Iranian Journal of Radiology
Year:2003 | Volume:1 | Issue:3-4|Papers Count:16

Background: The association of Behcet’s disease (BD) and ankylosing pondylitis (AS) is still a matter of debate. Objective: As the presence of sacroiliac joint (SIJ) involvement is an essential criterion in diagnosis of AS, we decided to determine the revalence of SIJ involvement in BD and compare it with that of a control group. Patients & Methods: We randomly selected two groups of 199 BD patients and 168 non-BD cases (the controls). All cases were over 20 years of age. Standard anteroposterior radiographs of the SIJ were obtained and interpreted by two rheumatologists and a radiologist blinded to the diagnosis. To determine the severity of the condition, the following 5-point scale was employed: Normal (0), pseudo-widening (1), sclerosis (2), erosion (3), and bony fusion (4). To eliminate any doubts, only grades 3 and 4 were considered as sacroiliitis. Both groups were separately evaluated for age ( 30, and >30), and gender. Results were compared using Chi square test. Results: The groups were matched for age and sex: There were 98 (49.2%) females in BD vs. 91 (54.2%) in the control group (p=0.35). The mean?SD age was 35?8.3 years in BD and 35?10 in control group (p=1). The SIJ was involved in 9 (4.6%) patients in BD and 7 (4.2%) patients in control group (p=0.93). Comparisons between the results of the unisexual cohorts revealed no significance either (p=0.68 for males, and p=0.64 for females). The age subdivisions (under- and over-30) again showed no significant difference (p=0.96 and p=0.69 for under- and over-30 patients, respectively). Conclusion: The presence of radiographic signs of SIJ involvement is not mandatory for the diagnosis of AS.

Background: Post-menopausal osteoporosis is one of the most important health problems. This condition frequently leads to bone fractures. Objectives: To determine the effect of physical activities on bone mineral density (BMD) in post-menopausal women, regardless of any concomitant predisposing risk factors for osteoporosis.Patients and Methods: BMDs of 174 consecutive post-menopausal women with a mean age of 59.7 years and a mean post-menopausal duration of 10.3 years were measured by dual energy X-ray absorptiometry (DEXA) technique. According to the reported T scores, risks of femur and lumbar vertebrae fractures were estimated. The correlation between physical activities,as well as other osteoporosis risk factors and the above-mentioned measured quantities was assessed.Results: 68% of the individuals with no physical activities and 25% of those who had regular physical activities were in the osteoporotic range. The femoral fracture risk was significantly higher for those with no physical activities (50%) than those physically active subjects (19%).Moreover, risk of developing vertebral fracture was higher in the former group (74% vs. 35%). BMDs were significantly different between the two groups in general; (p<0.001) as well as between their subgroups without (n=129, p<0.001) and with (n=45, p<0.01) other risk factors for osteoporosis). Conclusion: Physical activity has positive effects on BMD of post-menopausal women, resulting in their reduced likelihood of osteoporotic fractures, irrespective of presence or absence of other osteoporosis risk factors.

Fibrodysplasia ossificans progressiva (FOP) is a rare, dominantly inherited connective tissue disorder, characterized by congenital malformations of the great toes and thumbs and progressive heterotopic ossification of soft tissues of the trunk and extremities. The ossifications typically appear within the first decade of life and result in progressive ankylosis of the joints and severe disability. So far, more than 600 cases have been reported worldwide and presently there is no effective treatment or prevention. During the early phase, particularly prior to the development of calcifications, it is often mis-diagnosed as soft tissue sarcomas or fibromatoses, which considerably delays the diagnosis, and therefore leads to unnecessary and perhaps life threatening treatments. Herein, we present a case of a 21-year-old male with FOP diagnosed late in the course of his disease.

Tuberculosis (TB) is a major health problem in Iran. All parts of the astrointestinal (GI) tract can be affected by TB. Therefore, it should be included in the ifferential diagnoses of almost any GI diseases, and physicians should be aware of the imaging characteristics of TB in the GI tract. This is a report of 4 patients with different types of GI involvement by TB, along with its clinical pictures and maging characteristics.

