Pub Date : 2022-01-26DOI: 10.5812/iranjradiol.119390
Bahman Rasuli, T. Shooshtarizadeh, S. Hashemi
: Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis. Bilateral symmetric sclerosis of the long bones and possible multiorgan involvement are the main presentations of this disease. Histologically, lipid-laden foamy histiocytes are positive immunochemically for CD68 (occasionally for PS100) and negative for S100 and CD1a in ECD. Herein, we describe the case of a 35-year-old man diagnosed with ECD with peritoneal and retroperitoneal infiltrations and bone involvement. The diagnosis of ECD was only confirmed after two years of non-specific abdominal pain, nausea, and weight loss. Primarily, the patient’s clinical symptoms and abdominal computed tomography (CT) findings, which indicated omental caking, peritoneal thickening, and perinephric soft tissue density, suggested an intra-abdominal malignancy. Finally, a peritoneal biopsy was carried out, which demonstrated xanthogranulomatous infiltrations from ECD. Further radiographic skeletal survey based on histopathological results showed symmetric osteosclerosis of the long bones. Although ECD, associated with peritoneal and retroperitoneal infiltrations, is an uncommon finding, it should be included in the differential diagnosis of patients with non-specific gastrointestinal manifestations, along with multiorgan involvement and typical radiological findings.
{"title":"A Case of Erdheim-Chester Disease with Omental Caking Initially Mistaken for a Malignancy","authors":"Bahman Rasuli, T. Shooshtarizadeh, S. Hashemi","doi":"10.5812/iranjradiol.119390","DOIUrl":"https://doi.org/10.5812/iranjradiol.119390","url":null,"abstract":": Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis. Bilateral symmetric sclerosis of the long bones and possible multiorgan involvement are the main presentations of this disease. Histologically, lipid-laden foamy histiocytes are positive immunochemically for CD68 (occasionally for PS100) and negative for S100 and CD1a in ECD. Herein, we describe the case of a 35-year-old man diagnosed with ECD with peritoneal and retroperitoneal infiltrations and bone involvement. The diagnosis of ECD was only confirmed after two years of non-specific abdominal pain, nausea, and weight loss. Primarily, the patient’s clinical symptoms and abdominal computed tomography (CT) findings, which indicated omental caking, peritoneal thickening, and perinephric soft tissue density, suggested an intra-abdominal malignancy. Finally, a peritoneal biopsy was carried out, which demonstrated xanthogranulomatous infiltrations from ECD. Further radiographic skeletal survey based on histopathological results showed symmetric osteosclerosis of the long bones. Although ECD, associated with peritoneal and retroperitoneal infiltrations, is an uncommon finding, it should be included in the differential diagnosis of patients with non-specific gastrointestinal manifestations, along with multiorgan involvement and typical radiological findings.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46800639","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 : 2022-01-24DOI: 10.5812/iranjradiol.112562
Lei Yuan, Jia Chen, Hui Feng, Junwei Lv, Xuefang Lu, Mengyao Ji
Background: Early prediction of disease progression in COVID-19 patients can be helpful for personalized therapy, as well as the optimal allocation of public health resources. Objectives: This study aimed to present predictive models for identifying potential high-risk COVID-19 patients upon hospital admission, based on the examination of clinical and radiological features by radiologists and artificial intelligence (AI). Patients and Methods: A total of 786 initially non-severe COVID-19 patients were retrospectively enrolled in this study between January 2 and May 28, 2020. The patients were randomly divided into training (n = 628, 80%) and test (n = 158, 20%) groups. Clinical factors, laboratory indicators, and radiologist- and AI-extracted radiological features of pneumonia lesions were determined using a convolution neural network. The features were selected based on the Boruta algorithm with five-fold cross-validation. Four models, including a model based on clinical findings (model C), a model based on the physician’s examination of radiological features (R-Doc model), a model based on AI-derived radiological features (R-AI model), and an AI-based model mimicking the physician’s examinations (AI-Mimic-Doc model), were constructed for predicting COVID-19 progression