Pub Date : 2022-11-27DOI: 10.5812/iranjradiol-120869
K. Lee, In-Sik Jeong
Introduction: Ethanol ablation (EA) and radiofrequency ablation (RFA) are minimal invasive therapeutic modalities to treat primary hyperparathyroidism (PHPT). Case Presentation: A 77-year-old man presented a 3.5-cm parathyroid adenoma with mixed cystic and solid components. He was ineligible for parathyroidectomy because of his age and the surgical history of the coronary artery bypass graft. First, EA was performed to remove cystic component. After that, the volume of parathyroid adenoma was decreased (volume reduction rate: 94%); however, the level of serum parathyroid hormone (PTH) was persistently high (88 pg/mL). Subsequent RFA was performed to remove the remaining parathyroid adenoma. Further, it was completely disappeared on the following ultrasound examination, and PTH was normalized. The results during a 2-year follow-up confirmed clinical success, and no relevant complication was reported. Conclusion: The combination therapy of EA and subsequent RFA is safe and effective as an alternative therapeutic method to treat PHPT in patients ineligible for parathyroidectomy.
{"title":"Combination Therapy of Ethanol Ablation and Radiofrequency Ablation to Treat Parathyroid Adenoma in a Case with Primary Hyperparathyroidism","authors":"K. Lee, In-Sik Jeong","doi":"10.5812/iranjradiol-120869","DOIUrl":"https://doi.org/10.5812/iranjradiol-120869","url":null,"abstract":"Introduction: Ethanol ablation (EA) and radiofrequency ablation (RFA) are minimal invasive therapeutic modalities to treat primary hyperparathyroidism (PHPT). Case Presentation: A 77-year-old man presented a 3.5-cm parathyroid adenoma with mixed cystic and solid components. He was ineligible for parathyroidectomy because of his age and the surgical history of the coronary artery bypass graft. First, EA was performed to remove cystic component. After that, the volume of parathyroid adenoma was decreased (volume reduction rate: 94%); however, the level of serum parathyroid hormone (PTH) was persistently high (88 pg/mL). Subsequent RFA was performed to remove the remaining parathyroid adenoma. Further, it was completely disappeared on the following ultrasound examination, and PTH was normalized. The results during a 2-year follow-up confirmed clinical success, and no relevant complication was reported. Conclusion: The combination therapy of EA and subsequent RFA is safe and effective as an alternative therapeutic method to treat PHPT in patients ineligible for parathyroidectomy.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41448531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-17DOI: 10.5812/iranjradiol-117992
S. Sotoudeh-Paima, Navid Hasanzadeh, Ali Bashirgonbadi, Amin Aref, M. Naghibi, Mostafa Zoorpaikar, Arvin Arian, M. Gity, H. Soltanian-Zadeh
Background: Chest computed tomography (CT) scan is one of the most common tools used for the diagnosis of patients with coronavirus disease 2019 (COVID-19). While segmentation of COVID-19 lung lesions by radiologists can be time-consuming, the application of advanced deep learning techniques for automated segmentation can be a promising step toward the management of this infection and similar diseases in the future. Objectives: This study aimed to evaluate the performance and generalizability of deep learning-based models for the automated segmentation of COVID-19 lung lesions. Patients and Methods: Four datasets (2 private and 2 public) were used in this study. The first and second private datasets included 297 (147 healthy and 150 COVID-19 cases) and 82 COVID-19 subjects. The public datasets included the COVID19-P20 (20 COVID-19 cases from 2 centers) and the MosMedData datasets (50 COVID-19 patients from a single center). Model comparisons were made based on the Dice similarity coefficient (DSC), receiver operating characteristic (ROC) curve, and area under the curve (AUC). The predicted CT severity scores by the model were compared with those of radiologists by measuring the Pearson’s correlation coefficients (PCC). Also, DSC was used to compare the inter-rater agreement of the model and expert against that of 2 experts on an unseen dataset. Finally, the generalizability of the model was evaluated, and a simple calibration strategy was proposed. Results: The VGG16-UNet model showed the best performance across both private datasets, with a DSC of 84.23% ± 1.73% on the first private dataset and 56.61% ± 1.48% on the second private dataset. Similar results were obtained on public datasets, with a DSC of 60.10% ± 2.34% on the COVID19-P20 dataset and 66.28% ± 2.80% on a combined dataset of COVID19-P20 and MosMedData. The predicted CT severity scores of the model were compared against those of radiologists and were found to be 0.89 and 0.85 on the first private dataset and 0.77 and 0.74 on the second private dataset for the right and left lungs, respectively. Moreover, the model trained on the first private dataset was examined on the second private dataset and compared against the radiologist, which revealed a performance gap of 5.74% based on DSCs. A calibration strategy was employed to reduce this gap to 0.53%. Conclusion: The results demonstrated the potential of the proposed model in localizing COVID-19 lesions on CT scans across multiple datasets; its accuracy competed with the radiologists and could assist them in diagnostic and treatment procedures. The effect of model calibration on the performance of an unseen dataset was also reported, increasing the DSC by more than 5%.