A 31-year-old female with well-established polycythemia vera since one year before, presented with the sudden onset of tense ascites and hepatic encephalopathy since 12 days prior to admission. Real-time ultrasonography revealed a suprahepatic thrombosis extending toward the inferior vena cava (IVC). Thrombolytic therapy with systemic streptokinase (250,000 IU loading + 100,000 IU/hr infusion) was started. At the end of 72 hours’ infusion, the patient’s general condition improved. A color Doppler ultrasonography, then showed complete and partial resolution of the thrombosis in the suprahepatic vein and IVC, respectively. Despite this good response, 12 days later, the symptoms recurred. Venography detected complete obstruction of the IVC. Percutanous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.

We introduce a new method of measuring transmit and receive RF inhomogeneity in different RF coils of MRI systems. In this method a single slice of a uniform phantom is imaged from different flip angles, using a standard spin echo protocol. The signal intensity in these images is then fitted to a mathematical model which describes the relationship between the signal intensity and flip angle of the spin echo images. The results of this curve fitting process are two parameters, T(r) and R(r), whose variation with the spatial position shows RF transmit, and receive non-uniformity, respectively. In this approach a linear profile of B1 field distribution and receive sensitivity of RF coils are achieved which is also applicable in vivo. The method can be used to assess any commercial MR scanner and is highly recommended for the quality control (QC) of those MR scanners which are devoid of complicated protocols such as SEθ-2 θ. Such systems are still running in different clinics especially in the developing countries where the latest high performance MR scanners are not available and many scanners lack standard maintenance services.

Background/Objective: Protecting patients from unwarranted radiation is a great safety concern to radiology practitioners, as medical X-rays are the largest source of public exposure to ionizing radiation. Materials and Methods: The entrance skin exposure (ESE) was measured by solid state dosimeter for five common types of radiography. Dosimetery for a human of average size was performed in the radiology centers. The results of first ESE measurements together with recommendations according to CRCPD and NRPB were returned to the radiology centers. Two months later, all ESE measurements were repeated. Results: The mean, maximum and 3rd quartile ESEs were significantly decreased compared with the first measurements. This quality control program managed to decrease the patient doses (ESEs) of AP and lateral lumbar spine, AP cervical and lateral skull radiographs by about %10, 25%, 30% and 25% respectively. Conclusion: This survey indicates that in X-ray examinations of the lumbar, thoracic and cervical spine, skull and chest the patient dose can be significantly reduced without ruining the imaging quality.

Background; Hydatid disease primarily affects the liver and typically demonstrates characteristic imaging findings. Secondary involvement due to hematogenous dissemination may be seen in almost any locations, e.g., lung, kidney, spleen, bone and central nervous system (CNS). Objectives: To review the different aspects of hydatidosis of the CNS briefly and discuss the pathognomonic features and rare varieties of radiological findings useful in preoperative diagnosis of the disease in the human CNS.Material & Method; In a retrospective study, the records of almost 100 cases of CNS hydatidosis were analyzed. The available images were reviewed by independent observers, either a radiologist or a neurosurgeon, and reported separately. Results; In skull X-ray films, nonspecific changes denoted increased intracranial pressure, skull asymmetry and curvilinear calcification in rare instances. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated the round or oval, well-defined cystic mass with an attenuation or signal intensity similar to that of cerebrospinal fluid, with no associated perifocal edema, and no contrast enhancement as the pathognomonic findings of brain hydatidosis. Similar findings were detected in hydatid cysts involving the orbit, spinal column and spinal cord with some variations. Such findings as mild perifocal edema, nonhomogenous contrast enhancement, non-uniform shapes, calcification and multiplicity or septations have been the atypical radiological findings. Conclusion; In endemic areas, familiarity with typical and atypical radiological manifestations of hydatid disease of the CNS, will be helpful in making prompt and correct preoperative diagnosis leading to a better surgical outcome.