upon admission, using a logistic regression analysis. The predictive performance of the four models was evaluated by calculating the area under the receiver operating characteristic (AUC) curve with a 95% confidence interval (95% CI) and then compared using the DeLong test. Results: Overall, 238 out of 786 patients (30.3%) progressed into severe or critical pneumonia during the 14-day follow-up. Nine clinical findings, 17 laboratory indicators, 48 physician-extracted radiological features of pneumonia lesions, and 126 AI-driven radiological features were collected. The urea, albumin level, and lesion size in the basal segment of the right lower lobe of the lung or the proportion of CT values in the range of -200 - 60 in the left lung were the representative features for constructing the R-Doc and R-AI models, respectively. Comparison of the R-Doc model (AUC: 0.840, 95% CI: 0.747 - 0.933 for the training set and 0.731, 95% CI: 0.606 - 0.857 for the test set) with the R-AI model (AUC: 0.803, 95% CI: 0.701 - 0.906 for the training set and AUC: 0.731, 95% CI: 0.606 - 0.857 for the validation set) indicated a marginal difference in identifying patients at risk of progression to pneumonia upon admission (P < 0.1). The R-AI model was superior to model C, with an AUC of 0.770 for the training set (95% CI: 0.657 - 0.882) and 0.666 for the validation set to identify high-risk non-severe cases upon admission. Conclusion: By using radiological features along with blood tests, early identification of COVID-19 patients, who are at risk of disease progression, can be achieved on admission (rapidly by using AI); therefore, the use of these features can contribute to the clinical management of CO
{"title":"Early Identification of COVID-19 Progression to Its Severe Form Using Artificial Intelligence","authors":"Lei Yuan, Jia Chen, Hui Feng, Junwei Lv, Xuefang Lu, Mengyao Ji","doi":"10.5812/iranjradiol.112562","DOIUrl":"https://doi.org/10.5812/iranjradiol.112562","url":null,"abstract":"Background: Early prediction of disease progression in COVID-19 patients can be helpful for personalized therapy, as well as the optimal allocation of public health resources. Objectives: This study aimed to present predictive models for identifying potential high-risk COVID-19 patients upon hospital admission, based on the examination of clinical and radiological features by radiologists and artificial intelligence (AI). Patients and Methods: A total of 786 initially non-severe COVID-19 patients were retrospectively enrolled in this study between January 2 and May 28, 2020. The patients were randomly divided into training (n = 628, 80%) and test (n = 158, 20%) groups. Clinical factors, laboratory indicators, and radiologist- and AI-extracted radiological features of pneumonia lesions were determined using a convolution neural network. The features were selected based on the Boruta algorithm with five-fold cross-validation. Four models, including a model based on clinical findings (model C), a model based on the physician’s examination of radiological features (R-Doc model), a model based on AI-derived radiological features (R-AI model), and an AI-based model mimicking the physician’s examinations (AI-Mimic-Doc model), were constructed for predicting COVID-19 progression upon admission, using a logistic regression analysis. The predictive performance of the four models was evaluated by calculating the area under the receiver operating characteristic (AUC) curve with a 95% confidence interval (95% CI) and then compared using the DeLong test. Results: Overall, 238 out of 786 patients (30.3%) progressed into severe or critical pneumonia during the 14-day follow-up. Nine clinical findings, 17 laboratory indicators, 48 physician-extracted radiological features of pneumonia lesions, and 126 AI-driven radiological features were collected. The urea, albumin level, and lesion size in the basal segment of the right lower lobe of the lung or the proportion of CT values in the range of -200 - 60 in the left lung were the representative features for constructing the R-Doc and R-AI models, respectively. Comparison of the R-Doc model (AUC: 0.840, 95% CI: 0.747 - 0.933 for the training set and 0.731, 95% CI: 0.606 - 0.857 for the test set) with the R-AI model (AUC: 0.803, 95% CI: 0.701 - 0.906 for the training set and AUC: 0.731, 95% CI: 0.606 - 0.857 for the validation set) indicated a marginal difference in identifying patients at risk of progression to pneumonia upon admission (P < 0.1). The R-AI model was superior to model C, with an AUC of 0.770 for the training set (95% CI: 0.657 - 0.882) and 0.666 for the validation set to identify high-risk non-severe cases upon admission. Conclusion: By using radiological features along with blood tests, early identification of COVID-19 patients, who are at risk of disease progression, can be achieved on admission (rapidly by using AI); therefore, the use of these features can contribute to the clinical management of CO","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49253151","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 : 2022-01-24DOI: 10.5812/iranjradiol.115141
