Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701What The Gynecology Surgeon Wants To Know In Uterine Cervical Cancer Mri31317545610.22034/icrj.2018.75456ENLadan YounesiMD, Iran University of Medical Science, Shahid Akbarabadi Hospital
Assistant ProfessorJournal Article20181025Uterine cervical cancer is the third most common malignancy affecting the female genital tract in middle age group between 45 and 55 years. Its incidence is increasing rapidly in developing countries. Histologically, squamous cell carcinoma is the commonest type .The International Federation of Gynecology and Obstetrics (FIGO) staging system updated in 2009 is commonly used for treatment planning but is inadequate in the evaluation of prognostic factors like tumor volume and nodal status. Magnetic Resonance Imaging (MRI) is the preferred imaging modality because of its ability to assess soft tissue in detail, permitting thereby better identification of stromal and parametrial invasion as compared to computed tomography (CT). MRI tells us the exact volume, shape, and direction of the primary lesion, local extent of the disease, and nodal status accurately, which helps the clinician in treatment planning. Tumor behavior to chemoradiation is also better evaluated with MRI. FIGO staging system is used to stage cervical cancer on MRI.<br /> Error rates in clinical examination are significantly high, hence clinical staging may not be accurate in each and every patient. Important parameters that the clinicians want to know are accurate size of the tumor, status of parametrium, pelvic side walls, presence of lymph nodes, and spread to local and distant organs . MRI answers all these questions. Identification of early disease from advanced disease is crucial for treatment planning.<br /> Standard treatment for stage IA1 is cervical conization or total hysterectomy.. Pelvic lymphadenectomy is generally not advisable because the risk of pelvic lymph node metastasis is less than 1%.<br /> In stage IA2, modified radical hysterectomy with bilateral pelvic lymph node dissection is recommended because the risk of pelvic lymph node metastasis increases to 5%.<br /> Stages IB and IIA are treated either with combined external beam radiation and brachytherapy (BT) or radial hysterectomy and bilateral pelvic lymph node dissection. Concurrent chemotherapy with cisplatin has been shown to improve the patient survival.<br /> Radiation therapy with concurrent chemotherapy is the standard treatment for stage IIB, III, and IVA tumors. Patients without nodal disease or with disease limited to the pelvis are treated with pelvic RT, concurrent cisplatin-based chemotherapy, and BT.<br /> Stage IVB patients are incurable and cisplatin-based chemotherapy is the primary treatment offered to these patients<br /> MRI is very useful in local staging of the disease. It is a valuable tool in assessing the spread of the tumor to local and distant lymph nodes. It also assesses the disease response to chemoradiation and differentiates residual or recurrent disease from radiation fibrosis. Thus, MRI is valuable in deciding the treatment strategies.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Standard Sonography Reporting In Infertile Patients (Role Of Color Doppler Sonography ,Uterine Biophysical Profile)32327545710.22034/icrj.2018.75457ENElham KeshavarzAssistant Professor of Radiology, SBMU, Mahdieh HospitalJournal Article20181025We talk about baseline sonography (Ovarian Volume, Ovarian Structure ,Relation to the uterus, Rule out of PCO ,Any mass lesion in ovaries, Antral follicle count, Any echo free lesion larger than 15mm and Ovarian stromal perfusion) and mid cycle sonography (Ovarian Volume, Relation to the uterus, Any mass lesion ,Any follicles larger than 10 mm ,Perifollicular vascular perfusion).<br /> We talk about mid cycle perifollicular PSV and RI. Besides about uterine focal lesions vascularity ,mid cycle endometrial perfusion and uterine artery vascularity .Last we explain the uterine scoring system for reproduction (USSR) or uterine biophysical profile (Endometrial thickness in greatest AP dimension ,Endometrial layering, Blood flow within zone 3 using color Doppler, Myometrial blood flow(internal to the arcuate vessels), Uterine artery blood flow (PI), Homogeneous myometrial echogenicity and Myometrial contractions causing a wave like motion of the endometrium.)Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Ventriculomegaly &Diagnosis And Management33337545810.22034/icrj.2018.75458ENLadan YounesiIran University, Shahid Akbarabadi Hospital
