Reproductive factors and mammographic density within the International Consortium of Mammographic Density: A cross-sectional study.

BACKGROUND: Elevated mammographic density (MD) for a woman's age and body mass index (BMI) is an established breast cancer risk factor. The relationship of parity, age at first birth, and breastfeeding with MD is less clear. We examined the associations of these factors with MD within the International Consortium of Mammographic Density (ICMD). METHODS: ICMD is a consortium of 27 studies with pooled individual-level epidemiological and MD data from 11,755 women without breast cancer aged 35-85 years from 22 countries, capturing 40 country-& ethnicity-specific population groups. MD was measured using the area-based tool Cumulus. Meta-analyses across population groups and pooled analyses were used to examine linear regression associations of square-root (√) transformed MD measures (percent MD (PMD), dense area (DA), and non-dense area (NDA)) with parity, age at first birth, ever/never breastfed and lifetime breastfeeding duration. Models were adjusted for age at mammogram, age at menarche, BMI, menopausal status, use of hormone replacement therapy, calibration method, mammogram view and reader, and parity and age at first birth when not the association of interest. RESULTS: Among 10,988 women included in these analyses, 90.1% (n = 9,895) were parous, of whom 13% (n = 1,286) had ≥ five births. The mean age at first birth was 24.3 years (Standard deviation = 5.1). Increasing parity (per birth) was inversely associated with √PMD (ß: - 0.05, 95% confidence interval (CI): - 0.07, - 0.03) and √DA (ß: - 0.08, 95% CI: - 0.12, - 0.05) with this trend evident until at least nine births. Women who were older at first birth (per five-year increase) had higher √PMD (ß:0.06, 95% CI:0.03, 0.10) and √DA (ß:0.06, 95% CI:0.02, 0.10), and lower √NDA (ß: - 0.06, 95% CI: - 0.11, - 0.01). In stratified analyses, this association was only evident in women who were post-menopausal at MD assessment. Among parous women, no associations were found between ever/never breastfed or lifetime breastfeeding duration (per six-month increase) and √MD. CONCLUSIONS: Associations with higher parity and older age at first birth with √MD were consistent with the direction of their respective associations with breast cancer risk. Further research is needed to understand reproductive factor-related differences in the composition of breast tissue and their associations with breast cancer risk.

The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density.

BACKGROUND: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS: Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS: In pooled analyses, later age at menarche was associated with higher per cent density (ß√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (ß√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (ß√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (ß√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS: In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.

Assessing the Bone Age of Children in an Automatic Manner Newborn to 18 Years Range.

Bone age assessment (BAA) is a radiological process to identify the growth disorders in children. Although this is a frequent task for radiologists, it is cumbersome. The objective of this study is to assess the bone age of children from newborn to 18 years old in an automatic manner through computer vision methods including histogram of oriented gradients (HOG), local binary pattern (LBP), and scale invariant feature transform (SIFT). Here, 442 left-hand radiographs are applied from the University of Southern California (USC) hand atlas. In this experiment, for the first time, HOG-LBP-dense SIFT features with background subtraction are applied to assess the bone age of the subject group. For this purpose, features are extracted from the carpal and epiphyseal regions of interest (ROIs). The SVM and 5-fold cross-validation are used for classification. The accuracy of female radiographs is 73.88% and of the male is 68.63%. The mean absolute error is 0.5 years for both genders' radiographs. The accuracy a within 1-year range is 95.32% for female and 96.51% for male radiographs. The accuracy within a 2-year range is 100% and 99.41% for female and male radiographs, respectively. The Cohen's kappa statistical test reveals that this proposed approach, Cohen's kappa coefficients are 0.71 for female and 0.66 for male radiographs, p value < 0.05, is in substantial agreement with the bone age assessed by experienced radiologists within the USC dataset. This approach is robust and easy to implement, thus, qualified for computer-aided diagnosis (CAD). The reduced processing time and number of ROIs facilitate BAA.

The Relationship between Anthropometric Indices and Breast Cancer in Central Iran.