Murat Dokdok, Meltem Hale Gokmen Alpsan, K. Karaman, Oktay Karadeniz, Y. Kutukcu, S. Gocmen
Background: Dementia and its most common cause, Alzheimer's disease (AD), are growing health problems worldwide. In the pathological process, before the emergence of symptoms, magnetic resonance imaging (MRI) may be used as a non-invasive method for measuring brain perfusion. Objectives: This study aimed to investigate the feasibility and variability of brain perfusion maps derived from pulsed arterial spin labeling (PASL) MRI in a heterogeneous group of patients with cognitive disorders. Patients and Methods: In this cross-sectional study, 85 out of 134 patients with cognitive disorders, including 23 cases of AD, 24 cases of mild cognitive impairment (MCI), 31 cases of depression, and seven cases of subjective memory impairment (SMI), were considered eligible for the study. All patients were evaluated qualitatively with 3D PASL sequences, using inline cerebral blood flow (CBF) maps. Mental examinations and neuropsychological tests were also performed beforehand. Results: Based on the CBF maps, bilateral parietal hypoperfusion was significant in the AD and MCI groups (83 and 67%, respectively), compared to patients with depression or SMI (P < 0.01). However, it was significantly low in depressed patients (13%), and there was no hypoperfusion in the SMI group. There was a good interobserver agreement, based on the kappa coefficient in all groups (0.78%; 95% CI: 0.65 - 0.91). Conclusion: The PASL MRI technique can be valuable for evaluating cognitive disorders, as it is non-invasive, rapid, and easily accessible. Besides, the qualitative assessment of CBF maps using this technique is reproducible and feasible in routine clinical practice.
{"title":"Qualitative Assessment of Perfusion Maps Derived from Pulsed Arterial Spin Labeling Magnetic Resonance Imaging (PASL MRI) in Patients with Cognitive Disorders","authors":"Murat Dokdok, Meltem Hale Gokmen Alpsan, K. Karaman, Oktay Karadeniz, Y. Kutukcu, S. Gocmen","doi":"10.5812/iranjradiol.115141","DOIUrl":"https://doi.org/10.5812/iranjradiol.115141","url":null,"abstract":"Background: Dementia and its most common cause, Alzheimer's disease (AD), are growing health problems worldwide. In the pathological process, before the emergence of symptoms, magnetic resonance imaging (MRI) may be used as a non-invasive method for measuring brain perfusion. Objectives: This study aimed to investigate the feasibility and variability of brain perfusion maps derived from pulsed arterial spin labeling (PASL) MRI in a heterogeneous group of patients with cognitive disorders. Patients and Methods: In this cross-sectional study, 85 out of 134 patients with cognitive disorders, including 23 cases of AD, 24 cases of mild cognitive impairment (MCI), 31 cases of depression, and seven cases of subjective memory impairment (SMI), were considered eligible for the study. All patients were evaluated qualitatively with 3D PASL sequences, using inline cerebral blood flow (CBF) maps. Mental examinations and neuropsychological tests were also performed beforehand. Results: Based on the CBF maps, bilateral parietal hypoperfusion was significant in the AD and MCI groups (83 and 67%, respectively), compared to patients with depression or SMI (P < 0.01). However, it was significantly low in depressed patients (13%), and there was no hypoperfusion in the SMI group. There was a good interobserver agreement, based on the kappa coefficient in all groups (0.78%; 95% CI: 0.65 - 0.91). Conclusion: The PASL MRI technique can be valuable for evaluating cognitive disorders, as it is non-invasive, rapid, and easily accessible. Besides, the qualitative assessment of CBF maps using this technique is reproducible and feasible in routine clinical practice.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49398248","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 : 2021-12-31DOI: 10.5812/IRANJRADIOL.111481
