فهرست مطالب

Iranian Journal of Radiology
Volume:17 Issue: 1, Jan 2020

  • تاریخ انتشار: 1398/12/10
  • تعداد عناوین: 18
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  • Hakan Cebeci *, Cem Bilgin, Selman Candan, Selcuk Yilmazlar, Bahattin Hakyemez Page 1
    Background

     MR cisternography has the crucial role for diagnosis of cerebrospinal fluid (CSF) leakage in patients with rhinorrhea and otorrhea. Trauma is the major cause of rhinorrhea. Cephalocele is diagnosed in some rhinorrhea patients.

    Objectives

     To evaluate the CSF leakage in patients with rhinorrhea and assess the frequency of cephalocele in the etiology of rhinorrhea.
    Patients and

    Methods

     Intrathecal gadolinium enhanced MR cisternography and nonenhanced CT of paranasal sinus images of patients with suspected CSF rhinorrhea between October 2012 and September 2018 were evaluated retrospectively. Twenty-one patients with the diagnosis of contrast leakage causing rhinorrhea were included in the study. All patients had intrathecal gadolinium enhanced MR cisternography. Three dimensional (3D)-T1 weighted and 3D-fluid attenuated inversion recovery (FLAIR) head MRI was obtained after administration of 1 ml intrathecal gadoterate meglumine after half, 3, and 8 hours. Locations of contrast leakage and etiologies were analyzed.

    Results

     Patient group consisted of 21 patients with persistent or intermittent rhinorrhea. CT imaging showed bone defect in all patients. Intrathecal gadolinium enhanced MR cisternography revealed CSF leakage (10 ethmoid, 10 sphenoid, and 1 frontal). Cephalocele was detected in 10 of 21 patients.

    Conclusion

     MR cisternography with intrathecal gadolinium enhancement is an effective and safe imaging modality compared to other techniques used for diagnosis of CSF leakage. Accurate localization of CSF fistula and demonstration of herniating content from cranial bone defect is feasible with this technique.

    Keywords: Magnetic Resonance Imaging, Cerebrospinal Fluid, Cisternography, Cephalocele
  • Osman Nuri Ozyalvac*, Evren Akpinar Page 2
    Background

     There are many studies suggesting that the pelvic radiographs taken in posterior anterior (PA) projection cause far less radiation exposure than anterior-posterior (AP) projection. However, PA projection is rarely used in daily practice due to the concern that the obtained images will not provide radiological standards.

    Objectives

     The aim of the study was to determine whether PA projections meet the radiological criteria of correct positioning as AP projections.
    Patients and

    Methods

     In this prospective study, radiographs of 160 patients (80 PA and 80 AP images) were obtained randomly. Pelvic rotation index (PRI), symphysis ischium angle (SIA), pelvic inclination index (PII) were used to evaluate whether the pelvic radiographs were suitable for radiological assessment.

    Results

     The reliability of AP and PA projections was excellent for PRI (ICC = 0.66, 95% CI = 0.90 - 0.98), SIA (ICC = 0.99, 95% CI = 0.90 - 0.98), and PII (ICC = 0.95, 95% CI = 0.90 - 0.98).

    Conclusion

     PA projection instead of AP projection for pelvic radiography has no drawback in terms of acceptability criteria. Considering PA projection is a dose reducing technique requiring no additional equipment, it may be a safer option for children.

    Keywords: Pelvic Radiograph, Posterior-Anterior Projection, Radiation Exposure, X-Ray Dose Reducing
  • Parinaz Mehnati, Reza Malekzadeh, Baharak Divband, Mohammad Yousefi Sooteh * Page 3
    Background

     Application of nanomaterial has recently been introduced as a novel method to make a radiation shield to protect biological damage.

    Objectives

     The purpose of this study was to evaluate the effectiveness regarding the use of Nano shield on the protection of the breast in chest CT scan.