Assistant ProfessorJournal Article20181025Fetal ventriculomegaly is the most common detectable central nervous system abnormality affecting 1% of fetuses and is associated with abnormal neurodevelopment in childhood. Neurodevelopmental outcome is partially predictable by the 2D size of the ventricles in the absence of other abnormalities, while the etiology of the dilatation remains unknown.<br /> Fetal cerebral ventriculomegaly is a relatively common finding on second trimester obstetrical ultrasound examination. It is clinically important because it can be caused by a variety of disorders that result in neurological, motor, and/or cognitive impairment. Many cases are associated with other abnormal findings, but in some fetuses, ventriculomegaly is the only abnormality (Isolated ventriculomegaly)<br /> Assessment of the width of the atria of the lateral cerebral ventricles is recommended as part of the routine anomaly Scan. To measure the ventricle reliably is particularly problematic when the ventricular measurement is close to the standard threshold of 10 mm, a situation that is often referred to as ‘borderline ventriculomegaly.<br /> The consequences of such difficulties in measurement are important since ventriculomegaly is the pivotal finding for diagnosing central nervous system (CNS) pathology, justifying invasive procedures such as fetal karyotyping and generating considerable parental anxiety regarding the postnatal outcome. Even when there is a false positive test result on the initial routine ultrasound examination and the diagnosis is ultimately rejected, the anxiety generated does not dissipate easily.<br /> These issues regarding the measurement of the lateral ventricles and the medical and psychological consequences therefore justify revisiting the standardization of the measurement technique.<br /> In this lecture, we will focus on the correct ventricular diameter measurement technique and management of ventriculomegaly.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Ultrasonography Of Cervical Flaps34347545910.22034/icrj.2018.75459ENShahriar ShahriarianMD, Radiologist, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025Recent advances in Head and neck surgery, particulary in the oncologic domain and more necessity of reconstructive procedure, needs the radiologist know more about the surgical plans and different types of post surgical imaging changes in the anatomy of head and neck and particulay more knowledge of different types of free and rotating flaps is helpful in diagnosis of recurrence or post surgical changes in the patient’s follow up by different imaging methods. In this lecture, different types of surgical flaps and post surgical anatomopathologic changes are briefly considered mostly in the review of the radiologic concepts.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Fungal Disease In Paranasal Sinuses And Skull Base35357546010.22034/icrj.2018.75460ENJalal Jalal ShokouhiJournal Article20181025By two decades, there is increasing rate of fungal sinusitis and could be a fatal condition.<br /> CT and MRI are modalities for diagnosis.<br /> Forms of disease are invasive and non-Invasive.<br /> Clinically it could be divided to acute invasive, aggressive osseous destructive, chronic invasive, chronic granulomatosis, allergic and fungus ball.<br /> Infection could be occur in normal and immune compromised persons.<br /> Rare condition of fungal osteomyelitis could be happened after malignant external otitis in diabetic patients. Bone destruction, calcified material and no-response to medical treatment are hallmarks of fungal infection in PNS and skull base. fungal elements could be mucoraccae or mucormycosis “common”, aspergillus, mycetoma and ….Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Cavernous Sinuses Evaluation By Mri36367546110.22034/icrj.2018.75461ENAli RadmehrNeuroradiology and Muskuloskeletal FelowshipJournal Article20181025The paired cavernous sinuses(CS) are located immediately lateral to sella turcica.<br /> Because of its anatomy, Various pathological processes can be involved the CS.<br /> They could be benign or malignant tumors ,Infections, Inflammatory , Vascular or traumatic lesions.<br /> Regarding to available limited time, after a brief review of anatomy the tumoral lesions would be discussed.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Ultrasound Of Cervical Lymph Nodes And Fna37377546210.22034/icrj.2018.75462ENMohammad DavoodiAssistant Professor of Radiology. Shariati Hospital Tehran University of Medical Sciences Tehran, Iran.Journal Article20181025The purpose of this lecture is to investigate ultrasound criteria to determine the most accurate criterion to differentiate benign from malignant and metastatic cervical lymph nodes on ultrasound and evaluate the indications for ultrasound-guided fine needle aspiration biopsy from cervical lymph nodes.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Imaging Of Tumors Of The Endolymphatic Sac, Jugular Fossa And Inner Ear38387546310.22034/icrj.2018.75463ENHashem SharifianMD, Radiologist, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025Tumors of the endolymphatic sac, jugular fossa and inner ear, regarding to their location are in many times diagnosed late and surgical approach to them for biopsy and treatment is difficult. Review of imaging characteristics of these lesions can help us to diagnose them earlier with more accurate diagnosis and so more rapid and better therapeutic approach to them.<br /> It should be emphasized that most of these tumors are malignant or have invasive characteristics that lead us to consider an accurate and sophisticated approach to them.