Mahmut Corapli, B. Pehlivanoğlu, H. Alakus, H. Bulut
Background: Early detection of malignant thyroid nodules is possible using ultrasonography (US)-guided fine needle aspiration biopsy (US-FNAB), which is a minimally invasive and easily applicable method. There are several guidelines based on the US findings, including the Thyroid Imaging-Reporting and Data System (TI-RADS), to identify patients requiring FNAB or patients with nodules suspicious of malignancy. Objectives: To emphasize the importance of the easily applicable Kwak TI-RADS classification system. Methods: In this cross-sectional study, the radiological and pathological findings of 641 consecutive patients, who underwent US-FNAB in our center, were retrospectively evaluated. The relationship between the cytological/histopathological results and the US findings was investigated using univariate and multivariate analyses. The results were also compared with the data in the literature. Results: In the univariate analysis, US features, including the presence of a solid component, hypoechogenicity, microlobulation or irregular margins, microcalcifications, and a taller-than-wide shape, were significantly associated with malignancy (P < 0.05). However, in the multivariate analysis, only hypoechogenicity and a taller-than-wide shape significantly contributed to the diagnosis of malignancy (P < 0.05). The malignancy rates of TI-RADS 3, 4a, and 4b lesions were lower in the present study compared to the literature. Conclusions: The US features, including the presence of a solid component, microcalcifications, hypoechogenicity, microlobulation or irregular margins, and a taller-than-wide shape, must be evaluated during US examinations. Besides, the widespread use of Kwak TI-RADS classification system, similar to the Breast Imaging-Reporting and Data System (BI-RADS), should be encouraged to provide a common tool for clinicians and prevent unnecessary surgical procedures.
{"title":"Use of an Easily Applicable Thyroid Imaging-Reporting and Data System (TI-RADS): Our Kwak TI-RADS Experience","authors":"Mahmut Corapli, B. Pehlivanoğlu, H. Alakus, H. Bulut","doi":"10.5812/IRANJRADIOL.111481","DOIUrl":"https://doi.org/10.5812/IRANJRADIOL.111481","url":null,"abstract":"Background: Early detection of malignant thyroid nodules is possible using ultrasonography (US)-guided fine needle aspiration biopsy (US-FNAB), which is a minimally invasive and easily applicable method. There are several guidelines based on the US findings, including the Thyroid Imaging-Reporting and Data System (TI-RADS), to identify patients requiring FNAB or patients with nodules suspicious of malignancy. Objectives: To emphasize the importance of the easily applicable Kwak TI-RADS classification system. Methods: In this cross-sectional study, the radiological and pathological findings of 641 consecutive patients, who underwent US-FNAB in our center, were retrospectively evaluated. The relationship between the cytological/histopathological results and the US findings was investigated using univariate and multivariate analyses. The results were also compared with the data in the literature. Results: In the univariate analysis, US features, including the presence of a solid component, hypoechogenicity, microlobulation or irregular margins, microcalcifications, and a taller-than-wide shape, were significantly associated with malignancy (P < 0.05). However, in the multivariate analysis, only hypoechogenicity and a taller-than-wide shape significantly contributed to the diagnosis of malignancy (P < 0.05). The malignancy rates of TI-RADS 3, 4a, and 4b lesions were lower in the present study compared to the literature. Conclusions: The US features, including the presence of a solid component, microcalcifications, hypoechogenicity, microlobulation or irregular margins, and a taller-than-wide shape, must be evaluated during US examinations. Besides, the widespread use of Kwak TI-RADS classification system, similar to the Breast Imaging-Reporting and Data System (BI-RADS), should be encouraged to provide a common tool for clinicians and prevent unnecessary surgical procedures.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41934331","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 : 2021-12-17DOI: 10.5812/iranjradiol.115118
E. Mohammad Hosseini, A. Rasekhi, Keyvan Eghbal, A. Rahmanian, Arash Saffarrian, Abbas Rakhsha, Sulmaz Ghahramani, M. Jamali
: Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.