{"title":"A Multi-centric Evaluation of Deep Learning Models for Segmentation of COVID-19 Lung Lesions on Chest CT Scans","authors":"S. Sotoudeh-Paima, Navid Hasanzadeh, Ali Bashirgonbadi, Amin Aref, M. Naghibi, Mostafa Zoorpaikar, Arvin Arian, M. Gity, H. Soltanian-Zadeh","doi":"10.5812/iranjradiol-117992","DOIUrl":"https://doi.org/10.5812/iranjradiol-117992","url":null,"abstract":"Background: Chest computed tomography (CT) scan is one of the most common tools used for the diagnosis of patients with coronavirus disease 2019 (COVID-19). While segmentation of COVID-19 lung lesions by radiologists can be time-consuming, the application of advanced deep learning techniques for automated segmentation can be a promising step toward the management of this infection and similar diseases in the future. Objectives: This study aimed to evaluate the performance and generalizability of deep learning-based models for the automated segmentation of COVID-19 lung lesions. Patients and Methods: Four datasets (2 private and 2 public) were used in this study. The first and second private datasets included 297 (147 healthy and 150 COVID-19 cases) and 82 COVID-19 subjects. The public datasets included the COVID19-P20 (20 COVID-19 cases from 2 centers) and the MosMedData datasets (50 COVID-19 patients from a single center). Model comparisons were made based on the Dice similarity coefficient (DSC), receiver operating characteristic (ROC) curve, and area under the curve (AUC). The predicted CT severity scores by the model were compared with those of radiologists by measuring the Pearson’s correlation coefficients (PCC). Also, DSC was used to compare the inter-rater agreement of the model and expert against that of 2 experts on an unseen dataset. Finally, the generalizability of the model was evaluated, and a simple calibration strategy was proposed. Results: The VGG16-UNet model showed the best performance across both private datasets, with a DSC of 84.23% ± 1.73% on the first private dataset and 56.61% ± 1.48% on the second private dataset. Similar results were obtained on public datasets, with a DSC of 60.10% ± 2.34% on the COVID19-P20 dataset and 66.28% ± 2.80% on a combined dataset of COVID19-P20 and MosMedData. The predicted CT severity scores of the model were compared against those of radiologists and were found to be 0.89 and 0.85 on the first private dataset and 0.77 and 0.74 on the second private dataset for the right and left lungs, respectively. Moreover, the model trained on the first private dataset was examined on the second private dataset and compared against the radiologist, which revealed a performance gap of 5.74% based on DSCs. A calibration strategy was employed to reduce this gap to 0.53%. Conclusion: The results demonstrated the potential of the proposed model in localizing COVID-19 lesions on CT scans across multiple datasets; its accuracy competed with the radiologists and could assist them in diagnostic and treatment procedures. The effect of model calibration on the performance of an unseen dataset was also reported, increasing the DSC by more than 5%.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41345533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-14DOI: 10.5812/iranjradiol-123693
Qing-feng Xiong, Guanglie Wu, Xiaotian Fu, Di Zhou, Sheng-Peng Guo
Background: There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics. Objectives: This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and Methods: The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant. Results: In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 mSv. There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017). Conclusion: In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.
