ORIGINAL_ARTICLE
FETAL PULMONARY ARTERY DOPPLER EXAMINATION AS A NON- INVASIVE TEST FOR ASSESSING PRENATAL LUNG MATURITY
Background:
Fetal lung immaturity is considered as an important
factor for adverse neonatal complications such as respiratory distress syndrome. Therefore, multiple attempts have been made to determine prenatal lung maturity. Currently, the gold standard for this purpose is amniocentesis in order to examining lecithin to sphingomyelin ratio of the amniotic fluid. However, amniocentesis is an invasive testing that can cause maternal and/or fetal complications. Fetal pulmonary artery Doppler study is a non-invasive method that may be helpful in predicting fetal lung maturity and preventing postnatal complications.
Objectives:
To investigate the efficacy of fetal pulmonary artery Doppler examination as a predictor of fetal lung maturity.
Patients and Methods:
86 singleton pregnancies with indication of emergent cesarean section before 37 weeks of gestation were included in a prospective study. Pulmonary artery Doppler exam was performed and interpreted by an expert radiologist, 1-12 hour(s) prior to delivery. Fetal main pulmonary artery resistive index (RI), pulsatility index (PI), and acceleration time to ejection time (AT/ET) were determined using manual tracing of three contiguous waves (for RI and PI) and manual determination of times on one wave (for AT/ ET). None of included mothers had comorbidities and/or received corticosteroids after Doppler examination. NICU admission and/or neonatal death due to respiratory distress were considered as adverse postnatal outcome.
Results:
Gestational age at delivery was between 31 and 37 weeks. 16 neonates (19%) required NICU admission because of respiratory distress. No neonatal death occurred during 1-month follow-up. Gestational age was lower in NICU-admitted newborns compared to non-NICU-admitted ones (mean, 33.8±1.3 weeks versus 35.4±1.9 weeks, P =0.002). Pulmonary artery RI (mean, 0.86±0.15 versus 0.81±0.24, P =0.52)
as well as PI (mean, 2.18±0.27 versus 2.25±0.41, P =0.43) was not statistically different between NICU-admitted and non-NICU-admitted neonates. However, pulmonary artery AT/ET was found to be significantly lower in newborns with respiratory distress in comparison to those without respiratory distress (mean, 0.24±0.05 versus 0.33±0.09, P
<0.001). Receiver operating characteristic curve demonstrated that the optimal cut-off point for predicting fetal lung maturity based on pulmonary artery AT/ET is 0.31 with the ratios ≥0.31 indicating fetal lung maturity (sensitivity =75%, Specificity
=93%, negative predictive value =85%, positive
predictive value =82%).
Conclusions:
In conclusion, fetal pulmonary artery acceleration time to ejection time is a useful Doppler parameter for predicting fetal lung maturity non-invasively.
https://www.icrjournal.ir/article_100884_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
89
89
10.22034/icrj.2019.100884
fetal Doppler
fetal lung maturity
Respiratory Distress Syndrome
Mohammad
Zare Mehrjardi
zare@sbmu.ac.ir
1
Division of Clinical Research, Climax Radiology Education Foundation, Tehran, Iran; Division of Clinical Research, Iranian Association of Fetal Ultrasound, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
COMPARISON OF QUALITATIVE (TIME INTENSITY CURVE ANALYSIS), SEMI-QUANTITATIVE AND QUANTITATIVE MULTIPHASE 3T DCE- MRI PARAMETERS AS PREDICTORS OF MALIGNANCY IN ADNEXAL MASSES
Objective:
The present study aimed to compare the qualitative
(time intensity curve analysis), semi-quantitative and quantitative multiphase 3T dynamic contrast- enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses.
Materials and Methods:
In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one year to confirm benignity of their lesions, underwent multiphase 3T DCE-MRI. Qualitative (time intensity curve), semi- quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE- MRI sequences and their predictive values were compared.
Results:
A total of 17 benign and 14 malignant lesions were included. According to qualitative analysis, none of the lesions with type I time intensity curves (TIC) were malignant and none of the masses with type III TICs were benign. The accuracy of quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within a high signal area of the mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from an sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion:
We concluded that a type I TIC confirms a benign lesion, and a type III TIC confirms malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.
https://www.icrjournal.ir/article_100885_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
90
90
10.22034/icrj.2019.100885
Adnexal mass
DCE-MRI
qualitative
semi- quantitative
quantitative
Time Intensity Curve
Seyedeh Nooshin
Miratashi Yazdi
1
Emam Khomeini Hospital
LEAD_AUTHOR
ORIGINAL_ARTICLE
COGNITIVE FUNCTIONS AND WHITE MATTER LESIONS ON MR IMAGES IN A SAMPLE OF NORMAL IRANIAN POPULATION WITH CARDIOVASCULAR RISK FACTORS
Objectives:
Due to a suggestive three-way relationship between
brain structural disorders, microvascular lesions, and cognitive impairments, we aimed to examine the association of the volume and number of white matter hyperintensity (WMH) lesions and lacunar infarcts with the cognitive impairment among the patients with cardiovascular risk factors in a sample of Iranian population.
Methods:
This cross-sectional study was conducted on a total number of 156 normal subjectsaged 30 to 74 years with cardiovascular risk factors. We used the Framingham general cardiovascular risk factors prediction model to calculate the likelihood of each risk factor. All patients underwent Brain MRI. The total number of lacunar infarcts and the volume of WMH lesion were calculated. The cognition status was assessed using the Montreal cognitive assessment (MoCA) questionnaire.
