. The most common site of its origin is mainly the superior aspect of the posterior portion of the nasal septum. However, metaplastic ossification is a rare event in nasal polyp and to the best of our knowledge, septochoanal polyp with metaplastic ossification has not been reported in the literature. Herein, we report a case of huge septochoanal polyp with metaplastic ossification obstructing both the nasal cavity and nasopharynx, which was successfully removed via transnasal endoscopic approach.

Nasal Polys;Nasal Septum;Heterotopic Ossification;Metaplasia;Nasal Obstruction Nasal Polys;Nasal Septum;Heterotopic Ossification;Metaplasia;Nasal Obstruction http://www.Iranjradiol.com/index.php?page=article&article_id=35299 Il-Young Cho Il-Young Cho Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Jae-Wook Kim Jae-Wook Kim Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Hak-Jin Kim Hak-Jin Kim Department of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Kyu-Sup Cho Kyu-Sup Cho Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea; Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea. Tel: +82-512407824, Fax: +82-512468668 Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea; Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea. Tel: +82-512407824, Fax: +82-512468668
en 27878067 10.5812/iranjradiol.38252 Ultrasonography Findings of AlloDerm® Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review Ultrasonography Findings of AlloDerm<sup>®</sup> Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review case-report case-report

AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.

AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.

Alloderm®;Breast Reconstruction;Mastectomy;Ultrasonography Alloderm®;Breast Reconstruction;Mastectomy;Ultrasonography http://www.Iranjradiol.com/index.php?page=article&article_id=38252 Young Seon Kim Young Seon Kim Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea; Department of Radiology, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, Korea. Tel: +82-26204129, Fax: +50-43738795 Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea; Department of Radiology, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, Korea. Tel: +82-26204129, Fax: +50-43738795