Iranian Journal of Radiology
Volume:14 Issue: 1, Jan 2017

Obsessive-compulsive disorder (OCD) is considered neurodevelopmental disorder that shares the feature of dysfunctional frontal-subcortical circuitry, yet the relationship between structural abnormalities or neurobiochemistrical changes and OCD pathogenesis is still unknown..
This study aims to use magnetic resonance spectroscopy (MRS) to discover substance-metabolism abnormalities of brain circuits in patients with first-episode OCD, and to study the mechanism of OCD..
Patients and 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..
Cho/Cr ratios in the thalamus were significantly higher in the first-episode OCD patients than in the controls (P Distinct neurochemical and histological structure changes (cortico-striatal-thalamic-cortical cycle) exist in patients with first-episode OCD. 1H-MRS is capable of identifying these changes by assessing metabolic abnormalities..

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..
This study determined the value of sinogram-affirmed iterative reconstruction (SAFIRE) technology to assess coronary-calcified plaques. This value was compared with filtered back-projection (FBP) reconstruction..
Patients and Sixty-three cases with calcified plaques diagnosed via coronary CT examination were selected. The mean CT-number, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), number of calcium plaques, edges, lumen situation, and the subjective image quality ratings of the cases using FBP and SAFIRE1–SAFIRE5 (six groups) were analyzed and compared..
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)..
SAFIRE reconstruction provided better coronary image quality and displayed the number, morphology, and surrounding lumen of calcium plaques more accurately than traditional FBP reconstruction, with SAFIRE3 achieving the best results..

This study aims to use mean volume of fluid, which is drained from a liver hydatid cyst with cystobiliary fistula developing after percutaneous treatment, for determining the type of treatment as surgery versus conservative..
Patients and 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 20th day after detection of the biliary fistula were used. In addition, the mean volumes until the 20th day of 42 catheterization patients without biliary fistula were used as controls for quantitative analysis..
All 10 cysts with cystobiliary fistulas were managed with small (8 F) catheters. All patients in the conservative group had To reduce superfluous costs and time, cystobiliary fistula with

Malfunctions of totally implantable central venous ports (TICVPs) have become a problem, as the usage of TICVPs has increased enormously..
This study evaluated factors related with catheter malfunctions of TICVPs..
Patients and Between January 2010 and June 2012, 1,740 TICVPs in 1,740 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..
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..
Our data suggest that catheter malfunctions of TICVPs are more common in females than males. The incidence of TICVP malfunctions does not differ between the two devices (Celsite® vs. Humanport®)..

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..
The aim of our study was to evaluate the prevalence and gender differences in the radiological parameters associated with cam and pincer FAI morphologies in an asymptomatic young population, using computed tomography (CT)..
Patients and 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..
The data showed that 69.2% of the women’s joints and 60.5% of the men’s joints had at least one abnormal parameter associated with the FAI. Of the joints, 34.25% had two or more abnormal parameters, and in 38 (19%) of the patients, these abnormalities were bilateral. Unlike previous studies, we found that only 15% of the joints had mixed FAI morphologies..
The prevalence of radiological parameters associated with FAI is high, even in an asymptomatic young population. This high frequency of features may suggest that the threshold values have been set too low in the current literature, or that these findings may reflect anatomical variation rather than true pathological abnormalities..

The umbilical cord contains two arteries and one vein. Normally, the diameters of umbilical arteries are close in size, but this may vary, as one umbilical artery may be considerably smaller or more hypoplastic than the other..
This study aimed to investigate the effect of hypoplastic umbilical arteries on Doppler ultrasonography (US) findings for the common iliac arteries (CIAs), such as the pulsatility index (PI) and resistive index (RI) values, and to investigate the associations between hypoplastic fetal umbilical arteries and placental, umbilical cord, and fetal pathologies..
Patients and Doppler US was performed on 165 pregnant women between 18 and 22 weeks of gestation, and again between 27 and 37 weeks of gestation. The umbilical artery diameters and both CIA flow parameters (PI and RI) were measured during these visits. The presence of a diameter difference of greater than 25% (95th percentile) between the two umbilical arteries was accepted as a hypoplastic umbilical artery..
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 Our study revealed that the hypoplastic umbilical artery group’s non-dominant CIA had higher RI values than the contralateral dominant CIA..

