Predicting the outcome of asymptomatic univesicular liver hydatids: diagnostic accuracy of unenhanced CT.

OBJECTIVES: To establish the role of unenhanced CT in predicting the outcome of liver hydatid cysts. We sought to determine whether the presence of laminated membrane detachment (LMD) or pericyst degenerative changes (PDCs) detected on CT were reliable signs for predicting a favorable outcome of liver hydatids. METHODS: In a 20-year-long study, we prospectively followed changes occurred in CT of 106 cysts of 98 patients with incidentally discovered asymptomatic univesicular liver hydatids who accepted to enter a watch-and-wait program. An "unfavorable" outcome was defined as the occurrence of a complication (most commonly, cyst fistula or infection) or increase in the cyst size during the follow-up; otherwise, the outcome was considered "favorable." The parameters derived from a binary logistic regression analysis (with the outcome taken as the dependent variable), after appropriate transformation of the independent variables (presence of LMD or PDCs on CT), were used to calculate the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of the presence of either the abovementioned CT findings for the prediction of a favorable outcome. RESULTS: The presence of LMD or PDCs had a high specificity (88%) and positive predictive value (96%) for a favorable outcome; they had high false-negative rates. CONCLUSIONS: The presence of either LMD or PDCs on unenhanced CT, in incidentally discovered asymptomatic univesicular liver hydatids, was associated with a high probability of a favorable outcome. Their absence does not rule out a favorable outcome. KEY POINTS: • Computed tomography can be used for predicting the outcome of those with incidentally discovered univesicular liver hydatids. • The presence of laminated membrane detachment and/or pericyst degenerative changes is associated with a favorable outcome. • Their absence does not necessarily indicate an unfavorable outcome.

Challenges of diagnosis of COVID-19 in trauma patients: A case series.

Background: Diagnosis of COVID-19 can be challenging in trauma patients, especially those with chest trauma and lung contusion. Methods: We present a case series of patients from February and March 2020 who were admitted to our trauma center at Rajaee Hospital Trauma Center, in Shiraz, Iran and had positive SARS-CoV-2 PCR test or chest CT scan suggestive of COVID-19 and were admitted to the specific ICU for COVID-19. Results: Eight COVID-19 patients (6 male) with mean age of 40 (SD = 16.3) years old, were presented. All patients were cases of trauma injuries, with multiple injuries including chest trauma and lung contusion, admitted to our trauma center for management of their injuries, but they were diagnosed with COVID-19 as well. Two of them had coinfection of influenza type-B and SARS-CoV-2. All patients were treated for COVID-19 and three of them died; the rest were discharged from hospital. Conclusion: Since PCR for SARS-CoV-2 is not always sensitive enough to confirm the cause of pneumonia, chest CT manifestations can be helpful, though, they are not always differentiable from lung contusion. Therefore, both the CT scan and the clinical and paraclinical presentation and course of improvement can be beneficial in diagnosing COVID-19 in the trauma setting.

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.

Influence of dwell time homogeneity error weight parameter on treatment plan quality in inverse optimized high-dose-rate cervix brachytherapy using SagiPlan.

PURPOSE: Restricting the gradients of dwell times between adjacent dwell positions can potentially be beneficial in reducing the probability of unwanted hot/cold spots occurring, if the planned applicators/anatomy relative positions change before or during treatment. This constraint, however, may degrade plan quality. This study, for the first time, aims to quantify the impact of modulation restriction on plan quality indices in inverse optimization for cervix high-dose-rate (HDR) brachytherapy using the BEBIG SagiPlan treatment planning system. MATERIAL AND METHODS: Ten cervical cancer patient plans were optimized for treatment with a BEBIG SagiNova 60Co HDR afterloader using the min/max inverse planning method, with dwell time homogeneity error weight (DTHEW) parameter values of 0 to 10. Dwell time homogeneity and gradients as well as various plan quality indices were analyzed. RESULTS: For DTHEW = 0, min/max-based optimization yielded higher HR-CTV D90 values than the variance-based option (p < 0.001) and was therefore selected for this study. Averaging over all patients, selecting non-zero DTHEWs resulted in a general increase in dwell time homogeneity and decrease in mean and maximum adjacent dwell time gradients, especially between DTHEWs of 0 and 1. For DTHEW > 1, an increase of this parameter did not always result in more homogeneous dwell times or reduced gradients in individual patients. There was a negative correlation between DTHEW and both HR-CTV D90 and V100 (p < 0.001, r = -0.91). Increasing DTHEW also negatively affected conformity index (p < 0.001, r = -0.99). Changes in rectum and sigmoid colon D2cc were insignificant. There was a strong positive relationship between bladder D2cc and DTHEW (p < 0.001, r = 0.99). CONCLUSIONS: Assuming a static geometry, statistically significant degradation of plan quality can result from restricting the dwell time homogeneity in min/max-based optimization of cervix HDR brachytherapy plans using SagiPlan. Therefore, setting DTHEW to zero is indicated for the type of patient plans considered in this study.