Results:
Adverse association was revealed between MoCA cognition score and different cardiovascular risk profiles including Framingham BMI score (p < 0.001), Framingham lipid score (p < 0.001), Vascular Age Lipid Score (p < 0.001), and Vascular Age BMI Score (p = 0.001).The total volume of WMH was negatively associated with total MoCA cognition score (p < 0.001) as well as with some components of cognitive function including memory (p = 0.007), attention (p = 0.011), language (p = 0.027) and orientation (p = 0.003). Our study also showed an adverse association between total number of lacunar infarcts and total MoCA cognition score (p = 0.038) and consequently with some cognition components including memory (p = 0.013), attention (p = 0.037), abstraction (p = 0.046) and orientation (p = 0.002).
Conclusion:
The total volume of WMH and number of lacunar infarcts correlate with a lowering in cognitive function in normal subjects with cardiovascular risk factors, but without cardiovascular or cerebrovascular disorders. The periventricular lesions are associated with impaired memory, language and visuo- constructional function while the subcortical lesion are associated with impairment in naming, attention, language and abstraction functions in such subjects.
https://www.icrjournal.ir/article_100886_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
91
91
10.22034/icrj.2019.100886
Morteza
Sanei Taheri
saneim@yahoo.com
1
Shahid Beheshti University of Medical Sciences
AUTHOR
Mehran
Arab Ahmadi
2
Tehran University of Medical Sciences
LEAD_AUTHOR
Hamid Reza
Haghighatkhah
drhrhaghighatkhah@yahoo.com
3
Shahid Beheshti University of Medical Sciences
AUTHOR
Mohammad
Amiri
4
Tehran University of Medical Scienes
AUTHOR
Mostafa
Ranjbar
5
Shahid Beheshti University of Medical Sciences
AUTHOR
ORIGINAL_ARTICLE
THE COMMON STEM OF CALCARINE SULCUS AND PARIETOOCCIPITAL FISSURE IN THE AXIAL PLANE; A POTENTIAL EARLY MARKER OF CORTICAL DEVELOPMENT IN FETAL MRI
Purpose:
To investigate the development of the common stem
of calcarine sulcus and parietooccipital fissure in the axial plane as a potential early marker of cortical development in fetal MRI
Methods and Materials:
From September 2013 to 2016 out of the 658 fetal MRI’s performed in our tertiary care referral hospital 321 fetuses were performed before 20 weeks GA. Sixty-seven fetuses with normal fetal brain MRI and normal outcomes as measured by normal Ages and Stages Questionnaires obtained at least one-year post- delivery were included in the study. Three fetuses with GA of 16, 4 with GA of 17, 18 fetuses with GA of 18, and 42 fetuses with GA of 19 weeks were included in the study. Early midline sulci including the calcarine (cal) and parietooccipital (POF) fissures as well as their common stem were assessed in all fetuses by two radiologists in consensus. The visible sulci based on the method presented by Van der Knaap et al. (0-6).
Results:
The mean scores for the common POF-Cal sulcus stem in axial images were 1 and 0.5 and 0.44 and
1.36. The mean scores for Cal in the standard coronal plane was 0 and 0 and 0.16 and 0.10 in fetuses with
GA’s of 16, 17, 18 and 19 weeks respectively, while the mean scores for the proximal Cal in axial images was 0.66 and 0.25 and 0.44 and 1.33.
Conclusion:
The common POF-calcarine sulcus stem seems to become visible in MRI earlier than the age mentioned in previous fetal MRI studies. This sulcus is among the first sulci to develop in fetal pathology studies and can be potentially used as an early indicator of early fetal development.
https://www.icrjournal.ir/article_100887_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
92
92
10.22034/icrj.2019.100887
Fetal MRI
calcarine sulcus
parietooccipital fissure
Sepideh
Sefidbakht
sepidehsefidbakht@yahoo.com
1
Shiraz University of Medical Science
AUTHOR
Zahra
Hemmati
2
Shiraz University of Medical Science
LEAD_AUTHOR
Bijan
Bijan
drbijanbijan@gmail.com
3
Department of Radiology, University of California Davis Medical Center
AUTHOR
Pooya
Iranpour
4
Shiraz University of Medical Science
AUTHOR
Saeed
Esmaeilian
5
Shiraz University of Medical Science
AUTHOR
Pegah
Katibeh
6
Shiraz University of Medical Science
AUTHOR
ORIGINAL_ARTICLE
SPECTRUM OF CNS AND EXTRA CNS FINDINGS IN COMMISURAL AGENESIS, A FETAL MRI STUDY
Purpose:
To categorize structural CNS and extra-CNS
anomalies associated with abnormalities of the corpus callosum,.
Material and Methods:
The university ethics committee approved this
retrospective study. 821fetal MRI’s were done during 2017-2018 in our institution, including 34corpus callosum and commissural anomalies. MRI’s were done on a Seimens Avanto 1.5T Scanner and interpreted with prior knowledge of the mid trimester anatomical survey. Post-delivery follow-ups and images were obtained when available using patients phone numbers and national registry results.
Result:
The MR imaging studies of 167 fetal suspected with ventriculomegaly with ultrasound were reviewed to evaluate types of abnormalities of the corpus callosum. MRI confirmed presence of ventriculomegaly in 94 cases. In 45 (47.8%) out of 94 cases with ventriculomegaly the anomaly of corpus callosum was the suspected in ultrasound. Complete corpus callosum agenesis in 19 Cases and partial agenesis of the corpus callosum in 11 cases were identified, and the remaining 15 Cases had normal corpus callosum. Additional abnormalities were also implemented in the reviewed cases, categorized in two groups as “extra CNS” and “additional CNS” abnormalities. Anterior commissure was seen in 15 cases of complete agenesis while hippocampal commissure was seen in only one.