Background: Cervical spine and intervertebral discs are potentially prone to functional disorders. Objectives: This study sought type and distribution of different pathologies in the cervical spine and a possible relationship between the MRI findings and the probable risk factors of the degenerative disorders. Material and methods: This descriptive cross-sectional research was carried out from October 2000 to January 2002 in three referral centers in Tehran. All the patients had referred for cervical MRI for neck pain and/or radicular pain. Results: Totally 342 patients entered the study. Sixty percent of patients were male. The mean age was 55.1 12.1 years. Seventy-nine percent of patients had abnormal MRI findings (238 patients (70%) had signs of degenerative processes and 31 patients (9%) had the other findings) with a total 308 pathologies. The most common findings were disc bulging/ protrusion (%21.1), disc dehydration (%20.1), disc herniation (%18.1), and canal stenosis(%17.5). Older age, male gender and history of neck trauma were associated with increasing probability of degenerative changes (P-Values<0.05). Conclusion: Types of cervical spine pathologies are comparable to other reports. The anatomical distribution of disc bulging and protrusion in our study are similar to other reports. Likewise age, gender and a history of trauma to the neck were closely associated with the degenerative signs on the MR images.

Background: Testicular microlithiasis (TM) is an uncommon condition characterized by calcium deposits in the lumina of semineferous tubules. These intratesticular calcifications appear as bright 2-3-mm echogenic foci on testicular ultrasound. Cumulated experience points to an association between TM, intratubular germ cell neoplasia and other testicular tumors. Objective: To assess the prevalence of TM revealed on sonography in referred population and its association with the concurrent testicular tumors. Patients and Method: Over a 129-month period (August 1991–May 2002), 2165 high resolution (7.5 MHz) scrotal sonographies were performed in the Imaging Department of Mehr Hospital, a referral center in Tehran. Cases of testicular tumor and TM were selected. The diagnosis and histologic typing of tumors were made by histopathologic studies. Results: A total of 15 cases of TM were discovered, giving a prevalence of 0.7%. Concurrent TM and testicular neoplasia were detected in four patients (27% cases of TM). Conclusion: It is strongly suggested to follow those with TM with physical examination and ultrasonography at least annually and to encourage self-examination.

Background/Objectives: To evaluate the child with intermittent ureteral obstruction following antireflux surgery and to introduce a new imaging technique for diagnosis of the socalled “hook” phenomenon, the most serious complication of antireflux surgery. Patients and Methods: Twenty-five children with a history of antireflux surgery who were referred for either persistent urinary tract infection (UTI) or progressive hydronephrosis were included in the study. All the children with signs and symptoms of voiding dysfunction or persistent reflux were excluded. A new imaging technique was devised to evaluate these patients for the presence of “hook phenomenon”, in which a renal ultrasound was performed both on a full bladder and after voiding. If dilatation of the urinary tract was detected on full bladder, and this dilatation decreased dramatically following micturition, then a catheter was passed into the bladder and was filled with normal saline (based on the estimated bladder capacity in order to avoid over-distension). An intravenous urogram and saline cystogram were performed simultaneously. After 20 minutes, 2 abdominal radiographs were obtained on full and emptied bladder, both. Results: On the intravenous urogram, some children showed typical “J- hook-shaped” ureters. In all the cases marked hydronephrosis was noted, with no contrast material seen entering the bladder on the 20 minute radiogram. Upon evacuation of the bladder, both ureters promptly drained into the bladder and the”J-hooking” of the ureters and hydronephrosis resolved. Conclusion: "J- hook phenomenon” is one of the most common causes of hydronephrosis and hydroureter following ureteral re-implantation is intermittent ureteral obstruction from creation of the new ureteral hiatus at an inappropriate site. This complication is frequently misdiagnosed as irreversible uretero-vesical junction obstruction from ischemia or fibrosis. Once the diagnosis of “J- hook” phenomenon is confirmed, early ureteral reimplantation with creation of a new hiatus is the treatment of choice.