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701How To Increase Performance Of Us Examinations In Head And Neck39397546410.22034/icrj.2018.75464ENHashem SharifianMD, Radiologist, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025At now the ultrasound exam is the main or first way to approach various diseases of the neck. Thyroid, lymph nodes, salivary glands and masses of the neck can readily evaluated by ultrasound.<br /> Some discrepancies between methods to investigate above mentioned diseases are present that decrease efficacy of this valuable modality in the neck.<br /> I decide to show standard approach in investigation of neck lesions by US for better relation between specialists concerning about neck abnormalities.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Acr Thyroid Imaging Reporting And Data System (Acr Ti-Rads) 201740407546510.22034/icrj.2018.75465ENLeila AghaghazviniMD, Associated Professor, Department of Radiology, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025A thyroid nodule is a discrete lesion within the thyroid gland that is sonographically distinguishable from surrounding thyroid parenchyma.<br /> Gray-scale and color are used to evaluate the size, location within the thyroid, and US features, which include composition, echogenicity, regularity of the border or margin around the nodule, presence of a halo, vascular pattern, as well as presence or absence of coarse or fine calcifications. In this presentation we will discuss about the new scoring system of thyroid nodules according the TIRADS 2017.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Ultrasound Of Parathyroid Gland Anatomy And Pathologies41417546610.22034/icrj.2018.75466ENYasaman DavudiMD, Associated Professor, Mashad University of Medical Sciences, Mashad, IranJournal Article20181025Normal parathyroid glands are very small, measuring approximately 6 mm in the craniocaudal dimension and 3-4 mm in the transverse dimension, with a flattened disk shape.<br /> Normal-sized parathyroid glands are not usually identified by most imaging modalities. Therefore, a parathyroid gland that is visible in US is very suspicious for the presence of a pathological entity<br /> The role of radiologists in the treatment of parathyroid disease was previously limited to the preoperative localization of hyperfunctioning parathyroid lesions. However, radiologists have been required to play a more active role, because it is increasingly necessary to distinguish parathyroid incidentalomas (PTIs) detected during thyroid ultrasonography (US), from thyroid lesions.<br /> In this presentation, we would review the anatomy and pathology of parathyroid glands and the different imaging findings in parathyroid adenomas. We would briefly review the alternative imaging modalities in evaluation of enlarged parathyroid glands as well.<br /> We would also review the role of US-guided simple aspiration in Symptomatic nonfunctioning PCs .Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Panel Discussion Of Head And Neck Program42427546710.22034/icrj.2018.75467ENLeila AghaghazviniAssociated Professor, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025In this panel we decide to discuss about some cases in temporal bone and neck spaces (cases with cholesteatoma and differential diagnosis and also about temporal bone tumors) and also a case about cervical paraganglioma and differential diagnosis with therapeutic approaches will be discussed.<br /> Finally, the Conclusion regarding the cases will be proposed.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Cystic Masses Of Neck43347546810.22034/icrj.2018.75468ENMaryam MohammadzadehMD, Assistant Professor, Department of Radiology, Amiralam Hospital, Tehran University of Medical SciencesJournal Article20181025There are different congenital and acquired cystic masses of neck .Age of onset and various imaging modalities are helpful for discrimination between different cystic neck masses. Ultrasound is usually the first line of diagnosis. Computed tomography (CT) and magnetic resonance imaging (MRI) provide additional information regarding the internal texture of the lesion and extensions of the mass.<br /> Various congenital and acquired cystic masses of neck along with different imaging modalities will be discussed in the presentation with details.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Vascular Malformations And Neoplasms44447546910.22034/icrj.2018.75469ENMohammad Ali KazemiAssociated professor of radiology, Amir Alam hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025These are divided into two sub groups:<br /> <br /> High flow<br /> Which are included of hemangioma as a congenital neoplasm, AVM as a c hiongenital malformation & AVF as an acquired iatrogenic or congenital malformation<br /> <br /> Low flow<br /> Which are comprised of venous malformations as most type of congenital vascular malformation & lymphatic malformation which can also be seen with some congenital syndromes.