{"title":"The Bilateral Sacral Origin of a Spinal Dural Arteriovenous Fistula: A Case Report","authors":"E. Mohammad Hosseini, A. Rasekhi, Keyvan Eghbal, A. Rahmanian, Arash Saffarrian, Abbas Rakhsha, Sulmaz Ghahramani, M. Jamali","doi":"10.5812/iranjradiol.115118","DOIUrl":"https://doi.org/10.5812/iranjradiol.115118","url":null,"abstract":": Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45678969","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 : 2021-12-16DOI: 10.5812/iranjradiol.111918
L. Kwon, S. Hur, H. Jae, S. Min, S. Min, Sanghyun Ahn, A. Han
Background: Endovascular therapy is one of the standard treatment options for patients with peripheral arterial disease. Paclitaxel-eluting stents (PES) have shown promising results in the treatment of obstructive femoropopliteal lesions. Two types of PES, namely, Zilver PTX (Cook Medical, USA) and Eluvia (Boston Scientific, USA), are available worldwide. However, no study has yet compared the outcomes of applying both PES types in the real world. Objectives: This study aimed to assess the one-year outcomes of two different types of PES for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Patients and Methods: This single-center, retrospective, observational study examined 37 limbs of 34 patients (30 males and four females) with the mean age of 71.9 ± 9.1 years (range, 53-90 years), who were included consecutively from February 2017 to May 2018. In all patients, either a Zilver PTX (Cook Medical) or an Eluvia (Boston Scientific) PES was used for TASC C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Moreover, the patients’ one-year primary patency rate, freedom from clinically driven target lesion revascularization (TLR), and event-free survival rates were determined. Results: The mean lesion length was measured to be 24.6 ± 6.6 cm (range, 9 - 46 cm). Based on the results, 78% of the lesions (29 limbs) showed occlusion, and 46% (17 limbs) showed more than moderate calcification. According to the TASC classification, type D lesions were detected in 25 (68%) limbs, while type C lesions were detected in 12 (32%) limbs. The mean number of stents used was 2.5 ± 0.7 per limb (range, 1 - 3) to cover a mean length of 24.3 ± 7.9 cm (range, 6-35 cm). Overall, 56 Zilver PTX stents for 23 limbs and 36 Eluvia stents for 14 limbs were used. The Kaplan-Meier estimates of one-year primary patency and freedom from TLR were 78% and 88%, respectively (Zilver PTX stent, 76.3% and 81.2%, respectively; Eluvia stent, 91.7% and 100%, respectively). Major adverse events were reported in two patients (2/37, 5.4%), including acute thrombotic occlusion of the treated lesions. Conclusion: Both types of PES showed promising one-year outcomes for TASC C/D lesions regarding safety and efficacy, without any significant differences; therefore, they can be considered as an alternative therapeutic approach for surgery.