Background: Anthropometric indices have a debatable relationship with breast cancer (BC) among different ethnicity. In the current study, we have evaluated the relationship between anthropometric indices and BC in Iranian participants. Methods: Between 2012 and 2014, a total of 7,805 women were enrolled from different mammography centers in Isfahan province, Iran. For each participant, a detailed questionnaire was filled out and anthropometric indices were measured by trained technicians. We used logistic regression models to estimate odds ratios (OR) and 95% confidence interval (CI) for BC risk associated with anthropometry measurements, stratified on menopausal status. Results: In the postmenopausal group, weight ≥68 kg compared to weight <61.75 kg was associated with decreased risk of BC (OR = 0.78; 95% CI: 0.63-0.97). Postmenopausal women with Waist-Hip Ratio (WHR) ≥ 0.85 compared to WHR < 0.77 were at increased risk of BC (OR = 1.36; 95% CI: 1.07-1.73). Both premenopausal and postmenopausal women had a decreased risk of BC with higher Obesity Index (OI) and Relative Weight. Conclusion: Ethnicity appears to play an important role in the discrepancies between results of different studies about the correlation of anthropometric features with BC.

Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.

BACKGROUND: Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known. METHODS AND FINDINGS: We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35-85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (-0.46 cm [95% CI: -0.53, -0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (I2) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was -0.24 cm (95% CI: -0.34, -0.14; I2 = 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (-0.38 cm [95% CI: -0.44, -0.33]; I2 = 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature. CONCLUSIONS: Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction.

Mammographic density assessed on paired raw and processed digital images and on paired screen-film and digital images across three mammography systems.

BACKGROUND: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types. METHODS: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read by the same reader. Multi-level models of square-root percent MD were fitted, with a random intercept for woman, to estimate processed-raw MD differences. RESULTS: Breast area did not differ in processed images compared with that in raw images, but the percent MD was higher, due to a larger dense area (median 28.5 and 25.4 cm2 respectively, mean √dense area difference 0.44 cm (95% CI: 0.36, 0.52)). This difference in √dense area was significant for direct digital systems (Hologic 0.50 cm (95% CI: 0.39, 0.61), GE 0.56 cm (95% CI: 0.42, 0.69)) but not for Fuji CR (0.06 cm (95% CI: -0.10, 0.23)). Additionally, within each system, reader-specific differences varied in magnitude and direction (p < 0.001). Conversion equations revealed differences converged to zero with increasing dense area. MD differences between screen-film and processed digital on the subsequent screening round were consistent with expected time-related MD declines. CONCLUSIONS: MD was slightly higher when measured on processed than on raw direct digital mammograms. Comparisons of MD on these image formats should ideally control for this non-constant and reader-specific difference.

Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses.

BACKGROUND: We conducted our study on 1110 patients with breast masses in order to investigate different aspects of power Doppler sonography (PDS) for differentiating between benign and malignant breast lesions and their prognostication. MATERIALS AND METHODS: This study was conducted on the women who were referred to the sonography units of University Hospitals for breast sonography and had a BIRADS-3 mass or higher in gray scale sonography. Then, PDS was performed for all the patients. Vascularization, number of vessels, resistance index (RI), pulsatility index (PI), and vascularization patterns were evaluated for all the lesions. We compared our radiologic findings concerning different histopathologic and hormonal aspects of the lesions. RESULTS: The differences between mean vascular density in malignant lesions concerning size of the tumor, histological grade, stage, and hormone receptor status were statistically significant. Although, there was an overlap between benign and malignant values. A resistive index (RI) value higher than 0.83 as a sign for malignancy had sensitivity equal to 75% and specificity equal to 97% (P = 0.04 and 0.03, respectively). A PI value higher than 1.6 has a sensitivity and specificity value of 70% and 98%, respectively, as a malignancy sign (P = 0.02 and 0.04, respectively). CONCLUSION: It seems that while malignant tumors have significantly higher number of vessels in comparison to benign one, since the number of vessels overlap between benign and malignant tumors, this aspect has little clinical usefulness in distinguishing or prognostication of breast masses. In contrast RI, PI, and vascularization pattern have an ability to differentiate and predict the prognosis of breast lesions.

Partial frequency of radiation pneumonitis and its association with the energy and treatment technique in patients with breast cancer, Isfahan, Iran.