    Materials and Methods

     Bismuth oxide nanoparticles were prepared and synthesized in the Chemistry Laboratory of the University of Tabriz. Special tests were used to evaluate the properties of nanoparticles. Then, nano-bismuth oxide shields were designed with the silicon matrix at 10% and 15% ratios in 0.5- and 1-mm thicknesses, respectively. The dosimetry process was performed by thermoluminescent dosimeters (TLD) dosimeters in the skin and fourth layers of the breast in the chest CT scan. Also, signals and noises of the images were obtained to assess the effects of shield on image quality. Nano particles size was equal to 24 nm and they were spherical in shape. The distribution of nanoparticles in the silicone matrix was approved by scanning electron microscope energy dispersive spectroscopy (SEM-EDS).

    Results

     Nano bismuth shields reduced the dose value by 9% and 15% in the skin layer related to 10% and 15% bismuth nanoparticles ratio (0.5 mm thickness), respectively. Also, by increasing shield thickness to 1 mm, the dose of skin layer was reduced by 18% and 24% related to 10% and 15% of bismuth nanoparticles ratio, respectively. Analysis of CT image showed a 10% increase in the noise related to the 10% bismuth shield.

    Conclusion

     The nano bismuth composite shield with different ratios and thicknesses show significant dose reduction in the breast. This could play a role in breast cancer prevention during chest CT scan.

    Keywords: Breast Cancer, Image Quality, Nano Bismuth Oxide, om
  • Abdala Maulid Mkangala, Huimin Liang *, Xiang Jun Dong, Yangbo Su, Luo Haohao Page 4
    Background

     Isolated dissection of visceral artery organs is very infrequently reported and when occurred mostly affected is the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting features in symptomatic patients. Dissection can be detected by ultrasound and CT, but computed tomography angiography (CTA) is the best for demonstration of the true and false lumens of the lesion. Nonetheless, the perfect treatment has not been accepted yet. However, if left untreated it is a life-threatening condition.

    Objectives

     Our aim is to evaluate diagnostic imaging and endovascular treatment outcome of spontaneous isolated superior mesenteric artery dissection (SISMAD). Based on the angiographic configuration of SMA and location of dissection we will share our experience based on deployment of a bare straight stent, bare tapered stent, overlapping bare stent or coil assisting bare stent.
    Patients and Methods s: Medical data from patients presented with symptomatic superior mesenteric artery dissection (SMAD) and had received endovascular treatment between January 2007 and December 2017 were extracted. Patient demographics, symptoms, diagnostic imaging, endovascular treatment, and follow-up findings were analyzed.

    Results

     Total of 31 patients were included in this study [87.1% (n = 27) male, 12.9% (n = 4) female, and mean age 52.9 ± 8.2 years]. All patients had abdominal pain as the main presenting symptom. The mean length of dissection was (4.79 ± 3.03) cm, mean distance from the aorta to dissection entry was 2.5 ± 1.0cm, mean percentage stenosis was 63.3 ± 12.7%, Sakamoto type IIA 35.5% (n = 11), and type IIB 64.5% (n = 17). All of the patients received bare self-expandable stent whereby 90.3% (n = 28) received stent(s) without coil, of which 64.3% (n = 18) received single straight stent, 21.4% (n = 6) received overlapping stent and 14.3% (n = 4) received tapered stent. On the other hand, 9.7% (n = 3) received coil assisting stent. Post-procedure normal blood supply to the distal SMA and relief of symptoms was noted. One hundred per cent (n = 31) primary success rate was recorded during mean fasting and follow-up time of 4.9 ± 1.9 days and 15.5 ± 4.8 months, respectively.

    Conclusion

     Endovascular treatment with a bare stent is a safe, effective, and successful treatment for symptomatic SISMAD with satisfactory outcomes. We highly recommend it to be considered as a first-line treatment in severe co-morbidity patients who are unfit for open surgery.

    Keywords: Abdominal Pain, Dissection, Stent, Endovascular, CTA, Superior Mesenteric Artery, Bare
  • Guanfeng Shang, Yu Wang, Yanwei Jiang, Zhan Wang, Bin Zhao * Page 5
    Background

     The phase value of susceptibility weighted imaging (SWI) can quantitatively measure the content of deoxyhemoglobin in veins, thus facilitating understanding of the mechanisms of drainage veins in cerebellar infarction areas.

