Diagnostic accuracy of sixty four multi-slice ct angiography in assessment of arterial cut-off and run-off in comparison with surgical findings

The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography [MSCTA] in run-off and cut-off sites of arterial disease. Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease [AD] all of whom had the indication for vascular surgery. The mean age of patients was 34 +/- 15.86 [range, 23 to 93] years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases [81.6%]. Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites [18.2%]. MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis

Unilateral blindness as the only finding in a patient with high flow carotid-cavernous fistula

The authors reported a patient with unilateral blindness of the left eye after trauma. Apart from paralysis of the 4th cranial nerve and mild optic nerve edema, there was no structural problem during the ophthalmologic examination. Brain CT scan, CT angiography and MRI demonstrated aneurysm in the left pericavernous region. The patient underwent angiography for coiling of the aneurysm, which detected large carotid cavernous fistula [CCF] mainly draining into the petrous sinus. Therapeutic embolization was performed with balloon and the CCF vanished completely. The most important points of this case are the blindness without exophthalmia as the only presentation of CCF which has not been reported as the only symptom and failure of CT-angiography and MRI evaluation for the diagnosis of CCF

Traumatic pseudo-aneurysm and concurrent dissection of the aortic arch treated with endovascular stenting

The pseudo-aneurysms of thoracic aorta are rare and a life-threatening complication of aortic surgery and blunt chest trauma. This article demonstrates a case report of a traumatic aortic arch dissection and formation of a false aneurysm after blunt chest trauma in Iran. A 23-year-old man was referred complaining of chest pain and exertional cough. He had a history of chest and abdominal trauma five months ago after a car accident, resulting in acceleration-deceleration injury. The trauma resulted in an extensive injury on the left side of the chest and abdomen associated with multiple rib fractures, hemopneumothorax and splenic rupture. Splenectomy and left chest tube drainage was performed. The patient was admitted for 15 days. Finally, he recovered to normal and was discharged in satisfactory condition. However, his chest pain and cough restarted and its severity gradually increased. In chest x-ray, a left upper mediastinal mass was detected, which was later confirmed by 64 multi-slice chest CT scan as a false aortic arch aneurysm and aortic dissection. It seems endovascular stent-graft technique for the treatment of thoracic aorta aneurysm may present a good treatment choice with a low risk and less invasive approach

Tailoring of interventional procedures for HCC patients-review article

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma [HCC]. Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma [HCC] including transcatheter arterial chemoembolization [TACE] and many tumor ablation techniques, such as percutaneous ethanol injection [PEI], radio-frequency ablation [RFA], percutaneous microwave coagulation therapy [PMC], laser-induced interstitial thermotherapy [LITT], cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likely that in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography [CT] and magnetic resonance imaging [MRI] have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated. In this review article, we discuss the imaging modalities and also tailoring of interventional procedures for HCC patients

Carotid doppler ultrasonography in preoperative assessment of coronary artery bypass graft surgery in an Iranian population: association between atherosclerosis risk factors and carotid stenosis

The aim of this study was to assess the frequency of significant carotid artery stenosis and its association with the cardiovascular risk factors in a group of Iranian candidates for CABG. Three hundred and one patients with critical coronary artery disease, who were candidates for coronary artery bypass graft [CABG] were evaluated by internal carotid Doppler study. The relations between age, gender, hypertension, diabetes mellitus, smoking, lipid profile, left main coronary stenosis greater than 50% by diameter and coronary artery disease with carotid stenosis were assessed. Significant carotid stenosis greater than 70% was detected in 13 patients [4.3%]. According to the meaningful relationship between significant carotid stenosis and low HDL serum level [lower than 45 in women and lower than 35 in men, p=0.028], hypertension [p=0.021], history of smoking [p=0.026] and left main coronary artery stenosis greater than 50% [p=0.035], they were identified as risk factors valuable enough to guide for selective screening. Among all cardiovascular risk factors. It seems that serum HDL, smoking, left main coronary stenosis and hypertension could be associated with significant carotid artery stenosis in CABG candidates

Cerebral venous thrombosis in a patient with clinically isolated syndrome suggestive of multiple sclerosis

Cerebral venous thrombosis [CVT] may occur at any age and may be idiopathic or secondary to various causes. It has been described in patients with multiple sclerosis [MS] as well. On the other hand, because of the variations of MS per presentations, coincidence of other neurological disorders in MS patients could be ignored. Therefore, more clinical and paraclinical evaluations should be considered in MS patients with any new atypical symptom. We report a rare case with symptoms and signs of inflammatory demyelinating disease as clinically isolated syndrome [CIS] suggestive of MS onset. This case developed CVT after lumbar puncture and during high-dose methylprednisolone pulse therapy

Non-contrast spiral computed tomography in diagnosis of acute appendicitis

Approach to patients with acute right lower quadrant pain remains a clinical dilemma. Decreasing the risk of negative appendectomies is one of the major goals surgery units intend to achieve. This study has been conducted to determine the accuracy of non-contrast focused appendiceal computed tomography [CT] in preoperative diagnosis of acute appendicitis. During a period of three months, 50 consecutive adult and adolescent patients who were clinically diagnosed as acute appendicitis were included in this study. Focused non-enhanced appendiceal spiral computed tomography [CT] was performed for all patients, preoperatively. Two radiologists who were unaware of the surgical findings assessed the CT scans. After the operation and pathologic assessment, eight patients with negative appendectomy were found. The sensitivity of CT was 0.71 and 0.83 according to the interpretations of the first and second radiologists, respectively. Moreover, its specificity was 0.88 and 0.75 according to the first and second radiologists' reports, respectively. In patients with clinically diagnosed acute appendicitis, relying on abdominal CT is not helpful