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Imaging Of Head And Neck Paraganglioma45457547010.22034/icrj.2018.75470ENLeila AghaghazviniMD, Associated Professor, Department of Radiology, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025Paragangliomas of the head and neck originate most commonly from the paraganglia within the carotid body, vagal nerve, middle ear, and jugular foramen and also as glomus tumors from paraganglion cells of neuroectodermal origin near nerves and vessels. The function of most paraganglia in the head and neck is obscure<br /> Paragangliomas account for 0.6% of all neoplasms in the head and neck region, and about 80% of all paraganglioms are either carotid body tumors or glomus jugulare tumors.<br /> In this presentation we will discuss about imaging of head and neck paraganglioma by focus on MRI and CTscan.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Diabetic Foot Imaging36367547110.22034/icrj.2018.75471ENLeila AghaghazviniMD, Associated Professor, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025Diabetes-related foot problems consist of osteomyelitis and Charcot neuro-osteoarthropathy that are associated with a high morbidity so accurate diagnosis is important for early treatment.<br /> In this presentation we plan to discuss about the various imaging findings in diabetes related osteomyelitis and Charcot disease and differences with focus on MRI and Plain graphy.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Practical Approach To Diabetic Foot37377547210.22034/icrj.2018.75472ENMohammad Moamen GharibvandJournal Article20181025Foot ulceration is a dreaded complication of diabetes that often results in diminished quality of life. By ‘A rule of 15’ 15% of people develop an ulcer, 15% of ulcers will develop osteomyelitis and 15% ulcers result in amputation. 85% amputations result from non-healing ulcer. Approximately half of amputated patients will have contralateral amputations within 3 years and half will die within 5 years.<br /> Every break in the skin in diabetic foot is a portal of entry for bacteria and has the potential for disaster. Many patients go for amputation following a trivial lesion. A diabetic foot lesion should never be considered as trivial until it is healed and has remained healed for at least a month.<br /> The underlying cause of diabetic foot ulcer will have a signi cant bearing on the clinical management and must be determined before care plan is put into place. So in most patients peripheral neuropathy and peripheral arterial disease play a central role. The diabetic foot ulcers are commonly classif ed as 1. Neuropathic, 2. Ischaemic, 3. neuro ischaemic.<br /> Neuro ischemia is a combined e ect of diabetic neuropathy and ischaemia. Where by macro vascular disease and in some instances micro vascular dysfunction, impair perfusion in a diabetic foot.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701The Role Of Interventional Radiologists In Management Of Benign Biliary Strictures48487547310.22034/icrj.2018.75473ENJavad JaliliInterventional Radiologist
Department of Radiology, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20181025Benign biliary strictures are most commonly iatrogenic in nature and are typically the result of surgical<br /> injury. Postoperative strictures can be broadly divided into anastomotic and nonanastomotic strictures. Anastomotic strictures typically develop in patients who have undergone previous cholecystectomy (especially laparoscopic cholecystectomy), hepatobiliary surgery or liver transplantation. Liver transplant patients have a relatively higher incidence of biliary anastomotic stricture than those with other types of abdominal surgeries.<br /> Common etiologies for nonanastomotic benign biliary strictures include cholangitis, ischemic injury during liver transplantation, and cholelithiasis. Clinical manifestations of benign biliary strictures include jaundice, fever, elevated levels of serum alkaline phosphatase, and bilirubin.<br /> In cases of failed ERCP , Roux-en-Y reconstruction or those with esophageal or upper gastrointestinal obstruction, alternative approaches are percutaneous interventions to access the bile ducts for diagnosis and treatment of benign biliary strictures.<br /> Interventional radiologists play a vital role in the management of benign biliary strictures by providing percutaneous transhepatic biliary drainage(PTBD), balloon dilation, stent placement and stone removal.<br /> The purpose of this review is to summarize percutaneous techniques , complications, and novel techniques for management of benign biliary strictures.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Practical Approach To Treatment Of Hcc49497547410.22034/icrj.2018.75474ENHazhir SaberiMD, Professor of of Radiology (TUMS)Journal Article20181025Some patients are more susceptible to HCC (like HBV, Cirrhosis and …). in these patients screening imaging (ultrasound) is highly recommended. In positive cases next step would be 4-phasic CT Scan or dynamic MRI for confirm diagnosis and also staging.<br /> If there are typical signs of HCC (wash in, wash out), biopsy is not necessary in susceptible populations.