Spondyloarthritis (SpA) traditionally encompasses ankylosing spondylitis, psoriatic arthritis and reactive arthritis associated with inflammatory bowel diseases. Sacroiliac joint (SIJ) inflammation is an important and usually the first finding of SpA..
The aim of this retrospective study was to assess the value of different magnetic resonance imaging (MRI) sequences in evaluation of bone marrow and subchondral bone changes in active sacroiliitis and inter- and intra-observer reliability of these sequences..
Patients and 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..
Highest agreement between measurements of observer 1 and 2 was found on contrast enhanced fat suppressed T1 weighted imaging (CE FS T1 WI) (97.78%) among all sequences and on FS T2 WI of axial planes within sequences taken before contrast injections (97.78%)..
FS T2 W and CE FS T1 W sequences of axial planes were the most useful sequences in determination of active sacroiliitis. Therefore, in patients with renal failure or allergy to contrast media, FS T2 WI can be obtained to detect active sacroiliitis..

A number of earlier studies have attempted to establish the validity of various radiological parameters for the assessment of cardiac enlargement, but these were not fully quantitative as echocardiographic measurements..
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 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 ( There was no significant relationship between CTR and LVEF, but CA and CV showed a strong correlation with LVEF (P The CV value correlated more closely with low LVEF and more accurately indicated an enlarged heart than CA or CTR. This may be due to the fact that an anteroposterior measurement of heart size is included in the former but not the latter two measurements. These study results may help quantify left heart enlargement with greater accuracy than may be obtained from standard CXR..

There is a growing trend in ultrasound use in interventional pain management. Recently, the ease of use and clinical benefits of lumbar medial branch nerve block under ultrasound guidance have been identified..
In this study, we assessed the relevant anatomy and sonoanatomy of these specific interventional techniques. We also evaluated the feasibility and success rates of ultrasound guided lumbar medial branch nerve block..
Patients and 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..
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)..
Lumbar medial branch nerve block under ultrasound guidance was associated with high rates of treatment success and excellent treatment outcomes for facet joint pain. It is also feasible and administers no radiation. Thus, ultrasound-guided procedures can be used instead of conventional methods..

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..
Our main objective is to perform measurements of the cranium, cerebrum, and cerebellum in order to clarify the etiology of tonsillar herniation..
Patients and 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..
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..
Our results concerning cranium morphometry support the theory that hypoplastic posterior cranial fossa due to mesodermal insufficiency may play a role in the etiology of tonsillar herniation..

Reconstruction of positron emission tomography (PET) imagery is essential for accurate diagnosis in nuclear medicine. Thus, several image reconstruction methods were developed to enhance image quality and accuracy..
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..
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 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..
The location and size of myocardial infarction on PET images correlated closely with that observed with TTC staining. Among the four reconstruction methods, OSEM3D provided the best assessment of infarct size (r2 = 0.994, P OSEM3D may provide better image quality and higher contrast than other methods for small animal imaging with the new myocardial imaging agent, [18F] FPTP..

Superselective transarterial embolization (TAE) is the most commonly used treatment for lower gastrointestinal (LGI) bleeding when endoscopic management is impossible or fails. Its effectiveness and safety are increased using advanced techniques, instruments, and embolic materials..
To evaluate the outcome and safety of TAE for LGI bleeding and to analyze various influencing factors, including embolic material, embolization site, and anticoagulant or antiplatelet medication..
Patients and 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..
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..
Superselective TAE for LGI bleeding has a high success and low complication rate. There are no statistical correlations between the clinical success rate and several variables, including embolic material, embolization site, and anticoagulant or antiplatelet medication..

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..
To evaluate the outcome of ST-VAB and mammography-guided localization and excisional biopsy (MGL-EB) for microcalcifications..
Patients and 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..
The malignancy rates were 13.6% (3/22) for ST-VAB and 17.6% (6/34) for MGL-EB, respectively. Subsequent surgery was performed in five patients (n = 3, ST-VAB; n = 2, MGL-EB) and they were all confirmed as ductal carcinoma in situ. The discordant rates were 22.7 % (5/22) for ST-VAB and 14.7 % (5/34) for MGL-EB after imaging-histologic correlation. There was no malignancy detected on follow up studies..
ST-VAB and MGL-EB are reliable biopsy methods for microcalcifications. In proper indications, breast microcalcifications could be obtained by each method without missing diagnosis of breast cancer..

In this study, we shared the implementation success and clinical results for 38 patients treated with the cleaner™ pharmacomechanical thrombectomy device..
The impact and results of pharmacomechanical thrombectomy treatment on patients with deep vein thrombosis in the symptomatic acute and subacute phases were assessed..
Patients and Pharmacomechanical thrombectomy treatment was applied in a single session for 38 patients with lower extremity deep vein thrombosis in the acute and subacute phases between May 2012 and June 2014. Venography was performed and each assessment was made based on lysis rates and clinical 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..
Pharmacomechanical thrombectomy provides very satisfactory results in a single procedure, as a new method in the treatment of acute and subacute deep vein thrombosis..