In complete CCA extra CNS abnormalities
documented in 4cases consisted of Renal hypoplasia (1), pulmonary agenesis (1) lower extremimty palsy (1) and bilateral cleft lip (1). The additional CNS anomalies documented in 9 cases include; polymicrogyria (3), shallow insula (2), heterotopia
(2) , cerebellar hypoplasia (2).
In partial CCA, 1 case of extra CNS anomaly include bilateral cleft lip and palate (1) and 7 cases with additional CNS abnormalities documented constituted of; hydrocephaly(1), closed lip schizencephaly (1), polymicrogyria (2), septo optic dysplasia (2) , dandy walker malformation (1). In both groups all the extra-CNS findings had also been detected in ultrasound, while out of the extraCNS findings only the cerebellar hypoplasia was seen in ultrasound.
Conclusion:
MRI can detect additional CNS anomalies in patients with ACC and can help rule out callosal agenesis with confidence. Given the heterogeneous clinical outcome of ACC, this can have prognostic and counseling value.
https://www.icrjournal.ir/article_100888_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
93
93
10.22034/icrj.2019.100888
Sepideh
Sefidbakht
sepidehsefidbakht@yahoo.com
1
Shiraz University of Medical Science
AUTHOR
Nazanin
Sadraee
2
Medical Imaging Center, Shiraz University of Medical Sciences,Shiraz, IR
LEAD_AUTHOR
Bijan
Bijan
drbijanbijan@gmail.com
3
Department of Radiology, University of California Davis Medical Center
AUTHOR
Sara
Haseli
sarahaseli@gmail.com
4
Medical Imaging Centre, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Pedram
Keshavarz
5
(SUMS)
AUTHOR
Pooya
Iranpour
6
Shiraz University of Medical Science
AUTHOR
Seyed Hamed
Jafari
7
Shiraz University of Medical Science
AUTHOR
Neda
Rahimirad
8
(SUMS)
AUTHOR
Nasrin
Asadi
9
(SUMS)
AUTHOR
ORIGINAL_ARTICLE
RADIATION DOSE OPTIMIZATION IN CT FOR CRANIOSYNOSTOSIS EVALUATION
Background:
Computed Tomography (CT) is one of the most
important diagnostic methods for craniosynostosis evaluation to assess the skull sutures of pediatric patients. Since the risk of radiation dose is especially very serious in pediatric, the aim of this study is to evaluate the possibility of radiation dose reduction in CT scanning of skull for craniosynostosis, with respect to image quality.
Methods:
A cadaver skull bone was scanned, by 8-MDCT GE Health care, with standard dose (100 kVp, 9mAs) and with 20% reduced dose (80 kVp, 9mAs). Reconstructed 3D images (with 1.25mm slice thickness) were evaluated by two experienced radiologists, subjectively blinded to the exposure parameters. Image quality were reported to be acceptable in both standard and reduced dose cases. Therefore, dose reduction protocol was used to scan 57 pediatric patients, 1 to 36 months old, suspicious of craniosynostosis. Radiation dose indices including volume CT dose index (CTDIvol in mGy) and Dose Length Product (DLP in mGy.cm) for standard (41 patients) and dose reduction protocol were recorded from PACS system. Conversion factor k (in mSv/mGy. cm) was used to calculate effective dose (ED) in mSv.
Results:
Statistical analysis shows that the mean and standard deviation of CTDIvol, DLP and ED are 12.86±2.2 mGy, 199±48 mGy.cm, 1.94 mSv for standard dose and 5.35±0.2 mGy, 84.26±7.4, 0.77±0.17 mSv for
dose reduction protocol respectively with p<0.001 for all pair parameters.Conclusion:
Dose reduction protocol for scanning skull of pediatric patients, to evaluate craniosynostosis is able to reduce CTDIvol, DLP and ED values by 58%, 57.5% and 70% respectively relative to standard one, while the diagnostic image quality is acceptable. Therefore, standard dose protocol can be replaced by dose reduction one, as is established in this study.
RI’s were done during
https://www.icrjournal.ir/article_100889_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
94
94
10.22034/icrj.2019.100889
CT dose reduction
Craniosynostosis
Image quality
Fariba
Zarei
zareifari@sums.ac.ir
1
Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Zeynab
Mashayekhi
2
Department of Radiology, Shiraz University of Medical Sciences, Shiraz
AUTHOR
Rezvan
Ravanfar Haghighi
3
Medical Imaging Research Center, Shiraz University of Medical Sciences
LEAD_AUTHOR
ORIGINAL_ARTICLE
CAD SYSTEM BASED ON B-MODE AND COLOR DOPPLER SONOGRAPHIC FEATURES MAY PREDICT IF A THYROID NODULE IS HOT OR COLD
Abstract Objectives:
The aim of this study was to evaluate if the analysis
of sonographic parameters could predict if a thyroid nodule was hot or cold.
Methods:
Overall, 102 thyroid nodules, including 51 hyperfunctioning (hot) and 51 hypofunctioning (cold) nodules, were evaluated in this study. Twelve sonographic features (i.e., seven B-mode and five Doppler features) were extracted for each nodule type. The isthmus thickness, nodule volume, echogenicity, margin, internal component, microcalcification, and halo sign features were obtained in the B-mode, while the vascularity pattern, resistive index (RI), peak systolic velocity, end diastolic velocity, and peak systolic/end diastolic velocity ratio (SDR) were determined, based on Doppler ultrasounds. All significant features were incorporated in the computer-aided diagnosis (CAD) system to classify hot and cold nodules.
Results:
Among all sonographic features, only isthmus thickness, nodule volume, echogenicity, RI, and SDR were significantly different between hot and cold nodules. Based on these features in the training dataset, the CAD system could classify hot and cold nodules with an area under the curve (AUC) of 0.898. Also, in the test dataset, hot and cold nodules were classified with an AUC of 0.833.