{"title":"Evaluation of the Advantages of Myocardial Blood Flow Index in the Diagnosis of Chronic Obstructive Coronary Artery Disease Versus Coronary Computed Tomography Angiography: A Feasibility Study","authors":"Qing-feng Xiong, Guanglie Wu, Xiaotian Fu, Di Zhou, Sheng-Peng Guo","doi":"10.5812/iranjradiol-123693","DOIUrl":"https://doi.org/10.5812/iranjradiol-123693","url":null,"abstract":"Background: There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics. Objectives: This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and Methods: The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant. Results: In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 mSv. There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017). Conclusion: In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43928868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-25DOI: 10.5812/iranjradiol-127182
Zixin Zhang, Chun-shuang Guan, Budong Chen, R. Xie
Background: The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions. Objectives: This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART. Methods: Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated. Results: In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively. Conclusion: In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression.
{"title":"Correlation Between CD4 Cell Count, HIV Viral Load, and Chest CT Findings of AIDS-associated Pulmonary Cryptococcosis","authors":"Zixin Zhang, Chun-shuang Guan, Budong Chen, R. Xie","doi":"10.5812/iranjradiol-127182","DOIUrl":"https://doi.org/10.5812/iranjradiol-127182","url":null,"abstract":"Background: The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions. Objectives: This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART. Methods: Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated. Results: In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively. Conclusion: In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44776657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-23DOI: 10.5812/iranjradiol-121392
A. Ebrahimi, Arvin Arian, A. Akbari Sari, N. Ahmadinejad
Background: Although breast cancer is the most prevalent type of cancer among Iranian women, its screening is opportunistic in Iran. The available guidelines for breast cancer screening are based on mammography. A screening modality should have adequate diagnostic accuracy and be widely available at reasonable cost. Although mammography is highly accessible in Iran, its accuracy has not been investigated. Objectives: This study aimed to evaluate the accuracy of mammography in opportunistic screening regarding the current rate of patient attendance. Patients and Methods: A total of 491 women undergoing screening mammography were followed-up based on their medical records. They were divided into positive and negative screening groups, based on the breast imaging-reporting and data system (BI-RADS) categories and approaches. To evaluate the disease status of positive cases, pathology reports were investigated, and negative cases were followed-up for stability over time. Results: In the study sample, sensitivity was estimated at 73.08% (95% CI: 55.21 - 88.93), specificity was estimated at 94.41% (95% CI: 91.91 - 96.32), and accuracy was 93.28% (95% CI: 90.69 - 95.33). These test accuracy indices were not significantly different between the groups regarding age, family history, breast density, and history of breast interventions. Conclusion: The test’s sensitivity or ability to detect a disease was relatively low in opportunistic screening; it was found to be similar to the results of studies of first time implementation of screeninng. In both settings, a test needs to diagnose both incident and prevalent cases. The overall accuracy of mammography was acceptable, even in opportunistic screening.
{"title":"Diagnostic Accuracy of Opportunistic Breast Cancer Screening Based on Mammography in Iran","authors":"A. Ebrahimi, Arvin Arian, A. Akbari Sari, N. Ahmadinejad","doi":"10.5812/iranjradiol-121392","DOIUrl":"https://doi.org/10.5812/iranjradiol-121392","url":null,"abstract":"Background: Although breast cancer is the most prevalent type of cancer among Iranian women, its screening is opportunistic in Iran. The available guidelines for breast cancer screening are based on mammography. A screening modality should have adequate diagnostic accuracy and be widely available at reasonable cost. Although mammography is highly accessible in Iran, its accuracy has not been investigated. Objectives: This study aimed to evaluate the accuracy of mammography in opportunistic screening regarding the current rate of patient attendance. Patients and Methods: A total of 491 women undergoing screening mammography were followed-up based on their medical records. They were divided into positive and negative screening groups, based on the breast imaging-reporting and data system (BI-RADS) categories and approaches. To evaluate the disease status of positive cases, pathology reports were investigated, and negative cases were followed-up for stability over time. Results: In the study sample, sensitivity was estimated at 73.08% (95% CI: 55.21 - 88.93), specificity was estimated at 94.41% (95% CI: 91.91 - 96.32), and accuracy was 93.28% (95% CI: 90.69 - 95.33). These test accuracy indices were not significantly different between the groups regarding age, family history, breast density, and history of breast interventions. Conclusion: The test’s sensitivity or ability to detect a disease was relatively low in opportunistic screening; it was found to be similar to the results of studies of first time implementation of screeninng. In both settings, a test needs to diagnose both incident and prevalent cases. The overall accuracy of mammography was acceptable, even in opportunistic screening.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49368760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-19DOI: 10.5812/iranjradiol-123781
