Evaluation of diagnostic value of pelvic MRI in endometriosis in comparison with surgical findings: A cross-sectional study.

Background: Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can either be used alone or along with transvaginal ultrasonography. Objective: This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one year. Materials and Methods: This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings. Results: The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively. Conclusion: Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method.

Prevalence and characteristics of coronary artery anomalies (CAAS) in 3016 symptomatic adult participants undergoing coronary computed tomography angiography (CCTA): A single-center retrospective study in Iran.

Introduction: Coronary artery anomalies (CAAs) are associated with an increased risk of cardiovascular events, including sudden cardiac death, especially in young people. A different prevalence has been reported based on the USED diagnostic modality. This study aimed to determine the prevalence and type of these anomalies using coronary computed tomography angiography (CCTA). Methods: This single-center retrospective study was performed on 3016 consecutive cases who underwent CCTA for cardiac symptoms from March 2015 to August 2020 and the prevalence and types of CAAs were evaluated. Results: 38 cases (overall prevalence of 1.26%) including 21 men (55.3%) and 17 women (44.7%) were retrospectively diagnosed with CAAs. The most common anomalies were the Anomalous origin of LCX from the right coronary sinus (11 cases, 28.9%), Anomalous origin of RCA from the left coronary sinus (11 cases, 28.9%), and Anomalous origin of LM from the right coronary sinus (6 cases, 15.8%). There was no difference in the prevalence of CAAs in terms of patient's gender (P value=0.16) and age (P value=0.61). Conclusion: The prevalence of CAAs among patients who underwent CCTA was 1.26%. The most common anomalies observed were the anomalous origin of the LCX arising from the right coronary sinus, the anomalous origin of the RCA arising from the left coronary sinus, and the anomalous origin of the LM arising from the right coronary sinus. These findings emphasize the importance of CCTA in detecting and characterizing coronary artery anomalies, which may have clinical implications for patient management and treatment decisions.

Slow release curcumin-containing soy protein nanoparticles as anticancer agents for osteosarcoma: synthesis and characterization.

Curcumin-containing soy protein nanoparticles (curcumin-SPNs) were synthesized by desolvation (coacervation) method and characterized by SEM, DLS, FTIR, and XRD. For anticancer evaluation, osteogenic sarcoma (SAOS2) cell lines were incubated with different concentrations of nanostructures. The dialysis method was used for assessment of drug release. Intracellular reactive oxygen species (ROS) were evaluated in IC50 dose after 24 h of exposure to free curcumin and curcumin-SPNs. Characterization data showed that the size of drug-free SPNs and curcumin-SPNs were 278.2 and 294.7 nm, respectively. The zeta potential of drug-free SPNs and curcumin-SPNs were - 37.1 and - 36.51 mv, respectively. There was no significant difference between the control and drug-free SPNs groups in terms of cell viability (p > 0.05). The viability of cells in different concentrations of the designed curcumin-SPNs in Saos2 cell line was significantly higher than free drug (p < 0.05). The release of curcumin showed that more than 50% of the drug was released in the first 2 h of incubation. After this time, the slow release of drug was continued to 62-83% of drug. IC50 values of free curcumin and curcumin-SPNs (1/10) were 156.8 and 65.9 µg/mL, respectively (a free curcumin IC50 was 2.4 times more than curcumin-SPNs). Slow-release of the curcumin causes the cell to be exposed to the anticancer drug for a longer period of time. The intracellular ROS levels significantly increased in an IC50 dose after 24 h of exposure to both free curcumin and curcumin-SPNs compared with controls (p < 0.05).

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

CT Scan Incidental Findings in Head Trauma Patients - Yazd Shahid Rahnemoun Hospital, 2005-2015.

