Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Fluoroscopic Study Methods In Pediatric63637549010.22034/icrj.2018.75490ENElham ZareiMD, Assitant professor, Radiologist. Department of Radiology, Iran University of Medical Sciences, Ali Asghar Children HospitalJournal Article20181025Upper GI study is useful procedure for evaluation of anatomy and function of the esophagus ,stomach and duodenum.<br /> The majority of contrast enemas are performs in newborns and infants to evaluate the low intestinal obstruction.<br /> The goal of these radiologic examinations is to establish the presence or absence , nature of disease with the minimum radiation dose necessary.<br /> The indications and techniques for examining the GI tract in children , particularly in infants are often different from those of adult.<br /> This present included description of contrast agents, techniques of these studies and common abnormalities.<br /> The voiding cystourethrogram also named micturating cystourethrogram (MCUG ) is an X-ray exam of lower urinary tract that uses fluoroscopy and an iodinated contrast media to create the images.<br /> Properly performed VCUG can provide useful information about anatomical and functional integrity of lower urinary tract.<br /> This presentation discuses about indication , contraindication, technique and interpretation of this study.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Upper Gi Study Is Useful Procedure For Evaluation Of Anatomy And Function Of The Esophagus ,Stomach And Duodenum64647549110.22034/icrj.2018.75491ENElham ZareiMD, Assitant professor, Radiologist. Department of Radiology, Iran University of Medical Sciences, Ali Asghar Children HospitalJournal Article20181025The majority of contrast enemas are performs in newborns and infants to evaluate the low intestinal obstruction.<br /> The goal of these radiologic examinations is to establish the presence or absence , nature of disease with the minimum radiation dose necessary.<br /> The indications and techniques for examining the GI tract in children , particularly in infants are often different from those of adult.<br /> This present included description of contrast agents, techniques of these studies and common abnormalities.<br /> The voiding cystourethrogram also named micturating cystourethrogram (MCUG ) is an X-ray exam of lower urinary tract that uses fluoroscopy and an iodinated contrast media to create the images.<br /> Properly performed VCUG can provide useful information about anatomical and functional integrity of lower urinary tract.<br /> This presentation discus about indication, contraindication, technique and interpretation of this study.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Imaging Of Hepatocellular Carcinoma65657549210.22034/icrj.2018.75492ENGiuseppe BrancatelliMD, Associate Professor of Radiology
University of Palermo School of Medicine, ItalyJournal Article20181025Hepatocarcinogenesis represents a progressive process in which regenerative hepatocytes give rise to hyperplastic hepatocyte nodules, and these progress to dysplastic nodules, which are thought to be the direct precursor of hepatocellular carcinoma. Distinction among regenerative nodules, dysplastic nodules, and hepatocellular carcinoma with varying degrees of differentiation requires an assessment of the hemodynamic nature of the mass. As with regenerative nodules, dysplastic nodules receive predominantly portal venous flow and do not usually demonstrate bright enhancement on arterial phase after rapid bolus injection of intravenous contrast at cross-sectional imaging. As the degree of (de-differentiation) malignancy increases, portal blood supply decreases, whereas nontriadal arteries (i.e., unaccompanied by portal venules and biliary ducts) and aberrant capillaries (a process known as “capillarization”) develop to feed the nodules. When trying to characterise nodules developing in cirrhosis at cross-sectional imaging, marked arterial phase enhancement with rapid washout during the portal venous and delayed phase should be regarded as highly suspicious for the presence of hepatocellular carcinoma. While the diagnosis of large hepatocellular carcinoma does not usually represent a diagnostic challenge, hepatocellular carcinoma smaller than 3 cm will show typical imaging features (i.e., enhancement in the hepatic arterial phase and washout in the venous phase) in approximately 50% of cases only at CT and approximately 65% of cases on MR Imaging, posing a problem of differential diagnosis with dysplastic nodules and other lesions and pseudolesions. In our and others experience, higher accuracy can be achieved with the use of combined MR contrast agents, compared with pure extracellular contrast agents, although the differential diagnosis between dysplastic nodules and hepatocellular carcinoma remains challenging. When the tumor is hypervascular in the hepatic arterial phase and isointense to the background parenchyma in the venous phase, the information obtained with the hepatobiliary phase is crucial. If the lesion will show hypointensity in the hepatobiliary phase, it will likely be a hepatocellular carcinoma that has not lost portal supply yet. Hypointensity on hepatobiliary phase will allow higher sensitivity, but unfortunately specificity will drop. However, if the lesion is isointense in the hepatobiliary phase, differential diagnosis includes dysplastic nodules or pseudolesions. Finally, after combined agents injection, nodules might not be apparent at all in the extracellular portion of the study, being visible only in the hepatobiliary phase. These “invisible” nodules during the extracellular portion of the examination may show up in the hepatobiliary phase only as either hypointense or hyperintense, and are due to the altered ability of the hepatocytes to uptake the contrast medium through the vascular pole or excrete it through the biliary pole. While hypointense nodules have shown a high incidence of progression into hypervascular hepatocellular carcinoma, and should therefore be observed carefully, hyperintense nodules are usually benign (regenerative nodules), especially when multiple and below 1 cm. Hyperintensity in the hepatobiliary phase in larger nodules can however be observed in those hepatocellular carcinoma with a cholestatic components, the so called green hepatocellular carcinoma.