Iranian Journal of Radiology

Research Article

7/8/2016

Magnetic Resonance Spectroscopy of Brain Circuits in Patients with First-Episode Obsessive-Compulsive Disorder

Feng Chen, Min Guo, Tao Liu, Xiang Ling Jiang, Jian Jun Li, Jun Cheng Guo

Patients and Methods: Twenty patients with first-episode OCD and twenty gender- and age-matched normal controls were studied. Neurochemical abnormalities, including ratios of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho), were measured in the prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex, caudate nucleus, and thalamus with three-dimensional 1H-proton MRS (3D 1H-MRS). The data of the ratios in the two groups were analyzed with a independent samples t-test.

Results: Cho/Cr ratios in the thalamus were significantly higher in the first-episode OCD patients than in the controls (P < 0.01), and the NAA/Cr ratios in the caudate nucleus and thalamus were significantly lower in the first-episode OCD patients than in the controls (P < 0.01). However, NAA/Cr ratios in the anterior cingulate cortex and orbitofrontal cortex were higher in the first-episode OCD patients than in the controls (P < 0.01).

Research Article

5/3/2016

Value of Sinogram-Affirmed Iterative Reconstruction for Evaluating Coronary Calcified Plaques

Xianchun Zeng, Shaolei Kang, Rongpin Wang, Dan Han, Yong Wang, Shiping Yang

Background: Coronary computed tomography angiography (cCTA) technology as a kind of non-traumatic examination has been widely used in clinical practice. There are major issues that need to be considered. One is how to obtain high quality images and at the same time effectively reduce the radiation dose. The second is coronary artery calcified plaque artifacts that seriously affect the depiction of plaque morphology and luminal stenosis. In case of dose reduction, these artifacts are more outstanding.

Results: The subjective ratings of image quality using SAFIRE1–SAFIRE5 reconstructions were significantly higher than those using FBP, with SAFIRE3 achieving the highest rating. Compared with FBP reconstruction, the differences in noise, SNR, and CNR using SAFIRE1-SAFIRE5 were statistically significant (P < 0.05), with SAFIRE5 reconstruction achieving the highest SNR and CNR, and FBP reconstruction achieving the lowest. The revealed numbers of calcium plaques in the SAFIRE1-SAFIRE5 reconstruction groups were higher than that in the FBP reconstruction without significant differences in the number of calcium plaques among the SAFIRE1–SAFIRE5 groups (P > 0.05).

Research Article

17/8/2016

Percutaneous Management of Cystobiliary Fistulas by Small Catheters

Bilgin Kadri Aribas, Kemal Arda, Ozge Aribas, Nazan Ciledag, Emin Yildirim, Seyhmus Kavak, Yusuf Cosar, Ekrem Tekin

Patients and Methods: The cohort data was collected retrospectively from 10 out of 90 hydatid cysts in 10 out of 65 patients treated percutaneously with needle and catheterization methods. Groups were defined as surgical and conservative. The mean volumes until the 20^th day after detection of the biliary fistula were used. In addition, the mean volumes until the 20^th day of 42 catheterization patients without biliary fistula were used as controls for quantitative analysis.

Results: All 10 cysts with cystobiliary fistulas were managed with small (8 F) catheters. All patients in the conservative group had < 211 mL/day mean drainage for the 20 days. For the patients that developed cystobiliary fistulas of liver hydatid disease, 30% required surgical treatment. After receiver operating characteristic (ROC) curve analysis, the cut-off value for success of hydatid cyst treatment was 206 mL/day of drained content.

Research Article

6/8/2016

Malfunction of Totally Implantable Central Venous Ports

Hyo-Cheol Kim, Saebeom Hur, Hoyong Jeon

Patients and Methods: Between January 2010 and June 2012, 1,740 TICVPs in 1740 patients (874 men and 866 women) with an average age of 57.7 ± 12.8 years (range: 15 - 91 years) were implanted by an interventional radiology team at our institute. Catheter malfunctions were retrospectively analyzed. In the prospective study, we randomly allocated 176 patients to two kinds of TICVPs in a 1:1 assignment ratio. The primary outcome was the malfunction of TICVPs.

Results: In the retrospective study, the 32 malfunctioning TICVPs were caused by fibrin sheath formations (n = 15), chamber thrombosis (n = 8), TICVP rotation (n = 5), catheter migration (n = 2), and blood clots within the catheters (n = 2). Multivariate analysis showed that being female was a significant factor for poor patency rates of TICVPs (hazard ratio: 5.06; 95% confidence interval (CI) 1.32 - 19.46, P = 0.018). In the prospective study, two chamber thromboses occurred in Celsite® (n = 1) and Humanport® (n = 1). The primary patency rates of both Celsite® and Humanport® were 98.9% at 6 months, respectively.

Research Article

17/1/2016

Radiological Assessment of Femoroacetabular Impingement Morphology Using Computed Tomography in an Asymptomatic Young Population

Memik Teke, Cemil Goya, Celil Alemdar, Cihad Hamidi, Mehmet Guli Cetincakmak, Salih Hattapoglu, Emin Ozkul, Aslan Bilici

Background: Femoroacetabular impingement (FAI) is one cause of hip pain, and is an under-recognized cause of early osteoarthritis, especially in young and active people. The prevalence of FAI in adults is approximately 10 – 15% and depending on the clinical and radiographic findings, two types of impingement (which are often present in combination) can be distinguished: the cam type and the pincer type. Most patients (86%) have a combination of both forms of impingement.