Conclusions:
2D sonographic features could differentiate hot and cold thyroid nodules. The CAD system showed a great potential to achieve it automatically.
Key Points
Cold nodules represent higher volume (p = 0.005), isthmus thickness (p = 0.035), RI (p = 0.020), and SDR (p = 0.044) and appear hypoechogenic (p = 0.010) in US.
Nodule volume with an AUC of 0.6
https://www.icrjournal.ir/article_100890_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
95
95
10.22034/icrj.2019.100890
Afshin
Mohammadi
1
(UMSU)
LEAD_AUTHOR
Mohammad
Bagher Shiran
2
Department of Medical Physics, School of Medicine, Iran University of Medical Sciences
AUTHOR
Ali
Abbasian Ardakani
3
Department of Medical Physics, School of Medicine, Iran University of Medical Sciences
AUTHOR
Ali
Mohammadzadeh
4
Department of Radiology, Rajaie Cardiovascular, Medical and Research Center
AUTHOR
ORIGINAL_ARTICLE
BREAST TUMOR CLASSIFICATION IN SHEAR WAVE ELASTOGRAPHY IMAGES USING CONVOLUTIONAL NEURAL NETWORK
Abstract Background:
Breast cancer is the most common type of cancer among
women. About one in eight women are diagnosed with breast cancer during their lifetime. A malignant tissue is stiffer than normal and benign tissues. This stiffness could be evaluated by elastography. Patients and Methods:
A comprehensive dataset of shear wave elastography (SWE) images of breast tissue using an Esaote MyLab™ 9 system was provided. 100 images were related to breasts with benign tumors and 100 images contain malignant tumors. The gold standard for evaluation of proposed algorithm was biopsy, which was performed on all of examining lesions.
A convolutional neural network was applied to the dataset, to extract the visual features of the images. The architecture was based on Densenet architecture, which is modified for our purpose. We have used the network in both pre-trained and end-to-end training strategies and the results were compared. The network was pre-trained on the Imagenet dataset, due to the lack of sufficient dataset. On the other hand, with data augmentation the network underwent a full training strategy. Finally, the classification layer, which decides about the benignity or malignancy of the lump, is a softmax layer.
Results:
The results of the proposed methods are satisfying in both pre-trained and end-to-end training approaches. We have used various evaluation metrics contain precision, recall, F1-score, ROC curve, and training time for both strategies. The precision, recall, and F1-score were 0.87, 0.91, and 0.89 for the Densenet architecture trained from scratch and 0.93, 0.95, and 0.94 for the transfer learning approach. The ROC curves were plotted for both approaches and the area under the curves (AUCs) were calculated. The transfer learning approach yielded a 0.97 of AUC, whereas this number was 0.91 for the fully- trained approach. At last, the training time of transfer learning approach was less than training from scratch, as it was anticipated.
Conclusion:
The results show the superiority of the transfer learning approach in tumor classification. Higher statistical metrics with lower training time makes this approach more compatible with SWE images.
https://www.icrjournal.ir/article_100891_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
96
96
10.22034/icrj.2019.100891
Nasrin
Ahmadinejad
n_ahmadinejad@yahoo.com
1
Tehran University of Medical Sciences
AUTHOR
Mostafa
Ghelich Oghli
m.g31_mesu@yahoo.com
2
Rajaie Cardiovascular Medical and Research Center
LEAD_AUTHOR
Shakiba
Moradi
3
Sharif University of Technology, Tehran, Iran
AUTHOR
Arvin
Aryan
arvinaryan@yahoo.com
4
Tehran University of Medical Sciences
AUTHOR
Isaac
Shiri
5
Tehran University of Medical Sciences
AUTHOR
ORIGINAL_ARTICLE
FETAL GI TRACT OBSTRUCTION, IS MRI INDICATED?
Abstract Background:
Fetal gastrointestinal tract obstructions, while not
very common are among the potentially treatable fetal anomalies. The purpose of this study was to retrospectively review fetal MRI’s performed for evaluation of a suspected GIT obstruction in our center, correlate them with post-delivery follow-up and evaluate accuracy and value of MRI in diagnosis of these lesions.
Material and Methods:
The university ethics committee approved this retrospective study. 497 fetal MRI’s were done during2013-2016 in our institution. 21 studies were performed specifically for further evaluation of suspected GIT obstruction. Only fetuses in whom at least one-year post-delivery follow-up and/or pathology and operative results were available entered the study. 21fetal MRI’s were done for evaluation of suspected GI obstruction reported on anomaly US scan and followed to post-delivery /abortion to final diagnosis during2013-2016 in our institution, MRI’s were done on a Seimens Avanto 1.5T Scanner and interpreted with prior knowledge of the midtrimester anatomical survey. When operative diagnosis and pathology was not available, the fetuses were evaluated retrospectively in a multidisciplinary team including a radiologist, perinatologist, and pediatric surgeon. Results:
The final group included 12 GI tract obstruction with varying causes including small bowel atresia (4), esophageal atresia (3),midgut malrotaion (2), MMIHS ,anorectal malformation , external mass compression (each 1) . In 10 cases with distended stomach and suspected gastric outlet obstruction or duodenal atresia MRI was considered normal. In all of these cases third trimester ultrasound was normal. There was one case of anorectal malformation which was missed both by MRI and ultrasound.
US was sensitive for detecting GI obstruction (91%) but it was not specific(57%). This result is acceptable given the fact that ultrasound is a screening tool. Adding MRI to the ultrasound results increased the specificity significantly to 95% while the sensitivity remained unchanged at 91%.