H. Hayati
Background: The consequences of coronavirus disease (COVID-19) pandemic, especially the financial burden imposed on the healthcare systems and hospitals, have been unpredictable around the world. Radiology wards have been exposed to the highest burden during this pandemic. Objectives: This study aimed to calculate the cost of diagnostic imaging services before and during the COVID-19 pandemic, using the activity-based costing (ABC) method in an important diagnostic center of COVID-19 in Khorramabad, Iran. Patients and Methods: In this retrospective study, data were extracted from the hospital accounting sources in the radiology ward over two years (2019 - 2021). According to the ABC method, four types of cost were defined, including wage, supporting services, Consuming materials, and overhead expenses. Therefore, based on the monthly number of services, the unit cost of each service was calculated. Results: The unit cost of all services during the COVID-19 pandemic was higher than before, except for CT scan (before: 6.1 USD; during: 5.6 USD) (P = 0.008). The unit cost of MRI servicewas 5.7 USD before the pandemic and 7.1 USD during the pandemic (P = 0.57); the cost per radiography service was 1.8 USD before the pandemic and 7.1 USD during the pandemic (P = 0.01); and the cost per sonography service was 1.1 USD before the pandemic and 2.8 USD during the pandemic (P = 0.04). Finally, the cost of mammography increased dramatically during the pandemic (before the pandemic: 21.3 USD; during the pandemic: 48.2 USD) (P = 0.004). Conclusion: The COVID-19 pandemic has increased the radiology department expenses. The cost of CT scan services decreased due to the large number of services provided compared to the pre-pandemic period.
{"title":"Comparison of the Unit Cost of Diagnostic Imaging Services Before and During the COVID-19 Pandemic Using the Activity-Based Costing (ABC) Method","authors":"H. Hayati","doi":"10.5812/iranjradiol-123781","DOIUrl":"https://doi.org/10.5812/iranjradiol-123781","url":null,"abstract":"Background: The consequences of coronavirus disease (COVID-19) pandemic, especially the financial burden imposed on the healthcare systems and hospitals, have been unpredictable around the world. Radiology wards have been exposed to the highest burden during this pandemic. Objectives: This study aimed to calculate the cost of diagnostic imaging services before and during the COVID-19 pandemic, using the activity-based costing (ABC) method in an important diagnostic center of COVID-19 in Khorramabad, Iran. Patients and Methods: In this retrospective study, data were extracted from the hospital accounting sources in the radiology ward over two years (2019 - 2021). According to the ABC method, four types of cost were defined, including wage, supporting services, Consuming materials, and overhead expenses. Therefore, based on the monthly number of services, the unit cost of each service was calculated. Results: The unit cost of all services during the COVID-19 pandemic was higher than before, except for CT scan (before: 6.1 USD; during: 5.6 USD) (P = 0.008). The unit cost of MRI servicewas 5.7 USD before the pandemic and 7.1 USD during the pandemic (P = 0.57); the cost per radiography service was 1.8 USD before the pandemic and 7.1 USD during the pandemic (P = 0.01); and the cost per sonography service was 1.1 USD before the pandemic and 2.8 USD during the pandemic (P = 0.04). Finally, the cost of mammography increased dramatically during the pandemic (before the pandemic: 21.3 USD; during the pandemic: 48.2 USD) (P = 0.004). Conclusion: The COVID-19 pandemic has increased the radiology department expenses. The cost of CT scan services decreased due to the large number of services provided compared to the pre-pandemic period.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47325518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: 46,XY pure gonadal dysgenesis (PGD) is also known as Swyer syndrome. The chromosome analysis indicates a 46,XY karyotype. As different degrees of gonadal hypoplasia or degeneration occur in the process of embryonic development due to several factors, gonadal dysplasia or gonadal tumors are probable. Case Presentation: The patient was a 22-year-old female with no menstruation during puberty. Her chest was funnel-shaped, the breast development was classified as Tanner III grade, the vulva was normal, the pubic hair was classified as Tanner II grade, and the vaginal long was 6 cm. The endocrine examination indicated a follicle-stimulating hormone level of 95.0 mIU/mL and an estradiol level of 34.0 pg/mL. Tumor markers, including alpha-fetoprotein (AFP), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), and carcinoembryonic antigen (CEA), were normal. Dual-energy X-ray absorptiometry revealed that the bone mineral density was lower than the normal range at this age. Ultrasonography showed a hypoechoic mass in the left adnexal area, considering gonadal tissue with calcification. Pelvic MRI indicated a gonadal malignancy, and the gonadal tissue of the right adnexal area was cord-shaped. The chromosome analysis indicated a 46,XY karyotype. Accordingly, a clinical diagnosis of PGD was established. Moreover, laparoscopic gonadectomy and pathological examination were performed, and a final diagnosis of Swyer syndrome, complicated with a left-sided gonadoblastoma and asexual cell tumor, was made. Conclusion: PGD is associated with a high risk of gonadal tumors. Considering the rarity of this disease, a detailed evaluation of gonadal size and timely preventive gonadectomy are recommended for patients with gonadal dysplasia. Overall, imaging examinations can provide important information for the diagnosis of gonadal dysplasia. MRI can clearly indicate the size and shape of the gonads and the tumor, as well as the relationship between the tumor and the surrounding tissue.