BACKGROUND: Breast cancer is the most common type of cancer among women, and the second cause of cancer mortality after pulmonary cancer in this gender. Radiotherapy is one of the major treatments, which locally controls the disease and prohibits in recurrency. Radiation pneumonitis is one of the radiotherapy complications, which usually occurs within 1.5-3 months after radiotherapy. As there is no precise estimation concerning this complication in Isfahan, partial frequency of radiation pneumonitis and its association with the energy and treatment technique in patients with breast cancer were evaluated. MATERIALS AND METHODS: This was an analytic cross-sectional study performed in 2010 in university referral center. A total of 382 patients with breast cancer, undergone surgery and referred for radiotherapy entered the study. A posterior and anterior and lateral X-Rays were taken as control images before starting radiotherapy and all X-Rays were repeated after 3-4 months post radiotherapy. The occurrence of radiotherapy pneumonitis was evaluated by the same radiologist. Data were analyzed through SPSS version 20. RESULTS: Out of 382 patients undergone breast conservative surgery (BCS) or modified radical mastectomy (MRM), and radiotherapy, 60 patients had pneumonitis of whom 6 patients underwent BCS and were treated by tangential field (three cases by Co 60 and three cases by PH 9). The rest of radiotherapy pneumonitis patients (n = 54) underwent MRM of whom, 42 cases were treated by one-field and 12 by two-field treatment techniques. CONCLUSION: Incidence of radiotherapy pneumonitis was different with respect to the adopted technique (one-field, two-field and tangential) (P = 0.023), with the highest association with two-field radiotherapy.

Bone Age Assessment of Iranian Children in an Automatic Manner.

BACKGROUND: Bone age assessment (BAA) is a radiological process with the aim of identifying growth disorders in children. The objective of this study is to assess the bone age of Iranian children in an automatic manner. METHODS: In this context, three computer vision techniques including histogram of oriented gradients (HOG), local binary pattern (LBP), and scale-invariant feature transform (SIFT) are applied to extract appropriate features from the carpal and epiphyseal regions of interest. Two different datasets are applied here: the University of Southern California hand atlas for training this computer-aided diagnosis (CAD) system and Iranian radiographs for evaluating the performance of this system for BAA of Iranian children. In this study, the concatenation of HOG, LBP, and dense SIFT feature vectors and background subtraction are applied to improve the performance of this approach. Support vector machine (SVM) and K-nearest neighbor are used here for classification and the better results yielded by SVM. RESULTS: The accuracy of female radiographs is 90% and of male is 71.42%. The mean absolute error is 0.16 and 0.42 years for female and male test radiographs, respectively. Cohen's kappa coefficients are 0.86 and 0.6, P < 0.05, for female and male radiographs, respectively. The results indicate that this proposed approach is in substantial agreement with the bone age reported by the experienced radiologist. CONCLUSION: This approach is easy to implement and reliable, thus qualified for CAD and automatic BAA of Iranian children.

Isfahan Thyroid Cohort Study (ITCS).

BACKGROUND: The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status. METHODS: This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020-2021. RESULTS: The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%-90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%-6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%-1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6-3.7), subclinical hypothyroidism (20.6, 95% CI: 18-23), overt hyperthyroidism (1.9, 95% CI: 1-2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6-3.7) per 1000 (person-year). CONCLUSION: We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

Sonographic and functional characteristics of thyroid nodules in a population of adult people in Isfahan.

INTRODUCTION: The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran. MATERIAL AND METHODS: In a cross-sectional study conducted in 2006, 2523 adult people (age > 20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T(3), T(3), T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured. RESULTS: Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 microg/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography. CONCLUSIONS: The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population.

Thyroid incidentaloma in Isfahan, Iran - a population-based study.

INTRODUCTION: Thyroid nodules not detected in palpation but diagnosed following a radiological procedure or during surgery are called thyroid incidentalomas. We designed this study to investigate the prevalence of sonographic thyroid incidentaloma in Isfahan, Iran, for the first time. MATERIAL AND METHODS: By a multistage cluster sampling method, 2523 adults were selected randomly. From this group, 2045 had normal thyroid examination. 234 out of the 2045 were selected randomly for thyroid sonography. Thyroid stimulating hormone (TSH), urinary iodine concentrations (UIC) and antithyroid antibodies were measured. RESULTS: The prevalence of thyroid incidentaloma was 13.2% [Confidence interval (CI) 95% = 8-18]. The average age of subjects with and without incidentaloma was 46.1 (12.4) and 38.4 (12.1), respectively (P = 0.002). It was more prevalent in females than in males (19% vs. 10%) [Odds ratio (OR) = 2.59, CI 95% = 1.17-5.76, P value (P) = 0.01]. Median UIC in the incidentaloma group (14 microg/dl) was significantly lower than in the group of subjects without nodules (20 microg/dl) (OR = 0.9, CI 95% = 0.91-0.99, P = 0.02). There was no difference in the levels of TSH and antithyroid antibodies between the two groups (P > 0.05). Mean diameter of nodules was 8.14 (3.43) mm. CONCLUSIONS: The prevalence of thyroid incidentaloma was 13.2% in Isfahan. It was higher in females than males and increased with age.

