Pub Date : 2021-10-11DOI: 10.5812/iranjradiol.110963
G. Erbay, M. Goren, E. Karadeli, B. Pekoz, Z. Koc, S. Arıca
Background: The histopathological differentiation of renal neoplasms can be challenging via imaging. Objectives: To evaluate differences in histogram parameters on apparent diffusion coefficient (ADC) maps and to investigate the efficacy of histogram analysis in differentiation of oncocytomas from malignant renal neoplasm (MRN) subgroups. Patients and Methods: In this cross-sectional, retrospective study, the texture parameters of diffusion-weighted magnetic resonance images (DW-MRI) were evaluated in 65 patients with renal tumors (nine cases of oncocytoma and 59 cases of MRN) for a histological analysis. Results: A total of 68 lesions from 50 male and 15 female patients, with a median age of 55.4 years, were examined in this study. There were significant differences in the mean, median, and peak ADC values, as well as ADC percentiles, between the oncocytoma and MRN subgroups. Regarding the histopathological features of the lesions, 9 (11.5%) cases of oncocytomas, 23 (29.5%) cases of clear cell renal carcinoma (ccRCC), 14 (17.9%) cases of papillary renal cell carcinoma (pRCC), 12 (15.4%) cases of chromophobe renal cell carcinoma (chRCC), and 10 (12.8%) other tumors (including four cases of transitional cell carcinoma, four cases of non-Hodgkin’s lymphoma, and two cases of primitive neuroectodermal tumor) were identified. Significant differences were found in the mean and median ADC values between the oncocytoma, pRCC, chRCC, and other MRN subgroups. Moreover, significant differences were found in the mean and median ADC values between the ccRCC, pRCC, and chRCC subgroups. There were also significant differences in the percentiles of mean and median ADCs between oncocytomas and pRCC, chRCC, and other MRN subgroups. However, there were no significant differences in the mean and median ADCs (including the percentile histogram analysis) or the peak ADC between the oncocytoma and ccRCC groups. The mean, median, and percentile of ADC for renal masses were superior to kurtosis, skewness, and entropy. Conclusion: Although differentiation between ccRCC and oncocytoma was not possible by only measuring the mean, median, and peak ADC values, the histogram analysis of ADCs may improve differentiation between the MRN subgroups. Clearly, ADC cannot be used to differentiate between oncocytomas and MRNs.
{"title":"Use of Histogram Analysis in Diffusion-Weighted Magnetic Resonance Imaging for Differentiation of Renal Tumor Subgroups","authors":"G. Erbay, M. Goren, E. Karadeli, B. Pekoz, Z. Koc, S. Arıca","doi":"10.5812/iranjradiol.110963","DOIUrl":"https://doi.org/10.5812/iranjradiol.110963","url":null,"abstract":"Background: The histopathological differentiation of renal neoplasms can be challenging via imaging. Objectives: To evaluate differences in histogram parameters on apparent diffusion coefficient (ADC) maps and to investigate the efficacy of histogram analysis in differentiation of oncocytomas from malignant renal neoplasm (MRN) subgroups. Patients and Methods: In this cross-sectional, retrospective study, the texture parameters of diffusion-weighted magnetic resonance images (DW-MRI) were evaluated in 65 patients with renal tumors (nine cases of oncocytoma and 59 cases of MRN) for a histological analysis. Results: A total of 68 lesions from 50 male and 15 female patients, with a median age of 55.4 years, were examined in this study. There were significant differences in the mean, median, and peak ADC values, as well as ADC percentiles, between the oncocytoma and MRN subgroups. Regarding the histopathological features of the lesions, 9 (11.5%) cases of oncocytomas, 23 (29.5%) cases of clear cell renal carcinoma (ccRCC), 14 (17.9%) cases of papillary renal cell carcinoma (pRCC), 12 (15.4%) cases of chromophobe renal cell carcinoma (chRCC), and 10 (12.8%) other tumors (including four cases of transitional cell carcinoma, four cases of non-Hodgkin’s lymphoma, and two cases of primitive neuroectodermal tumor) were identified. Significant differences were found in the mean and median ADC values between the oncocytoma, pRCC, chRCC, and other MRN subgroups. Moreover, significant differences were found in the mean and median ADC values between the ccRCC, pRCC, and chRCC subgroups. There were also significant differences in the percentiles of mean and median ADCs between oncocytomas and pRCC, chRCC, and other MRN subgroups. However, there were no significant differences in the mean and median ADCs (including the percentile histogram analysis) or the peak ADC between the oncocytoma and ccRCC groups. The mean, median, and percentile of ADC for renal masses were superior to kurtosis, skewness, and entropy. Conclusion: Although differentiation between ccRCC and oncocytoma was not possible by only measuring the mean, median, and peak ADC values, the histogram analysis of ADCs may improve differentiation between the MRN subgroups. Clearly, ADC cannot be used to differentiate between oncocytomas and MRNs.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49235434","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 : 2021-10-11DOI: 10.5812/iranjradiol.113845
Z. Arslan, A. Altunkeser, N. Aksoy, M. Korez, Ethem Omeroglu
Background: Digital mammography (DM) is one of the most common and effective radiological methods for breast cancer screening and detection. A dense fibroglandular breast tissue can lead to false negative results by superimposing on the lesion margins. Therefore, adjunctive imaging methods, such as digital breast tomosynthesis (DBT) and ultrasonography (US), are needed to increase mammographic sensitivity. Objectives: This study aimed to examine the contribution of US and DBT to DM in different patient groups (patients group of BI-RADS 0 and 3-4 lesions, patients with dense breast parenchyma, patients with non-dense breast parenchyma).. Whether US and DBT can upgrade or downgrade the BI-RADS category of uncertain lesions detected on DM was also investigated. Patients and Methods: Forty-six patients, who were classified as BI-RADS categories 0, 3, and 4 in DM, according to DBT and US findings, were included in the study. DM followed by DBT was performed for the patients, and the BI-RADS classification system was applied. Subsequently, the patients were evaluated sonographically, and the BI-RADS system was applied according to the US results. Each BI-RADS category was compared with the histopathological and multimodality follow-up results. The diagnostic performance of all modalities was also examined alone and in combination. Results: The sensitivity and specificity of DM alone was 42% and 87%, respectively. DBT detected the lesions with 92% sensitivity and 68% specificity. The modality with the highest sensitivity for the detection of malignant lesions was US (100%). Besides, the specificity of DBT was significantly high for dense breasts (P < 0.001). There was no significant difference in terms of the diagnostic accuracy of US measurements between dense and non-dense breasts. For indeterminate lesions, the integration of DBT and US to DM increased the diagnostic accuracy. Conclusion: The contribution of DBT is more valuable than US in patients with dense breast parenchyma.