    Objectives

     To explore the clinical application value of the drainage veins in acute cerebellar infarction.
    Patients and

    Methods

     SWI was used to measure the phase value of the bilateral cerebellar hemispheres in 30 normal volunteers. In addition, phase values, expressed as Δφ, were analyzed in 18 patients with cerebellar infarction. The scanning sequences included SWI, arterial spin labeling, and diffusion weighted imaging.

    Results

     The phase value of the infarct area was higher than that of the contralateral region (P = 0.001) and was negatively correlated with regional cerebral blood flow in the infarct area (r = -0.433, P = 0.027). However, analysis of the regional cerebral blood flow revealed a positive correlation with the regional apparent diffusion coefficient (r = 0.566, P = 0.003), but the phase value was not correlated with the regional apparent diffusion coefficient of the infarct area (r = -0.293, P = 0.146). Using receiver operating characteristic curve analysis, we determined the phase value of drainage veins and the regional cerebral blood flow value of the critical infarction in the ischemic penumbra of the cerebellar infarction to be 301 spin and 22.25 mL/(min·100g), respectively.

    Conclusion

     Our study showed the relevance of using phase value and its correlation with cerebral blood flow to characterize cerebellar infarction. In addition, our findings suggested possible venous reverse perfusion and venous congestion in the infarcted cerebellar hemisphere, which may be critically related to the development of infarct. Furthermore, our approach using a combination of non-invasive imaging parameters including the susceptibility imaging, cerebral perfusion and diffusion may be helpful in the diagnosis and management of stroke involving the cerebellum.

    Keywords: Diffusion Weighted Imaging, Susceptibility Weighted Imaging, Diffusion Weighted Imaging Susceptibility Weighted Imaging Arterial Spin Labeling, Receiver Operating Characteristic (ROC) Curve
  • Yasuo Amano*, Fumi Yanagisawa, Ryota Takagi, Shinsuke Harasawa, Yuko Omori, Naoya Matsumoto Page 6
    Background

     Vascular calcification, including medial calcification and intimal calcification inducing luminal stenosis, of the lower extremities are commonly associated with in hemodialysis (HD), whereas their distribution has not been assessed comprehensively. Three-dimensional (3D) computed tomography angiography (CTA) may be a powerful imaging tool for detection of vascular calcification and arterial stenosis with high spatial resolution in patients with HD and peripheral artery disease (PAD).

    Objectives

     The aim of this study was to investigate the distribution of medial calcification and luminal stenosis in symptomatic patients with HD and PAD using 3D CTA.
    Patients and

    Methods

     Forty-seven patients with HD and symptomatic PAD underwent 3D CTA of the lower extremities. We used 3D maximum intensity projection with and without subtraction by precontrast from postcontrast images in order to assess the medial calcification and luminal stenosis in the common, external, and internal iliac arteries, superficial femoral arteries, and lower limb arteries.

    Results

     The external iliac artery (EIA) was significantly spared from both medial calcification and luminal stenosis, while the internal iliac, superficial femoral artery (SFA), and tibioperoneal arteries had either arterial disorders.

    Conclusion

     The characteristic distribution of medial calcification and luminal stenosis, such as spared EIA and SFA involvement, is observed in patients with HD and symptomatic PAD by 3D CTA.

    Keywords: Hemodialysis, Computed Tomography Angiography, Medial Calcification
  • *Huanan Zhang, Chaochao Wang, Yuan Zhang, Shaohua Xu, Ying Wang, Wei Wang Page 7
    Background

     Lung cancer is not only the most common tumor, but also the tumor of supreme incidence and death rate in all malignant tumors. Bronchoscopy has been widely used in the diagnosis of space occupying lung lesions, but the diagnostic rate of pulmonary peripheral lesions (PPL) is relatively low. The emergence of intra-airway ultrasound technology is a milestone for the development of respiratory endoscopy technology. The appearance of miniature lung ultrasound probe has greatly improved the accuracy of diagnosis of peripheral lung diseases, especially peripheral lung cancer. In recent years, guided sheath (GS) endobronchial ultrasonography with trans-bronchial lung biopsy (EBUS-TBLB) has been used to diagnose pulmonary peripheral lesions. The diagnostic rate is over 70%, and the incidence of adverse reactions is low.