Investigation of Frequency Distribution of Breast Imaging Reporting and Data System (BIRADS) Classification and Epidemiological Factors Related to Breast Cancer in Iran: A 7-year Study (2010-2016).

BACKGROUND: The first cause of women mortality due to cancer is breast cancer. Mammography plays a central part in early detection of breast cancers. The screening methods can play a major role to reduce the morbidity and mortality rate due to this malignancy. We sought the basic data in this study on our population because knowing about the baseline data is apt and vital. MATERIALS AND METHODS: In this study, data were collected from a questionnaire, contained baseline bio data information, and mammographic imaging of the patients came during 7 years. Breast imaging reporting and data system (BIRADS) score, breast composition, presence of axillary lymph nodes, microcalcifications, and other incidental positive findings were determined by a radiologist and analysis was performed by SPSS package. RESULTS: The most common indication for mammography was annual screening. The mean age of participants to the study was 55 ± 7.9 years. The majority (80%) of the patients with known breast cancer (BIRADS 6) had the extremely dense breast. The most common incidental findings in mammogram studies were focal asymmetry, architectural distortion, intramammary lymph node and accessory breasts, respectively. CONCLUSION: The frequency distribution of BIRADS classification in our society was clarified. It seems that the breast cancer risk is higher in women with dense breasts. Architectural distortion was also correlated to BIRADS score.

Prevalence of Chondrocalcinosis in Patients above 50 Years and the Relationship with Osteoarthritis.

BACKGROUND: Some studies showed a relation between chondrocalcinosis and osteoarthritis (OA). Hence, considering the importance of chondrocalcinosis diagnosis andnecessity for its integration with OA, the current study aims at investigating prevalence of chondrocalcinosis in patients above 50 years admitted to Isfahan Al-Zahra Medical Center and its relationship with OA. MATERIALS AND METHODS: In a cross-sectional study, 600 patients who referred to the radiology units of Al-Zahra Hospital for radiography of different joints were studied during 2013-2014. The patients images were studied for chondrocalcinosis and OA by a radiologist and also examined clinically and results of imaging by an expert rheumatologist. The prevalence of chondrocalcinosis and it relation with OA was determined by Statistical Package for Social Sciences software and using of Chi-square and t-test. RESULTS: 23 patients under study had chondrocalcinosis (3.83%). patients with chondrocalcinosis had higher age average, and they were in age group of 70 years and older, but no significant difference was observed regarding the prevalence of the disease in both genders. Chondrocalcinosis prevalence in terms of body mass index showed significant differences (P = 0.001). All patients with chondrocalcinosis had a history of joint disease and prevalence of chondrocalcinosis in terms of joint disease history showed a significant difference (P < 0.001). CONCLUSION: Prevalence of chondrocalcinosis is relatively high in the Iranian population of 70 years and older. Hence, more investigation considering to the diagnosis of chondrocalcinosis among patients with OA is very important.

Risk of diabetes in combined metabolic abnormalities and body mass index categories.

AIM: The present study was designed to estimate the progression rates from combination of normal weight, overweight, obesity, and number of metabolic abnormalities (MA) to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran. METHODS: A total of 1869 non-diabetic first-degree relatives (FDR) of patients with T2D 30-70 years old were examined and followed for a mean (SD) of 7.3 (2.2) years for T2D incidence. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test. RESULTS: The metabolically healthy overweight and obese at baseline were associated with incidence of T2D, independently of age and gender. Any one MA increased the risk of developing T2D among normal weight, overweight and obese individuals. Those with normal weight and ≥3 MA were over 20 times (odds ratios (OR) 20.21; 95% confidence intervals (CI) 2.4, 170.4) and those with overweight and ≥3 MA 22.5 times (OR 22.5; 95% CI 3.0, 167.0) and obese with ≥3 MA were 25.4 times (OR 25.4; 95% CI 3.4, 187) more likely to develop T2D than those with normal weight and without MA. Compared with participants without MA, obese individuals with concomitant MA were not significantly more likely to progress to T2D. CONCLUSION: Our data provide further evidence that normal weight, overweight and obese individuals with MA had a higher risk of incident T2D than normal weight individuals without MA.

International Consortium on Mammographic Density: Methodology and population diversity captured across 22 countries.