Fluoroscopic versus conventional computed tomography-guided biopsy

To determine the success rate of computed tomographic [CT] fluoroscopic CT [FCT] and conventional CT [CCT] for needle navigation in biopsies from mediastinum, bone, abdomen, liver and pelvis. Data from 122 consecutive percutaneous interventional biopsies performed with use of FCT guidance [mean age of 50.5; range: 1-79 years] and 84 consecutive biopsies with CCT guidance [mean age: 50.7; range, 12-83 years] were gathered from the interventional radiologist and general practitioner. The success rate of procedure was increased in the FCT group as compared with that of CCT group in some organs such as bone, abdomen, liver and pelvis. A statistically significant difference was noted when we compared FCT group with CCT in liver biopsies [P=0.019]. The mean procedure time was lower in FCT group. The overall mean [ +/- SD] FCT time was 200 +/- 90 [range: 20-400] sec; in CCT group, it was 420 +/- 260 [range: 605-800] second. FCT facilitates CT-guided biopsy procedures and reduces the procedure time by allowing visualization of the needle tip from skin entrance to the target point

Functional imaging of Broca's area in native Persian speakers: an fMRI study

The problem of localization of speech associated cortices using noninvasive methods has been of utmost importance in many neuroimaging studies, but the results are difficult to resolve for specific neurosurgical applications. In this study, we used fMRI to delineate language-related brain activation patterns with emphasis on the Broca's area during the execution of two Persian language tasks. The subjects comprised of nine healthy right-handed men who participated voluntarily in this study. They performed two consequent fMRI paradigms namely; "Word Production" and "Reverse Word Reading". The fMRI data were collected and analyzed. Then, functional images were registered to anatomical images using FSL software. The laterality indices were also calculated in regions of interest with different threshold levels. The results indicate that Broca's area, as the classical language-production center, was robustly activated while performing these two tasks. In eight out of nine subjects, the left hemisphere dominancy and Broca's area activation were observed and in one case activation was prominent in the homologous area in the right hemisphere. Similar pattern of cortical activation during Persian word production and Anglophone languages such as English was revealed. fMRI is a valuable means for brain mapping in language studies

Report pf bilateral inferior petrosal sinus sampling in Iran

The differential diagnosis of ACTH-dependent Cushing syndrome is a challenging issue for clinical endocrinologists. MRI is commonly used to diagnose Cushing disease and remains the obvious technique to identify pituitary microadenomas in a noninvasive manner but it has proved to be problematic in some cases

Multidetector CT evaluation of congenital heart disease: a pictorial essay

Multidetector computed tomography [MDCT] with or without ECG-synchronized images can successfully evaluate cardiac morphology and congenital heart diseases which mainly involve great vessels. In this pictorial essay, we present the great capability of MDCT for the evaluation of complex congenital heart disease

[Incidental sinus abnormalities in 256 patients referred for brain MRI]

Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality. In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >/= 5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity. Among our cases, 111 [43.5%] were male and 145 [56.5%] were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects [42.9%], 55.5% of which were male and 44.5% were female [P=0.001]. Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis [29% versus 19.1%; P<0.01]. Of those patients with sinus involvement, 16% were involved in the sphenoid sinus and 5% in the frontal sinus. The results obtained from the patients with sinus abnormality revealed that 85% suffered from cough, nasal obstruction, runny nose, facial pain and post nasal discharge and 24% had been diagnosed with chronic sinusitis by physician. Our results showed that there was a high rate of incidental abnormalities in the paranasal sinuses that are unrelated to the patient's presenting problems

Moyamoya: report of a pediatric case

Moyamoya [a Japanese term, meaning 'hazy things'] was first described by Takeuchi In 1963. Two forms of this disease have been distinguished: 1-Primary moyamoya, or moyamoya disease, with a strong hereditary predisposition and girls are more frequently affected. 2-Secondary moyamoya, or moyamoya syndrome, which is caused by a variety of underlying diseases. The Japanese scientists have classified moyamoya into four types: hemorrhagic, epileptic, infarct, and transient ischemic attack. Herein, we introduce an 8-years-old girl with the chief complaint of speech disorder. In her physical examination, we detected expressive aphasia. and right-sided central facial palsy. After a few days, right hemiplegia and cortical blindness appeared as well. Gradually she was totally unable to move and was transferred to the ICU because of loss of consciousness. MRI showed diffuse hyper signal lesions in the left temporoparietal and bilateral occipital area. MRA showed narrowing of the internal carotid artery and abnormal collaterals [moyamoya vessels]. After indirect bypass surgery [EDAS], she Is now able to sit, walk, run and speak. There are rare angiographically proven moyamoya cases. To our knowledge this was the first EDAS in Iran and a rare case of moyamoya with a dramatic response to operation

Nodular regenerative hyperplasia of the liver: report of a case

Nodular regenerative hyperplasia of the liver [NRHL] is characterized by hepatocellular nodules without fibrous septa between the nodules, and has been described in association with certain diseases. The NHRL should be considered in a liver mass and coexisting portal hypertension. We described the case of a 33-year-old Iranian man with NRHL in association with essential thrombocythemia