<br /> Gold standard treatment of HCC is surgery (resection or liver transplantation). In those cases which are not candidate for surgery, Loco-Regional treatments are key players. The most noticeable of these are: TACE (Trans Arterial Chemoembolization) and Local Ablations (RF, Microwave, Alcohol injections & … ). Site and Size of tumors should be considered in decision for ablative techniques. Limitations for RF are 1) tumors more than 3 cm or 2)subcapsular location or 3)neighboring to large vessels, but there are less limitations in Microwave. TACE is one of the treatment of choice in cases which are not candidate for surgery or thermal ablations (intermediate stage). There are also some limitations for TACE which the most important one is decompensated cirrhosis (child B8,9 & C). In this technique there are two factors (Ischemia & Chemotherapy) attenuating the tumors with synergistic effect.<br /> Generally TACE has a palliative situation in the guidelines but could be used as a bridge for curative plan (surgery or liver transplantation) alone or in combination with ablation techniques.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Practical Difference Of Phill & Onyx50507547510.22034/icrj.2018.75475ENRambod SaloutiMDJournal Article20181025Liquid Embolic are injectable embolic agents primarily intended for the treatment of vascular malformations through an endovascular approach. The goal of liquid embolic embolization is the immediate and permanent obliteration of a targeted vessel or structure. PHIL™ is a liquid embolic agent made of a co-polymer dissolved in DMSO during the liquid phase and linked with an iodine agent for radiopacity purpose during injection. PHIL™ Copolymer will solidify in an aqueous (Water) environment and is Non-Thrombogenic and No chemical reaction as nBCA polymerization, Non-adhesive, Radiopaque and Cohesive. Radio Density of PHILL is moderate but Homogenous and onyx has High Density. In MR or CT we have Minimal MR or CT Artifact for PHILL but is Significant for onyx. PHILL No need for shaking Ready to use in Sterile preloaded syringe but onyx Must be shaken at least for 20 minutes and Transfer from vial to syringe. Better forward penetration is observed with PHIL™ than with Onyx.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Update On Acute Stroke Intervention51517547610.22034/icrj.2018.75476ENRamin PourghorbanMD, Affiliation: Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20181025After the results of five positive trials being published in 2015, mechanical thrombectomy is now becoming a standard of care in acute ischemic stroke patients with large vessel occlusion. A close cooperation among the departments of emergency, neurology, and neurointervention is needed to improve the quality of life of the patients with large vessel occlusion. Although the concept of time window to send the patients to thrombectomy is recently changed after the two recent trials, including DAWN and DEFUSE 3 trials, there is no debate on the biologic effect of time on neurons damage after a vascular occlusion. In this lecture, the changes on the AHA/ASA 2018 guidelines for the early management of patients with acute ischemic stroke will be discussed. Also, the factors to select the patients for mechanical thrombectomy and their importance will be discussed. Among them are pre-stroke morbidity, infarct core, Alberta stroke program early computed tomography score (ASPECTS), collaterals, location of clot, perfusion, time, age, and National Institutes of Health Stroke Scale (NIHSS) score. The topics that are still missing on the clinical stroke researches will also be discussed, including the role of thrombectomy in posterior circulation occlusion, general anesthesia vs. conscious sedation, aspiration vs. stent retrievers, use of balloon guiding catheter, bridging vs. direct mechanical intervention, workflow and system of care, and imaging selection (CT or MRI, perfusion imaging, collaterals).Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Microwave Ablation Of Lung Tumor53537548010.22034/icrj.2018.75480ENShahram AkhlaghpoorMD, Pardis Noor Medical Imaging Center,Journal Article20181025Approximately 20% of patients with lung metastases and resected primary soft tissue tumors have a limited number of metastases isolated to the lung and are potential candidates for surgical resection or metastasectomy.<br /> The role of thermal ablation in the treatment of thoracic malignancies has been growing for more than a decade<br /> It has become an established treatment alternative to surgical resection in patients with both primary lung cancer and metastatic disease, as well as in patients with locally recurrent tumor following treatment Complete ablation in potentially curative in Lung cancer ≤ 3 cm<br /> Local therapy such as surgery, radiotherapy and radiofrequency ablation for the relapsed sites could thus improve patient’s survival<br /> Ablative therapies can also be used as alternative modalities for localized control in the management of unrespectable lung tumors.<br /> Heat-based modalities cause localized tissue heating which results in irreversible coagulative tumor necrosis and localized tumor control. Microwave ablation (MWA) is performed by microwave energy (900–2,450 MHz) inducing dipole excitation, which in turn causes the water molecules to spin, transferring some of their kinetic energy and creating friction, resulting in heat generation and tissue hyperthermia.<br /> Selection Criteria are including, size, location, number and adjacent structures.