Conclusion:
When performed with prior knowledge of ultrasound results fetal MRI might be able to increase specificity of the diagnosis of fetal bowel obstructions in terms of level and cause of fetal bowel obstruction.
ologist, perinatologist, and pediatric surgeon.
https://www.icrjournal.ir/article_100892_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
97
97
10.22034/icrj.2019.100892
Reza
Jahankhah
1
(SUMS)
LEAD_AUTHOR
Sepideh
Sefidbakht
sepidehsefidbakht@yahoo.com
2
Shiraz University Of Medical Science
AUTHOR
Pedram
Keshavarz
3
(SUMS)
AUTHOR
Bijan
Bijan
drbijanbijan@gmail.com
4
Department of Radiology, University of California Davis Medical Center
AUTHOR
Ali
Bahador
5
(SUMS)
AUTHOR
Maryam
Kasraeean
6
(SUMS)
AUTHOR
ORIGINAL_ARTICLE
DIAGNOSTIC VALUE OF CORONARY TRANSLUMINAL ATTENUATION GRADIENT IN CORONARY CT ANGIOGRAPHY FOR DETERMINING STENOSIS SEVERITY
Abstract Background:
The purpose of the present study was to determine the
diagnostic accuracy ofTransluminal attenuation gradient (TAG) in 64-slice multislice computed tomography in the detection of significant coronary artery disease, using diameter stenosis as the comparison. Methods:
In 82 patients scheduled for coronary CTangiography, 64-slice MSCT was performed and evaluated for the presence of significant (>50% luminal narrowing) stenosis. Then TAG determined from the change in HU per 5-mm length of coronary artery and defined as the linear regression coefficient between intra-HU and length from the ostium (millimeters).
Result:
Total mean (S.E) of TAG is -2.87(0.28), the TAG is significantly different (PV<0.0001) in patients with significant stenosis -4.71(0.36) in compare with nonsignificant stenosis -1.30(0.23). Also we definition the cutoff point for TAG for better evaluation of severity.
Conclusion:
The present study confirms that TAG is the accurate and noninvasive functional method to determine the significant coronary artery stenosis.
https://www.icrjournal.ir/article_100893_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
98
98
10.22034/icrj.2019.100893
Pooya
Akbari
1
Medical University of Isfahan
LEAD_AUTHOR
Mehdi
Karami
m_karami@med.mui.ac.ir
2
Medical University of Isfahan
AUTHOR
Maryam
Moradi
moradi@med.mui.ac.ir
3
Medical University of Isfahan
AUTHOR
Maryam
Farghadani
dr_mar_far@yahoo.co.uk
4
University of Esfahan
AUTHOR
Fariba
Alikhani
5
Uninersity of Isfahan Medical Sciences
AUTHOR
ORIGINAL_ARTICLE
APPLICATION OF OPTICAL IMAGING IN MEASURING BREAST CANCER TUMOR RESPONSE TO NEOADJUVANT CHEMOTHERAPY
Abstract Background:
Breast cancer is the second cause of death and the
most prevalent cancer among women. common imaging methods used to diagnose breast cancer are mammography, MRI and ultrasound. main part of breast cancer treatment is the surgical removal of the cancerous tissue. treatment of large tumors usually starts with neoadjuvant chemotherapy (NAC) to shrink the size of the tumor before surgery and also to control distance metastases. Neoadjuvant chemotherapy (NAC) has been established as the standard-of-care treatment for locally advanced inoperable breast cancer. Early knowledge of response to NAC is necessary for providing the optimal treatment strategy. optical imaging has received new interest as a technique to assess tumor response to NAC. Diffuse optical spectroscopy (DOS) uses near-infrared light to provide quantitative spectral information about tissue absorption and scattering properties. We aim to have a review of optical imaging in assessing of breast cancer tumor response to neadjuvant chemotherapy in order to have better understanding of it and it’s application.
Methods:
Literature search was conducted in PUBMED, SCOPOUS and Google Scholar using terms “breast cancer”, “optical imaging”, “spectroscopy” and “neoadjuvant chemotherapy”. Half of the articles reviewed were identified appropriate considering the title of this article.
Result:
in one of studies, Diffuse optical spectroscopy (DOS) scans were acquired after the first, third, and last cycle of chemotherapy. As early as after the first chemotherapy cycle, a significant difference between responders and nonresponders was found using DOS, the differences continued during treatment. Using dynamic contrast enhanced MRI (DCE-MRI) a difference between responders and nonresponders was found halfway treatment using tumor volume measurement calculations. DOS was equally effective in predicting tumor response halfway treatment compared with DCE-MRI.
Conclusion:
DOs is a nonionized, noninvasive, cost-effective technique that does not require breast compression or low breast compression. DOS can detect changes in tumor absorption within the first days after the treatment and so could characterize breast tumor response to NAC at an earlier time than other modalities, and is able to differentiate between responders and nonresponders in early stages of therapy and also it could be combine with other imaging modalities to have better and accurate results.
https://www.icrjournal.ir/article_100895_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
100
100
10.22034/icrj.2019.100895
breast cancer
Neoadjuvant chemotherapy
Spectroscopy and Optical imaging
Samaneh
Hassanpour
1
Tabriz Med University
LEAD_AUTHOR
Ali
Ghafari
alighafaritehrani@yahoo.com
2
B.Sc. Student of Radiology Technology, Member of the Paramedical faculty Student Research Committee, Tabriz university of Medical Sciences, Tabriz, Iran
AUTHOR
Davood
Khezerloo
3
Radiology Department, Paramedical Faculty, Tabriz University of Medical Sciences
AUTHOR
ORIGINAL_ARTICLE
MRI-BASED OXYGENATION IMAGING IN DIFFERENTIATING HIGH VS LOW- GRADE GLIOMA
Abstract Background:
Glioblastoma is the most common primary malignant
neoplasm in adults, with a median survival of 15-18 months after diagnosis. Our group has previously demonstrated that quantitative blood oxygen level dependent (qBOLD) magnetic resonance imaging (MRI)-derived levels of oxygen saturation (SO2) can be used as a surrogate to map oxygen tension in patients with glioblastoma. We investigated whether qBOLD MRI was also able to differentiate different grades of gliomas.