{"title":"Which Modality Should Be Integrated to Increase the Diagnostic Efficiency of BI-RADS 0, 3, and 4 Lesions? Ultrasonography or Digital Breast Tomosynthesis?","authors":"Z. Arslan, A. Altunkeser, N. Aksoy, M. Korez, Ethem Omeroglu","doi":"10.5812/iranjradiol.113845","DOIUrl":"https://doi.org/10.5812/iranjradiol.113845","url":null,"abstract":"Background: Digital mammography (DM) is one of the most common and effective radiological methods for breast cancer screening and detection. A dense fibroglandular breast tissue can lead to false negative results by superimposing on the lesion margins. Therefore, adjunctive imaging methods, such as digital breast tomosynthesis (DBT) and ultrasonography (US), are needed to increase mammographic sensitivity. Objectives: This study aimed to examine the contribution of US and DBT to DM in different patient groups (patients group of BI-RADS 0 and 3-4 lesions, patients with dense breast parenchyma, patients with non-dense breast parenchyma).. Whether US and DBT can upgrade or downgrade the BI-RADS category of uncertain lesions detected on DM was also investigated. Patients and Methods: Forty-six patients, who were classified as BI-RADS categories 0, 3, and 4 in DM, according to DBT and US findings, were included in the study. DM followed by DBT was performed for the patients, and the BI-RADS classification system was applied. Subsequently, the patients were evaluated sonographically, and the BI-RADS system was applied according to the US results. Each BI-RADS category was compared with the histopathological and multimodality follow-up results. The diagnostic performance of all modalities was also examined alone and in combination. Results: The sensitivity and specificity of DM alone was 42% and 87%, respectively. DBT detected the lesions with 92% sensitivity and 68% specificity. The modality with the highest sensitivity for the detection of malignant lesions was US (100%). Besides, the specificity of DBT was significantly high for dense breasts (P < 0.001). There was no significant difference in terms of the diagnostic accuracy of US measurements between dense and non-dense breasts. For indeterminate lesions, the integration of DBT and US to DM increased the diagnostic accuracy. Conclusion: The contribution of DBT is more valuable than US in patients with dense breast parenchyma.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45881375","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 : 2021-10-11DOI: 10.5812/iranjradiol.113846
A. Altunkeser, Z. Arslan, M. Eryılmaz, M. Korez, Z. Bayramoğlu
Background: Digital mammography (DM) and digital breast tomosynthesis (DBT) are important radiological modalities, which increase the survival of breast cancer patients. Breast cancer is a morphologically heterogeneous disease with various histopathological parameters and multiple receptors in its biological profile. Objectives: This study aimed to analyze the morphological features of invasive breast cancer on DM and DBT, to investigate the contribution of DBT to DM, to examine the association of DBT findings with pathological molecular subtypes, Bloom-Richardson grade, and Ki-67 index, and to determine the effect of breast parenchyma density on the relationship between DBT findings and hormone receptors. Patients and Methods: A total of 36 patients with malignant lesions were evaluated in this study. According to the American College of Radiology (ACR) classification, the lesion features were divided into subgroups based on DM and DBT, and the findings were compared. The relationships between DBT findings and the hormone receptor status, molecular classification, and Bloom-Richardson grade were also investigated, and the effect of density on these relationships was assessed. Results: The mean age of the patients (n = 36) was 53 years. Based on the comparison of DM and DBT findings, spiculated margins, mass density, architectural distortion, and microcalcifications were significantly more frequent in DBT. Lesions with indistinct margins on DM were observed as mass lesions with spiculated margins on DBT (P < 0.001). Regarding the relationship between DBT findings and hormone receptor status and Ki-67 proliferation index, in PR-positive patients, an irregular tumor shape was more common (89.7%). In PR-negative patients, skin changes and nipple retraction were more frequently seen (P = 0.03 for skin changes, and P = 0.049 for nipple retraction). Regarding the association between Bloom-Richardson grade and DBT findings, tumors with a higher grade were more likely to be associated with a high tumor density (P = 0.032). Also, considering the relationship between molecular classification and DBT findings, skin changes and nipple retraction were significantly more frequent in triple-negative masses compared to other subtypes (P = 0.011 for skin changes and P = 0.016 for nipple retraction). Conclusions: DBT is superior to DM, as it reveals the lesion margins, density, and architectural distortion more accurately. The majority of PR-positive tumors were irregular, while most PR-negative cases were round. The mass density also increased as the tumor grade increased. Skin change and nipple retraction were frequently seen in triple-negative tumors compared to other subtypes. Therefore, DBT is a promising diagnostic tool for showing molecular subtypes in dense breasts.