Patients and Methods: A retrospective study was performed on 200 individuals (400 hip joints), ranging from 15 - 40 years of age, who were seen in our hospital between July of 2013 and April of 2014 for nonspecific abdominal pain. Multiplanar reformatted CT images of these patients were assessed for the existence of radiological abnormalities, and six measurements (acetabular version angle, acetabular index, lateral center-edge angle, alpha angle in the oblique axial plane, alpha angle in the radial [one o’clock position] plane, and femoral head neck offset) were made relating to the FAI.

Research Article

7/8/2016

Effects of Hypoplastic Fetal Umbilical Artery on Doppler Findings For Common Iliac Arteries

Asli Tanrivermis Sayit, Ali Ipek, Ilkay Sedakat Idilman, Nurdan Cay, Pinar Gunbey, Mustafa Karaoglanoglu

Results: Eleven of the 165 patients (6.7%) demonstrated a hypoplastic umbilical artery. Second-trimester US showed median dominant and non-dominant CIA PI values of 1.43 and 1.60 (P = 0.062), respectively, and median dominant and non-dominant CIA RI values of 0.80 and 0.85 (P < 0.001), respectively, in the hypoplastic umbilical artery group. Third-trimester US showed median dominant and non-dominant CIA PI values of 1.24 and 1.66 (P = 0.062), respectively, and median dominant and non-dominant CIA RI values of 0.73 and 0.82 (P = 0.002), respectively, in the hypoplastic umbilical artery group. We did not observe an association between hypoplastic umbilical arteries and placental, umbilical cord, or fetal pathologies.

Research Article

9/8/2016

Contrast Enhanced Magnetic Resonance Imaging in Sacroiliitis

Ozgur Tosun, Gulden Saglamer Tangal, Nurdan Cay, Yuksel Maras, Karabekir Ercan, Halil Arslan

Patients and Methods: Ninety patients (65 males, 25 females; mean age 33.44 ± 11 years; range 15 to 62) with MRI findings suggestive of active sacroiliitis were selected from picture archive and communication system (PACS) by the consensus of two radiologists. The SIJs were retrospectively analyzed by two radiologists separately blinded to each other’s evaluations. Each sequence was evaluated at different times (one week apart from each other) in the same monitor of PACS system by each observer. Periarticular bone edema and contrast enhancement were recorded separately by each observer.

Research Article

17/1/2016

Predictive Value of Radiographic Measurements as a Diagnostic Marker of Systolic Heart Failure in a Retrospective Study: An Old Method, a New Approach

Tolga Aksu, Tumer Erdem Guler, Veli Kaya, Nurcan Arat, Omac Tufekcioglu

Objectives: In our study, we aimed to determine the diagnostic accuracy of certain radiological parameters including the cardiothoracic ratio (CTR), cardiac area (CA) and cardiac volume (CV), derived from posteroanterior (PA) and lateral chest X-rays (CXR) in patients with impaired left ventricular ejection fraction (LVEF) suffering from dyspnea by comparing them with echocardiographic measurements of left ventricular (LV) dimensions and LVEF.

Patients and Methods: This retrospective study included 374 patients (258 females and 116 males) aged 35 to 78 years with the complaint of dyspnea. CXR and echocardiographic examination were performed on each patient upon admission. Based on LVEF, the patients were divided into two groups: Group 1 consisted of patients with impaired LVEF (< 50%) and group 2 consisted of patients with normal LVEF (≥ 50%). The sensitivity, specificity, and cut-off points were evaluated by both receiver-operator characteristic (ROC) analyses and area under the ROC curve (AUC) to determine the diagnostic accuracy of CA, CV, and CTR.

Research Article

28/6/2016

Ultrasound Guidance for Interventional Pain Management of Lumbar Facet Joint Pain: An Anatomical and Clinical Study

Masoud Hashemi, Seyed Mohammad Jazayeri, Asadollah Saadat Niaki, Mahshid Nikooseresht, Alireza Hosseinpanah, Seyed Sajad Razavi, Farshad Farivar, Farideh Shahandeh

Patients and Methods: Thirty patients with facet joint pain who were referred to the Akhtar hospital pain clinics between 2011 and 2012 were evaluated. Eighty-nine ultrasound-guided lumbar medial branch nerve blocks were performed. The target point for the lumbar nerve block was the cephalad margin of the transverse process groove in the vicinity of the superior articular process. C-arm fluoroscopy was performed to confirm the needle location. Pain levels were measured by a visual analog scale (0 - 10 scale), the Oswestry disability index (0 - 5 scale), and patient satisfaction scores (0 - 3 scale). The patients were followed for 6 weeks.

Results: The success rate was 98% (87/89 blocks), which was due to our use of ultrasound guided needle placement for the correct positioning of the needles. The mean procedural time was 5.9 ± 1 minutes. The average time of needle insertion was 4 ± 1 minutes. The pain intensity significantly improved from an initial value of 5 to 2.8 in the final follow-up (P = 0.0001). The oswestry disability index score significantly improved from 33.9 to 18.3 in the final follow-up (P = 0.0001). Patient satisfaction significantly improved from poor satisfaction immediately after the medial branch nerve block to excellent satisfaction in the final follow-up (P = 0. 0001). Analgesic requirements were also significantly reduced after 6 weeks of follow-up (P = 0.046).