Patients and Methods:
10 patients were enrolled into this prospective study. All patients underwent a preoperative MRI with Ferumoxytol as a contrast agent. Two volumes of interest from the tumor were chosen for biopsy, from sites with different levels of hypoxia. These samples were stained with histological markers and graded by neuropathologists through consensus on a 0-3 scale. Patients with glioblastoma were compared with lower- grade gliomas. Scores were assessed for significant differences using Wilcoxon Two-Sample Test.
Results:
In total, 6 patients had pathological GBM; 1 patient had diffuse astrocytoma; and 3 patients had anaplastic astrocytoma. 1 patient a low-grade glioma had an inconclusive biopsy and was therefore excluded from the study. Although VOIs with different levels of SO2 were chosen, SO2 of VOIs did not differ, and histological markers were not significantly different within high-SO2 VOIs. However, within low-SO2 areas GBM showed significantly higher levels of CAIX (p=0.02), and nearly for VEGF (P=0.08). HIF1a staining did not differ (P=0.13). Conclusions:
Advanced qBOLD MRI can potentially differentiate high-grade from low-grade glioma.
https://www.icrjournal.ir/article_100896_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
101
101
10.22034/icrj.2019.100896
Glioblastoma
qBOLD
MRI
oxygen saturation
Pejman
Maralani
1
University of Toronto
LEAD_AUTHOR
Sunit
Das
2
University of Toronto
AUTHOR
Aimee
Chan
3
University of Toronto
AUTHOR
ORIGINAL_ARTICLE
ASSOCIATION OF HORMONAL AND HER2 STATUS OF INVASIVE DUCTAL CARCINOMA WITH ULTRASOUND DESCRIPTORS IN VARIOUS AGE GROUPS
Abstract
Background /Objective:
To evaluate the ultrasound features of solid malignant masses detected in the US with different hormonal (ER/PR) status and HER 2 sub-types in various age groups (under 35, 36 to 50 and over 51).
Patients and Methods:
High-resolution US images of 160 consecutive cases of solid masses with final pathology of invasive ductal carcinoma ( IDC ) analyzed and correlated with pathology and biomarkers.
Results:
Comparing different age groups there was a significant difference between cancerous masses in terms of margin (p=0.0001), shape (p=0.018), and orientation (p=0.037).
The irregularly shaped cancers were significantly higher in the over 35 and the round shaped ones were more prevalent in age over 51 (p=036).
In the case of margin, there was no malignant with speculated/angular margin at age under 35 years. On the other hand, in over 51 years, the speculated margin was more common (23.1%). Malignant masses with circumscribed margin were significantly higher in patients’ age under 35. Parallel malignant masses were significantly more prevalent in younger than 35. In elder cases, nonparallel malignant masses were more frequent.
There was a significant difference between the margin and shape of the masses with the ER/PR status (P=0.045); ER-positive malignant masses showed commonly indistinct border (57/116,49.1%) while the most of ER-negative tumors showed micro lobulated edge(15/35,39.5%).
In overall, in both groups, the masses were more irregular, but in the ER-negative group, this was significantly higher ( 66.4% vs. 47.4%).
The number of round masses was also significantly higher in the hormone negative group (7/38, 18.4% vs. 7/116, 6%).
HER 2 positive masses were further heterogeneous
(53.7%, 58/108) with the p-value of 0.076.
The HER 2 positive cancers had grade III (39/99(39.4%) vs. 27/44(61.4%)) with a significant analytical difference. Few of the HER 2 positive group had Grade 1, while this level was significantly higher in HER 2 negative group (P=0.004).
In term of mass size, ER-positive cancers were discovered in smaller sizes than negative types (P=0.035).
Most of the patients under age 35 were ER/PR negative (57.8%).In age over 36, most of them were ER/PR positive in 82.7% and 75.8% respectively. This difference was significant (p<0.0001).
Tumors were mostly graded of 3 in age over 50 (48.6%). At the age of under 35, there were more grade 3 also (16/23, 69.5%).
Conclusion:
ER-negative breast tumors were mostly with the microlobulated margin with a higher interest in displaying round or oval/lobulated shapes.
ER-positive cancers are mostly demonstrated masses with indistinct margin and irregularly shaped. Larger Pseudo-benign appearing features are more common in ER-negative cancers which may be due to its higher vascularity and less fibrosis component.
https://www.icrjournal.ir/article_100897_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
102
102
10.22034/icrj.2019.100897
invasive ductal carcinoma
Ultrasound
breast cancer
hormonal status
HER 2 status
Maryam
Jafari
1
ACECR
LEAD_AUTHOR
Parvaneh
(Masoumeh) Gity
2
Tehran University of Medical Sciences
AUTHOR
Fateme
Sari
3
(ACECR)
AUTHOR
Asiie
Olfatbakhsh
4
(ACECR)
AUTHOR
ORIGINAL_ARTICLE
AMID PROTON TRANSFER IMAGING: BASIC CONCEPT AND CLINICAL APPLICATION
Abstract
Molecular imaging using endogenous molecules has generated a lot of interest because the methodology does not have the adverse effects of gadolinium (Gd) contrast agents and has clinical benefits in pediatric patients or patients with a contraindication for the use of an exogenous contrast agent.
Amide proton transfer (APT) imaging has recently emerged as an important contrast mechanism for magnetic resonance Imaging (MRI) in the field of molecular and cellular imaging which has higher sensitivity and spatial resolution than magnetic resonance spectroscopy technique.