<br /> Outcome data are limited regarding MWA therapy for lung cancer or pulmonary metastatic disease, although results would be expected to be at least as good for MWA because ablation zones trend toward being more robust, with less thermal sink effect. Wolf et al reported their results on mixed pulmonary tumors and found 1-, 2-, and 3-year overall survivals of 65%, 55%, and 45%, respectively. Unlike RFA, the overall survivals were not affected by index lesions > 3cm in size; however, there was a statistically significant decrease in local control for those tumors > 3cm in size.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Comparison Of Surgical Treatment Of Benign Thyroid Nodules With Radio Frequency Ablation54547548110.22034/icrj.2018.75481ENH. EbrahiminikMD, Interventional Radiologist, Assistant Professor of Radiology, AJA University of Medical ScienceA. SouroshProfessor of General Surgery, Tehran University of Medical Sicence, Shariati HospitalN. FattahResident of General Surgery, Tehran University of Medical Sicence, Shariati HospitalA. Mosadegh KhahMD, Endocrinologist, AJA University of Medical ScienceM. JafariResearch Center for Improvement of Surgical Outcomes and Procedures, Tehran, IranE. SadeghianResident of General Surgery, Tehran University of Medical Sicence, Shariati HospitalJournal Article20181025Introduction:<br /> Palpable or nonpalpable benign thyroid nodules are a common disease. In the symptomatic patients who complain from pain or obstructive sign, surgery is the therapeutic option that is associated with complications. Radiofrequency ablation is one of the new methods for treatment of benign thyroid nodule.<br /> Materials and Methods:<br /> This randomized clinical trial, conducted on 88 patients who meet inclusion criteria. 8 patients were excluded during the study and the remaining 80 patients were randomly divided into two groups (In each group, 40). Initially, 40 patients (group A) with definite diagnosis of benign thyroid nodule are selected for RFA. The initial nodule size with ultrasound and baseline TSH should be recorded and then at intervals of 1 and 6 months later, size and TSH is evaluated. In the other group (B), prospectively 40 patients who were underwent thyroidectomy secondary to benign nodule, their complication such as hypocalcemia, hypothyroidism, obstructive sign and scar were evaluated. Finally, the data of these two groups of patients was compared.<br /> Results:<br /> 80 patients, including 20 males and 60 females with an average age of 48.3 ± 9.2 years, were evaluated. ANOVA analysis showed that the nodule volume decreased after RFA (P=0.002). Dysphagia improvement after thyroidectomy was statistically significant (P=0.003), in Group A dysphagia severity had not significantly decreased (P=0.337). Analysis showed improvement in foreign body sensation in both groups. The severity of dyspnea in both groups has declined. But group A’s patients was not statistically reduced (P=0.448 vs P=0.038). It was showed that cosmetic results in bothgroups were different, the mean beauty score improved in both groups but the satisfaction of beauty who underwent RFA were higher (P <0.001).Analysis showed that there were a statistically significant difference between both groups in hypocalcemia (P <0.035).Group B, 15 of 40 patients had hypocalcemia after surgery, but in group A, none of patients were being hypocalcemic. It was showed that the risk of hypothyroidism was different in both group, patients who underwent surgery are more likely to being hypothyroidism (P =0.048).<br /> Conclusion:<br /> In comparison to surgery, RFA is a minimal invasive approach for treatment of benign nodule that is associated with less complication such as hypocalcemia, hypothyroidism and it has better cosmetic result. Improvement of obstructive sign in surgery approach is significant despite RFA approach. We suggested that patient who is asymptomatic and just suffer from abnormal neck appearance, radiofrequency ablation is better therapeutic option and who complain from obstructive sign, surgery is recommended.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Practical Approach For Prostatic Arterial Embolization(Pae)55557548210.22034/icrj.2018.75482ENMohammad Reza BabaeiAssistant Professor of Interventional Radiology, Iran University of Medical ScienceJournal Article20181025BPH refers to the increase in size of the prostate in middle-aged and elderly men .The normal prostate is composed of a combination of glandular, stromal, and smooth muscle cells.<br /> BPH is due to a proliferation of glandular elements, fibromuscular (stromal) elements, or both, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate<br /> Benign prostatic hyperplasia (BPH) has a high prevalence rate in men aged 50–79 years (1) and is ubiquitous with aging (2).<br /> Prostatectomy by open surgery or by transurethral resection of the prostate is still considered the gold standard of treatment.Urinary tract infection, strictures, postoperative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are complications associated with surgical treatments.