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Inflammatory Bowel Disease Imaging, New Insights66667549310.22034/icrj.2018.75493ENEmillio QuaiaMD, Honorary Consultant in Radiology – Senior Lecturer University of Edinburgh ,UKJournal Article20181025Crohn’s disease (CD) is a chronic transmural inflammatory disease of the gastrointestinal tract which can be assessed by ultrasound. Unenhanced ultrasound may evaluate the localization and the length of the affected intestinal segments and may suggest the presence of mural fibrosis based on the layered appearance of the bowel wall. Contrast-enhanced ultrasound of the bowel is performed by wideband transducers including the microbubble resonance frequency. Contrast-enhanced ultrasound has become an important imaging modality in patients with CD for the grading of disease activity, the differentiation between small bowel stricture due to inflammation or mural fibrosis, and for the assessment of the response to specific pharmacologic therapy. New dedicated software packages allow the accurate quantification of the enhancement within the small bowel wall after microbubble contrast agent injection to obtain different kinetic parameters - percentage of the maximal enhancement, the time-to-the peak enhancement, and the area under the time–intensity curve - which may differentiate mural inflammation from fibrosis and responders from non-responders to the specific pharmacologic therapy. The main advantage of contrast-enhanced ultrasound in the real-time assessment of the perfusion of the bowel wall but the scan is necessarily limited to one single loop each time. US strain or shear wave elastography can be considered an additional tool to complete US assessment of the bowel wall in patients with CD. US strain elastography allows to assess the bowel wall stiffness to distinguish acute inflammation from fibrosis in patients with CD and increases the diagnostic confidence if compared to contrast-enhanced US alone.<br /> Outline<br /> <br /> US technique to scan small bowel<br /> Contrast-enhanced ultrasound and microbubble contrast agents<br /> Assessment of Crohn disease activity by contrast-enhanced ultrasound<br /> Differentiation of mural inflammation and fibrosis by contrast-enhanced ultrasound<br /> Quantitation of echo-signal intensity to identify responders from non-responders to therapy<br /> Differentiation of mural inflammation and fibrosis by US strain elastography<br /> Major strengths and weakness of contrast-enhanced US and strain elastography in comparison to the other imaging modalitiesIranian Society of RadiologyIranian Congress of Radiology2588554534320180901Mr & Ct Enterography: Technical Tips With Review Of Interesting Cases67677549410.22034/icrj.2018.75494ENAmir Reza RadmardMD, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences. North Kargar Ave., Tehran 14114, Iran.Journal Article20181025MR enterography (MRE) and CT enterography (CTE) have become the modality of choice in the diagnosis and follow-up of Crohn’s disease, and could potentially play a similar role in a variety of other small bowel disorders. MRE & CTE deliver an image of the entire length of small bowel and surrounding structures making it superior to various endoluminal studies. In this workshop, the technical tips and tricks in MRE and CTE will be reviewed and practical points on reporting be discussed. We will focus on the clinical significance of each enterography finding in cases of Crohn’s disease. Then series of interesting and challenging small bowel cases other than Crohn’s disease will be shown which could be educational mostly for residents and young radiologists.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Vascular Disorders Of The Liver68687549510.22034/icrj.2018.75495ENGiuseppe BrancatelliAssociate Professor of Radiology
University of Palermo School of Medicine, ItalyJournal Article20181025The liver has three vascular systems: the portal vein, the hepatic vein, and the hepatic artery. The vascular disorders that will be presented in this talk can be divided into disorders of the inflow and disorders of the outflow. Disorders of the inflow are hepatic artery thrombosis and portal vein trhombosis, that can be divided into acute, subacute and chronic.<br /> Arteriovenous shunts are among the causes of transient hepatic perfusion disorders and may simulate a hypervascular hepatic lesion on arterial-phase imaging. A more common cause of hepatic perfusion disorders is occlusion of a portal venous branch with compensatory increased arterial flow, causing arterial phase hyperenhancement. These perfusion pseudolesions can usually be distinguished from tumor by their peripheral location, wedge shape, lack of mass effect, and isoattenuation with liver on all other phases. Cavernous transformation of the portal vein occurs with long-standing portal vein thrombosis due to the development of periportal, serpiginous collaterals around the occluded main portal vein (Fig. 3). The atropy hyhypertrophy complex (hypertrophy of the caudate lobe, left lateral segment atrophy and a normal or enlarged segment IV segment) is frequently observed in patients with cavernous transformation of the portal vein. Disorders of the outflow are typically associated with the occurrence of dilatation of the hepatic capillaries, known as sinusoids.. Most of the time this condition is caused by hepatic venous outflow obstruction, which results in vascular stasis and congestion of hepatic parenchyma. In this setting, hepatic sinusoidal dilatation can be related to pericardial disease, heart failure, compression or thrombosis of the hepatic veins or inferior vena cava (i.e. Budd Chiari syndrome) or central veins/sinusoids involvement (i.e. sinusoidal obstruction syndrome). Nevertheless, some extra hepatic inflammatory conditions (such as pyelonephritis, cholecystitis, pneumonia, pancreatitis, intestinal bowel disease and others) may be associated with hepatic sinusoidal dilatation without concurrent venous outflow obstruction. On contrast-enhanced cross-sectional imaging, hepatic sinusoidal dilatation is typically characterized by a mottled, reticular enhancement of the liver, usually referred to as “mosaic” pattern. Other hepatic and extra-hepatic imaging features, such us the dilatation of the hepatic veins or the presence of ascites, can help in identifying the cause of sinusoidal dilatation.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Panel: Difficult Small Bowel Cases From My Workstation69697549610.22034/icrj.2018.75496ENAmir Reza RadmardDepartment of Radiology, Shariati Hospital, Tehran University of Medical Sciences. North Kargar Ave., Tehran, IranAli ShirkhodaDepartment of Radiological Science, University of California at Irvine, School of Medicine, CA, USAAndrea LaghiDepartment of Radiological Sciences, Oncology and Pathology, Sapienza, University of Rome, Latina, Italy.Siavosh Nasseri-MoghaddamDigestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences. North Kargar Ave., Tehran, Iran.Journal Article20181025Small bowel is the most inaccessible part of gastrointestinal tract for the clinicians. Advances in imaging of small bowel with the new techniques including MR enterography (MRE) and CT enterography (CTE) have become the preferred diagnostic examinations for evaluation of entire small bowel. They can also provide valuable information about the extra luminal findings. Proper communication of radiologist with the clinician has a significant role in the diagnosis, management and treatment of patients with small bowel diseases. In this panel, interesting and difficult cases with small bowel abnormalities will be presented to the expert panelists and they will discuss about the imaging findings, probable diagnoses and clinical challenges.