{"title":"One-Year Outcomes of Two Different Paclitaxel-Eluting Stents (Zilver PTX and Eluvia) for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D Obstructive Femoropopliteal Lesions","authors":"L. Kwon, S. Hur, H. Jae, S. Min, S. Min, Sanghyun Ahn, A. Han","doi":"10.5812/iranjradiol.111918","DOIUrl":"https://doi.org/10.5812/iranjradiol.111918","url":null,"abstract":"Background: Endovascular therapy is one of the standard treatment options for patients with peripheral arterial disease. Paclitaxel-eluting stents (PES) have shown promising results in the treatment of obstructive femoropopliteal lesions. Two types of PES, namely, Zilver PTX (Cook Medical, USA) and Eluvia (Boston Scientific, USA), are available worldwide. However, no study has yet compared the outcomes of applying both PES types in the real world. Objectives: This study aimed to assess the one-year outcomes of two different types of PES for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Patients and Methods: This single-center, retrospective, observational study examined 37 limbs of 34 patients (30 males and four females) with the mean age of 71.9 ± 9.1 years (range, 53-90 years), who were included consecutively from February 2017 to May 2018. In all patients, either a Zilver PTX (Cook Medical) or an Eluvia (Boston Scientific) PES was used for TASC C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Moreover, the patients’ one-year primary patency rate, freedom from clinically driven target lesion revascularization (TLR), and event-free survival rates were determined. Results: The mean lesion length was measured to be 24.6 ± 6.6 cm (range, 9 - 46 cm). Based on the results, 78% of the lesions (29 limbs) showed occlusion, and 46% (17 limbs) showed more than moderate calcification. According to the TASC classification, type D lesions were detected in 25 (68%) limbs, while type C lesions were detected in 12 (32%) limbs. The mean number of stents used was 2.5 ± 0.7 per limb (range, 1 - 3) to cover a mean length of 24.3 ± 7.9 cm (range, 6-35 cm). Overall, 56 Zilver PTX stents for 23 limbs and 36 Eluvia stents for 14 limbs were used. The Kaplan-Meier estimates of one-year primary patency and freedom from TLR were 78% and 88%, respectively (Zilver PTX stent, 76.3% and 81.2%, respectively; Eluvia stent, 91.7% and 100%, respectively). Major adverse events were reported in two patients (2/37, 5.4%), including acute thrombotic occlusion of the treated lesions. Conclusion: Both types of PES showed promising one-year outcomes for TASC C/D lesions regarding safety and efficacy, without any significant differences; therefore, they can be considered as an alternative therapeutic approach for surgery.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41364456","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 : 2021-12-12DOI: 10.5812/iranjradiol.117498
Tae Young Park, S. Y. Kim, S. Bae, S. Han
: Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality in solid organ transplant recipients and immunocompromised hosts. However, tissue-invasive CMV infection, causing cutaneous or subcutaneous diseases, has been rarely reported in the literature, and proper diagnosis can be easily delayed due to the rarity. Here, we report a rare case of a 45-year-old male renal transplant recipient, presenting with subcutaneous nodules. The nodules were initially suspected as a post-transplant lymphoproliferative disorder (PTLD) on CT scan. However, biopsy later indicated a CMV infection. Based on the present findings, clinicians and radiologists are suggested to consider CMV infection as a differential diagnosis of subcutaneous nodular lesions in solid organ transplant recipients.