Determination of the working length (WL) is important on the success of the endodontic treatment. There are several techniques used for the determination of endodontic WL, whereas new technologies may include clinical practice and, therefore, they should be investigated..
The goal of the cone beam computed tomography (CBCT) based investigation was to compare determination of the WL performance of the electronic apex locator (EAL), CBCT and digital radiography..
Totally, 30 single rooted, freshly extracted permanent teeth were included. Root canal WL measurements were performed using actual length (AL), EAL, digital radiograph and CBCT. The percentages of ± 0.5 mm measures to the AL, among the experimental groups, were compared by using Chi-Squared and Fischer Exact tests. The statistical significance was determined at P The CBCT was the most accurate method to evaluate the root canal WL, with accuracy of 70%. Accuracy for the apex locator and periapical radiograph were 40% and 30%, respectively..
The CBCT may be safe to use in determining root canal WL. Because lower radiation dose, a pre-existing CBCT can be useful to detect the root canal WL more precisely..

The tendency of myxofibrosarcoma (MFS) to have a non-nodular appearance on magnetic resonance imaging (MRI) may present a challenge in detection of local recurrence. Appropriate index of suspicion of expected imaging appearance can alleviate this challenge..
Our objectives were to determine if: 1) imaging pattern at recurrence is associated with delayed diagnosis, and 2) appearance at recurrence can be predicted based on appearance at presentation..
Patients and A retrospective cohort study was performed. Two analysis groups were used: patients with recurrence captured on MRI (objective 1) and patients with MRI prior to resection and at recurrence (objective 2). Three radiologists scored images independently and in consensus as infiltrative (tail-like spread), focal (absence of spread), or mixed. Consensus results were used for analysis with Fisher’s exact test..
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)..
Imaging appearance at baseline does not reliably predict imaging appearance at recurrence. Therefore, a high index of suspicion for the infiltrative pattern is required in assessment of post-operative MRIs in patients with MFS..

To evaluate the mammography image and reporting quality in Turkey..
One hundred sixty five units which provide mammography examination services were included in the audit. Samples of mammographic examinations conducted between July 1st and December 31st, 2012 were evaluated. Auditors completed web-based evaluation forms, including quality parameters and descriptive statistics on the patients and institutions..
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 The audit showed significant deficiencies in terms of quality. We suggest investing more time and effort to train both radiologists and radiologic technicians to implement image and report quality standards in their units. Moreover, our study emphasized the importance of the accreditation of the units..

In addition to fiber tracking, stereoscopic display of the peripheral nerves can be obtained based on magnetic resonance (MR) diffusion tensor imaging (DTI) data using post-processing methods, including volume rendering (VR) and maximum intensity projection (MIP). However, sufficient suppression of the image noise remains a challenge..
To achieve three-dimensional (3D) display of the peripheral nerves in the wrist region using two post-processing methods for DTI, i.e. VR reconstruction for single-direction images and the subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI); to compare the quality of images obtained via the two approaches; and to explore their clinical applications..
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..
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..
VR reconstruction for both single-direction images and SUSHI using DTI25 raw data provides excellent 3D displays of the peripheral nerves in the wrist region. SUSHI post-processing is a useful denoising tool because it automatically reduces the majority of isotropic object noise..

While using the automatic exposure control technique in computed tomography (CT), the scout view determines the radiation dose for the CT scan by taking anatomical morphology into consideration..
The goal of this study was to estimate radiation doses during scout scanning and to evaluate the hypothesis that the radiation dose during CT depends on the location and order of the X-ray tubes..
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..
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..
Scout views may be useful in determining dose and image quality in CT scanning; however, it is necessary to first determine the most appropriate scout view for CT scans..

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..
To evaluate the diagnostic value of hip digital tomosynthesis at special functional position (DT-SFP) in detecting acetabular and proximal femoral radiographic abnormalities compared with conventional radiography..
Patients and Ninety-four consecutive patients with discomfort around the hip joint underwent DT-SFP and conventional radiography. The imaging features of the acetabular and proximal femoral bone abnormalities were analyzed and the detection rate of the two methods was compared by chi-square test..
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)..
DT-SFP can improve the detection of relatively early bone abnormalities in acetabular and proximal femur compared with conventional radiography. DT-SFP can also observe the abnormal impact between acetabular and proximal femur..

With regards to the increasing use of implants in the field of dentistry, the recognition of critical landmarks is essential. Nasopalatine canal (NPC) is one of these important indices, which due to high esthetic expectations in premaxilla, should be precisely evaluated before surgery..
This study aimed to evaluate the morphological and anatomical variations of the NPC..
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..
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 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..