    Objectives

     The aim of the current study was to determine the diagnostic value of endobronchial ultrasonography with a guide sheath combined with virtual bronchoscopic biopsy (EBUS-GS-TBLB+VB) for PPL, and to find the factors that were correlated with greater diagnostic accuracy of EBUS-GS-TBLB.
    Patients and

    Methods

     In this retrospective study, 87 patients with PPL were grouped according to different instrument-guided TBLB techniques, which included conventional TBLB, EBUS-GS-TBLB (E-TBLB), and EBUS-GS-TBLB+VB (E+V-TBLB). The diagnostic accuracy and duration of the operations were compared. Correlative factors were determined and any complications related to the operations were recorded.

    Results

     The diagnostic accuracy of E+V-TBLB (16/20, 80%) and E-TBLB (22/29, 75.9%) were significantly better (P < 0.05) than that of TBLB (18/38, 47.4%), and the duration of the operation (minutes) was significantly shorter in E+V-TBLB (7.78 ± 2.0) than in E-TBLB (12.97 ± 3.4) (P = 0.018). We found that lesions with a diameter ≥ 2 cm (27/29, 93.1%) that were probe-penetrable (30/32, 93.5%), and with a computed tomography (CT) attenuation value > 20 HU were related to higher diagnostic accuracy in EBUS-GS-TBLB. All the patients tolerated the TBLB operations well. Bleeding occurred in one patient from the TBLB group. There was no pneumothorax, hemoptysis, or other complications in the other groups.

    Conclusion

     The diagnostic accuracy of EBUS-GS-TBLB was much greater than that of TBLB, and patients showed better tolerance to it.

    Keywords: Ultrasonography, Biopsy, Bronchoscopy, Peripheral Pulmonary Lesion, Virtual Bronchoscopy
  • Chenxia Li, Xiang Li, Haitian Liu, Rong Wang, Gang Niu, Jian Yang, Yuelang Zhang * Page 8
    Objectives

     To reveal the change of renal cortical blood perfusion in primary glomerular disease (PGD) and renal aging by flow-sensitive alternating inversion recovery (FAIR) arterial spin labeling (ASL) technique.
    Patients and

    Methods

     Renal cortical perfusion was estimated in 24 PGD patients and 30 healthy volunteers using FAIR-ASL in this case-control study. MRI examination was repeated after one week in six randomly selected healthy volunteers. In PGD patients, we regard estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 as mild PGD and eGFR < 60 mL/min/1.73 m2 as moderate-late PGD. The correlations between ASL perfusion values and eGFR in healthy volunteers, mild and moderate-late PGD patients were assessed.

    Results

     In healthy volunteers, the perfusion values between the twice ASL scanning with one week-interval showed an excellent agreement by Bland-Altman analysis. The mean perfusion value of the bilateral kidneys decreased with age increase (25 - 72 years) (r = -0.496, P = 0.012). There were significant differences in ASL perfusion values among healthy volunteers, mild and moderate-late PGD patients (P < 0.0001). Perfusion values correlated strongly with eGFR in all PGD patients (r = 0.868, P < 0.0001), but not in healthy volunteers (r = 0.156, P = 0.405). The correlation coefficient of perfusion values with eGFR in mild and moderate-late PGD patients were 0.749 (P = 0.008) and 0.809 (P = 0.010), respectively.

    Conclusion

     FAIR-ASL technique represents a feasible approach to monitor the renal perfusion variations in PGD patients. It is a noninvasive technique to discover the early abnormality of renal function, and assess the degree of renal aging.

    Keywords: Chronic Kidney Disease, Magnetic Resonance Imaging, Glomerular Filtration Rate, Arterial Spin Labeling
  • Pooya Torkian, Taraneh Faghihi Langroudi *, Kobra Eslami, Abbas Arjmand Shabestari, Reza Talaie Page 9
    Background

     Calcified plaque build-up can increase the risk of subsequent vascular complications in pelvic solid organ transplantation and vascular bypass procedures.