Research Article

8/8/2016

The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation

Yaşar Taştemur, Vedat Sabanciogullari, İsmail Salk, Muhittin Sönmez, Mehmet Cimen

Background: Tonsillar herniation is a condition that manifests as herniation of the brain parts, originating from the hindbrain and progressing through the foramen magnum into the cervical vertebral canal. Although the etiology of tonsillar herniation is unclear, it has been suggested that it may be congenital or acquired. In particular, there is speculation that primary mesodermal insufficiency may affect the size of the posterior cranial fossa.

Patients and Methods: Magnetic resonance images were taken for 1,052 patients (629 females and 423 males) with no disease affecting the bones. Chiari malformation type I (CMI) was detected in 63 of the patients. The remaining 989 patients were considered to be the control group. The patients’ mean age was 36.58 ± 22.34 (1 - 94 years). Measurements were performed using midsagittal and axial T1 and T2 images. Nine parameters were used to evaluate cranium morphometry, while a further nine were used to evaluate cerebrum and cerebellum morphometry. The data collected were analyzed using SPSS version 14 statistics software, in addition to the t-test and the Mann-Whitney U test. The significance level was set at 0.05.

Results: In individuals with tonsillar herniation, while the front-back diameter of the foramen magnum, the cerebellum height, and the sagittal diameter of the cerebellum increased, the maximum cranial height, supraocciput length, clivus length, and height of the posterior cranial fossa decreased. Also, in the case of all age groups, there was no statistically significant difference between the healthy controls and the people with tonsillar herniation in terms of tentorial slope angle. The mean herniation value was 4.85 ± 3.09 mm in those with tonsillar herniation.

Research Article

10/8/2016

Comparison of Reconstruction Methods in a Small Animal Cardiac Positron Emission Tomography Study Using a 18F-Labeled Myocardial Agent, [18F] FPTP

Hyeon-Sik Kim, Byeong-il Lee, Ju Han Kim, Hee-Seung Bom, Dong-Yeon Kim, Jung-Joon Min

Objectives: We performed PET studies using a new myocardial imaging agent, (5-[¹⁸F] fluoropentyl) triphenylphosphonium cation ([¹⁸F]FPTP), in left coronary artery (LCA)-occluded rats, and compared the quality of cardiac PET images generated via four reconstruction methods (FBP, OSEM2D, OSEM3D, and 3DRP). Additionally, the infarction size was measured on the polar map of each reconstructed image and compared with defect size measured via 2, 3, 5-triphenyltetrazolium chloride (TTC) staining.

Materials and Methods: MicroPET was performed in Sprague-Dawley rats (n = 8) with LCA ligation. Static images were acquired for 30 min after the injection of [¹⁸F] FPTP (37 MBq/200 µL) via tail vain. MicroPET images were generated using four different reconstruction methods: filtered backprojection (FBP), two-dimensional or three-dimensional ordered subsets expectation maximization (OSEM2D or OSEM3D), and three-dimensional reprojection (3DRP) algorithm. Image contrast was calculated using the maximum and minimum perfusion values in the polar map. The infarction size was measured on the polar map of each reconstructed image and compared with defect size measured from TTC staining.

Research Article

9/8/2016

Superselective Transarterial Embolization for Lower Gastrointestinal Bleeding: An Analysis of its Effectiveness and Safety

Tae-Hoon Nam, Sung Bum Cho, Gyoung Min Kim, Tae-Seok Seo, Hwan Hoon Chung, Seung Hwa Lee, Yun Hwan Kim, Young Kwon Cho

Patients and Methods: Fifty-two patients who underwent superselective TAE for LGI bleeding between 2003 and 2011 were included, and their clinical and imaging information were retrospectively reviewed. Outcome and safety measures, including technical and clinical success, early and delayed rebleeding, and complications, were evaluated. Logistic regression analysis was used to determine whether the clinical success rate was associated with specific variables.

Results: Technical and clinical success was achieved in 52 (100%) and 43 (83%) patients, respectively. The prior embolization site was the point of rebleeding in five of the nine patients with early rebleeding. Delayed rebleeding was documented in four patients, including two patients with angiodysplasia. Logistic regression analysis showed that embolization site, embolic material, and anticoagulant or antiplatelet medication were not statistically significant factors affecting the clinical success rate of TAE for LGI bleeding. A major complication, ischemic colitis, occurred in one patient.

Research Article

10/8/2016

Vacuum Assisted-Biopsy and Mammo-Guided Localization and Excisional Biopsy in the Microcalcifications Sampling of Breast: An Experience of Single Institution

Minho Park, Yu-Mee Sohn

Background: Sterotactic vacuum assisted biopsy (ST-VAB) is safe and effective method for nonpalpable mammographically visible microcalcifications or masses. ST-VAB is less invasive and is associated with less scar formation than surgical excision. Also ST-VAB can avoid unnecessary additional surgery. But ST-VAB has possibility of histologic underestimation of high-risk lesions such as atypical ductal hyperplasia and atypical lobular hyperplasia.

Patients and Methods: Two radiologists retrospectively reviewed the medical records of patients who underwent breast biopsy for microcalcification from January 2011 to March 2013. They underwent ST-VAB (n = 22) and MGL-EB (n = 34). The clinicoradiological factors of two groups were evaluated, respectively. The malignancy rate and imaging histologic discordant rate in the two groups were assessed. We evaluated follow-up studies of all patients for newly developed or missed breast cancer.