{"title":"An Atypical Subcutaneous Cytomegalovirus Infection Mimicking a Post-transplant Lymphoproliferative Disorder in a Solid Organ Transplant Recipient","authors":"Tae Young Park, S. Y. Kim, S. Bae, S. Han","doi":"10.5812/iranjradiol.117498","DOIUrl":"https://doi.org/10.5812/iranjradiol.117498","url":null,"abstract":": Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality in solid organ transplant recipients and immunocompromised hosts. However, tissue-invasive CMV infection, causing cutaneous or subcutaneous diseases, has been rarely reported in the literature, and proper diagnosis can be easily delayed due to the rarity. Here, we report a rare case of a 45-year-old male renal transplant recipient, presenting with subcutaneous nodules. The nodules were initially suspected as a post-transplant lymphoproliferative disorder (PTLD) on CT scan. However, biopsy later indicated a CMV infection. Based on the present findings, clinicians and radiologists are suggested to consider CMV infection as a differential diagnosis of subcutaneous nodular lesions in solid organ transplant recipients.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44246303","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 : 2021-11-24DOI: 10.5812/iranjradiol.114976
Hongfang Xu, Wei Zeng, Z. Fu, Qing Cui
Background: Early diagnosis and timely treatment are crucial for breast cancer patients. Objectives: This study aimed to investigate the diagnostic value of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and magnetic resonance imaging (MRI) for breast cancer. Patients and Methods: This study was performed on 210 patients diagnosed with breast cancer and benign breast lesions (n = 105) by FFDM, DBT, MRI, and pathological examination from January 2019 to December 2020. The patients’ imaging and clinical data were retrospectively analyzed. The lesions were evaluated according to the breast imaging-reporting and data system, with pathological diagnosis as the gold standard. The diagnostic efficiency of the examination methods was analyzed by plotting the receiver operating characteristic (ROC) curves. The DBT and MRI results were finally compared. Results: In 210 patients, 105 benign and 105 malignant lesions were detected. The area under the ROC curve (AUC) of FFDM, DBT, MRI, FFDM + DBT, and FFDM + MRI was 0.734, 0.857, 0.883, 0.865, and 0.924, respectively. Based on the results, the AUC values were significantly higher for DBT, MRI, FFDM + DBT, and FFDM + MRI compared to FFDM (P < 0.05), while similar values were reported for the former methods (P > 0.05). The diagnostic sensitivity of MRI was higher than that of DBT and FFDM; the sensitivity of DBT was higher than that of FFDM; and the specificity and positive predictive value were higher for DBT compared to MRI and FFDM. Conclusion: Compared to FFDM, DBT and FFDM + DBT could significantly improve the diagnostic efficiency of breast cancer; the diagnostic efficiency of these modalities was comparable to that of MRI and FFDM + MRI. The sensitivity of DBT was lower than that of MRI and higher than that of FFDM, while its specificity and positive predictive value were higher than those of MRI. Overall, FFDM + DBT and FFDM + MRI are conducive to early diagnosis.
{"title":"Diagnostic Value of Digital Breast Tomosynthesis Combined with Magnetic Resonance Imaging for Breast Cancer in Dense Breast Tissues","authors":"Hongfang Xu, Wei Zeng, Z. Fu, Qing Cui","doi":"10.5812/iranjradiol.114976","DOIUrl":"https://doi.org/10.5812/iranjradiol.114976","url":null,"abstract":"Background: Early diagnosis and timely treatment are crucial for breast cancer patients. Objectives: This study aimed to investigate the diagnostic value of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and magnetic resonance imaging (MRI) for breast cancer. Patients and Methods: This study was performed on 210 patients diagnosed with breast cancer and benign breast lesions (n = 105) by FFDM, DBT, MRI, and pathological examination from January 2019 to December 2020. The patients’ imaging and clinical data were retrospectively analyzed. The lesions were evaluated according to the breast imaging-reporting and data system, with pathological diagnosis as the gold standard. The diagnostic efficiency of the examination methods was analyzed by plotting the receiver operating characteristic (ROC) curves. The DBT and MRI results were finally compared. Results: In 210 patients, 105 benign and 105 malignant lesions were detected. The area under the ROC curve (AUC) of FFDM, DBT, MRI, FFDM + DBT, and FFDM + MRI was 0.734, 0.857, 0.883, 0.865, and 0.924, respectively. Based on the results, the AUC values were significantly higher for DBT, MRI, FFDM + DBT, and FFDM + MRI compared to FFDM (P < 0.05), while similar values were reported for the former methods (P > 0.05). The diagnostic sensitivity of MRI was higher than that of DBT and FFDM; the sensitivity of DBT was higher than that of FFDM; and the specificity and positive predictive value were higher for DBT compared to MRI and FFDM. Conclusion: Compared to FFDM, DBT and FFDM + DBT could significantly improve the diagnostic efficiency of breast cancer; the diagnostic efficiency of these modalities was comparable to that of MRI and FFDM + MRI. The sensitivity of DBT was lower than that of MRI and higher than that of FFDM, while its specificity and positive predictive value were higher than those of MRI. Overall, FFDM + DBT and FFDM + MRI are conducive to early diagnosis.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45061483","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 : 2021-11-23DOI: 10.5812/iranjradiol.112305