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Ct Colonography For Colorectal Cancer70707549710.22034/icrj.2018.75497ENAndrea LaghiFull Professor of Radiology, Director Radiology Unit, Sant’Andrea University Hospital, Rome, ITALYJournal Article20181025CT colonography (CTC) is a robust and reliable imaging test of the colon. The technique is easy, less labor-intensive than barium enema and conventional colonoscopy (CC) and is inherently safer with a rate of reported procedure-related complications lower than barium enema itself. The success rate of CTC is approximately 100%, if bowel preparation and distension are optimal and no sedation is required. From the patient’s perspective, the major advantages of CTC include the very brief time required to perform the examination, the absence of contrast enemas and the potential for same-day CC when polyps are detected.<br /> The issue of diagnostic accuracy of CT Colonography (CTC) for colo-rectal cancer (CRC) and polyps has been a source of debate for a long time, because of the conflicting results of some of the papers published in the literature. However, data from recent meta-analyses and large trials (SIGGAR, ACRIN, IMPACT, COCOS) all agree that, for CRC detection, CTC is largely superior to barium enema and has similar sensitivity to conventional colonoscopy (CC). And also for the detection of advanced adenomas, diagnostic accuracy is close to CC. Despite the good results there are still some open issues: the significance of diminutive ( Current CTC indications include the evaluation of Patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the Patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis).<br /> The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In Patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open.<br /> It is desirable that in the future CTC would be the first-line and only diagnostic test for colonic diseases, leaving to CC only a therapeutic role.<br /> <br /> Take -Home Messages:<br /> CT colonography is a robust, accurate and noninvasive diagnostic test for the detection of colonic polyps and cancer<br /> CT colonography can completely replace double-contrast barium enema and it is complementary to Colonoscopy<br /> Current CTC indications include the evaluation of Patients who had undergone a previous incomplete Colonoscopy, those who are unfit for Colonoscopy (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation) and those with a suspected or known diverticular disease<br /> CTC can be offered as an opportunistic CRC screening test, if the patient is correctly informed about pros and cons of this technique in comparison with other currently available testsIranian Society of RadiologyIranian Congress of Radiology2588554534320180901Abdominal Complications In Oncology Patients71717549810.22034/icrj.2018.75498ENKourosh NourisamieJournal Article20181025The purpose of this presentation is to review common abdominal complications in oncology patients post chemotherapy. It is important for the radiologists to be aware of the therapy that oncology patient is<br /> receiving. Failure to recognize these complications may be mistaken for recurrent disease, disease<br /> progression any may prompt unnecessary abdominal surgery.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Incidental Lesions Of The Liver And Pancreas72727549910.22034/icrj.2018.75499ENKourosh NourisamieJournal Article20181025The purpose of this presentation is to learn strategies for optimizing management in patients with<br /> incidental findings in the liver and pancreas. It is important to know guidelines for determining which<br /> incidentalomas can be ignored, which can be monitored and which lesions require more aggressive<br /> workup.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Ct Evaluation Of The Small Bowel Obstruction73737550010.22034/icrj.2018.75500ENKourosh NourisamieJournal Article20181025Small bowel obstruction (SBO) is a relatively common surgical condition. CT has excellent sensitivity and specificity. The purpose of this presentation is to recognize CT findings in patients with small bowel obstruction.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Hepatocellular Adenomas74747550110.22034/icrj.2018.75501ENNiloofar Ayoobi YazdiMD, Assistant Professor of Radiology, Imam Khomeini Hospital, Tehran University of Medical ScienceJournal Article20181025Hepatocellular adenomas are a heterogeneous group of tumors, which their potential complication such as evolving to hepatocellular carcinomas (HCC) and hemorrhagic complications being closely linked to their molecular characteristics .<br /> There are four molecular types of adenoma:<br /> telangiectatic or inflammatory adenomas (40–50%),<br /> adenomas with HNF1α mutations (20–40%),<br /> adenomas with β catenin mutations (5–10%) and<br /> non-specific adenomas (10–20%), with no molecular or phenotypic characteristic known to date<br /> The MRI signs of adenomas appear to be correlated with their genotype in some of them and can be diagnosed by imagingIranian Society of RadiologyIranian Congress of Radiology2588554534320180901Cystic Liver Lesions75757550210.22034/icrj.2018.75502ENGiuseppe BrancatelliAssociate Professor of Radiology, University of Palermo School of Medicine, ItalyJournal Article20181025Cystic liver lesions can be classified based on their nature as benign and malignant. In the benign category are, among others, developmental and infectious/inflammatory cysts, while neoplastic cyst can be subdivided into primary and secondary. Developmental cysts originate from abnormal ductal plate malformation and consist of hepatic (bile duct) cyst, bile duct hamartomas, Caroli’s disease and polycystic liver disease. Infectious/inflammatory cysts include, among others, abscesses (pyogenic and amoebic) and hydatid cysts. Primitive neoplastic cystic lesions are cystoadenoma and cystoadenocarcinoma. Secondary lesions can originate mostly from mucinous tumours such as colon and ovary. The role of crosssectional imaging in the detection and characterisation of these entities will be discussed, with an emphasis on the differential diagnosis with CT and MR Imaging.