Research Article

25/6/2016

Pharmacomechanical Thrombolytic Treatment in Symptomatic Acute and Subacute Deep Vein Thrombosis

Ekin Ilkeli, Oytun Saffet Kahyaoglu, Selim Capci, Ramazan Buyukkaya, Nilay Aydin Oktay, Aysegul Koc

Results: Deep vein thrombosis was found in the left lower extremity in 25 patients (65%) and in the right lower extremity in 13 patients (35%). No patient was found to have bilateral deep vein thrombosis. Thrombus localization was in the iliofemoral area in 17 patients (44%), the iliocaval area in three patients (8%), and the femoropopliteal area in 18 patients (56%). When thrombus resolution was assessed at the end of the process, grade III and grade II lysis was achieved in 36 (94%) out of 38 patients. Complete resolution was achieved in 28 patients (74%) in the acute and subacute groups.

Research Article

7/8/2016

Performance of the Working Length Determination using Cone Beam Computed Tomography, Radiography and Electronic Apex Locator, in Comparisons to Actual Length

Cihan Yildirim, Ali Murat Aktan, Emrah Karataslioglu, Fatih Aksoy, Ozlem Isman, Emre Culha

Research Article

20/6/2016

Pattern of Recurrence of Myxofibrosarcoma is not Associated with Pattern at Presentation or Rate of Delayed Diagnosis

Corey Daniels, Wei-Lien Wang, John Edward Madewell, Wei Wei, Behrang Amini

Results: There was substantial agreement among the 3 readers (k = 0.72, 95% confidence interval: 0.59 - 0.85). Half of all infiltrative cases were associated with a delay in diagnosis, compared to 10% of mixed or focal cases; however, there was no statistically significant association between infiltrative pattern at recurrence and delayed diagnosis (P = 0.08). In 70% of cases, recurrence had the same appearance as presentation, suggesting a trend; however, there was no association between appearance at baseline and recurrence (P = 0.1).

Research Article

20/6/2016

Mammography Quality in Turkey: Auditors’ Report on a Nationwide Survey

Arzu Ozsoy, Erkin Aribal, Levent Araz, Merter Bora Erdogdu, Aydin Sari, Irfan Sencan, Nevra Elmas

Results: Nine hundred eighty eight mammography examinations were evaluated; 47.34% of them used mammography machines less than 5 years old. Most of the older machines (10 years old or more) were grouped in private hospitals (22.1%) and university hospitals (21%). Mammographic image quality evaluation showed 56.1% non-compliance with the standard parameters. Private institutions showed the highest failure rates (P < 0.001), and low-quality images mostly (42.2%) resulted from mistakes in positioning. In 32% of the mammography reports, some mandatory information was incomplete. The reports were deemed inadequate in 59.2% of the cases.

Research Article

22/6/2016

Volume-Rendered Three-Dimensional Display of the Peripheral Nerves in the Wrist Region Using Magnetic Resonance Diffusion Tensor Imaging

Jian Hui Gu, Xue Jun Zhou, Dong Sheng Jin, Wen Quan Ding, Xin Wang

Materials and Methods: We performed DTI scans using 6 (DTI6) and 25 (DTI25) encoding diffusion directions for 20 wrists of 10 healthy adult volunteers. We used VR to reconstruct 2 types of images: 1, single-direction (anterior-posterior [AP] direction) and 2, SUSHI (AP direction with the subtraction of the superior-inferior [SI] direction). The 3D nerve image quality, noise level, and degree of noise-removal difficulty were evaluated according to custom evaluation scales. The preliminary clinical applications of these methods were explored through follow-ups with patients with nerve laceration in the wrist region.

Results: Single-direction VR reconstruction clearly showed the nerves for both DTI6 and DTI25 but with obvious noise. In DTI25, VR reconstruction for SUSHI showed the nerves clearly with excellent nerve signal intensity. In DTI6, SUSHI post-processing lost some ulnar nerve signal intensity, resulting in a significant difference in image quality scores between single-direction images and SUSHI. Most of the noise was removed after SUSHI post-processing.

Research Article

7/9/2016

Comparison of Radiation Dose and Image Quality with Various Computed-Tomography Scout Views: The Angular Modulation Technique Based on Information Calculated from Scout Views

Myeong Seong Kim, Jong-Woong Lee, Sun Geun Kim, Dae Cheol Kweon

Materials and Methods: A CT scanner (GE VCT 64-channel) with the X-ray tubes placed in the anteroposterior (AP), lateral, and posteroanterior (PA) positions was used to acquire the scout views. The effective doses were assessed using an anthropomorphic chest phantom (RSD Inc., Long Beach, CA), an AAPM CT performance phantom (CIRS model 610), and CT dose indices (CTDI) head phantom. Both single and two scout views were tested with the three views combined according to the order of scanning. The CTDIs obtained from the CT unit dose report were used to compare the chest CT radiation doses, while the image quality was evaluated based on the root-mean-square error values calculated using the Image program.

Results: The results of this study indicate that single AP (0°) scout views obtained with the z-axis modulation technique (AutomA) during chest CT scanning resulted in CTDIs that were lower than those generated by using lateral (90°) or PA (180°) scout views. The analysis of two-scout views using AutomA alone revealed the lowest CTDI in the 90° - 0° scout views. However, based on the CT image noise analysis, a scout angle order of 0°-90° resulted in the optimal scout view combination with the minimal dose.

