Comparison of global strain values of myocardium in beta-thalassemia major patients with iron load using specific feature tracking in cardiac magnetic resonance imaging.

Thalassemia defined a spectrum of diseases characterized by reduced or absent production of one of the globin chains of hemoglobin. High iron deposition in the myocardium may cause functional impairment even before any changes in left ventricular (LV) ejection fraction. These impairments may appear as changes in strain values. Early detection of myocardial dysfunction is essential for improving survival and preventing further complications. Therefore, this study aims to evaluate the cardiac strain patterns by Feature Tracking -Cardiac Magnetic Resonance Imaging (FT-CMR) method and their correlation with T2* values as a new parameter in determining myocardial iron overload (MIO). In this retrospective investigation, ninety-one patients with B-thalassemia major included from May 2016 to July 2019. Twenty-three healthy subjects, also incorporated as a control group. CMR used to evaluate ventricular volumes, LVEF, and the amount of myocardial T2*. Moreover, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS), and Global Radial Strain (GRS) were measured and analyzed in both rights and left ventricles. Correlations of cardiac T2* with GLS, GCS, and GRS were evaluated. The optimal cutoff value of GLS for prediction of cardiac T2* < 20 ms (as an indicator of inadequate chelation) calculated as well. There were significant correlations between cardiac T2* with LV GLS, LV GCS, and right ventricular GLS (p < 0.05 for each one). Moreover, a significant difference detected between the group of TM - MIO and TM + MIO and control group in terms of GLS (p < 0.001). The optimal cutoff value of GLS for prediction of cardiac T2* < 20 ms was at - 16.5% with sensitivity and specificity of 73% and 63%, respectively. Our study demonstrates that strain values measured by FT and myocardial T2* values are correlated. FT-CMR can be considered as an efficient tool for early detection of iron deposition and its effects on cardiac tissue so that proper and timely modification could have applied to chelation therapy.

The Effect of Females' Reproductive Factors on Pituitary Gland Size in Women at Reproductive Age.

Background and Objectives: The brain imaging of the pituitary gland in females has shown a change in pituitary size and volume in the female's population. It has been proven that the pituitary gland is affected by pregnancy, giving birth, and hormone-related factors. Therefore, this study aimed to evaluate the factors which may have an impact on the pituitary size in females at reproductive age and compare the pituitary size in females with a history of pregnancy, those at the postpartum period, and nullipara females. Materials and Methods: This population-based study was conducted on 208 healthy women aged 12-55 years old. Participants underwent cranial Magnetic resonance imaging (MRI), and pituitary diameters (craniocaudal, anteroposterior, and transverse) and volume were measured for each subject. The correlation of age, gravity, parity, lactation, and intake of oral contraceptives with pituitary size were analyzed. Results: One-hundred and eighty females met the criteria for participation. The pituitary volume correlated negatively with hormone-related factors. The gravity (r = -0.35) and parity (r = -0.35) had significant negative effects on the pituitary volume (p < 0.001). The use of oral contraceptives and lactation were also in negative correlation with the pituitary volume (r = -0.20, p = 0.006, r = -0.56, p < 0.001, respectively). The craniocaudal diameter was also affected by gravity (r = -0.62), parity (r = -0.57), intake of contraceptives (r = -0.32), and lactation (r = -0.70), p < 0.001. The anteroposterior diameter of the pituitary gland associated significantly with gravity (r = -0.19, p = 0.009), parity (r = -0.20, p = 0.007), and lactation (r = -0.25, p = 0.001). The transverse diameter of the pituitary gland also related negatively with reproductive factors such as gravity (r = -0.15, p = 0.04), parity (r = -0.17, p = 0.02), and lactation (r = -0.17, p = 0.02). The pituitary gland of nullipara females was the greatest in size. Recent pregnancy led to increased craniocaudal and anteroposterior diameters. Conclusions: In this study, we found a negative effect of pregnancy and giving birth on pituitary size. Nullipara females were found to have the greatest pituitaries, even greater than the females in the postpartum period.

Diagnostic Accuracy of a 64-Slice Multi-Detector CT Scan in the Preoperative Evaluation of Periampullary Neoplasms.

Periampullary tumors are highly malignant masses with poor prognosis. Surgical resection is the only treatment for patients with this disease. The preoperative evaluation of masses is essential to determine the tumor resectability and vascular invasion. The aim of this study was to determine the diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) in detecting the resectability of periampullary masses. A cross-sectional study was conducted on patients with a definite diagnosis of periampullary cancer. All the participants underwent an MDCT scan before the surgical pancreaticoduodenectomy. The preoperative results were compared to the intraoperative findings and the diagnostic accuracy was determined based on the sensitivity and specificity of the MDCT. From June 2015 until June 2016, 32 patients with periampullary carcinoma were enrolled in the study. Of 32 masses, one of them considered nonresectable because of the gross vascular invasion in th CT images. After the operation, the overall resectability rate was 81.3%. The sensitivity and specificity of MDCT for tumor resectability was 100% and 16.7%, respectively, with an overall accuracy of 84.4%. To sum up, MDCT had high sensitivity but low specificity in the preoperative evaluation of preampullary carcinomas. The low specificity resulted from the low accuracy of the CT scan in detecting vascular involvement.