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901New Techniques In Scrotal Imaging: When To Do Mri Or Elastography76767550310.22034/icrj.2018.75503ENSeyed Morteza BagheriIran University of Medical SciencesJournal Article20181025In practice, during testicular ultrasound examination, there are numerous cases of testicular lesion, that we can not be able to distinguish non-tumoral lesions (especially infective or traumatic lesions) from tumoral lesions. Also, in cases of suspected tumoral lesions, sometimes there is no distinction feature between benign tumors and malignant tumors.<br /> In this lecture, we try to talk about the role of new imaging modalities in testicular evaluation to differentiating these lesions from each other, along with a general overview of the testicular imaging.<br /> Some of these new imaging techniques that we talk about them are; Color Doppler ultrasound, ultrasound elastography, DWI sequences of MRI and dynamic contrast MRI .<br /> Finally, general Conclusions and step-by-step imaging recommendations in various testicular lesions will be discussed.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Opportunities & Threats In Radiology77777550410.22034/icrj.2018.75504ENAbdolrasoul SedaghatJournal Article20181025Opportunities:<br /> 1. Imaging fundamental to clinical diagnoses.<br /> 2. Range and volume of Imaging examinations are increasing.<br /> 3. Imaging has key role in disease management, follow-up and screening.<br /> 4. Imaging guided minimally invasive therapies by radiologists increasingly utilized.<br /> Threats to radiology:<br /> A) Insufficient radiologists for workload and lack of public understanding of radiologists role.<br /> B) Digital imaging & PACS have separating radiologist from monitoring, referring clinicians and patients.<br /> C) Self-referral problem.<br /> D) Increasing requiring subspecialist competence in radiology parallel to increasing subspecialities between clinicians.<br /> E) Most of radiologists are not adequately involved in the new horizons developments.<br /> Radiologists need some changes, because:<br /> Radiology is expanding dramatically.<br /> Radiology departments may change configuration.<br /> Teleradiology could make radiology a commodity.<br /> Radiologist must add value to the clinicians.<br /> Radiologists, invisible to the public.<br /> Clinicians becoming increasingly involved in imaging.<br /> Delivering the expansion of imaging and research.<br /> Subspecialisation and clinical competence.<br /> More knowledge in E-heath and teleradiology.<br /> Radiology is too much expanded in different ways:<br /> 1. Whole body and MDCT.<br /> 2. Advances in MRI with amazing anatomical and functional sequences.<br /> 3. Molecular imaging.<br /> 4. PET combining with CT/MRI.<br /> 5. Image guided interventions.<br /> 6. Integration of functional and structural information.<br /> Developments in radiology are accompanied with some Threats:<br /> 1. Insufficient radiologists for quantity of work.<br /> 2. Altered workflow demographics.<br /> 3. Developments in clinicians with more knowledge in medical imaging.<br /> What should we do:<br /> A) Increase involvement of trainees.<br /> B) Enough time for research.<br /> C) Annual radiology congress, subspecialty committees in ISR and subspecialty conferences.<br /> D) Medical imaging research center in at least 5 main universities.<br /> E) Communication: Radiologists should build strong networks with clinicians and scientists.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Cerebral Venous Sinus Thrombosis78787550510.22034/icrj.2018.75505ENMaryam MashayekhiJournal Article20181025Cerebral venous sinus thrombosis (CVST) is an uncommon but life-threatening emergency. It is an important cause of stroke especially in children and young adults that requires quick diagnosis and rapid treatment.<br /> The most common clinical manifestations are headache, seizures, altered consciousness and neurologic focal signs on physical examinations. Underdiagnosis or misdiagnosis of cerebral venous thrombosis can lead to severe consequences including hemorrhagic infarction and death.<br /> Imaging can vary from the most subtle findings of sulcal effacement to the extremely complex with concomitant infarct, vasogenic edema often complicated by hemorrhage; thus, making cerebral venous thrombosis a challenging diagnosis to both radiologists and clinicians.<br /> In this article 28 patients with cerebral venous-sinus thrombosis, who referred to Parto Teb Azma and Tabesh Parto Medical Imaging Centers in Qom from 2015 until the end of 2017 are reviewed and their radiologic findings are evaluated. Both CT and MRI are used to diagnose CVST. Since MRI and MRV are the most common tools for diagnosis, this article is focused on MRI findings in CVST with evaluation of different pulse sequences and MR venography.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Prenatal Diagnosis Of Corpus Callosum Abnormalities79797550610.22034/icrj.2018.75506ENBehnaz MoradiMD, Assistant professor, Women’s Yas hospital, Tehran University of Medical SciencesJournal Article20181025The corpus callosum is the major interhemispheric commissure and its abnormalities include agenesis, partial agenesis, hypoplasia, hyperplasia and lipoma.<br /> Anomalies of the corpus callosum are commonly associated with other malformations, aneuploidies or genetic syndromes. Furthermore, even in isolated cases, the risk of abnormal neurodevelopment is high.<br /> Antenatal diagnosis of complete callosal agenesis is easy after midtrimester by ultrasound even in axial plane. More subtle findings (hypoplasia and partial agenesis) may also be recognized antenatally. In these situations sonographic diagnosis is very difficult because the axial view of the fetal head is often unremarkable and obtaining a true sagittal view usually needs more experience.<br /> Nomograms for fetal corpus callosal biometry have been published and are of critical importance for diagnosis of such subtle abnormal findings.<br /> When pathology of the corpus callosum is suspected fetal MRI is an important adjunct to sonography in evaluating its anatomy and associated anomalies. Many additional findings that are not visible by ultrasound such as abnormal sulcation and heterotopia can be identified by MRI.