Murat Bayav, M. Şahin
Background: Anatomical variations in vascular structures are frequently encountered. In the cerebellopontine region, anatomical variations, especially variations in the anterior inferior cerebellar artery (AICA) in relation to cranial nerves passing through the internal acoustic canal (IAC), are common. Magnetic resonance imaging (MRI) provides detailed information for the evaluation of the cerebellopontine region and the IAC anatomy. Objectives: This study aimed to examine the relationship between the IAC anatomy and AICA loop variations and to investigate the frequency of anatomical variations and its correlation with demographic variables. Patients and Methods: In this study, 253 patients (age > 18 years), who underwent 3-Tesla MRI of the temporal bone between July 2019 and December 2019, were retrospectively evaluated. The exclusion criteria were images of poor diagnostic quality due to technical or patient-related reasons and the presence of a localized tumor that could disrupt the IAC. Four patients were excluded from the study because they had tumors related to IAC. The AICA variations were categorized according to the Chavda classification. The IAC size, canal diameter, canal length, and meatus width were measured, and the canals were characterized as cylindrical, funnel-shaped, and bud-shaped. Results: A total of 249 patients were included in this study. The Chavda type I vascular loop was the most common type on both sides. The mean size measurements of IACs were significantly higher in the group of vascular loops compared to the group without vascular loops. The presence of a vascular loop was significantly more common in funnel- and bud-shaped IACs compared to cylindrical IAC. Also, there was a negative correlation between the patient’s age and all IAC dimensions. Conclusion: The results of the present study showed that the AICA loop variations were closely related to the size and shape of the IAC.
{"title":"Evaluation of the Relationship Between the Internal Acoustic Canal Anatomy and Loops of the Anterior Inferior Cerebellar Artery Using 3-Tesla Magnetic Resonance Imaging","authors":"Murat Bayav, M. Şahin","doi":"10.5812/iranjradiol.112305","DOIUrl":"https://doi.org/10.5812/iranjradiol.112305","url":null,"abstract":"Background: Anatomical variations in vascular structures are frequently encountered. In the cerebellopontine region, anatomical variations, especially variations in the anterior inferior cerebellar artery (AICA) in relation to cranial nerves passing through the internal acoustic canal (IAC), are common. Magnetic resonance imaging (MRI) provides detailed information for the evaluation of the cerebellopontine region and the IAC anatomy. Objectives: This study aimed to examine the relationship between the IAC anatomy and AICA loop variations and to investigate the frequency of anatomical variations and its correlation with demographic variables. Patients and Methods: In this study, 253 patients (age > 18 years), who underwent 3-Tesla MRI of the temporal bone between July 2019 and December 2019, were retrospectively evaluated. The exclusion criteria were images of poor diagnostic quality due to technical or patient-related reasons and the presence of a localized tumor that could disrupt the IAC. Four patients were excluded from the study because they had tumors related to IAC. The AICA variations were categorized according to the Chavda classification. The IAC size, canal diameter, canal length, and meatus width were measured, and the canals were characterized as cylindrical, funnel-shaped, and bud-shaped. Results: A total of 249 patients were included in this study. The Chavda type I vascular loop was the most common type on both sides. The mean size measurements of IACs were significantly higher in the group of vascular loops compared to the group without vascular loops. The presence of a vascular loop was significantly more common in funnel- and bud-shaped IACs compared to cylindrical IAC. Also, there was a negative correlation between the patient’s age and all IAC dimensions. Conclusion: The results of the present study showed that the AICA loop variations were closely related to the size and shape of the IAC.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49319653","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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