{"title":"A Case of Swyer Syndrome Complicated with Left-sided Gonadoblastoma and Asexual Cell Tumor","authors":"Xu Shengfang, Zhao-Dong Li, Zhang Jinlong, Yen-Chang Lei, Qian Jifang","doi":"10.5812/iranjradiol-119646","DOIUrl":"https://doi.org/10.5812/iranjradiol-119646","url":null,"abstract":"Introduction: 46,XY pure gonadal dysgenesis (PGD) is also known as Swyer syndrome. The chromosome analysis indicates a 46,XY karyotype. As different degrees of gonadal hypoplasia or degeneration occur in the process of embryonic development due to several factors, gonadal dysplasia or gonadal tumors are probable. Case Presentation: The patient was a 22-year-old female with no menstruation during puberty. Her chest was funnel-shaped, the breast development was classified as Tanner III grade, the vulva was normal, the pubic hair was classified as Tanner II grade, and the vaginal long was 6 cm. The endocrine examination indicated a follicle-stimulating hormone level of 95.0 mIU/mL and an estradiol level of 34.0 pg/mL. Tumor markers, including alpha-fetoprotein (AFP), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), and carcinoembryonic antigen (CEA), were normal. Dual-energy X-ray absorptiometry revealed that the bone mineral density was lower than the normal range at this age. Ultrasonography showed a hypoechoic mass in the left adnexal area, considering gonadal tissue with calcification. Pelvic MRI indicated a gonadal malignancy, and the gonadal tissue of the right adnexal area was cord-shaped. The chromosome analysis indicated a 46,XY karyotype. Accordingly, a clinical diagnosis of PGD was established. Moreover, laparoscopic gonadectomy and pathological examination were performed, and a final diagnosis of Swyer syndrome, complicated with a left-sided gonadoblastoma and asexual cell tumor, was made. Conclusion: PGD is associated with a high risk of gonadal tumors. Considering the rarity of this disease, a detailed evaluation of gonadal size and timely preventive gonadectomy are recommended for patients with gonadal dysplasia. Overall, imaging examinations can provide important information for the diagnosis of gonadal dysplasia. MRI can clearly indicate the size and shape of the gonads and the tumor, as well as the relationship between the tumor and the surrounding tissue.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47146328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18DOI: 10.5812/iranjradiol-128725
Nasrin Moulodi, M. Jalali, J. Sarrafzadeh, F. Azadinia, A. Shakourirad
Background: The muscle volume considerably changes with aging, pathologies, mechanical loading and exercise, and immobilization. It is recognized as an important parameter that can be measured by various methods to evaluate the effectiveness of interventions focusing on muscle strengthening and function. However, before the application of any measurement method, their reliability needs to be investigated and established. Objectives: This study aimed to evaluate the inter- and intra-rater reliability of the manual measurement method of the abductor hallucis muscle volume in feet with hallux valgus deformities using magnetic resonance imaging (MRI). Patients and Methods: The MRI images of the feet of 15 samples with a hallux valgus deformity were selected in this study. The cross-sectional areas of the abductor hallucis muscle were measured in the cuts along the entire length of the foot and multiplied by slice thickness. Two trained raters performed the measurements. The second rater repeated the measurements after five days to eliminate the memory effect. The intra-rater reliability and inter-rater reliability were assessed based on the intraclass correlation coefficient [ICC (2, 1)] to evaluate the extent of agreement between the raters at a 95% confidence interval. Results: The between- and within-rater ICCs were 0.92 (0.79 - 0.97) and 0.99 (0.97 - 0.99), respectively. The standard error of measurements was also small in both inter-rater (6.2%) and intra-rater (2.1%) reliability analyses. Conclusion: The manually outlined slice-by-slice volume measurement of the abductor hallucis muscle based on MRI images showed excellent inter- and intra-rater reliability. The excellent intra-rater reliability, besides the lower standard error percentage of measurements, indicates the superiority of measurements by a single person. However, further studies with a larger sample size are recommended.