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether they are consistent across populations worldwide. We included 11755 women, from 27 studies in 22 countries, on whom individual-level risk factor data were pooled and original mammographic images were re-read for ICMD to obtain standardized comparable MD data. In the present article, we present (i) the rationale for this consortium; (ii) characteristics of the studies and women included; and (iii) study methodology to obtain comparable MD data from original re-read films. We also highlight the risk factor heterogeneity captured by such an effort and, thus, the unique insight the pooled study promises to offer through wider exposure ranges, different confounding structures and enhanced power for sub-group analyses.

The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method.

BACKGROUND: Since introduction of Greulich and Pyle (GP) method for bone age determination, several studies have been performed for evaluation of applicability of this method in different geographic and ethnic groups. In this study we investigated the accuracy of this method in Iranian population. MATERIALS AND METHODS: 425 (303 male and 122 female) healthy children aged between 6 and 18 years old, without genetic, metabolic, endocrine, growth or nutritional disorders who had plain hand and wrist radiographs were enrolled. All radiographs were taken for an indication of trauma from January 2009 to August 2010. Both sexes were divided into three subgroups (6-10, 10-14, 14-18 years old). Skeletal age (SA) was determined according to GP atlas by a radiologist who was blind to chronological age (CA). Mean CA was compared with mean SA in whole population, each sex group and in each age subgroup. Difference score (DS) was calculated by subtracting SA from CA and determined for whole population, each sex group and also for each age subgroup. Statistical analysis was performed using t-test and ANNOVA correlation test. RESULTS: Considering whole study population, mean SA was 12.15±4.16 years and mean CA was 12.4±4.09 years and mean difference score (CA-SA) was 0.25±0.95 years. In male subjects mean SA was 12.68±4.07 years and mean CA was 13.04±3.93 years and mean difference score was 0.37±0.98 years (equal to 4.5 months). In female subjects mean SA was 10.84±4.11 and mean CA was 10.81±4.06 and mean difference score of girls was -0.04±0.78 years (equal to -0.5 month). DS shows no significant difference among three age subgroups in either male (P(value)=0.63) and female (P(value)=0.59) group. CONCLUSION: According to this study skeletal age of boys was 4.5 months less than chronological age, but in girls skeletal age was 0.5 month more than it. Considering the possibility of few months difference, GP atlas could be applicable in Iranian children with acceptable accuracy.

Comparing the performance of image enhancement methods to detect microcalcification clusters in digital mammography.

BACKGROUND: Mammography is the primary imaging technique for detection and diagnosis of breast cancer; however, the contrast of a mammogram image is often poor, especially for dense and glandular tissues. In these cases the radiologist may miss some diagnostically important microcalcifications. In order to improve diagnosis of cancer correctly, image enhancement technology is often used to enhance the image and help radiologists. METHODS: This paper presents a comparative study in digital mammography image enhancement based on four different algorithms: wavelet-based enhancement (Asymmetric Daubechies of order 8), Contrast-Limited Adaptive Histogram Equalization (CLAHE), morphological operators and unsharp masking. These algorithms have been tested on 114 clinical digital mammography images. The comparison for all the proposed image enhancement techniques was carried out to find out the best technique in enhancement of the mammogram images to detect microcalcifications. RESULTS: For evaluation of performance of image enhancement algorithms, the Contrast Improvement Index (CII) and profile intensity surface area distribution curve quality assessment have been used after any enhancement. The results of this study have shown that the average of CII is about 2.61 for wavelet and for CLAHE, unsharp masking and morphology operation are about 2.047, 1.63 and 1.315 respectively. CONCLUSION: Experimental results strongly suggest that the wavelet transformation can be more effective and improve significantly overall detection of the Computer-Aided Diagnosis (CAD) system especially for dense breast. Compare to other studies, our method achieved a higher CII.

A case report of Gorlin-Goltz syndrome as a rare hereditary disorder.

Gorlin-Goltz syndrome is an autosomal dominant and a rare hereditary disease. Diagnosis of this syndrome is based on major and minor criteria. We report a Gorlin-Goltz syndrome in a 25-year-old male who was presented with progressive pain of maxilla and mandible over 5 years. The pain was diffuse and compatible with expansile cyst in alveolar ridges on panoramic radiography. In physical examination, he had coarse face and prognathism. Computer tomography of face revealed two expansile maxillary and one mandibular cyst. Calcification of entire length in falx and tentorium were detected in bone window.