Morphological active contour driven by local and global intensity fitting for spinal cord segmentation from MR images.

BACKGROUND: Spinal cord (SC) segmentation from magnetic resonance (MR) images can be used to study neurological disorders and facilitates group analysis. Variation of intensity inhomogeneity and small cross section of SC are difficulties that restrict automizing SC segmentation. NEW METHODS: In this paper we present a method for accurate SC segmentation from MR images. The proposed morphological local global intensity fitting model (MLGIF) is based on region based morphological active contour model that utilizes local and global information. The local information is obtained using local morphology fitting and has been embedded into region based active contour to deal with images intensity inhomogeneity and variable contrast levels between SC and the cerebrospinal fluid. The contour evolution has been performed using successive application of a set of morphological operators. RESULTS: The proposed method has been validated on 28 T1-weighted and 29 T2-weighted MR images and simulated MR images with different noise levels. Assessment of the results shows the accuracy of the proposed method for SC segmentation. COMPARISON TO EXISTING METHOD(S): The proposed MLGIF method was comparable with existing SC segmentation methods. Between segmented images and corresponding ground truth images, the mean DICE similarity coefficient, mean conformity coefficient and mean Hausdorff distance were 0.90 (092), 0.8 (0.83) and 0.85 mm (0.70 mm), respectively, for T1(T2)-weighted images. CONCLUSION: The MLGIF model was proposed to achieve a robust method to deal with intensity inhomogeneity and lack of contrast between SC and surrounding tissues. Moreover, accuracy and less sensitivity to initial curve were seen.

The Predictive Value of Repeated Abdominal Ultrasonography in Patients with Multiple Trauma and Decreased Level of Consciousness: The Experience of a Resource-Limited Centre.

OBJECTIVE: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC). METHODS: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results. RESULTS: Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury. CONCLUSION: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.

Effects of Oral Glibenclamide on Brain Contusion Volume and Functional Outcome of Patients with Moderate and Severe Traumatic Brain Injuries: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

OBJECTIVE: This study investigated effects of oral glibenclamide on brain contusion volume and functional outcome of patients with moderate and severe traumatic brain injuries. METHODS: A randomized clinical trial including 66 patients with moderate (Glasgow Coma Scale score 9-12) to severe (Glasgow Coma Scale score 5-8) traumatic brain injury and brain contusions of <30 mL volume was conducted from May 2015 to August 2016 in a Level I trauma center in southern Iran. Patients who required surgical intervention were excluded. Patients were randomly assigned to receive 10 mg oral glibenclamide daily for 10 days (n = 29) or placebo in the same dosage (n = 23). Brain contusion volumetry was performed on days 0, 3, and 7 using spiral thin-cut brain computed tomography scan (1-mm thickness). Outcome measures including modified Rankin Scale, Glasgow Outcome Scale, and Disability Rating Scale were evaluated 3 months after injury. RESULTS: There was no significant difference between the 2 study groups in baseline, day 3, and day 7 contusion volumes. Patients receiving glibenclamide had a significantly lower expansion ratio from first to second volumetry (P < 0.001). Similarly, the first to third expansion ratio was significantly lower in the glibenclamide group compared with placebo (P = 0.003). There was no significant difference between the 2 groups regarding functional outcome measured by Glasgow Outcome Scale, modified Rankin Scale, and Disability Rating Scale. CONCLUSIONS: Oral glibenclamide is associated with decreased contusion expansion rate in patients with moderate and severe traumatic brain injuries sustaining cerebral contusions.

Staging of Fatty Liver Diseases Based on Hierarchical Classification and Feature Fusion for Back-Scan-Converted Ultrasound Images.