{"title":"Intra- and Inter-rater Reliability of a Magnetic Resonance Imaging-Based Volumetric Analysis of the Abductor Hallucis Muscle","authors":"Nasrin Moulodi, M. Jalali, J. Sarrafzadeh, F. Azadinia, A. Shakourirad","doi":"10.5812/iranjradiol-128725","DOIUrl":"https://doi.org/10.5812/iranjradiol-128725","url":null,"abstract":"Background: The muscle volume considerably changes with aging, pathologies, mechanical loading and exercise, and immobilization. It is recognized as an important parameter that can be measured by various methods to evaluate the effectiveness of interventions focusing on muscle strengthening and function. However, before the application of any measurement method, their reliability needs to be investigated and established. Objectives: This study aimed to evaluate the inter- and intra-rater reliability of the manual measurement method of the abductor hallucis muscle volume in feet with hallux valgus deformities using magnetic resonance imaging (MRI). Patients and Methods: The MRI images of the feet of 15 samples with a hallux valgus deformity were selected in this study. The cross-sectional areas of the abductor hallucis muscle were measured in the cuts along the entire length of the foot and multiplied by slice thickness. Two trained raters performed the measurements. The second rater repeated the measurements after five days to eliminate the memory effect. The intra-rater reliability and inter-rater reliability were assessed based on the intraclass correlation coefficient [ICC (2, 1)] to evaluate the extent of agreement between the raters at a 95% confidence interval. Results: The between- and within-rater ICCs were 0.92 (0.79 - 0.97) and 0.99 (0.97 - 0.99), respectively. The standard error of measurements was also small in both inter-rater (6.2%) and intra-rater (2.1%) reliability analyses. Conclusion: The manually outlined slice-by-slice volume measurement of the abductor hallucis muscle based on MRI images showed excellent inter- and intra-rater reliability. The excellent intra-rater reliability, besides the lower standard error percentage of measurements, indicates the superiority of measurements by a single person. However, further studies with a larger sample size are recommended.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43683780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-14DOI: 10.5812/iranjradiol-122424
Jinye Li, Lixin Sun, Linsheng Wang, N. Hu, Longxi Li, G. Song, Hang Xu, Ting Xu, W. Dou, R. Gong, Chuanting Li
Background: There is no gold standard diagnostic test for endolymphatic hydrops (EH). Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging has been reported to depict EH with administration of gadolinium-based contrast media (GBCM). However, the optimal scan interval and angulation remain unknown in 3D-FLAIR labyrinthine imaging following double-dose injections of a gadolinium-based contrast agent in patients with vertigo and sensorineural hearing loss. Objectives: This study aimed to determine the optimal parameters of 3D-FLAIR labyrinthine imaging, including the optimal scan angulation and scan interval, for patients with sensorineural hearing loss and vertigo. Patients and Methods: In this cross-sectional clinical study, following the double-dose administration of a gadolinium contrast agent, 3D-FLAIR labyrinthine images were acquired from 22 patients with unilateral vertigo and sensorineural hearing loss at different intervals after injection. The corresponding contrast-to-noise ratios (CNRs) and signal-intensity ratios (SIRs) of these images, acquired at different intervals, were measured. Moreover, separate visualization of endolymphatic and perilymphatic spaces was scored, and angulation of the anterior skull base scan was investigated in the sagittal position. Results: The 3D-FLAIR images showed the strongest image contrast in the cochlea with a double-dose gadolinium-based contrast injection at six hours post-injection. Significantly higher SIR and CNR values were reported at six hours post-injection in both unaffected and affected ears compared to other intervals (4 h vs. 6 h in the affected side, SIR: 1.65 ± 0.24 vs. 2.09 ± 0.47, CNR: 