BACKGROUND: Incidental findings are presented in radiology reports. Many of these findings do not require further investigation; however, some require further investigation and repeated imaging. The aim of this study was to determine the frequency of incidental findings on CT scans of patients with head trauma from 2005 to 2015. METHODS: This analytical cross-sectional study was conducted in years on 5,193 CT scan reports referred to Shahid Rahnemoun hospital in Yazd, Iran. The images were evaluated by consensus agreement of two radiologists. The relationship between age, sex and incidental findings was analyzed using the SPSS 20 software. RESULTS: A total of 5,193 subjects with a mean age of 34.16 ± 21.17 were examined. About 64% of cases were male. The frequency of incidental findings was 10.9%. The most common finding was calcification with a frequency of 3.3% and the least was Dandy Walker finding at 0.02%. There was no relationship between age, sex and the frequency of incidental findings. No significant trend was found between IFs frequency during ten years. CONCLUSION: The results of this study indicated that most incidental findings were related to benign findings, but also malignant findings were diagnosed.

PATIENT-SPECIFIC DOSIMETRY FOR PEDIATRIC IMAGING OF 99mTc-DIMERCAPTOSUCCINIC ACID WITH GATE MONTE CARLO CODE.

In this study, radiation absorbed dose of 99mTc-dimercaptosuccinic acid (DMSA) in critical organs was calculated using Monte Carlo simulation. Ten child patients with genitourinary abnormalities were imaged using a series of planar, SPECT and MRI, after injection with 99mTc-DMSA. Patient-specific organ segmentation was performed on MRI and used as input in GATE. Organs with substantial uptake included kidneys, bladder and liver. The mean organ absorbed dose coefficients (mGy/MBq) were 0.063, 0.058, 0.018, 0.016, 0.013 and 0.010 for the right kidney, left kidney, bones, urinary bladder wall, liver and gonads, respectively. The absorbed dose coefficients in the remainder of the body was 0.012 mGy/MBq. The authors implemented an image-based Monte Carlo method for patient-specific 3D absorbed dose calculation. This study also demonstrates the possibility to obtain patient-specific attenuation map from MRI to be used for the simulations of radiation transport and energy deposition in phantom using Monte Carlo methods.

The Normal Value of Tibial Tubercle Trochlear Groove Distance in Patients With Normal Knee Examinations Using MRI.

Patellar instability is a multifactorial common knee pathology that has a high recurrence rate, and the symptoms continue and ultimately predispose the patient to chondromalacia and osteoarthritis. Tibial tuberosity-trochlear groove distance (TTTG) is very important in the assessment of patellofemoral joint instability. The purpose of this study was to report the normal value of TTTG in males and females in different age groups and to assess the reliability of MRI in measuring TTTG. All patients presenting with knee pain and normal examinations of the knee joint, with a normal MRI report, referring to Shahid Sadoughi hospital of Yazd, Iran, from April 2014 to September 2014, were included in the study. MR images were studied once by two radiologists and for the second time by one radiologist. Mean value of TTTG was reported for males and females and in three age groups. Intra- and inter-observer reliability was calculated. A total of 98 patients were eligible to evaluate during 6 months (68 male and 30 female). Mean TTTG was 10.9±2.5 mm in total, which was 10.8±2.8 mm and 11.3±2.3 mm in males and females, respectively (P>0.05). Mean TTTG in males ≤30 years, 30-50 years and, ≥51-year-old were 10.8±2.6 mm, 10.8±2.7 mm, and 10.8±2.6 mm, respectively; that was 12.1±3.4 mm, 11.4±1.9 mm, and 10.5±1.7 mm in females ≤30 years, 31-50 years and, ≥51-year-old, respectively (95% CI). The coefficient of variation was <10% for both intra- and interobserver analysis. The results of the present study showed no significant difference in TTTG value between males and females in different age groups. In addition, it demonstrated that MRI is a reliable method in assessment of TTTG and identified normal value for TTTG at 10.9±2.5 mm.