    Objectives

     To assess the atherosclerotic calcification of pelvic vessels by measuring Agatston score and comparing it among abdominal aorta, common iliac artery (CIA), external iliac artery (EIA), and common femoral artery (CFA).
    Patients and

    Methods

     We retrospectively reviewed the unenhanced computed tomography scans of 197 patients from August 2016 to March 2018. Using calcium-scoring software, we examined the distribution map of calcified plaques, focusing on four different arterial segments -the abdominal aorta, the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery (CFA)- to determine which one showed the least mural calcification.

    Results

     A total of 197 patients (118 men, 79 women) with a mean age of 61.19 ± 10.8 years were included in this study. The right EIA segment had the lowest average calcification score (92.1 ± 18.2), including 180 cases (91.4%) of zero calcification, followed by 178 cases (90.4%) of zero calcification in the left EIA. When adjustments were made for age, gender, smoking status, diabetes, hypertension and hyperlipidemia, the odds ratio (OR) of the left EIA for reaching a higher calcium score level was 1.19 (P = 0.44) times greater than the reference group (right EIA). The ratio was markedly higher in the abdominal aorta segment (OR = 146.7.4, P < 0.001), followed by the right CIA (OR = 42.5, P < 0.001), the left CIA (OR = 27.3, P < 0.001), the right CFA (OR = 3.96, P < 0.001), and the left CFA (OR = 3.51, P < 0.001).

    Conclusion

     The study demonstrates a significantly less calcific plaque burden in EIA compared to the adjacent arterial bed.
     

    Keywords: Atherosclerosis, External Iliac Artery, Calcified Plaque, Arterial Graft
  • Jiong Cai *, Xin Li, Feng Mao, Pan Wang, Yaping Luo, Kun Zheng, Fang Li, Zhaohui Zhu Page 10
    Background

     Non-invasive monitoring of human epidermal growth factor receptor 2 (HER2) status in malignant lesions of breast cancer patients has been established in clinical positron emission computed tomography (PET).

    Objectives

     In this study, we try to evaluate the feasibility of 99mTc-labeled affibody in monitoring HER2 expression for breast cancer patients using single-photon emission computed tomography (SPECT) apparatus fused with a conventional CT scanner (SPECT/CT).
    Patients and

    Methods

     HER2 affibody with endogenous chelating site was recombinantly expressed and purified. 99mTc was added to HER2 affibody at carboxyl-terminal cystein site specifically. Breast cancer patients were enrolled for whole-body SPECT/CT imaging following intravenous administration of 99mTc-labeled HER2 affibody. Regions of interest were drawn manually over tumor sites and the normal surrounding muscle. The HER2 status of breast cancer lesions was determined by post-surgical immunohistochemistry, and correlated with the uptake of 99mTc-labeled affibody as measured by SPECT.

    Results

     Administration of 99mTc-labeled HER2 affibody was well tolerated by all patients without noticeable adverse side effects. 99mTc-labeled affibody SPECT imaging clearly visualized HER2 positive breast cancer lesions at approximately 1.5 and 4.5 hours after affibody treatment. The tumor to background (T/B) ratios of locally hot breast cancer lesions by HER2 imaging were closely related to post-surgical HER2 expression levels of cancer tissues by immunohistochemistry. When the tumor:muscle ratio exceeded 2.4 (cutoff value) in transverse imaging, the tumor lesion was considered to be HER2-positive arbitrarily. The diagnostic sensitivity of 99mTc-labeled affibody SPECT/CT in identifying HER2 positive breast cancer was 80 percent (12/15), while the specificity and accuracy of 99mTc-labeled affibody SPECT/CT were 60 percent (9/15) and 70 percent (21/30) respectively. In tumors with a diameter greater than 12 mm, the sensitivity of 99mTc-labeled affibody SPECT/CT was 100 percent (12/12).

    Conclusion

     99mTc-labeled affibody SPECT/CT may find utility in evaluating HER2 expression in breast cancer patients, and may provide new modality for guiding HER2 targeted therapy complementary to biopsy in breast cancer.
     

