Iranian Journal of Radiology
Year:2012 | Volume:9 | Issue:1|Papers Count:12

Background: Epilepsy، a well-known mostly idiopathic neurologic disorder، has to be correctly diagnosed and properly treated. Up to now، several diagnostic approaches have been processed to determine the epileptic focus.Objectives: The aim of this study was to discover whether proton-MR-spectroscopic imaging (MRSI) aids in the diagnosis of temporal lobe epilepsy in conjunction with classical electroencephalography (EEG) findings.Patients and Methods: Totally, 70 mesial temporal zones consisting of 39 right hippocampi and 31 left hippocampi of 46 patients (25 male, 21 female) were analyzed by proton MRSI. All patients underwent a clinical neurologic examination, scalp EEG recording and prolonged video EEG monitoring. Partial seizures on the right, left or both sides were recorded in all patients. All patients were under medical treatment and none of the patients underwent amygdalohippocampectomy and similar surgical procedures.Results: The normal average lactate (Lac), phosphocreatine, N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), myo-inositol، glutamate and glutamine (Glx) peaks and Nacetyl aspartate/Cr, NAA/ Cho + Cr, Cho/Cr ratios were measured from the healthy opposite hippocampi or from the control subjects. The Lac، glutamate and glutamine (Glx), myo-inositol، phosphocreatine and NAA metabolites plus Cho/Cr ratio showed statistical difference between the normal and the epileptic hippocampi. Cho, Cr metabolites plus NAA/Cr, NAA/ Cho + Cr ratios were almost the same between the groups. The sensitivity of Proton-MR-Spectroscopy for lateralization of the epileptic foci in all patients was 96% and the specificity was 50%.Conclusions: Proton-MRSI can easily be considered as an alternative modality of choice in the diagnosis of temporal lobe epilepsy and in the future; Proton-MR-Spectroscopy may become the most important technique used in epilepsy centers.

Background: Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course، these flow changes may not be detected in ophthalmologic exams، but it seems that color Doppler sonography of retinal arteries may be helpful in these cases.Objectives: In previous studies on CKD patients who underwent chronic hemodialysis، hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question.Patients and Methods: Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis,  17patients (34 eyes) with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive، diabetic patients and patients with cardiovascular disease.Results: The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis,38.8  in CRF and 51.6 in normal patients, P value=0.001 and EDV was  7.4, 11.8 ,9.4 respectively, P value=0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters in the central retinal artery.Conclusions: The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that micro vascular disease and endothelial cell dysfunction of the orbital vasculature are related to CRF and not to chronic hemodialysis.

Objectives: The aim of the present study was to determine diagnostic accuracy of chargecoupled devices (CCD), Photo Stimulable Phosphor (PSP) and film radiography in detecting non-cavitated caries.Patients and Methods: Seventy-two non-cavitated approximal surfaces of extracted human posterior teeth were radiographed under standardized conditions using three intraoral modalities: CCD Dixi3 (Planmeca، Finland), PSP Digora PCT (Soredex, Finland), and E-speed film (Kodak, USA). Radiographs were interpreted by four observers and caries lesions were classified as sound (R0), restricted to enamel (R1), reaching the dentin enamel junction (DEJ) and the outer half of the dentin (R2) and the inner half of the dentin (R3). The teeth were subsequently sectioned for histological analysis which served as the gold standard for radiographic examination.Results: Microscopic examinations showed that the distribution of caries were 63.9% sound,18.1%  enamel,9.7%  DEJ and outer half of the dentin and 8.3% into the inner half of the dentin. The sensitivity and specificity of film, CCD and PSP for the detection of enamel caries were 38% and 98%; 15% and 96%; and 23% and 98% ,respectively. The sensitivity and specificity of film ,CCD and PSP for the detection of both dentin and enamel caries were 55% and 100%; 45% and 100%; and 55% and 100%, respectively.Conclusions: The results demonstrated that the diagnostic accuracy of digital images is similar to that of conventional film radiography in the detection of non-cavitated approximal caries.

Background: Chronic obstructive pulmonary disease (COPD) is a devastating disease. While there is no cure for COPD and the lung damage associated with this disease cannot be reversed, it is still very important to diagnose it as early as possible.Objectives: In this paper، we propose a novel method based on the measurement of air trapping in the lungs from CT images to detect COPD and to evaluate its severity.Patients and Methods: Twenty-five patients and twelve normal adults were included in this study. The proposed method found volumetric changes of the lungs from inspiration to expiration. To this end, trachea CT images at full inspiration and expiration were compared and changes in the areas and volumes of the lungs between inspiration and expiration were used to define quantitative measures (features). Using these features, the subjects were classified into two groups of normal and COPD patients using a Bayesian classifier. In addition، t -tests were applied to evaluate discrimination powers of the features for this classification.Results: For the cases studied، the proposed method estimated air trapping in the lungs from CT images without human intervention. Based on the results, a mathematical model was developed to relate variations of lung volumes to the severity of the disease.Conclusions: As a computer aided diagnosis (CAD) system، the proposed method may assist radiologists in the detection of COPD. It quantifies air trapping in the lungs and thus may assist them with the scoring of the disease by quantifying the severity of the disease.