Comparative Diagnostic Performance of Ultrasonography and 99mTc-Sestamibi Scintigraphy for Parathyroid Adenoma in Primary Hyperparathyroidism; Systematic Review and Meta- Analysis

Objective: Ultrasonography (US) and parathyroid scintigraphy (PS) with 99mTc-MIBI are common methods for preoperative localization of parathyroid adenomas but there discrepancies exist with regard to diagnostic accuracy. The aim of the study was to compare PS and US for localization of parathyroid adenoma with a systematic review and meta-analysis of the literature. Methods: Pub Med, Scopus (EMbase), Web of Science and the reference lists of all included studies were searched up to 1st January 2016. The search strategy was according PICO characteristics. Heterogeneity between the studies was accounted by P < 0.1. Point estimates were pooled estimate of sensitivity, specificity and positive predictive value of SPECT and ultrasonography with 99% confidence intervals (CIs) by pooling available data. Data analysis was performed using Meta-DiSc software (version 1.4). Results: Among 188 studies and after deletion of duplicated studies (75), a total of 113 titles and abstracts were studied. From these, 12 studies were selected. The meta-analysis determined a pooled sensitivity for scintigraphy of 83% [99% confidence interval (CI) 96.358 -97.412] and for ultra-sonography of 80% [99% confidence interval (CI) 76-83]. Similar results for specificity were also obtained for both approache. Conclusion: According this meta- analysis, there were no significant differences between the two methods in terms of sensitivity and specificity. There were overlaps in 99% confidence intervals. Also features of the two methods are similar.

A Comparison of Patients Absorption Doses with Bone Deformity Due to the EOS Imaging and Digital Radiology.

BACKGROUND: This study has aimed to measure the patient dose in entire spine radiography by EOS system in comparison with the digital radiography. METHODS: EOS stereo-radiography was used for frontal and lateral view spine imaging in 41 patients in a prospective analytical study. A calibrated dose area product (DAP) meter was used for calibration of the DAP in EOS system. The accuracy and precision of the system was confirmed according to the acceptance testing. The same procedure was used for 18 patients referred for lumbar spine digital radiology (overall 36 images). RESULTS: Although radiation fields in the EOS were almost twice of that in digital radiology, and the average peak tube voltage (kVp), current supply to the tube (mA), and the average size and age of the patients referred for EOS imaging were greater than digital radiology, however, the average DAP in EOS was 1/5 of that in digital radiology system. Also, the average dose in the EOS was about 1/20 of that in digital radiology. CONCLUSION: The patient dose in EOS imaging system was lower in comparison with digital radiology (1/20).

Comparison of Diffuse Weighted Imaging and Fluid Attenuation Inversion Recovery Sequences of MRI in Brain Multiple Sclerosis Plaques Detection.

OBJECTIVE: Suitable magnetic resonance imaging (MRI) techniques from conventional to new devices can help physicians in diagnosis and follow up of Multiple Sclerosis (MS) patients. The aim of present research was to compare effectiveness of Fluid Attenuation Inversion Recovery (FLAIR) sequence of conventional MRI and Diffuse Weighted Imaging (DWI) sequence as a new technique in detection of brain MS plaques. MATERIALS & METHODS: In this analytic cross sectional study, sample size was assessed as 40 people to detect any significant difference between two sequences with a level of 0.05. DWI and FLAIR sequences of without contrast brain MRI of consecutive MS patients referred to MRI center of Shahid Sadoughi Hospital, Yazd, Iran from January to May 2012, were evaluated. RESULTS: Thirty-two females and 8 males with mean age of 35.20±9.80 yr (range = 11-66 yr) were evaluated and finally 340 plaques including 127(37.2%) in T2WI, 127(37.2%) in FLAIR, 63(18.5%) in DWI and 24(7.1%) in T1WI were detected. FLAIR sequence was more efficient than DWI in detection of brain MS plaques, oval, round, amorphous plaque shapes, frontal and occipital lobes, periventricular, intracapsular, corpus callosum, centrum semiovale, subcortical, basal ganglia plaques and diameter of detected MS plaques in DWI sequence was smaller than in FLAIR. CONCLUSION: Old lesion can be detected by conventional MRI and new techniques might be more useful in early inflammatory phase of MS and assessment of experimental treatments.

Elimination of routine chest radiographs following off-pump coronary artery bypass surgery: A randomized controlled trial study.