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..
In this study, we aim to compare new MRI protocols of 3D T2SPACE, PD BLADE and T2 BLADE with the conventional protocols, including T2 FSE, PD FSE, and T1 FSE in case of signal intensity..
Patients and 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..
SNR of the cartilage, TFCC on 3D T2SPACE and T1 FSE was better than other sequences (P High-resolution MR images of the wrist using 3D T2SPACE, PD BLADE and T2 BLADE were superior to those using conventional sequences quantitatively. High-SNR and CNR MR imaging with SPACE and BLADE would be a promising method to diagnose wrist lesions..

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..
The goal of this study was to evaluate the long-term efficacy and safety of combined TACE with RFA, and TACE alone in hepatocellular carcinoma of 2 to 5 cm..
Patients and This was a retrospective study including 207 consecutive patients who were enrolled using computerized hepatocellular carcinoma database consisting of 105 patients who underwent combined TACE with RFA, and 102 patients who underwent TACE alone with long-term follow-up..
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 Complete local tumor control by combination of TACE with RFA could improve overall survival in comparison with TACE alone for long-term follow-up. The combination of TACE with RFA should be considered for achieving complete local tumor control before progression to advanced stage in HCC of 2 to 5 cm..

Quantitative shear wave elastography (SWE) has been developed and utilized to aid in the differentiation between benign and malignant breast lesions based on their stiffness..
The purpose of this study was to evaluate the clinical effects of the additional use of SWE to conventional ultrasound (US) according to the maximum (Emax) and mean (Emean) elasticitiy values..
Patients and 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 Emax and Emean values. Next, we obtained the optimal Emax and Emean 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..
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 Emax were 84.4 %, 89.1 %, 71.1 %, 94.7 %, and 88.0 %, respectively, and the corresponding values based on Emean were 84.8 %, 93.0 %, 91.0 %, 80.0 %, and 94.9 %, respectively. The optimal Emax and Emean cutoff values were 81.3 and 60.7 kPa, respectively. However, there was no significant difference between Emax and Emean. 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 The additional use of SWE to conventional US resulted in marked improvements in specificity, PPV, and accuracy and slight diminutions in sensitivity and NPV for the differentiation benign and malignant breast lesions. Both Emax and Emean were effective diagnostic parameters, and there was no significant difference between these two parameters..

Mitral regurgitation frequently accompanies dilated cardiomyopathy (DCM), which is associated with poor prognosis..
To evaluate morphological and functional abnormalities in DCM patients and correlate these features with the severity of coexistent mitral regurgitation using 3.0 T magnetic resonance imaging (MRI)..
Patients and Forty-one patients with DCM and 26 healthy control subjects underwent MRI and echocardiography examinations. The maximum and minimum mitral annulus areas (MAA), diameters of left ventricle and atrium, end-diastolic and systolic volumes, and ejection fraction were assessed with MRI and were indexed to body surface area. Mitral regurgitation severity grading was estimated by echocardiography..
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 Mitral regurgitation in DCM patients is associated with morphological and functional abnormalities of left heart and mitral valve annulus. The indexed LVESD, LAESD, and minimum MAA values can assist in predicting the severity of mitral regurgitation with a high sensitivity and specificity..

Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) have become the primary options for treating hepatic abscesses. Thus far, various studies have examined the clinical data and computed tomography (CT) features for predicting PCD outcomes..
The goal was to compare CT features between hepatic abscesses classified based on strain and quantitative outcome of PCD or PNA, and to analyze clinical outcomes..
Patients and 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 ( 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 Less frequent occurrence of rim enhancement on CT may serve as an indicator of KHA and presence of thick wall on CT may serve as a predictor of greater percentage of initial drainage amount per CT volume during PCD or PNA in hepatic abscess with a tendency of shorter length of hospital stay. Hence, CT findings may be useful for predicting the outcome of PCD or PNA in patients with hepatic abscess..

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..

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..

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..

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..

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..

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..

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..

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.

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..

In this session, we will discuss 7 cases in pediatric musculoskeletal field. These cases will include different aspects of bone and MSK disorders in pediatrics such as bone tumors (benign and malignant), bone involvement in metabolic and hematologic disorders, infectious diseases and soft tissue vascular lesions. During this session, we will ask some volunteered radiology residents to explain the radiological findings and deliver their differential diagnosis. Then, they will discuss the case interacting with the audience who will also comment on the topic and finally the confirmed diagnosis that will be offered and discussed in more depth.