13.88 ± 5.54 vs. 19.17 ± 6.81; in the unaffected side, SIR: 1.58 ± 0.27 vs. 1.82 ± 0.34, CNR: 12.20 ± 3.88 vs. 15.42 ± 4.58, P < 0.001 for all; 6 h vs. 8 h in the affected side: SIR: 2.09 ± 0.47 vs. 1.72 ± 0.43, CNR: 19.17 ± 6.81 vs. 12.22 ± 4.96; in the unaffected side, SIR: 1.82 ± 0.34 vs. 1.57 ± 0.30, CNR: 15.42 ± 4.58 vs. 10.61 ± 3.87, P < 0.001 for all). Visualization of the endo- and perilymphatic spaces for both the cochlea and vestibule was significantly better at six hours post-injection compared to four hours post-injection in both affected sides (P < 0.05 for both). The optimal angulation ranged from 6.20° to 13.6° (P < 0.001). Conclusion: By using an optimal scan interval, together with an optimal scan angulation, 3D-FLAIR imaging can reliably visualize the endolymphatic space and sensitively indicate cochlear blood-labyrinth barrier disruptions without requiring extra image reconstruction.
{"title":"Contrast-Enhanced Three-Dimensional Fluid-Attenuated Inversion Recovery Imaging with an Optimal Scan Interval and Angulation to Visualize Endolymphatic Hydrops","authors":"Jinye Li, Lixin Sun, Linsheng Wang, N. Hu, Longxi Li, G. Song, Hang Xu, Ting Xu, W. Dou, R. Gong, Chuanting Li","doi":"10.5812/iranjradiol-122424","DOIUrl":"https://doi.org/10.5812/iranjradiol-122424","url":null,"abstract":"Background: There is no gold standard diagnostic test for endolymphatic hydrops (EH). Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging has been reported to depict EH with administration of gadolinium-based contrast media (GBCM). However, the optimal scan interval and angulation remain unknown in 3D-FLAIR labyrinthine imaging following double-dose injections of a gadolinium-based contrast agent in patients with vertigo and sensorineural hearing loss. Objectives: This study aimed to determine the optimal parameters of 3D-FLAIR labyrinthine imaging, including the optimal scan angulation and scan interval, for patients with sensorineural hearing loss and vertigo. Patients and Methods: In this cross-sectional clinical study, following the double-dose administration of a gadolinium contrast agent, 3D-FLAIR labyrinthine images were acquired from 22 patients with unilateral vertigo and sensorineural hearing loss at different intervals after injection. The corresponding contrast-to-noise ratios (CNRs) and signal-intensity ratios (SIRs) of these images, acquired at different intervals, were measured. Moreover, separate visualization of endolymphatic and perilymphatic spaces was scored, and angulation of the anterior skull base scan was investigated in the sagittal position. Results: The 3D-FLAIR images showed the strongest image contrast in the cochlea with a double-dose gadolinium-based contrast injection at six hours post-injection. Significantly higher SIR and CNR values were reported at six hours post-injection in both unaffected and affected ears compared to other intervals (4 h vs. 6 h in the affected side, SIR: 1.65 ± 0.24 vs. 2.09 ± 0.47, CNR: 13.88 ± 5.54 vs. 19.17 ± 6.81; in the unaffected side, SIR: 1.58 ± 0.27 vs. 1.82 ± 0.34, CNR: 12.20 ± 3.88 vs. 15.42 ± 4.58, P < 0.001 for all; 6 h vs. 8 h in the affected side: SIR: 2.09 ± 0.47 vs. 1.72 ± 0.43, CNR: 19.17 ± 6.81 vs. 12.22 ± 4.96; in the unaffected side, SIR: 1.82 ± 0.34 vs. 1.57 ± 0.30, CNR: 15.42 ± 4.58 vs. 10.61 ± 3.87, P < 0.001 for all). Visualization of the endo- and perilymphatic spaces for both the cochlea and vestibule was significantly better at six hours post-injection compared to four hours post-injection in both affected sides (P < 0.05 for both). The optimal angulation ranged from 6.20° to 13.6° (P < 0.001). Conclusion: By using an optimal scan interval, together with an optimal scan angulation, 3D-FLAIR imaging can reliably visualize the endolymphatic space and sensitively indicate cochlear blood-labyrinth barrier disruptions without requiring extra image reconstruction.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42201209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-11DOI: 10.5812/iranjradiol-121573
Shiva Hassanzadeh, S. Livani, Malihe Azaderah, Mehdi Madadi, Fazel Isapanah Amlashi