{"title":"Is Digital Breast Tomosynthesis Superior to Digital Mammography? A Preclinical Evaluation of Tumor Histopathological Markers Using Digital Breast Tomosynthesis","authors":"A. Altunkeser, Z. Arslan, M. Eryılmaz, M. Korez, Z. Bayramoğlu","doi":"10.5812/iranjradiol.113846","DOIUrl":"https://doi.org/10.5812/iranjradiol.113846","url":null,"abstract":"Background: Digital mammography (DM) and digital breast tomosynthesis (DBT) are important radiological modalities, which increase the survival of breast cancer patients. Breast cancer is a morphologically heterogeneous disease with various histopathological parameters and multiple receptors in its biological profile. Objectives: This study aimed to analyze the morphological features of invasive breast cancer on DM and DBT, to investigate the contribution of DBT to DM, to examine the association of DBT findings with pathological molecular subtypes, Bloom-Richardson grade, and Ki-67 index, and to determine the effect of breast parenchyma density on the relationship between DBT findings and hormone receptors. Patients and Methods: A total of 36 patients with malignant lesions were evaluated in this study. According to the American College of Radiology (ACR) classification, the lesion features were divided into subgroups based on DM and DBT, and the findings were compared. The relationships between DBT findings and the hormone receptor status, molecular classification, and Bloom-Richardson grade were also investigated, and the effect of density on these relationships was assessed. Results: The mean age of the patients (n = 36) was 53 years. Based on the comparison of DM and DBT findings, spiculated margins, mass density, architectural distortion, and microcalcifications were significantly more frequent in DBT. Lesions with indistinct margins on DM were observed as mass lesions with spiculated margins on DBT (P < 0.001). Regarding the relationship between DBT findings and hormone receptor status and Ki-67 proliferation index, in PR-positive patients, an irregular tumor shape was more common (89.7%). In PR-negative patients, skin changes and nipple retraction were more frequently seen (P = 0.03 for skin changes, and P = 0.049 for nipple retraction). Regarding the association between Bloom-Richardson grade and DBT findings, tumors with a higher grade were more likely to be associated with a high tumor density (P = 0.032). Also, considering the relationship between molecular classification and DBT findings, skin changes and nipple retraction were significantly more frequent in triple-negative masses compared to other subtypes (P = 0.011 for skin changes and P = 0.016 for nipple retraction). Conclusions: DBT is superior to DM, as it reveals the lesion margins, density, and architectural distortion more accurately. The majority of PR-positive tumors were irregular, while most PR-negative cases were round. The mass density also increased as the tumor grade increased. Skin change and nipple retraction were frequently seen in triple-negative tumors compared to other subtypes. Therefore, DBT is a promising diagnostic tool for showing molecular subtypes in dense breasts.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47570170","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 : 2021-10-09DOI: 10.5812/iranjradiol.114397
M. Mohammadzadeh, Z. Sheibani, M. Shakiba, A. Azimi, Arezou Hashemzadeh, Mojtaba Barzegar, H. Naghibi
Background: Magnetic resonance imaging (MRI) with gadolinium (GAD)-based contrast agents has been the imaging modality of choice for early detection and monitoring of multiple sclerosis (MS) patients. Objectives: This study aimed to assess the effect of multiple injections of linear GAD-based contrast agents on the signal intensity of the dentate nucleus (DN) in MS patients. Patients and Methods: A cohort of 122 MS patients with GAD-enhanced MRI scans and 61 healthy controls were enrolled in this study. The final standard GAD-enhanced MRI scans were acquired using 1.5T MRI systems. Non-enhanced T1-weighted MRI was performed to assess the DN hyperintensity. The signal intensity ratio (SIR) was also calculated by setting the regions of interest (ROIs) on the DN and pons and dividing the signal intensity of DN to that of pons. The patients were also divided into two subgroups, based on the total number of MRI exposures (> 4 times vs. others), and the subgroups were compared in terms of the mean SIR and hyperintensity. Results: Overall, 68% (n = 83) of the patients were exposed to a contrast agent more than four times. Of these patients, 31.3% (n = 26) showed DN hyperintensity, while no hyperintensity was found in other patients or healthy controls (P < 0.02 for both). The mean SIRs were 1.10 ± 0.07 and 1.04 ± 0.02 in the patients and healthy controls, respectively (P < 0.001). Besides, the mean SIR was 1.14 ± 0.04 in patients with DN hyperintensity and 1.09 ± 0.07 in other patients (P < 0.001). Based on the results, the mean SIR was 1.12 ± 0.7 in patients with > 4 contrast injections, while it was 1.06 ± 0.04 in patients with < 4 contrast injections (P < 0.001). Conclusion: The SIR and visible DN hyperintensity increased by increasing the number of GAD injections, which could be due to the tissue deposition of GAD.