<br /> Alternative options include minimally invasive treatments and were originally conceived as an attempt to offer equivalent efficacy without the burden and risk of operative morbidity. <br /> The introduction of arterial embolization to treat uterine fibroids has led to its use for Benign Prostatic Hyperplasia (BPH). Prostatic arterial embolization (PAE) is a technically demanding procedure that blocks the blood supply of the arteries that supply the prostate gland.<br /> With CTA we define the male pelvic vascular anatomical pattern and the PA anatomy (number of independent PAs, their origin, trajectory, termination, and anastomoses with surrounding arteries). Each pelvic side should be considered separately.<br /> It is much more difficult than performing a fibroid embolization because:<br /> Thin tortuous atherosclerotic vessels, Difficulty of visualization superselective catheterization of the inferior vesical artery and prostate arteries, requires the use of microcatheters in all cases. <br /> The inferior vesical artery and finally the prostatic vessels were selectively catheterized with a 3-F coaxial microcatheter. For embolization, nonspherical 200-_m PVA particles were used.<br /> We conclude that PAE is a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, Associated with a reduction in prostate volume.<br /> The response to treatment was measured at 1, 3, and 6 months after the procedure. The prostate volume was also measured by MR before and 6 months after PAE.Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Case Selection And Practical Approach To Tips56567548310.22034/icrj.2018.75483ENAlireza RasekhiMD, Shiraz IranJournal Article20181025Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment. Recently, applying TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding. In addition, TIPS is recommended as the second-line treatment for secondary prophylaxis. For bleeding gastric varices, applying TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities, including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices. TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy. In patients with refractory ascites, there is growing evidence that TIPS not only results in better control of ascites, but also improves long-term survival in appropriately selected candidates. In addition, TIPS is a promising treatment for refractory hepatic hydrothorax. However, the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined. The advantage of TIPS is offset by a risk of developing hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Brain Trauma, Update 201857577548410.22034/icrj.2018.75484ENAnne OsbornMD, Professor of Radiology, University Distinguished William H. and Patricia W. Child Presidential Endowed Chair in Radiology, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT USAJournal Article20181025Not all epidural hematomas are the same, with different imaging findings and clinical implications. This lecture distinguishes between “classic” EDHs and less common variant types such as “vertex” venous EDHs, anterior middle fossa EDHs and clival EDHs in children. New data on isolated peritentorial acute subdural hematomas (aSDHs) has demonstrated that these thin blood collections do not enlarge and therefore do not need interval followup. The brain UNDER convexity SDHs may show significant perfusion alterations so beware the elderly patient with a minor fall who has mass effect disproportionate to the size of the SDH as it may be the manifestation of impending disastrous brain swelling. A new concept in head trauma imaging that will be discussed is the hematohygroma and its implications in abusive head trauma.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Imaging In Acute Encephalopathy: Getting It Right When It Counts!!58587548510.22034/icrj.2018.75485ENAnne OsbornMD, Professor of Radiology, University Distinguished William H. and Patricia W. Child Presidential Endowed Chair in Radiology, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT USAJournal Article20181025Patients who present with “altered mental status,” confusion or delirium, or simply “not acting right” frequently are referred for brain imaging. This two-part lecture focuses on those hyperacute and acute entities in which a correct diagnosis within minutes or a few hours may significantly affect patient outcome. We begin with an overview of toxic-metabolic CNS disorders and their radiologic-pathologic correlation. Using this as a foundation, we then approach imaging in the patient with acutely altered mental status. We consider what to do with unexpected findings in disorders such as Wernicke encephalopathy. Acute hypertensive encephalopathy with “atypical” findings, liver disease with acute hyperammonemia, hypoglycemia, nonconvulsive status epilepticus and “weird strokes” will be discussed. We will also consider less well-recognized non-metabolic causes of acute mental decompensation in settings such as critical illness-associated encephalopathy and post-operative CNS disorders.