Research Article

14/12/2016

Detection of Acetabular and Proximal Femoral Radiographic Abnormalities Showed by Hip Digital Tomosynthesis in Special Functional Position Compared with Conventional Radiography

Hui-zhao Wu, Mahrukh Latif, Zhi-wei Zhong, Bao-hai Yu, Wen-juan Wu, Feng Zhang, Shu-man Han, Zu-zhuo Zhang

Background: The acetabular and proximal femoral bone abnormalities are very common in the clinical practice. Conventional radiography has some difficulties in detecting early osseous changes. Digital tomosynthesis (DT) can remove the overlap of the anatomical structures, which improves the detection of early osseous changes. A special functional position can simulate the status of clinical symptoms; provide more evidence for clinical study of the acetabular and proximal femoral bone abnormalities and improve the accuracy.

Results: The herniation pits (HPs) of the femoral neck, acetabular/labral ossification, femoral head-neck junction bone protrusion, acetabular cysts, and acetabular osteophytes were detected by DT-SFP and conventional radiography. The detection rates of DT-SFP were 35%, 21%, 33%, 17% and 40% respectively, which were significantly higher than conventional radiography (21%, 9%, 10%, 7% and 31% respectively) (P = 0.000, 0.000, 0.000, 0.000, 0.001). The detection rate of coxa profunda, posterior wall sign and hip joint space narrowing showed no significant difference between using DT-SFP and conventional radiography (41%, 8% and 6% respectively) (P = 1.000, 1.000, 1.000).

Research Article

6/6/2016

Assessment of Nasopalatine Canal Anatomic Variations Using Cone Beam Computed Tomography in a Group of Iranian Population

Yaser Safi, Mahkameh Moshfeghi, Sepideh Rahimian, Mahtab Kheirkhahi, Maryam Eslami Manouchehri

Materials and Methods: A total of 326 individual cone beam computed tomography (CBCT) images were analyzed in sagittal, coronal, and axial planes in order to evaluate the dimensions, morphology and anatomic features of the NPC. The canal shape, length, and curvature, incisive and Stenson’s foramina (SF) dimensions, and the number of openings on both sides of the canal were assessed. The correlation of age, gender, and dental status with all considered parameters were analyzed.

Results: The most dominant shape of the NPC was cylindrical (65.33%). The mean NPC length was 12.85 ± 2.63 mm, which was greater in men and showed significant differences between two genders (P < 0.001). The most frequent canal anatomical variation in the coronal plane was Y-type (50%). Through statistical analysis, the effect of gender on the canal length, anteroposterior dimension of SF, and mediolateral dimension of SF and incisive foramen (IF) and the number of orifices at the nasal floor was significant. Also, a significant relationship existed between dental status and curvature of the canal, anteroposterior dimension of IF and SF and furcation level of the canal.

Conclusion: This study has highlighted the anatomical variations of NPC regarding its dimension, location and morphological appearance. Cylindrical was the most common shape followed by funnel-shape, hourglass, and spindle, which were the other canal shapes with less frequency, respectively. The results suggest significant relationship between NPC, and gender and dental status. The influence of age was not as significant as gender and dental status.

Research Article

3/9/2016

Comparison of Quantitative Assessment of BLADE and Isotropic Three-Dimensional Fast Spin Echo Cube (3D T2 SPACE) Sequences with Conventional Protocols of wrist Joint at 3 Tesla Magnetic Resonance Imaging

Hamed Naghibi, Hedayatolah Soroush, Fariborz Faeghi, Madjid Shakiba, Amir Reza Farhoud, Hassan Hashemi

Background: Magnetic resonance imaging (MRI) of the wrist joint is a useful method in the diagnosis of triangular fibrocartilage complex (TFCC), ligaments and tendons, peripheral nerves, cartilage and carpal tunnel syndrome. However, the evaluation of these small anatomical structures is a topic of investigation. In some instances, the diagnostic indices of MRI in tears and other lesions of cartilage and ligamentous structures are relatively low, so the protocols should be optimized.

Patients and Methods: Twenty patients with a history of wrist trauma or suspected wrist lesions were referred by orthopedic hand surgeons and enrolled into the study. All the protocols were carried out on all patients and the images were assessed quantitatively by measurement of signal to noise ratio (SNR) and contrast to noise ratio (CNR). Then, these parameters were compared between different protocols. SPSS ver.18 was used for the statistical analyses.

Results: SNR of the cartilage, TFCC on 3D T2SPACE and T1 FSE was better than other sequences (P < 0.001). SNR of the bone on PD BLADE was significantly higher (P < 0.001) than that of conventional protocols. PD BLADE images showed significantly higher bone- cartilage CNR and bone- TFCC CNR (P < 0.001 to P < 0.001). CNR of cartilage-TFCC on T1 FSE was better than other sequences, but no significant statistical differences were seen.

Research Article

4/10/2016

Outcomes of Transarterial Chemoembolization With or Without Additional Radiofrequency Ablation in Hepatocellular Carcinoma of 2 to 5 cm in Diameter

Mi-Young Kim, Jin Woong Kim, Dae-Seong Myung, Chung-Hwan Jun, Wan-Sik Lee, Yang Jun Kang, Sung-Kyu Choi, Young-Eun Joo, Sung-Bum Cho

Background: Hepatocellular carcinoma (HCC) is worldwide one of the most common and lethal malignant tumors despite attempts at treatment using various therapeutic modalities. Combination of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) can have expanded indication as curative therapy in patients with larger size HCC (2 - 5 cm) that is unsuitable for RFA alone, but there are few studies showing long-term survival and larger sample size.