{"title":"Evaluation of the Effect of Multiple Linear Gadolinium-Based Contrast Agent Exposures on the Signal Intensity of the Dentate Nucleus in Multiple Sclerosis Patients","authors":"M. Mohammadzadeh, Z. Sheibani, M. Shakiba, A. Azimi, Arezou Hashemzadeh, Mojtaba Barzegar, H. Naghibi","doi":"10.5812/iranjradiol.114397","DOIUrl":"https://doi.org/10.5812/iranjradiol.114397","url":null,"abstract":"Background: Magnetic resonance imaging (MRI) with gadolinium (GAD)-based contrast agents has been the imaging modality of choice for early detection and monitoring of multiple sclerosis (MS) patients. Objectives: This study aimed to assess the effect of multiple injections of linear GAD-based contrast agents on the signal intensity of the dentate nucleus (DN) in MS patients. Patients and Methods: A cohort of 122 MS patients with GAD-enhanced MRI scans and 61 healthy controls were enrolled in this study. The final standard GAD-enhanced MRI scans were acquired using 1.5T MRI systems. Non-enhanced T1-weighted MRI was performed to assess the DN hyperintensity. The signal intensity ratio (SIR) was also calculated by setting the regions of interest (ROIs) on the DN and pons and dividing the signal intensity of DN to that of pons. The patients were also divided into two subgroups, based on the total number of MRI exposures (> 4 times vs. others), and the subgroups were compared in terms of the mean SIR and hyperintensity. Results: Overall, 68% (n = 83) of the patients were exposed to a contrast agent more than four times. Of these patients, 31.3% (n = 26) showed DN hyperintensity, while no hyperintensity was found in other patients or healthy controls (P < 0.02 for both). The mean SIRs were 1.10 ± 0.07 and 1.04 ± 0.02 in the patients and healthy controls, respectively (P < 0.001). Besides, the mean SIR was 1.14 ± 0.04 in patients with DN hyperintensity and 1.09 ± 0.07 in other patients (P < 0.001). Based on the results, the mean SIR was 1.12 ± 0.7 in patients with > 4 contrast injections, while it was 1.06 ± 0.04 in patients with < 4 contrast injections (P < 0.001). Conclusion: The SIR and visible DN hyperintensity increased by increasing the number of GAD injections, which could be due to the tissue deposition of GAD.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42743048","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 : 2021-09-21DOI: 10.5812/iranjradiol.112648
Dalin Zhu, Manxia Wang, F. Feng, Nan Nan, Yuefen Liu, Jinyun Shi, B. Mao
Background: Brain injury in premature infants (BIPI) is a severe brain damage in premature infants, resulting in a series of neurological sequelae. Diffusion tensor imaging (DTI), as a magnetic resonance imaging (MRI) technique, is more widely used for premature infants. It is of paramount importance to improve the early diagnosis, treatment, and intervention for this population by using DTI. There are few reports on the application of DTI for the evaluation of BIPI in low-birth-weight (LBW) and very-low-birth-weight (VLBW) infants. Objectives: To analyze the clinical characteristics of BIPI in LBW and VLBW infants and to explore the value of MRI-based DTI in the evaluation of BIPI in LBW infants. Patients and Methods: This prospective study was conducted on 31 cases of BIPI (16 LBW and 15 VLBW infants) and 20 normal control premature infants, undergoing MRI-based DTI at the postmenstrual age (PMA). Differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between the BIPI and control groups and also between the LBW and VLBW groups with BIPI were analyzed. Also, differences with normal controls in terms of the FA and ADC values were investigated in different brain regions. Results: The FA values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, posterior limb of the internal capsule (PLIC), and ventral thalamus were significantly lower in the BIPI group as compared to the control group (P < 0.05). The ADCs were lower in the BIPI group compared to the control group, and there was a significant difference (P < 0.05). Comparison of FA and ADC values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, PLIC, and ventral thalamus did not show any significant differences between the LBW and VLBW groups with BIPI (P > 0.05). Conclusion: The FA and ADC values of DTI can be used for the quantitative evaluation of BIPI in LBW and VLBW infants. The FA value was found to be more accurate than the ADC. Overall, different FA values in different brain areas reflect differences in the brain development of normal premature infants.