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701“Brain In Flame”: Pathology And Imaging Of Noninfectious Cns Inflammation59597548610.22034/icrj.2018.75486ENAnne OsbornMD, Professor of Radiology, University Distinguished William H. and Patricia W. Child Presidential Endowed Chair in Radiology, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT USAJournal Article20181025The brain is an actively regulated site of immune surveillance. Microglia are the brain’s resident immune cells and their activation is a hallmark of CNS pathologies ranging from trauma and neurodegeneration to vascular and neoplastic disease. Inflammasomes are large multiprotein complexes within the microglia that mediate their proinflammatory, excitotoxic responses. We will examine the role of neuroinflammation in a spectrum of pathologies with an emphasis on trauma, autoimmune encephalitis (the “brain in flame”), vasculitis (vessels “on fire”), dementing disorders and primary brain tumors. Findings suggestive of neuroinflammation on conventional MRI will be emphasized along with PET TSPO (translocator protein) imaging that can detect early or abnormally prolonged microglial activation.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Interactive Neuroimaging Presentation60607548710.22034/icrj.2018.75487ENAnne OsbornMD, Professor of Radiology, University Distinguished William H. and Patricia W. Child Presidential Endowed Chair in Radiology, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT USAJournal Article20181025In this 2-hour case-based session Prof. Osborn will focus on CNS neoplasms AND their mimics. Each case will be presented, the imaging findings identified and a reasonable radiologic differential diagnosis established. The correct pathologically-proven diagnosis will then be discussed and the specific entity briefly summarized. Each attendee will keep a score of his or her correct answers. Prof. Osborn will present a free autographed copy of her new second edition of Osborn’s Brain to the winner. In the case of a tie, a lucky draw will pick the recipient. All attendees can have a personal “photo op” with Prof. Osborn after the session.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Role Of Neuroimaging In Evaluation Of Dementia61617548810.22034/icrj.2018.75488ENAhmad AlizadehJournal Article20181025The role of neuroimaging in evaluation of Dementia is widespread;excluding neurosurgical lesions,early diagnosis of diseases such as Alzheimer’s disease, predementia condition such as Mild cognitive impairment, systematic score for global atrophy ,focal atrophy,vasculardiseases (infarct,white matter lesion,lacunes) and what is more discussing is systematic approach of structural disorders for differential diagnosis which including periinsular atrophy (progressive non fluent aphasia), parietooccipital atrophy (suggest PCA,CBD or Lewy Body Dementia),infratentorial atrophy (PSP), disproportiate ventriculomegaly (NPH) and cortical/BG hyperintensity on DWI (CJD) could be mentioned.<br /> Detailed evaluation of Focal Lobar Atrophy and asymmetrical pattern as especially in FTLDcan be diagnostic.Even predilection of atrophy to left or right side could be mentioned as behavioral variant FTD,Progressive non fluent aphasia and in temporal atrophy Semantic dementia versus Logopenic aphasia can be differentiated.Iranian Society of RadiologyIranian Congress of Radiology2588554534220180701Imaging In Pancreas Inflammation, Old Rules And New Trends62627548910.22034/icrj.2018.75489ENMaryam FarghadaniAssistant professor of department of Radiology, Isfahan university of medical sciences, Isfahan, IranJournal Article20181025Background:<br /> In 1992, the Atlanta classification for acute pancreatitis was introduced as a universally applicable classification system for the various manifestations of acute pancreatitis . This system was designed to facilitate understanding and correlation of findings seen by gastroenterologists, pathologists, radiologists, and surgeons. This approach was to be particularly useful for assessment and treatment of the various fluid collections identified during the course of acute pancreatitis. It defined acute pancreatitis as an acute inflammatory process of the pancreas with variable involvement of other local tissues and remote organ systems.<br /> This initial Atlanta classification system represented major progress, but advancing knowledge of the disease process, improved imaging, and ever-changing treatment options such as minimally invasive radiologic, endoscopic, and laparoscopic procedures soon rendered some of the definitions inadequate or ambiguous , presenting a need to revise and update the Atlanta classification. The revision in 2012 places major emphasis on revised on new criteria for pancreatic fluid collections and revises some of the clinical criteria and terminology.<br /> Objectives:<br /> To learn how imaging should be scheduled (or not) for patients with acute pancreatitis<br /> To become familiar with the imaging features and the new terminology proposed in the revised 2012 Atlanta classification<br /> To discuss the remaining limitations of the 2012 Atlanta Classification<br /> Conclusion: <br /> <br /> The goal is for radiologists, gastroenterologists, surgeons, and pathologists to use the revised classifications to standardize imaging terminology to facilitate treatment planning and enable precise comparison of results among different departments and institutions.<br /> <br />