Results: The complete remission rate was meaningfully higher in the combination group (97.1%, 102/105) than in the TACE group (54.9%, 56/102) (P < 0.001). The mean follow-up periods of the combination group and the TACE group were 49.3 ± 16.9 months and 46.3 ± 26.7 months, respectively. The TACE group (90.2%, 92/102) showed significantly higher tumoral recurrence or persistence than the combination group (59.0%, 62/105) during follow-up periods (P < 0.001). The cumulative survival rates at 1, 2, 3, 4, and 5 years were 88.6, 82.9, 79.0, 75.2, and 74.3%, respectively in the combination group and 93.1, 73.5, 59.8, 50.0, and 45.1%, respectively in the TACE group. Independent factors associated with improved overall survival were the combination group, Child-Pugh class A, complete remission at 1 month, negative intrahepatic new tumors, and no adverse event.

Research Article

4/9/2016

Clinical Application of Shear Wave Elastography in Breast Masses

Jin Young Chang, Jin Hee Moon, Sung Hye Koh, Sun-Young Park, Kwan Seop Lee

Patients and Methods: A total 115 patients with 133 lesions were assessed using conventional US and SWE. All patients underwent US-guided core needle biopsy or surgery, and the pathological results were used as reference standards. We compared the diagnostic values including sensitivities, specificities, positive predictive values (PPVs) and negative predictive values (NPVs) and accuracies of conventional US and SWE according to the E_max and E_mean values. Next, we obtained the optimal E_max and E_mean cutoff values for SWE. Using these cutoff values, we analyzed the clinical effects of the additional use of SWE to conventional US based on the corrected results.

Results: Of the 133 breast lesions, 32 were malignant and 101 were benign. In the differentiation of benign and malignant lesions, conventional US resulted in sensitivity of 100 %, specificity of 43.0 %, PPV of 57.1 %, NPV of 36.7 %, and accuracy of 100 %. Regarding SWE, the sensitivity, specificity, PPV, NPV, and accuracy values based on E_max were 84.4 %, 89.1 %, 71.1 %, 94.7 %, and 88.0 %, respectively, and the corresponding values based on E_mean were 84.8 %, 93.0 %, 91.0 %, 80.0 %, and 94.9 %, respectively. The optimal E_max and E_mean cutoff values were 81.3 and 60.7 kPa, respectively. However, there was no significant difference between E_max and E_mean. The corrected results related to the additional use of SWE to conventional US indicated 97.0 % sensitivity, 93.0 % specificity, 82.1 % PPV, 98.9 % NPV, and 94.0 % accuracy (P < 0.0001).

Research Article

11/9/2016

Assessing Mitral Regurgitation in Patients with Dilated Cardiomyopathy Using 3.0T Cardiac Magnetic Resonance Imaging: Correlation with Morphological and Functional Abnormalities

Ling-yi Wen, Zhi-gang Yang, Ying-kun Guo, Jia-yu Sun, Hua-yan Xu

Results: Of the 41 patients with DCM, echocardiography examination revealed 11 patients (27%) without mitral regurgitation and 12 (29%) with mild, 11 (27%) with moderate, and seven (17%) with severe mitral regurgitation. All of the morphological and functional parameters of left ventricle, atrium and mitral valve in DCM patients were greater than those in healthy subjects (all P < 0.05), except for ejection fraction. The indexed end-systolic diameters of left ventricle (LVESD) and atrium (LAESD) and indexed minimum MAA might have the capability to distinguish no/mild mitral regurgitation patients from moderate/severe patients (areas under the receiver operating characteristic curve [AUC] = 0.876, 0.816, and 0.773, respectively; all P < 0.05). Using a combination of indexed LAESD, LVESD and minimum MAA, the specificity increased to 91.3%.

Research Article

25/9/2016

Features of Hepatic Abscesses on Computed Tomography: Predicting the Outcomes of Percutaneous Catheter Drainage or Needle Aspiration

Soon Cheol Baek, Jisun Lee, Min Ho Kang, Kyung Sik Yi, Yook Kim, Bum Sang Cho, Kil sun Park, Sang-Yong Eom

Patients and Methods: Eighty-seven patients who had undergone PCD or PNA with pyogenic hepatic abscess in a 5-year period were included. They were divided into Klebsiella pneumoniae monomicrobial pyogenic hepatic abscess (KHA) group and non- Klebsiella pneumoniae monomicrobial or polymicrobial pyogenic hepatic abscess (non-KHA) group. Patients were categorized into the following subgroups based on strain and percentage of initial drainage volume per CT volume: groups A (< 50%) and B (≥ 50%), groups C and D in KHA group, and groups E and F in non-KHA group. We compared clinical findings, CT features, and clinical outcomes between the two groups, respectively.

Results: In univariate and multivariate analysis, patients with KHA group were associated with less frequent rim enhancement (P = 0.024). More frequent occurrence of thicker wall (P < 0.001) and lower mean attenuation (P = 0.047) were the most significant predictors in group B and thicker wall (P = 0.002) was the most significant predictor in group D. Length of hospitalization in group D was significantly shorter than that in group C (P = 0.026).