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Intracranial Pseudotumors: Making Sense Of The Maddening Mystery80807550710.22034/icrj.2018.75507ENAnne G. OsbornJournal Article20181025The definition of a pseudotumor is something that looks like a neoplasm—but isn’t. “Intracranial inflammatory pseudotumor” (IIPT) is an umbrella term that encompasses a spectrum of nonneoplastic infectious, reactive and/or reparative processes that are characterized histopathologically by mass-like cellular aggregates consisting of polyclonal mononuclear infiltrates in a prominent fibrocollagenous stroma. Some IIPTs are idiopathic but a growing number have recognized causes such as IgG4-related disease. In this presentation we delineated 5 major anatomic patterns of IIPTs, each with its distinctive imaging findings and associated pathologies. We emphasize the falcotentorial/posterior fossa pattern and the “Eiffel by night” sign on coronal contrast-enhanced T1-weighted MR. At least half of these cases are associated with chronic dural sinus thrombosis. In the anterior pattern (orbital apex, superior orbital fissue/cavernous sinus ± dura), orbital pseudotumor, IgG4-RD and inflammatory myofibroblastic tumors predominate. Focal rather than diffuse dura-arachnoid thickening is seen with intracranial inflammatory myofibroblastic tumors, a recently-recognized entity that can be associated with invasion of the underlying brain.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Second Look Target Ultrasound After Mammography81817550810.22034/icrj.2018.75508ENMaryam RahmaniProfessor of Radiology
Tehran University of Medical Science
Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Journal Article20181025Second look targeted ultrasound or so-called Diagnostic ultrasound nowadays is commonly performed for an abnormality detected on mammography, such as a mass or an asymmetric and also in the evaluation of lesions detected on MRI, such as mass or non-mass enhancement.<br /> Ultrasound is useful in the assessment of palpable masses in dense mammography.<br /> Palpable masses with benign sonography characteristics can be managed with short-interval follow-up, rather than biopsy.<br /> Also US guided biopsy is preferred way of biopsy even the lesion is first detected on mammography. It is cost effective and easier to perform.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Cruciate Ligaments82827550910.22034/icrj.2018.75509ENLeila AghaghazviniJournal Article20181025The anterior and posterior cruciate ligaments are important stabilizers of knee joint. Although they are similar in their appearance, they have different properties and complete each other in function. MRI is the choice modality, but also radiographs and CT has a role in pre- and post-operative imaging. The aim of this abstract is to present imaging findings of injured cruciate ligaments and pitfalls.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Biopsy Of Breast Lesions, Which Modality, Which Needle83837551010.22034/icrj.2018.75510ENMasoumeh GityJournal Article20181025New developments in breast imaging resulted in early detection of small non palpable breast lesions which need image guided biopsy to proved or exclude malignancy.<br /> Different techniques and different deedless could be used for breast biopsy according to indication, size and type of lesion. In this talk we will discuss different available needles and different image guided techniques including FNA, core biopsy, vacuum assisted biopsy, RF ablation and HIFU. Also advantages and disadvantages of each method will be presented.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Pre_Op. Localization Of Breast Lesions, Conventional And New Techniques84847551110.22034/icrj.2018.75511ENAli ArabkheradmandJournal Article20181025Since the beginning of breast cancer screening by mammography and early detection of non palpable breast lesions, different techniques have been implemented to accursed localize small lesions before operation. This is done to make breast conservation therapy possible and to reduce the size of tissue to be excised.<br /> Injection of Metylen blue and isotope agents, wire localization and RF sensitivitie markers are among the most successful tools which have been developed for pre op localization. Each method has advantages and disadvantages which will be discussed.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Recent Findings About Radiation Modifiers In Treatment Of Cancer85857551210.22034/icrj.2018.75512ENAli Shabestani MonfaredProfessor of Medical Physics, Faculty of Medicine, Babol University of Medical SciencesMehrangiz AmiriAssociate Professor of Nuclear Medicine, Faculty of Medicine, Babol University of Medical SciencesJournal Article20181025Ionizing radiations may induce biologic responses that depend on many factors such as Physical specifications of ionizing radiation as well as biological system factors. It is shown that patients with same type of Cancer and treatment regimen may show different radiosensitivity which may be due to different specifications of their biological systems. It is revealed that many biologic factors including age, sex, smoking and existence of genetic background disease affect radiosensitivity. However, by elimination of these factors and also by similar doses of radiation, Patients may still show different biological responses such as acute and low responses. A review on recent findings about radiation modifiers in treatment of Cancer is the subject of the present article.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Shifting From Dna Centric View Of Radiation Damage In Radiobiology And Its Impact On Low Dose Radioprotection86867551310.22034/icrj.2018.75513ENHossein MozdaraniPh.D, Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.Journal Article20181025A classic experiment of Munro on mammalian cells has clearly shown that the critical targets for radiation induced damages are located in cell nucleus. In the nucleus, DNA has been considered as primary target for radiation induced damage. We now know that ionizing radiation damage DNA directly by direct energy deposition and indirectly via formation of free radicals due to water radiolysis in vicinity of DNA molecules. Damage to a key molecule may be lethal for a cell and has led to the development of target theory of radiation damage. Target theory considers one hit damage for high LET radiation and multi-hit damage for low LET radiation. However, the initial radiation induced DNA damage undergo various repair processes, however un-repaired or mis-repaird DNA damages are converted into mutations, chromosomal aberrations and cell death. Stochastic effects of low dose ionizing radiation for induction of genetic effects and carcinogenesis have been considered as the most important genetic and somatic effects of low dose radiation. It is commonly believed that “any radiation dose, no matter how small, can cause genetic damage and cancer (linear model). However, the last 15 years have seen a major paradigm shift in radiation biology. Several discoveries challenge the DNA centric view which holds that DNA damage is the critical effect of radiation irrespective of dose. Observations of bystander effects in neighboring cells that have not been directly hit have led to suggestions that at low doses these non-targeted effects could contribute to the adverse consequences of low dose radiation exposure. Adaptive response, believed as a beneficial low dose effect and inherent radiosensitivity might also affect linear non-threshold (LNT) concept. Although, it is believed that these radiobiological phenomena affect on LNT model. Radiation protection principles are developed based on linear model and shifting from this theory make changes in radiation protection principles. These biological paradigms at low doses make estimation of low dose ionizing radiation risk estimation more difficult than ever.