{"title":"Application of Diffusion Tensor Imaging in the Evaluation of Brain Injury in Premature Infants with Low and Very Low Birth Weight","authors":"Dalin Zhu, Manxia Wang, F. Feng, Nan Nan, Yuefen Liu, Jinyun Shi, B. Mao","doi":"10.5812/iranjradiol.112648","DOIUrl":"https://doi.org/10.5812/iranjradiol.112648","url":null,"abstract":"Background: Brain injury in premature infants (BIPI) is a severe brain damage in premature infants, resulting in a series of neurological sequelae. Diffusion tensor imaging (DTI), as a magnetic resonance imaging (MRI) technique, is more widely used for premature infants. It is of paramount importance to improve the early diagnosis, treatment, and intervention for this population by using DTI. There are few reports on the application of DTI for the evaluation of BIPI in low-birth-weight (LBW) and very-low-birth-weight (VLBW) infants. Objectives: To analyze the clinical characteristics of BIPI in LBW and VLBW infants and to explore the value of MRI-based DTI in the evaluation of BIPI in LBW infants. Patients and Methods: This prospective study was conducted on 31 cases of BIPI (16 LBW and 15 VLBW infants) and 20 normal control premature infants, undergoing MRI-based DTI at the postmenstrual age (PMA). Differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between the BIPI and control groups and also between the LBW and VLBW groups with BIPI were analyzed. Also, differences with normal controls in terms of the FA and ADC values were investigated in different brain regions. Results: The FA values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, posterior limb of the internal capsule (PLIC), and ventral thalamus were significantly lower in the BIPI group as compared to the control group (P < 0.05). The ADCs were lower in the BIPI group compared to the control group, and there was a significant difference (P < 0.05). Comparison of FA and ADC values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, PLIC, and ventral thalamus did not show any significant differences between the LBW and VLBW groups with BIPI (P > 0.05). Conclusion: The FA and ADC values of DTI can be used for the quantitative evaluation of BIPI in LBW and VLBW infants. The FA value was found to be more accurate than the ADC. Overall, different FA values in different brain areas reflect differences in the brain development of normal premature infants.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46538008","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 : 2021-09-11DOI: 10.5812/iranjradiol.113862
N. Jung, B. Kang, Sung Hun Kim, I. Yoo, Y. Lim, W. Yoo
Background: Accurate preoperative detection of the invasive components of ductal carcinoma in situ (DCIS) is essential for an appropriate treatment. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan, which can indicate the metabolic activity and aggressiveness of breast cancer, may be used as one of the predictors of the invasive components of DCIS in needle biopsy. Objectives: To determine whether the FDG-PET/CT findings are associated with the histological upgrade of DCIS in biopsy. Methods: In this retrospective cohort, we reviewed 165 cases of DCIS in 162 patients, who underwent preoperative FDG-PET/CT examinations between April 2008 and September 2015. The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared, based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. The significant predictors of DCIS histological upgrade were age (P = 0.011), SUVmax (P < 0.001), visual analysis of FDG-PET/CT (P = 0.004), and pathological tumor size (P = 0.003) in the univariate analysis. In the multivariate analysis, the SUVmax (odds ratio [OR] = 3.31, P = 0.003) and tumor size (OR = 1.20, P = 0.022) were significant when the model included the SUVmax, age, and size (model 1). On the other hand, age (OR = 0.96, P = 0.032), visual analysis (OR = 4.67, P = 0.006), and tumor size (OR = 1.25, P = 0.005) were significant predictors when the model included visual analysis, age, and size (model 2). The sensitivity was significantly higher in the visual analysis, whereas the specificity, positive predictive value (PPV), and accuracy were significantly higher in the semi-quantitative analysis. Conclusion: FDG-PET/CT is a potentially useful imaging tool to predict the upgrade of DCIS to invasive cancer.
{"title":"Role of FDG-PET/CT in Identification of Histological Upgrade of Ductal Carcinoma in Situ (DCIS) in Needle Biopsy","authors":"N. Jung, B. Kang, Sung Hun Kim, I. Yoo, Y. Lim, W. Yoo","doi":"10.5812/iranjradiol.113862","DOIUrl":"https://doi.org/10.5812/iranjradiol.113862","url":null,"abstract":"Background: Accurate preoperative detection of the invasive components of ductal carcinoma in situ (DCIS) is essential for an appropriate treatment. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan, which can indicate the metabolic activity and aggressiveness of breast cancer, may be used as one of the predictors of the invasive components of DCIS in needle biopsy. Objectives: To determine whether the FDG-PET/CT findings are associated with the histological upgrade of DCIS in biopsy. Methods: In this retrospective cohort, we reviewed 165 cases of DCIS in 162 patients, who underwent preoperative FDG-PET/CT examinations between April 2008 and September 2015. The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared, based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. The significant predictors of DCIS histological upgrade were age (P = 0.011), SUVmax (P < 0.001), visual analysis of FDG-PET/CT (P = 0.004), and pathological tumor size (P = 0.003) in the univariate analysis. In the multivariate analysis, the SUVmax (odds ratio [OR] = 3.31, P = 0.003) and tumor size (OR = 1.20, P = 0.022) were significant when the model included the SUVmax, age, and size (model 1). On the other hand, age (OR = 0.96, P = 0.032), visual analysis (OR = 4.67, P = 0.006), and tumor size (OR = 1.25, P = 0.005) were significant predictors when the model included visual analysis, age, and size (model 2). The sensitivity was significantly higher in the visual analysis, whereas the specificity, positive predictive value (PPV), and accuracy were significantly higher in the semi-quantitative analysis. Conclusion: FDG-PET/CT is a potentially useful imaging tool to predict the upgrade of DCIS to invasive cancer.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47916174","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 : 2021-08-06DOI: 10.21203/rs.3.rs-781540/v1
K. Sim, B. Park, Byunjun Kim, Y. Han, N. Y. Han, Min Ju Kim, D. Sung, Sang-Hyun Park, Kwang-Sig Lee, Yongwon Cho
Background: To investigate the usefulness of body navigation-loaded ultrasound including a real time transducer location and the inspection site compared with conventional ultrasound images.Methods: Under the approval of institutional review board, we prospectively enrolled total 29 healthy adult volunteers. One gastrointestinal radiologist performed abdominal ultrasound simultaneously using Ultrasound Navigation Image Convergence System developed by researchers. Subsequently, an equivalent conventional ultrasound image set was prepared. Three radiologists independently evaluated the two ultrasound image sets regarding the recognition of the target organ (2-points), the transducer location (2-points), and the transducer orientation (1-point). At intervals of two-weeks, conventional ultrasound images were analyzed first, and body navigation-loaded images were later analyzed. The score differences between the first and second evaluations were compared using the Wilcoxon signed rank test. Inter-rater agreement of three reviewers was obtained by the Fleiss’ Kappa test.Results: A total of 1402 navigation-loaded ultrasound images were obtained. Ultrasound operator carefully selected a total of 203 images for analysis. In all three reviewers, the interpretation score of each evaluation was significantly increased in the second analysis using the body navigation-loaded ultrasound image (in reviewer A, from 4.07±1.56 to 4.79±0.69 points; in reviewer B, from 3.83±1.59 to 4.49±0.88 points; in reviewer C, from 3.43±1.60 to 4.19±1.01 points; P<.0001). The inter-rater agreement of each evaluation also increased significantly in the second analysis using the body navigation-loaded ultrasound image (P<.0001).Conclusion: The body navigation-loaded ultrasound imaging system allows other medical staffs to easily and accurately interpret ultrasound images.