BACKGROUND: Post cardiac surgery routine chest radiographs (CXRs), ordered without any clinical and laboratory indications, is a standard obligatory practice in many cardiothoracic centers. Routine CXRs incur cost, manpower, and radiation. The objective of this study is to assess early outcome in off-pump coronary artery bypass (OPCAB) patients with postoperative routine versus clinically indicated CXR protocols. MATERIALS AND METHODS: This study is a randomized clinical trial conducted on 231 OPCAB candidates in Afshar Cardiac Center, Yazd, Iran. Patients were categorized into two groups. All 118 patients in group A had routine postoperative CXRs. The 113 patients in group B were selectively exposed to CXR only on clinical indications. All patients were postoperatively followed up for 30 days. Data gathered from both groups were statistically analyzed. RESULTS: Routine postoperative CXRs obtained in 118 OPCAB group A candidates showed abnormal findings in 20 patients that did not require new intervention. One month follow-up of these patients showed no complications. In 113 OPCAB candidates of group B, 7 on-demand CXRs were obtained on clinical evaluation that required added intervention. In a 1-month follow-up of this group, five patients presented with symptomatic complaints. On re-examination, none needed readmission, intervention, or paraclinical evaluation. No complications were observed due to CXR elimination. CONCLUSION: The study suggests that postoperative CXR selected on clinical grounds in place of routine CXR does not change early postoperative outcome of OPCAB procedure.

Comparative study of the diagnostic value of panoramic and conventional radiography of the wrist in scaphoid fractures.

BACKGROUND: Scaphoid fractures are the most common type of carpal fractures. OBJECTIVES: The aim of the study was to compare the diagnostic value of panoramic and conventional radiographs of the wrist in scaphoid fractures. PATIENTS AND METHODS: The panoramic and conventional radiographs of 122 patients with acute and chronic wrist trauma were studied. The radiographs were analyzed and examined by two independent radiologist observers; one physician radiologist and one maxillofacial radiologist. The final diagnosis was made by an orthopedic specialist. Kappa test was used for statistical calculations, inter- and intra-observer agreement and correlation between the two techniques. RESULTS: Wrist panoramic radiography was more accurate than conventional radiography for ruling out scaphoid fractures. There was an agreement in 85% or more of the cases. Agreement values were higher with better inter and intra observer agreement for panoramic examinations than conventional radiographic examinations. CONCLUSION: The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.

Isolated humeral metastasis in uterine cervical cancer: a rare entity.

Bone metastasis in cancer of uterine cervix, especially in the form of isolated bone involvement is a rare manifestation. Herein, we report the first case of isolated humeral metastasis in a known case of locally advanced cervical cancer. A fifty-six-year old female presented with International Federation of Gynecology and Obstetrics (FIGO) Stage IV A squamous cell carcinoma of uterine cervix. She was treated with a combination of radiation and chemotherapy and then total abdominal hysterectomy with bilateral salpingo-oophorectomy. Seven months later, she developed an isolated lytic lesion in the left humerus, which turned out to be a bone metastatic lesion.

Results of noncontrast brain computed tomography scans of 1-18 year old epileptic children.

OBJECTIVE: The advent of computed tomography (CT) scan revolutionized the diagnostic evaluation of neurologic patients. The aim of this study was to evaluate brain CT results of epileptic children. MATERIALS & METHODS: In a descriptive cross-sectional study, noncontrast brain CT scan of 150 consecutive 1-18 year old epileptic children whom were referred to pediatric neurology clinic of Shahid Sadoughi University of Medical Sciences, from May 2008 to October 2010 in Yazd-Iran, evaluated. RESULTS: Sixty two girls and 88 boys with mean age of 6.6 ± 4.3 years were evaluated. In 38 (25.3 %) children, seizure onset age was under one year and 38 others had abnormal mental / developmental status. Fifty three children (35.3 %) and 97 (64.7%) had partial and generalized seizures, respectively. Partial seizures were more prevalent in children with seizure onset in < 1 year [41.5% (22/53) vs. 16.5% (16/97)] Result of CT was normal in 74 % (n=111). Among the patients with abnormal results, 18(46%) had brain atrophy, 10 (25.6%) structural CNS dysgenesia, six (15.4%) intracranial calcification, three (7.8%) hydrocephaly and two had (5.2%) brain tumor. Abnormal brain CT was more prevalent in patients with seizure onset in less than one year of age [60.5% (23 of 38) vs. 14.3% (16 of 112), p = 0.003], partial epilepsy [51% (27 of 53) vs. 12% (12/97)], and abnormal developmental status [ 81.5% (31 of 38) vs.7% (8 of 112]. Mean age of seizure onset in epileptic children with abnormal brain CT scan was less (M ± SD:1/17 ± 0.6 years versus 4.02±1.9 years). CONCLUSION: Brain CT scan might be considered in evaluation of epileptic children with partial seizures, seizure onset in less than one year of age or neurodevelopmental delay.