Fatty liver disease is progressive and may not cause any symptoms at early stages. This disease is potentially fatal and can cause liver cancer in severe stages. Therefore, diagnosing and staging fatty liver disease in early stages is necessary. In this paper, a novel method is presented to classify normal and fatty liver, as well as discriminate three stages of fatty liver in ultrasound images. This study is performed with 129 subjects including 28 normal, 47 steatosis, 42 fibrosis, and 12 cirrhosis images. The proposed approach uses back-scan conversion of ultrasound sector images and is based on a hierarchical classification. The proposed algorithm is performed in two parts. The first part selects the optimum regions of interest from the focal zone of the back-scan-converted ultrasound images. In the second part, discrimination between normal and fatty liver is performed and then steatosis, fibrosis, and cirrhosis are classified in a hierarchical basis. The wavelet packet transform and gray-level co-occurrence matrix are used to obtain a number of statistical features. A support vector machine classifier is used to discriminate between normal and fatty liver, and stage fatty cases. The results of the proposed scheme clearly illustrate the efficiency of this system with overall accuracy of 94.91% and also specificity of more than 90%.

Comparison between Computed Tomography and Ultrasonography in Detecting Foreign Bodies Regarding Their Composition and Depth: An In Vitro Study.

STATEMENT OF THE PROBLEM: Impaction of foreign bodies in the soft tissues is a sequela of traumatic and penetrating injuries. Such foreign bodies should be removed due to the complications they cause. Patient's history, clinical evaluation and imaging examinations aid in the proper detection and localization of the foreign bodies. PURPOSE: The aim of the present study was to compare the sensitivity of computed tomography (CT) and ultrasonography for detecting foreign bodies in in-vitro models simulating facial soft tissues. MATERIALS AND METHOD: Fifty foreign particles with five different compositions including wood, glass, metal, plastic, and stone were embedded in five calf tongues at 1, 2, 3, 4 and 5 cm depths. CT and ultrasonography were compared regarding their capability of detecting and localizing the foreign bodies. RESULTS: Wood and plastic foreign bodies were demonstrated more clearly on ultrasonography images. High density materials such as metal, stone, and glass were detected with almost the same accuracy on CT and ultrasonography examinations. Visibility of the foreign bodies deteriorated on ultrasonography images as their depth increased; however, CT appearances of the foreign particles were not influenced by their depths. CONCLUSION: Ultrasonography is an appropriate technique for detection of foreign bodies especially the ones with low density. Therefore, it seems logical to perform ultrasonography in combination with CT in cases with the suspicion of foreign body impaction.

The Feasibility of Ultrasonography in Defining the Size of Jaw Osseous Lesions.

STATEMENT OF THE PROBLEM: Jaw bone lesions are common pathologic conditions. The role of ultrasonography in evaluation of the extra-osseous lesions is confirmed, however, this imaging modality is not the diagnostic routine for the intra-osseous jaw lesions. PURPOSE: The purpose of this study was to evaluate the efficiency of ultrasonography in diagnosis of intra-osseous jaw lesions concerning their size and content and also to study its correlation with the histopathological findings. MATERIALS AND METHOD: For this study, 15 patients with intra-osseous jaw lesions in the maxilla and mandible were selected from those referred to the Department of Oral Surgery. Panoramic imaging, computed tomography (CT) or cone beam computed tomography (CBCT) and ultrasonography (USG) were performed for all the lesions. The size of the lesions was measured by USG and then compared with CT or CBCT. Moreover, the correlation amongst the echographic patterns and histopathologic results was evaluated. RESULTS: In 12 cases, size values were in complete agreement with CT or CBCT. The size of 3 lesions could not be measured by the radiologist due to the thickness of buccal cortical plate. CONCLUSION: Findings of this study suggested that USG might be feasible in estimating the size of intra-osseous jaw lesions with little underestimation. This study also confirmed that ultrasound imaging was a very useful imaging technique which could provide significant diagnostic information regarding the content of jaw bone lesions where the buccal bone thickness was thin enough.

Effect of Cortical Bone Thickness on Detection of Intraosseous Lesions by Ultrasonography.

Background. Usefulness of ultrasound (US) in detection of intrabony lesions has been showed. A cortical bone perforation or a very thin and intact cortical bone is prerequisite for this purpose. Objective. The current in vitro study was aimed at measuring the cut-off thickness of the overlying cortical bone which allows ultrasonic assessment of bony defects. Materials and Methods. 20 bovine scapula blocks were obtained. Samples were numbered from 1 to 20. In each sample, 5 artificial lesions were made. The lesions were made in order to increase the overlying bone thickness, from 0.1 mm in the first sample to 2 mm in the last one (with 0.1 mm interval). After that, the samples underwent ultrasound examinations by two practicing radiologists. Results. All five lesions in samples numbered 1 to 11 were detected as hypoechoic area. Cortical bone thickness more than 1.1 mm resulted in a failure in the detection of central lesions. Conclusion. We can conclude that neither bony perforation nor very thin cortical bones are needed to consider US to be an effective imaging technique in the evaluation of bony lesion.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre.