    Keywords: Breast Cancer, HER2, SPECT CT, 99mTc, Affibody
  • Behnaz Moradi, Ali Borhani *, Fariba Yarandi, Maryam Rahmani, Elham Shirali, Mahrooz Malek, Nasim Batavani, Mohamad Ali Kazemi Page 11
    Background

     Early diagnosis of gestational trophoblastic neoplasia and its complications are pivotal for prompt and efficacious treatment. Transvaginal pelvic ultrasound could detect myometrial invasion and endometrial thickening following dilation and evacuation of hydatiform mole and also in the assessment of response to chemotherapy.

    Objectives

     In this study we aimed to investigate transvaginal ultrasound findings of stage I low-risk gestational trophoblastic neoplasia (GTN) and whether there is an association between ultrasound findings and chemotherapy response.
    Patients and

    Methods

     This study included 31 consecutive patients with postmolar stage I low-risk GTN. We recorded International Federation of Gynecology and Obstetrics (FIGO) score, and transvaginal ultrasound findings including color and pulsed Doppler interrogation at the time of β-hCG rise. The number of Act-D cycles that each patient needed to achieve complete remission was also recorded.

    Results

     Of the 31 patients with post-evacuation trans-vaginal ultrasound evaluation, 2 (6.5%) patients had no detectable finding, 4 (12.9%) had lesions limited to the endometrium, 12 (38.7%) had lesions with < 50% invasion into myometrium, 7 (22.6%) had lesions with > 50% invasion into myometrium, 4 (12.9%) had lesions that reached uterine serosal surface and 2 (6.5%) had AVM-like myometrial lesions. The number of Act-D cycles patients needed to achieve remission was 6 cycles in patients with no finding, lesion limited to endometrium and less than 50% myometrial invasion and was 8 cycles in patients with > 50% invasion ± involvement of serosal surface. One patient in first group and two in second group need multi-agent chemotherapy. But these differences were not significant (P = 0.172).

    Conclusion

     There was a non-significant increase in treatment duration and need of multiagent chemotherapy with more extensive ultrasound findings among patients with stage I low risk GTN.

    Keywords: Gestational Trophoblastic Neoplasia, Transvaginal Ultrasound, Actinomycin D
  • Hossein Ghanaati, Kavous Firouznia, Mehdi Rezaei*, Madjid Shakiba, Nafiseh Ghavami Page 12
    Background

     Osteoid osteomas (OO) are the third most common benign bone tumors affecting mostly children and adolescents with more tendency toward males. There are different treatment options consisting of medical therapy . Of note percutaneous thermal ablation (PTA) procedures that refer to radio frequency ablation (RFA) and interstitial laser photocoagulation (ILP) have also been recently applied with high success rates.

    Objectives

     We aimed to assess the safety and outcomes of RFL and ILP in patients with OO as well as compare the efficacy of these two procedures.
    Patients and

    Methods

     Medical records of 60 OO patients were retrospectively reviewed. Patients were divided into two groups, of which 40 underwent RFA procedures and 20 went through ILP. All patients were followed up clinically either through telephone interview or outpatient clinic visit and imaging was conducted in case signs and symptoms recurred.

    Results

     In patients who underwent RFA, pain was relieved within 1 - 7 days in 35, and 1 - 3 months in five patients. Primary and secondary clinical effectiveness were 90.00% and 92.50%, respectively. In ILP, the technical success rate was 100% and the initial clinical success rate was 85.00%.

    Conclusion

     Similar to previous published studies, this study showed high success rates for both RFA and ILA. Total pain relief occurred in 96.6% of the patients.

    Keywords: Radiofrequency, Osteoid Osteoma
  • Abdulrasool Alaee*, Reza Zarei, Samaneh Farnia, Mohammad Khademloo Page 13
    Background

     The parieto-frontal integration theory of intelligence revealed a novel scope of investigation examining how performance networks are related to structural networks in the brain.

    Objectives

     These investigations highlighted the role of brain commissures, but no evaluation has been performed examining the anterior commissure (AC) in determining the level of intelligence.
    Patients and

    Methods

     A total of 100 healthy volunteers were selected, and their brain MRIs were acquired. Measurements were performed for the AC and the corpus callosum (CC) on MRI. Intelligence quotient (IQ) was calculated using the Wechsler Adult Intelligence Scale-R (WAIS-R). P < 0.05 was considered significant.