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Prevalence Of Lymph Node And Maximum Short Axis In Traumatic Patients87877551510.22034/icrj.2018.75515ENMaryam TakiIsfahan university of medical scienceJournal Article20181026Introduction:<br /> Normal size of mesenteric lymph nodes has not been well-evaluated, as these lymph nodes are small but may be seen frequently in computed tomography(CT). The aim of this study is to determine the prevalence of mesenteric lymph nodes at root of mesentery and mesentery itself.<br /> Method and Materials:<br /> This is a cross-sectional study on traumatic patients with normal multi-detector computed tomography(MDCT) referred to Al-Zahra Hospital in2014-2016. largest short axis of Lymph nodes was recorded. Their location was divided to 3groups of mesenteric root, peripheral mesentery and mesentery of right lower quadrant(RLQ). Size and number of lymph nodes in terms of locations were recorded. Number of more than 6 nodes in a position was defined as cluster nodes. Data were analyzed using SPSS-20. P-value of Results:<br /> 400 traumatic patients underwent MDCT-scanning. The mean age of these patients was 36.6±13.4 years. The number of lymph nodes was less than3 in 49.3%, 52.5% and52.2%; 3-6 in 45.8%, 42.8% and 42.8%; more than 6 in 5%, 4.8% and4.8% of central, peripheral and RLQ mesentery, respectively. The average size of largest central, peripheral and RLQ lymph nodes were 4.53±1.33, 4.37±1.68 and 4.37±1.68respectively(P-value=0.64). Largest size of short axis in patients with cluster lymph nodes was significantly more than non-cluster nodes(P-value Conclusion:<br /> Mean size of mesenteric lymph nodes was similar to previous study but the largest nodes were considerably larger. Also largest short axis of cluster nodes were significantly more than non-cluster ones.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Assessment Of Some Immunological And Hematological Factors Among Radiation Workers88887551610.22034/icrj.2018.75516ENYousef NaderyJournal Article20181026Although the ionizing radiations cause various disorders in different parts of the human body, the importance and extensiveapplication of radiations in medicine are undeniable. In this study, we have tried to evaluate the effect of radiation on immunological and hematological parameters in the radiation workers compared with the control group. Two groups including radiation workers (test group) and a control group were determined. Test and control groups were selected from imaging staffs in teaching hospitals of Hamadan and healthy employees working in other parts of the hospital, respectively.<br /> They were matched according to age and sex. The serum levels of cytokines IFN-γ, IL-4, IL-10 and IL-17 were determined and the results were analyzed by using SPSS 18. The obtained results indicated that the level of the IFN-γ and IL-10 in the radiation workers were significantly lower than the control group (P <0.05). There was a statistically significant difference in the white blood cell count and percentage of peripheral blood lymphocytes between the radiation workers and the control group (P <0.05). Based on the results of this study and comparison with the results obtained from other studies, the effects of ionizing radiation (in the radiation workers) appear certain on blood and immune systems. However, type, the exact location and severity of the effect, require more extensive researches on the number of people under study.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Comparing The Diagnostic Value Of Magnetic Resonance Imaging (Mri)With Colour-Doppler Ultrasound For Placenta Accreta89897551710.22034/icrj.2018.75517ENSaeed NaghibiAzad UniversityJournal Article20181026Background:<br /> Placenta adhesive disorder (PAD) is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta Previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities.<br /> Material and Methods:<br /> In this cross-sectional study, Seventy-nine pregnant women who were high risk for PAD and had inclusion criteria underwent color Doppler ultrasound and MRI. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P Result:<br /> Mean maternal age was 32.9894.8 years. The history of the previous cesarean section was seen in 68 cases (86%) and 11 patient had curettage. The diagnosis of placenta accrete was found in 45 cases (57%). Doppler sonography sensitivity was 91% and MRI sensitivity was 73.3% , Doppler sonography specificity was 64.7% and MRI specificity was 79.4%.<br /> Conclusion:<br /> Women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Accuracy Of Mri In Rectal Cancer After Preoperative Neoadjuvant Chemoradiotherapy90907551810.22034/icrj.2018.75518ENSaeed NaghibiAzad UniversityJournal Article20181026Introduction:<br /> About1/4 colorectal cancers are related to the rectum. There 40.000 Patients with the mean age of 50 years diagnosed with rectal cancer in USA. The symptoms are in a wide spectrum such as rectal bleeding, changing of defecation habits, pain, incontinenecy in the case of esphincter invasion. The diagnosis depends on Getting a detailed history and a physical examination. For years the main treatment of rectal cancer was abdominoperineal resection with permanent clostomy. Today’s treatment plan includes less invasive surgical techniques combined with neoadjuvant chemoradiotherapy which results in less recurrent rates. MRI is a reliable modality in staging primary tumors but there has been conflicts about its accuracy for restaging after neoadjuvant chemoradiotherapy. In this study, accuracy, sensitivity and specifity of MRI will be discussed.<br /> Material and Methods:<br /> Study on 34 patients diagnosed with rectal adenocarcinoma referred to oncology clinic was conducted. The treatment plan included 4050 cGY radiotherapy and 5FU, Xeloda chemotherapy. All patients were assessed with 1/5 T MRI 6 to 8 weeks after treatment. T1 and T2 images with sagittal, coronal and axial planes with and without contrast agent were obtained and interpreted by two radiologists and compared with pathologic specimens as a gold standard.