Amide proton transfer (APT) imaging is a novel molecular MRI technique that detects low- concentration endogenous mobile proteins and peptides in tissue noninvasively. It can indirectly reflect intra cellular metabolic change and physiological and pathological information in vivo. APT imaging is able to detect tissue pH changes in stroke (where pH decreases) and identify the spatial extent and pathological grade of some tumors due to increased mobile protein and peptide.
APT imaging has added a new dimension to in vivo molecular imaging by its ability to demonstrate mobile proteins and physicochemical properties of tissue. High sensitivity in reflecting protein contents enables various applications in brain tumor imaging and stroke imaging in terms of diagnosis and treatment monitoring.
In this review, we describe the basic concepts of APT imaging, particularly with regard to the benefit in clinics from the current literature .Clinical applications of APT imaging are described from two perspectives: in the diagnosis and monitoring of the treatment response in brain tumor by reflecting endogenous mobile proteins and peptides, and in the potential for stroke imaging with respect to tissue acidity.
https://www.icrjournal.ir/article_100898_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
103
103
10.22034/icrj.2019.100898
Vahid
Shahmaei
vahidshahmaei.sbmu@gmail.com
1
(SBMU)
AUTHOR
ORIGINAL_ARTICLE
SURROGATE ASSESSMENT OF TUMOR CELLULAR DENSITY AND PROLIFERATION: MAGNETIC RESONANCE SPECTROSCOPY
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) exploits the unique resonant frequencies of protons within differing molecules in tissue to produce a graphical representation of the distribution of metabolites in a region of interest, expressed as a series of peaks on the horizontal axis and by the parts per million and signal amplitude on the vertical axis. Careful attention must be paid to voxel placement, minimising magnetic field inhomogeneity by shimming and adequate fat and water suppression methods to address spectral contamination and optimise results. Higher magnet strengths allow for better discrimination between metabolite peaks. The most widely accepted marker of malignancy in MRS is elevation of the metabolite choline (spectral peak 3.2 ppm), an indirect index of cell turnover and proliferation. This is often referenced to the concentrations of citrate (spectral peak 2.6 ppm) and creatine (spectral peak
3.04 ppm) as a ratio. Spectroscopy has been used in
the setting of cerebral glioma to inform tumor typing and grading as well as to facilitate targeted biopsy especially when combined with 18F-FDG PET to identify representative areas of higher metabolic activity. Metabolites such as N-acetylaspartate (NAA), choline, myoinositol, choline, lipids and lactate have proven of use in the evaluation of benign and malignant neuropathology. In general, astrocytomas tend to show elevated choline with reduced NAA and creatine, whilst glioblastoma multiforme classically demonstrates a high lipid (0.9 and 1.3 ppm) and lactate peak. MRS has also been used in the assessment of prostatic malignancy. The normal peripheral zone usually demonstrates high concentrations of citrate; this decreases in the central gland due to the lower proportion of glandular tissue. A reversal of the normal choline to creatine ratio is seen in malignancy. Elevated choline/creatine ratios are also seen in breast, cervical, prostate, colorectal, lymphoma and head and neck squamous cell cancers. There may be a role for MRS in the evaluation of treatment response in several tumour types. Two studies evaluating the choline lipid ratios by 1H-MRS in a total of 94 tumours before and after transcatheter arterial chemoembolisation of hepatocellular carcinoma found a significant decrease in the ratio post-treatment. In a study of 22 patients with uterine cervical carcinoma undergoing neoadjuvant chemotherapy prior to hysterectomy, a significant drop in the triglyceride peak post treatment correlated with a reduction in tumour volume though no advantage was found in terms of survival. In a study of 80 patients with cerebral glioma, MRS, in particular the choline/ NAA ratio, was found to be equal in terms of sensitivity (81.8%) but superior to diffusion-weighted imaging in specificity (84 versus 69%), positive (81 versus 69%) and negative predictive values (81 versus 84%) in predicting disease response to treatment.
https://www.icrjournal.ir/article_100899_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
104
104
10.22034/icrj.2019.100899
Tumor
Imaging
MRI
Mohammad
Hossein Jamshidi
1
Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
PREOPERATIVE EVALUATION OF TUMOR ADHESION TO THE ADJACENT BRAIN TISSUE IN PATIENT WITH MENINGIOMA WITH BSMI METHOD
Abstract Purpose:
To investigate the ability of BSMI, to preoperative
evaluation of tumor adhesion to the adjacent brain tissue in the patient with meningioma and comparing this method to the Width of edema around the tumor, using finding at surgery as the reference standard.
Methods:
Thirty Patients with meningioma brain tumor who underwent surgery from Loghman hospital were entered the study between November 2016 and January 2018. The level of edema according to the classification of Ide et al. (1995) compared to the surgical finding Blinded to the results, neurosurgeons made a qualitative assessment of tumor adhesion at the time of resection. The ability of BSMI and level of edema to predict the surgical assessment of adhesion was tested using The Fisher exact test.
Results:
BSMI method was performed on patients with meningioma brain tumor, it judged 22 (73.3%) patients as adhesion (+) and 8 (26.66%) patients as adhesion (-). In this case, there was a significance relationship between BSMI judge and surgical findings (p-value<0.0001). The sensitivity, specificity, precision and accuracy was high, at 91.30%, 85.71%, 94.45% and 90%, respectively. Using T2 sequence, of the 30 patients, 13 (43.3%) were judged as adhesion (+) and 17 (56.7%) as adhesion (-) from edema, whereas surgical findings evaluated 23 (76.7%) as adhesion (+) and 7 (23.3%) as adhesion (-). The sensitivity was moderate but the specificity was high, at 52.17% and 85.71%, respectively. Other criteria such as precision and accuracy were 92.31% and 60%, respectively.