INTRODUCTION: Cervical spine, thoracic and pelvic fractures are the main causes of devastation in patients who have suffered blunt trauma. Radiographic imaging plays an important role in diagnosing such injuries. Nevertheless, the present dominant approach, the routine use of X-ray studies, seems to have no cost-benefit justification for healthcare systems. METHODS: This prospective cross-sectional study was performed over a 3-month period. During the determined time frame, all haemodynamically stable, high-energy blunt trauma patients were included. Based on the predefined criteria, selective radiographic images of the neck, chest and pelvis were obtained. Patients were followed during their hospital stay and for a 2-week period after discharge. RESULTS: 1002 cases were included in the final survey. 247/1002 (24.6%) cervical radiographic images, 500/1002 (49.9%) CXRs and 171/1002 (17%) pelvic radiographic images of the patients were taken on the first day of hospital admission. New X-ray images required during the patients' hospital stay resulted in 5/1002 (0.4%) cervical, 4/1002 (0.3%) chest and 8/1002 (0.7%) pelvic radiographies. In the 2-week period after discharge, 4/1002 cases (0.3%) needed to repeat neck radiography. Overall, 697.44 mSv X-ray radiation was potentially prevented and US$426,450 were potentially saved. CONCLUSIONS: Selective radiographic imaging of the neck, chest and pelvis together with a precise history-taking and physical examination in cases of high-energy blunt trauma could eliminate unnecessary costs to patients and healthcare systems, and significantly save resources.

Ultrasonographic findings of mesenchymal chondrosarcoma of the mandible: report of a case.

Today, ultrasound imaging is being widely used to assess soft tissue lesions in the maxillofacial region. However, ultrasound investigations of intra-osseous lesions are rare, especially for tumors of the jaws. This report emphasized the capability of this useful imaging modality in identification of the characteristics of malignant conditions involving the bone. Mesenchymal chondrosarcoama, one of the unusual malignant conditions of the jaw, was presented in a young male with significant facial swelling. Different imaging modalities parallel with the histopathologic investigation confirmed the diagnosis. Interestingly, destruction of the bony cortex and new bone formation with a characteristic "sun ray appearance", highly suggestive of sarcomas, was manifested on the ultrasonograph. Thus, this report presented the ultrasonographic features of chondrosarcoma of mandible and considered the ultrasonography to be a useful imaging modality to evaluate intra-osseous jaw lesions.

Numerical analysis of micro- and nano-particle deposition in a realistic human upper airway.

A computational model was developed for studying the flow field and particle deposition in a human upper airway system, including: nasal cavity, nasopharynx, oropharynx, larynx and trachea. A series of coronal CT scan images of a 24 year old woman was used to construct the 3D model. The Lagrangian and Eulerian approaches were used, respectively, to find the trajectories of micro-particles and concentration of nano-particles. The total and regional deposition fractions of micro/nanoparticles were evaluated and the major hot spots for the deposition of inhaled particles were found.

Prevalence of hepatosplenomegaly in beta thalassemia minor subjects in Iran.

INTRODUCTION: Thalassemia is the most common hereditary blood disorder in the world. Iran is located on the thalassemic belt and there is a high prevalence of the hepatosplenomegaly in beta thalassemia minor patients which is reported to be very variable. The goal of this research was to study the frequency of these signs in the cases with beta thalassemia minor patients in Iran. MATERIALS AND METHODS: Two hundred and fifty-nine cases that referred to center for pre-marriage tests were divided into two groups according to their MCV, MCH, and HbA2 (beta thalassemia minor cases and control groups). Liver and spleen sizes were determined by ultrasonographic method and the two groups were compared with each other. RESULTS: Average spleen volumes in case and control groups were 163.48+/-133.97 and 126.29+/-53.98mm(3), respectively. Average spleen lengths in case and control groups were 10.71+/-1.52 and 10.60+/-5.4cm, respectively. CONCLUSION: In the regions with high frequency of beta thalassemia, in case of finding large spleen size in the ultrasonography, a probable harmless differential diagnosis will be beta thalassemia minor that is not indicative of any serious disease. Volumetric measurement of spleen is more reliable for detection of splenomegaly in these patients.