Case Report

18/1/2016

Rhabdomyosarcoma Metastasis to the Breast: Appearance on Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Sequences

Chermaine Deepa Antony, Kartini Rahmat, Anushya Vijayananthan, Jayalakshmi Pailoor

Rhabdomyosarcoma is a common primary childhood malignancy that rarely metastasizes to the breast. We report a patient with a primary sinonasal rhabdomyosarcoma metastasizing to the breast, with no distant spread. We describe the imaging appearance of rhabdomyosarcoma on magnetic resonance imaging (MRI), particularly on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences. Rhabdomyosarcoma metastasis has a variable appearance on ultrasound and MRI, and may mimic common benign tumors. However, it appears hyperintense on DWI and produces a low value on the ADC, which may be more accurate for determining its malignant nature.

Case Report

25/4/2016

Anomalous Origin of the Right Coronary Artery from the Mid-Portion of the Left Anterior Descending Artery in a Patient with Single Left Coronary Artery: A Rare Coronary Artery Anomaly and Review of Literature

Mahmoud Beheshti Monfared, Hamid Ghaderi, Taraneh Faghihi Langroudi, Seyedeh Adeleh Mirjafari, Mahnoosh Foroughi, Mohammad Forozeshfard, Farshid Heidarpour Kiaie

Origination of the right coronary artery (RCA) from the left anterior descending (LAD) artery is a case of single coronary artery. It is an extremely rare coronary artery abnormality and usually an incidental finding during coronary angiography. A 73-year-old man with a medical history of hypertension arrived with chest pain. Medical therapy started for ST elevated myocardial ischemia. During his diagnostic coronary angiogram, RCA was visualized as abnormally orientating from the mid-portion of LAD. A significant lesion in the proximal part of LAD, significant long lesion in the diagonal artery, and several stenoses in the obtuse marginal artery (OMA) were observed. To evaluate the course of RCA, coronary computed tomography angiography (coronary CTA) scan was performed. The patient underwent coronary artery bypass graft (CABG) for three vessels. He was discharged without any complication and no problems were detected in follow-up. In conclusion, if during classic angiography, RCA is not seen, the physician should keep in mind that RCA may originate from LAD. Current classification cannot exactly determine this anomaly and needs revision. When there is suspicion for coronary anomaly, performing coronary CTA can be helpful for better management and planning of therapy.

Case Report

19/6/2016

99mTc-HMPAO-Labeled Autologous Leukocyte SPECT/CT for Diagnosis of Bacterial Endocarditis of the Prosthetic Pulmonary Conduit: A Clinical Case

Svetlana Ivanovna Sazonova, Julia Nikolaevna Ilyushenkova, Konstantin Valer’evich Zavadovsky, Yuri Borisovich Lishmanov

In this paper, we present a case of bacterial endocarditis of the prosthetic pulmonary conduit found in a 26-year-old man. An echocardiography study around the pulmonary valve showed the presence of a floating mass attached to the wall of the conduit. This formation was thought to be a floating calcific leaflet of the conduit or a developed vegetation of the conduit. Due to the uncertainty of the results, pulmonary multidetector row computed tomography (MDCT) angiography was performed. The MDCT examination showed the presence of a floating 4 × 8-mm sized mass in the pulmonary conduit. Taking into account the patient’s complaints, medical history data, and clinical-instrumental examination, myocardial scintigraphy with ^99mTc-HMPAO-labelled autologous leukocytes combined with CT (^99mTc-HMPAO-SPECT/CT) was performed. Based on overlaying of the scintigraphic images and the MDCT aortography scans, anatomic localization of the pathologic accumulation was found in a projection of the pulmonary valve prosthesis. Surgical intervention, with cardiopulmonary bypass, was performed for replacement of the valve-containing conduit. Pathomorphologic study of the surgical material confirmed the hypothesis of bacterial endocarditis. Therefore, hybrid technologies such as ^99mTc-HMPAO-SPECT/CT contribute to the earlier and more precise diagnosis of infectious endocarditis, avoiding many errors associated with patient treatment and the development of complications.

Case Report

22/8/2016

Alteration of Signal Intensity on Follow-Up Magnetic Resonance Imaging in Spinal Epidural Inflammatory Myofibroblastic Tumor: A Case Report and Literature Review

Jinyoung Chang, Sun-Young Park, Soo Kee Min, Sung Hye Koh, Kwan Seop Lee

Inflammatory myofibroblastic tumor (IMT) in the spine or paraspinal area is extremely rare. Here, we report a rare case of a 56-year-old man who had pathological-proven spinal epidural IMT showing a malignancy-like infiltrative feature on MR imaging with alteration of T2 signal intensity on follow-up from slightly high to low compared with initial MR imaging. To the best of our knowledge, this is the first report to describe paraspinal IMT monitoring with various imaging modalities without treatment. From this case, we were able to gain understanding of the natural course of IMT, and it could be helpful in the differential diagnosis of infiltrative paraspinal masses.

Case Report

24/8/2016

Primary Breast Fibrosarcoma Mimicking Invasive Ductal Carcinoma in a Patient with Interstitial Injection Mammoplasty: Magnetic Resonance Imaging and Pathologic Findings

Soo Young Chae, Ok Hee Woo, Hye Seon Shin, Chung Yeul Kim

Primary breast sarcoma is a rare disease of the breast that comprises a heterogeneous group of malignant mesenchymal neoplasms, including angiosarcoma, liposarcoma, leiomyosarcoma, fibrosarcoma, sarcomas with bone and cartilage, and malignant fibrous histiocytoma. Yet the exact incidence of primary breast sarcoma has not been reported, but it approximately accounts for less than 1% of all breast cancers. Herein, we report the MRI findings of fibrosarcoma mimicking invasive ductal carcinoma in a 79-year-old female patient with a previous history of interstitial injection mammoplasty.