    Results

     The average age of men was 32.58 ± 8.84 years, and the average age of women was 32.88 ± 7.83 years. The average IQ of volunteers in the study was 103.57 ± 4.178. Partitioning the subjects by gender did not lead to significant results. No significant correlation was determined between the dimensions of AC and IQ. The height of the CC had a positive correlation with IQ. However, the thickness of the genu, body, and splenium of the CC demonstrated no significant relation to IQ.

    Conclusion

     The AC had no clear relationship with IQ, although it may have a role in women. The height parameter of the CC had a significant correlation with IQ, suggesting the interference between the anterior and posterior parts of the brain in the human intelligence process.

    Keywords: MRI, Brain, IQ, Gender, ommissure, Corpus Callosum Fiber Development
  • Yu-Li Zhu, Ding Hong*, Tian-Tian Fu, Shi-Yao Chen, Jian-Jun Luo, Chen Xu, Yuan Zhuang, Wen-PingWang Page 14
    Background

    Accurate evaluation of the degree of fibrosis and cirrhosis is crucial for determining treatment strategies, surveillance, and prognosis in patients with chronic hepatitis B (CHB).

    Objectives

    To explore the value of acoustic radiation force impulse (ARFI) elastography in assessing the stage of liver fibrosis and the severity of cirrhosis based on portal hypertension.

     Patients and Methods

    One hundred ninety-six consecutive CHB patients who underwent partial hepatectomy and sixty-four advanced cirrhosis patients who underwent hepatic vein pressure gradient (HVPG) measurement were examined with ARFI imaging. Liver stiffness measurements (LSMs) were obtained and compared with the hepatic histological findings by using Scheuer scoring system and with the value of HVPG, respectively. A spleen stiffness measurement (SSM) and spleen index were also performed, and the values were compared with HVPG measurements.

    Results

    Areas under the receiver operating characteristics curve (AUROCs) were 0.952 and 0.976, respectively for the diagnosis of significant fibrosis (S ≥ S2) and cirrhosis (S4), with the corresponding values of 1.26 m/s and 1.58 m/s for optimal LSM cutoff points. For advanced cirrhotic patients (n = 64), the correlation coefficient between LSM and HVPG was 0.637 (P < 0.001). The cutoff values for predicting HVPG ≥ 10 mm Hg and HVPG ≥ 12 mm Hg were 1.79 m/s and 1.90 m/s, respectively (AUROC: 0.665 and 0.859). Neither the value of SSM nor the spleen index showed a statistical relationship with HVPG in the advanced cirrhosis group, but they were significantly correlated with each other (ρ = 0.604, P < 0.05).

    Conclusion

    As a noninvasive elastosonography for the evaluation of liver stiffness, ARFI imaging could not only be used to stage liver fibrosis in CHB patients, but also to evaluate the severity of cirrhosis based on portal hypertension.

    Keywords: Liver Fibrosis, Stiffness, Acoustic Radiation Force Impulse (ARFI), Portal Hypertension, Hepatic Vein Pressure Gradient(HVPG)
  • Yoo Kyeong Seo, Go Eun Yang *, Taek Geun Ohk Page 15

    Cowden syndrome is an uncommon, multi-system disease that increases the risk of breast cancer. The most common breast malignancy is ductal carcinoma including ductal carcinoma in situ or infiltrating ductal carcinoma. Rare types of breast cancer exist, such as infiltrating tubular carcinoma and lobular carcinoma. There has been rarely a reported case of this type of breast cancer in Cowden syndrome. In this report, a 34-year-old woman diagnosed with Cowden syndrome underwent simple mastectomy for invasive carcinoma of no special type (NST) in the left breast, and simple mastectomy for cribriform carcinoma in the contralateral breast. Herein, we describe a case of Cowden syndrome with bilateral breast cancer, invasive carcinoma of NST in one breast and cribriform carcinoma in the contralateral breast.