Herein، we report a 40-year old man who presented with flank and abdominal pain with dilatation of the bilateral pyelocalyceal system detected in ultrasonography. Computed Tomography (CT) scan showed a soft tissue mass at the level of the fourth and fifth lumbar vertebrae in the retroperitoneal region. There were no blood flow signals in 64-slice multidetector CT (MDCT) which confirms the Retroperitoneal Fibrosis (RPF). Pathological examination showed infiltration of plasma cells, macrophages، lymphocytes and eosinophils accompanied by fibrosis, which is consistent with idiopathic RPF. In conclusion, 64-slice MDCT imaging is useful in the diagnosis of RPF.

Desmoid tumors (DTs) are benign tumors which are not seen very often، and most of the radiologists and clinicians do not know the characteristics of them very well. Correct and early diagnosis of DTs is important for decreasing mortality and morbidity. Computed tomography enterography (CTE) is a new modality for small bowel imaging which combines the improved spatial and temporal resolution of multidetector computed tomography (CT) with large volumes of ingested enteric contrast material to permit evaluation of the small bowel wall and lumen and also the entire abdomen. We report a familial adenomatous polyposis (FAP) patient with localized mesentery and abdominal wall DTs. We showed the exact location of the DTs and their relation with the small bowel by CTE. In conclusion, CTE is a useful technique for DT localization, the degree of extension and invasion to local structures, presence of partial and complete small bowel obstruction, and the relationship of the tumors with vasculature and whether ischemia has occurred as a result or not.

Necrotizing sarcoid granulomatosis (NSG) is a rare disease which is classified in the spectrum of pulmonary angiitis and granulomatosis. It is a variant of sarcoidosis and differs from it histologically. Diagnosis is based on the pathological features, but radiology may help in the differential diagnosis. It is characterized by alveolar infiltrates or parenchymal nodules in multidetector computed tomography (MDCT). We report a case of a 50-year-old man with the diagnosis of NSG mimicking lung malignancy. Radiological and pathological findings and also the destructive course of the disease will be discussed.

Deep seated cavernous angioma (CA) is a very rare entity، those occurring in the hypothalamus are still less common. We present a case of a 52-year-old man who presented with behavior and memory disturbance attacks. He had a CA of the hypothalamus as revealed by magnetic resonance imaging (MRI). We will discuss the role and importance of imaging in such scenario and also the differential diagnoses of this rare entity.

Neurofibroma is an autosomal dominant disorder which has major criteria such as hyperpigmentation (cafe-au lait spots), cutaneous and subcutaneous tumors and bone deformities. In this report، a case of multifocal intraosseous neurofibroma in a 16-year-old male with right facial asymmetry, multiple unerupted maxillary posterior teeth and a previous history of infratemporal and orbital neurofibroma is presented. The majority of reported cases occurred in the posterior portion of the mandible and a limited number in the maxilla. Cone beam CT (CBCT) was performed for better evaluation of the extension and form of the maxillary and mandibular lesions. This report presents a rare situation of simultaneous peripheral neurofibromatosis (NF) and multifocal intraosseous NF in the mandible, maxilla and orbits and also focuses on advanced imaging findings of bony and soft tissue neurofibroma.

Acute leukemia is the most common malignancy in childhood، which mainly involves children less than 15 years of age. The growing skeleton is the main site of involvement in children. Leukemic cells proliferate within the massive red bone marrow in children. So besides the pallor, petechial, purpura and ecchymosis in the skin and mucosal surfaces, bone pain and other bony lesions are other manifestations of leukemia. On the other hand, bony lesions are more prevalent in children than adults with no poor prognosis in comparison to patients without bone lesions. These bony lesions may precede other laboratory tests so familiarity with these presentations is very important for earlier diagnosis. In this pictorial essay, we tried to gather the most common bony lesions that may be seen in acute leukemia in different cases admitted to our hospital with general malaise and localized tenderness and discomfort leading us to perform plain X-ray for further evaluation. Finding these bony lesions helps clinicians to reach the diagnosis quickly. These findings include metaphyseal lucent band and erosion، periosteal reaction, small lucent bone lesion and permeative appearance, reduced bone density and collapsed vertebra.

Hereby، we will report a rare case of cervical spine chondrosarcoma producing a dumbbell shape foraminal mass lesion. Generally، spinal neural foraminal widening has several causes. They may be tumoral such as neurogenic tumors، developmental or vascular. Occasionally spinal neural foraminal widening is in the shape of a dumbbell lesion. In this case، the differential diagnosis is limited but a little more different. Neurogenic tumors (schwannoma and neurofibroma) are the most common.

Dear Editor,Urethral stricture is a common urological problem affecting the male gender (1-5). There is currently progressive increase in the incidence of this condition due to the improved living standards، the increased number of permanent catheter bearers, the surge of sexually transmitted diseases’ (STDs) incidence, and misuse of transurethral diagnostic or therapeutic instrumentation (1-5). Studies have shown that the peak prevalence is at 40-45 years of age and is very rare below 9 years (2-6).