Background: One of the common problems in children, especially infants, is gastroesophageal reflux (GER). Objectives: This study was performed to compare the diagnostic value of lower esophageal sonography with that of barium swallow. Patients and method: Our trial was a triple-blind, performed on 50 patients of 1 month to 15 years of age. The patients suspicious of having GER were evaluated by sonography and barium swallow. Esophageal pH monitoring was the standard test, and both the ultrasound and barium swallow were compared to it. Results: The results showed that sonography was 90% sensitive, vs. 50% for barium swallow. Both tests had the same specificity equal to 35%. Conclusion: We concluded that sonography was a better test than barium swallows, for evaluation of suspected patients with GER, and screening of the infants.

Uterine fibroids are commonly asymptomatic. They often cause pelvic pain, abnormal and increased vaginal bleeding, etc. Traditional treatment of symptomatic uterine fibroids was trans-abdominal hysterectomy. Nowadays, uterine artery embolization (UAE), also called uterine fibroid embolization, is considered as a safe and highly-effective nonsurgical treatment for women with symptomatic uterine fibroid tumors. Advantages of UAE over conventional hormonal suppression and surgical procedures include avoidance of the side effects of drug therapy and surgery-related physical and psychological trauma. These patients commonly resume their normal activities within a week after the procedure; weeks earlier than that for trans-abdominal hysterectomy. Over the past 30 years, interventional radiologists have done UAE for treatment of emergency uterine bleeding. Since 1995, interventional radiologists have turned their attention to treatment of uterine fibroids with a similar procedure. The first fibroid embolization in Iran was done approximately three years ago. So far, more than 100 cases have been treated by this method and it is going to be quickly accepted as a safe alternate for surgery.

Rhabdomyosarcoma of the middle ear is a rare tumor. It may be locally invasive or spread by distant metastasis. It generally has a poor prognosis. We describe a case of rhabdomyosarcoma of the middle ear with extension to cavernous sinus, internal auditory and carotid canals.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major worldwide health problem. In countries where TB is of moderate to high prevalence, the issue of MDR-TB carries significant importance. MDR-TB, similar to drug-sensitive TB, is contagious. Meanwhile its treatment is not only more difficult but also more expensive with lower success rates. Regarding clinical findings, there is no significant difference between MDR-TB and drug-sensitive TB. Therefore determination of characteristic radiological findings in cases of MDR-TB might be of help in early detection, and hence appropriate management of this disease condition. Objective: To explain the radiological spectrum of pulmonary MDR-TB. Patients and Methods: We retrospectively evaluated the radiographic images of 35 patients with clinically- and microbiologically-proven MDR-TB admitted to our tertiary-care TB unit over a period of 13 months. The latest chest X-ray of all patients and the conventional chest CT scan without contrast of 15 patients were reviewed by three expert radiologists who rendered consensus opinion. Results: Of the 35 patients with imaging studies, 23 (66%) were male and 12 (34%) were female. The mean±SD age of participants was 38.2±17.3 (range: 16–80) years. 33 patients were known as secondary and only 2 had primary MDR-TB. Chest radiography revealed cavitary lesion in 80%, pulmonary infiltration in 89% and nodules in 80% of the cases. Pleurisy was the rarest finding observed in only 5 (14%) patients. All of 15 chest CT scans revealed cavitation, 93% of which were bilateral and multiple. Pleural involvement was seen in 93% of patients. Conclusion: Presence of multiple cavities, especially in lungs, nodular and infiltrative lesions, and pleural effusion are main features of MDR-TB as compared to drug-sensitive TB.

5-year-old male farmer presented with left hemifacial pain and double vision of two months' duration. He denied any history of medical diseases. Physical examination revealed left facial hypoesthesia and left abducent nerve palsy. His plain chest radiography and routine blood tests were normal. Axial CT scan without contrast demonstrated a hypodense area in the left temporal lobe (Figure 1). Enhanced CT scan showed a hyperdense mass in the left parasellar region (Figure 2 MRI (T2 –W image) showed a hypointense lesion in the parasellar region with areas of hyperintensity in the ipsilateral temporal lobe (Figure 3).