<br /> Results:<br /> The demographic information was: mean age of 65/26 years, 19 Men (55/9%), 15 women(44/1%). Accuracy of MRI at T and N staging were 38/2 % and 61/8% with the highest sensitivity of T3NM0 and specifity of T1N2.<br /> Conclusion:<br /> MRI can be used for assessing rectal tumors and restaging after preoperative chemoradiotherapy.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901A Neuroimaging Pattern-Recognition Approach To Mitochondrial Respiratory Chain Complex I Deficiency In The Genetic Era91917551910.22034/icrj.2018.75519ENMohammad Zare MehrjardiDepartment of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Division of Clinical Research, Climax Radiology Education Foundation, Tehran, IranMorteza Sanei TaheriDepartment of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, IranShaghayegh Sadat KhabbazDepartment of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, IranJournal Article20181026Background:<br /> Mitochondrial disorders are the most common congenital metabolic diseases. They are due to dysfunction of the mitochondria, the organelles that are responsible for energy (adenosine triphosphate) generation through the respiratory chain. Mitochondria are present in almost every body cells, therefore, their disorders cause various manifestations including encephalomyopathy, cardiomyopathy, and gastrointestinal symptoms. About 25% of mitochondrial disorders are secondary to mitochondrial DNA (mtDNA) genes mutations, and 75% are due to mutations in genes encoded in the nucleus (nuclear DNA or nDNA). Mitochondrial respiratory chain has five major complexes. Defect of each component can cause different clinical and imaging manifestations.<br /> Isolated complex I deficiency (OMIM: 252010) is the most common defect of respiratory chain in pediatrics. Complex I (NADH:ubiquinone oxidoreductase) is the largest component of the respiratory chain. It has 38 core subunits encoded by nDNA, and 7 core subunits encoded by mtDNA. Mutations of 17 nDNA genes (NDUFS1−4 and 6−8; NDUFA1, 2, 10, 11; NDUFB3, 9, 11; NDUFV1, 2; NDUFAF3; FOXRED1; ACAD9; MTFMT), and 7 mtDNA genes (MTND1−6; MTTS2) have been reported to cause complex I deficiency.<br /> Objectives:<br /> To investigate the neuroimaging patterns of pediatric mitochondrial respiratory chain complex I deficiency based on the affected gene.<br /> Methods:<br /> 16 genetically proven pediatric patients with complex I deficiency were found through searching the database of a genetics center and a pediatric neurology referral hospital. Of the included cases, conventional MRI of 14 patients were retrieved by calling the parents. The MR images were reviewed and reported by an expert radiologist blinded to the genetics results. The neuroimaging pattern of each gene mutation was determined by genotype-MRI correlation. Mann-Whitney U test and Fisher’s exact test were used for analyses.<br /> Results:<br /> Of 14 investigated patients, eight patients had nDNA genes mutation (NDUFS1 in four cases, NDUFS4 in two cases, NDUFA1 in one case, and NDUFV2 in one case) and six cases revealed mtDNA genes mutation (MTND3 in four cases, MTND4 in one case, and MTND6 in one case). 11 patients (78%) were male, and the rest were female. The mean age of the patients at the time of brain imaging was 3.1 years (range, 6 months−11 years). The mean age of the patients with nDNA mutations was significantly lower compared to the patients with mtDNA mutations (1.4 versus 5.3 years, p =0.03).<br /> Symmetrical brainstem lesions were present in all of the patients. Involvement of the basal ganglia was observed in 5/8 patients with nDNA and 5/6 cases of mtDNA mutations (p =0.58). Progressive cavitating leukoencephalopathy (periventricular and centrum semiovale white matter cavitary lesions with a rim of hyperintensity and subcortical sparing) was observed in three patients, all of whom had NDUFS1 mutation. All of these three patients revealed corpus callosal lesions. Corpus callosal involvement was absent in the rest of cases. Cortical hyperintensities were seen in 3/6 cases of mtDNA mutations (all with MTND3 mutation). Supratentorial cerebral atrophy was observed in 1/6 case of mtDNA mutation. Cerebellar signal abnormalities were present in 3/8 patients with nDNA and 3/6 cases of mtDNA mutations (p =1.00). Cerebellar atrophy was observed in 4/6 cases of mtDNA mutations (three cases with MTND3 and one case with MTND6 mutations), but none of nDNA mutations (p =0.01).<br /> Conclusions:<br /> In summary, neuroimaging abnormalities are manifested earlier in nDNA compared to mtDNA mutations. Brainstem involvement is a constant feature of complex I deficiencies. Cavitating leukoencephalopathy is highly suggestive of NDUFS1 mutation. Cortical signal abnormalities and cerebellar atrophy are present in mtDNA, but not nDNA, mutations. MRI pattern recognition can aid the physician and the geneticist to focus on a specific set of genes as the main cause of symptoms in a child.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901First-Order Histogram Features For Categorizing Functional Vs. Non-Functional Pituitary Macro-Adenoma And Tumor Consistency92927552010.22034/icrj.2018.75520ENMorteza SaneiShahidbeheshti university of Medical SciencesFarnaz Kimiashahid beheshti university of medical sciencesMersad Mehrnahadshahid beheshti university of medical sciencesHamid Reza SalighehradQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesHamid Reza Haghighatkhahshahid beheshti university of medical sciencesAfshin MoradiDepartment of Pathology, Shahid Beheshti University of Medical SciencesAnahita Fathi KazerooniQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesMohamad Reza AlviriQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesJournal Article20181026Purpose:<br /> To investigate first-order histogram (FOH) features for prediction of pituitary adenoma consistency in combination with pathological results as well as to differentiate functional vs. non-functional tumors.<br /> Materials and Methods:<br /> MR imaging was done using the standard protocols of T1-weighted with and without contrast, T2-weighted, and axial fluid attenuated inversion recovery images in 32 patients with pituitary macro-adenoma. Regions of interest (ROI) and apparent diffusion coefficient (ADC) maps were generated and FOH features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and were graded as <1%, 1-3%, and > 3%. Microscopic photographs, in three random regions, were analyzed using the online software. Non-parametric statistics and receiver-operator characteristic (ROC) curves were statistical methods with 95% confidence interval.