    Keywords: Cancer, Breast, Cowden Syndrome
  • Niloofar Ayoobi Yazdi, Habibollah Dashti, Masoomeh Safaei, Faezeh Salahshour, Maryam Fotouhi, Ali Jafarian, Ghazaleh Amjad* Page 16

    Solitary fibrous tumors (SFTs) are mesenchymal tumors that mostly occur in the pleural cavity. Extra-thoracic location is rare and hepatic origin is extremely rare. Most lesions are benign, 10% - 15% show aggressive behavior and few metastasizing SFTs have been reported. Imaging features of solitary fibrous tumors of the liver (SFTLs) are nonspecific and definite diagnosis usually needs histopathological and immunohistochemistry evaluation. We report ultrasound, CT and MRI features of such a rare malignant SFTL in a 47-year-old man who came with vague abdominal symptoms in detail along with reviewing literature considering imaging features which is valuable for radiologists. The lesion seen as a huge dominantly cystic lesion on ultrasound was initially misinterpreted as hydatid. On CT scan it was seen as a large encapsulated mass with arterial hyper-enhancement and delayed contrast retention and multiple cystic spaces. On MRI, solid components showed iso-intensity to adjacent liver on T1 and T2 images, small areas of restriction on diffusion weighted imaging (DWI) and few hemorrhagic cystic components beside enhancement pattern and multiple large cystic components similar to CT scan. Our patient was admitted for resection of huge hepatic mass and experienced an episode of altered mental status due to hypoglycemia during hospital admission, which is a rare finding in SFTL. The patient underwent right hepatectomy and solitary fibrous tumor was confirmed on pathologic examination of the resected tumor. Hypoglycemic episodes were resolved and the patient was asymptomatic in 28 months follow-up.

    Keywords: Solitary Fibrous Tumor. Enhanced MRI, Malignant Transformation, CT Scan
  • Bo Zhang, Zhong Wei Tian, Ji Zhang *, Kun Mao Yuan, Hong Yu Page 17

    Thrombus in the right atrium is an extremely rare manifestation. Here we report a case of calcified ball thrombus in the right atrium in a 72-year-old female with chest tightness and bilateral lower extremity edema for over 3 daysComputed Tomography. The patient had no obvious pro-thrombosis risk factors. Multimodality imaging examination depicted an oval soft tissue mass in the right atrium. Histopathological examination confirmed that to be a thrombus in the right atrium. To conclude, when a soft-tissue-like space-occupying lesion in the right atrium is encountered, especially with a ring-like calcification, thrombus should be considered as one of the differential diagnosis.

    Keywords: Computed Tomography, Thrombus, Right Atrium
  • Hamid Taghavi, Mohsen Bakhshandeh *, Alireza Montazerabadi, Hossein Nazari Moghadam, Seyyed Behnam Mazloom Shahri, Mohammad Keshtkar Page 18
    Background

     Gold nanoparticles with high atomic number and density have good potential to be used as contrast media in computed tomography.

    Objectives

     In this study, we aimed to assess radiation dose and contrast enhancement performance of gold nanoparticles by measuring contrast to noise ratio compared to clinically used iodinated contrast agents at same concentrations. Contrast enhancement was evaluated in different tube voltages and currents.

    Methods

     First, polyethylene glycol coated gold nanoparticles were synthesized with concentrations of 0.5 mM, 0.6 mM, and 0.7 mM. Gold nanoparticles and iodinated contrast media were scanned with CT imaging system at different tube voltages and time-current product. CT dose index (CTDI) value was measured by special phantom and electrometer. Improving in image contrast was assessed by contrast to noise ratio.

    Results

     Results showed that gold nanoparticles in all concentrations and energies from 80 to 130 kVp display higher image contrast-to-noise ratio (CNR) than iodinated contrast media. Image CNR was increased by increasing kVp and mAs. The CNR value was maximum at the voltage of 80 and 130 kVp for iodinated compounds and gold nanoparticles, respectively. The CNR value for gold nanoparticles at 130 kVp and 200 mAs was approximately five times higher than that of iodinated compounds.

    Conclusion

     Gold nanoparticles could be a good candidate for optimizing CT imaging by lowering radiation dose as low as possible while enhancing the image contrast.
     

    Keywords: Computed Tomography, Gold Nanoparticles, Radiation Dose, Iodinated Compounds, Image Contrast