Case Report

24/9/2016

Contralateral Pneumothorax Mimicking Bilateral Pneumothoraces in a Patient with Autopneumonectomy

Ye Kyeong Jun, Jeong Min Ko, Hyun Jin Park, Jun Hyun Baik, Deog Gon Cho

Contralateral pneumothorax crossing the midline in a patient with autopneumonectomy can mimic bilateral pneumothoraces on chest radiography. In this study, we report a rare case of right pneumothorax mimicking bilateral pneumothoraces in a patient with left autopneumonectomy. A 37-year-old man complained of progressive chest pain and dyspnea. The initial chest radiography revealed visible visceral pleura with air in bilateral upper pleural spaces, suggesting bilateral pneumothoraces. Mediastinal structures were shifted to the left side and increased opacities with internal tubular and cystic radiolucencies were noted in the left lower lung zone. After immediate placement of a drainage tube into the right pleural space, the patient underwent chest computed tomography (CT). CT scan revealed a destroyed and totally collapsed left lung and hyper-inflated right lung with right pneumothorax crossing the midline. The contralateral pneumothorax was then gradually absorbed by keeping the chest tube in the right hemithorax. No pneumothorax recurred in 2 years of follow-up. A greater awareness of this rare condition is important in clinical practice, as catastrophic consequences can occur if a chest tube is blindly placed in the autopneumonectomy site.

Case Report

16/10/2016

Emergent CT Diagnosis of Right Ventricular Rupture Caused by Central Venous Catheter Injury

Sang Hoon Kim, Seung Min Yoo, Hwa Yeon Lee, Gun Lee, Hyung Jong Kim, Minjung Shim, Sung-ik Kim, In Song Song, Hye Rin Kim, Charles S White

Diagnosis of cardiac tamponade has been mainly based on clinical features and echocardiography. However, CT may be an initial tool for the evaluation of cardiac tamponade because cutting edge CT is increasingly being installed in the emergency room, and presentation of cardiac tamponade can be nonspecific. Importantly, CT has better spatial resolution compared with echocardiography. Thus, identification of the etiology of cardiac tamponade is possible on CT. We report a case of cardiac tamponade demonstrating direct leakage of contrast material from the right ventricle into the pericardial space caused by central venous catheter injury diagnosed on CT.

Case Report

15/8/2016

Adult-Onset Hyperplasia of An Ectopic Cervical Thymus Associated with Uncontrolled Hyperthyroidism: A Case Report

Hiroaki Takahashi, Manabu Minami, Tomohiko Masumoto, Takashi Hiyama, Yuka Kujiraoka, Mariko Nakamagoe, Yuko Minami

Ectopic cervical thymus (ECT) is an essentially benign condition that is identified during the development of the thymus, and is rare among the adult population. Thymic hyperplasia is another thymus-associated condition, which is known to occur secondary to hyperthyroidism. A 39-year-old woman with hyperthyroidism presented with an enlarging submandibular mass, which was diagnosed as a benign hyperplasia of the ECT. Computed tomography and magnetic resonance imaging largely contributed to its diagnosis, and an unnecessary surgical resection was avoided. To the best of our knowledge, this is the first report that describes clinically significant hyperthyroidism-induced ECT hyperplasia during adulthood.

Case Report

25/9/2016

Malignant Peripheral Nerve Sheath Tumor in the Lesser Sac Masquerading as a Gastrointestinal Stromal Tumor of the Stomach: A Case Report

Seung-Gu Yeo, Eun Seok Kim, Min-Jeong Kim, Hong Il Ha, Kwanseop Lee, Mi Jung Kwon

A malignant peripheral nerve sheath tumor (MPNST) is very rare, representing 3 - 10% of all soft tissue sarcomas. Approximately half of all such tumors are diagnosed in patients with neurofibromatosis type 1 (NF1). The extremities are involved most commonly, and the patient’s age is usually 20 - 50 years. Herein, we present a case of an MPNST that developed sporadically in an unusual location and in an unusually younger patient. A 16-year-old girl presented with dyspepsia and abdominal distension. Computed tomography (CT) demonstrated a well-defined mass approximately 12 cm in diameter in the lesser sac. The mass was composed principally of a heterogeneously enhancing solid portion and exhibited some cystic changes. Clinically and radiologically, the mass appeared to be a gastrointestinal stromal tumor of the stomach. The patient underwent exploratory laparotomy and mass excision. The surgical specimen revealed a solid firm mass measuring 13 × 13 × 6 cm. Histopathological and immunohistochemical analyses identified an MPNST. The patient underwent adjuvant chemotherapy but developed local recurrence with peritoneal seeding 8 months after surgery. Despite treatment with a different chemotherapeutic regimen, the disease progressed systemically and the patient died 3 years and 5 months after surgery. The uncommon tumor location and CT findings of our present MPNST case provide valuable information in terms of future clinical diagnoses of this rare but highly malignant disease.

Iranian Journal of Radiology: Jan 2017, 14 (1), 35 articles.