<br /> Results:<br /> FOH features obtained for 21 (65.6%) males and 11 (34.4%) females. Only uniformity (P=0.02), 75th percentile (P=0.03), and tumor smoothness (P=0.02) were different significantly between functional and non-functional tumors. Tumor smoothness > 5.7×10-9 (AUC= 0.752) had at least 80% sensitivity and 76.19% specificity for diagnosis of functional tumors. Uniformity ≤ 179.271 had a sensitivity of 60% and specificity of 90.48% (AUC=0.757) and 75th percentile >0.7 had a sensitivity of 80% and specificity of 66.67% for categorizing tumors to functional and non-functional types (AUC= 0.738).<br /> Conclusion:<br /> FOH features could be helpful in differentiating functional vs. non-functional pituitary macro-adenoma. FOH features were not meaningfully different for semi-quantitative collagen content. We have proposed some cutoffs for some valuable FOH features, which may be used in clinical settings.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901First Order Histogram (Foh) Features Of Magnetic Resonance Imaging (Mri) From Tumoral Or Peritumoral Edema And Enhanced Region Could Be Helpful In Differential Diagnosis Of Glioblastoma Tumors From Cerebral Lymphomas93937552110.22034/icrj.2018.75521ENMorteza SaneiShahidbeheshti university of Medical SciencesMersad MehrnahadShahid Beheshti University of Medical SciencesFarnaz Kimiashahid beheshti university of medical sciencesHamid Reza SalighehradQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesHamid Reza HaghighatkhahShahid Beheshti University of Medical sciencesAfshin MoradiDepartment of Pathology, Shahid Beheshti University of Medical SciencesAnahita Fathi KazerooniQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesMohamad Reza AlviriQuantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical SciencesJournal Article20181026Background:<br /> Todays, definitive differential diagnosis of glioblastoma GBM) from cerebral lymphoma (CL) needs surgical operations which is highly invasive. Then, MR imaging methods could be of diagnostic choice if they have proper sensitivity and specificity for distinguishing tumor types. The aim of the current study is to investigate the potency of FOH features in differential diagnosis of GBM tumors from cerebral lymphoma.<br /> Materials and Methods:<br /> By preoperative MRimaging of patient with diagnosis of GBM and cerebral lymphoma, apparent diffusion coefficient (ADC) maps obtained and calculated from region of interest (ROI) in three different regions: 1. Tumor lesion itself (82 patients); 2. Area with enhancement and 3. Peritumoral Edema regions (47patients). FOH were analyzed statistically using Mann-Whitney or independent t-test for meaningfulness and Receiver-operator characteristic (ROC) curves plotted for determination of area under the curve (AUC), sensitivity (SE) and specificity (SP) of FOH in discrimination of GBM form cerebral lymphoma.<br /> Results:<br /> FOH were Maximum (Max), Mean, Median (MED), Minimum(Min), Normalized Mean, Standard Deviation, Third Moment, Uniformity (UNF), Entropy, Kurtosis, 25, 75 and 95 Percentiles of ADCs. Meaningful FOH were Mean, Max and Median in tumor group and enhanced area in addition to Smoothness, Uniformity and Entropy (P<0.05; CI=0.95). In the group peritumoral Edema, all FOH were significant between GBM and cerebral lymphoma except Max, Min, Smoothness, Uniformity and Kurtosis. Most meaningful variables had significant values with higher than 50 to 95 percent sensitivity or specificity for GBM discrimination from cerebral lymphoma.<br /> Conclusion:<br /> differential diagnosis between GBM and cerebral lymphoma is possible with some FOH and using presented cut-off values. Radiographic methods are not as invasive as surgical pathology methods (SPMs); then, we propose FOH evaluations as the proper biomarkers instead SPMs. FOH will help neurologists and surgeons for desiring treatment or operation. Anyway, our presented information needs verification throughout other centers in the world and by other researchers.Iranian Society of RadiologyIranian Congress of Radiology2588554534320180901Phase Sensitive Reconstruction Of T1-Weighted Inversion Recovery In The Evaluation Of The Cervical Cord Lesions In Multiple Sclerosis; Is It Similarly Eligible In 1.5 Tesla Magnet Fields?94947552210.22034/icrj.2018.75522ENAzin ShayeganfarIsfahan universityJournal Article20181026Background:<br /> In primary studies with 3 T Magnets, phase sensitive reconstruction of T1-weighted inversion recovery (PSIR) have showed ability to depict the cervical multiple sclerosis (MS) lesions some of which may not be detected by short tau inversion recovery (STIR). Regarding to more availability of 1.5 T MRI, this study was designed to evaluate the eligibility of PSIR in 1.5 T for detection of spinal cord MS lesions.<br /> Method: In a prospective study between September 2016 till March 2017 the patients with proven diagnosis of MS enrolled to the study. The standard protocol (sagittal STIR and T2W FSE and axial T2W FSE) as well as sagittal PSIR sequences were performed using a 1.5 T magnet. The images were studied and the lesions were localized and recorded as sharp or faint on each sequence. Also normalized contrast between lesion and normal-appearing spinal cord was measured for each sequence.<br /> Results:<br /> Of 25 patients (22 females and 3 males, with mean age of 33.5 ± 9.8 years and mean disease duration of 5.4 ± 3.9 years) 69 lesions in STIR, 53 lesions in T2W FSE, 47 lesions in Magnitude reconstruction of PSIR (Magnitude), and 30 lesions in phase sensitive (real) reconstruction PSIR were detected. A Wilcoxon signed-rank test showed STIR has a statistically significant higher detection rate of the plaques rather than other three sequences. T2W FSE and Magnitude both had a statistically significant superiority in detection of the plaques rather than real PSIR. STIR had a statistically significant difference in the boundary definition of the plaques rather than other three sequences. There was no statistically significant difference in the boundary definition of the plaques between Magnitude and real reconstructions. The mean of normalized lesion-to-cord signal on STIR, T2FSE, Magnitude and real reconstructions were 49.54 ± 18.46, 35.40 ± 25.68, 85.61 ± 47.07, 103.05 ± 47.01 percent, respectively.<br /> Conclusion:<br /> This study shows that in the setting of a 1.5 T magnet field, STIR significantly has a superiority over both of the PSIR reconstructions (i.e. real and magnitude) for the detection as well as the boundary definition of the cervical cord lesions of MS. This result is in contrast with other reports performed by 3T Magnet fields. It should be mentioned in Magnims protocol that PSIR reconstructions can be an alternative of STIR only in 3T.