{"title":"Body Navigation-loaded Ultrasound Acquisition Technology: a Pilot Comparison With Conventional Ultrasound","authors":"K. Sim, B. Park, Byunjun Kim, Y. Han, N. Y. Han, Min Ju Kim, D. Sung, Sang-Hyun Park, Kwang-Sig Lee, Yongwon Cho","doi":"10.21203/rs.3.rs-781540/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-781540/v1","url":null,"abstract":"\u0000 Background: To investigate the usefulness of body navigation-loaded ultrasound including a real time transducer location and the inspection site compared with conventional ultrasound images.Methods: Under the approval of institutional review board, we prospectively enrolled total 29 healthy adult volunteers. One gastrointestinal radiologist performed abdominal ultrasound simultaneously using Ultrasound Navigation Image Convergence System developed by researchers. Subsequently, an equivalent conventional ultrasound image set was prepared. Three radiologists independently evaluated the two ultrasound image sets regarding the recognition of the target organ (2-points), the transducer location (2-points), and the transducer orientation (1-point). At intervals of two-weeks, conventional ultrasound images were analyzed first, and body navigation-loaded images were later analyzed. The score differences between the first and second evaluations were compared using the Wilcoxon signed rank test. Inter-rater agreement of three reviewers was obtained by the Fleiss’ Kappa test.Results: A total of 1402 navigation-loaded ultrasound images were obtained. Ultrasound operator carefully selected a total of 203 images for analysis. In all three reviewers, the interpretation score of each evaluation was significantly increased in the second analysis using the body navigation-loaded ultrasound image (in reviewer A, from 4.07±1.56 to 4.79±0.69 points; in reviewer B, from 3.83±1.59 to 4.49±0.88 points; in reviewer C, from 3.43±1.60 to 4.19±1.01 points; P<.0001). The inter-rater agreement of each evaluation also increased significantly in the second analysis using the body navigation-loaded ultrasound image (P<.0001).Conclusion: The body navigation-loaded ultrasound imaging system allows other medical staffs to easily and accurately interpret ultrasound images.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43453293","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 : 2021-07-31DOI: 10.5812/iranjradiol.114097
M. Abdo, M. Al-Shatouri
Background: Hepatobiliary disorders are common problems during pregnancy, causing significant morbidity and mortality in both mother and fetus. Biliary pancreatitis and cholangitis are common sequelae that warrant urgent endoscopic interventions. However, fetal radiation exposure is a major concern during endoscopic retrograde cholangiopancreatography (ERCP). Fetal malformation, preterm labor, and intrauterine fetal death are the recognized complications of ERCP. Objectives: To evaluate the application of transabdominal ultrasound (US) guidance in endoscopic biliary stenting as a substitute for fluoroscopy and contrast injection. Methods: In this study, we reviewed the data of ten pregnant patients, who had undergone endoscopic biliary stenting under US guidance without fluoroscopy between January 2018 and October 2020. An abdominal US examination was performed to confirm that the guide wire and the stent were placed inside the common bile duct (CBD) without fluoroscopy. The CBD clearance was postponed until after delivery. Results: The mean gestational age was 12 weeks (range: 5 - 33 weeks), and the mean maternal age was 23 years (range: 19 - 33 years). All procedures were performed successfully, with biochemical and clinical improvements after endoscopy. In none of the patients, maternal or fetal complications were reported after endoscopy or at birth. Also, no cases of post-endoscopic pancreatitis were documented. Conclusions: Based on the present findings, abdominal US guidance in endoscopic biliary stenting can be a safe and effective approach.