Renal power Doppler ultrasonographic evaluation of children with acute pyelonephritis.

Urinary tract infections are common in children. The available gold standard method for diagnosis, Tc-99m dimercaptosuccinic acid scan is expensive and exposes patients to considerable amount of radiation. This study was performed to compare and assess the efficacy of Power Doppler Ultrasound versus Tc-99m DMSA scan for diagnosis of acute pyelonephritis. A quasi experimental study was conducted on 34 children with mean age of 2.8 ± 2.7 years who were hospitalized with their first episode of febrile urinary tract infection. All children were evaluated in the first 3 days of admission by Doppler Ultrasound and Tc-99m DMSA scan. Patients with congenital structural anomalies were excluded. Each kidney was divided into three zones. The comparison between efficacy of Doppler Ultrasound and DMSA scan was carried out based on number of patients and on classified renal units. Based on the number of patients enrolled; the sensitivity, specificity, positive and negative predictive values and accuracy of Doppler Ultrasound were 89%, 53%, 70%, 80% and 74%, respectively but based on the renal units, it was 66%, 81%, 46%, 91% and 79% , respectively. Although Doppler Ultrasound has the potential for identifying acute pyelonephritis in children, but it is still soon to replace DMSA scan.

The value of ultrasound in diagnosing vesicoureteral reflux in young children with urinary tract infection.

Urinary tract infection is a common pediatric problem and vesicoureteral reflux is its most common complication. Detection of this reflux has classically been achieved by voiding cystouretrography (VCUG). Ultrasonography for evaluation of vesicoureteral reflux is shown to be feasible but is not widely accepted. Our aim was to assess the value of routine sonography in detecting vesicoureteral reflux is young children with urinary tract infection. This study was carried out in 105 patients suffering from urinary tract infection admitted to Shahid Sadughi Hospital in Yazd, Iran. These patients were evaluated by two methods (sonography and VCUG). Overall sensitivity and specificity value of sonography in suggesting vesicoureteral reflux were 63% and 95% respectively. The most accurate results were obtained with high grades reflux (75% and 955). The results reconfirmed that sonography is reliable in the exclusion or verification of high grade reflux and it has a low sensitivity in low grade vesicoureteral reflux.

Influence of physiological factors on thyroid size determined by ultrasound.

According to its superficial anatomical location, the thyroid gland is easily accessible by sonography. Sonography allows an exact documentation of the size and thyroid volume. The relationship between thyroid volume and anthropometric characteristics is a matter of controversy. The aim of this study was to investigate thyroid volume and its determinants in healthy adult. A cross-sectional study was performed from June2003 until April 2005 in 314 healthy adults aged over 18 years old in Yazd, Iran. Data were collected on age, sex, and weight and thyroid size by sonography. Mean of thyroid volume in male and female was 9.08 ± 2.49 and 7.93 ± 3.2 milliliter which the differences was significant (P<0.003).Differences between thyroid volume and weight was significant (P=0.001). Mean of female weight and proportion of thyroid volume to their weight was 61.83 ± 12.09kg and 0.130 ± 0.33. Mean of male weight and proportion of thyroid volume to their weight was 71.41 ± 9.05kg and 0.126 ± 0.028 (P<0.003). Results of study is similar to other studies .Mean of thyroid volume in Yazd citizens is not differ from other Iranian but is different from other countries. This difference could be related to food intake habit, geographical region and daily oral iodine consumption.