Background: Preeclampsia can increase the risk of cardiovascular diseases (CVDs) later in life. Also, increased intima-media thickness (IMT) of the carotid artery was introduced as an independent risk factor for CVDs. Objectives: This study aimed to evaluate and compare the IMT of carotid and femoral arteries between women with early preeclampsia and normotensive pregnant and nulligravid women. Methods: In this study, which was conducted between May 2019 and January 2020, three groups of women were evaluated: early-onset preeclamptic pregnant women, normotensive pregnant women, and nulligravid women. The IMTs of the common femoral artery, superficial femoral artery, common carotid artery, carotid bulb, and internal carotid artery were measured using B-mode ultrasound. Results: A total of 100 women were enrolled in each group. The means ± SD of age in preeclamptic, normotensive and nulligravid women were 27.78 ± 3.23, 27.16 ± 3.09, and 27.11 ± 2.95, respectively. The mean gestational age of the two pregnant groups was nearly 32 weeks. Based on the results, the mean systolic blood pressure, diastolic blood pressure, and arterial pressure were significantly higher in the preeclamptic group compared to the other groups (P < 0.001). The mean IMT of both sides of the common carotid artery, carotid bulb, internal carotid artery, common femoral artery, and superficial femoral artery was significantly higher in the preeclamptic group compared to normotensive pregnant and nulligravid women (P < 0.001). Conclusion: Preeclampsia was associated with the increased IMT of common and internal carotid arteries, as well as common and superficial femoral arteries. Therefore, IMT measurements in preeclamptic women can provide an opportunity to identify those who may benefit from early screening and preventive care to reduce the risk of CVDs in the future.
{"title":"Increased Intima-Media Thickness of Carotid and Femoral Arteries in Women with Early Preeclampsia","authors":"Shiva Hassanzadeh, S. Livani, Malihe Azaderah, Mehdi Madadi, Fazel Isapanah Amlashi","doi":"10.5812/iranjradiol-121573","DOIUrl":"https://doi.org/10.5812/iranjradiol-121573","url":null,"abstract":"Background: Preeclampsia can increase the risk of cardiovascular diseases (CVDs) later in life. Also, increased intima-media thickness (IMT) of the carotid artery was introduced as an independent risk factor for CVDs. Objectives: This study aimed to evaluate and compare the IMT of carotid and femoral arteries between women with early preeclampsia and normotensive pregnant and nulligravid women. Methods: In this study, which was conducted between May 2019 and January 2020, three groups of women were evaluated: early-onset preeclamptic pregnant women, normotensive pregnant women, and nulligravid women. The IMTs of the common femoral artery, superficial femoral artery, common carotid artery, carotid bulb, and internal carotid artery were measured using B-mode ultrasound. Results: A total of 100 women were enrolled in each group. The means ± SD of age in preeclamptic, normotensive and nulligravid women were 27.78 ± 3.23, 27.16 ± 3.09, and 27.11 ± 2.95, respectively. The mean gestational age of the two pregnant groups was nearly 32 weeks. Based on the results, the mean systolic blood pressure, diastolic blood pressure, and arterial pressure were significantly higher in the preeclamptic group compared to the other groups (P < 0.001). The mean IMT of both sides of the common carotid artery, carotid bulb, internal carotid artery, common femoral artery, and superficial femoral artery was significantly higher in the preeclamptic group compared to normotensive pregnant and nulligravid women (P < 0.001). Conclusion: Preeclampsia was associated with the increased IMT of common and internal carotid arteries, as well as common and superficial femoral arteries. Therefore, IMT measurements in preeclamptic women can provide an opportunity to identify those who may benefit from early screening and preventive care to reduce the risk of CVDs in the future.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44831970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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