{"title":"Radiation-Free Transabdominal Ultrasound-Guided Endoscopic Biliary Stenting in Pregnant Women with Choledocholithiasis","authors":"M. Abdo, M. Al-Shatouri","doi":"10.5812/iranjradiol.114097","DOIUrl":"https://doi.org/10.5812/iranjradiol.114097","url":null,"abstract":"Background: Hepatobiliary disorders are common problems during pregnancy, causing significant morbidity and mortality in both mother and fetus. Biliary pancreatitis and cholangitis are common sequelae that warrant urgent endoscopic interventions. However, fetal radiation exposure is a major concern during endoscopic retrograde cholangiopancreatography (ERCP). Fetal malformation, preterm labor, and intrauterine fetal death are the recognized complications of ERCP. Objectives: To evaluate the application of transabdominal ultrasound (US) guidance in endoscopic biliary stenting as a substitute for fluoroscopy and contrast injection. Methods: In this study, we reviewed the data of ten pregnant patients, who had undergone endoscopic biliary stenting under US guidance without fluoroscopy between January 2018 and October 2020. An abdominal US examination was performed to confirm that the guide wire and the stent were placed inside the common bile duct (CBD) without fluoroscopy. The CBD clearance was postponed until after delivery. Results: The mean gestational age was 12 weeks (range: 5 - 33 weeks), and the mean maternal age was 23 years (range: 19 - 33 years). All procedures were performed successfully, with biochemical and clinical improvements after endoscopy. In none of the patients, maternal or fetal complications were reported after endoscopy or at birth. Also, no cases of post-endoscopic pancreatitis were documented. Conclusions: Based on the present findings, abdominal US guidance in endoscopic biliary stenting can be a safe and effective approach.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47335007","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 : 2021-07-31DOI: 10.5812/iranjradiol.114717
Xianghu Meng, Xue-Ying Sun, Rong Cong, L. Qi, Zengjun Wang, Ri-jin Song
Background: Most previous studies have demonstrated the possibility of using dual-source dual-energy computed tomography (DSDECT) to distinguish pure stones with high accuracy. While stones are usually composed of a mixture of substances, very few studies have focused on these stone compositions. Objectives: To retrospectively evaluate the diagnostic accuracy of DSDECT in predicting the composition of mixed urinary calculi in vivo compared to the postoperative infrared spectroscopy (IRS) for stone analysis. Materials and Methods: We retrospectively included 111 patients with 117 mixed urinary stones, detected by IRS, who underwent DSDECT between June 2018 and March 2020. Patients diagnosed with urolithiasis were examined by DSDECT preoperatively. The final stone composition was detected by IRS in vitro postoperatively. Also, the stone composition predicted by DSDECT was compared to the IRS results, known as the reference standard. Results: According to the results of IRS, 117 mixed urinary calculi, composed of a main constituent and minor admixtures, were divided into four groups: calcium oxalate (CaOx)-hydroxyapatite (HA) (n = 70); HA-CaOx (n = 36); uric acid (UA)-CaOx (n = 8); and cystine (CYS)-HA (n = 3). The accuracy of DSDECT in predicting different components of mixed urinary stones was 68.4%, 64.1%, 97.4%, and 97.5% for the CaOx-HA, HA-CaOx, UA-CaOx, and CYS-HA stones, respectively. The imaging characteristics of different mixed urinary stones, as shown by DSDECT, revealed that the CaOx-HA ratio value was lower than that of HA-CaOx (1.59 ± 0.11 vs. 1.66 ± 0.22; P < 0.05). Meanwhile, the computed tomography (CT) values of CaOx-HA under 150 kV were higher than those of HA-CaOx (915.41 ± 226.84 vs .799.56 ± 252.01; P < 0.05). Conclusion: Although DSDECT has a relatively low accuracy for predicting the components of CaOx-HA and HA-CaOx in vivo, its combination with the measured ratio and CT values may help differentiate these stones.
背景：以前的大多数研究都证明了使用双源双能计算机断层扫描（DSDECT）来高精度区分纯结石的可能性。虽然石头通常由多种物质的混合物组成，但很少有研究关注这些石头的成分。目的：回顾性评价DSDECT在预测体内混合性尿路结石成分方面的诊断准确性，并与术后红外光谱（IRS）进行结石分析进行比较。材料和方法：我们回顾性纳入了111名患者，其中117例混合性尿路结石，由IRS检测，他们在2018年6月至2020年3月期间接受了DSDECT。术前对诊断为尿石症的患者进行DSDECT检查。术后通过体外IRS检测最终结石成分。此外，还将DSDECT预测的石材成分与IRS结果（即参考标准）进行了比较。结果：根据IRS结果，将117例混合型尿路结石分为四组：草酸钙（CaOx）-羟基磷灰石（HA）（n=70）；HA-CaOx（n=36）；尿酸（UA）-CaOx（n=8）；和胱氨酸（CYS）-HA（n=3）。对于CaOx-HA、HA-CaOx、UA CaOx和CYS-HA结石，DSDECT预测混合性尿路结石不同成分的准确率分别为68.4%、64.1%、97.4%和97.5%。DSDECT对不同混合性尿路结石的影像学特征显示，CaOx-HA比值低于HA-CaOx（1.59±0.11vs.1.66±0.22；P<0.05），CaOx-HA在150kV下的CT值高于HA-CaOx（915.41±226.84 vs 799.56±252.01；P<0.05）。
{"title":"Characterization of Mixed Urinary Stone Compositions with Dual-Source Dual-Energy Computed Tomography in Vivo Compared to Infrared Spectroscopy","authors":"Xianghu Meng, Xue-Ying Sun, Rong Cong, L. Qi, Zengjun Wang, Ri-jin Song","doi":"10.5812/iranjradiol.114717","DOIUrl":"https://doi.org/10.5812/iranjradiol.114717","url":null,"abstract":"Background: Most previous studies have demonstrated the possibility of using dual-source dual-energy computed tomography (DSDECT) to distinguish pure stones with high accuracy. While stones are usually composed of a mixture of substances, very few studies have focused on these stone compositions. Objectives: To retrospectively evaluate the diagnostic accuracy of DSDECT in predicting the composition of mixed urinary calculi in vivo compared to the postoperative infrared spectroscopy (IRS) for stone analysis. Materials and Methods: We retrospectively