Conclusions:
BSMI evaluated adhesion of the tumor to the adjacent brain tissue with high-accuracy presurgicaly. This method was more effective than Edema method in evaluating adhesion between meningioma and the brain.
https://www.icrjournal.ir/article_100900_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
105
105
10.22034/icrj.2019.100900
Sonia
Rezaei
1
Department of Radiology, School of Allied Medical Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Fariborz
Faeghi
f.drfaeghi@yahoo.com
2
Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
DIAGNOSTIC VALUE OF CERVICAL CONSISTENCY INDEX FOR PREDICTION OF SPONTANEOUS PRETERM BIRTH
Abstract Background:
Pre-term birth (PTB) has been a major problem leading to CNS damage and requires expensive and intensive care.To date, the gold screening tool is cervical length (CL) measurement which has not been shown to be adequate as a single predictor of PTB. The aim of this investigation was to determine the predictive value of cervical consistency index (CCI) in low risk pregnancies.
Methods:
This was a prospective cross-sectional study performed on pregnant women at 14-28 weeks of gestation. The cervical length (CL) and anteroposterior cervical diameter were measured at rest (AP) and after at least 5 minutes gradual maximum compression (AP’) using the trans-vaginal probe and the CCI was calculated using this formula: CCI = (AP′ /AP)×100. The primary outcome was sPTB before 34+0w & 37+0w. Logistic regression and analysis of ROC curves were performed to evaluate the diagnostic power of CCI compared to CL.The inter-observer & intra-observer agreements were validated by ICC.
Results:
Among 110 participants with follow-up,11.7% leaded to PTB. Mean CCI for all subjects were 79.13%+/-10.3% that was lower in PTBs(58.2%). Pearson correlation coefficient was found to show a positive correlation between the weeks of pregnancy leading to delivery and the cervical length of women under study (P = 0.0001), and also show a positive correlation between GA in weeks and CCI in women (P = 0.013). According to ROC curve the best cutoff was CCI= 68.82%, which had sensitivity of 68.8% and specificity =70.9% for prediction of PTB comparing with current cutoff CL<25mm which had sensitivity= 34.8% & specificity =67.3%. The AUC for CCI for prediction of sPTB<37w was 0.863 while AUC for CL was 0.324.Inter-observer ICC for CCI and CL was 0.928 and 0.970 respectively while Intraobserver ICC was >0.90 for both.
Conclusion:
Among low risk women for PTB,CCI shows better diagnostic value than CL. This new variable appears to provide better prediction of sPTB than does CL.
https://www.icrjournal.ir/article_100901_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
106
106
10.22034/icrj.2019.100901
Pre term birth
Cervical consistency index
Cervical length
Trans-vaginl Sonography
Mandana
Barfei
1
(SBMU)
LEAD_AUTHOR
Elham
Keshavarz
elhamkeshavarz@yahoo.com
2
University of Shahid Beheshti
AUTHOR
Hamid Reza
Haghighatkhah
drhrhaghighatkhah@yahoo.com
3
Shahid Beheshti University of Medical Sciences
AUTHOR
Mojgan
Kalantari
mojgankalantary@gmail.com
4
Uninersity of Shahid Beheshti Medical Sciences
AUTHOR
Ensi Khalili
Pouya
5
Uninersity of Shahid Beheshti Medical Sciences
AUTHOR
ORIGINAL_ARTICLE
USING DEEP LEARNING FOR ABNORMALITY DETECTION IN MUSCULOSKELETAL RADIOGRAPHS
Abstract
One of the most remarkable applications of deep learning is in medical diagnoses and new improvements in this field have shown that with large enough datasets and right methods, one can achieve results as reliable as experienced doctors. One of such developments is MURA which is a dataset about musculoskeletal radiographs consisting of 14,863 studies from 12,173 patients, resulting in a number of 40,561 multi-view radiographic images. Each one of these studies is about one of seven standard upper extremity radiographic study types, namely, finger, forearm, elbow, hand, shoulder, humerus, and wrist. Each study was categorized as normal or abnormal by board-certified radiologists in the diagnostic radiology environment between 2001 and 2012. Abnormality detection in muscular radiography is of great clinical applications. This gains more importance in cases which abnormality detection is difficult for physicians. If the proposed model can help us in detection, the process of treatment will precipitate. This model is termed inception-v3. The AUROC of our model is 0.94, and the operating point is 0.83 for sensitivity and specificity of 0.90. Although the average opinion of radiologists still shows better results, in images in which fracture detection is delicate, like finger fracture, the proposed model works more accurately, and it can as a decision support assistant for physicians in final detection of fracture. If the image is separated from normal images using Platinum, and a new class is made, and pre-processing is done, the precision of the proposed model enhances.
So, a model which can automatically detect
abnormality, can identify the part of image which is detected to be abnormal by the model. If this model is efficient, it can interpret the images more efficiently, it can reduce errors, and it can enhance quality. In order to evaluate the integration of this model with other models of deep learning in clinical setting, more studies are needed to be carried out.
https://www.icrjournal.ir/article_100902_d41d8cd98f00b204e9800998ecf8427e.pdf
2019-09-01
107
107
10.22034/icrj.2019.100902
Musculoskeletal Radiographs
Deep Learning
medical image processing
Abnormal detection
Zahra
Rezaei
1
Department of Computer and Electrical Engineering University of Kashan, Kashan, Iran
LEAD_AUTHOR
Hossein
Ebrahimpour-Komleh
2
Department of Computer and Electrical Engineering University of Kashan, Kashan, Iran
LEAD_AUTHOR
Kaveh
Daneshmand Jahromi
3
Post-MBA student in Business Intelligence (BI), Industrial Management Institute (IMI), Tehran, Iran
LEAD_AUTHOR