included 111 patients with 117 mixed urinary stones, detected by IRS, who underwent DSDECT between June 2018 and March 2020. Patients diagnosed with urolithiasis were examined by DSDECT preoperatively. The final stone composition was detected by IRS in vitro postoperatively. Also, the stone composition predicted by DSDECT was compared to the IRS results, known as the reference standard. Results: According to the results of IRS, 117 mixed urinary calculi, composed of a main constituent and minor admixtures, were divided into four groups: calcium oxalate (CaOx)-hydroxyapatite (HA) (n = 70); HA-CaOx (n = 36); uric acid (UA)-CaOx (n = 8); and cystine (CYS)-HA (n = 3). The accuracy of DSDECT in predicting different components of mixed urinary stones was 68.4%, 64.1%, 97.4%, and 97.5% for the CaOx-HA, HA-CaOx, UA-CaOx, and CYS-HA stones, respectively. The imaging characteristics of different mixed urinary stones, as shown by DSDECT, revealed that the CaOx-HA ratio value was lower than that of HA-CaOx (1.59 ± 0.11 vs. 1.66 ± 0.22; P < 0.05). Meanwhile, the computed tomography (CT) values of CaOx-HA under 150 kV were higher than those of HA-CaOx (915.41 ± 226.84 vs .799.56 ± 252.01; P < 0.05). Conclusion: Although DSDECT has a relatively low accuracy for predicting the components of CaOx-HA and HA-CaOx in vivo, its combination with the measured ratio and CT values may help differentiate these stones.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49374734","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 : 2021-07-31DOI: 10.5812/iranjradiol.109932
Zeinab Dolatshahi, F. Mezginejad, Shahin Nargesi, Moslem Saliminejad
Context: If the diameter of an aneurysm increases by more than 6 cm, the risk of aortic rupture increases by 50% within 10 years. Therefore, rupture of aneurysm, which is usually asymptomatic, can lead to severe complications and increase the risk of mortality. The current study aimed to systematically review studies comparing the cost-effective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) as the primary treatment options for patients with ruptured abdominal aortic aneurysms (AAAs). Methods: An electronic search was conducted in PubMed, EMBASE, Science Direct, Scopus, and other scientific economic databases. Relevant articles were searched from 1999 to 2020 using keywords, such as “abdominal aortic aneurysm”, “endovascular”, “open surgery”, “rupture”, “economic evaluation”, and “cost-effectiveness”. The quality of articles was assessed using the Quality of Health Economic studies (QHES) checklist; finally, five articles were included in this review. Results: The results of the QHES checklist showed that most studies had a good quality. A third-party payer’s perspective was the dominant perspective in all selected studies, comparing EVAR with OSR. All studies considered the direct medical costs and did not disclose any discount rates, except for one study, reporting a 3.5% discount rate. Almost all included studies found EVAR to be a cost-effective intervention; only one study concluded that EVAR, with a cost-effectiveness ratio of €424,542, was not the best treatment option. Conclusion: In patients with ruptured AAAs, the EVAR intervention improved the quality of life, decreased the mortality rate, and shortened the hospital stay as compared to OSR.
{"title":"Cost-Effectiveness of Endovascular Aneurysm Repair Versus Open Surgical Repair for Ruptured Abdominal Aortic Aneurysms: A Systematic Review","authors":"Zeinab Dolatshahi, F. Mezginejad, Shahin Nargesi, Moslem Saliminejad","doi":"10.5812/iranjradiol.109932","DOIUrl":"https://doi.org/10.5812/iranjradiol.109932","url":null,"abstract":"Context: If the diameter of an aneurysm increases by more than 6 cm, the risk of aortic rupture increases by 50% within 10 years. Therefore, rupture of aneurysm, which is usually asymptomatic, can lead to severe complications and increase the risk of mortality. The current study aimed to systematically review studies comparing the cost-effective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) as the primary treatment options for patients with ruptured abdominal aortic aneurysms (AAAs). Methods: An electronic search was conducted in PubMed, EMBASE, Science Direct, Scopus, and other scientific economic databases. Relevant articles were searched from 1999 to 2020 using keywords, such as “abdominal aortic aneurysm”, “endovascular”, “open surgery”, “rupture”, “economic evaluation”, and “cost-effectiveness”. The quality of articles was assessed using the Quality of Health Economic studies (QHES) checklist; finally, five articles were included in this review. Results: The results of the QHES checklist showed that most studies had a good quality. A third-party payer’s perspective was the dominant perspective in all selected studies, comparing EVAR with OSR. All studies considered the direct medical costs and did not disclose any discount rates, except for one study, reporting a 3.5% discount rate. Almost all included studies found EVAR to be a cost-effective intervention; only one study concluded that EVAR, with a cost-effectiveness ratio of €424,542, was not the best treatment option. Conclusion: In patients with ruptured AAAs, the EVAR intervention improved the quality of life, decreased the mortality rate, and shortened the hospital stay as compared to OSR.","PeriodicalId":50273,"journal":{"name":"Iranian Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44102192","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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